瓦里安高分辨率多叶准直器叶片位置误差对肺肿瘤立体定向放疗剂量学影响

目的 研究瓦里安高分辨率(HD120)多叶准直器叶片位置误差对肺部肿瘤体部立体定向放疗(SBRT)的剂量学影响。方法 选取江苏省肿瘤医院 9例已完成治疗的基于HD120调制的肺部肿瘤SBRT计划作为参考计划,采用基于Varian Eclipse 15.6治疗计划系统自带应用程序接口的自编程序修改计划参数,分别生成包含叶片位置同向系统误差、异向系统误差和随机误差的误差模拟计划。计算各个模拟计划与参考计划剂量学指标的偏差并做回归分析,以此评估HD120的三类叶片位置误差对SBRT的剂量学影响。结果 计划靶体 积D99%、D2cm和双 肺V5Gy均随同向系统误差绝对值增大呈抛物线型降低,二次回归分析后得到一阶敏感度为(-0.06~-0.26)%/mm,二阶敏感度为(-0.55~-1.17)%/mm²(R²=0.96~0.99,P<0.01),其中计划靶体 积D99%最大变化为-3.13%。对异向系统误差和随机误差的影响做线性回归分析,得出适形指数偏差随这两种误差变化的敏感度分别为25.16%/mm (R²=0.98,P<0.01)和-4.84%/mm (R²=0.99,P<0.01),其余剂量学偏差随异向系统误差变化的敏感度范围为(4.80~5.12)%/mm (R²=0.96~0.98,P<0.01),随随机误差变化的敏感度范围为(-0.47~-1.01)%/mm (R²=0.96~0.99,P=0~0.02)。结论 基于HD120调制的肺部肿瘤SBRT计划的剂量学偏差对叶片位置异向系统误差极为敏感,但对随机误差敏感性较弱。叶片位置同向系统误差会导致靶区覆盖剂量一定程度降低,因此临床工作中需严格控制SBRT计划执行时HD120叶片位置的系统误差。     

Circular RNA circCRIM1 inhibits invasion and metastasis in lung adenocarcinoma through the microRNA (miR)‐182/miR‐93‐leukemia inhibitory factor receptor pathway

In recent years, circular RNAs (circRNAs) have been revealed to have important roles in carcinogenesis. Metastasis is the leading cause of lung adenocarcinoma (LUAC) death. However, the contributions of circRNA to the metastasis of LUAC remain largely unknown. Based on circBase data and our biobank tissues, we identified circCRIM1 (a circRNA derived from exons 2, 3 and 4 of the CRIM1 gene, hsa_circ_0002346) as having a significantly decreased expression in LUAC samples compared with matched normal control samples. Both in vivo and in vitro experiments revealed that circCRIM1 suppresses the invasion and metastasis of LUAC. In vitro precipitation of circRNAs, luciferase reporter assay, and biotin‐coupled microRNA capture were carried out to investigate the Ago2‐dependent interaction of circCRIM1 and microRNA (miR)‐93/miR‐182. Mechanistically, we found that circCRIM1 could promote the expression of leukemia inhibitory factor receptor, a well‐known tumor suppressor, by sponging miR‐93 and miR‐182. In the clinical and pathological analyses, the downregulation of circCRIM1 in LUAC was significantly correlated with lymphatic metastasis and TNM stage, which served as an independent risk factor for the overall survival of patients with LUAC. Our study showed that circCRIM1 inhibits the invasion and metastasis of lung adenocarcinoma cancer cells, which makes it a potential therapeutic target.     

Trends in Diet Counseling Among Stroke Versus Non-Stroke Patients: Evidence from the NAMCS, 2011–2016

IntroductionDietary modifications in post-stroke patients facilitated by diet counseling improves post-stroke recovery and stroke recurrence. The extent to which clinicians provide dietary counseling for these patients is unknown.Methods2011 to 2016 National Ambulatory Medical Care Surveys (NAMCS) data were used to assess trends in post-stroke diet consultations by age. Multivariate logistic regression models assessed the likelihood of dietary counseling provision among patients with and without stroke.ResultsThe proportion of patients with stroke aged 60–79 who received diet counseling decreased from 18.2% in 2011 to 5.3%, 11.9%, 8.7%, 13.4%, and 15.2% in 2012–2016, respectively. Among patients without stroke aged 60–79, diet counseling rate decreased from 12.9% in 2011 to 7%, 9.5%, 10.5%, 13.5%, and 12% in 2012–2016, respectively. Similar trends were observed among patients with and without stroke aged over 80.ConclusionsThe proportion of patients with and without stroke receiving dietary counseling has remained low over the past half-decade. It is likely multifactorial– related to clinician knowledge, patients' receptiveness, and system-level factors of time and reimbursement. Future interventions should explore methods to address barriers to nutrition recommendations for post-stroke patients and patient activation to adopt dietary changes.     

Denial of Cerebrovascular Events in a National Clinical Quality Registry for Stroke: A Retrospective Cohort Study

ObjectivesTo investigate cerebrovascular event (CVE) denials reported by registered patients to the Australian Stroke Clinical Registry, and to examine the factors associated with CVE denial.Material and methodsCVE denials reported from January 1, 2017 to June 30, 2018 were followed up with hospitals to verify their discharge diagnosis. CVE denials were compared with all non-CVE denial registrants and a 5% random sub-sample of non-CVE deniers according to patient and clinical characteristics, quality of care indicators and health outcomes. Multilevel, multivariable logistic regression models were used. Factors explored were age, sex, stroke severity, type of stroke, treatment in a stroke unit, length of stay and discharge destination. Level was defined as hospital.ResultsOverall, 339/23,830 (<2%) CVE denials were reported during the 18-month period. Hospitals confirmed 117 (61%) of CVE denials as a verified diagnosis of stroke or transient ischaemic attack (TIA). Compared to non-CVE deniers, CVE deniers were younger, had a shorter median length of stay (four days versus one day) and were more likely to be diagnosed with a TIA (64%) compared to the other types of stroke (11% intracerebral haemorrhage; 20% ischaemic; 5% undetermined).ConclusionVery few patients denied their CVE, with the majority of denials subsequently confirmed as eligible for registry inclusion. Diagnosis of a TIA and shorter length of stay were associated with CVE denial. These findings provide evidence that very few cases are incorrectly entered into a national registry, and highlight the characteristics of those unlikely to accept their clinical diagnosis where further education of diagnosis may be needed.     

Effets secondaires endocriniens de la radiothérapie : diagnostic,prévention et traitements

Endocrine complications after radiotherapy are usually delayed and require prolonged follow-up by the radiation oncologist. Endocrine glands are dispersed throughout the body and can be included in the radiation field of several tumors. As the symptomatology can sometimes be insidious and non-specific, their screening is based on a directed clinical examination but also on systematic hormonal assays. The thyroid gland is particularly radiosensitive, and hypothyroidism is generally observed for doses of more than 30 Gy. After cervical irradiation, it is recommended to perform a TSH assay every 6 to 12 months. The risk of secondary thyroid cancer only concerns children and exists even at low doses, systematic screening is required. The risk of pituitary insufficiency is dose-dependent, with different sensitivity for each axis. In children, the main concern is the early detection of somatotropic insufficiency in order to prevent the risk of short stature. Reproductive function can be impaired after receiving 4–6 Gy requiring fertility preservation. Endocrine side effects can be treated to improve quality of life; therefore, we propose several approaches to be followed in order to promote screening and treatment.