宫颈癌术后调强放疗摆位误差对靶区累积剂量偏差的影响

目的:千伏级锥形束 CT（CBCT）获取分次间宫颈癌术后调强放射治疗(IMRT)摆位误差,分析分次间摆位误差对靶区累积剂量偏差的影响。方法:选取61例宫颈癌术后行调强放疗的患者,全程916次CBCT获取摆位误差,将误差值输入治疗计划系统中,由分次间摆位误差剂量叠加得到累积摆位误差剂量,通过偏差公式与标准计划剂量计算偏差百分比。结果:摆位误差x、y、z方向的偏差和偏移等中心距离分别为0.04（-0.16, 0.25）、-0.05（-0.37, 0.28）、0.10（-0.06, 0.24）和0.55（0.38, 0.78） cm。临床靶区除CTV的HIsum-HIplan和CTV1 的Dsum_D50-Dplan_D50与HIsum-HIplan无统计学差异外,其他临床靶区的配对检验均有统计学差异。计划靶区除PGTVnd的Dsum_median-Dplan_median、Dsum_mean-Dplan_mean、Dsum_D50-Dplan_D50无统计学差异外,其他计划靶区均有统计学差异。累积摆位误差剂量与标准计划剂量分布对比呈现负偏态分布,峰度降低。GTVnd、CTV、CTV1、CTVn、CTV_all与PGTVnd、PTV、PTV1、PTVn、PTV_all剂量偏差均呈降低,计划靶区的累积剂量偏差比临床靶区偏差明显增大。Dmin偏差、D98偏差、D95偏差偏离最大,Dmax偏差、D5偏差、D2偏差变化次之,Dmedian偏差、Dmean偏差、D50偏差变化最小,反S型DVH曲线向左偏移,斜率增大。临床靶区HI偏差均上升。结论:宫颈癌术后调强放疗摆位误差对靶区累积剂量影响存在统计差异性,靶区累积剂量降低、均匀性变劣。宫颈癌术后调强放疗在每次治疗前需进行CBCT位置校准以保证靶区各结构剂量准确性。在放疗计划设计时考虑增加CBCT次数带来额外剂量的风险。     

Use of Reaction Time in the Temporal Analysis of Normal Swallowing

This study was performed to establish the swallowing trigger by using the reaction time from an auditory stimulus. With this stable temporal starting point, we described the chronology of the different acoustic, electrophysiologic, and respiratory events that occurred during swallowing in a population of normal adults. We studied the swallowing reaction time (SRT) in 18 subjects aged 23 to 73 years by using acoustic, electroglottographic (EGG), and aerodynamic recordings. The chronology (the beginning of EGG activity, apnea, and respiratory sound and release) was identified in 91% of the recordings. The average SRT was 264 ms and the average swallowing duration was 977 ms, without any significant difference with respect to gender. The swallowing sound produced during apnea was composed of either two or three components. The reaction time procedure also demonstrated that the first sound component was unstable. By using this procedure for studying swallowing, we were able to stabilize the chronology of the different events, improve the subjects' attention, and establish a fixed benchmark for performing temporal measurements.     

Malignant transformation rate in oral submucous fibrosis over a 17-year period

Sixty-six patients with oral submucous fibrosis were followed-up for a period of 17 yr (median observation 10 yr) in Ernakulam District, Kerala, India. Oral cancer developed in five (7.6%) patients. The malignant transformation rate in the same sample was 4.5% over a 15-yr observation period (median 8 yr). These findings impart a high degree of malignant potential to this condition.     

Efficacy of mifepristone for cervical priming for second-trimester surgical termination of pregnancy

Objective

To determine whether mifepristone plus misoprostol was as effective as misoprostol with or without laminaria (depending on gestational age) for cervical preparation for second-trimester termination of pregnancy.

Methods

A retrospective cohort study was carried out among women who underwent surgical termination between 14 and 19 + 6 weeks of pregnancy. Those who received preoperative mifepristone were compared with those who did not. The study group received mifepristone plus misoprostol before dilation and evacuation of the uterus between May 2008 and September 2011. The comparison (non-mifepristone) group received misoprostol with or without laminaria between January 2005 and April 2008.

Results

There was no difference between the groups in terms of difficulty of cervical dilation, with an overall relative risk for moderate–difficult dilation in the mifepristone group of 0.91 (95% confidence interval, 0.49–1.68). There was no difference between the groups with regard to complications arising from the procedure.

Conclusion

Mifepristone is effective for cervical priming prior to second-trimester dilation and evacuation in both multiparous and primiparous women, without an increase in complication rates.     

Etiology of oral submucous fibrosis with special reference to the role of areca nut chewing

Oral submucous fibrosis (OSF) is a high risk precancerous condition, predominantly affecting Indians. Consumption of chilli was hypothesized as an etiologic factor on the basis of ecological observations and a solitary animal experimental study. Subsequent epidemiologic studies that included case-series reports, large cross-sectional surveys, case-control studies, cohort and intervention studies have identified areca nut as the major etiologic agent. Tissue-culture studies involving human fibroblasts, areca nut extracts and areca nut alkaloids supported this etiologic hypothesis by showing fibroblastic proliferation and increased collagen formation. Currently, the role of genetic susceptibility and that of autoimmunity are receiving attention. The influence of nutritional factors, if any, remains unclear.     

中医骨伤手法联合中药内服对颈椎病的效果分析

目的 探讨中医骨伤手法联合中药内服治疗颈椎病的临床效果。方法 选取2018年7月至2020年7月北京市丰盛中医骨伤专科医院和金融街社区卫生服务中心收治的70例颈椎病患者作为研究对象,采用随机数字表法将其分为观察组与对照组,每组各35例。对照组患者采用中药内服治疗,观察组患者采用中医骨伤手法联合中药内服治疗。比较两组患者的治疗总有效率、生活质量评分和焦虑抑郁情绪评分。结果 观察组患者的治疗总有效率高于对照组,差异有统计学意义（P<0.05）。治疗前,两组患者的生活质量评分比较,差异无统计学意义（P>0.05）;治疗后,两组患者的生活质量评分高于治疗前,且观察组患者的生活质量评分高于对照组,差异有统计学意义（P<0.05）。治疗前,两组患者的焦虑、抑郁评分比较,差异无统计学意义（P>0.05）;治疗后,两组患者的焦虑、抑郁评分低于治疗前,且观察组患者的抑郁、焦虑评分低于对照组,差异有统计学意义（P<0.05）。结论 在颈椎病患者的临床治疗中,采用中医骨伤手法联合中药内服医治措施具有较好的治疗效果,能够更加有效地改善患者的生活质量,更具优越性,值得临床推广应用。     

"安神定志"辨

近读李永昌先生所著《中国按摩术》一书,获益匪浅.但书中在介绍"安神定志法"时,我认为作者有一个小小的失误.     

“扶正祛邪”组方探讨

作为治疗疾病的工具之一,方剂是在各项辨证诊断治疗原则指导下由药物组合而成的。换言之,它是“辨证论治”、“扶正祛邪”诸理论和原则的药物体现方式。下面我们就依据这些基本理论和原则,探讨一下方剂的通用结构组成。外邪侵袭是导致疾病发生的主要原因之一,因此,“祛邪药”就