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Objective:To evaluate the clinical application of online adaptive radiotherapy based on iterative cone-beam computed tomography (iCBCT) for the pelvic malignancies.Methods:This was a prospective clinical trial of iCBCT guided online adaptive radiotherapy for pelvic malignancies in Department of Radiation Oncology, Peking Union Medical College Hospital. Clinical data of 13 patients with pelvic malignancies who received online adaptive radiotherapy from August to November, 2022 were preliminarily analyzed (2 cases of cervical cancer, 4 postoperative cervical cancer, 3 postoperative endometrial cancer, 3 bladder cancer and 1 prostate cancer). The feasibility of online adaptive radiotherapy, adaptive radiotherapy time, the frequency and magnitude of edits for organs at risk and target volume, target volume coverage and organs at risk doses were analyzed. Statistical analysis was performed by SPSS software. Data conforming to normal distribution were described by Mean±SD, and data with non-normal distribution were expressed by M ( Q1, Q3). Data with homogeneous variances were analyzed by t-test, and data with non-normal distribution or heterogeneous variances were analyzed by nonparametric test. Results:The average adaptive time was 15 min and 38 s (from acceptance of acquired CBCT scan to completion of the final plan selection). 85.4% (830/972 fractions) of influencer structures (system-defined organs adjacent to and with high impact on the generation of clinical target volume and planning target volume, primarily bladder, rectum and small intestine in pelvic neoplasms) automatically generated by artificial intelligence required no edits or minor editors, and 89.8% (491/547 fractions) of clinical target volume automatically generated by artificial intelligence required no edits or minor editors. The adapted plan was adopted in 98.5% (319/324 fractions) of radiotherapy fractions. Compared with the scheduled plan, the adapted plan showed better target volume coverage and reduced the dose of organs at risk.Conclusions:iCBCT guided online adaptive radiotherapy for the pelvic malignancies can be achieved within clinically acceptable timeslots. In addtion, better dose coverage of target volume shows the advantages of online adaptive radiotherapy.
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Objective:To analyze the differences in dosimetric quality and plan complexity of volumetric modulated arc therapy (VMAT) plans based on Halcyon 2.0 and Truebeam for different treatment sites of the patients.Methods:Halcyon 2.0 VMAT plans in head & neck, chest, abdomen, and pelvis treatment sites of 49 cases were retrospectively selected and the VMAT plans were re-designed based on Truebeam with the same optimization parameters. The differences in dosimetric metrics and plan complexity between the two types of plans were compared and analyzed. P<0.05 was considered as statistically significant. Results:In terms of PTV, Halcyon 2.0 plans showed better homogeneity index (HI), conformal index (CI) in the head & neck and chest. Besides, Halcyon 2.0 plans yielded better D 98% and CI in the abdomen and better D 2% in the pelvis. For organs at risk (OAR), the D 20% and D mean of bilateral lungs, and D meanof heart for Halcyon 2.0 plans in the chest were lower than those for Truebeam plans (all P<0.05). For the complexity metrics, the median average aperture area variability (AAV) of Halcyon 2.0 plans in the head & neck, abdomen and pelvis were 0.414, 0.425 and 0.432, which were better than 0.385, 0.368 and 0.361 of Truebeam plans in the corresponding sites, respectively. In the abdomen and pelvis, Halcyon 2.0 plans showed better median modulation complexity score (MCS) than Truebeam plans (0.320 vs. 0.268, 0.303 vs. 0.282; both P<0.05). The median small aperture score (SAS) for all plans of Halcyon 2.0 were better than that of Truebeam plans (all P<0.05), and the median plan average beam area (PA) of all plans of Halcyon 2.0 were larger than that of Truebeam plans (all P<0.05). Conclusions:Compared with conventional fractionated VMAT plans based on Halcyon 2.0 and Truebeam, Halcyon 2.0 plans have similar or even better dosimetric quality. However, Halcyon 2.0 plans have lower plan complexity, which makes it an advantage in clinical application.
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Objective:To study the clinical feasibility and advantages of the RapidPlan module based on Halcyon 2.0 ring medical linear accelerator in the design of volumetric modulated arc therapy (VMAT) plans after cervical cancer surgery.Methods:The data of 98 clinical cervical cancer cases were selected from the database, and VMAT artificial radiotherapy plans were designed based on Halcyon 2.0. Then, the designed plans were imported into the RapidPlan module to train the module for a prediction model with high goodness of fit. Another 20 patients after cervical cancer surgery were selected as the validation set to compare the differences in dosimetry, plan consistency, and plan execution efficiency between the manual plans and RapidPlan automatic plans.Results:The RapidPlan automatic plans could obtain dose distribution of target volume and organs at risk with the same quality as the manual plans. The RapidPlan automatic plans provided slightly inferior protection of the femoral head but superior protection of the spinal cord compared to the manual plans, and the difference was statistically significant ( t = 4.71, P<0.001). The average MU of the RapidPlan automatic plans was 687.46, which was lower than that of the manual plan (815.34), and the difference was statistically significant ( t = 6.09, P < 0.05). The portal dosimetry (PD) verification revealed that the average γ passing rate (1 mm/1%) of the RapidPlan automatic plans was 89.48%and that of the manual plans was 88.22%, and the difference was statistically significant ( t = 3.35, P < 0.05). Conclusion:RapidPlan automatic plans based on the Halcyon 2.0 platform can meet the clinical needs of the VMAT program for cervical cancer and has certain advantages.
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Objective:To help clinicians simplify the post-processing operations of structures by developing rapid processing software for target area and organs at risk structures based on ESAPI.Methods:SmartStructure script software was developed based on ESAPI, verified and evaluated in clinical work. 10 cases of rectal cancer receiving neoadjuvant radiotherapy, 10 breast cancer treated with postoperative radiotherapy, 10 cervical cancer receiving postoperative radiotherapy, 10 nasopharyngeal carcinoma receiving radical radiotherapy and 10 lung stereotactic body radiotherapy (SBRT) were selected, and different types of tumors had different post-processing operations of structures. In each case, three methods were used for post-processing of structures. In the control group (manual group), normal manual processing was employed. In the experimental group 1(SmaStru-N group), scripts without templates were utilized. In the experimental group 2(SmaStru-P group). scripts combined with templates were adopted. The processing time of the three methods was compared. Clinicians scored the scripting software from multiple aspects and compared the feeling scores of scripting software and manual operation.Results:All three methods can be normally applied in clinical settings. The error rate in the manual group was 7.0%, 3.0% in the SmaStru-N group 0% in the SmaStru-P group, respectively. Compared with the manual method, SmaStru-N shortened the processing time of target area and organs at risk by 60.9% and 93.3% for SmaStru-P. In addition, SmartStructure was superior to manual method in terms of using feeling scores. Clinicians gave lower score for the" applicability" and" simplicity" , and higher score on the" accuracy" and" efficiency" .Conclusions:Compared with conventional manual structure processing method, SmartStructure software can rapidly and accurately process all structures of the target area and organs at risk, and its advantages become more obvious with the increasing number of structures that need to be processed. SmartStructure software can meet clinical requirements, reduce the error rate, elevate processing speed, improve the working efficiency of clinicians, providing basis for the development of adaptive radiotherapy.
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Objective:To compare the dosimetric parameters and plan complexity between newly-delicated HyperArc (HA) and conventional volumetric-modulated arc therapy (VMAT) in the treatment of brain metastases.Methods:For 26 patients with brain metastases, HA, conventional coplanar (Cop) and non-coplanar (Non-cop) VMAT plans with a prescription dose of 9 Gy 3fx or 6 Gy 5fx were generated. The dosimetric parameters for planning target volume (PTV), RTOG conformity index (RTOG CI), Paddick CI, homogeneity index (HI), gradient index (GI), maximum dose (D max) of brainstem and dose-volume parameters of brain-PTV(V 2Gy-V 26Gy) were statisticaly compared among these three approaches. In addition, the monitor unit (MU) and the plan complexity parameters (including MCSv and AlPO) were statistically compared. Results:To prevent missed targets during treatment, all plans were established with RTOG CI of greater than 1.1. For Paddick CI, HA provided significantly higher conformity (0.89±0.019) than Non-cop (0.87±0.036, P=0.001) and Cop (0.88±0.017, P=0.003) VMAT. For GI, the fastest dose fall-off was noted in HA (3.35±0.64), followed by conventional Non-cop VMAT of (3.70±0.80), and conventional Cop VMAT of (4.90±1.85)(all P<0.05). For the brainstem sparing, HA plan performed better than Non-cop plan[(604.14±531.61) cGy vs.(682.75±558.22) cGy, P<0.05)]. For normal brain tissue sparing, HA approach showed significant reduction than conventional Cop and Non-cop VMAT (both P<0.05). For MU, HA approach (2 872.60 ± 566.93) was significantly lower than those of Non-cop VMAT (3 771.28 ± 1 022.38, P<0.05) and Cop VMAT (4 494.08 ± 1 323.09, P<0.05). In terms of plan complexity, the MCSv of Cop plan was the lowest, indicating that the complexity was the highest ( P<0.05). The AlPO of HA was significantly higher than that of Non-cop VMAT ( P<0.05), suggesting that the complexity of HA plan was lower ( P<0.05). Conclusion:For the treatment of brain metastases, HA provides better conformity, more rapid dose fall-off, better sparing of brainstem and normal brain tissues and less plan complexity compared with conventional VMAT.
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Objective:To study the feasibility of using pelvic iterative cone beam CT images for dose calculation of radiation therapy planning, so as to provide support for adaptive radiotherapy.Methods:The CIRS 062 M phantom was scanned by Varian Halcyon v2.0 o-ring accelerator, and the average CT number under different scattering conditions was calculated, and then the ICBCT-ED conversion curve was established. CT images of CIRS 002PRA pelvic IMRT phantom and ICBCT images at different positions were collected. Treatment plan using VMAT technique based on CT image was designed and transplanted into ICBCT image with dose recalculated. The differences of gamma passing rate among target volume, organs at risk and 3-dimensional dose were compared. Based on the actual treatment plan of patients, the differences of 3-dimensional dose gamma passing rate in 10 pelvic patients were analyzed retrospectively.Results:There was a large CT value deviation at central position between the isolated no-scattering condition and the full-scattering condition, and the maximum deviation was 144 HU. The CT values of other positions in full-scattering condition were similar to those of the central position, and the maximum deviation was less than 50 HU. Based on the calculated result of ICBCT images at different positions of the pelvic phantom, the dose deviation of the target volume or organs at risk was less than 1 Gy. Compared with the plan based on CT images, the average 3-dimensional dose gamma passing rate under the criteria of 1% dose difference (DD)/1 mm distance-to-agreement (DTA) and 2% DD/2 mm DTA in plan based on ICBCT images were (88.86 ±1.18)% and (98.38±0.89)%, respectively. The ranges of average 3-dimensional dose gamma passing rate under the criteria of 2% DD/2 mm DTA and 3% DD/3 mm DTA in 10 patients with pelvic tumors were 90.03%-95.43% and 93.58%-97.78%, respectively, and the worst result was only 85.90% and 92.90%, respectively. The main reason of the worst result was the dose difference caused by large variation of bladder contour due to over-filling.Conclusions:Under comprehensive scattering conditions, the ICBCT-ED conversion curve is reconstructed and the treatment plan can be designed by using the ICBCT image of Halcyon v2.0 linear accelerator. The accuracy meets the standards of clinical application, which provides assurance for adaptive radiotherapy in the future.
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Objective:To discuss the design details of accelerator room for a novel enclosed O-ring linac Halcyon, and to optimize its protection and layout.Methods:According to the optimization principle of radiation protection and the requirements of national radiation protection standards, and the structural characteristics of Halcyon accelerator, the differences between conventional and this novel accelerator rooms were analyzed by discussing the space layout of the machine room, shielding calculation, electrical facilities, purifying ventilation, temperature and humidity control and other factors.Results:The Halcyon machine had a compact structure, a closed ring frame design and a main beam shielding device, which could greatly reduce the radiation protection pressure while improving the space utilization rate of the machine room. The optimized design layout of the machine room could eliminate hidden dangers, avoid design defects, and prevent adverse consequences caused by design errors.Conclusions:The overall structure of Halcyon accelerator is different from that of conventional accelerators. The design details should be taken into full consideration to ensure the optimization of radiation protection, lay a good foundation for subsequent installation, debugging and operation of the equipment and create a good treatment environment for patients and medical staff.
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Objective:To access the effectiveness and safety of the intrauterine balloon tamponade verse gauze packing combined with temporary abdominal aortic balloon occlusion in the management of placenta accreta spectrum (PAS).Methods:This was an open-label, randomized controlled trial conducted in Nanjing Drum Tower Hospital. The patients suspected with PAS for uterine preservation surgery under the multidisciplinary team care were recruited between Aug 2015 and Jan 2018. When bleeding could not be achieved after fetus delivered, and a temporary abdominal aortic balloon occlusion and the compression sutures as needed, the women were randomly allocated 1∶1 into balloon tamponade ( n=81) or gauze packing ( n=80) group. The primary outcome was successful bleeding arrests by avoiding second line surgeries. The secondary outcomes included the volume of blood loss during and after cesarean section, the rate of PPH, incidence and amount of blood transfusion, hysterectomy, postpartum pain, ICU admission, need for re-laparotomy, and the length of hospital stay, readmission, and interventional radiology complications. Results:All the women [100% (81/81)] in the balloon group were obtained hemostasis without further intervention, significantly higher than 88% (70/80) in the gauze group ( P=0.001). Before uterine tamponade, blood loss were 820 ml (620-1 230) ml and 850 ml (605-1 442) ml, while placenta bed were sutured in 96%（78/81, 77/80） respectively ( P>0.05).The proportion of blood loss≥1 000 ml was higher in the gauze group than that in the balloon group ( P=0.006). Maternal adverse events involving total blood loss, puerperal morbidity and postpartum pain occurred more frequently in the gauze group ( P<0.05). The following outcome showed no statistically significant difference between the two groups: the vascular occlusion time, the dose of radiation, and interventional radiology complication ( P>0.05). The median volume infused into the lower and upper balloons is 70 ml (50-100 ml) and 180 ml (100-240 ml). Conclusions:Incrauterine balloon tamponade is as effective as gauze packing in hemostasis following the placenta delivery in PAS. Compared with gauze packing, the uterine balloon tamponade is more effective.
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with the increasing prevalence of myopia in Chinese children, there are more methods for its prevention and control.Orthokeratology is one of the most appealing techniques for myopia correction.In recent years, an increasing number of hospitals have applied this technology, and its acceptance among patients is increasing.The safety of the orthokeratology have drawn increasing attention, especially in relation to orthokeratology-associated infectious keratitis.Acanthamoeba keratitis (AK) is one of the most worrying diseases.The onset of AK is slow, and its early clinical manifestation is particularly atypical, which often leads to incorrectly diagnosis, so as to mistreatment or delay of medical therapy, and subsequently irreversible impairment of visual function.Therefore, it is very important to reinforce the knowledge of its early symptoms in order to improve the early diagnosis level, and manage the associated risk factors.Early diagnosis and promper treatment can contribute to good visual outcomes.
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Objective To explore and establish accurate detection quality control method of source positioning and timer precision for afterloading equipment. Methods The source positioning detection device was made of hd camera,EBT3 disposable film and steel rule,collecting source in each resident point for video images and film. Accurate measurement of radioactive source positioning and timer accuracy, including the timing absolute error and linear error through analysis of image sampling rate. After the film grayscale distribution analysis,comparison between film gray peak position and the measurement of resident point geometry,got the stay point source physics and radiation center deviation. Results Radioactive source physics and radiation center deviation was (-0.33± 0. 10) mm;For all default dwell time,timer average absolute deviation was (0.22±0. 02) s,linear fitting result was y=x-0. 226,R2=1,timing linear error was-0. 01％ Conclusions established detection means through the video images and film exposure quantitative analysis for accurately determination of source positioning,dwell time and source radiation center precision. After experimental testing the machine precision satisfied the requirement of clinical use.
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Objective To evaluate the long-term efficacy of neonatal immunoprophylaxis in children born from mothers infected with hepatitis B virus (HBV),and to clarify whether a booster vaccination is required.Methods Totally 252 children of HBV infected mothers,who were negative for hepatitis B surface antigen (HBsAg) tested in Nanjing Drum Tower Hospital in 2012,were enrolled to participate in this study from July to September,2017.Revaccination of hepatitis B vaccine was recorded and other relevant informations were collected.HBV serologic markers were detected in each child.Results Totally 198 children (78.6％) were followed up.They were (8.4 ± 2.2) years old and 112 cases were boys.All 198 children were negative for both HBsAg and hepatitis B core antibody (anti-HBc).The overall positive rate of hepatitis B surface antibody (anti-HBs) (≥ 10 IU/L) was 65.7％.During period of 2012 to 2017,53 children were boosted with hepatitis B vaccine.Their median anti-HBs titer in 2017 was higher than that in 2012 (327.95 IU/L vs.158.01 IU/L),and the difference was significant (Z =-4.480,P ＜0.05).The other 145 children were not revaccinated,their median anti-HBs titer was decreased from 214.19 IU/L in 2012 to 70.49 IU/L in 2017,and the difference was significant (Z =-6.575,P ＜ 0.05).Of 145 children who were not revaccinated,25 cases had anti-HBs levels ＜ 10 IU/L and 120 cases ≥ 10 IU/L in 2012,and the other 47 cases also showed the antibody ＜ 10 IU/L in 2017,but none of them was infected with HBV.Conclusions Neonatal immunoprophylaxis in infants from HBV-infected can provide long-term protection against hepatitis B.The children with anti-HBs ＜ 10 IU/L are still immune to HBV and booster vaccination for them seems unnecessary.
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Objective To assess the current practice in managing hypertensive disorders of pregnancy (HDP) and provide possible interventions to improve the quality of care.MethodsA checklist was developed based on Chinese Medical Association's guideline on HDP. A criteria-based audit was conducted on 66 HDP patients who were admitted to the Intensive Care Unit (ICU) of Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School between January 1, 2014 and December 31, 2016. The quality of care during antepartum and hospitalized period were evaluated, and patient factors were also considered. We also collected data on patients' demographics, complications of HDP, acute physiology and chronic health evaluation (APACHE)Ⅱ score and duration of hospital stay.T or Mann-WhitneyU test orChi-square test was performed. Results(1) From 2014 to 2016, the number of deliveries in Nanjing Drum Tower Hospital was 18573, with 1561 cases (8.4％) of HDP. Among the 66 cases being audited, 44 (66.7％) were preeclampsia; 16 (24.2％) were preeclampsia complicated by chronic hypertension; six (9.1％) were eclampsia; no maternal death was reported. (2) Complications of HDP in this study included heart failure (17 cases, 25.8％), hemolysis, elevated liver enzyme levels, low platelet count (HELLP) syndrome (15 cases, 22.7％), anemia and/or thrombopenia requiring transfusion (12 cases, 18.2％), renal dysfunction (seven cases, 10.6％), eclampsia (six cases, 9.1％), pulmonary edema/acute respiratory distress syndrome (five cases, 7.6％), placenta abruption (four cases, 6.1％), cerebral venous and sinus thrombosis (two cases, 3.0％), cerebral hemorrhage (one case, 1.5％) and hepatic rupture (one case, 1.5％). Their APACHEⅡ score was 9.0±3.9. The duration of ICU and hospital stay was 2 (1-30) d and 8 (4-32) d, respectively. (3) Compared with the gravidas who registered during antenatal care, those without registrations were older [(33.0±6.0) vs (29.1±5.4) years old,t=-2.616], having less antenatal visits [2 (0-4) vs 5 (2-10) times, Z=110.000] and higher blood pressure on admission [(177.0±24.1) vs (155.5±24.6) mmHg of systolic blood pressure (t=-3.322), and (116.4±14.6) vs (108.0±18.7) mmHg of diastolic blood pressure (t=-3.013, 1 mmHg=0.133 kPa)], and only a few of them were nulliparas [23.8％(5/21) vs 71.1％(32/45),χ2=13.006] (all P<0.05). (4) Among the 66 cases, seven (10.6％) had preeclampsia history, but none of them received aspirin for HDP prevention; 21 (31.8％) did not have regular testing of blood pressure during antenatal check; 24 (36.4％) did not receive proper antenatal evaluation when hypertension was identified. (5) After excluding 20 cases directly admitted upon the first diagnosis of HDP, the rest 46 were managed in the outpatient department. Eighteen of them (39.1％) did not have blood pressure monitoring and 26 of them (56.5％) did not have a regular test of hemoglobin, platelet, urine protein, liver or renal function. (6) Twenty-nine gravidas (43.9％) suffered a delay in referral or admission. (7) All gravidas received magnesium sulphate administration. Thirty-three cases with severe hypertension (systolic blood pressure≥160 mmHg or diastolic blood pressure≥110 mmHg) were given antihypertensive drugs with satisfactory blood pressure control. Thirty-six cases with living fetus (26-34+6 gestational weeks) received antenatal dexamethasone. Termination of pregnancy was delayed in three cases after admission.ConclusionsThe management of HDP is not good enough in patients' education, screening for high-risk population, early diagnosis and antenatal care. Quality improvement efforts should be focused on strengthening patient education, training of doctors in primary and secondary hospitals, implementing protocols on antepartum care of preeclampsia and establishing a referral system for patients with severe obstetric complications.
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Objective Preoperative autologous blood donation(PABD) can reduce the demand of allogeneic blood transfusion and its safety in obstetrical application has been proved.The article aimed to explore the effects of PABD on reducing allogeneic blood transfusion in pregnant women with placenta previa and the optimal PABD volume for implanted placenta.Methods Retrospective analysis were made on 156 cases with placenta previa hospitalized in our hospital from January 2015 to April 2016, including 78 cases with placenta implantation.According to the volume of PABD, the cases were classified into no PABD group, 300~400mL PABD group, and 600ml PABD group.Data of postpartum hemorrhage volume and allogeneic blood transfusion after delivery were collected to analyze the effectiveness of PABD in reducing the need for allogeneic blood transfusion during pregnancy.Results The hemorrhage volume during the delivery of all 156 patients with placenta previa was 230-5670mL (median 985ml), the rate of severe postpartum hemorrhage (PPH) was 49.4% (77/156), and the rate of allogeneic blood transfusion was 33.3% (52/156).In patients who had no PABD, the rate of allogeneic blood transfusion was 48.2% (40/83).However, this rate dropped down to 16.4% in PABD patients (12/73)(χ2=17.624,P<0.001).The rate of allogeneic blood transfusion in patients was different according to the situation of placenta planting, 43.3% in patients with no placenta plantingand 53.8% in patients with placenta planting.600ml autologous blood could meet all the needs for blood transfusion if there was no placenta implantation.300-400mL PABD could meet the needs of more than 80% patients.11.2%-13.3% of ABD patients might need allogeneic blood transfusion in addition to autologous blood.However, the amount of allogeneic RBC and FFP per capita reduced.Conclusion Patients with placenta previa is in high risk of PPH and PABD can improve their medical safety by reducing the rate and volume of the allogeneic blood transfusion.The strategy of 300-400mL PABD during pregnancy are recommended if there is no contraindication.
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Background Allergic conjunctivitis is common in clinical practice.But some patients,especially pediatric patients,are not diagnosed and treated correctly because of different classifications and other associated symptoms.A comprehensive understanding of the clinical characteristics of allergic conjunctivitis helps to correct diagnosis and management.Objective This study tried to analyze the clinical characteristics of allergic conjunctivitis.Methods A descriptive study was carried out.The clinical data of 745 cases of various classifications of allergic conjunctivitis who received treatment in Beijing Tongren Eye Center from April 2011 to March 2015 were retrospectively analyzed.The general status,disease history,family medical history,personal allergy history,medication history,disease course,attacked duration,affecting factors of symptoms,other non-ocular allergic diseases,other associated eye disease,the findings of the anterior ocular segment,treating outcomes were summarized and the correlation of age with symptoms was evaluated.Results In the 745 cases,75.44％ cases (562/745 were seasonal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC),21.88％ cases (163/745 were vernal keratoconjunctivitis (VKC),2.42％ cases (18/745) were giant papillary conjunctivitis (GPC),and 0.27％ cases (2/745) were atopic keratoconjunctivitis (AKC).The number of patients was most in July (180,24.16％) and least in December (26,3.49％).The itching was found in 53.02％ patients,redness in 36.64％ patients,blinking in 21.88％ patients.In the patients,58.26％ patients were ≤ 14 years,34.09％ patients were 15-39 years and 7.65％ patients were ≥40 years,and a significant difference in gender was found in various age groups (x2 =89.431,P =0.000).The co-morbidities appeared to be allergic rhinitis,eczema,urticaria,allergic purpura and asthma,and the ocular coexisting conditions included dry eye,refractive error,blepharitis and meibomian gland dysfunction,corneal epithelial disorders,triehiasis and anterior uveitis.Logistic regression analysis revealed that blinking patients were more and dry eye,foreign body sensation and pain were less in ≤ 14 years patients than those in the ＞14 patiens (3=-2.039,P =0.000;3 =1.585,P=0.001;3=1.174,P=0.003;3=1.218,P =0.037).The symptoms of allergic conjunctivitis were relieved by the administration of dual-acting antiallergic agent/antihistamine drug,glucocorticoid or immunosuppressor agents.Conclusions SAC and PAC are more common classifications of allergic conjunctivitis,followed by VKC.July is a high-occurrence duration and clinical symptoms are diverse and often accompanied by other allergic diseases.The administration of dual-acting antiallergic agent/antihistamine drug,glucocorticoid or immunosuppressor agents is an effective approach to the management of allergic conjunctivitis.
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Objective To investigate the safety of trial of labor after cesarean (TOLAC) and clinical factors associated with successful TOLAC and to compare TOLAC with elective repeat caesarean section (ERCS) in terms of obstetric and neonatal outcomes.Methods A prospective cohort study was conducted among gravidas who had a history of lower segment cesarean section and were hospitalized in the Department of Obstetrics and Gynecology,the Affiliated Drum Tower Hospital of Medical School of Nanjing University from January to December 2014.Exclusion criteria included indications for caesarean section (such as placenta previa,placenta accreta,twin pregnancy,breech presentation and severe preeclampsia),serious maternal complications after cesarean section,lower uterine segment thinner than 3 mm and poor healing of uterine incision.Totally,287 gravidas were enrolled.Among them,142 chose TOLAC and the other 145 requested ERCS.Clinical data of those gravidas were collected and statistically analyzed by t-test,Log-rank test,Chi-square or Fisher's exact test.Results (1) The success rate of TOLAC was 90.8％ (129/142).There was no significant difference in maternal age,gestational age,thickness of lower uterine segment,interval between the two deliveries and neonatal birth weight and asphyxia rate between the successful (n=129) and unsuccessful (n=13) groups (all P＞0.05).Although the two groups had no significant difference in postpartum hemorrhage (PPH) rate,the gravidas who failed in TOLAC lost more blood than those who succeeded [425 (195-675) vs 200 (50-1 400) ml,P＜0.05].Moreover,higher amniotic fluid contamination rate was observed in the unsuccessful group [6/13 vs 17.1％ (22/129),P＜0.05].In the TOLAC group,99.3％ (141/142) were under continuous fetal heart rate monitoring.Incomplete uterine rupture occurred in one women without serious maternal or neonatal outcomes.The reasons for 13 failed TOLAC cases were unbearable pain during labor,abnormal labor,fetal distress and threatened rupture of uterus.(2) Compared with the ERCS group,the TOLAC group showed shorter interval from last cesarean section to the indexed delivery[5 (2-18) vs 6 (2-19) years],younger maternal age [(31±4) vs (33 ±4) years old] and less blood loss [200 (50-1 400) vs 300 (100-1 500) ml] (all P＜0.05).Conclusion Our study shows that,those who preferred TOLAC were younger,or had shorter pregnancy interval from last cesarean section.The success rate of TOLAC is high for women undergoing systematic prenatal assessment and close management during labor with less blood loss and non-serious maternal and neonatal complications compared with ERCS.
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ObjectiveTo understand the prevalence of maternal anemia and iron deficiency during the second and third trimesters and their relationship with adverse pregnant outcomes.MethodsData of 3 262 gravidas, who received prenatal care and delivered at Drum Tower Hospital from October 1, 2013 to October 31, 2014, were retrospectively collected and analyzed. Blood routine test was performed for all subjects both at the second (20-22 weeks) and third trimesters (38 weeks of gestation or before delivery) using automatic blood analyzer. Moreover, serum ferritin level was determined at the second trimester with microparticle chemiluminescence immunoassay. Treatment was offered to those diagnosed as iron deficiency anemia or severe iron deficiency, and the adverse pregnancy outcomes were analyzed.Chi-square test and TrendChi-square test were performed for statistics.Results(1) Out of the 3 262 women, 601 (18.42%) were diagnosed as anemia at second trimester, among which 444 (73.88%) recovered at the third trimester after proper treatment. However, there were 285 (8.74%) new-onset anemia pregnancies at last trimester. Thus, the total prevalence of anemia in pregnancy was 27.16% (886/3 262). (2) The mean serum ferritin level at the second trimester was (29.40± 30.12) ng/ml, and 1 565 (47.98%) were diagnosed as iron deficiency at the same period. (3) During the mid-term pregnancies, 345 iron deficiency anemic women were identified, which accounted for 57.40% of all anemic cases in this study. Two hundred and fifty out of the 345 women were cured at the third trimester. However, another 206 new-onset iron deficiency anemic pregnancies were identified at the third trimester. For iron deficiency anemia both at mid- and late-term pregnancy, the prevalence was 16.89% (551/3 262), which accounted for 62.19% (551/886) of all anemic patients. (4) There were more women with microcytic hypochromic anemia in the late-trimester than in the mid-trimester [19.93%(60/301) vs 4.93% (17/345),χ2=34.478,P<0.01]. (5) Among women with serum ferritin≥30,≥20- <30,≥10- <20- <10 ng/ml, the prevalence of mild anemia in mid-trimester was 13.33%(142/1 065), 14.40%(91/632), 14.71%(130/884) and 24.82%(169/681), the prevalence of new-onset anemia in the third trimester was 3.94%(42/1 065), 5.85%(37/632), 12.78%(113/884), and 13.66%(93/681) respectively. The lower the serum ferritin level, the higher the prevalence of anemia in the mid-trimester (χ2trend=30.697,P<0.01) and the new-onset anemia in the last trimester (χ2trend=69.871,P<0.01). (6) The incidence of postpartum hemorrhage in pregnancies with serum ferritin level at≥10 but <20 ng/ml was significantly higher than those normal one [20.39%(52/255) vs 11.92%(75/629),χ2=10.577,P<0.01]. Neither serum ferritin level nor anemia was associated with other adverse pregnancy outcomes.ConclusionsThe incidences of anemia and iron deficiency remain at a high level at the second and third trimesters. The lower the serum ferritin level at mid-trimester, the higher the incidence of anemia.
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Objective To discuss the success rate of external cephalic version (ECV) for breech presentation in singleton pregnancies and the factors influencing ECV,and complications induced by ECV.Methods A prospective study was conducted which included 204 pregnant women who underwent regular prenatal examinations and delivered in Nanjing Drum Tower Hospital between March 1,2011 and February 29,2012.The 204 cases were single pregnancy with breech presentation identified by ultrasound during 32-37+6 weeks of gestation,and without other indications for cesarean section (CS).According to willingness of the participants,204 cases were divided into two groups.The 101 pregnant women who refused EVC (control group) were asked to practice knee-chest position twice a day; and 103 pregnant women volunteered to undergo EVC (ECV group) during 32-37+6 weeks of gestation.The proportion of cephalic presentation at delivery,CS rate and the incidence of PROM,premature delivery and cord around the neck were compared between the two groups.Factors influencing the success rate of ECV were analyzed.Chi-square or adjusted Chi-square test were used for statistical analysis.Results The proportion of cephalic presentation at delivery in the ECV group was higher than that in the control group [68.9％ (71/103) vs 29.7％ (30/101),x2=31.39]; the CS rate in the ECV group was lower than that in the control group [49.5％ (51/103) vs 78.2％ (79/101),x2=18.18],as was the rate of CS due to breech presentation [62.7％ (32/51) vs 89.9％ (71/79),x2=13.86],all P＜0.05.The success rates in frank breech presentation,complete breech presentation and incomplete breech presentation were 77.1％ (37/48),72.7％ (24/33) and 45.5％ (10/22),respectively (x2=7.37,P＜0.05),and the success rate in frank breech presentation was higher than that in incomplete breech presentation (x2=6.84,P＜0.017).No significant differences were observed in the success rates between primiparas and multiparas [67.7％ (63/93) vs 8/10,x2=0.19],placenta attached at front wall of uterus and other attachment sites [61.0％ (25/41) vs 74.2％ (46/62),x2=2.01],and EVC performed at 32-35+6weeks of gestation and 36-37+6 weeks [70.5％ (62/88) vs 9/15,x2=0.65],allP＞0.05.No significant differences were observed for the incidence of PROM [7.8％ (8/103) vs 6.9％ (7/101)],premature delivery [2.9％ (3/103) vs 2.0％ (2/101)] and cord around the neck [17.5％ (18/103) vs 21.8％ (22/101)] between the ECV and control group (x2=0.05,0.19 and 0.60,all P＞0.05).Conclusions ECV for breech presentation in singleton pregnancies can effectively correct the fetal position and reduce the CS rate.ECV performed after 32 weeks of gestation does not increase the risk of PROM and premature delivery.
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Objective Preoperative autologous blood donation ( PABD) may reduce the need for allogeneic blood , but it may also cause a short massive blood loss in pregnant women , and its fetal and maternal safety has to be adequately assessed .This study was to evaluate the feasibility and safety of PABD for pregnant women and their fetuses . Methods A prospective observational study was conducted among the women who met the inclusion criteria and gave birth in Nanjing Drum Tower Hospital between January and December 2013 .According to the clinical validation of risk stratification criteria for peripartum hemorrhage of California 2013 , the ca-ses were classified into a low-, a medium-, and a high-risk group.Data on blood donation procedures , obstetric outcomes, and blood transfusions were collected after delivery for analysis . Results Totally, 92 pregnant women accomplished 115 blood donations .The median volumes of the donated blood were 300, 300, and 400 mL in the low-, medium-, and high-risk groups, respectively ( P>0.001).There were no significant changes in HR , SBP and SpO2 during the blood donation procedures (P>0.05) except for the fall of diastolic blood pressure by an average of 3.4 mmHg (P0.05), which were similar to those in the cases who donated twice , with no significant differences before and after the donation (P>0.05). Homologous blood transfusion was performed for 5 cases (17.9%) in the high-risk group, with the volume of blood loss >2000 mL in all the cases.All the newborns survived without asphyxia and there was no perinatal death . Conclusion PABD can provide timely autologous whole blood donation for pregnant women .Under strict management , PABD is feasible and safe for pregnant patients who are at a high risk for massive blood loss during delivery or have a rare type of blood no readily available .
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To investigate the impact of maternal hepatitis B virus (HBV) carrier state on twin pregnancy outcomes. Methods From January 2004 to December 2012, 569 women with twin pregnancy were hospitalized in Nanjing Drum Tower Hospital. Thirty-two women positive for hepatitis B surface antigen (HBsAg)(negative for hepatitis B e antigen, with normal liver function before conception)were included in the HBsAg-positive group and the other 537 women were included in the HBsAg-negative group. The pregnancy outcomes of the two groups were compared by t test and Chi-square test. The risk factors for neonatal birth weight were analyzed by multivariate regression analysis. Results Compared with the HBsAg-negative group, the HBsAg-positive women had a higher incidence of abnormal liver function (alanine aminotransferase≥50 U/L) [18.8% (6/32) vs 5.8% (31/537), χ2=6.367, P=0.012]. The incidence of gestational diabetes mellitus was 21.9% (7/32) in the HBsAg-positive group, which was higher than in the HBsAg-negative group [11.6% (62/537)], although the difference was not significant (χ2=2.132, P=0.144). The incidences of intrahepatic cholestasis of pregnancy,hypertensive disorders complicating pregnancy, premature rupture of membranes, placenta previa, fetal distress, postpartum hemorrhage, preterm birth, caesarean section, umbilical cord around the neck, meconium-staining amniotic fluid and neonatal asphyxia were no statistical difference between two groups (all P<0.05, respectively). Multivariate regression analysis showed that gestational diabetes mellitus (β=67.869, 95%CI: 0.494-135.244, P=0.048), maternal age (β=6.592, 95%CI: 2.020-11.880, P=0.006) and gestational age (β=164.069, 95%CI:154.426-173.712, P<0.01) were risk factors for neonatal birth weight, but not the maternal HBsAg-positive status (β=78.864, 95%CI: -16.950-174.678, P=0.107). Conclusion Twin pregnancy and HBV carrier state increase the risk of abnormal liver function, but not other adverse pregnancy outcomes and newborn diseases.
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By taking American Penn State University Medical Center as an example, the paper introduced the current American radiology resident education training situation and elaborated the radiology resident rotation system, multiform teaching model and academic research training. Medical education in American sheds light on how to reasonably arrange rotation, mobilize students' subjective initiative and improve scientific research ability, which radiology resident medical education in China can draw lessons from.