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1.
Clin Radiol ; 2021 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-34801223

RESUMO

AIM: To investigate if positive changes in the clinical performance of radiologists are associated with reading mammographic test sets. MATERIALS AND METHODS: This study investigated the clinical audit history for a cohort of 39 participants in the BreastScreen Reader Assessment Strategy who have read for BreastScreen New South Wales in the period between 2010 and 2018, inclusively. Based on the year in which each radiologist completed his or her first test set, data of multiple clinical audit metrics from two calendar years before test-set reading were compared against similar data from three different periods after test-set completion. The same process was repeated after dividing radiologists into two subgroups based on their median screen-reading volume (3,688), to test if experience is a determinant of post-test set performance. RESULTS: On average, radiologists showed significant improvements (p<0.05) in the recall rate for subsequent screening rounds, in positive predictive value 1 (PPV1), and in specificity. When dividing radiologists based on their average annual reading volume, radiologists with higher reading numbers demonstrated similar significant improvements in the recall rate and in PPV1. In addition, they showed significant improvements in the detection rates of invasive breast cancer and ductal carcinoma in situ (DCIS). In contrast, the radiologists with lower reading volume indicated significant changes in the recall rate and in PPV1, both accruing in one of the three compared periods. CONCLUSION: Mammographic test-set participants improve over time in identifying normal breast screens and detecting breast cancer in association with reading higher volumes of breast screening cases.

2.
Zhonghua Wai Ke Za Zhi ; 59(11): 912-917, 2021 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-34743453

RESUMO

Objective: To examine the clinical application effects of two-complex and one-plane technique for the renal artery dissected location in transperitoneal laparoscopic radical nephrectomy(LRN). Methods: Clinical data of patients diagnosed as renal tumor between January 2016 and December 2019 that treated with transperitoneal LRN and the two-complex and one-plane technique was performed to locate and dissect the renal arteries were analyzed retrospectively. A total of 206 qualified patients were enrolled, included 71 cases from Kaifeng Central Hospital and 135 cases from the First Affiliated Hospital of Zhengzhou University. There were 126 males and 80 females with median age of 54 years (range: 35 to 82 years). Renal tumor lived at left kidney in 102 cases and at the right in 104 cases, with a maximum tumor diameter of (6.8±2.5)cm (range: 3.0 to 12.7 cm). During the procession of transperitoneal LRN, The genital veins was followed to locate renal veins, soon the renal vein complex and renal lower pole complex and psoas major muscle plane that named as "two-complex and one-plane"anatomical markers were applied to the dissected location of renal arteries. The established application of two-complex and one-plane technique for renal artery location, and the anatomical features along with its locational time of renal artery, as well as vascular-related complications were recorded and analysed. The χ2 test or t test was used to compare the results of different lateral operations. Results: The surgical procedures were successful in all 206 patients. The operation time was (54.4±13.6) minutes (range:22 to 116 minutes), no injury to liver, spleen or intestine. Two-complex and one-plane technique was used to complete renal arteries location of 206 patients that accompanied with one or more arterial branch in the procession of transperitoneal LRN. Single renal artery branch was found in 163 cases, two or more renal artery branches were found in 43 cases, and 60 branches of accessory renal artery that in addition to the main trunks were detected in 14 cases (13.7%, 14/102) on left-side and 29 cases (27.9%, 29/104) on the right(χ²=6.251, P=0.012).The main branch of renal artery that directly been located inferior or posterior to renal vein in 165 cases, and the other 41 cases that born with higher-position of main branch been located through an upper"window-opening"of renal veins complex. Of the 60 accessory renal artery, 46 branch (76.6%, 46/60) been located inferior or posterior to renal veins, and the other 14 branch with higher-position (23.3%, 14/60) been located by a"window-opening"technique. The renal artery dissected location time was (21.2±9.4) minutes (range:11 to 43 minutes) in left-side and (17.5±9.3) minutes (range:9 to 32 minutes) in the right (t=2.840, P=0.005).The intraoprative bleeding was (51.8±25.2) ml (range:20 to 400 ml). There were 4 cases of vascular injury occured and treated with laporoscopy, only one need blood transfusion. Conclusions: The anatomical markers of renal vein complex and renal lower pole complex and psoas major muscle plane that can apply to locate various anatomical position types of renal artery in transperitoneal LRN effectively. The exactly application of two-complex and one-plane technique that could shorten the operational time of renal artery location and reduce the complications of vascular injury.


Assuntos
Neoplasias Renais , Laparoscopia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrectomia , Artéria Renal/cirurgia , Estudos Retrospectivos
3.
Zhonghua Gan Zang Bing Za Zhi ; 29(9): 867-872, 2021 Sep 20.
Artigo em Chinês | MEDLINE | ID: mdl-34638206

RESUMO

Objective: To investigate the impact of non-alcoholic fatty liver disease (NAFLD) on the incidence of type 2 diabetes mellitus (T2DM) in an elderly population. Methods: A rural elderly population of Kunshan city, Jiangsu Province were used as the research subject. Prior diabetes mellitus, heavy alcohol consumption and incomplete data were excluded from prospective cohort study analysis. Annual physical examination and follow-up were conducted from 2007 to 2016. T2DM onset, death and loss to follow-up visits were observed as the research subject end points. According to the baseline physical examination results, the study subjects were divided into NAFLD and control groups, and further baseline data of both groups were analyzed whether there were match. The cumulative incidence rate of T2DM were statistically analyzed and compared between the two groups. Simultaneously, the relationship between the two groups of various indexes and the newly developed T2DM were analyzed using Kaplan-Meier. The variables with P < 0.1 were selected and incorporated into the Cox proportional hazard regression model. The impact of NAFLD on the incidence of T2DM was analyzed in an elderly population. Results: At baseline, there were statistically significant differences in the distribution of age, sex, waist circumference, body mass index, systolic blood pressure, diastolic blood pressure, direct bilirubin, blood urea nitrogen and triglycerides between NAFLD and non-NAFLD groups. However, fasting blood glucose, serum creatinine, total bilirubin, total cholesterol, low density lipoprotein cholesterol and high-density lipoprotein cholesterol had no statistically significant differences between the two groups. After nine years of follow-up, 207 newly developed T2DM cases, 52 NAFLD cases and 155 control group were selected as the study subjects. The cumulative incidence rates were 4.25%, 10.34%, and 3.55%, respectively. Kaplan-Meier analysis result showed that there were statistically significant differences in the cumulative incidence rates between the two groups from five-year. NAFLD had increased the T2DM risk in an elderly population by approximately 2.14 times (2.14 CI: 1.132 ~ 4.047) at five-year, and then had increased year by year thereafter. Univariate analysis showed that T2DM risk was 2.76 times higher in NAFLD than non-NAFLD groups (95% CI: 2.015 ~ 3.777). After adjustment for gender, age, body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, serum creatinine, triglyceride, total cholesterol, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol, T2DM risk ratio was 1.68 times higher in NAFLD than control groups (95% CI: 1.163 ~ 2.425). Conclusion: NAFLD is an independent long-term risk factor for the T2DM onset in an elderly population.


Assuntos
Diabetes Mellitus Tipo 2 , Hepatopatia Gordurosa não Alcoólica , Idoso , Estudos de Coortes , Diabetes Mellitus Tipo 2/epidemiologia , Humanos , Incidência , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Estudos Prospectivos
4.
J Infect ; 2021 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-34614399

RESUMO

OBJECTIVES: We aim to study the viral kinetics and host inflammatory response of RSV infection in older adults, and their correlation with disease severity. METHODS: We performed a prospective observational study in adults with RSV infection. We serially collected nasal-throat swabs for quantification of RSV-A and RSV-B viral load, and peripheral blood samples for measurement of cytokine/chemokine concentrations. The study endpoints were (i) requiring supplemental oxygen therapy, and (ii) non-invasive ventilation, intensive care, or died within 30 days of admission. We performed multivariable logistic regression models to identify independent variables for severe disease. RESULTS: We enrolled 71 hospitalized patients and 10 outpatients treated for RSV infection (median age 75 years, 51% male, and 74% with comorbidities). Among hospitalized patients, 61% required supplemental oxygen therapy, and 18% had severe disease requiring non-invasive ventilation or intensive care, or died within 30 days. Inflammatory cytokine/chemokines IL-6, CXCL8/IL-8, CXCL9/MIG and CXCL10/IP-10 increased significantly during the acute phase of illness. IL-6 concentration was independently associated with severe disease after adjusting for confounding factors. RSV viral load was not associated with disease severity throughout the course of illness. CONCLUSION: Host inflammatory response is a major marker of severe disease in older adults with RSV infection.

6.
Zhonghua Yu Fang Yi Xue Za Zhi ; 55(9): 1059-1066, 2021 Sep 06.
Artigo em Chinês | MEDLINE | ID: mdl-34619922

RESUMO

Objective: To study the characteristics and risk factors of psychological and behavioral problems of children and adolescents of different ages and genders in long-term home-schooling during the coronavirus disease-2019 pandemic. Further, to provide scientific basis for more targeted psychological intervention and coping strategies in the future. Methods: A cross-sectional survey using an online questionnaire was conducted on students aged 6-16 years old in five representative cities of North (Beijing), East (Shanghai), West (Chongqing), South (Guangzhou) and Middle (Wuhan) in China. In this study, the social behavior and psychological abnormalities which was defined as the positive of any dimension were investigated in multiple dimensions during long-term home-schooling. The influencing factors of psycho-behavioral problems were analyzed by Logistic regression, and the confounding factors were corrected with graded multivariable adjustment. Results: A total of 6 906 valid questionnaires were collected including 3 592 boys and 3 314 girls, of whom 3 626 were children (6-11 years old) and 3 280 were adolescents (12-16 years old). The positive detection rate of psychosocial-behavioral problems were 13.0% (900/6 906) totally, 9.6% (344/3 592) in boys and 16.8% (556/3 314) in girls respectively, and 7.3%(142/1 946) in boys aged 6-11, 14.0%(235/1 680) in girls aged 6-11, 12.3%(202/1 646) in boys aged 12-16, 19.6%(321/1 634) in girls aged 12-16 respectively. There were significant differences between the psychological problems group and the non-psychological problems group in gender, parent-offspring conflict, number of close friends, family income change, sedentary time, homework time, screen exposure time, physical activity, dietary problems (χ²=78.851, 285.264, 52.839, 26.284, 22.778, 11.024, 10.688, 36.814, 70.982, all P<0.01). The most common symptoms in boys aged 6-11 years were compulsive activity, schizoid and depression, in girls aged 6-11 years were schizoid/compulsive activity, hyperactivity and social withdrawal, in boys aged 12-16 years were hyperactivity, compulsive activity and aggressive behavior, and in girls aged 12-16 years were schizoid, anxiety/compulsive activity and depression/withdrawal, respectively. After graded multivariable adjustment, besides the common risk factors, homework time and online study time were the risk factors of 6-11 years old groups [boys OR(95%CI): 1.750 (1.32-2.32), 1.214(1.00-1.47), girls: 1.579(1.25-1.99), 1.222(1.05-1.42), all P<0.05], videogames time were the risk factors of 12-16 years old groups [ boys: 2.237 (1.60-3.13), girls: 1.272 (1.00-1.61), all P<0.05]. Conclusions: Some children and adolescents may have psychological and behavioral problems during long-term home-schooling. The psychological and behavioral manifestations differed in age and gender subgroups, which deserve special attention in each subgroups. Schools, families and specialists should actively provide precise psychological support and comprehensive intervention strategies according to special features and risk factors.


Assuntos
COVID-19 , Adaptação Psicológica , Adolescente , Criança , China , Estudos Transversais , Feminino , Humanos , Masculino , SARS-CoV-2
7.
Zhonghua Shao Shang Za Zhi ; 37(9): 811-820, 2021 Sep 20.
Artigo em Chinês | MEDLINE | ID: mdl-34645146

RESUMO

Objective: To establish an efficient human intestinal trefoil factor (ITF) recombinant expression and purification strategy and to observe the effect of recombinant human ITF (rhITF) on intestinal mucosal injury and repair in burned rats and to explore the mechanism. Methods: The experimental research method was applied. New yeast expression vector pGAPZαA and yeast X33 were used to express recombinant ITF. The protein was purified by metal chelation affinity chromatography and anion and cation exchange chromatography. The rhITF was identified by non-reductive sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and Western-blotting. The rhITF was mixed with pepsin solution and trypsin solution in a volume ratio of 1∶1, respectively. After mixed with pepsin solution for 0.5, 1.0, 1.5, 2.0 h and trypsin solution for 1.0, 2.0, 4.0 h, the stability of rhITF was analyzed with non-reductive SDS-PAGE. One hundred and five male BALB/c mice aged 6-8 weeks were divided into sham injury group (n=30), burn alone group (n=45), and burn+rhITF group (n=30) according to the random number table. Mice in burn alone group and burn+rhITF group were inflicted with 30% total body surface area full-thickness burn on the back, while mice in sham injury group were simulated with burn. After burn, mice in burn+rhITF group were intragastrically administered with rhITF of 1 mg/kg, while mice in the other two groups were given the same amount of normal saline. At post injury hour 24, 15 mice in burn alone group were collected to prepare burn serum, which was used in the cell experiment. On post injury day (PID) 3, 5, and 7, 10 mice in each group were sacrificed to collect the small intestinal tissue. The pathological changes of the intestinal mucosa were observed by hematoxylin-eosin staining, and the activities of diamine oxidase (DAO) and lactic dehydrogenase (LDH) in the intestinal tissue were determined by spectrophotometry and enzyme linked immunosorbent assay. Three batches of human colorectal adenocarcinoma HT-29 cells were taken and divided into negative control group, 25 µg/mL rhITF group, 50 µg/mL rhITF group (n=3), normal control group, burn serum group, burn serum+rhITF group (n=3), and CK869 inhibitor group, CK666 inhibitor group, solvent control group (n=2), respectively, which were dealt with the corresponding treatment. After 12 h of culture, the migration of cells were observed by Transwell experiment. Another 2 batches of HT-29 cells were taken and each batch of cells were divided into normal control group, burn serum group, and burn serum+rhITF group (n=6). After 24 h of culture, the protein expressions of adenosine monophosphate activated protein kinase (AMPK), phosphorylated AMPK (p-AMPK), Ras related C3 botulinum toxin substrate 1 (Rac1), and actin-related protein 2/3 (Arp 2/3) complex, subunit 1B (ARPC1B) in the cells were detected by Western blotting, and the Rac1 activity of the cells was detected by activated magnetic bead pull-down test. Data were statistically analyzed with analysis of variance for factorial design, one-way analysis of variance, and Student-Newman-Keuls test. Results: Totally 82.35 mg rhITF was gathered from per litre of fermentation broth with protein purity up to 98%, and the rhITF had good antigenicity. The rhITF was stable in pepsin solution and trypsin solution, with 45% rhITF remained after 2.0 h in trypsin solution, and there was 90% rhITF remained after 4.0 h in pepsin solution. At each time point post injury, no hyperemia, or edema was observed in intestinal mucosa of mice in sham injury group, the main pathological manifestations of intestinal mucosa in mice of burn alone group were hyperemia, edema, erosion, and hemorrhage, and the main manifestations of intestinal mucosa of mice in burn+rhITF group were hyperemia and edema on PID 3 and 5, which were alleviated on PID 7. Compared with those of burn alone group, the activities of DAO and LDH in intestinal tissue of mice in sham injury group and burn+rhITF group were significantly increased on PID 3, 5, and 7 (P<0.05 or P<0.01 ). After 12 h of culture, the number of cell migration in 25 µg/mL rhITF group was 58±12, which was obviously more than 16±5 in negative control group (P<0.01) and obviously less than 123±9 in 50 µg/mL rhITF group (P<0.05). After 12 h of culture, the number of cell migration in burn serum group was 60±13, which was significantly less than 143±11 in normal control group and 138±8 in burn serum+rhITF group (P<0.05). After 12 h of culture, the number of cell migration in solvent control group was 155±9, which was significantly more than 33±5 in CK666 inhibitor group and 28±5 in CK869 inhibitor group (P<0.01). After 24 h of culture, the protein expressions of AMPK and Rac1 of cells in burn serum group were close to those of normal control group and burn serum+rhITF group (P˃0.05), the protein expression of p-AMPK of cells in burn serum group was significantly higher than that of normal control group and burn serum+rhITF group, respectively (P<0.05 or P<0.01), and the protein expression of ARPC1B of cells in burn serum group was significantly lower than that of normal control group and burn serum+rhITF group (P<0.05). After 24 h of culture, the Rac1 activity of cells in burn serum group was significantly lower than that in normal control group and burn serum+rhITF group, respectively (P<0.05 or P<0.01). Conclusions: The rhITF obtained in this study has high purity and super stability, which can resist extreme pH and hydrolysis of protease and can relieve intestinal mucosal damage in burned mice. The rhITF can promote the migration of intestinal epithelial cells and accelerate the repair of intestinal mucosa through inhibiting phosphorylation of AMPK to maintain Rac1-Arp2/3 activity.


Assuntos
Queimaduras , Animais , Humanos , Mucosa Intestinal , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Ratos , Ratos Sprague-Dawley , Fator Trefoil-3
8.
Int J Radiat Oncol Biol Phys ; 111(3S): e237, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34700985

RESUMO

PURPOSE/OBJECTIVE(S): The infiltration of CD4+CD25+Foxp3+ regulatory T cells (Treg) in the tumor microenvironment is one of the main reasons for radiation resistance and tumor recurrence after radiotherapy. It has been established that Treg is more resistant to radiation than other T cells, but the proliferation of immune cells after radiotherapy is affected by other factors, including tumor cells. Treg frequency in the tumor microenvironment after radiotherapy has not been defined. We studied the effect and mechanism of increased Treg frequency induced by irradiated ESCC cell, TE-1. MATERIALS/METHODS: After 2 Gy irradiation, TE-1 cells were co-cultured with normal peripheral blood lymphocytes for 48 hours. Flow cytometry was used to detect Treg/CD4+T cell frequency. The mRNA expression of TGF-ß1 and TGF-ß2 in TE-1 was detected by qPCR, and the protein content of TGF-ß1 and TGF-ß2 in the medium was detected by ELISA. RESULTS: Compared with non-irradiation group, the expression of TGF-ß1 and TGF-ß2 in TE-1 cells of irradiation group increased, and the protein content of TGF-ß1 and TGF-ß2 in culture medium increased, the difference was statistically significant (P < 0.001). Flow cytometry showed that CD4+CD25+/CD4+Tcell and CD4+CD25+Foxp3+/CD4+Tcell were increased in the radiotherapy group after co-culture, and the difference was statistically significant (P < 0.001). CONCLUSION: The expression of TGF-ß1 and TGF-ß2 in esophageal squamous cell carcinoma cells increased after irradiation, and the frequency of Treg induced by co-culture increased, suggesting that esophageal squamous cell carcinoma cells after radiotherapy can induce the increase of Treg cells, which may be achieved mainly through the mechanism of increasing the secretion of TGF-ß1 and TGF-ß2.

9.
Int J Radiat Oncol Biol Phys ; 111(3S): e514, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34701634

RESUMO

PURPOSE/OBJECTIVE(S): A novel O-ring Linac (ORL) offers a fully enclosed gantry with a single energy (6 MV) flattening filter-free photon beam, improved kV CBCT, a maximum treatment length of 36 cm (dual-isocenter setup), and a translation-only 3DOF couch for IGRT. The purpose of this study was to evaluate the viability of this ORL for use in a single-room clinic setting and to assess implementation challenges. MATERIALS/METHODS: Treatment statistics of the single-energy ORL over a 1-year period from our main campus (5-linac lineup) were used to develop a ORL machine utilization model; 2 years of treatment statistics from 3 single-room locations with multi-energy C-arm Linac were analyzed to generate a population-based disease distribution model for a typical single-room center. A percentage frequency distribution of key anatomical sites is summarized in Table 1. The ORL utilization model was then extended to the network disease distribution model to assess the percentage of patients in network that can be treated using the ORL. RESULTS: Table 1 shows the 9 anatomical sites accounting for ∼96% of network cases, all of which have corresponding active treatment protocols using the ORL at our main campus. Some 2D/3D treatments required modifications to planning workflow based on technical limitations of the ORL. Less than 1% of treatments at network locations required field sizes exceeding 36 cm, which is the ORL's limit. Electron treatments constitute ∼10% of network cases, of which 74% were for breast boost treatments. Considering 80% of breast boost treatments at our main campus were delivered on ORLs, over half of network electron cases can be safely treated on an ORL with photons. kV-CBCT is required for all ORL daily treatments. Despite the lack of 6DOF couch, ∼80% of ORL treatment fractions did not require manual repositioning for rotational corrections. Averaged appointment durations were reduced from 20 min on C-Arm Linac to 14 min on ORL. CONCLUSION: Our model indicated that approximately 95% of the patient population at a single-Linac clinic can be treated using the ORL photon-only system. Streamlined IGRT workflow improved the ORL's overall efficiency compared to C-Arm Linac. Although some modifications to planning workflows are required, the ORL improves overall efficiency and is in general suitable for a single-room clinic.

10.
Int J Radiat Oncol Biol Phys ; 111(3S): e520-e521, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34701650

RESUMO

PURPOSE/OBJECTIVE(S): This study investigates the feasibility of using a commercially available handheld device with augmented reality (AR) cameras, enhanced by light detection and ranging (LiDAR), for pre-treatment collision detection and patient positioning. The on-device LiDAR scanner detects object depths with direct time-of-flight (ToF) measurements, thus improving the accuracy of contrast-based visual depth estimation. Our proposed approach leverages AR for near-real-time reconstruction of patient external contour during simulation and setup. This is advantageous compared with conventional laser-tattoo alignment and photo-based patient position, by providing an intuitive 3D rendering of the patient's body and immobilization devices at arbitrary angles. MATERIALS/METHODS: Two possible modes for AR-assisted positioning were investigated: mesh and point-cloud mode. In mesh mode, surface mesh of a mock pediatric phantom (50 × 40 × 15 cm3) was rapidly reconstructed via the default meshing algorithm from the software development kit (SDK). Resulting 3D contours were manually registered to a computerized tomography (CT) scan of the phantom in a third-party open source image processing suite. For point cloud mode, surface anchor points of the phantom and its supporting devices were detected and placed in the real-world frame of reference, which were subsequently overlaid on the real-time color image. Each handheld scanning session was kept at 30 seconds. The native pulse intervals of 0.2 - 0.5 nsec of the LiDAR scanner were used; depth map was updated at 60 frames per second (fps). Scanning method was kept consistent and mimicked CT scans, with the device camera rotated about the superior-inferior axis pointing towards the phantom. The resolution of the resulting surface mesh and point cloud was quantified. Extent of the volume reconstructed was estimated. RESULTS: The scan and on-device real-time reconstruction were completed within 30 seconds. We successfully extracted the reconstructed mesh and registered that to a CT scan of the phantom. A mean distance of 1.5 ± 1.0 cm between each adjacent vertex was achieved. The point cloud density was on an average 20.9 ± 0.9 points/cm2, with decreased point density 35cm superior to the phantom midpoint (10.0 points/cm2). Both modes captured approximately 4 × 4 × 4m3 volume of the phantom and its supporting structures. CONCLUSION: AR has emerged as a promising modality for surface guided patient positioning, yet several previous studies have found a lack of sufficient mesh resolution and/or accuracy. LiDAR improves both aspects with directly measured depth information. We demonstrated that sub-cm full 3D rendering of the patient body contour and supporting device is achievable with a handheld device in under 30 seconds, which could provide a viable option for improved guidance on collision check and patient positioning.

11.
Int J Radiat Oncol Biol Phys ; 111(3S): e534, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34701685

RESUMO

PURPOSE/OBJECTIVE(S): To investigate the applicability of surface imaging for image guidance in the hypofractionated radiotherapy for intracranial metastasis with open face mask immobilization. MATERIALS/METHODS: Nineteen patients were treated with hypofractionated radiotherapy for intracranial metastasis were included. Before the start of treatment, each patient underwent simulation with open face mask immobilization. During treatment, CBCT images were collected for verification each time. Marking based positioning was used for the first fraction and new reference surface images were captured after first CBCT registration (6D of freedom,6DoF) for subsequent treatment. Subsequent treatment was randomly divided into marking guided positioning fraction group (MFG) and surface guided positioning fraction group (SFG). In the SFG, the patient was aligned manually by the therapist until the rotation tolerance was within 1°. The residual translation and rotation errors were corrected using the "Move Couch" function of the optical surface system Align RT (Vision RT, London, UK). The six-dimensional error data of patients with the two positioning methods were compared and expressed as mean ± standard deviation. Meanwhile, the correlation and consistency between the optical surface error data and the gold standard CBCT error data were compared during the MFG. A scientific 2D graphing and statistics software was used for data processing and mapping, and a statistical software was used for mean analysis and normality test. Pearson correlation analysis was used to analyze the correlation, and Bland-Altman plot analysis was used to test the coincidence between the two methods. RESULTS: Total of 103 MFG CBCT images and 87 SFG CBCT images were analyzed. Compared with the marking guided positioning, the 3D magnitude error of the optical surface guided positioning was reduced from 0.35 ± 0.16 cm to 0.14 ± 0.07 cm and the rotation error was reduced from 0.06° ± 1.36°, 0.62° ± 1.18°, 0.21° ± 1.19° to -0.04° ± 0.68°, -0.03° ± 0.73°, 0.04° ± 0.69° on Pitch, Roll and Rotation. The Pearson coefficient R2 was 0.91,0.70,0.78 on Lateral, Longitudinal and Vertical directions, R2 was 0.75,0.85,0.77 on Pitch, Roll and Rtn directions, respectively (all P < 0.01). It showed high correlation between two methods. The 95% agreement limits of agreement were within preset 3 mm tolerance (lateral [-0.19-0.19cm], longitudinal [-0.25cm,0.25cm], vertical[-0.27cm,0.19cm]), and the 95% agreement limits of agreement were within preset 3 ° tolerance (Pitch [-1.76°,1.76°], Roll [-1.54°, 1.60°], Rotation [-2.18°,1.69°]) for two methods. CONCLUSION: The optical surface error and cone-beam CT error have good correlation and coincidence. The optical surface guided positioning can reduce the setup errors and the results support the application of 3D surface imaging for image guidance in the hypofractionated radiotherapy for intracranial metastasis with open face mask immobilization.

12.
Int J Radiat Oncol Biol Phys ; 111(3S): e536, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34701691

RESUMO

PURPOSE/OBJECTIVE(S): Beam gating with deep inspiration breath hold (DIBH) has been widely used for motion management in radiotherapy. It commonly relies on some external surrogate for internal target motion, while the exact internal motion is unknown. In this study, we tracked internal targets and characterized the residual motion during DIBH treatment for pancreatic cancer patients guided by a surface imaging system. We also report the treatment time statistics. MATERIALS/METHODS: Eight consecutive patients with pancreatic cancer treated with surface-guided DIBH volumetrically-modulated arc therapy in 2019-2020 were selected for this study, each with some radiopaque markers (fiducial markers or surgical clips) implanted near or inside the target. Five patients were treated in 25 fractions, two were treated in 15 fractions, and one was treated in 10 fractions. The surface imaging system monitored a three-dimensional surface with gating thresholds of 3 mm translation and 3° rotation. During dose delivery, kV images were automatically taken every 20˚ or 40˚ gantry rotation, from which internal markers were identified. The marker displacement from their initial positions and the residual motion amplitudes were calculated. For the analysis of treatment efficiency, the treatment time of every session was obtained from imaging and treatment timestamps recorded at the treatment console. RESULTS: Even though the external surface was limited to 3 mm / 3°, significant residual internal target motion was observed for some patients. The residual motion ranged 3-21 mm. The average target displacement relative to the initial position was 0-3 mm for the cohort. The magnitude of instantaneous displacement was > 5 mm in 13% of the images analyzed. The average treatment time was 16 min with standard deviation 3 min. CONCLUSION: Internal target motion may differ significantly from external surrogate motion in DIBH treatment, even with surface image guidance. Radiographic verification of target position at the beginning and during each fraction is essential for accurate delivery of radiotherapy.

14.
Zhonghua Yu Fang Yi Xue Za Zhi ; 55(10): 1232-1239, 2021 Oct 06.
Artigo em Chinês | MEDLINE | ID: mdl-34706510

RESUMO

To investigate Streptococcus suis (S.suis) isolated from patients in Shandong province using genomic epidemiology and pathogenologic analysis. To provide the foundation to establish reasonable and accurate prevention and control measures of human S. suis infection. Molecular typing, whole genome phylogenetic tree, virulence gene typing, antibiotic resistance profile and mobile genetic elements carrying antibiotic resistance genes of isolated S. suis strains were investigated. The pathogenicity of isolated strains was also evaluated by comparing their capacity to induce pro-inflammatory cytokine production in vitro. S. suis infections in Shandong province were predominantly due to serotype 2 and sequence type 1 strains. The major symptoms were meningitis. The studied strains could be divided into five lineages. All strains belong to highly pathogenic type in Shandong province,Strains from lineage 2 possessed higher capacity to stimulate pro-inflammatory cytokine production than other strains did, even though other strains belong to highly pathogenic strains. In addition, multiple antibiotic resistance genes and corresponding mobile genetic elements werewidespread in S. suis strains from Shandong province, except strains from lineage 3. High diversities in genome, evolutionary path and pathogenicity of S. suis strains from Shandong province were revealed. It was necessary to surveillant the S. suis strain in genomic level.


Assuntos
Infecções Estreptocócicas , Streptococcus suis , Genômica , Humanos , Filogenia , Infecções Estreptocócicas/epidemiologia , Streptococcus suis/genética , Virulência/genética
15.
Artigo em Inglês | MEDLINE | ID: mdl-34489157

RESUMO

Head and neck squamous cell carcinoma (HNSCC) is one of the most common malignancies and has a low 5-year survival rate. Mounting evidence suggests that oral potentially malignant disorders, such as oral leukoplakia (OLK), may progress to HNSCC. Given that OLK and HNSCC are often insidious and asymptomatic, the identification of markers of OLK malignant transformation and therapeutic targets in HNSCC is critical. Using various online tools and publicly available gene expression datasets, the secreted phosphoprotein 1 gene (SPP1) was identified as a significant differentially expressed gene among OLK, HNSCC, and non-cancerous tissues. SPP1 mRNA levels were elevated in HNSCC tissues and were associated with cancer stage, tumor grade, and human papillomavirus infection status. High SPP1 mRNA levels were correlated with poor overall survival of HNSCC patients. In contrast, SPP1 mutations were not significantly associated with overall survival, although their frequency in HNSCC was very low (0.6%). Furthermore, SPP1 expression levels in HNSCC were positively correlated with the infiltration of CD4+ cells, macrophages, neutrophils, and dendritic cells. The study results suggest that SPP1 may represent a diagnostic and prognostic biomarker, as well as a potential therapeutic target in HNSCC.

16.
Zhonghua Yi Xue Za Zhi ; 101(35): 2787-2791, 2021 Sep 21.
Artigo em Chinês | MEDLINE | ID: mdl-34551495

RESUMO

Objective: To evaluate the efficacy of two-lung ventilation with different tidal volume assisted by CO2 pneumothorax for airway management in patients undergoing radical esophagectomy using combined thoracoscopic and laparoscopic approach. Methods: One hundred and eighty patients undergoing radical esophagectomy using combined thoracoscopy and laparoscopy under general anesthesia from the Affiliated Cancer Hospital of Zhengzhou University between February and September 2019 were randomly divided into three groups (group V1, V2, V3, n=60) according to the tidal volume (TV) used. The TVs of group V1-V3 were 4, 5, 7 ml/kg during thoracoscopic surgery, respectively. All the patients were intubated with a single-lumen endotracheal tube and underwent two-lung ventilation assisted by continuous positive pressure CO2 pneumothorax in group V1, V2 and V3, with the CO2 pressure of 10 mmHg (1 mmHg=0.133 kPa) and the frequency of 20 times/min. Mean arterial pressure (MAP) and heart rate (HR) were recorded before thoracoscopic surgery (T1), 30 minutes after thoracoscopic surgery (T2), at the end of thoracoscopic surgery (T3), after thoracoscopic surgery and 30 minutes after two-lung intermittent positive pressure ventilation, respectively. The results of arterial blood gas were collected at T1, T2, T3 and T4. Recovery time from anesthesia, consciousness recovery time, and lung collapse condition were recorded. Results: At T2, the value of MAP in group V1 was (81±10) mmHg, which was higher than those of group V2 [(69±7) mmHg] and group V3 [(71±8) mmHg], with a statistically significant difference (F=9.270, P<0.05). Meanwhile, at T2, the value of HR in group V1 was (83±7) times/min, which was higher than those of group V2 [(68±6) times/min] and group V3 [(71±7) times/min], and there was a statistically significant difference (F=23.460, P<0.05). However, at T2, the values of arterial partial pressure of oxygen (PaO2) in three groups were (262±16), (249±16) and (241±20) mmHg, respectively, with no statistically significant difference (F=1.929, P>0.05). At T3, the value of arterial partial pressure of carbon dioxide (PaCO2) in group V3 was (46±5) mmHg, which was lower than those of group V1 [(63±9) mmHg] and V2 [(62±10) mmHg], with a statistically significant difference (F=20.890, P<0.05). Moreover, at T3, the value of pH in group V3 was (7.35±0.04), which was higher than those of group V1 (7.28±0.04) and V2 (7.32±0.04), and there was a statistically significant difference (F=9.309, P<0.05). Additionally, the satisfaction rates of lung collapse in group V3 was 57.1%, which was lower than those of group V1 (94.7%) and group V2 (96.3%), with a statistically significant difference (χ²=7.601, P<0.05). There was no statistical significance in the time of awakening and consciousness recovery among three groups (F=1.020 and 1.110, both P>0.05). Conclusion: The two-lung ventilation with 5 ml/kg tidal volume assisted by CO2 pneumothorax has advantages in terms of hemodynamics and surgical field exposure, and is more suitable as the appropriate dose for respiratory management in patients undergoing radical resection of esophageal cancer using combined thoracoscopic and laparoscopic approach.


Assuntos
Neoplasias Esofágicas , Laparoscopia , Pneumotórax , Dióxido de Carbono , Neoplasias Esofágicas/cirurgia , Humanos , Pulmão , Respiração Artificial , Volume de Ventilação Pulmonar
17.
Obes Res Clin Pract ; 2021 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-34561173

RESUMO

OBJECTIVE: To compare the extent to which visceral adiposity, as measured by mesenteric fat thickness, contribute to cardiometabolic risk, especially insulin resistance, in women with PCOS and healthy control. METHODS: This is a cross-sectional study with a total of 190 women with PCOS fulfilling the Rotterdam diagnostic criteria. Women without PCOS were recruited from a previous study, which comprised 416 healthy women controls with normal glucose tolerance. All subjects underwent OGTT, biochemical assessment, and sonographic assessment with measurements of mesenteric, preperitoneal and subcutaneous fat thickness. RESULTS: Mesenteric fat thickness was strongly correlated to cardiometabolic traits including blood pressure, fasting and 2-h glucose, triglycerides, HOMA-IR; and was negatively correlated to HDL-C in both cohorts (all p < 0.01). In PCOS, positive correlation was observed between mesenteric fat thickness and free androgen index (p < 0.01). Compared with controls, the regression line between mesenteric fat and HOMA-IR is much steeper in PCOS (p < 0.01). CONCLUSION: Women with PCOS remain more insulin resistant compared to controls at any given degree of visceral adiposity.

19.
Zhonghua Gan Zang Bing Za Zhi ; 29(8): 754-758, 2021 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-34517456

RESUMO

Objective: To evaluate the short- and medium-term clinical efficacy of TIPS approach combined with AngioJet thrombus aspiration technology treatment in acute portal vein thrombosis. Methods: 63 cases with acute portal vein thrombosis treated in our center from May 2017 to July 2019 were studied retrospectively, including 49 males and 14 females, aged 35-61 (46 ± 5) years. TIPS approach (with/without) combined with Angiojet thrombus aspiration and gastroesophageal varices embolization was performed simultaneously according to the patient's condition. Regular follow-up for 3-33 (22 ± 3) months after surgery was used to observe the curative effect. Results: The technical success rate was 100%. Portal vein and superior mesenteric vein blood flow were returned to normal after the operation. Two cases of biliary tract injury were untreated. Simultaneously, two cases of intrahepatic arteriovenous fistula were treated with superselective arterial embolization. During the follow-up period, 47 cases (74.61%) had complete portal vein recanalization, 13 cases (20.63%) had partial recanalization, 3 cases (4.76%) had complete portal cavernoma, 7 cases (11.11%) had symptomatic hepatic encephalopathy, 1 case had received artificial liver treatment (1.59%), 1 case had peptic ulcer (11.11%), 6 cases (9.52%) had lost to follow-up, and there was no portal hypertension-related bleeding or death. Conclusion: TIPS approach combined with AngioJet thrombus aspiration technology is safe, effective and feasible in the treatment of acute portal vein thrombosis, and the short- and medium-term clinical effects are satisfactory.


Assuntos
Derivação Portossistêmica Transjugular Intra-Hepática , Trombose , Feminino , Humanos , Masculino , Veia Porta/cirurgia , Estudos Retrospectivos , Tecnologia , Resultado do Tratamento
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