Objective To compare the safety and efficacy of direct and remedial rotational atherectomy in the treatment of heavily calcified coronary artery lesions.Methods We retrospectively reviewed 58 patients admitted in the Shanghai Chest Hospital and Liaocheng People Hospital from May 2012 to July 2015 who had received stent implantation and rotational atherectomy.The 58 patients were divided into two groups which were the direct atherectomy group (n =27) and the remedial atherectomy group (n =31).General clinical date,lesion and procedural characteristics,intraoperative complications,in-hospital and follow-up MACCE were compared between the two groups.Results There were no differences between the two groups in general clinical date intraoperative complications,amount of contrast agent used,proceduraltime,rates of in-hospital and follow-up MACCE.Nevertheless,compared with the direct artherectomy group,the remedial group had more number of balloon dilations during procedure [3 (1,5) vs.2 (1,2),P ＜ 0.001] and higher peak cardiac troponin levels [1.1 (0.3,3.0) μg/L vs.0.5 (0.1,2.3) μg/L,P =0.032].Conclusions Remedial rotational atherectomy with drug-eluting stent had the same safety and efficacy as direct atheretomy with drug-eluting stent in treating patients with heavily calcified coronary lesions.It is reasonable and safe to transform routine PCI to remedial rotational atherectomy when the 2.0 mm semi compliant balloon or/and 2.5 mm non-compliant balloon cannot pass through or dilate the lesions.

Objective:To compare the dosimetric differences between the VenusX accelerator with an orthogonal dual-layer multi-leaf collimator (MLC) and the Varian′s CLINAC IX and EDGE accelerators with a single-layer MLC for hippocampus protection in the whole-brain radiotherapy (WBRT).Methods:Forty patients with multiple brain metastases admitted to the Radiotherapy Department of the Shanghai General Hospital from June 2021 to February 2023 were selected in this study. Three whole-brain treatment plans were designed based on the above three accelerators for each patient. Under the same prescription dose, radiation field, and plan constraints, the three plans were compared in terms of the dosimetric differences in target volumes, hippocampi, and adjacent organs at risk (OARs), as well as the execution efficiency.Results:For the planning target volume (PTV), there were statistically significant differences in approximate maximum dose ( D2) between the VenusX and IX plans ( t = 4.94, P < 0.05), in approximate minimum dose ( D98) between the VenusX and EDGE plans ( t = 5.98, P < 0.05), in the target conformity indices (CIs) between VenusX plan and EDGE plans, and between the VenusX and IX plans ( t = -6.84, -14.30; P < 0.05), and dose homogeneity indices (HIs) between the VenusX and IX plans ( t = 3.48, P < 0.05). For OARs, the maximum doses ( Dmax) and average doses ( Dmean) to bilateral hippocampi of the VenusX plan were lower than those of the EDGE and IX plans ( t = 8.59-17.11, P < 0.05); the maximum doses ( Dmax) to bilateral lenses, bilateral optic nerves, and optic chiasma of the VenusX plan were lower than those of the other two plans ( t = 2.10-20.80, P < 0.05); and the differences between the maximum doses ( Dmax) to the brain stem of the VenusX and EDGE plans were statistically significant ( t = 3.86, P < 0.05). In terms of plan execution efficiency, the number of machine jumps (MU) and the treatment time of the VenusX plan were higher than those of the EDGE and IX plans, with statistically significant differences ( t = -56.48, -56.90, P < 0.05). Conclusions:The doses to target volumes of the three treatment plans all meet the prescription requirements, and the VenusX plan outperforms the EDGE and IX plans in the protection of OARs. Despite the reduced execution efficiency, the VenusX plan shortens the actual treatment time by improving the dosage rate, thus meeting the clinical requirements.

Objective To compare the effects of different respiratory signal acquisition methods on the delineation of moving tumor targets. Methods A cube phantom containing a sphere was placed on a motion platform to simulate respiratory movement by setting motion period, frequency, and direction. Respiratory signal was acquired by real-time position management (RPM) method and GE method independently. Target delineation was conducted using the maximum intensity projection (MIP) sequence. The difference between the reconstructed volume and the theoretical moving volume was compared under the two respiratory signal acquisition methods for cube and sphere targets. Results Under the same respiratory signal acquisition method, the same respiratory amplitude, and different respiratory frequencies, reconstructed volume changes were relatively small. For the sphere target, the deviation between the reconstructed volume and the theoretical moving volume was −1.5% to 5.7% with the RPM method and −1.3% to −13.8% with the GE method (both P < 0.05). For the cube target, the deviation between the reconstructed volume and the theoretical moving volume was 0.2% to 0.9% with the RPM method and −2.6% to 0.9% with the GE method, with no statistical significance. Conclusion For small-volume sphere targets, the target volumes obtained from MIP images by the two respiratory signal acquisition methods are both smaller than the actual moving volume. For large-volume cube targets, there is no significant difference between the reconstructed and theoretical results with any respiratory signal acquisition method. The RPM method produces smaller deviation and better image quality when reconstructing small-volume targets.

Objective To explore the cognitive level of patients with breast cancer who were undergoing adjuvant endocrine therapy and their needs for related knowledge, so as to provide powerful references for making effectively compliance interventions. Methods An in-depth interview was conducted on 12 breast cancer patients who were undergoing adjuvant endocrine therapy. Data were analyzed by Colaizzi analysis procedure. Results The views on adjuvant endocrine therapy were very disagree and the main needs were: the related knowledge of adjuvant endocrine therapy, side effects of adjuvant endocrine therapy and its cope measures, the needs about healthy lifestyle during taking medicine, the needs of communicating with doctors and nurses, the regulation methods on alleviating psychological stress and releasing worries of the drug costs. Conclusion More efforts should made to strengthen the health education on adjuvant endocrine therapy and create effectively follow-up system, strengthen multi-discipline cooperation and doctor-patient communication, also we need deeply recognize the cognitive level about endocrine therapy of the patients and meet their psychological needs, aim directly interventions to relieve or eliminate their concerns, thus reinforce their believes of drug administration and promote the adherence of adjuvant endocrine therapy.