10.3969/j.issn.2095-4344.2013.23.023

Thyroid carcinoma is the most common malignant tumor in the endocrine diseases,with a rising morbidity.As more investigations were made,thyroid stimulating hormone receptor is showed up,and it is believed some contacts are existed between thyroid stimulating hormone receptor and thyroid carcinoma.We believe that making sure of these contacts can help patients in diagnosis,treatment,and prognosis.

BACKGROUND:Hemostatic dressing can directly contact with the body tissues on the wound surface. The biocompatibility is one of the important indicators of evaluating the advantages and disadvantages of dressing. The hemostatic dressing prepared with calcium alginate as raw material has become a research focus owing to its low cost and good compatibility. OBJECTIVE:To observe the cytotoxicity of calcium alginate hemostatic dressings and to compare the cytotoxicity between calcium alginate hemostatic dressing and gelatin hemostatic sponge, absorbing cotton, ordinary gauze. METHEDS:Leaching solution method: the DMEM high glucose culture solution was taken as the leaching medium. The calcium alginate hemostatic dressing, gelatin hemostatic sponge, absorbing cotton and ordinary gauze leaching solution were respectively prepared. Five concentration gradients of 100%, 75%, 50%, 25%, 50% were set. The fibroblast cels of L-929 mouse were cultured for 24 hours with the above material leaching solution. The volume fraction of 10% DMEM high glucose culture medium was taken as control group, and DMEM high glucose culture medium containing 5% DMSO was taken as positive control group to observe the cel proliferation and morphological changes. Direct contact method: The fibroblast cels of L-929 mouse were respectively seeded in calcium alginate hemostatic dressing, gelatin hemostatic sponge, absorbing cotton and ordinary gauze and cultured for 24 hours. The changes in cel morphology were observed.
RESULTS AND CONCLUSION: Leaching solution method: The cytotoxicity of alginate fiber hemostatic dressing, gauze, absorbing cotton leaching solution with different concentration gradients was grade 1, which was in line with GB/T16886/ ISO10993 biological evaluation standard of medical apparatus and instruments. The cytotoxicity of 100%, 75% gelatin hemostatic sponge extract solution was grade 3, causing severe inhibition of cel proliferation. Direct contact method: The cytotoxicity of gauze and alginate fiber hemostatic dressing was grade 1, absorbing cotton was grade 2, gelatin hemostatic sponge was grade 3. These results demonstrate that calcium alginate hemostatic dressing has no cytotoxicity.

The ergonomics of equipment is important,it is essential to make the ergonomic evaluation in the stage of design. The operation of expanded shelter is a typical form of combination of human labor and machine. The fuzzy comprehensive evaluation model is founded. The high-level factor set include the states of operation, the ratio of every state time to the total time is the corresponding weight for the elements in high-level factor set, the lower-level factor set include the elements which influence the states of operation. For the elements in lower-level factor set, the corresponding weight is given by the experts.

Objective To investigate the methods and effects of posterior fixation and fusion in treatment of complete thoracolumbar fracture and dislocation.Methods The study enrolled 8 cases of complete thoracolumbar fracture and dislocation treated by posterior fixation and fusion with pedicle screwrod system between January 2006 and December 2012.There were 7 males and 1 female,at mean age of 31.9 years (range,19-49 years).Mean time interval between injury and surgery was 8.1 days (range,4-12 days).Fracture-dislocation classification was AO type C,Denis three-column injury,and Meyerding grade V.According to American Spinal Injury Association (ASIA),there 5 cases at grades A,1 at grade B,1 at grade C 1 at grade E.Fracture-dislocation segments included T5-T6 in 1 case,T12-L1 in 3,L1-L2 in 2,L3-L4 in 1 and L4-L5 in 1.Results Mean duration of surgery was 220.6 minutes (range,135-335 minutes) and mean intraoperative blood loss was 1 150 ml (range,500-2 400 ml).Seven cases sustained dural laceration during the operation,which were sutured or covered with autologous fat grafts,but 3 of them were subjected to cerebrospinal fluid leakage and healed after conservative therapy.Anatomic reduction was achieved in 6 cases,partial reduction in 1 and non-reduction in 1.Mean Cobb angle improved from 29.3 ° (range,8 °-51 °) preoperatively to 1.9 ° (range,-5°-10 °) postoperatively.After a mean follow-up of 39.3 months (range,2-76 months),2 cases were recovered from preoperative ASIA grade A and B to C respectively and 6 cases (4 A,1 C,1 E) revealed no significant improvement.There was no implant loosening or breakage.One case was died of lung-related complications at postoperative 4 years.One case sustained lumbar deep infection at postoperative 3 weeks and managed by debridement,irrigation,drainage and implant retention.Conclusion Posterior fixation and fusion is the general treatment principle for complete thoracolumbar fracture and dislocation,but the degree of reduction depends on severity of the injured spinal cord.

Objective To investigate the prevalence rate and the related risk factors of posttraumatic stress disorder ( PTSD) in the rescue paratroopers 1.5 year after Wenchuan earthquake. Methods A total of 183 rescue paratroopers who participated in disaster rescue after Wenchuan earthquake were investigated with the questionnaires composed by General state of health questionnaire, PTSD Checklist-Civilian Version ( PCL-C), Symptom Checklist-90 ( SCL-90), Self-Rating Depression Scale ( SDS) and Eysenck Personality Questionnaire (EPQ). Results Six rescue paratroopers had total PCL-C score ≥ 38 points, with the prevalence rate of PTSD for 3.28%. Total PCL-C score was positively correlated with total SCL-90 score, N score of EPQ and total SDS score (P ＜ 0. 01), but negatively correlated with E score of EPQ. Total PCL-C score showed statistical difference between injury group and uninjury group, family loss group and family integrity group, contacting corpses group and none contacting corpses group (P＜0.05 or ＜0.01). Regression analysis showed the length of military service, nervousness, family loss by earthquake, suffering injuries or contacting corpses during relief operations were the risk factors for PTSD. Conclusion The prevalence rate of PTSD in the rescue paratroopers is higher than that in normal troops (0.49% ) 1.5 year after Wenchuan earthquake, indicating that further attention should be paid to the rescue paratroopers in later period after earthquake.

Objective To study the novel methods of VMAT planning based dose volume histogram ( DVH) optimization, evaluated the dosimetry and planning efficiency in VMAT planning for Esophageal Carcinoma. Methods Twelve Esophageal carcinoma patients were enrolled in this study. The conventional VMAT planning as the reference, using multi?criterion optimization DVH ( MCO?DVH ) and overlapping volume histogram prediction DVH ( OVH?DVH ) two different methods to get ideal objectives function for informing VMAT plans, Then evaluate the dosimetric, planning efficiency for all new VMAT plans. The difference between the paired t?test groups. Results The two VMAT plans based DVH objective function can meet the clinical needs. Compared with the conventional VMAT plan, Conformity index ( CI ) and Homogeneity index ( 0. 77 vs. 0. 72, P=0. 017 and 0. 10 vs. 0. 12, P=0. 047 ) is better in DVH informed plans;lung V5 and spinal cord V50 are better in MCO?DVH informed plan (54. 66 vs.60. 23,P=0. 013 and 0. 98 vs.0. 49,P=0. 037).Furthermore,the DVH informed plans had higher planning efficiency (8. 2 vs. 19. 5,P=0. 023) . Conclusions DVH Objective informed VMAT Planning can achieve clinical needs with much uniform dose to target,lower OAR dose and higher planning efficiency.

BACKGROUND:In recent years, calcium alginate dressing has been widely used in surgical hemostasis, traumatic hemostasis, postoperative nasal hemostasis and puncture site hemostasis,etc.; however, there are few reports on their hemostatic mechanisms. OBJECTIVE: To preliminarily study the hemostatic mechanism of calcium alginate dressing. METHODS: Human anticoagulant blood was respectively dropped on sodium alginate dressing, nasopore dressing and medical cotton gauze. After 2 minutes, the interaction between materials and blood was observed at the room temperature using scanning electron microscopy. Calcium alginate dressing, nasopore dressing and medical cotton gauze were added in human red blood cel suspensions respectively. After 15 minutes, the interaction between materials and red blood cels was observed using scanning electron microscopy. The red blood cels were suspended by different concentrations (10, 5, 2.5 g/L) of alginate dressing extracts. The erythrocyte sedimentation rate was observed at different time points (30, 60, 120 minutes). Platelets rich plasma was incubated with different concentrations (10, 5, 2.5 g/L) of alginate dressing extract at 37℃, then CD62P positive platelet percentage was measured by flow cytometry after 10 minutes of incubation. RESULTS AND CONCLUSION: Dense fibrin network was formed after calcium alginate dressing contacting with an anticoagulant. A large number of blood cels were recruited. There were only a smal amount of red blood cels and platelets adhesion in the nasopore dressing and medical cotton gauze groups. After the calcium alginate dressing interacting with red blood cels, red blood cel deformability was visible, with a pseudopodia-like change. The red blood cel morphology was unchanged in the nasopore dressing and medical cotton gauze groups. The calcium alginate dressing extract dose-dependently and time-dependently increased the red blood cels aggregation, comparative differences between groups was statisticaly significant(P < 0.01). The calcium alginate dressing extract dose-dependently enhanced the CD62P positive platelet percentage, comparative differences between groups was statisticaly significant (P< 0.01). These results demonstrate that calcium alginate dressing promotes hemostasis and coagulation process by releasing of calcium ions, causing red blood cel aggregation and deformation and activating platelets.

Objective To compare the errors of double-center and single-center setup, and to study the role of both on reducing the rotational setup errors for the patients with esophageal carcinoma depend on rigid registration errors between online kV-cone-beam computed tomography (kV-CBCT) images and plans for CT images. Methods 20 patients with middle esophageal carcinoma received image scanning before treatment every week by using double-center setup and CBCT, and single-center setup images of 20 patients were taken from the X volume image (XVI) system. Then the images of both setup types, registration errors of CT image and rotational setup errors were compared respectively. Every patient received kV-CBCT scanning analysis before treatment every week, and 6 times in total. 240 group of kV-CBCT images from all of the patients were off-line matched with plans for CT images to calculate the errors of X-axis, Y-axis, Z-axis. Then the data of linear errors and rotational setup errors from patients were collected, aiming at putting the error data into the patients treatment program and analyzing the significances. Results The standard registration of double-center setup was as follows: T (X) (0.28 ±0.19) cm, T (Y) (0.27 ±0.19) cm, T (Z) (0.33 ±0.12) cm, R (X) (0.40 ±0.19)° , R (Y) (0.30 ±0.18)° , R (Z) (0.30 ±0.19)° . The standard registration of single-center setup was as follows:T(X) (0.32±0.20) cm, T(Y) (0.29±0.25)cm, T(Z) (0.31±0.16) cm, R(X) (2.2±0.68)°, R(Y) (0.5±0.32)°, R(Z) (2.10±0.60)°. There were statistical differences between linear errors in T(X) and rotational setup errors in R(X), R(Y) or R(Z) (P< 0.05). Conclusion Double-center position can reduce the rotational setup errors, especially in X-axis, Y-axis errors, and may provide more help for the radiation oncology departments without on-board CBCT.

Objective To compare the size of target volume,amplitudes of movements in different directions,movement vector,dose to the diseased lung,whole lung volume,and setup error between free breathing fixation (method A) and four-dimensional computed tomography (4DCT)-guided abdominal balloon compression fixation (method B),and to demonstrate that the 4DCT-guided abdominal balloon compression fixation is effective in the treatment of non-small cell lung cancer (NSCLC).Methods A retrospective analysis was performed among 80 patients with NSCLC in our hospital.In those patients,40 received method A and 40 method B.The GTVfree and GTVpress were delineated on the maximum intensity projection (MIP) images of 10 respiratory phases using method A and method B,respectively.The PTVfree and PTVPress were obtained by expansion of the GTVfree and GTVpress,respectively.The paired t test was used to analyze the differences in the PTV,maximum amplitudes of movements in three dimensions,absolute value of the movement vector (|V|),and volume between method A and method B.The treatment planning system was used to compare the V5,V10,V20,and V30 of the diseased lung and the whole lung volume between method A and method B.All patients underwent cone-beam CT (CBCT) scans after positioning.Setup error was obtained by matching the CBCT images with the MIP images in the XVI system based on bone and grayscale values.Results The PTVfree and PTVpress were (283.2± 12.74) and (201.8± 12.99)cm3,respectively (P=0.002).The maximum amplitudes of movements in the right-left,superior-inferior,and anterior-posterior directions as well as thel V | value were (0.22±0.02),(1.85±0.08),(0.43±0.26),and (1.91±0.27) em,respectively,for method A,and (0.05±0.01),(0.41±0.03),(0.16±0.16),and (0.44±0.16) cm,respectively,for method B (P=0.120,0.001,0.070).The V5,V10,V20,and V30 for the diseased lung and total lung volume were (61.26± 4.27) ％,(44.52± 1.70) ％,(28.22± 3.13) ％,(18.26±5.17)％,and (3556±223.12) cm3,respectively,for method A,and (52.74±4.78)％,(38.76±4.92) ％,(23.71 ±4.03) ％,(15.54±3.43) ％,and (3376±311.65) cm3,respectively,for method B (P =0.001,0.003,0.004,0.021,0.004).There was no significant difference in setup error obtained by the XVI system between the two fixation methods (P＞0.05).Conclusions Without increasing setup error,abdominal balloon compression can effectively control the lung movement amplitude,reduce the planning target volume,and reduce the radiation dose to the lung in patients with NSCLC.