Objective:To explore diagnostic value of 6min walking test (6MWT) for coronary heart disease (CHD) . Methods :A total of 192 patients suspected of CHD ,including 123 men and 69 women ,who were treated in our hos‐pital ,were selected .After hospitalization ,all patients received 6MWT and coronary angiography (CAG) examina‐tion .With CAG results as the gold standard for diagnosing CHD ,sensitivity ,specificity ,accuracy ,positive predic‐tive value and negative predictive value of 6MWT diagnosing CHD were calculated ,and they were compared be‐tween men and women .Detections of 6WMT among groups of different diseased number of vessels were compared . Results :With CAG results as the standard ,accuracy ,specificity ,sensitivity ,positive predictive value and negative predictive value of 6MWT diagnosing CHD were 71.35% ,80.58% ,60.67% ,72.97% and 70.34% respectively . Compared with female patients ,there were significant rise in accuracy (57.97% vs .77.24% ) ,sensitivity (39.29%vs .70.49% ) ,specificity (70.73% vs .83.87% ) and positive predictive value (47.83% vs .81.13% ) , P<0.05 or<0.01 ,and significant reductions in false positive rate (29.27% vs .16.13% ) and false negative rate (60.71% vs . 29.51% ) in male patients (P<0.05 or <0.01) ,there was no significant difference in negative predictive value be‐tween two groups (P>0.05) .Compared with single - and double -vessel coronary disease ,there was significant rise in true positive rate (43.75% ,54.05% vs .100% ) of triple - or multi -vessel coronary disease diagnosed by 6MWT , P< 0.01 both . Conclusion:The 6min walking test possesses high specificity and sensitivity diagnosing CHD ,and its diagnostic value is higher for male patients and patients with serious condition .Its procedures are sim‐ple with low cost and no damage to patients ,which can be used as adjunctive examination for CHD diagnosis and ex‐tended in clinic .

Objective To evaluate the feasibility and the safety of thulium laser vaporization enucleation of prostate(TVEP) combined with traditional transurethral resection of prostate (TURP) for therapy benign prostate hyperplasia (BPH) with its volume larger than 80 millilitres.Methods Twenty-five BPH patients (volume larger than 80 millilitres) underwent TVEP combined with TURP.The operation time,intraoperative blood loss,enucleation time,cutting time,bladder irrigating time,catheterization time,perioperative and 6 months' follow-up data such as the international prostate symptom score,quality of life score,the maximum urinary flow rate,the residual urine volume and so on were observed.Results The operation time was (66 ± 26) min.The enucleation time was (25 ± 9) min.The cutting time was (32 ± 8) min.The intraoperative blood loss was (140 ± 25) ml.The bladder irrigation time was (3.0 ± 1.0) d.The catheterization time was (5.7 ± 1.0) d.After 6 months,the maximum urinary flow rate,residual urine volume,international prostate symptom score and quality of life score were improved:(18.7 ± 1.7) ml/s vs.(6.8 ± 1.7) ml/s,(18.9 ± 1.8) ml vs.(65.7 ±8.1) m1,(8.7 ± 1.6) scores vs.(25.7 ±4.3) scores,(1.7 ± 1.2) scores vs.(4.7 ± 1.1) scores,and there were significant differences (P ＜ 0.05).Urethral stricture developed in 2 patients and epididymitis happened in 3 patients.No blood transfusion events and transurethral electric cutting syndrome occurred.Conclusion TVEP combined with TURP for therapy BPH larger than 80 millilitres is safe,and the incidence of complications is low.

ObjectiveTo investigate the dosimetric difference in the application of RapidArc using 6 and 15 MV X-rays for radiotherapy of multiple hepatic malignancy.MethodsA total of 12 cases with multiple hepatic tumors ( primary 5 cases and secondary 7 cases) were selected.All patients underwent the three dimensional CT simulation in free breathing.For each patient,RapidArc plans with single or two 358° arcs using 6 or 15 MV X-rays were designed respectively,the prescription dose was 2Gy per fraction × 25 fractions.The dosimetric differences were compared among RapidArc plans.ResultsAll of RapidArc plans could meet the clinicalrequirement.There were no significant differences in the conformity index ( CI ),homogeneity index ( HI),the maximum dose and the minimum dose of PTV among RapidArc plans ( P ＞ 0.05).All the CI could get to 0.91 and HI could get to 0.88.In the RapidArc plans with two 358° arcs,the Vs,V10,V15 of normal liver were higher than with single arc,while V20,V25,V30,V35,V40 were lower than with single arc.There were no significant differences in the different radiation dose of normal liver,stomach,duodenum and spinal cord among different plans ( P ＞0.05 ).The monitor units of RapidArc plans using 6 MV X-rays increased 12％ compared to 15 MV averagely.CondusionThe 6 MV X-ray would be selected chiefly in the radiotherapy of multiple haptic tumor using RapidArc with whole arc(s).

Objective To research the feasibility of using three-dimensional CT (3DCT) associated with active breathing control (ABC) in determination of the individual internal tumor volume (ITV) for hepatocellular carcinoma (HCC) comparing the four-dimensional CT (4DCT).Methods After 4DCT scans of 15 HCC patients who had accepted TACE,completed the 3DCT scans associated with ABC in three ways of breathing:free breathing ( FB),end inspiration hold ( EIH),end expiration hold (EEH).4DCT images were sorted into 10 phases and the maximum intensity projection (MIP) images were constructed.The GTVs were manually contoured on 4DCT and 3DCT images (labeled as GTV0,GTV10.….GTV90,GTVMIP,,GTVFB,GTVEIH and GTVEEH).GTV0…GTV90,GTV0 and GTV50,GTV0,GTV20 and GTV50,GTVEIH and GTVEEH were respectively merged into IGTV1,IGTV2,IGTV3,IGTV4.The volume and geometry displacement of GTVs and IGTVs were compared.Results All patients were compatible with the ABC technique and completed the CT scans in two ways.The motion of diaphragm measured between 4DCT and 3DCT images was not significantly different ( 1.39 cm and 1.39 cm,t =-0.02,P =0.983 ),it was similar to the volume difference among GTV0,GTV20,GTV50,GTVEIH,GTVEEH and GTVFB (56.4,54.6,55.5,55.6,55.2,59.7 cm3,F =0.01,P =1.000 ).The comparison result of volume difference among IGTV1,IGTV2,IGTV3,IGTV4 and GTVMIP (77.9,71.4,73.4,72.3 and 66.3 cm3,F =0.02,P =1.000)were similar to the differences of geometry displacement in x,y and z axial among them (F =0.48,0.04,0.02,P =0.750,0.997,0.999,respectively).Conclusion The application of 3DCT associated with ABC in determination of the individual IGTV for HCC is feasible and safe comparing to 4DCT.

ObjectiveTo study the feasibility of RapidArc (RA) associated with active breath coordinator (ABC)for hepatocelluar carcinoma (HCC)radiotherapy comparing of three-dimensional conformal radiotherapy (3DCRT),intensity modulated radiotherapy (IMRT),RA treatment plans in different breath status.Methods12 HCC cases were selected.Three series CT scanning were completed in Free Breathing (FB),End Inspiration Hold (EIH) and End Expiration Hold (EEH) associated with ABC device.3DCRT,IMRT and RA (three 135° arcs) treatment plans were respectively designed on planning target volume (PTV) in different breath status.The dosimetric differences among 3 DCRT,IMRT and RA,among RA plans under different breath status were compared.ResultsThe PTV in FB was larger than in EEHand EIH (160.8 cm3,89.5 cm3,83.1 cm3,F=6.63,P=0.004). The conformity index and homogeneity index of RA plans were better than IMRT and 3DCRT ( 0.92,0.90,0.77,F =72.55,P =0.000 ;0.90,0.89,0.84,F =125.49,P =0.000 ) ;the V20,V30,V40 of normal liver in 3DCRT were higher than IMRT and RA (24％,20％,19％,F=3.56,P =0.032;13％,10％,10％,F=5.74,P =0.004;8％,5％,6％,F =3.72,P =0.027).The normal liver mean dose,V10,V20,V30,V40 of RA plans in FB were higher than in EEH and EIH ( 13.46 Gy,10.25 Gy,9.48 Gy,F =3.627,P =0.038 ;46％,35％,32％,F =2.96,P=0.066;24％,16％,16％,F=3.69,P=0.036;13％,8％,8％,F=4.28,P=0.022;8％,5％,5％,F =2.39,P =0.108 ).The duodenum D5 cm3 of RA in EEH was lower than in FB and EIH (8.78 Gy,19.35 Gy and 11.67 Gy,F =1.56,P =0.224 ).The mean monitor units for 3 DCRT,IMRT,RA was 254.06 MU,626.33 MU and 550.28 MU ( F =147.35,P =0.000 ),while the mean treatment time was 135 s,540 s and 130 s respectively (F =62.83,P =0.000).ConclusionsThe RapidArc applying three 135°arcs with ABC in HCC radiotherapy can achieve better PTV coverage than IMRT with fewer monitor units,shorter treatment time and sparing more normal liver.

Purpose To investigate the dosimetric differences among RapidArc (RA) plans which were designed on different target volumes in hepatocellular carcinoma (HCC).Methods A total of 10 HCC patients underwent 3D-CT scan under free breathing ( FB),end inspiration hold ( EIH ) associated with active breath coordinator (ABC) and 4D-CT scan.The 4D-CT were sorted into 10 sets of CT images according to respiratory cycle.The gross tumor volume (GTV) was manually contoured on different CT images.The individual internal gross target volume ( IGTV1 ) was obtained from 4D-CT,and the individual margins from GTVFB to IGTV1.IGTV2 were obtained from GTVFB using individual margins.The planned target volumes (PTV-1,PTV-2,PTV-3 and PTV-4 ) were obtained from GTVFB,IGTV1,IGTV2 and GTVEIA applying different margins.The RA plans (RA1,RA2,RA3 and RA4 ) were designed from different PTVs,and for RA1,RA2 and RA3 the simple 358° arc were used,while three 135° arcs were used for RA4.The dosimetric differences were compared.Results The PTV-1 and PTV-3 were larger than PTV-2 and PTV-4; the mean values of PtV-1/PTV-2 and PTV-1/PTV-4 were 2.5 and 1.9,respectively.There were no significant differences in conformal index,homogeneity index,maximum dose,and minimum dose of PTV among 4 RA plans.The irradiation dose of normal liver of RA3 and RA4 were 8.23 Gy and 7.63 Gy respectively,both significantly lower than those of RA1 and RA2 (10.21 Gy,9.62 Gy,x2 =10.68,P ＜0.05 ),and the V30of RA3 and RA4 were 5.24％ and 5.05％ respectively,both significantly lower than those of RA1 and RA2 (7.76％,6.12％,x2 =14.76,P ＜ 0.05 ).There were no significant differences in irradiation doses of stomach and duodenum among different plans.Conclusions Using 4D-CT or ABC technology with RapidArc in HCC can define the target volume accurately and achieve prefect dose distribution sparing more normal liver volume,compared to the traditional margins.4D-CT and ABC play similar roles in sparing normal liver.

Objective To compare the survival outcomes between operative versus non-operative treatment of advanced intrahepatic cholangiocarcinoma.Methods This is a retrospective study.The data from 122 patients with intrahepatic cholangiocarcinoma treated at the Hunan People's Hospital,the Hepatobiliary Hospital and the Oncology Department from January 2012 to October 2017 were retrospective studied.87 patients who underwent radical surgery (anatomical hepatectomy + regional lymph node dissection) formed the operation group;35 patients who were treated with chemotherapy and/or radiotherapy and/or biological targeted therapy formed the non-operative group.The general characteristics of the two groups including age,sex,ALT,AST,CA19-9,liver function,Child's classification,AJCC staging,tumor number,vascular (hepatic artery,portal vein) invasion and regional lymph node metastasis rates were compared.The overall survival of the two groups was compared.Results There were no significant differences in age,sex,ALT,AST,CA19-9,liver function,Child's classification,AJCC staging,tumor number,vascular (hepatic artery,portal vein) invasion and regional lymph node metastasis rates (P＞0.05).The overall survival of the operation group was significantly longer than that of the non-operative group (P＜0.05).The mean overall survival for the 2 groups of patients were 32 months and 15 months respectively.The 1-year survival rates were 74.8％ and 58.7％,and the 3 year survival rates were 42.4％ and 6.5％,respectively.The 5 years survival rates were 12.3％ and 0,respectively.Conclusion Operative treatment resulted in better median survival,as well as 1-,3-and 5-year survival rates than non-operative treatment for patients with advanced intrahepatic cholangiocarcinoma.

Objective:To explore the application value of whole-process ultrasound-guided percutaneous portal vein puncture islet transplantation.Methods:From October 2018 to May 2021, 16 diabetics underwent whole-process ultrasound-guided percutaneous portal vein puncture islet transplantation at First Affiliated Hospital of Sun Yat-sen University.The whole process was guided by ultrasound for completing percutaneous portal vein puncture catheterization, islet infusion monitoring, bleeding prevention and ablation hemostasis after bleeding.Results:Ten patients [8 males and 2 females with a mean age of(45.9±21.1)years]underwent 16 islet transplants, including one islet(5 cases), two islets(4 cases)and three islets(1 case). A single puncture was successfully performed without damage to other extrahepatic organs, persistent portal hypertension, portal vein embolism or infection.Bleeding at liver puncture site occurred in 3 cases and ultrasound radiofrequency ablation was performed for immediate hemostasis.Among them, postoperative blood glucose stabilized at 4~12 mmol/l post-operation.And 5 cases(31.3%)achieved insulin independence for>2 months and 10 cases(62.5%)lowered insulin dosage by>50% as compared with preoperative level.The level of fasting C-peptide recovered or was higher than normal in 10 cases(62.5%)and became obviously elevated in the remainders.In 11 cases(68.8%)of them, liver transaminase was briefly and mildly elevated post-operation, and no other complications were observed.Conclusions:The whole-process ultrasound-guided percutaneous portal vein islet transplantation is both safe and feseasible.It avoids the injury of transplanted kidney caused by contrast agent and radiological radiation to operator and patient.It is a method of islet transplantation worth a wider popularization.