BACKGROUND: In recent years, the effects of cytokines on osteoporosis have Received much attention, and of these cytokines, interleukin-6(IL-6) is considered to play an important role in the regulation of bone absorption.OBJECTIVE: To observe the changes of bone mineral density(BMD) and serum IL-6 rats with in senile osteoporosis after reperfusion with kidney and spleen-tonifying and blood flow-promoting prescription of traditional Chinese medicine.DESIGN: A randomized controlled experimental study based on the experimental animals.SETTING: Second Department of Cadre, Bethune International Peace Hospital of Chinese PLA; department of regimen and rehabilitation in a college of traditional Chinese medicine.MATERIALS: The experiment was conducted in the Center of Experimental Animals, Hubei College of Traditional Chinese Medicine between May and August 2003. Thirty 15-month-old Wistar rats(15 males and 15 females) were provided by the Experimental Animal Center of Tongji Medical College,Huazhong University of Science and Technology.METHODS: According to random number table method, 30 rats were divided into normal control group, pathological control group and traditional Chinese prescription treatment group. Rat models of senile osteoporosis were established in the latter two groups by injection with 2.5 mg/kg dexamethasone given twice a weeks for 6 consecutive weeks. Rats in normal control group and pathological control group were given oral administration of saline,and those in the treatment group were treated with the traditional Chinese prescription. After 6 weeks of treatment, blood samples were obtained from all rats by removing the eyeballs and the serum was separated by centrifugation,followed by truncation of the right hindlimb for dissection of the femoral bone. Serum IL-6 was measured by radioimmunoassay and BMD determined by means of displacement of acetone.MAIN OU TCOME MEASURES: BMD of the femoral bone and serum IL-6 level.RESULTS: The BMD of the pathological control group was significantly lower ( P < 0.01), but the serum IL-6 level was significantly higher( P < 0.01 ) than those of the normal control group. The BMD of the treatment group was significantly higher but serum IL-6 level significantly lower than those of the pathological control group ( P < 0.01 for both comparisons).CONCLUSION: The traditional Chinese prescription can decrease the production of IL-6 and lower serum IL-6 level to reduce the bone loss in senile rats.

Objective To find humoral protein markers to develop new experimental diagnostic methods for tuberculous pleurisy. Methods Proteomes of 7 d and 14 d culture filtrate of Mycobacterium tuberculosis growing in Middlebrook 7H9, serum and pleural effusion from five patients with tuberculous pleurisy were detected by surface-enhanced laser desorptionionization time-of-flight massspectrometry (SELDI-TOF-MS). And the data were analyzed with descriptive statistics method to observed the protein components all owned by three kinds of proteome. Results From protein species, proteins of all culture filtrate were far more than that of pleural effusion and serum while proteins of pleural effusion in four cases were more than that of serum. The kinds of common proteins between culture filtrate and pleural effusion, between culture filtrate and serum, between serum and pleural effusion, among culture filtrate and pleural effusion and serum were different. But the protein of relative molecular mass of 2 660 depending on the ratio of mass to charge existed in all samples of culture filtrate, pleural effusion and serum. Conclusion The protein of relative molecular mass of 2 660 possess the latent quality as a specific humoral protein marker for tuberculous pleurisy. But it is essential that must be further confirmed among large samples.

Objective:To analyze the correlation between the monitor units and pass rate of plan dose verification in the volumetric intensity modulated arc therapy (VMAT) plan.Methods:VMAT plans for 20 patients with nasopharyngeal carcinoma (NPC) and 30 patients with cervical cancer who underwent radiotherapy at Liuzhou Workers' Hospital from January to October 2020 were retrospectively chosen. The Detector 1500 array and Octavius 4D phantom from German PTW company were used for dose measurement. The pass rates of dose verification of relevant plans were analyzed under the conditions of 3%/2 mm and 2%/2 mm. The correlation between the monitor units and pass rate of plan dose verification in VMAT plans was assessed by Pearson's bivariate correlation analysis.Results:Under the condition of 3%/2 mm, the correlation coefficients between the monitor units and gamma pass rate were -0.873 ( P<0.001), -0.800 ( P<0.001), -0.781 ( P<0.001), -0.493 ( P=0.006) for NPC_1Arc, NPC_2Arc, NPC_1Arc+NPC_2Arc and Cervix_2Arc, respectively. Under the condition of 2%/2 mm, the correlation coefficients between the monitor units and gamma pass rate were -0.842 ( P<0.001), -0.770 ( P<0.001), -0.748 ( P<0.001) and -0.531 ( P=0.003) for NPC_1Arc, NPC_2Arc, NPC_1Arc+NPC_2Arc and Cervix_2Arc, respectively. Conclusion:Significant negative correlation can be observed between the monitor units and plan dose verification pass rate in VMAT plan.

Malnutrition, as an independent predictor of incidence and mortality in patients with chronic heart failure (CHF), has a serious impact on the treatment effect of patients. Conducting nutritional risk assessment and providing nutritional interventions for CHF patients can effectively improve their quality of life. On the basis of elaborating on the risk factors for malnutrition in CHF patients, this paper reviews the assessment tools for malnutrition in CHF patients, aiming to promote the localization of malnutrition assessment tools and the research and clinical application of malnutrition specific assessment tools, making nutrition assessment a routine part of overall health assessment for CHF patients.

Objective To compare the dosimetric characteristics of the VMAT plans between the flattening-filter-free (FFF) and flattening filter (FF) modes for nasopharyngeal carcinoma and analyze the feasibility of VMAT plans in the FFF model applied in clinical practice.Methods Ten patients diagnosed with stage Ⅱ nasopharyngeal carcinoma between 2016 and 2017 were recruited in this investigation.For the CT image and clinical target volume (CTV) of the identical patient,FFF-and FF-mode VMAT plans were established with the identical prescription dose of 6 975 cGy and the identical modified parameters on the RayStation platform (6 MV X-ray).The dosimetric characteristics,the number of machine hops and the time of beam were recorded and statistically compared between the FFF and FF modes.Results The minimum dose D98％ target,target coverage,conformal index (CI) did not significantly differ between the FF and FFF plans (P=0.262-0.975),whereas the maximum dose of D2％,the average dose of D and target homogeneity index (HI) of the FF plans were slightly advantageous to those of the FFF plan (P=0.004-0.038).The acceptable dose of bilateral lenses,the volume of the left parotid gland with an acceptable dose of＞ 30 Gy and the average dose of the left temporal lobe in the FFF mode were declined compared with those in the FF mode (P=0.002-0.025).The volume of normal tissues (Body) within the dose range of 2-30 Gy in the FFF mode was less than that in the FF mode (P=0.000-0.003).In the FFF mode,the mean number of machine hops was 1.188 times (P=0.000) and the average time of beam was 91.2％ of the FF plan (P=0.024).Conclusions Both the FF and FFF plans qualify the dosimetric requirements in clinical settings.FF plan is advantageous in terms of the dose distribution in the target area,whereas FFF plan yields better OAR protection and low-dose irradiation.In spite of the increasing quantity of machine hops,the time of beam is declined in the FFF plan.Consequently,FFF mode probably contributes to enhance the clinical efficacy.

Objective To analyze the relationship between planning factors of intensity-modulated radiation therapy (IMRT) and gamma index and investigate the effect of each parameter upon the γ passing rate of IMRT.Methods Gamma analysis was performed using 3％/3 mm acceptance criteria for 457 IMRT beams with different planning factors.During multi-factor ANOVA analysis of planning factors and gamma passing rate,the control variables primarily included the minimum segment area,minimum number of monitor unit (MU),number of segment,segment conversation,and the spatial resolution in the measured dose distribution.Results The percentage of pixels with passingγsignificantly differed under different minimum segment area,segment conversation and the spatial resolution in the measured dose distribution (all P＜ 0.05).No significant correlation was observed between the passing rate and the minimum number of MU and the number of segment (P＞ 0.05).Conclusions According to the actual situation of the equipment,the minimum segment area should be determined during IMRT planning.Direct machine parameter optimization should be performed.Appropriate resolution of the plane dose images can be chosen according to the minimum detector interval of dose matrix device,

Objective:To study the differences in the dosimetry and delivery time between helical tomotherapy (HT) and volumetric modulated arc therapy (VMAT) in postoperative radiotherapy of synchronous bilateral breast cancer (SBBC) and to explore the feasibility of clinical application of the HT technology.Methods:A retrospective analysis was conducted for nine SBBC patients who underwent modified radical postoperative radiotherapy in the Fourth Affiliated Hospital of Guangxi Medical University from February 2017 to May 2022. For each patient, the Precision planning system was used to formulate the HT plan, and the RayStation planning system was employed to develop the VMAT plan. All plans obtained were divided into HT group and VMAT group according to plan type. The paired sample t-test was used to compare the dosimetric parameters of the target volume and organ at risk (OAR) and delivery time between the two radiotherapy technologies. Results:The plans of both groups could meet the clinical treatment requirements. The coverage ( D95% and V100%), conformity index (CI), average dose ( Dmean), and median dose ( D50%) of the target volumes in the HT group were better than those in the VMAT group, and the differences were statistically significant ( t=-3.21, -3.39, -5.03, 3.76, 4.97, P < 0.05). The differences in the maximum dose ( D2%), minimum dose ( D98%), high dose volumes ( V107% and V110%), and homogeneity index (HI) of the target volumes between the two groups were not statistically significant ( P > 0.05). Regarding the OAR, the V20 and Dmean of both lungs in the HT group were significantly lower than those in the VMAT group, but the irradiation volume V5 of both lungs in the HT group was significantly higher than that in the VMAT group ( t=-3.01, 3.83, -2.81, P < 0.05). Moreover, V20, V30, V40, and Dmean of heart and the V20 and Dmean of liver in the HT group were significantly lower than those in the VMAT group, with statistically significant differences ( t=3.76, -2.83, -2.74, 5.93, 4.57, 4.48, P < 0.05). There was no significant difference in the radiation doses to other OARs (spinal cord, thyroid gland, and humerus head, P > 0.05). The delivery time of the HT group was significantly higher than that of the VMAT group ( t = 11.32, P < 0.05). Conclusions:Compared with VMAT, HT has greater dosimetric advantages, and can provide higher target coverage, conformability and average dose, and significantly reduce the overall radiation doses to both lungs, heart, and liver in OARs. However, the irradiation volume V5 at low-dose areas of both lungs and the delivery time in the HT group are higher than those in the VMAT group, but still meet the clinical treatment requirements. Therefore, it is feasible to apply the HT technology to the modified radical postoperative radiotherapy of SBBC.

Objective:To evaluate the effect of different reconstruction points of intrauterine applicator on the source dwell positions and plan dosimetry in intracavitary brachytherapy for cervical cancer.Methods:Clinical data of 43 patients with cervical cancer who had completed radical radiotherapy in Liuzhou Workers' Hospital from May 2020 to October 2022 were retrospectively analyzed. Among 43 patients, aged 32-79 years, 40 cases were diagnosed with squamous carcinoma and 3 cases of adenocarcinoma. All patients received external irradiation for 50.4 Gy / 28 fractions and CT-guided intracavitary brachytherapy (45° intrauterine applicator) was 36 Gy / 6 fractions. Brachytherapy was performed by using Fletcher applicator, the curvature of intrauterine applicator were 15°, 30°and45°. Two sets of brachytherapy plans were simulated for each patient. One set of plans extracted the simulated CT positioning images and the original plan of the patient's brachytherapy. The reconstruction point of the curved part of the 45° intrauterine applicator was adjusted to slice-by-slice reconstruction. The plan was optimized to meet clinical requirements according to the prescription, which was called the slice-by-slice group. In the other set of plans, slice-by-slice group was used as a template. The reconstruction points of the curved section of the 45° intrauterine applicator were adjusted to 1, 3, 5, and 7, without modifying the applicator weights and other parameters, which was called the average group 1, 3, 5 and 7. The deviation analysis of 15°, 30° and 45° intrauterine applicator with different number of reconstruction points was carried out, the reconstruction deviation of 45°, 30° and 15° intrauterine applicator at different reconstruction points was compared. Paired-sample t-test or Wilcoxon signed rank test were used to compare the differences in high-risk clinical target volume (HR-CTV) D 50%, D 90%, D 100%, V 100%, V 150%, V 200% and conformity index (CI) as well as D 2 cm3, D 1 cm3 and D 0.1 cm3 in bladder, rectum, and small intestine between two groups of 45° intrauterine applicator. Results:The reconstruction deviation in the average group was mainly from the vertical direction of the 45° intrauterine applicator. The mean reconstruction deviations of 45° (1, 3, 5, 7 reconstruction points), 30° (1, 3, 5 reconstruction points) and 15° (1, 2 reconstruction points) were 1.30 mm, 0.32 mm, 0.14 mm and 0.08 mm; 0.57 mm, 0.14 mm and 0.06 mm; 0.14 mm and 0.06 mm, respectively. There was no significant difference in the parameters of high-risk clinical target volume (HR-CTV) in the slice-by-slice group compared with the average group 5 and 7 (all P>0.005), and no significant difference was found between the average group 5 and 7 (all P>0.005). There were no statistically significant differences in bladder and rectum doses between the slice-by-slice group and the average groups or within the average groups (all P>0.005). The parameters of small intestine in the slice-by-slice group were higher than those of the average group 1, the difference was statistically significant ( P=0.002,<0.001,<0.001). The dose of small intestine in the slice-by-slice group was not statistically significant compared with those in the average group 5 and 7 (both P>0.005). The dose of small intestine in the average group 5 was not statistically significant compared with that in the average group 7 ( P>0.005). The small intestine dose deviations of D 0.1 cm3, D 1 cm3 and D 2 cm3 in the average groups at 1 reconstruction point were 2.41%±1.70%, 1.95%±1.27% and 1.71%±1.10%, respectively. Conclusion:The number of reconstruction points is recommended to be no less than 1, 3 and 5 of the curved part of the 15°, 30°and 45° Fletcher intrauterine applicator, respectively, during intracavitary brachytherapy for cervical cancer.

Objective:To evaluate the effectiveness and feasibility of 3D ResSE-Unet-based intelligent delineation of clinical target volume (CTV) in postoperative adjuvant radiotherapy for breast cancer.Methods:A total of 974 cases of breast cancer treated in the Cancer Diagnosis and Treatment Center of the Fourth Affiliated Hospital of Guangxi Medical University from September 2018 to June 2022 were enrolled in this study, including 614 cases receiving total mastectomy and 360 cases treated with breast-conserving surgery. They were divided into a training set, a validation set, and a testing set. The training set consisted of 874 cases and was used to build a model of 3D ResSE-Unet-based intelligent CTV delineation. The validation set comprised 40 cases and was used to evaluate the feasibility and effectiveness of the clinical application of AI-based CTV design in the radiotherapy for breast cancer. The testing set was composed of 60 cases and was used to test the accuracy of intelligent CTV. The Wilcoxon rank test was used to compare the Dice similarity coefficient (DSC), 95% Hausdorff distance (HD95), and average surface distance (ASD) obtained using the intelligent delineation model.Results:The intelligent delineation model showed high precision. The CTV of cases treated with total mastectomy (CTV cw) and the CTV of cases treated with breast-conserving surgery (CTV b) had DSCs greater than 0.80 and greater than 0.88, respectively. Therefore, compared with CTV cw, CTV b had a higher DSC (0.91 ± 0.03 vs.0.83 ± 0.05, t = 7.11, P < 0.05). Both CTV cw and CTV b had lower HD 95 [(7.56 ± 3.42) mm vs.(8.77 ± 5.89) mm] and ASD [(1.85 ± 0.71) mm vs.(1.86 ± 0.83)mm], without statistically significant difference ( P > 0.05). The left/right supraclavicular and infraclavicular CTV (CTV2) had DSCs greater than 0.8. CTV2 also had low average HD95 and ASD, without statistically significant difference ( P > 0.05). Conclusions:The 3D ResSE-Unet-based intelligent CTV delineation has better consistency and feasibility in postoperative adjuvant radiotherapy for breast cancer, especially the CTVs after breast-conserving surgery.

Objective: To evaluate the dosimetric effects of set-up errors on nasal NK/T cell lymphoma by introducing set-up errors into the radiotherapy planning system for dose reconstruction. Methods: Ten patients with nasal NK/T cell lymphoma were recruited. A non-coplanar volumetric modulated arc therapy plan was designed for CT image and clinical target area of each patient. After the completion of the plan, the set-up errors were introduced into the radiotherapy plan by changing the ISO of the treatment, and dose calculation was performed to reconstruct the dose distribution. Results: With the increase of system set-up errors, the dose of target was decreased and the order affected by set-up errors in different directions was: left-right direction> head-foot direction> front-rear direction. When the translational set-up errors in each direction were -3 mm to 3 mm and the rotating set-up errors were -3° to 3°, the range of dose change in all targets was less than ±3%. When the set-up errors in all directions were ≤ 3 mm, the dose of organ at risk was less than or similar to the prescribed dose. When the set-up errors were> 3 mm, the doses of lens, spinal cord, parotid gland and optic nerve gradually exceeded the prescribed dose. Only when the rotating set-up errors were ≥ 3°, the dose of lens exceeded the prescribed dose. Special attention should be paid to the influence of the greater set-up errors in the left and right direction on lens, spinal cord and parotid gland, as well as on the spinal cord due to the larger set-up errors in the front and rear direction. After the actual set-up errors were introduced from our department, it exerted slight effect on the irradiation dose of GTV and CTV, which was less than ±2%. In a few cases, the dose of organ at risk potentially exceeded the prescribed dose limit, and special attention should be diverted to overdose of the lens and optic nerve. Conclusions The set-up errors will result in target dose deficiency and overdose of organ at risk in nasal NK/T cell lymphoma, especially upon the set-up errors in the left and right direction. The effect of 3 mm and 3° set-up errors on target and organ at risk is limited. Therefore, it is recommended to maintain the single direction set-up errors within 3 mm and 3°. The actual set-up errors introduced from our department exert little effect on the target dose, but a small number of organs are at risk of exceeding the prescribed dose limit. It is necessary to increase the evaluation of the extension region of organ at risk.