Objective Explore the risk factors and prevention of HAP after surgical excision of Esophageal carcinoma in elderly Patients.Methods Two hundred and eight elderly patients with HAP after Surgical excision of Esophageal carcinoma from 2009 to 2012 were analyzed.Logistic regression analysis was used to find the related risk factors.Results The incidence of HAP was 25.9％.In several factors Logistic regression analysis,smoking,low lung function,postoperative non-epidural analgesia,injure of recurrent laryngeal nerve and fistula of anastomotic were the risk factors.Conclusions The preoperative evaluation,Intensive monitoring during the postoperative period and reducing the complication after operation can decrease the incidence of HAP.

Objective To study the image quality control system to ensure that equipment meet clinical needs.Methods It was scanning the Catphan504 phantom with models of high quality head,standard dose head and pelvis,we could get the results of CT numbers linearity,uniformity,spatial resolution,contrast resolution.Using T test to compare different scanning technique results.Results The standard dose head scanning technique was better than the pelvis scanning technique in CT numbers linearity test,and gets the best result in uniformity test.The result of CT numbers uniformity was higher in the standard dose head scanning than the high quality head and the pelvis scanning (9.7 ±3.9 vs.17.9 ±5.3,P =0.00 and 9.5 ± 4.0 vs.31.1 ± 5.7,P =0.00).The result of contrast resolution was higher in the pelvis scanning than the high quality head and the pelvis scanning (5.6 ± 0.1 vs.1.3 ± 0.5,P =0.00 and 6.0 ± 1.0 vs.1.3 ± 0.5,P =0.00).The result of spatial linear distance was very accurate,the range was 4.98 -5.06 cm.Conclusions The results of spatial linearity test are stable and accuracy,but CT numbers linearity and uniformity test are affected by the scanning technique significantly for device.To spatial resolution test and contrast resolution test,we need to set the standard and tolerance according to each linear accelerator specialty.

Objective To study the dosimetry characteristics of 9 equal spaced fields and 9 fields with beam angle optimization (BAO) process for cervix uteri.Methods 12 cervix uteri cancer patients CT Images were transferred into Eclipse planning system.Each patient,the 9 equal spaced fields and 9 fields by BAO process were IMRT plan designed with the same CT image.Make a evaluation of dose distribution for target volume and OARs,and paired t test for them.Results Comparing to 9 equal spaced fields IMRT plan,the quality of 9 fields IMRT plan with BAO process the the PTV V95％ was 99.31％ vs 99.42％,P =0.020,at the same time V105％,V110％,Dmax,D got 60.54％ vs 47.92％,P =0.013;7.14％ vs 0.37％,P =0.000;56.62 Gy vs 55.47 Gy,P =0.000;53.29 Gy vs 52.72 Gy,P =0.000,the CI and HI was 0.85 vs 0.89,P =0.000 ;0.10 vs 0.13,P =0.000.For organs at risk,bladder V40 was increased by 4.7 ％ (P =0.013) ;the D40 of rectum was 0.5 Gy higher (P =0.004) ; the small bowel's DVH showed that V40 and Dmax increased by 0.6％ (P =0.015) and 1.4 Gy (P =0.000),D of bone marrow were raised separately by 1.3 Gy (P =0.000),the spinal cord's dose D0.1 cm3 was also increased by 2.0 Gy (P =0.000).Conclusion The quality of 9 equal spaced fields IMRT plan will be better than those achieved by BAO process optimized plans.

Objective To investigate the long time prognosis of liver resection or transcatheter arterial chemoembolization(TACE) of Barcelona clinic liver cancer stage C(BCLC-C) patients who have portal vein tumor thrombsis.Methods Totally 86 BCLC-C patients who satisfied our including criteria from our surgical database of People's Hospital of Yichang City from January 2000 to September 2015 were selected as the research object.According to different treatment,86 patients were divided into liver resection group(n=50) and TACE group(n=36).The general information of two groups were compared.Cox multi-factors analysis and overall survival rate were calculated.ResultsThe long-term prognosis of liver resection group was better than that of TACE group(5-year OS:26% vs.0,P<0.001).Multi-factors analysis revealed that multiple tumors (HR:1.510,95%CI[1.120,2.316],P=0.020),AST>40 IU/L(HR:0.615,95%CI[0.488,1.206],P=0.013) as well as HBV-DNA>1 000(HR:1.204,95%CI:[0.920,2.540],P=0.038)were adverse factors for prognosis.ConclusionLiver resection is better than TACE for BCLC-C patients with portal vein tumor thrombosis.However,randomized controlled trial still need to be used to further confirm our conclusion.

Objective To compare the dose distribution of the three-dimensional conformal radiotherapy(3D-CRT)and 5-field or 7-field intensity modulated radiation therapy(IMRT), and to explore the value of IMRT in preoperative radiotherapy for rectal cancer.Methods Ten rectal cancer patients treated with preoperative combination radiotherapy and chemotherapy were enrolled in this study. 3D-CRT plan and the 5.field or 7-field IMRT plans were performed for each patient.The conformal index (CI),heterogeneity index(HI)of the planning target volume(PTV)and the dose of normal organs of 3D-CRT plan(3D-CRTp)and the 5-field or 7-field IMRT plans(IMRT5fp or IMRT7fp)were analyzed with the dose-volume histogram.Results The CI values of PTV were 0.91,0.87 and 0.78 in IMRT7fpIMRT5fp and 3D- CRT but with IMRT7fp>IMRT5fp>3D-CRTp(t=-5.69、-8.91,P<0.01),respectively.The HI values of PrV were 1.09,1.08 and 1.05 in IMRT5fp,IMRT7fp and 3D- CRTp but with IMRT5fp >IMRT7fp>3D- CRTp(t=3.41、-6.89,P<0.01),respectively.The ratio of dose volume were 0.08,0.10 and 0.19(t=2.79、3.52,P<0.05)in IMRT7fp,IMRT5fp and 3D- CRTp on the small intestine V50,with 0.07,0.10 and 0.19(t=2.58、3.40,P<0.05)in IMRT7fp,IMRT5fp and 3D-CRTp on the bladder V50 and 0.01,0.01 and 0.05(t=3.00、3.17,P<0.01)in IMRT7fp,IMRT5fp and 3D- CRTp on the fomoral head V45.The ratio of dose volume were 0.31 and 0.38(t=3.91,P<0.01)in IMRT7fp and IMRT5fp on the bone marrow V50,with 0.07 and 0.10 in IMRT7fp and IMRT5fp on bladder V45.Conclusions IMRT plan is superior to 3 D- CRT plan in dose conformal degrees of PTV with preoperative radiotherapy of rectal cancer and can significantly protect the normal tissues.The 7-field IMRT plan might be the optimal plan for dose conformal degree and dose uniformity compared with 5-field IMRT.

Objective To study the effect of leaf movement speed on the setup error of multileaf collimator (MLC) in RapidArc mode,and to improve quality assurance and verify the reliability of RapidArc.Methods Referring to the PicketFenceStatic_M120.dcm and PicketFenceRA_Ml20.dcm files,the Tilt tests with different adjacent leaf speed were designed and setup errors of MLC were obtained by analyzing electronic portal imaging device images.Results In the Tilt tests,the setup errors gradually increased from gapl 1 to gapS0 in both static gantry mode and RapidArc mode.With a gantry angle of 270°,gap41 had the maximum setup error of-0.55 mm.In the RapidArc mode,gap46 had the maximum setup error of-0.67 mm.The deviation of gap width was no greater than 15％ in any mode.There was no significant difference in deviation pattern of gap width between four modes with different gantry angles.The same gaps in different stripes showed a consistent trend in gap width.The RapidArc mode had a larger variation in percentage deviation of gap width than the static gantry mode.Conclusions The setup error increases with the increase in the speed of MLC leaf.The variation in the leaf speed has no significant impact on the gap width.There is no correlation between the leaf speed and the deviation of gap width.Four different gantry angles give similar deviation patterns of gap width,suggesting that the deviation of gap width is related to the leaf rather than the gantry angle.The RapidArc mode has a greater impact on the gap width than the fixed gantry mode.

ObjectiveTo investigate the anatomical changes and dose variation of rectum during radiotherapy in patients with cervical cancer.Methods Ten patients with cervical cancer underwent intensity-modulated radiotherapy using online cone beam computed tomography (CBCT) before each fraction.Rectum was contoured on each CBCT and projected onto the planning CT to analyze the changes of the rectal volume and position.The rectal volume receiving ≥ 45 Gy ( V45 ) was evaluated accordingly.Results227 CBCT images in 10 patients were collected.The rectal volume changed from ( 35.0 ± 7.3)cm3 to (97.7±14.7) cm3.The shift of rectal center was (0.14 ±0.06) cm in left and right direction,(0.24±0.10) cm in anterior and posterior direction,and (0.55±0.28) cm in superior and inferior direction.The V45 of rectum varied from (9.19±2.46)％ to (60.54 ±11.67)％.In7 of the 10 patients,rectal volume and V45 of the rectum had significant positive correlation (r =0.582 - 0.743,all P ＜ 0.01 ).Among the 227 images,the V45 of rectum was ≤50％ in 68 images (30.0％ ).ConclusionsSignificant changes in rectal volume and position occurred during fractionated radiotherapy in patients with cervical cancer,which resuhs in variations in the dose rectum received.For most patients,rectal volume and the V45of rectum had significant positive correlation.

Objective To investigate bladder anatomical changes and dose variation in patients with cervical cancer.Methods We analyzed 20 patients,undergoing external beam radiotherapy scanning cone beam CT(CBCT)before each fraction.Bladder was contoured on each CBCT,was projected onto the planning CT and assesses anatomical changes and dose variation.Results A total 451 CBCT images,for 20 patients were collected for analysis,show more change in bladder volume and position.In 15 cases bladder volume and V45 had no significant correlation(r=0.225 -0.473,all P>0.05),4 cases shows negative correlation(r=-0.564,P<0.05;r=-0.597,P<0.01;r=-0.942,P<0.01;r=-0.816,P<0.01),1 case shows positive correlation(r=0.662,P<0.01).Have more than the criteria(V45≤50%)number is 64/451(14.2%)in whole treatment.Conclusions For most patients by filling adequacy bladder,bladder dose variation is acceptable:CTV lager for individual patients should be closely observed its regression,implementation of the offline or online calibration.

BACKGROUND: This study aimed to observe the effect of early goal directed therapy (EGDT) on tissue perfusion, microcirculation and tissue oxygenation in patients with septic shock. METHODS: Patients with early septic shock (<24 hours) who had been admitted to the ICU of Zhongda Hospital Affiliated to Southeast University from September 2009 through May 2011 were enrolled (research time: 12 months), and they didn't meet the criteria of EGDT. Patients who had one of the following were excluded: stroke, brain injury, other types of shock, severe heart failure, acute myocardial infarction, age below 18 years, pregnancy, end-stage disease, cardiac arrest, extensive burns, oral bleeding, difficulty in opening the mouth, and the onset of septic shock beyond 24 hours. Patients treated with the standard protocol of EGDT were included. Transcutaneous pressure of oxygen and carbon dioxide (PtcO2, PtcCO2) were monitored and hemodynamic measurements were obtained. Side-stream dark field (SDF) imaging device was applied to obtain sublingual microcirculation. Hemodynamics, tissue oxygen, and sublingual microcirculation were compared before and after EGDT. If the variable meets the normal distribution, Student's t test was applied. Otherwise, Wilcoxon's rank-sum test was used. Correlation between variables was analyzed with Pearson's product-moment correlation coefficient method. RESULTS: Twenty patients were involved, but one patient wasn't analyzed because he didn't meet the EGDT criteria. PtcO2 and PtcCO2 were monitored in 19 patients, of whom sublingual microcirculation was obtained. After EGDT, PtcO2 increased from 62.7±24.0 mmHg to 78.0±30.9 mmHg (P<0.05) and tissue oxygenation index (PtcO2/FiO2) was 110.7±60.4 mmHg before EGDT and 141.6±78.2 mmHg after EGDT (P<0.05). The difference between PtcCO2 and PCO2 decreased significantly after EGDT (P<0.05). The density of perfused small vessels (PPV) and microcirculatory flow index of small vessels (MFI) tended to increase, but there were no significant differences between them (P>0.05). PtcO2, PtcO2/FiO2, and PtcCO2 were not linearly related to central venous saturation, lactate, oxygen delivery, and oxygen consumption (P>0.05). CONCLUSION: Peripheral perfusion was improved after EGDT in patients with septic shock, and it was not exactly reflected by the index of systemic perfusion.

Objective:To research the clinical effects of ulinastatin in the treatment of sepsis induced acute renal injury and its possible mechanisms.Methods:114 cases of patients with sepsis induced acute kidney injury from 2014.02 ～ 2016.08 were selected and randomly divided into the control group (n=57) and experimental group (n=57) according to the draw method,the control group was given conventional treatment,while the experimental group was treated by ulinastatin based on the control group,the urine urinary injury molecule-1 (KIM-1),atrialnatriuretic peptide (ANP),cyscatin-c (CYS-C),interleukin l,6 (IL-1,IL-6),c-reactive protein (CRP),tumor necrosis factor-α(TNF-α),nitric oxide (NO),endothelin 1 (ET-1),immunoglobulin A,G,M (IgA,IgG,IgM) levels,APACHE-Ⅱ score were compared between two groups before and after the treatment.Results:After treatmented,the urine of KIM-1,ANP,serum of CYS-C,IL-l,IL-6,CRP,TNF-α,ET-1 levels and APACHE-Ⅱ score of experimental group were significantly lower than those of the control group (P＜0.05).The serum NO,IgA,IgG,IgM levels of experimental group were significantly higher than those of the control group (P＜0.05).Conclusion:Ulinastatin could significantly relieve sepsis induced acute renal injury,which might be related to the inhibition of inflammatory response,improvement of the renal blood flow and immune function.