Objective:To observe the curative effect of cervical chiropractic for cervical spondylosis of vertebral artery type (CSA) and to explore its possible mechanism.Methods:Sixty CSA patients were randomly divided into two groups.Thirty patients in the treatment group were treated with chiropractic manipulation for cervical vertebrae,once every other day,7 treatments in total.The other 30 patients in the control group received oral administration of flunarizine hydrochloride,10 mg per night,for 14 d.Cervical vertigo and functional assessment scale and transcranial cerebral Doppler (TCD) were measured before treatment and 7 days after treatment.Results:The total effective rate was 96.7％ in the treatment group and 83.3％ in the control group.The curative rate was 66.7％ in the treatment group and 20％ in the control group.The differences between the two groups in the total effective rate and the curative rate were statistically significant (both P＜0.05).The scores of cervical vertigo symptom and functional assessment after treatment in both groups were significantly higher than those before treatment (both P＜0.01);the difference between the two groups was statistically significant (P＜0.05).After treatment,the maximum systolic velocity (Vs),the maximum diastolic velocity (Vd),the mean velocity (Vm),the pulsatility index (PI) and the vascular resistance index (RI) in both groups were significantly improved compared with those before the treatment (all P＜0.01);there were significant differences between the two groups (all P＜0.05).Conclusion:Cervical chiropractic is an effective method for CSA,and its curative effect is better than that of flunarizine hydrochloride alone.Its mechanism may relate to correcting cervical instability.

Dust ; Humans ; Silicon Dioxide ; adverse effects ; Silicosis ; etiology

OBJECTIVETo explore the dosimetric variance in forward intensity modulated radiotherapy (IMRT) based on 4D CT and 3D CT after breast conserving surgery.

METHODSSeventeen patients after breast conserving surgery underwent 3D CT simulation scans followed by respiration-synchronized 4D CT simulation scans at free breathing state. The treatment plan constructed using the end inspiration (EI) scan was then copied and applied to the end expiration (EE), and 3D scans and dose distribution were calculated separately. Dose-volume histograms (DVHs) parameters for the CTV, PTV, ipsilateral lung and heart were evaluated and compared.

RESULTSThe CTV volume difference was biggest between T0 and 3D CT, and the volume difference was 4.10 cm(3). Mean dose of PTV at EE was lower than that at EI (P = 0.019), but there were no statistically significant difference between 3D and EI, EE (all P > 0.05). The homogeneity index (HI) at EI, EE, 3D plans were 0.149, 0.159 and 0.164, respectively, and a significant difference was only between EI and EE (P = 0.039). The highest conformal index (CI) was at EI phase (P < 0.05), and there was no significant difference between EE and 3D (P = 0.758). The V(40) and V(50) of ipsilateral lung at EE phase were lower than that at EI (P < 0.05). There were no significant differences in all the indexes for heart (P > 0.05).

CONCLUSIONSThe breast deformation during respiration may be disregarded in whole breast IMRT. PTV dose distribution is significantly changed between EI and EE phases, and the differentiation of the lung high dose area between EI and EE phases may be induced by thorax expansion. 3D treatment planning is sufficient for whole breast forward IMRT, but 4D CT scans assisted by respiratory gating ensures more precise delivery of radiation dose.

Adenocarcinoma, Mucinous ; diagnostic imaging ; radiotherapy ; surgery ; Adult ; Breast Neoplasms ; diagnostic imaging ; radiotherapy ; surgery ; Carcinoma, Ductal, Breast ; diagnostic imaging ; radiotherapy ; surgery ; Dose Fractionation ; Female ; Four-Dimensional Computed Tomography ; methods ; Humans ; Imaging, Three-Dimensional ; methods ; Mastectomy, Segmental ; Middle Aged ; Organs at Risk ; Radiotherapy Dosage ; Radiotherapy, Intensity-Modulated ; Respiration

Objective:To observe the effect of hyperthermia combined with paclitaxel on the proliferation, apoptosis and cycle of human tongue squamous cell carcinoma cell line CAL-27, and to explore the underlying mechanism.Methods:The working concentration of paclitaxel was determined by CCK-8 assay, and the cultured CAL-27 cells were divided into the control, paclitaxel, 42℃ hyperthermia and combined treatment groups. The ability of cell proliferation was detected by colony formation assay, and the cell cycle and apoptosis were determined by flow cytometry. The expression levels of AKT, p-AKT, Bcl-2 and Bax proteins in each group were measured by Western blot.Results:Compared with the control group, the proliferation was significantly inhibited and the apoptosis of CAL-27 cells was significantly promoted in the combined treatment, hyperthermia and paclitaxel groups (all P<0.05), and the anti-proliferation and apoptosis-promoting effect in the combined treatment group was significantly better than those in the hyperthermia and paclitaxel groups (all P<0.05). Western blot showed that hyperthermia combined with paclitaxel could significantly up-regulate the expression level of Bax protein and significantly down-regulate the expression levels of P-AKT and Bcl-2 in CAL-27 cells (all P<0.05). Conclusions:Hyperthermia combined with paclitaxel can play a synergistic role in inhibiting proliferation and promoting apoptosis of tongue squamous cell carcinoma CAL-27 cells. The mechanism may be related to the inhibition of AKT activation and the activation of Bax/Bcl-2 apoptosis signaling pathway.

OBJECTIVETo explore the relationship of dose-volume histogram (DVH) parameters and computed tomography grading of radiation-induced lung injury in patients with non-small cell lung cancer (NSCLC) treated by three-dimensional conformal radiotherapy (3D-CRT).

METHODSOne hundred sixty-nine patients with stage I approximately III NSCLC, treated by 3D-CRT and followed by CT scan for more than six months after 3D-CRT, were divided into grade 0 to grade 4 based on the appearance of radiation-induced lung injury on CT image defined jointly by radiotherapist and radiologist. The patients were divided into CT positive group (grade 2 to grade 4) and CT negative group (grade 0 to grade 1), then the treatment planning shown to the patients were reviewed to compare and analyze the relationship of CT grading of radiation-induced lung injury and the DVH parameter selected.

RESULTSRegardless of whole lung or tumor-bearing lung, there was a statistically significant difference in normal tissue complication probability (NTCP) between the patients grouped with different CT grading of radiation-induced lung injury, and the mean of NTCP increased along with upgrade of CT grading. There was a statistically significant difference of mean lung dose (MLD) regardless of whole lung or tumor-bearing lung between the patients grouped with different CT grading of radiation-induced lung injury, and MLD increased along with upgrade of CT grading. There was a statistically significant difference of the volume received equal or more than 20 Gy (V(20)), 30 Gy (V(30)), 40 Gy (V(40)) of whole lung and tumor-bearing lung between the patients grouped with different CT grading of radiation-induced lung injury, and V(20), V(30), V(40) increased along with upgrade of CT grading. There were not statistically significant differences of the DVH parameters of the contralateral lung in the patients of different groups based on the CT grading. On statistical analysis, the DVH parameters of whole lung and tumor-bearing lung closely correlated with CT grading of radiation-induced injury of the tumor-bearing lung, and there was a relatively strongest relationship between NTCP and CT grading of the tumor-bearing lung (eta = 0.522).

CONCLUSIONDVH parameters such NTCP, MLD, V(20), V(30), and V(40) are statistically correlated closely with CT grading of radiation-induced lung injury after radiotherapy for the patients with NSCLC treated by 3D-CRT. Therefore the parameters can be selected as the reference for evaluation after 3D-CRT for patients with NSCLC.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung ; diagnostic imaging ; pathology ; radiotherapy ; Dose-Response Relationship, Radiation ; Female ; Follow-Up Studies ; Humans ; Lung ; radiation effects ; Lung Injury ; etiology ; Lung Neoplasms ; diagnostic imaging ; pathology ; radiotherapy ; Male ; Middle Aged ; Neoplasm Staging ; Radiation Injuries ; etiology ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Conformal ; adverse effects ; methods ; Retrospective Studies ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVETo explore the influence of intrafraction and interfraction target displacement on the dose distribution in the target of forward whole-breast intensity-modulated radiotherapy (IMRT) assisted by active breathing control (ABC).

METHODSEach of the selected patient who had received breast conserving surgery was immobilized and received the primary CT simulation assisted by ABC device to get five sets of CT images in three different breathing status, including free breathing (FB) (one set), moderate deep inspiration breathing hold (mDIBH)(two sets) and deep expiration breathing hold (DEBH) (2 sets). After 10 to 15 fractions of radiation, the repeated CT simulation was completed and the same five sets of CT images were obtained at FB, mDIBH, and DEBH, respectively. In the Pinnacle3 treatment planning system, the forward IMRT planning was completed on the first set of mDIBH CT images from the primary CT simulation, and the planning was separately copied by the special system order to the second set of CT images from the primary CT simulation and to the first set of CT images from the repeated CT simulation, keeping the primary angle, direction, size and shape of the MLC field and prescribed dose un-changed. the volumes covered by selected high dose area in the selected segment were compared.

RESULTSIn the planning based on the first set of mDIBH CT images from the primary CT simulation, the volume irradiated by equal and more than 103% of prescribed dose in the segment was (1.16 +/- 0.39) cm3, and the volumes were (3.88 +/- 1.07) cm3 and (51.66 +/- 8.68) cm3 in the plannings copied from the first set of mDIBH CT images from the primary CT simulation respectively to the second set of CT images from the primary CT simulation and first set of CT images from the repeat CT simulation, the difference of the volume in the two plannings based on the two set mDIBH CT image from the primary CT simulation was not statistically significant (t = -1.672, P = 0.103). The difference of the volume in the two plannings based on the two sets of mDIBH CT images respectively from the primary and repeat CT simulations had a significant difference (t = -5.728, P < 0.01).

CONCLUSIONIf the same threshold of mDIBH is maintained during IMRT after breast conserving surgery, the influence of the intrafraction target displacement on the dose distribution is not significant. However, if set-up error is not adjusted, the interfraction change of position of the segment given to cover the high dose area in the IMRT planning will be significant, resulting in a significant change of dose distribution in the breast.

Breast Neoplasms ; diagnostic imaging ; radiotherapy ; surgery ; Carcinoma, Ductal, Breast ; diagnostic imaging ; radiotherapy ; surgery ; Carcinoma, Lobular ; diagnostic imaging ; radiotherapy ; surgery ; Dose Fractionation ; Female ; Humans ; Mastectomy, Segmental ; Postoperative Period ; Radiography ; Radiotherapy Planning, Computer-Assisted ; methods ; Radiotherapy, Intensity-Modulated ; methods ; Respiration ; Respiratory-Gated Imaging Techniques ; methods

OBJECTIVETo determine occupational hazards in work sites of a large solid waste landfill and analyze their adverse health effects.

METHODThe national standardized detection methods were used to determine dust concentration, harmful gas and physical factors in worksites. Routine physical examination, pulmonary function, hearing tests and nervous system test were performed in workers for 2 consecutive years. Urine lead, cadmium and mercury contents were detected. The comet assay was use to measure DNA damage in peripheral blood lymphocytes among workers.

RESULTThe main occupational hazard factors in this solid landfill are dust, harmful gas, high temperature and noise. The oxides, carbon monoxide, and noise and high temperatures in summer at some work sites exceeded the national occupational exposure limits. The prevalence of respiratory inflammation and rate of pulmonary function decrease among front-line workers and on-site technical managers are 21.2% and 11.5%, which are significantly higher than those among administrative staff (7.1% and 0) (P < 0.05). Nervous system abnormalities rate of front-line workers and on-site technical managers was 50.0%, which is significantly higher than that (26.7%) of administrative staff (P < 0.05). Because of long-term exposure to high intensity noice, hearing loss rate of bulldozer drivers was 10.3%. In addition, about 75% of workers with DNA damage in peripheral blood lymphocyte are front-line workers.

CONCLUSIONAdverse health effects from occupational hazards were observed among workers in this solid waste landfill.

Adult ; Female ; Humans ; Male ; Middle Aged ; Occupational Diseases ; epidemiology ; Occupational Exposure ; Refuse Disposal ; Respiratory Tract Infections ; epidemiology ; Risk Factors ; Workplace

OBJECTIVETo investigate the influence of registration based on different reference markers on the displacement of the geometry consisted of all clips in the cavity for external-beam partial breast irradiation at moderate deep inspiration breath holding assisted by active breathing control device.

METHODSTwenty-seven early stage breast cancer patients feasible for external beam partial breast irradiation (EB-PBI) were selected. The patients undertaken three-dimensional computed tomography (3DCT) simulation scan at moderate deep inspiration breath holding (mDIBH) assisted by active breathing control device, and two sets of mDIBH CT images were got and transferred to the Pinnacle 3 planning system. All of the silver clips were delineated and a geometry consisted of all clips were generated. On the account of automatic registration of mDIBH CT images, manual registration was carried out based separately on the topside clip in the cavity, the labeled skin at anterior surface of the cavity at central level and the metal mark on the body surface near the cavity, then the displacements of center of the geometry in left-right (LR), anterior-posterior (AP) and superior-inferior (SI) directions based separately on the three registrations were measured.

RESULTSThe displacements of center of the geometry in LR, AP and SI directions based on registration of the clips, the labeled skin and the metal mark were (0.61 ± 0.62)mm vs. (1.11 ± 1.21)mm vs. (1.31 ± 1.55)mm, (0.63 ± 0.59)mm vs. (0.92 ± 0.93)mm vs. (1.19 ± 1.24)mm and (0.91 ± 0.96)mm vs. (2.13 ± 2.12)mm vs. (1.93 ± 1.55)mm, respectively. Compared the displacements of center of the geometry in the same direction between the three registrations, significant differences were found only in SI direction between clip registration and skin registration, clip registration and mark registration (t = 5.045, 7.210 and P = 0.025, 0.007) . Compared the displacements of center of the geometry between three dimensional directions for each reference registration, there was no significant difference (all P > 0.05).

CONCLUSIONSWhen EB-PBI is carried out in state of mDIBH, measurement of the intrafraction displacement based on registration of the clip in the cavity is a reasonable selection. Otherwise, excessive margin enlargement of PTV in SI direction will be generated if the regional skin or metal mark is selected as registration reference.

Breast Neoplasms ; diagnostic imaging ; radiotherapy ; Breath Holding ; Female ; Fiducial Markers ; Humans ; Imaging, Three-Dimensional ; Radiography ; Radiotherapy Planning, Computer-Assisted ; methods ; Surgical Instruments

At present,because market price survey and health insurance payment standard adjustment mechanism in china is incomplete,health insurance payment standard can not be completely equivalent to the actual market price of drugs. This paper analyzed and summarized the main factors affecting the balance and formation mechanisms under differ-ent medical insurance payment standard policies. It is found that the balance formation mechanism depends not only on the reimbursement ratio of drugs,but also on the development pattern of the payment standard and on the source of the refer-ence price system selected. On the issue of the ownership of the balance,from the specific practices of pilot cities such as Chongqing and Shaoxing,it can be seen that the merits and demerits still exist to the medical institutions for internal de-velopment models or re-allocated by the government agencies'performance-based. Compared with the simple balance reten-tion model,the redistribution model can enhance the service of medical institutions by regulating their behavior. However, medical institutions may provide false data to get more balance in the redistribution model,and game theory was used to reduce the policy risk of misreporting the private balance of data from medical institutions,and the analysis of strategic choices of medical institutions and supervisory departments Finally,"three-step"policy proposal was proposed on the issue of balance attribution. In the short term,the balance should be given to the medical institutions to increase their bargaining motivation. At the same time,the performance appraisal and supervision methods should be explored to enhance the feasi-bility of redistribution model. In the long run,the balance should be eliminated gradually through the improvement of mar-ket price survey and medical insurance payment standard adjustment mechanism.

Objective To evaluate the relative bioavailability and bio-equivalence of azathiopfine tablets in healthy volunteers.Methods A single oral dose of 100 mg azathioprine test and reference tablets were given to 20 male healthy volunteers in a randomized crossover study.Plasma metabolite 6-mercaptopurine of azathioprine wag determined by RP-HPLC.The pharmacokinetic parameters and relative bioavailability were calculated with DAS program to evaluate the bioequivalence of the two preparations.Results The concentration-time curves were fitted to a one-compartment open modeL The main pharmacokinetic parameters of azathioprine test and reference tablets were as follows:t_(1/2)were(1.30±0.25)and(1.30±0.34)h;t_(max) were(1.25±0.16)and(1.24±0.21)h;C_(max) were(48.44±17.09)and(52.32±24.37)μg·L~(-1);AUC_(0-1)were(89.49±19.25)and(91.90±25.31)μg·h·L~(-1);AUC_(0-∞)were(96.11±19.74)and(98.36±24.66)μg·h·L~(-1),re-spectively.The relative bioavailability of F_(0-t) and F_(0-∞) were(99.62±15.29)%and(99.39±13.59)%,respectively.Conclusion The two azathiprine preparations are bioequivalent.