Objective To compare the dosimetric differences of target and organs at risk (OAR) induced by the tangential and non-coplanar multi-fields used in the dynamic intensity modulated radiotherapy (IMRT) plans for breast cancer patients after breast-conserving surgery.Methods Forty patients with early-stage left breast cancer after breast-conserving surgery were included.Based on the CT anatomy of the same patient,dynamic IMRT treatment plans using two tangential fields,3,4 and 5 non-coplanar fields were designed respectively utilizing the same optimization objects.The plans were compared by means of target dose distribution,the doses and irradiated volumes of heat,left lung,right breast,and total monitor units (MUs).Results The conformal index (CI) and homogeneity index (HI) of planning target volume (PTV) in the plans using 4 and 5 fields were better than that using 2 fields (P ＜ 0.05).Maximum doses (Dmax) in PTV were significantly lower in the plans of 4 and 5 fields than of 2 fields (P ＜0.05).Yet the plans of 4 and 5 fields generated significant higher minimum doses (Dmin) in PTV than that of 2 fields (P ＜ 0.05).No significant difference was observed between plans of 2 or 3 fields.Across the four plans,the differences of right breast V5 (relative volume acquired at least 5 Gy of dose),heart V30,heart mean dose (D),left lung V20,V5 and D were not significant.Yet the disparities of total MUs were statistically significant (F =25.63,P ＜ 0.05).The least MUs were used by the 2 fields and the most MUs were observed in the 5-field plans.Conclusions Comparing with IMRT plans of 2 fields,using 4 or 5 non-coplanar fields can improve the target dose distribution without increasing OAR doses.As a tradeoff,more MUs are needed for multi-fields plans.

Objective To compare the dosimetric difference between volumetric are modulation with RapidArc and fixed field dynamic IMRT for breast cancer radiotherapy after breast-conserving surgery.Methods Twenty patients with early left-sided breast cancer received radiotherapy after breast-conserving surgery.After target definition,treatment planning was performed by RapidAre and two fixed fields dynamic IMRT respectively on the same CT scan.The target dose distribution,homogeneity of the breast,and the irradiation dose and volume for the lungs,heart,and eontralateral breast were read in the dosevolume histogram (DVH) and compared between RapidAre and IMRT.The treatment delivery time and monitor units were also compared.Results In comparison with the IMRT planning,the homogeneity of clinical target volume (CTV) ,the volume proportion of 95% prescribed dose (V95%) was significantly higher by 0.65% in RapidAre (t =5.16,P = 0.001) ,and the V105% and V110% were lower by 10.96% and 1.48 % respectively,however,without statistical significance (t =-2.05 ,P =0.055 and t =-1.33 ,P =0.197).The conformal index of planning target volume (PTV) by the Rap~dAre planning was (0.88±0.02),significantly higher than that by the IMRT planning [(0.74±0.03),t = 18.54,P < 0.001].The homogeneity index (HI) of PTV by the RapidArc planning was 1.11±0.01,significantly lower than that by the IMRT planning (1.12±0.02,t =-2.44,P =0.02).There were no significant differences in the maximum dose (Dmax) and V20 for the ipsilateral lung between the RapidArc and IMRT planning,but the values of V10,V5 ,Dmin and Dmean by RapidArc planning were all significantly higher than those by the IMRT planning (all P < 0.01).The values of max dose and V30 for the heart were similar by both techniques,but the values of V10 and V5 by the RapidArc planning were significantly higher (by 18% and 50% ,respectively).The V5 of the contralateral breast and lung by the RapidArc planning were increased by 9.33% and 3.04% respectively compared to the IMRT planning.The mean MU of the RapidArc was 608 MU,significantly higher than that by the IMRT planning (437 MU,t = 10.86,P < 0.001).The treatment time by the RapidArc planning was 111.3 s,significantly longer than that by IMRT planning (103.6 s,t = 3.57,P = 0.002).Conclusions The RapidArc planning improves the dose distribution of CTV and homogeneity of PTV for breast cancer radiotherapy after breast-conserving surgery.However,it significantly enlarges the volume of normal tissues irradiated in low dose areas,prolongs the treatment delivery time,and increases the MU value in comparison with IMRT.

OBJECTIVE: To investigate the effect of oral administration of insulin on insulitis beta cell apoptosis and diabetes in non-obese diabetic (NOD) mice, and to explore the mechanism of immune tolerance induced by insulin. METHODS: Eighty-six female NOD mice were randomly divided into an insulin group (n=43) and a phosphate buffered saline (PBS) group (n=43). From 4 weeks of age, the recombinant human insulin (Humulin R) 1 mg (70 microL) was administrated in the oral insulin group and 70 microL PBS in the control group respectively, twice per week before 12 weeks of age and then once weekly until 30 weeks. Insulitis and beta cell apoptosis of islets were observed at 12 weeks. IL-4 and IFN-gamma in the sera were measured by enzyme linked immunosorbent assay (ELISA). The expression levels of I-Abeta(g7), IL-4, IFN-gamma, IL-1beta, Fas and TGF-beta mRNA of islets, and IL-4, IFN-gamma, TGF-beta mRNA of Peyer's patch were measured by reverse transcription-polymerase chain reaction (RT-PCR) at 12 weeks. RESULTS: The incidences in the insulin group were significantly lower than those in the PBS group (55.6% vs 85.7% at 30 weeks, 70.4% vs 96.4% at 52 weeks, P<0.05). The insulitis scores in the insulin group were lower than those in the PBS group, but there was no statistical significance. Fas expression on islets and apoptotic beta cell rates in the insulin group were lower than those in the PBS group (P<0.05). In the insulin group, serum IL-4 levels were higher, and IFN-gamma levels were lower than those in the PBS group (P<0.05). The levels of I-Abeta(g7), IFN-gamma, IL-1beta and Fas mRNA transcription in islets and IFN-gamma mRNA transcription in Peyer's patch were both lower in the insulin group, and IL-4, TGF-beta mRNA levels were higher than those in the PBS group (P<0.05). CONCLUSION The specific autoantigen insulin may induce the immune tolerance and prevent the diabetes in NOD mice, but it cannot block the progression of insulitis. Oral administration of insulin can induce the regulatory T cells, and make Th1 to Th2 cytokine shifts in the system and islets, thus preventing the Fas-mediated beta-cell apoptosis and diabetes.
Administration, Oral ; Animals ; Apoptosis ; drug effects ; Cytokines ; metabolism ; Diabetes Mellitus, Type 1 ; drug therapy ; pathology ; Female ; Insulin, Regular, Human ; administration & dosage ; pharmacology ; Islets of Langerhans ; cytology ; drug effects ; Mice ; Mice, Inbred NOD ; Th1-Th2 Balance ; fas Receptor ; metabolism

Objective To investigate whether elevated pre-procedural C-reactive protein (CRP) and Interleukin-6 (IL-6) concentrations may be relevant to early outcome in patients undergoing PCI.Method 100 consecutive patients undergoing pereutaneuous coronary intervention (PCI) were included in our study.Peripheral blood samples for CRP and IL-6 testing were withdrawn before PCI.Acute vascular complications resulted from PCI were determined by subsequently coronary angiography.The early coronary events during hospitalization were clinically followed.Results Thirty patients developed acute vessel occlusion,and another one developed subacute coronary thrombosis at 2 days after PCI.Increased levels of CRP correlated well with the occurrence of vascular complications as regards the significant difference existing amongⅠvsⅢandⅠvsⅣquartile groups,P

OBJECTIVE: To investigate the effects of subcutaneous administration of insulin on insulitis,beta cell apoptosis and diabetes in non-obese diabetic (NOD) mice, and to explore the mechanism of immune tolerance induced by insulin. METHODS: Sixty female NOD mice were randomly divided into insulin group (n=32) and phosphate buffered saline (PBS) group (PBS group, n=28). Insulin was subcutaneously injected with humulin N (60 microL, 6U)+IFA (60 microL) at 4, 12, 20, and 28 weeks respectively, while the PBS group received PBS (60 microL) + IFA (60 microL). Insulitis and beta cell apoptosis of islets were observed at 12 weeks. IL-4 and IFN-gamma in the sera were measured by enzyme linked immunosorbent assay (ELISA). The expression levels of I-Abeta(g7), IL-4, IFN-gamma, IL-1beta, and Fas mRNA of islets were measured by reverse transcription-polymerase chain reaction (RT-PCR) at 12 weeks. RESULTS: The incidences in the insulin group were significantly lower than those in the PBS group (21.4% vs 71.4% at 30 weeks, 28.6% vs 85.7% at 52 weeks, P<0.05). The insulitis scores in the insulin group were lower than those in the PBS group, but there was no statistical significance. Fas expression on islets and apoptotic beta cell rates in the insulin group were lower than those in the PBS group (P<0.05). In the insulin group, serum IL-4 levels were higher, but IFN-gamma levels were lower than those in the PBS group (P<0.05). The levels of I-Abeta g7, IFN-gamma, IL-1beta and Fas mRNA transcription in islets were lower in insulin group, but IL-4 mRNA levels were higher than those in the PBS group (P<0.05). CONCLUSION The specific autoantigen insulin may induce immune tolerance and prevent diabetes in NOD mice, but it can't block the progression of insulitis. Subcutaneous administration of insulin can induce the regulatory T cells, and make Th1 to Th2 cytokine shifts in system and islets, thus preventing the Fas-mediated beta-cell apoptosis and diabetes.
Animals ; Apoptosis ; drug effects ; Diabetes Mellitus, Experimental ; prevention & control ; Diabetes Mellitus, Type 1 ; prevention & control ; Female ; Injections, Subcutaneous ; Insulin ; administration & dosage ; pharmacology ; Islets of Langerhans ; immunology ; pathology ; Mice ; Mice, Inbred NOD ; Pancreatitis ; prevention & control ; Random Allocation

OBJECTIVETo investigate the efficacy and safety of the magnetic navigation system used in the real world percutaneous coronary artery intervention.

METHODSAll lesions detected by the coronary artery angiography in the magnetic-navigation catheter lab indicated for percutaneous coronary artery intervention (PCI) were included and treated under the guidance of the magnetic navigation system. The characteristics of the target lesion, process of the procedure, time and dosage of the X-ray exposure, and procedure-related complication were recorded and analyzed.

RESULTSOne hundred and twenty one patients with 138 lesions were recruited and intervened by PCI during the period from April 2006 to June 2008. Thirty lesions were classified as type A, 50 as type B1, 36 as type B2, 22 as type C (including seven total occlusions). The average stenosis of the target lesions was (85.3 +/- 10.0)%, mean length was (21.1 +/- 10.0) mm. Under the guidance of the magnetic navigation system, 134 target lesions were passed by the magnetic guide-wires, the lesion passing ratio was 97.1%. The X-ray exposure time, X-ray dosage and the contrast volume used during the period of the wire placement were (55.9 +/- 35.4) seconds, (98.0 +/- 86.1) mGy/(490.0 +/- 422.2) microGym(2) and (8.0 +/- 5.4) ml, respectively. A total of 164 stents were implanted in the vessels where the target lesions were passed by the magnetic wires. There was no magnetic navigation system associated complication. Magnetic guide-wires failed to pass four target lesions, two of which were chronic total occlusions (CTOs), and the other two were calcified subtotal occlusions.

CONCLUSIONSIt is feasible and safe to adopt the magnetic navigation system for the real-world coronary artery intervention. The magnetic guide-wire possesses a high lesion-passing ratio. The CTOs and calcified subtotal occlusions are not ideal lesions for use of the magnetic navigation system.

Aged ; Angioplasty, Balloon, Coronary ; methods ; Coronary Artery Disease ; therapy ; Coronary Vessels ; Female ; Humans ; Magnetics ; Male ; Middle Aged ; Surgery, Computer-Assisted

Coal ; Dust ; analysis ; Gases ; adverse effects ; Humans ; Male ; Middle Aged ; Occupational Exposure ; analysis ; Pulmonary Alveolar Proteinosis ; etiology

OBJECTIVETo evaluate the possible vascular effects of an environment carcinogen benzo(a)pyrene (BaP).

METHODSThe cytotoxicit of BaP and rat liver S9 (0.25 mg/mL)-activated BaP were examined by MTT assay. Thoracic aortic rings were dissected from Sprague-Dawley rats. Contraction of aortic rings was induced by 60 mmol/L KCl or 10(-6) mol/L phenylephrine (PE) in an ex-vivo perfusion system after BaP (100 μmol/L) incubation for 6 h. [Ca(2+)](i) was measured using Fluo-4/AM. For in-vivo treatment, rats were injected with BaP for 4 weeks (10 mg/kg, weekly, i.p.).

RESULTSBaP (1-500 μm) did not significantly affect cell viability; S9-activated BaP stimulated cell proliferation. BaP did not affect the contractile function of endothelium-intact or -denuded aortic rings. BaP did not affect ATP-induced ([Ca(2+)](i)) increases in human umbilical vein endothelial cells. In BaP-treated rats, heart rate and the number of circulating inflammatory cells were not affected. Body weight decreased while blood pressure increased significantly. The maximum aortic contractile responses to PE and KCl and the maximum aortic relaxation response to acetylcholine were significantly decreased by 25.0%, 34.2%, and 10.4%, respectively.

CONCLUSIONThese results suggest, in accordance with its DNA-damaging properties, that metabolic activation is a prerequisite for BaP-induced cardiovascular toxicity.

Animals ; Aorta ; drug effects ; Benzo(a)pyrene ; pharmacology ; Calcium ; metabolism ; Endothelial Cells ; drug effects ; metabolism ; Humans ; Male ; Rats ; Vasoconstriction ; drug effects

BACKGROUNDThe subtemporal transtentoral approach has been reported for nearly two decades; however it was not well used due to some limitations in dealing with large and giant petroclival meningiomas. The clinical outcome and merit of the modified subtemporal transpetrosal apex approach in large and giant petroclival meningiomas, as well as the choices, the improvements and the therapy strategies of the microsurgical approach in such patients were evaluated in this study.

METHODSTotally 25 cases of large and giant petroclival meningiomas undergone the modified subtemporal transpetrosal apex approach between April 2004 and January 2010 were enrolled in this study. The choice and improvement of the approach, the basis of anatomy and related research, the effect of accessory equipment, the exposure of tumor and the changes of neurofunction pre- and post-operation were all reviewed retrospectively. The operation outcomes and complications in this approach were also compared with those in the transpetrous presigmoid approach done in 14 cases in the same period.

RESULTSAll 25 cases underwent the modified subtemporal transpetrosal apex approach under electrophysiologic monitoring of cranial nerves and brain stem function. Trochlear nerve was partly wrapped in 14 cases, totally wrapped but can be explored in the initial segment of the cerebellum tentorium in 8 cases, totally wrapped and could not be seen until tumor was partly removed in 3 cases. The cerebellum tentorium was cut along the temporal bone from the anterior part of the apex to the mastoid part of superior petrous sinus in 6 cases, from the posterior part of the apex to the mastoid part of superior petrous sinus in 19 cases. Gross tumor resection was accomplished in 17 (68%) patients, subtotal resection in 7 (28%) patients, and partial resection in 1 (4%) patient. The most common postoperative complication was new neurological deficits or aggravations of preexisting deficit (64%). Follow-up ranged from 3 to 69 months. Compared with the transpetrous presigmoid approach done in 14 cases in the same period, the modified subtemporal transpetrosal apex approach showed obvious advantages such as simplicity in manipulating, microinvasiveness, less time-consuming, less complication, higher rate of tumor resection though the rates of gross tumor resection might be of no significant difference.

CONCLUSIONSModified subtemporal transpetrosal apex approach has obvious advantages compared with the transpetrous presigmoid approach. Some complications need to be solved by practice and modification of the approach as well as the accumulation of the experiences.

Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Meningioma ; pathology ; surgery ; Middle Aged ; Neurosurgical Procedures ; methods ; Young Adult

OBJECTIVETo explore the relationship between myeloperoxidase (MPO) 129 A/G promoter polymorphisms and the severity of coronary artery disease (CAD).

METHODSThe study enrolled 267 patients who had been diagnosed as coronary artery diseases by coronary angiography. The serum MPO activity was detected by colorimetric method. PCR-RFLP method was used to decide the genotypes of the patients. The severity of CAD was evaluated by the numbers of stenotic coronary arteries and the Gensini scores respectively.

RESULTSThe MPO 129 locus G and A alleles frequency were 0.893 and 0.107, respectively. No significant difference was observed in serum MPO activity between different genotypes (P > 0.05). The distribution of genotypes in different Gensini score groups had no significant difference (P > 0.05). The patients with GG genotypes were prone to develop mutivessel diseases.

CONCLUSIONNo significant correlation exists in MPO 129 locus polymorphism and serum MPO activity. The MPO 129 locus polymorphism isn't a reasonable predict factor of CAD severity.

Adult ; Aged ; Aged, 80 and over ; Coronary Angiography ; Coronary Artery Disease ; blood ; genetics ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Peroxidase ; blood ; genetics ; Polymorphism, Genetic ; Promoter Regions, Genetic ; genetics ; Risk Factors ; Severity of Illness Index