Objective To study the accuracy of SentinelTM system for patient setup using rigid-body phantom.Methods A 002LFC IMRT phantom was placed on Elekta HexaPODTM 6-degree couch using tattoo and the laser in the treatment room.When a well-know shift (3 directions) and rotation (3 positions) was moved,CBCT and SentinelTM system were scanned respectively,and the measuring errors of six dimensions were recorded.The absolute differences between applied and measured errors were compared and paired t-test.Results Total 15 well-know shifts were investigated.The SentinelTM system was very good stability and the largest absolute difference only 0.9 mm (z direction) and 0.2° (arbitrary direction).At the same time,a good conformance between SentinelTM system and CBCT was displayed because the largest absolute difference between applied and measuring error was less than 0.9 mm (z direction) and 0.2° (arbitrary direction).Conclusions SentinelTM system is fast,simple,non-invasive and seems to be reliable in detecting patient setup errors.It maybe hold potential to ensure precise patient positioning with reduced CBCT frequency in tumor locations with fixed relation to surface structures.

Objective To investigate the impact of oral contrast agent for assisting in outlining the small bowel on pelvic volumetric modulated arc therapy (VMAT) dose in patients with cervical cancer.Methods Nine cervical cancer patients for postoperative radiotherapy underwent CT scans,and the target volumes and organs at risk including the small bowel were contoured.The VMAT plan was designed for each case.Then another plan was generated by re-calculating the radiation dose after changing the electron density of the small bowel.The first plan (plan A) was the conventional VMAT plan,and the second one (plan B) specified the electron density of the small bowel.Paired t-test was used to compare the dose distribution between the two plans.Results The Dg8,D5o,conformity index,and homogeneity index of plans A and B were 4 989.1 vs.5 000.1 cGy (P =0.026),5 208.6 vs.5 191.6 cGy (P =0.005),0.766 vs.0.765 (P =0.920),and 0.081 vs.0.074(P =0.055),respectively.The volumes of the small bowel receiving at least 30 Gy for plans A and B were 309.3 vs.314.3 cm3(P =0.207),while bladder V45 of the two plans was 52.4％ vs.51.1％ (P =0.168).To achieve the same prescribed dose,plan A and plan B needed 893.3 MU and 865.8 MU (P =0.093).Conclusions The contrast agent filling the small bowel does not lead to a significant increase in the pelvic VMAT dose in patients with cervical cancer after surgery.

Objective To explore the effects of passive smoking on vascular endothelial function in office women.Methods Totally,94 healthy office women volunteers from urban(36 women)and townships or towns(58 women)were divided into three groups based on the extent of their daily exposure to passive smoking,group A exposed to one to eight cigarettes,group B exposed to nine to 15 cigarettes,and group C exposed to more than 15 cigarettes,respectively,with 20 healthy young women without exposure to passive smoking as controls.Internal diameter of the brachial artery Was measured by color Doppler ultrasound scanning for each of the participants and its changes were observed before and after congestive reaction of the brachial artery test and nitroglycerin test.Results Thirteen of 36 office women from urban and 38 of 58 from townships or towns exposed to passive smoking of more than eight cigarettes daily,with chi-square of 7.74,P=0.0054.The brachial artery in groups A,B and C dilated less than that in the controls did.The brachial artery in group C dilated less than that in the groups A and B did.Conclusion Passive smoking could damage vascular endothelial dilatation function in office women.

Objective To compare the difference between volume computed tomography dose index (CTDIvol) and size-specific dose estimates (SSDE) in evaluating the radiation dose of abdominal CT scan.Methods Abdominal CT scan were performed on 180 patients with a Philips 256-slices spiral CT.The anterior-posterior dimension (AP) and lateral dimension (LAT) of each patients were measured at the level of left renal vein, and the effective diameter (ED) and SSDE were calculated with recorded CTDIvol Patients were categorized into 3 groups depending on body mass index (BMI): group A, BMI ＜ 20.0 kg/m2;group B, 20.0-24.9 kg/m2;group C, BMI ＞ 24.9 kg/m2.The differences between CTDIvoland SSDE of 180 patients and three different BMI groups were compared respectively.Results There was a significant difference between CTDIvol and SSDE of the 180 patients (t =-13.354, P ＜ 0.01), CTDIvol and SSDE were (9.91 ± 2.91) and (14.01 ± 2.82) mGy, respectively.For group A, CTDIvol and SSDE were (7.96 ± 1.83) and (12.83 ± 2.52) mGy, respectively (t =-8.417, P ＜ 0.01).Group B, CTDIvol and SSDE were (9.28 ± 1.76) and (13.62 ±2.18) mGy, respectively (t =-15.051, P ＜ 0.01).Group C, CTDIvol and SSDE were (12.19 ± 3.65) and (15.39 ± 3.47) mGy, respectively (t =-4.535, P ＜ 0.01).In addition, the mean percentage values of difference between CTDIvol and SSDE for the three groups were 62.83％, 47.80％, 28.40％, respectively, which meant CTDIvol underestimated the radiation dose compared to SSDE.With the BMI increasing, the values of difference between CTDIvol and SSDE decreased.Conclusions SSDE can be used to estimate the radiation dose of abdominal CT scan for a given size person.

OBJECTIVE: To evaluate the clinical value of heterogeneous acellular dermalmatrix with autologous bone meal in open tympanoplasty. METHOD: Twenty-eight cases (30 ears) with middle ear cholesteatoma were trea- ted by open tympanoplasty and repaired by heterogeneous acellular dermalmatrix autologous bone meal on study team. Twenty-two cases (22 ears) with middle ear cholesteatoma were treated by open tympanoplasty on control team. All patients were followed up for 12 to 18 months and assessed the fuction postoperatively. RESULT: The re- construction of external auditory canal structure is close to normal, and no narrow happens on study team. The rate of dry ear was about 90%. All cases had no recurrence of cholesteatoma. CONCLUSION Application of decellu- larized dermal matrix with autologous bone meal can rise early to cover the wound, promote wound healing and to reduce the external auditory canal, reduce the effect of granulation and scar formation. It is a kind of method of repair to be promoted.
Acellular Dermis ; Biological Products ; Cholesteatoma, Middle Ear ; surgery ; Cicatrix ; Ear Canal ; surgery ; Humans ; Minerals ; Postoperative Period ; Recurrence ; Tympanoplasty ; methods ; Wound Healing

Objective To investigate the clinical efficacy of biological amniotic membrane for otoscpic repair of traumatic perforation of tympanic membrane. Methods Otoscpic repair was performed on the patients with tympanic membrane perforation which was not healed for 6 months. The efficacy was observed postoperatively. Results The success rate of the procedure was 97.37%, except that one patient was not healing by first intention due to wound infection. Conclusions Biological amniotic membrane is definitely efficacious in the surgical repair of perforation of tympanic membrane. Otoscpic sugical repair is less invassive and has a higher success rate.

Objective To evaluate the influence of dosage,operation method,adverse reaction of endoscopic photodynamic therapy (EPDT) on its therapeutic efficacy in rabbit models of in-situ rectal cancer,so as to provide preclinical basis of photodynamic therapy for rectal cancer.Methods 20 rabbits with in-situ VX2 rectal cancer were randomly divided into control group,PDT low dose group,intermediate dose group,and high dose group.At 24 h before PDT,photosensitizer (hermimether) was intravenously injected into rabbits.630 nm semiconductor laser was used as light source.The growth of the tumor was observed by conventional endoscopy and endoscopic ultrasonography,and the survival time,general conditions and adverse reactions were recorded.The histopathological changes were observed by hematoxylin-eosin staining.Results At 7 d after PDT,the total response rates of low dose,intermediate dose and high dose group respectively were 40％ (slight),80％ (60％ remarkable and 20％ slight),100％ (20％ remarkable and 80％ slight).The average survival times of the three groups were 14 d,10 d and 5 d,respectively.The main adverse reactions were inflammation,intestinal obstruction,intestinal peristalsis loss and death.Conclusions The dosage of PDT is an important factor to influence the curative effect.The appropriate dose of PDT will have a better effect on the treatment of rectal cancer.A thorough study of these problems is helpful to the clinical application of PDT in the treatment of rectal cancer.

OBJECTIVETo explore the pattern of lymphatic metastasis and risk factors of esophageal carcinoma that invades less than adventitia.

METHODSClinical data of 484 patients receiving esophagectomy from January 2011 to August 2014 were reviewed, whose carcinoma invaded less than adventitia. The lymph node metastasis pattern of the primary tumor and corresponding influence factor were analyzed.

RESULTSTotal lymph node metastatic rate was 32.0% (155/484). Sixteen of 61 upper thoracic esophageal carcinoma patients (26.2%) had lymphatic metastasis. Fifty-five of 201 middle thoracic esophageal carcinoma patients (27.4%) had lymphatic metastasis. Eighty-four of 222 lower thoracic esophageal carcinoma patients(37.8%) had lymphatic metastasis. The deeper tumor invaded, the easier lymph node metastasis occurred, as well as the lower of the tumor differentiation and the larger of the tumor diameter. Multivariate analysis revealed lesion diameter (P=0.005), differentiation degree (P=0.007) and invasion depth (P=0.001) were independent risk factors of lymphatic metastasis in esophageal cancer that invaded less than adventitia.

CONCLUSIONDepth of tumor invasion, diameter of tumor and tumor differentiation are risk factors of lymph node metastasis of esophageal carcinoma that invades less than adventitia.

Adventitia ; pathology ; Esophageal Neoplasms ; pathology ; Esophagectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Metastasis ; Multivariate Analysis ; Retrospective Studies ; Risk Factors

Objective To compare the differences in setup error ( SE) assessment and correction between three-dimensional cone-beam computed tomography ( 3DCBCT ) and four-dimensional CBCT ( 4 DCBCT ) in breast irradiation patients during free breathing after breast-conserving surgery . Methods Twenty patients with breast cancer after breast-conserving surgery were recruited for external beam breast irradiation and 4DCBCT and 3DCBCT simulation. The target volumes were delineated. Volumetric modulated arc therapy plans were designed using the MONACO v510 treatment planning system. 3DCBCT and 4DCBCT images were collected alternately five times each before breast irradiation. The CT images were matched, and the interfraction SEs were acquired. After online setup correction, the residual errors were calculated, and the SEs, systematic errors, and random errors were compared. The paired t test was used for comparison between groups. Results The SEs acquired by 4DCBCT were significantly larger than those acquired by 3DCBCT in three directions ( P=0035, 0018, 0040 ) . After online setup correction, the random errors based on 3DCBCT were significantly smaller than those based on 4DCBCT in left-right and anterior-posterior ( AP ) directions ( 0.5± 039 mm vs. 0.7± 030 mm, P=0005;0.9± 109 mm vs. 1.2± 048 mm, P=0000) , and the residual errors based on 3DCBCT were also significantly smaller than those based on 4DCBCT in AP direction (0.2±033 mm vs. 0.6±063 mm, P=0000). The setup margins based on 4DCBCT was significantly larger than those based on 3DCBCT in AP direction both before and after online setup correction (P=0002). Conclusions Compared with 3DCBCT, 4DCBCT has more advantages in monitoring the SEs in three directions. Both 3DCBCT and 4DCBCT have similar efficacy in random error correction. The satisfying position repeatability and minimized target volume margins will be achieved by online setup correction.