The image guided radio therapy (IGRT) Imaging System based on cone-beam computer tomography (CBCT) can reach the goal of improving the accuracy of the radiotherapy. However, because the clinical registration between CBCT images and Planning CT images is carried out manually, it inevitably reduces radiation positioning accuracy to some extent. To tackle the problem, we proposed a new feature vector selection method for the CBCT image elastic registration in the framework of hierarchical attribute matching mechanism for elastic registration (HAMMER) algorithm. We analyzed the characteristics of HAMMER algorithm and used Canny operator which has a better edge detection and positioning performance to replace the noise-sensitive gradient amplitude. Therefore, we used a new attribute vector, which consisted of the intensity, Laplacian of the Gaussian and Canny operator, to ex tract the image feature points in CBCT and planning CT images. We also presented an adaptive feature-point selection method and the choice criteria of attribute vector weights. Experimental results showed that the new feature vector effectively avoided the noise interference resulted from scattering lines in CBCT images to improve registration accuracy, and it also decreased the required feature point numbers and reduced the computation redundancy, so that it provided a new approach for the clinical elastic registration of CBCT and Planning CT rapidly and accurately.
Algorithms ; Cone-Beam Computed Tomography ; Humans ; Radiotherapy ; methods ; Radiotherapy Planning, Computer-Assisted

Objective To compare the incidence of cardiopulmonary complications between treatment of video assisted thoracoscopic operation and traditional thoracotomy operation in elderly patients with non-small cell lung cancer.Methods 122 cases of elderly patients with non small cell lung cancer were treated in our hospital from Mar 2010 to Jun 2014,and randomly divided into observation group (therapeutic lobectomy by video assisted thoracoscopic operation) and control group (therapeutic lobectomy by traditional thoracotomy operation) (n=61,each).The postoperative cardiopulmonary complications and relevant indexes of cardiopulmonary function were analyzed and compared between the two groups.Results Before operation,there was no significant difference in the relevant indexes of cardiopulmonary function between the two groups (P＞0.05).After operation,the forced expiratory volume in one second (FEV1) and maximal ventilatory volume (MMV) were higher and the heart rate was lower in observation group than in control group (t=3.682,2.243,5.677,all P＜0.05).The incidence of cardiopulmonary complication was lower in observation group than in control group (13.1％ vs.27.9％,x2 =4.075,P=0.044).Conclusions Video assisted thoracoscopic operation is better for the recovery of cardiopulmonary function,and can reduce cardiopulmonary complication in elderly patients with non-small cell lung cancer.

To study the expression of transforming growth factor β1 (TGFβ1) and platelet-derived growth factor (PDGF) in alveolar type Ⅱ cells and their significance in the process of pulmonary fibrosis. MethodsCultivation of alveolar type Ⅱ cells were mode from normal adult rat and of silicotic animal model of rat was established. In situ hybridization and irnmunohistochemieal staining were applied to detect the gene expression of TGFβ1 and PDGF-B in the alveolar type Ⅱ cells of primary culture and silicotic tissue. Results(1) In situ hybridization and immunohistochemical staining showed the positive expression of TGFβi, PDGF-B rnRNAs and their relevant proteins in cultured alveolar type Ⅱ cells. (2) The positive expression of TGFβ1, PDGF-B rnRNAs and their proteins were prominent in the proliferative alveolar type Ⅱ cells of experimental group of silicotic models. Weak expression of TGFβ1 mRNA were found only in a part of normal alveolar type Ⅱ cells of control group. ConclusionThe proliferative alveolar type Ⅱ cells express TGFβ1 and PDGF-B, which may play an important role in silicotic fibrcsis.

Objective To investigate the clinical manifestation,pathological characteristics,neurological imaging,indications,operative approach and microsurgieal technique of surgery for brain stem tumor.Methods 17 cases of brain stem tumor treated by applying microsurgical skills were retrospectively analyzed from Jan.2002 to Dec.2007.Ten cases were operated via the suboccipito-retromastoid approach,among which 5 situated in pons,3 in medulla oblongata and 2 invoved both pens and medulla oblongata;4 cases were performed via the posteromedian-suboccipital approach,among which 2 located in pens,1 in medulla oblongata and 1 involved both midbrain and pens;3 lesions situated in varying sites of mesencephalon were operated by the suboceipito-supratentorial,infratemporal approach and pterional approach respectively.Results In the series of the patients,lesion was totally excised in 6 cases,subtotally in one,without surgical mortality.All patients were followed up for years ranging from 5 months to 4 years.During the follow-up period,seven patients resumed work and normal life;4 patients could perform physical labor;3 patients obtained self care capability;2 patients needed to be taken care of,1 patient died from pneumonia after discharge.Conclusion Fine therapeutic efficacy and low disability rate could be obtained while applying microsurgical techniques to resect brain stem tumors with correct indication,appropriate approach and elaborate microneurosurgical skills.

Objective To evaluate the potential risk of aorta injury by simulating different lateral misplacement patterns of thoracic pedicle screws (TPS) in the treatment of adolescent idiopathic scoliosis (AIS).Methods From December 2010 to August 2011,50 AIS patients were admitted to our hospital,including 7 males and 43 females,aged from 13 to 18 years (average,15.3±2.6 years).All patients underwent axial magnetic resonance imaging (MRI) scans from T5 to T12.The left pedicle-aorta (LtP-Ao) angle and distance were measured on the axial MR images by the software of PACS Client.The lateral misplacement of pedicle screw was simulated with variable direction errors (10°,20°,30°) and different lengths of pedicle screw (30 mm,35 mm,40 mm).A total of nine patterns of lateral pedicle screw misplacement were set up,and a warning misplacement was defined as the mimic pedicle screw crossed the aorta.The percentages of warning misplacement were compared in each pattern of lateral pedicle screw misplacement and each level from T5 to T12.Correlation analysis was made between the percentages of warning misplacement and the direction errors as well as length of pedicle screw.Results The mean LtP-Ao angle increased from 34.3°±8.5° at T5 level to 45.7°±4.1° at T7 level,and then gradually decreased to 9.2°±5.6° at T12 level.The mean LtP-Ao distance increased from 28.2±7.3 mm at T5 level to 37.7±6.5 mm at T12 level.The percentages of warning misplacement were positive correlation with the direction errors and length of pedicle screw.The percentage of warning misplacement was higher at the T11 level.Conclusion The potential risk of aorta injury increases with enlarging of direction error and lengthening of thoracic pedicle screw,particularly at the T11 level.

Objective To investigate the risk factors and revision strategies for rod fracture in patients with severe kyphoscoliosis following posterior vertebral column resection (PVCR).Methods Between June 2003 and June 2011,7 patients (4 males and 3 females) who developed rod fractures following PVCR in our institution were retrospectively reviewed.The average age was 24.4 years (range,12-39 years) at the time of primary surgeries.The occurrence times and locations of the rod fractures were recorded and the risk factors for the fractures were analyzed.Results The occurrence times of the rod fractures ranged from 6 to 53 months.Five cases of fracture occurred within 2 years after the primary surgeries,while the other 2 cases occurred more than 4 years after the primary surgeries.Six cases of fracture occurred at levels of osteotomies and 1 case occurred at 1 level below the osteotomy.The potential reasons for rod fractures were listed as follows:(1)residual kyphosis (1 case); (2) residual kyphosis combined with unsteady gait (1 case); (3) residual kyphosis combined with single rod fixation (1 case); (4) residual kyphosis combined with malposition of titanium mesh cage (1 case); (5) residual kyphosis combined with anterior column defect; (6) injury (2 cases).Six patients underwent revision surgeries,5 patients received one-stage combined anterior-posterior approach surgeries,while 1 patient received single posterior surgery.They were followed up for 12 to 22 months (average,18months).At final follow-up,all patients obtained satisfying corrections and graft fusion,without internal fixationrelated complications.Conclusion Rod fractures mostly occur at levels of osteotomies within 2 years after PVCR.Residual kyphosis is the main risk factor for the rod fracture.Injury,anterior column defects,unsteady gait,single rod fixation and malposition of titanium mesh cage also increase risks of rod fractures.

Objective To assess the effects of femtosecond laser-assisted anterior capsulotomy versus manual continuous curvilinear capsulorhexis on intraocular lens (IOL) centration by measuring and comparing shape,size and positional parameters.Methods Eighty cases (80 eyes) with age-related cataract from March 2015 to July 2016 in our hospital were collected.Forty patients (40 eyes) in the femtosecond group underwent femtosecond laser anterior capsulotomy and 40 patients (40 eyes) in the annular group were treated with annular continuous capsulorhexis.At postoperative 1 week,1 month,1 year,the slit lamp digital photography and Pentacam anterior segment analyzer were used to collect the anterior segment images,and the parameters include horizontal and vertical diameter,roundness,package and partial centre of IOL were analyzed by image analysis software image-pro-plus 6.0.Using repeated measurement of variance analysis,Fisher exact probability,and Generalized estimation equations (GEE),the differences between parameters of the groups and IOL decentration predictor were analyzed.Results The vertical diameter,roundness,maximum distance,minimum distance,package and horizontal deviation were statistically significant between the femtosecond group and the annular group at 1 week and 1 month after operation (all P ＜ 0.05),and there was no significant difference in horizontal diameter and vertical deviation between two groups (all P ＞ 0.05).At 1 year after operation,the maximum distance,minimum distance,package and horizontal deviation between two groups were statistically significant (all P ＜ 0.05).There was no significant difference in vertical and horizontal diameter,roundness,and vertical deviation between two groups (all P ＞ 0.05).There was no patient with horizontal shift ＞ 0.4 mm in the femtosecond group at 1 week,1 month and 1 year;The ratio of cases with horizontal shift ＞0.4 mm and ＜0.4 mm in the annular group at 1 week,1 month and 1 year were 2/38,4/36,8/32,respectively.There was significant difference in the horizontal shift ＞ 0.4 nun between the two groups after 1 year(P ＜ 0.05).In the univariate generalized estimating equation model,the capsulorhexis type was a significant predictor of horizontal shift.Of all the capsulorhexis parameters,the difference of inclusion degree was statistically significant (P =0.001).There was negative correlation between the horizontal shift and package at different time points in the femtosecond group at 1 week,1 month and 1 year (r =-0.89,P ＜ 0.05;r =-0.72,P ＜ 0.05;r =-0.58,P ＜ 0.05);There was negative correlation between the horizontal shift and package at different time points in the annular group at 1 week(r =-0.68,P ＜ 0.05),but no correlation at 1 month and 1 year (r=-0.41,P＞0.05;r=-0.33,P＞0.05).Conclusion The anterior capsule made by femtosecond laser anterior capsulotomy is more round,centered and accurate,pocket IOL position is more stabled and neutral.

Objective To explore the effect of anoxic microenvironment and hypoxia related microRNA-210 (miR-210) on the epithelial-mesenchymal transition (EMT) in gastric cancer cell line 803.Methods The mRNA relative expressions of E-cadherin and Twist1 were detected by qRT-PCR in gastric cancer cell line after being induced hypoxia by CoCl2 (100,200 and 300 μ mol/L),which was compared with normoxic group (0 mol/L).The cell proliferation of gastric cancer cell line was observed by cell proliferation assay.The relative expressions of E-cadherin and Twist 1 were detected in gastric cancer cell line after transfecting miR-210 mimics.Results With the increase of the concentrations of CoCl2,the relative expression of miR-210 and the proliferation rate of gastric cancer cells showed a tendency of increase first and then decrease (P ＜ 0.05).The relative expression of E-cadherin mRNA was lower in hypoxia group than that of normoxic group.The relative expression of Twist1 mRNA was higher in hypoxia group than that of normoxic group.The relative expressions of Ecadherin mRNA were significantly higher in 200 and 300 μ mol/L CoCl2 groups than that of 100 μmol/L CoCl2 group (P ＜0.05).There was no significant difference in the relative expression of Twist1 mRNA between the three CoCl2 groups.The relative expression of Twist1 mRNA was higher in the transfection group than that of control group.The relative expression of E-cadherin mRNA was significantly lower in the transfection group than that of control group (P ＜ 0.05).Conclusion Hypoxia can promote the proliferation and EMT of gastric cancer cells.The up-regulation of miR-210 can also promote the procession of EMT,which may be the intermediate link in the process of EMT induced by hypoxia.

Objective To compare the clinical and radiological outcomes between hybrid and total pedicle screw instrumentation in adolescents undergone posterior spinal fusion (PSF) for thoracic scoliosis secondary to Chiari malformation..Methods A total of 75 patients undergone PSF were included and divided into two groups:the all pedicle screw group (Group A,n=44) and the hybrid group (Group B,n=31).Patients were evaluated before surgery,immediately after surgery,and at the 2-year follow-up in radiographic changes in curve magnitude,apical vertebral translation (AVT),apical vertebral rotation (AVR),trunk shift,thoracic kyphosis (TK),lumbar lordosis (LL),and sagittal vertical axis (SVA).These parameters were further analyzed with respect to preoperative TK in both groups.Results After surgery,the average correction of the thoracic curve was 60.2％ and 51.3％ in Group A and B,respectively (t=2.372,P=0.023).The average lumbar curve correction was 61.7％ in Group A,representing a significant increase compared to Group B (51.1％,t=2.431,P=0.020).At the final follow-up,loss of the thoracic curve correction was less in Group A (0.3％) than in Group B (1.7％),however,there was no statistical significance (t=-0.468,P＞0.05).AVT of the thoracic curve improved in Group A from 25.0 mm to 6.9 mm,while in Group B it changed from 24.1 mm to 7.4 mm.For patients with a preoperative TK greater than 40°,the proximal junctional angle was found to be significantly larger in Group A (10.0 degrees versus 4.5 degrees,t=-2.031,P=0.052) by the final follow-up,along with a significantly increased incidence of proximal junctional kyphosis (20％ versus 9％).Conclusion Total pedicle screw instrumentation provided a significantly better correction of the major and minor curves than hybrid constructs for the operative treatment of thoracic scoliosis secondary to Chiari malformation.However,for patients with thoracic hyperkyphosis,all-screw instrumentation had a higher risk of adjacent level proximal kyphosis.

Objective To explore the activity and its possible neural mechanism of brain default mode network by using resting state functional magnetic resonance imaging (fMRI) in patients with mild cognitive impairment (MCI). Methods The 20 amnestic MCI patients and 25 healthy controls were included in this study, and all subjects underwent mini-mental state examination (MMSE), auditory verbal learning test (AVLT) and fMRI. The data were analyzed by amplitude of low frequency fluctuation (ALFF), and the enhanced and weakened regions of ALFF were observed and compared in both MCI patients and healthy controls. Results MMSE and AVLT tests showed that the memory function was seriously impaired in MCI patients compared with healthy controls, which is based on the short and long delayed episodic memory impairment (2.4±1.7 vs. 6.6±1.4, t=3.70, P＜0.01; 2.1±1.6 vs. 6.7±1.5, t=4.16, P＜0.01). The resting state fMRI showed that MCI patients had significant decreases of ALFF in hippocampal formation, parahippocampal cortex and lateral temporal cortex as compared with health controls (t=2.58, 2.43 and 1.75, all P＜0.01), which were closely relevant to the episodic memory. And they had significant increases in temporal-parietal joint and inferior parietal lobule (t=3.14 and 2.77, both P＜0.01). Conclusions MCI patients show significant decreased active intensity of some DMN nodes that is related to episodic memory in resting state. Increased active intensity in MCI patients would be some type of compensation.