Objective To analyze the effect of Fufang Xueshuantong capsule on glaucomatous optic atrophy and its influence on ocular hemodynamics.Methods 124 cases of patients with glaucomatous optic atrophy from April 2014 to December 2016 in our hospital were selected,and randomly divided into experimental group and control group according to the order of hospital admission , with 62 cases in each group.The control group was treated with nerve growth factor plus vitamin needling,the experimental group was treated with nerve growth factor and vitamin and compound Xueshuantong capsule.Observation and comparison the total effective rate, visual function (visual acuity, total gray value) improvement of the two groups of patients, as well as the changes of ocular hemodynamic parameters (systolic peak velocity, diastolic End-stage blood flow velocity, resistance index, pulsatility index).Results The total effective rate of the experimental group was 93.55%(58/62), the total effective rate of the control group was 70.97%(44/62), the total effective rate of the experimental group was higher than the control group (P <0.05)).After treatment, the visual acuity of the experimental group was significantly higher than the control group, the total gray value of the experimental group was significantly lower than the control group (P<0.05).The peak systolic velocity and end diastolic velocity in the experimental group were significantly higher than those in the control group (P<0.05).The resistance index and pulsatility index in the experimental group were lower than those in the control group (P<0.05). Conclusion Compound Xueshuantong capsule is effective in the treatment of glaucomatous optic atrophy , can improve the ocular hemodynamics and improve the visual function.

Objective:To characterize the imaging distortion of the 1.5T magnetic resonance imaging-guided linear accelerator (MR-Linac) and to analyze the influence of MR-Linac and peripheral devices on the geometric distortion.Methods:Specialized MRI imaging distortion phantom and analysis software were applied. The baseline of imaging distortion within diameter spherical volume (DSV) around the center of the magnet was established. The influence of the beam generation system, mechanical system and peripheral devices on the imaging distortion was analyzed. The long-term stability of imaging distortion was tested on the MR-Linac.Results:Imaging distortion of the MR-Linac was increased with the increasing distance to the center of the magnet. Within DSV 400 mm, few test points surpassed 1 mm imaging distortion in 3D directions. However, imaging distortion surpassed 2 mm in part of region within DSV 400-500 mm, with the largest distortion over 7 mm. Imaging distortion of the MR-Linac remained unchanged within 7 months after installation. And the influence of the MR-Linac and peripheral devices on the imaging distortion was only observed in the overall largest distortion within DSV 400-500 mm.Conclusions:Cautions should be taken during the application of high-field MR-Linac in patients whose tumor location is over 20 cm from the ISO center. Imaging distortion of the MR-Linac remains stable within 7 months after installation. The influence of the MR-Linac and peripheral devices on the imaging distortion is trivial, which can be neglected in clinical practice.

Objective:To establish an automatic segmentation network based on different receptive fields for gross target volume (GTV) and organs at risk in patients with nasopharyngeal carcinoma.Methods:Radiotherapy data of 100 cases of nasopharyngeal carcinoma including CT images and GTV and organs at risk delineated by the physicians were collected. Ninety plans were randomly selected as the training dataset, and the other 10 plans as the validation dataset. Firstly, the images were subject to three data augmentation methods including center cropping, vertical flipping and rotation (-30°to 30°), and then input into MA_net networks proposed in this study for training. The model performance of networks was assessed by the number of network parameters (NP), floating-point number (FPN), the running memory (RM) and Dice index (DI), and eventually compared with DeeplabV3+ , PSP_net, UNet+ + and U_Net networks.Results:When the input image was in the size of 240×240, MA_net had a NP of 23.20%, 20.10%, 25.55% and 27.11% of these 4 networks, 50.02%, 19.86%, 6.37% and 13.44% for the FPN, 40.63%, 23.60%, 11.58% and 14.99% for the RM, respectively. For the DI of GTV, MA_net was 1.16%, 2.28%, 1.27% and 3.59% higher than these 4 networks. For the average DI of GTV and OAR, MA_net was 0.16%, 1.37%, 0.30% and 0.97% higher than these 4 networks.Conclusion:Compared with those four networks, the proposed MA_net network has slightly higher Dice index with fewer parameters, lower FPN and smaller RM.

Objective To evaluate the efficacy and safety of ureteral stenting after transurethral resection ( TUR) of bladder tumors involving the ureteral orifice.Methods From March 2009 to November 2015,34 cases of non-muscle invasive bladder tumor including 28 male and 6 female aged from 26 to 79 years( mean 51 years) were treated by TUR.14 cases had single tumor and 20 had multiple tumors,and 29 were primary and 5 were recurrent.All the patients had tumors involving the ureteral orifice without preoperative hydronephrosis revealed by IVU or CTU examination.The tumors were resected into the deep muscle layer and the involved ureteral orifices were resected during the procedure,and after that a double-J ureteral stent was placed in 18 cases.All patients received one immediate intravesical instillation of 50mg epirubicin after TUR, and further scheme of adjuvant intravesical chemotherapy instillations were made according to the pathological diagnosis.Ureteral stents were removed 10-12 weeks after TUR,and cystoscopy and urinary tract ultrasound examinations were performed every 3 months for 1-2 years postoperatively. Results The operations were successful without complications.No serious adverse reaction occurred in immediate and further adjuvant intravesical chemotherapy.During the follow-up period of 3-71 months, no ureteral stricture, hydronephrosis or tumor recurrence in the upper urinary tract occurred in all the 18 patients with ureteral stent, and the resected ureteral orifices recovered well with normal appearance and ejecting urine.Hydronephrosis was observed in 3 of 16 patients without ureteral stent including 2 cases of nontumoral stenosis at the ureterovesical junction requiring ureteral reimplantation and 1 case of lower ureteral tumor on the involved side requiring nephroureterectomy and bladder cuff excision.No patient complained of symptoms secondary to vesicoureteral reflux or continuous unrelievable lower urinary tract symptoms.2 cases of bladder tumor recurred out of the resected area.Conclusions Ureteral stenting after TUR of bladder tumors involving the ureteral orifice can prevent stricture at the ureterovesical junction without increasing the risk of tumor cell seeding along the upper urinary tract.The existence of a double-J ureteral stent does not increase complications of adjuvant intravesical chemotherapy, and also won't cause intolerable lower urinary tract symptoms.

Objective:To investigate the methods and complications of ultrasound-guided percutaneous nephrostomy (PCN) for treat-ing cancer-related hydronephrosis. Methods:From June 2003 to December 2015, 289 patients (342 kidneys) with cancer-related hy-dronephrosis were treated by ultrasound-guided PCN in Fujian Provincial Hospital. Among the 97 cases of renal insufficiency, 4 pa-tients were treated with hemodialysis before PCN. Except for the anterior mid calyx of nine kidneys in nine patients, the posterior mid or lower pole calyx of all other kidneys was punctured with ultrasound guidance. With the one-step PCN technique, 8F pigtail nephros-tomy tubes were placed into six kidneys in six patients;with the Seldinger PCN technique, 14F balloon and Malecot catheters were placed into 25 kidneys in 25 patients and 311 kidneys in 258 patients, respectively. Results:No severe bleeding and injury in the intes-tine, liver, spleen, pleura, or lung occurred. Two pigtail tubes were blocked one week after PCN. Seven balloon catheters failed to drain well because of the tip and balloon of the catheters located in the proximal part of the dilated ureters. Four balloons slipped out of the collection system of the kidney because of the auto-deflation of three balloons and one case of meager renal parenchyma failing to hold the balloon after a severe hydronephrosis was emptied. All, except 1, Malecot catheter drained well, and 8/9 PCNs through anteri-or mid calyx were successful. Serum creatinine levels were significantly decreased in all the 97 patients with renal insufficiency, of which 81 cases returned to normal, and no one needed persistent hemodialysis. Conclusion:Ultrasound-guided PCN is safe and effec-tive for treating cancer-related hydronephrosis. For appropriately selected patients, puncturing the anterior mid calyx may be an op-tion without additional complications. One-step pigtail nephrostomy tubes are recommended for patients with poor systemic condi-tions. For patients with long life expectancy or suspected complicated urinary infection, large sized Malecot catheters should be consid-ered.

Objective:To investigate the clinical feasibility of the Unity radiotherapy system guided by magnetic resonance imaging.Methods:Twenty-four patients were enrolled and received a total of 384 fractions of treatment at Unity system. According to the treatment site, all patients were divided into head-neck, abdomen-thorax, pelvic, spine and limb groups. The patients were set-up without external laser. And then, the time required at different stages in online treatment process and the registration error of each fraction were separately calculated. The geometric deformations of MR images were weekly measured by using MR geometric deformation phantom. At last, the Arccheck was used to perform the dose verification of reference plan, online plan and offline plan.Results:The mean duration of radiotherapy in the five groups were 29.1, 27.6, 26.6, 25.6 and 32.0 min, respectively. The set-up errors in the left-right, superior-inferior and anterior-posterior direction in the five groups were: head-neck group (0.08±0.06 cm, 0.16±0.13 cm, 0.08±0.05 cm), abdomen-thorax group (0.23±0.18 cm, 0.50±0.47 cm, 0.12±0.1 cm), pelvic group (0.25±0.19 cm, 0.32±0.25 cm, 0.11±0.09 cm), spine group (0.46±0.38 cm, 0.26±0.26 cm, 0.13±0.07 cm) and limb group (0.33±0.30 cm, 0.34±0.23 cm, 0.08±0.06 cm), respectively. In the central region, the geometric deformation of MR was less than 0.3 mm, and that of the sphere with a diameter of 500 mm was less than 2.1 mm. The meanγ pass rate of the reference plan, online plan and offline plan were 97.92%, 97.84% and 94.58%, respectively.Conclusions:MR-guided radiotherapy has great potential for clinical application, whereas the process of Unity system is relatively complex. The synergy of different departments has a great impact on the treatment, which needs further optimization.

Objective To investigate the clinical efficacy of continuous arterial catheter directed thrombolysis for ischemia disease of lower extremity.Methods Retrospective analysis of clinical data of 29 patients undergoing continuous arterial catheter directed thrombolysis from June 2016 to June 2018 in Department of Aortic and Vascular Surgery Center,Fuwai Hospital,CAMS&PUMC was conducted.There were 25 males and 4 females,aged (65.3 ± 11.2) years,with an age range of 51-81 years.The patients were diagnosed after admission and received continuous arterial thrombolysis.After thrombolytic therapy,estimate was conducted whether to place the stent further based on the result of angiographit.The patients' pain symptom relief,embolism,bleeding and other complications were observed in the 6 months,12 months and 24 months by telephone follow-up or outpatient review.Meanwhile,the patients improved the color Doppler ultrasound examination.Results The 21 patients were markedly effective,7 patients were effective,and 1 patient was ineffective in all the 29 patients who accepted the continuous arterial catheter directed thrombolysis therapy.Two of the patients developed distal toe arterial embilization during thrombolysis and improved after drug treatment.The total effective rate was 96.5％ (28/29).Stents implant rate was 20.7％ (6/29).The follow-up rate was 86.2％ (25/29).No symptom relapse was observed.Conclusion Continuous arterial catheter directed thrombosis for ischemia disease of lower extremity is minimally invasive,safe and effective.

Objective:To investigate the predictive value of serum vascular endothelial growth factor (VEGF), squamous cell carcinoma-associated antigen (SCCAg) and miRNA let-7a in lymph node metastasis and postoperative recurrence in patients with laryngeal cancer.Methods:A total of 82 patients with laryngeal cancer in the Second Central Hospital of Baoding from November 2017 to October 2019 were selected as the research subjects, including 18 cases of lymph node metastasis (metastasis group) and 64 cases of non metastasis (non metastasis group). The blood routine was tested before operation, and the baseline data, serum VEGF, SCCAg and miRNA let-7a levels were compared between the two groups. Logistic regression was used to analyze the related influencing factors of lymph node metastasis in patients with laryngeal cancer. The correlation between serum VEGF, SCCAg, miRNA let-7a levels and clinicopathological characteristics was analyzed. The receiver operating characteristic (ROC)curve was used to analyze the value of each index and the combined diagnosis of lymph node metastasis in patients with laryngeal cancer. After 1 year of follow-up, the serum VEGF, SCCAg and miRNA let-7a levels of patients with or without recurrent laryngeal cancer were compared. ROC curve was used to evaluate the value of VEGF, SCCAg, and miRNA let-7a in predicting the recurrence of laryngeal cancer.Results:There were statistically significant differences in tumor node metastasis (TNM) stage, degree of infiltration, degree of differentiation, serum VEGF, SCCAg, and miRNA let-7a levels between the metastasis group and non metastasis group (all P<0.05). Serum VEGF, SCCAg, miRNA let-7a levels in patients with laryngeal cancer were related to TNM stage, degree of infiltration and degree of differentiation (all P<0.05). The combined diagnosis of serum VEGF, SCCAg and miRNA let-7a levels in the diagnosis of lymph node metastasis in patients with laryngeal cancer showed that the diagnostic sensitivity and specificity were 88.89% and 70.31%, respectively. The serum VEGF and SCCAg levels of patients with recurrence after operation were higher than those without recurrence, and the level of miRNA let-7a was lower than those without recurrence (all P<0.05). The sensitivity and specificity of combined serum VEGF, SCCAg and miRNA LET-7a levels in predicting postoperative recurrence of laryngeal cancer were 72.97% and 91.11%, respectively. Conclusions:VEGF, SCCAg, miRNA let-7a in patients with laryngeal cancer have a certain correlation with clinicopathological characteristics, which can assist in the diagnosis of lymph node metastasis and help clinical prediction of postoperative recurrence in patients with laryngeal cancer, and provide a reference for the formulation of clinical treatment plans.

Objective: To improve the diagnosis and treatment of primary adrenal cortical carcinoma. Methods: The clinical and pathological data of 11 patients who diagnosed as primary adrenal cortical carcinoma by pathology were retrospectively analyzed.The median age was 43 years, including 6 males, 5 females.7 cases(63.6%) got the tumor on the left.9 cases(81.8%) presented the maximum diameter of tumor more than 6 cm, and the average maximum diameter was 12.9 cm.All cases had CT or MRI imaging examination.Among most of them, CT showed mixed density lesions, or MRI showed mixed signal.Only 3 cases(27.3%) were considered adrenal cortical cancer through preoperative examinations. Results: 11 patients were treated with surgical treatment.Of them, 9 cases(81.8%) had complete resection of tumor.3 cases were lost to follow-up, while other 8 cases were followed up for 5-58 months.3 cases presented tumor-specific death at 5-15 months after surgery, with each 1 case in AJCC stage Ⅱ, Ⅲ and Ⅳ, respectively.Survive were in 5cases, and 3cases of them were tumor-free survival, while the other 2 cases of them had local recurrence. Conclusion Adrenal cortical carcinoma is very difficult to diagnose preoperatively.Adrenal cortical cancer should be considered when tumor size more than 4cm and tumor presenting inhomogeneous enhancement.Then, the surgical treatment should be performed as soon as possible, and as appropriate, chemotherapy and other comprehensive treatment should be given subsequently.Clinical and basic research such as genes test may provide more treatment options for advanced tumors in future.

Objective To establish a three-dimensional (3D) dose prediction model,which can predict multiple organs simultaneously in a single model and automatically learn the effect of the geometric anatomical structure on dose distribution.Methods Clinical radiotherapy plans of patients diagnosed with the same type of tumors were collected and retrospectively analyzed.For every plan,each organs at risk (OAR) voxel was regarded as the study sample and its deposited dose was considered as the dosimetric feature.A regularized multi-task learning method than could learn the relationship among different tasks was employed to establish the relationship matrix among tasks and the correlation between geometric structure and dose distribution among organs.In this experiment,the spinal cord,brainstem and bilateral parotids involved in the intensity-modulated radiotherapy (IMRT) plan of 15 nasopharyngeal cancer patients were utilized to establish the multi-organ prediction model.The relative percentage error between the predicted dose of voxel and the clinical planning dose was calculated to assess the feasibility of the model.Results Ten cases receiving IMRT plans were utilized as the training data,and the remaining five cases were used as the test data.The test results demonstrated a higher prediction accuracy and less data demand.And the average voxel dose errors among the spinal cord,brainstem and the left and right parotids were (2.01±0.02)％,(2.65± 0.02) ％,(2.45± 0.02) ％ and (2.55± 0.02) ％,respectively.Conclusion The proposed model can accurately predict the dose of multiple organs in a single model and avoid the establishment of multiple single-organ prediction models,laying a solid foundation for patient-specific plan quality control and knowledge-based treatment planning.