Objective To explore the changes of nitric oxide (NO) and nitric oxide synthase (NOS) of the aged rat brain, and the relationship between this change and neuronal apoptosis. Methods Five month old and 30 month old rats were used in the study. NO level and NOS activity were measured by Griess reaction and high presssure liquid chromatography. Neuronal NOS(nNOS) gene and bcl 2 gene were examined by in situ hybradization; nNOS protein level and free calcium level in synaptosome were determined by immunohistochemical method and Fura 2 fluorescence probe respectively. Apoptosis was observed using terminal transferase marking method. Results NO level and nNOS activity in the brain tissue of aged rats was (2 61?0 10) ?mol/L and (398 22?21 62) fmol?mg -1 ?min -1 , respectively,being significantly higher than that of the young rats(1 54?0 15) ?mol/L and (234 38?16 24)fmol?mg -1 ?min -1 respectively. Also both the nNOS gene transcription and protein expression increased in aged rats while bcl 2 gene expression reduced with aging. Free calcium level in synaptosome of aged and young rats was (485 26?28 48) nmol/L and (372 99?19 20) nmol/L respectively. Apoptosis in brain tissue was observed in aged rats, but not in young ones. Conclusions The increase of NO level in the aged rat brain is due to the increase of nNOS activity which is at least partially determined by the increased gene expression. Abnormal enhancement of NO in the aged rats may cause damage, even death of the brain. As an anti oxidant, bcl 2 gene expression reduced with aging and resulted in the brain tissue more vulnerable to oxidative stress and thus produced more lesions. Therefore, it is a promising method to screen and develop drugs that can be anti apoptotic and anti oxidative, and reduce the formation of pathologic NO to prevent and retard brain aging.

Objective To evaluate a preliminary outcome of volar surgical treatment of dorsally displaced fractures of distal radius with open reduction and internal fixation with T shape locking compression plate.Methods From January 2009 to January 2012,32 cases with dorsally unstable distal radius fractures were treated with open reduction and internal fixation with T shape locking compression plate.Results All patients were followed; the average follow-up period was 12 (8-18) months.The patients all healed well.According to Dienst scoring system,the results were excellent in 23 cases,good in 7 cases,fair in 2 cases,the excellent and good rate was 93.75％(30/32).Conclusions The volar fixation of T shape locking compression plate for dorsally displaced fractures of distal radius has advantage of stable and reliable,high healing rate,low rate of complications and early motion.It is especially suitable for osteoporosis patients.

Objective:To evaluate the effect of radical image-guided radiotherapy (IGRT) on the target dose in cervical cancer and investigate the appropriate application mode.Methods:Twenty patients with cervical cancer treated with helical tomotherapy (HT) in Seventh Medical Center of PLA General Hospital from 2012 to 2016 were selected. A megavoltage CT (MVCT) scan was performed before each treatment. The obtained MVCT images were used for dose parameter in the adaptive module of HT to obtain the actual dose (Plan 1) and the non-image-guided dose parameter was simulated (Plan 2). Each single dose distribution and the corresponding fused CT images were transferred to the software Mimvista 6.5 to obtain the total radiation dose parameter by dose superposition.Results:The motion of CTV, uterus and GTV in Plan 2 was significantly larger than that of Plan 1(all P<0.05), and the largest changes were seen in the ventrodorsal and uterine direction. The V 45Gy, V 50Gy, D 98% and D mean of CTV and uterus and V 50Gy of GTV in Plan 2 were significantly decreased compared with those in Plan 1(all P<0.05). The left-right motion of Plan 1 was negatively correlated with D 2% and D 98% of CTV and uterus (both P<0.05). The head-foot motion was negatively associated with V 45Gy and V 50Gy of GTV (both P<0.05). The ventrodorsal motion was negatively correlated with D 98% of uterus ( P<0.05). The left-right motion of Plan 2 was negatively correlated with D 2% of CTV and V 50Gy of uterus (both P<0.05). The head-foot motion was negatively associated with D 98% of CTV, and D 98%, D mean, V 45Gy and V 50Gy of uterus (all P<0.05). The ventrodorsal motion was negatively correlated with D 98% of CTV, D 98%, D mean, V 45Gy and V 50Gy of uterus, and D mean and V 45Gy of GTV (all P<0.05). Conclusions:In intensity-modulated radiotherapy for cervical cancer, the uterine body displacement is large and the low CTV area is mainly located in the uterine body. IGRT can significantly reduce the dosimetric deviation induced by organ movement.

Objective To analyze the changes in volume and the planning volume of the bladder and rectum during helical tomotherapy (HT) treatment for cervical cancer,and to evaluate the impacts of bladder and rectum filling on their dosimetric parameters.Methods Twenty patients with cervical cancer who received HT in our hospital from 2012 to 2016 were enrolled as subjects.Before treatment,megavolt computed tomography (MVCT) and registration of planning CT images were preformed to recalculate the dose distribution,delineate the target volume,and measure the volume and position of the bladder and the rectum.Each MVCT image and the corresponding single dose were obtained by dose reconstruction using the Planned Adaptive module in HT planning workstation.The fused MVCT images and the corresponding single dose for each MVCT were loaded to MIM Maestro software 6.0 for dose stacking.The obtained total radiation dose was compared with that obtained by kilovolt CT.Between-group comparison was made by paired t-test or analysis of variance.Results If the volume change in the bladder was more than 400 ml or the rate of volume change was higher than 60％,the displacements of the bladder centroid toward the foot and dorsal sides were significantly increased;the Dmean and V50 were significantly increased (P＜0.05).If the volume change in the rectum was more than 30 ml or the rate of volume change was higher than 30％,the displacements of the rectum centroid toward the head and ventral sides were significantly increased;the V45 and V50 for the rectum were significantly increased (P＜0.05).Conclusions Although the bladder filling status has little effect on the radiation dose to the bladder,the volume change or the rate of volume change should be no more than 400 ml or 60％,respectively.Moderately filled bladder is recommended for positioning and treatment,which achieves satisfactory repeatability of the treatment.A volume change of more than 30 ml or a rate of volume change of higher than 30％ can result in an increase in the dose to the rectum.Empty rectum can effectively reduce the dose to the rectum.

In recent years, with the popularization of low-dose computed tomography (LDCT) and high-resolution CT (HRCT), the discovery rate of early-staged non-small cell lung cancer has been on the rise, and more thoracic surgeons have explored more reasonable resection scope. Clinical studies have demonstrated that there is a lower rate of local tumor recurrence in patients with negative lung margins compared with positive ones. Therefore, it is of great clinical significance to ensure the negative margin during sublobar resection for early-staged lung cancer. This paper will focus on this area.
.
Carcinoma, Non-Small-Cell Lung ; pathology ; surgery ; Humans ; Lung ; pathology ; surgery ; Lung Neoplasms ; pathology ; surgery ; Neoplasm Staging ; Recurrence

Objective:To help clinicians simplify the post-processing operations of structures by developing rapid processing software for target area and organs at risk structures based on ESAPI.Methods:SmartStructure script software was developed based on ESAPI, verified and evaluated in clinical work. 10 cases of rectal cancer receiving neoadjuvant radiotherapy, 10 breast cancer treated with postoperative radiotherapy, 10 cervical cancer receiving postoperative radiotherapy, 10 nasopharyngeal carcinoma receiving radical radiotherapy and 10 lung stereotactic body radiotherapy (SBRT) were selected, and different types of tumors had different post-processing operations of structures. In each case, three methods were used for post-processing of structures. In the control group (manual group), normal manual processing was employed. In the experimental group 1(SmaStru-N group), scripts without templates were utilized. In the experimental group 2(SmaStru-P group). scripts combined with templates were adopted. The processing time of the three methods was compared. Clinicians scored the scripting software from multiple aspects and compared the feeling scores of scripting software and manual operation.Results:All three methods can be normally applied in clinical settings. The error rate in the manual group was 7.0%, 3.0% in the SmaStru-N group 0% in the SmaStru-P group, respectively. Compared with the manual method, SmaStru-N shortened the processing time of target area and organs at risk by 60.9% and 93.3% for SmaStru-P. In addition, SmartStructure was superior to manual method in terms of using feeling scores. Clinicians gave lower score for the" applicability" and" simplicity" , and higher score on the" accuracy" and" efficiency" .Conclusions:Compared with conventional manual structure processing method, SmartStructure software can rapidly and accurately process all structures of the target area and organs at risk, and its advantages become more obvious with the increasing number of structures that need to be processed. SmartStructure software can meet clinical requirements, reduce the error rate, elevate processing speed, improve the working efficiency of clinicians, providing basis for the development of adaptive radiotherapy.

Objective:To evaluate the robustness of fully automated adaptive planning for Ethos online adaptive radiotherapy (ART) based on the intelligent optimization engine (IOE).Methods:Clinical data of 11 stage ⅠB cervical cancer patients admitted to Peking Union Medical College Hospital between June 2021 and June 2022 were retrospectively analyzed. Original planning images and iterative cone-beam computed tomography (iCBCT) images of each radiotherapy treatment were acquired, and all patient data were imported into the Ethos simulator. IOE-based 9-field automatic plan generation was performed for 11 patients using Ethos, and the generated plans were sent to online adaptive radiotherapy simulation to obtain each online adaptive radiotherapy plan (273 fractions in total) and complete the simulated treatment. For comparison, manual plan design was performed based on the images and contoured structures used for online adaptive radiotherapy planning, and the manually plans created with evenly divided 9 fields. Dosimetric parameters, plan complexity parameters, and Mobius quality assurance (QA) pass rates were collected to compare and evaluate the robustness of the online adaptive radiotherapy plan in terms of organs at risk (OAR), target volume dosimetric parameters, and plan complexity by using paired t-test or rank sum test. Results:The online adaptive plan of cervical cancer had comparable planning target volume (PTV) coverage compared to the manual plan. For the clinical target volume (CTV) D 99%, online adaptive plan was significantly higher than the manual plan [(45.93±0.36) vs. (45.32±0.31) Gy, P<0.001]. For hot dose area, the maximum point dose (PTV D max) of adaptive plan was significantly higher than the manual plan [(49.89±1.25) vs. (48.48±0.77) Gy, P<0.001], but the PTV D 1% of adaptive plan was significantly lower than the manual plan [(47.22±0.29) vs. (47.59±0.48) Gy, P<0.001]. There was no statistical difference in the conformal index ( P=0.967). And there was significant difference in the homogeneity index, with same medians and less dispersion in adaptive plan ( P<0.001). For OAR dose, bladder D mean, rectal V 40 Gy, small intestine D mean of adaptive plan was slightly higher than that of the manual plan; the rectal D mean, small intestine D 2 cm3 of the adaptive plan was slightly lower than that of manual plan; dosimetric parameters of right and left femoral heads, spinal cord and bone marrow of the adaptive plan were better than those of manual plan. The adaptive plan had more monitor units (MU) than the manual plan, but the complexity of the adaptive plan was significantly lower than that of the manual plan (0.135±0.012 vs. 0.151±0.015, P<0.001). For Mobius γ pass rate (5%/3 mm), both adaptive and manual plans met clinical requirements. Conclusion:Ethos cervical cancer online adaptive plan, which is based on the IOE engine, demonstrates good robustness and ensures the quality of online adaptive plans generated for each treatment fraction.

Objective:To evaluate the automatic optimization performance and clinical feasibility of the intelligent optimization engine (IOE) in the Ethos online adaptive radiotherapy platform.Methods:Clinical data of 11 patients with postoperative cervical cancer treated with Halcyon accelerator were retrospectively analyzed. Manual planning was performed for all patients using the 4 full arc volumetric modulated arc therapy (VMAT) (Manual-4Arc) in Eclipse, with a prescription dose of 45 Gy/25F. Patient images and structures were imported into the Ethos simulator, and appropriate clinical goals were added based on clinical requirements. The target coverage was normalized to 95%. Automatic plan generation was conducted using IOE, resulting in 7, 9, and 12 field intensity modulated radiotherapy (IMRT) plans (IMRT-7F、IMRT-9F、IMRT-12F), as well as 2 and 3 arc VMAT plans (VMAT-2Arc、VMAT-3Arc). Dosimetric index comparisons were made between the Manual-4Arc plans and the 5 groups of IOE-generated plans through one-way analysis of variance. Based on the analysis results, Turky post hoc multiple comparisons were performed to evaluate the automatic optimization performance of IOE.Results:In terms of the high dose area, the IMRT-12F plans showed the lowest D 1% for the planning target volume (PTV), and there were significant differences compared to the Manual-4Arc plans ( P=0.004). Regarding target coverage, all groups produced clinical target volume (CTV) plans that met the clinical requirements. Although the Ethos online adaptive plans were normalized during planning, the PTV coverage was slightly insufficient. For organs at risk (OAR) close to the target, such as the bladder, there were significant differences in V 30 Gy, V 40 Gy, and D mean among the 6 groups of plans. The dose ranking for the bladder was generally as follows: IMRT-12F

Objective:To propose an automatic planning approach for Eclipse15.6 planning system based on Eclipse scripting application programming interface (ESAPI) and evaluate its clinical application.Methods:20 patients with nasopharyngeal carcinoma and 20 cases of rectal cancer were selected in the clinical planning. The developed automatic planning script SmartPlan and RapidPlan were used for automatic planning and dosimetric parameters were compared with manual planning. The differences were compared between two groups by using Wilcoxon signed rank test. Results:The dosimetric results of automatic and manual plans could meet clinical requirements. There was no significant difference in target coverage in nasopharyngeal carcinoma planning between two groups ( P>0.05), and automatic plans were superior to manual plans in organs at risk sparing ( P<0.05). Except for the homogeneity index of PTV and the maximum dose of bowel in rectal cancer plans, the other dosimetric parameters of the automatic plans were better than those of the manual plans (all P<0.05). Conclusions:Compared with the manual plans, the automatic plans have the same or similar target coverage, similar or better protection of organs at risk, and more convenient implementation. The developed SmartPlan based on ESAPI has clinical feasibility and effectiveness.