Objective:To explore the sensitivity of intensity-modulated radiotherapy(IMRT)designed respectively by overlapping method and gradient optimization method on fixed field of whole brain and whole spinal cord of pediatric patients to positioning error.Methods:A retrospective study analyzed 10 pediatric patients who underwent radiotherapy on whole brain and whole spinal cord at The First Affiliated Hospital of Guangzhou Medical University during December 1,2022 and January 1,2024.Overlapping method and gradient optimization method were respectively adopted to design IMRT plan for whole brain and whole spinal cord.The length of the merged region of the field was set as 10 cm.The positioning errors of±1 mm,±3 mm and±5 mm on head-foot direction that occurred in spinal cord segmentation and other isocenter field were simulated,and the flux optimization did not be conducted,and the dose distribution was recalculated.The exposure doses of D2%,D98%,V30Gy,homogeneity index(HI),conformity index(CI)and organ at risk(OAR)of target regions in the merged region of field were recorded and compared,thus the robustness of the two optimization methods were assessed.Results:The IMRT plan of whole brain and whole spinal cord that were designed respectively by overlapping method and gradient optimization method can meet the clinical requirements under the condition that did not introduced positioning error.With the increasing of positioning error,the changes of cold and hot spots(ΔD2%,ΔD98%and ΔV30 Gy)of doses in the merged region of field were more and more significant.In the merged region of field,theΔD2%,ΔD98%and ΔV30 Gy of the overlapping method were respectively 13.98%±3.29%,-17.26%±3.44%and-44.06%±9.17%,and those of the gradient optimization method were respectively 6.0%±0.75%,-6.31%±0.81%and-37.37%±4.3%when positioning error was 5 mm.The differences of them between the overlapping method and the gradient optimization method were statistically significant(t=-10.889,15.928,2.808,P<0.05).Conclusion:With increase of positioning error in the merged region of field of IMRT plan for whole brain and whole spinal cord,the gradient optimization method can effectively relieve the changes of the cold and hot spots in the merged region of field,and its each indicator was less than that of the overlapping method.Therefore,it can effectively improve the plan's robustness.

Objective:To explore the sensitivity of intensity-modulated radiotherapy(IMRT)designed respectively by overlapping method and gradient optimization method on fixed field of whole brain and whole spinal cord of pediatric patients to positioning error.Methods:A retrospective study analyzed 10 pediatric patients who underwent radiotherapy on whole brain and whole spinal cord at The First Affiliated Hospital of Guangzhou Medical University during December 1,2022 and January 1,2024.Overlapping method and gradient optimization method were respectively adopted to design IMRT plan for whole brain and whole spinal cord.The length of the merged region of the field was set as 10 cm.The positioning errors of±1 mm,±3 mm and±5 mm on head-foot direction that occurred in spinal cord segmentation and other isocenter field were simulated,and the flux optimization did not be conducted,and the dose distribution was recalculated.The exposure doses of D2%,D98%,V30Gy,homogeneity index(HI),conformity index(CI)and organ at risk(OAR)of target regions in the merged region of field were recorded and compared,thus the robustness of the two optimization methods were assessed.Results:The IMRT plan of whole brain and whole spinal cord that were designed respectively by overlapping method and gradient optimization method can meet the clinical requirements under the condition that did not introduced positioning error.With the increasing of positioning error,the changes of cold and hot spots(ΔD2%,ΔD98%and ΔV30 Gy)of doses in the merged region of field were more and more significant.In the merged region of field,theΔD2%,ΔD98%and ΔV30 Gy of the overlapping method were respectively 13.98%±3.29%,-17.26%±3.44%and-44.06%±9.17%,and those of the gradient optimization method were respectively 6.0%±0.75%,-6.31%±0.81%and-37.37%±4.3%when positioning error was 5 mm.The differences of them between the overlapping method and the gradient optimization method were statistically significant(t=-10.889,15.928,2.808,P<0.05).Conclusion:With increase of positioning error in the merged region of field of IMRT plan for whole brain and whole spinal cord,the gradient optimization method can effectively relieve the changes of the cold and hot spots in the merged region of field,and its each indicator was less than that of the overlapping method.Therefore,it can effectively improve the plan's robustness.

This article analyzed the specific path of iron overload affecting EMT "blood countercurrent cell survival/adhesion/invasion/angiogenesis ectopic lesions" from the three aspects of mediating NF-κB and inflammatory reaction, stimulation of abnormal activation of macrophages, and induction of oxidative stress injury; introduced the theoretical connotation of the pathogenesis of "cold coagulation and blood stasis", and briefly described the progress of the pathogenesis of EMT from the perspective of "blood out of menstruation - injury caused by cold pathogenic factors - cold coagulation and blood stasis - long-term accumulation syndrome"; based on the mutual confirmation of "menstruation countercurrent - iron overload microenvironment - cell survival/adhesion/invasion/angiogenesis - ectopic focus" and "blood out of menstruation - cold pathogen injury - cold coagulation and blood stasis - chronic accumulation syndrome", it was believed that starting from iron overload could tap the scientific connotation and microscopic materials of the pathogenesis of "cold coagulation and blood stasis" in EMT, so as to provide new directions and theoretical references for the research of the pathogenesis of EMT and the mechanism of drugs.

In vitro cell experiment based on serum pharmacology is a common way to study the pharmacodynamic mechanism of Chinese medicine， and screening the optimal intervention concentration of serum containing Chinese medicine is a key step in the whole experiment. Over-diluted serum containing Chinese medicine or over-high concentration leads to false negative or positive results， while the optimal concentration of medicated serum reduces the number of groups in subsequent experiments as well as the operation error. Thus it is of great significance to screen the optimal serum concentration in studying the pharmacodynamic mechanism of Chinese medicine in in vitro cell experiments. However， there has been no unified standards for the screening methods at present. After reviewing the literature in China and abroad in the past 20 years， this paper conducted an analysis from three aspects of intragastric dose of Chinese medicine， blood collection time and serum dilution degree， and then summarized the screening methods for optimal concentration of serum containing drugs， providing guidance for the study of pharmacodynamic mechanism of Chinese medicine. The screening methods mainly included "same intragastric dose， same blood collection time， and different concentrations" "different intragastric doses， same blood collection time， and same concentration" "same intragastric dose， different blood collection time， and same concentration" "different intragastric doses， different blood collection time， and different concentrations" "serum lyophilized powder" "simulation of gradient concentration of serum containing western medicine" and "pure serum intervention". Among them， the former two were the dominant ways in current related research. The above screening methods had their own advantages and disadvantages， and researchers should make a reasonable choice according to the specific requirements and actual situation of the experiments.

OBJECTIVETo evaluate the effect of cervical esophagostomy for the treatment of patients with dysphagia induced by radiotherapy, in order to improve the therapeutic effects.

METHODSA retrospective study was performed on 53 nasopharyngeal carcinoma (NPC) patients with dysphagia, who received cervical esophagostomy. The nutritional status of these patients was measured at five given time before and after operation. The occurrence of pneumonia and reflux esophagitis before and after operation was recorded, and the quality of life based on SF-36 quality of life (QOL) scale was studied.

RESULTSAfter operation, the nutritional status of these patients improved substantially, including the weight, levels of hemoglobin, total protein, albumin and transferring (P<0.05). The pneumonia-infection decreased from 60.38% (32/53) before operation to 15.22% (7/46) after operation (χ(2)=21.04, P<0.01). The incidences of reflux esophagitis decreased from 26.42% (14/53)without operation to 6.52% (3/46) after operation (χ(2)=5.00, P<0.01). Meanwhile, the status of physical health, mental health as well as physical function and social function of these patients were improved significantly at 1 month, 6 months, 1 year and 2 years after operation (P<0.05).

CONCLUSIONCervical esophagostomy can improve the life quality of patients with dysphagia induced by radiotherapy for nasopharyngeal carcinoma.

Carcinoma ; Deglutition Disorders ; complications ; surgery ; Esophagitis, Peptic ; complications ; Esophagostomy ; Humans ; Incidence ; Nasopharyngeal Neoplasms ; complications ; radiotherapy ; Pneumonia ; complications ; Quality of Life ; Radiotherapy ; adverse effects ; Retrospective Studies

OBJECTIVE: To investigate the effect of operation on Benign thyroid nodules with hoarseness as primary symptom. METHOD: Twelve patients were underwent the operation of subtotal thyroidectomy and exposing of recurrent laryngeal nerve. We evaluating the effect by fibrolaryngoscope and voice acoustic analysis before and after operation. RESULT: All the 12 patients underwent surgery successfully. The hoarseness improved obviously and vocal cords were reactivate. Jitter, shimmer and dysphonia severity index showed significant difference pre and one month after surgery. CONCLUSION Benign thyroid nodules could also cause vocal cord paralysis and hoarseness, the effect can be satisfying by subtotal thyroidectomy and exposing of recurrent laryngeal nerve if it can be early diagnosed.
Adult ; Aged ; Female ; Follow-Up Studies ; Hoarseness ; etiology ; Humans ; Male ; Middle Aged ; Thyroid Nodule ; complications ; surgery ; Treatment Outcome ; Young Adult

OBJECTIVE: To define the oncologic efficacy of transoral endoscopic CO2 laser surgery in early glottic carci noma. METHOD: A retrospective study of 112 patients with laryngocarcinoma treated. Surgical treatment included endoscopic CO2 laser cordectomies according to the classification of the European Laryngological Society. After the patients were given the general anesthesia and oral intubation, the tumors in the study group were resected along the margin of the tumor under larynscope, and the safety margin was reserved as 3-5 mm. All the patients were followed-up for 12-62 months. RESULT: Eight relapses were detected in 112 cases of glottic laryngeal carcinoma after CO2 laser surgery. The local recurernce rate was 7.14% (8/112),of the rate for T1a, T1b and T2 were 0.89%, 0.89% and 5.04% respectively, with significant differences among groups (chi2 = 5.306, P < 0.01) . The rate of local recurrence rate of anterior commissure involvement was 7.14% and that was 7.14% when this site was not compromised by the tumor, which has no statistically significant differences (chi2 = 0.000, P > 0.01). CONCLUSION According to our reaserch, endoscopic CO2 laser sur gery is an effective treatment for early laryngocarcinoma.
Adult ; Aged ; Aged, 80 and over ; Carbon Dioxide ; therapeutic use ; Female ; Follow-Up Studies ; Humans ; Laryngeal Neoplasms ; surgery ; Laser Therapy ; Lasers, Gas ; therapeutic use ; Male ; Middle Aged ; Treatment Outcome

OBJECTIVE: To investigate the influence of obstructive sleep apnea hypopnea syndrome (OSAHS) on children's growth. METHOD: Fifty-three children diagnosed as OSAHS were included in the treatment group and underwent tonsillectomy or adenoidectomy, and 51 normal children were employed as the control group. Main data monitored by PSG and growth hormone (GH) in children of the treatment group were recorded before and after surgery, in addition, growth hormone, height and weight of children in the treatment group and control group were respectively recorded and compared. RESULT: Height and weight of children with OSAHS before treatment were lower than that of the normal children and the difference was significant (P<0.05). Compared with the data before surgery, oxygen saturation of blood in children of treatment group recorded by PSG increased (P<0.05), while value of other data decreased (P<0.05). Growth hormone in children of the treatment group was lower than that of the control group and the difference between two group was significant (P<0.05), while the content of growth hormone in children of the treatment group elevated after 3 months postoperatively and at this time no difference was found between the two groups. CONCLUSION Children with OSAHS present the symptom of upper airway obstruction, which badly affects sleep quality and results in decreased secretion of growth hormone and finally the height and weight of children is got involved. Timely surgery is necessary to alleviate the symptom.
Body Height ; Body Weight ; Case-Control Studies ; Child ; Child, Preschool ; Female ; Human Growth Hormone ; analysis ; Humans ; Male ; Postoperative Period ; Sleep Apnea, Obstructive ; surgery

OBJECTIVE: To evaluate the application of flaps or musculocutaneous flaps in repairing cervical postradiation ulcer (cpu) at nasopharyngeal carcinoma. METHOD: Deltopectoral flaps and pectoralis major flaps were applied to repair cervical radiation ulceration with different size and depth in 19 cases. RESULT: Twelve cases repaired with deltopectoral flaps and 7 cases repaired with pectoralis major flaps, impaired wound healing happened at distal end of one deltopectoral flap, and the wound was healing hy second intention after debridement and dressing change. All the other deltopectoral flaps and pectoralis major flaps stayed alive. Flaps stayed alive without the recurrence of ulcer after the long-term follow-up for one to ten years. CONCLUSION The effectiveness of cervical radiation ulceration reconstruction by deltopectoral flaps and pectoralis major flaps was proved. The reconstruction could prevent the recurrence of ulcer. Refer to the poor prognosis of chronic radiation ulceration with expectant treatment, precautions do count.
Adult ; Aged ; Carcinoma ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; radiotherapy ; Neck ; Radiation Injuries ; etiology ; surgery ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; methods ; Surgical Flaps

OBJECTIVE: To compare the therapeutic effect between endoscopic thyroidectomy and open thyroidectomy. METHOD: One hundred and nine patients were randomly divided into two groups. The first group with 52 patients were carried out endoscopic thyroidectomy; and the second group with 57 patients was carried out open thyroidectomy. Clinical features including operation time, operative blood loss, hospitalization and complications were compared between the two groups. RESULT: The average operative time was (105.1 +/- 30.2) min in endoscopic group and (145.3 +/- 27.4) min in open group (P<0.01); the mean operative blood loss was (7.5 +/- 4.2) ml in endoscopic group and (48.6 +/- 18.6) ml in open group (P<0.01); the average hospitalization after operation was (4.1 +/- 1.4) days and (8.0 +/- 1.9) days (P<0.01), the complication rate was 5.8% in endoscopic group and 8.8% in open group (P<0.01). CONCLUSION Compared to the traditional open surgery, endoscopic thyroidectomy is safe and effective,with advantages in terms of the aesthetic property,the amount of bleeding and the postoperative complications.
Adult ; Female ; Humans ; Laryngoscopy ; Male ; Middle Aged ; Thyroid Neoplasms ; surgery ; Thyroidectomy ; methods ; Treatment Outcome ; Young Adult