Objective:To design a method to introduce random six-dimensional setup error (6D-SE) into the intensity-modulated radiotherapy (IMRT) planning for rectal cancer and evaluate its dosimetric effect.Methods:A total of 21 IMRT plans for patients with rectal cancer were randomly selected as reference plans [2 Gy per fraction for a total of 50 Gy; a 5 mm uniform margin around the clinical target volume (CTV) was taken as the planning target volume (PTV)]. For each fraction of the reference plan, a randomly generated 6D-SE was introduced by adjusting the geometrical parameters of the radiation field, and the dose was recalculated. The overall dose distribution with 6D-SE was obtained by adding up the dose of each fraction. A treatment simulation program that could complete the above workflow was developed using the Varian Eclipse scripting API (ESAPI). 6D-SEs that obey two preset distributions [distribution 1: translational error obey N(0, 4 2), and rotational error obey N(0, 2 2); distribution 2: translational error obey N(0, 2 2), and rotational error obey N(0, 1 2)] were introduced into the reference plans, and the dosimetric effects were assessed. Results:When the reference plans, error distribution 1, and error distribution 2 were applied, the Dmin values of the CTV were (49.4±0.41), (47.56±0.76), and (49.17±0.64) Gy, respectively; the D98% values of the CTV were (50.23±0.07), (49.98±0.10), and (50.27±0.09) Gy, respectively; the D98% values of the primary target area (the kernel part of the target area, excluding the margins) were (50.25±0.08), (50.42±0.13), and (50.33±0.10) Gy, respectively; the D98% values of the marginal area were (50.22±0.10), (49.88±0.11), and (50.26±0.10) Gy, respectively. In addition, compared with the result of the reference plans, the result of errors 1 and 2 showed no significant changes in the mean dose of the bladder and femoral heads ( P>0.05), despite slight decreases in the conformity index of the dose distribution with limited clinical significance. Conclusion:The proposed method and the treatment simulation program developed thereupon can introduce the 6D-SE obeying different distributions into the IMRT plans for rectal cancer on demand and provide overall dosimetric changes.

目的:评估基于瓦里安实时位置管理(RPM)系统的呼吸门控放疗中病人呼吸基线波动对呼吸预测滤波器(BPF)性能的影响.方法:分析20例RPM相位式呼吸门控放疗病例的参考呼吸波形和残余呼吸信号以及共146次治疗时的呼吸波形和残余呼吸信号,作以下处理:(1)将呼吸波形(包括参考和治疗时)经Savitsky-Golay平滑、峰值检测和异常点剔除后得到呼吸基线,计算其标准差做为衡量基线波动强弱的指标,计算各次治疗时基线波动相对于参考基线波动的相对偏差;(2)计算残余呼吸信号(包括参考和治疗时)标准差,将其作为衡量呼吸信号强弱的指标,同样计算各次治疗时残余呼吸相对于参考残余呼吸的相对偏差;(3)对基线波动偏差和残余呼吸信号偏差做Pearson相关性分析.结果:146次治疗中呼吸基线波动偏差最小值和最大值分别为-61.0％、752.3％,四分位数分别为42.8％、90.3％、161.7％;残余呼吸信号偏差最小值和最大值分别为-74.8％、174.0％,四分位数分别为-7.8％、15.1％、48.8％;残余呼吸信号偏差与基线波动偏差之间的相关系数为0.544,差异有统计学意义(P<0.01);线性拟合系数为0.2.结论:当前RPM相位式呼吸门控技术条件下,治疗时病人实际残余呼吸信号偏差与呼吸基线波动偏差线性显著相关,每100％的基线波动偏差平均可导致20％的残余呼吸信号偏,表明BPF性能受到影响;临床工作中需要制定有效的质量控制方案以避免治疗时病人出现缓慢的呼吸基线波动偏差.

目的 了解和分析苏州市当前经济和社会模式下5年内儿童意外伤害死亡率变化情况及其流行病学特征,为制定相关卫生政策和评价干预效果提供科学依据.方法 收集2016—2020年苏州市儿童生命监测资料,利用描述性分析、χ2检验对儿童意外伤害流行病学特征进行分析.结果 2016—2020年儿童意外伤害死亡率从80.17/10万下降到77.84/10万.意外死因顺位前3位为溺水(2.30/万)、意外窒息(1.90/万)、交通意外(1.42/万).外地户籍儿童溺水、交通意外的死亡构成比均要大于本地儿童(χ2=16.44,χ2=5.284,均有P<0.05).男童溺水死亡占其总死亡的8.74％,明显要高于女童的5.03％(χ2=9.36,P<0.05),是男童首要意外死因,而女童的首要意外死因为意外窒息.1～4岁儿童死亡中,意外死亡占57.49％,其首要意外死因为溺水,占38.62％,婴儿首位意外死因是意外窒息,占81.44％.不同类别的意外伤害发生具有明显的季节性,冬季是意外窒息的高发季节,而溺水则高发于夏季.结论 苏州市2016—2020年针对5岁以下儿童意外伤害采取的防治措施初见成效,研究结果显示外地户籍5岁以下儿童应作为意外伤害死亡的重点防范人群,可依据不同年龄阶段儿童、不同性别、不同户籍及不同季节呈现出的高发意外伤害类型制定针对性预防措施.

目的:提出一种相位式呼吸门控放疗中门控窗口的选择方法.方法:采用数字表法随机选取某院已完成基于实时位置管理(real position management,RPM)系统的相位式呼吸门控放疗的38例患者.针对每个患者的参考呼吸波形,分别计算所有可选的100(10×10)个窗口内的呼吸信号标准差,作为衡量该窗口内呼吸运动稳定性的指标.在100个可选窗口中,将与临床所选窗口占空比相同但呼吸信号标准差最小的窗口作为建议窗口.比较并分析38例患者的临床窗口和基于该方法选择的建议窗口之间的呼吸信号标准差差异,并进行配对样本t检验.结果:38例患者中,临床窗口的呼吸信号标准差为(0.114±0.050)cm,建议窗口的呼吸信号标准差为(0.108±0.049)cm,二者相比有统计学差异(P=0.009).27例患者的建议窗口与临床窗口一致,其余11例患者的建议窗口与临床窗口相比呼吸信号标准差有所减小(窗口内呼吸运动稳定性提高),其中1例下降幅度超过30％,8例下降幅度在5％～30％,2例下降幅度在5％以内.结论:在相位式呼吸门控放疗中,基于窗口内的呼吸信号标准差选择门控窗口的方法可以保证和提高临床所选门控窗口的质量.

目的:对门诊抗菌药物处方进行处方点评,分析用药不合理处方,并提出解决对策,以促使临床合理用药.方法:从2019年1月至12月本院门诊药物处方共抽取4334张处方,收集统计抗菌药物处方,并按照《医院处方点评管理规范(试行)》的标准点评所抽取的抗菌药物处方用药是否合理等.结果:我院门诊抗菌药物应用率31.98％,同时在抗菌药物处方中不合理处方占25.97％,且不合理表现包括无适应症用药(32.11％)、联合用药不当(16.97％)、药物用法用量不当(43.81％)、药物选择不当(5.96％)、疗程不合理(1.15％).结论:目前我院门诊抗菌药物使用较为不合理,仍需进一步加强抗菌药物的应用监管,并加强临床医师对抗菌药物使用的培训学习,以持续提高临床合理用药水平,保障患者用药安全.

目的 比较在临床药师指导下口服与静脉补充铁剂的安全性与经济性.方法 回顾性分析2016年1月～2019年12月南京市妇幼保健院妇科收治的224例围术期轻中度缺铁性贫血患者的临床资料,所有患者均经临床药师实施药学干预,按照治疗方法不同分为口服铁剂组(119例)和静脉铁剂组(105例),口服铁剂组应用口服铁剂补充铁元素,静脉铁剂组采用静脉滴注蔗糖铁联合口服铁剂补充铁元素.比较两组的输血率、术后感染率、术后心功能变化、甲类切口愈合率、ICU入住率、总住院天数、再入院率及药物成本花费.结果 两组的输血率比较,差异无统计学意义(P>0.05).两组的术后感染率、术后心功能变化、甲类切口愈合率、ICU入住率(病死率)、总住院天数、7 d和30 d再入院率比较,差异均无统计学意义(P>0.05).静脉铁剂组的贫血治疗总费用高于口服铁剂组,差异有统计学意义(P<0.05).结论 口服补充铁剂可有效纠正铁缺乏和贫血,安全性较好,且更加经济实惠,这一研究结果为后续药学干预提供了有力支持.

Objective:To evaluate the effect of leaf position error of Varian high-definition multi-leaf collimator (HD120) on the dosimetry of stereotactic body radiation therapy (SBRT) for lung tumors.Methods:Nine SBRT plans based on HD120 for lung tumors were selected as the reference plans. The parameters of the plans were modified by the in-house program based on the Varian Eclipse 15.6 scripting application program interface to generate the simulation plans with three types of leaf position errors including the isotropic systematic error, the anisotropic systematic error and the random error, respectively. Then, the dosimetric metric deviation between each simulation plan and the corresponding reference plan was calculated and regression analysis was performed to evaluate the dosimetric effect of three types of leaf position errors of HD120 on SBRT.Results:The planning target volume (PTV) D 99%, D 2cm and V 5Gy of double lungs were decreased quadraticly with the increase of the absolute value of the isotropic systematic error. The first-order sensitivity was -0.06%/mm to -0.26%/mm, and the second-order sensitivity was -0.55%/mm 2 to -1.17%/mm 2 ( R2=0.96-0.99, P<0.01). The maximum change of PTV D 99% was -3.13%. The linear regression analysis of the effects of the anisotropic systematic error and random error showed that the sensitivity of CI was 25.16%/mm ( R2=0.98, P<0.01) and -4.84%/mm( R2=0.99, P<0.01), and the sensitivity of other dosimetric deviations with the anisotropic systematic error was 4.80%/mm to 5.12%/mm ( R2=0.96-0.98, P<0.01), whereas the sensitivity with the random error was -0.47%/mm to -1.01%/mm ( R2=0.96-0.99, P=0-0.02). Conclusions:The dosimetric deviation of SBRT plan based on HD120 for lung cancer is highly sensitive to the anisotropic systematic error of leaf position, but less sensitive to the random error. In addition, the isotropic systematic error of leaf position will lead to the decrease of target coverage to a certain extent. Consequently, it is necessary to strictly control the systematic error of HD120 leaf position in the implementation of SBRT plan in clinical work.

目的:探讨和评估光学体表监测系统(optical surface monitoring system,OSMS)在胸部肿瘤放疗摆位中的临床应用.方法:选取胸部肿瘤放疗患者40例共160例次放疗摆位(首次放疗摆位不计).将160例次摆位分为两组:对照组80例次摆位以体表激光线标记为准进行摆位,然后行锥形束CT(cone beam,CBCT)扫描,经图像配准之后得出并记录六维摆位偏差;实验组80例次摆位在首次治疗摆位时以CBCT为基准获取OSMS体表图像(VRT)作为参考图像,在后续摆位时以VRT为准进行OSMS摆位,然后行CBCT扫描经过图像在线配准后得出并记录六个维度摆位偏差.对比并分析两组摆位的系统偏差、随机偏差、最大偏差、残余误差率以及摆位时间.结果:对照组在Vrt、Lat、Lng、Roll、Pitch、Rtn维度上的偏差分别为(0.11±0.21)cm、(0.04±0.25)cm、(0.10±0.28)cm、(0.20±1.25)°、(0.14±0.88)°、(-0.12±1.04)°,实验组则分别为(0.01±0.17)cm、(0.03±0.12)cm、(0.02±0.11)cm、(-0.04±0.79)°、(0.21±0.66)°、(0.23±0.63)°.对照组在Vrt、Lat、Lng、Roll、Pitch、Rtn维度上的最大摆位偏差分别为(0.5/-0.5)cm、(1.0/-0.7)cm、(0.8/-0.4)cm、(3.4/-3.4)°、(1.9/-2.2)°、(2.4/-2.5)°,实验组则分别为(0.24/-0.3)cm、(0.3/-0.32)cm、(0.26/-0.36)cm、(2.5/-2.0)°、(1.9/-1.7)°、(1.4/-2.7)°.在Vrt、Lng和Rtn维度上,两组间的摆位偏差差异有统计学意义(P<0.05).结论:将OSMS技术应用于胸部肿瘤放疗之中能够改善系统偏差、随机偏差、最大偏差和残余摆位误差率,并且增加的治疗时间在可接受范围内.

为实施国家重大公共卫生服务项目的有关要求,加强农村妇女"两癌"(乳腺癌和宫颈癌)检查工作,该文阐述目前农村妇女"两癌"检查项目服务现状,发现并总结项目开展过程中主要问题和合理建议,探讨如何优化项目方案,逐步提高项目覆盖率,以形成两癌检查项目"防、治、康、管"的长效机制.

目的 分析近几年苏州市孕产妇保健和健康状况及其变化,为进一步改进和完善孕产妇系统管理提供科学依据.方法 采用苏州2014—2017年间孕产妇保健和健康情况年报表数据.结果 2014—2017年苏州市剖宫产率及各项保健服务指标均呈下降趋势(P<0.01);孕产妇艾滋病病毒感染率由2014年的0.66‰.上升至2017年的1.71‰.(P<0.01),产妇乙肝表面抗原阳性率由2014年的4.26％下降至2017年的3.13％(P<0.01).孕产期贫血患病率包括重度贫血患病率均有上升趋势.结论 仍需加强对孕产妇相关知识的健康教育及防护措施宣传,有利于阻断母婴传播;进一步重视孕产妇系统管理服务以提高孕产期保健服务质量.

目的:探讨持续质量改进模式在埋藏式起搏器患者术后舒适度管理中的应用效果.方法:将228例埋藏式起搏器患者分为实验组(134例)和对照组(84例),实验组采用持续质量改进模式进行护理,实行术后弹力绷带包扎伤口,术后卧床休息为主,术后2小时可下床活动,对照组则按原有的流程护理患者.结果:运用持续质量改进模式管理,实验组患者的舒适度明显高于对照组,差异有统计学意义(P<0.01),同时未发生起搏器并发症等意外事件.结论:持续质量改进模式在埋藏式起搏器患者术后舒适度管理中发挥了积极的作用,提高了起搏器患者术后舒适度.

Objective:To explore the effects of semantic navigation strategy (SNS) on naming ability in patients with aphasia.Method:Fourteen patients with aphasia were randomly divided into SNS group (n=7) and unrelated semantic (US) group (n=7).One hundred and twenty-two words chosen from Chinese word association norms were used in this study.The presentation sequence of words was generated automatically with network analysis techniques in SNS group and randomly without network analysis techniques in US group.After baseline tests of Western Aphasia Battery (WAB) and Mini Mental Status Examination (MMSE),all the patients with aphasia received speech training once a day for 10 consecutive days.The naming ability was evaluated with 75 pictures before and after training respectively in all the patients.Result:The number of correct responses after training in SNS group was significantly higher than that before training in the same group and that after training in US group.The number of no response after training in SNS group was significantly lower than that before training in the same group and that after training in US group.There was significantly positive correlation between the number of correct responses after training and the naming scores of WAB in SNS group.Conclusion:SNS may effectively improve the naming ability in patients with aphasia.