Objective:To evaluate the usability of Gafchromic HD-V2 film for dose dosimetry in the ultra-high dose-rate (UD) electron beam from a modified medical linac, and to investigate the response between the energy and dose-rate dependence to the film.Methods:The HD-V2 film was utilized to measure the average dose-rate of the UD electron beam. The measured result was compared with those by advanced Markus chamber and alanine pellets. And characteristics of the UD electron beam were also measured by HD-V2 film. Energy dependence of HD-V2 film at three beam energies (6 MV X-ray, 9 MeV and 16 MeV electron beam) was investigated by obtaining and comparing the calibration curves based on the clinical linear accelerator in the dose range of 10-300 Gy. The dose-rate dependence of HD-V2 film was also studied by varying the dose rate among 0.03 Gy/s, 0.06 Gy/s and 0.1 Gy/s, and range of 100-200 Gy/s.Results:The measured average maximum dose-rate of 9 MeV UD electron beam at source skin distance (SSD) 100 cm was approximately 121 Gy/s using HD-V2 film, consistent with the results by advanced Markus chamber and alanine pellets. The measured percentage depth dose (PDD) curve parameters of the UD electron beam were similar to the conventional 9 MeV beam. The off-axis dose distribution of the UD electron beam showed the highest central axis, and the dose was gradually decreased with the increase of off-axis distance. The energy dependence of HD-V2 film had no dependency of 6 MV and 9, 16 MeV while measuring the dose in the range from 20 to 300 Gy. The HD-V2 film had no significant dose-rate dependency at the dose rate of 0.03 Gy/s, 0.06 Gy/s and 0.1 Gy/s for the clinical linear accelerator. Likewise, there was also no dose-rate dependence in the range 100-200 Gy/s in the modified machine.Conclusion:HD-V2 film is suitable for measuring ultra-high dose rate electron beam, independent of energy and dose rate.

Objective:To investigate the feasibility of transforming conventional medical accelerator to achieve ultra-high dose rate required to achieve Flash radiotherapy (Flash-RT), and to understand the physical properties of the Flash-RT beam.Methods:By transforming the Varian 23CX medical accelerator, the radiation average dose rate at the isocenter was not less than 40 Gy/s. The relevant physical measurement scheme was designed to accurately measure the actual radiation dose rate of different source skin distance (SSD) conditions, the percent depth dose (PDD) curve and the off-axis dose distribution of the beam.Results:The average dose rate of 9 MeV electron beam after the transformation was measured using the HD-V2 type film, the average dose rate of 3 s was 97.9 Gy/s, and the average dose rate of 6 s was 99.27 Gy/s. When the SSD was 100 cm, 80 cm and 60 cm, the average dose rate of 9 MeV electron beam after the transformation was 99.3 Gy/s, 168 Gy/s and 297.5 Gy/s, respectively. After the transformation, the R100 of the 9 MeV beam was 2.2 cm underwater, R50 was 3.87 cm underwater, the electron range Rp was 4.58 cm, and the maximum possible energy Ep,0 on the phantom surface was 9.28 MeV. These parameters were slightly higher than those of the conventional 9 MeV beam, manifested with slight increase in the surface dose and widening high dose flat area. The overall deposit dose distribution exhibited the highest central axis and the increase in dose declines from the axis distance. Under the condition that the field size was 20 cm×20 cm and the SSD was 100 cm, the FWHM of the vertical and horizontal off-axis dose distribution curves were 16.6 cm and 16.4 cm, respectively. Conclusion:By transforming conventional medical accelerator, the average dose rate of the beam at the isocycle meets the requirement of Flash-RT, and the average dose rate under the condition of 60 cm SSD is much higher than the requirement of at least 40 Gy/s for Flash-RT.

目的:研究单纯疱疹病毒脑炎(HSE)患者粪便和血清中炎症相关指标的变化,探讨肠道炎症在HSE中的作用.方法:使用ELISA法检测65例HSE患者及65例健康对照者粪便中粪钙卫蛋白(FC)、粪α-1-抗胰蛋白酶(FAT)、粪连蛋白(FZ)、粪乳铁蛋白(FLF)和血清中脂多糖(LPS)、脂多糖结合蛋白(LBP)水平.根据入院时改良Ranking量表评分将HSE患者分为轻度神经功能障碍组(A组,n=11)、中度神经功能障碍组(B组,n=15)和严重神经功能障碍组(C组,n=39).对6例(A组、B组、C组各2例)HSE患者及5例健康对照者进行肠黏膜活检.分别分析HSE组和健康对照组以及A组、B组、C组之间血清、肠道炎症指标之间的差异,进一步分析HSE患者血清炎症指标与肠道炎症指标的相关性.结果:HSE组FC、FAT、FZ、LPS和LBP水平高于健康对照组,差异有统计学意义(P<0.05),而两组间FLF差异无统计学意义(P>0.05);A、B、C 3组HSE患者FC、FAT、FZ、LPS和LBP水平比较差异有统计学意义(P<0.05),3组FLF水平比较差异无统计学意义(P>0.05);HSE患者血清炎症指标LPS、LBP水平与肠道炎症指标FC、FAT、FZ呈正相关(P<0.05),而与FLF无相关性(P>0.05);6例HSE患者肠黏膜活检均显示不同程度的肠道炎症.结论:肠道炎症可能参与HSE的发病及病情进展.

Migraine is a common clinical chronic neurovascular disease, which seriously affects the quality of life of patients. Studies have shown that patent foramen ovale (PFO) may be related to migraine, such as transient hypoxemia caused by patent foramen ovale related right ⁃ to ⁃ left shunt, or vasoactive substances passing through an unclosed oval foramen, avoiding lung tissue metabolism and directly entering the arterial system, and contradictory micro ⁃ embolism and other mechanisms may be related to migraines related to patent foramen ovale, especially migraine with aura. The closure of patent foramen ovale can benefit some migraine patients. This article intends to outline the relationship between patent foramen ovale and migraine, and its mechanism, prevention and treatment.

目的:探究隐源性卒中(CS)患者肠道炎症及肠道屏障的变化情况及其临床意义.方法:采用ELISA法检测53例CS患者及53例对照者粪便炎症标记物粪钙卫蛋白(FC)、粪乳铁蛋白(FLF)含量,选取8例CS患者及5例对照者的肠镜活检标本行HE染色及免疫组化染色检测紧密连接蛋白Occludin与ZO-1蛋白表达水平.结果:CS组粪便FC、FLF含量高于对照组(P<0.001).与对照组相比,CS组肠黏膜炎性细胞浸润增加,肠组织ZO-1和Occludin表达水平降低(P<0.001).结论:CS患者存在肠道炎症及肠道屏障改变,其可能是促成CS发生发展的重要因素.

目的:研究脊髓小脑共济失调3型(SCA3)患者脑脊液及血浆中 γ-氨基丁酸(GABA)和谷氨酸(Glu)的水平,探讨二者在SCA3发生中的作用及临床意义.方法:使用超高效液相色谱-质谱联用法检测24例SCA3患者及9例正常对照脑脊液及血浆中GABA、Glu水平.对24例SCA3患者行国际共济失调评定量表(ICARS)评分.分析SCA3患者GABA和Glu水平与年龄、CAG重复数及ICARS评分的关系.结果:与正常对照比较,SCA3患者脑脊液与血浆中GABA水平较低,Glu水平较高(P<0.05).SCA3患者脑脊液中GABA水平与ICARS评分呈负相关(r=-0.412,P<0.05),SCA3患者脑脊液与血浆中Glu与CAG重复数呈正相关(r=0.414、0.485,P<0.05).结论:脑脊液中GABA水平可反映SCA3患者病情严重程度.

目的:检测单纯自主神经功能衰竭(PAF)患者皮肤、胃小弯及膀胱组织中磷酸化 α-突触核蛋白(pα-syn)的表达情况,寻找诊断PAF的生物标志物.方法:收集17例PAF患者和12例对照参与研究,分别使用皮肤钻孔取样器、电子胃镜、膀胱镜及活检钳收集皮肤(含真皮层)、胃小弯(含黏膜下层)、膀胱(含肌层)组织标本,利用免疫组化法检测pα-syn的表达情况.结果:PAF患者周围组织中均可检出pα-syn的表达,而对照周围组织均未检出.结论:PAF患者皮肤、胃小弯及膀胱组织有广泛的pα-syn沉积,pα-syn可能参与了PAF的发病,或可作为诊断PAF的生物标志物.

目的 观察注射用丹参多酚酸治疗中度急性缺血性脑卒中的有效性和安全性.方法 采用多中心、随机、双盲、平行对照临床研究方法.以美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分为6～22分的急性缺血性卒中患者为对象,将其随机分为研究组和对照组.两组患者均给予常规基础治疗,研究组在基础治疗上加用注射用丹参多酚酸静脉滴注,每日1次,每次130 mg,对照组在基础治疗上给予等量生理盐水,两组均连续治疗14 d.在用药后第14 d、第30 d和第90 d评估NIHSS评分、Barthel指数评分,以治疗后30 d、90 d时改良Rankin量表评分(modified Rankin scale,mRS)评估预后(0～2分为预后良好),根据患者不良事件进行安全性评估.结果 共纳入1529例脑卒中患者,其中研究组1021例,对照组508例.研究组和对照组在治疗后第14 d、第30 d和第90 d的NIHSS评分、Barthel指数组间差异均有统计学意义(均P＜0.05),治疗后30 d、90 d研究组预后良好率高于对照组,组间差异有统计学意义(P＜0.05).研究组与对照组不良事件发生率差异无统计学意义(P＞0.05).结论 注射用丹参多酚酸用于治疗中度急性脑卒中有效且安全,在连续治疗2周后其疗效优于基础治疗.

目的 通过比较IC Profiler与三维剂量分析仪的测量结果,研究IC Profiler的性能.方法 使用IC Profiler与三维剂量分析仪分别测量6 MV X射线、10 MV X射线、6 MV FFF(FFF:Flattening Filter Free,射线束没有被匀整过滤)X射线和10 MV FFF X射线的平坦度、对称性、射野宽度、半影、中心点,对两种设备的测量结果进行对比分析,将IC Profiler测量值减去三维剂量分析仪测量值,得出两者差值数据.结果 用IC Profiler测量的射野平坦度结果比使用三维剂量分析仪稍小.对比测量FF和FFF不同大小射野的对称性,IC Profiler均与三维剂量分析仪测量值差别很小,符合度好,可以用于测量所有射野的对称性.射野宽度测量中,用IC Profiler测量的数值比三维剂量分析仪测量值稍小,差别均值为1.3 mm.IC Profiler半影测量值较小,与三维剂量分析仪结果差别较大.射野中心的测量,两种方法差别较小.结论 IC Profiler不宜测量照射野半影;测量射野的宽度会产生2～3 mm的误差;测量射野平坦度、对称性、射野中心位置,与三维剂量分析仪相一致.在快速检查射野性能、调试加速器时,IC Profiler是一个较好的工具.

Objective To find the gap between the new domestic accelerator and the import accelerator, and to better use XHA600E accelerator for clinical treatment, we performed a systematic test with the technical indicators of XHA600E digital accelerator and a comparative analysis between the Unique accelerator and XHA600E accelerator in the key parameters.Methods Firstly, the mechanical parameters, ray parameters, MLC parameters and EPID performance of the XHA600E accelerator were tested by using tools such as spirit level, coordinate paper, three-dimensional water tank, rinse-free film and Las Vegas phantom according to the national standard GB/T 19046 "medical electron accelerator acceptance test and periodic inspection procedures". Then the key parameters include the accuracy of isocenter, ray quality, field flatness and symmetry of Unique accelerator were tested. Finally, two equipment test results were compared and evaluated.Results The technical indicators of XHA600E accelerator were all within the scope of error requirements. Two devices had little difference in the key parameters such as accuracy of isocenter, ray quality, field flatness and symmetry, and Unique overall was superior to XHA600E.Conclusion Compared with the previous generation of 600D model, XHA600E has greatly improved in hardware and software performance, which narrows the gap with the import accelerator. However, there is still a lot of room for improvement in 3D image verification and dose verification.

Unique直线加速器(美国瓦里安公司)是一种用于肿瘤精确放射治疗的低能医用直线加速器,其主要产生单能量为6 MV的X射线,多配备120片多叶光栅和图像引导系统,可实现三维适型调强放射治疗和容积调强放射治疗等.相比高能加速器其具有结构简单、可靠高效等优势[1].郑州大学附属肿瘤医院放疗科的Unique直线加速器在治疗过程中遇到过3例治疗头旋转故障,故障现象均为旋转过程中时断时续,随着运动时间加长,停止频率增多直到不运动,但停止一段时间后又可运动,且出现该现象时加速器不报连锁,无故障代码.虽然三次故障现象都相同,但每次处理结果并不相同.为此,对3例故障案例进行总结,供同行参考.

This paper aims to discuss maintenance methods of Xinhua XHA600E linear accelerator by analyzing normal faults of this machine. The Xinhua XHA600E linear accelerator in our hospital encountered tungsten door HWFA and FLOW interlock, and could not be used normally. Maintenance person implemented targeted maintenance by watching failure phenomenon, reading device drawing and analyzing failure reasons. It's necessary to record potentiometer supply voltage of tungsten door and exclude encoder failure for problem of tungsten gate movement, and it's necessary to exclude quality problem of cooling circulating water and inner wall of cooling water pipe.

Objective To investigate the clinical features of riboflavin-reactive lipid storage myopathy (LSM) caused by ETFDH gene mutation and the therapeutic effect of using riboflavin.Methods Three patients in two family with LSM were diagnosed by muscle magnetic resonance imaging (MRI), biopsy, and genetic testing, and the changes in motor symptoms before and after treatment with riboflavin were evaluated.Results In both 3 patients, MRI and muscle biopsy of the left deltoid muscle showed muscle lipid deposition.The gene detection revealed the presence of the complex heterozygous mutation c.1395 dupT (p.G466 Wfs*24) and c.770 A＞G (p.Y257 C) in the ETFDH gene in one patient, and two patients carry the c.770 A＞G (p.Y257 C) homozygosis mutation in the ETFDH gene, and significant improvement in motor symptoms were observed after 1 month of treatment with riboflavin in 3 patients.Conclusion This report suggests that patients with dual lower limb weakness caused by no obvious cause can be diagnosed by muscle biopsy and genetic testing, and the application of riboflavin can effectively improve the patient's motor symptoms.