目的 探究五行音乐疗法联合碳酸锂治疗双相情感障碍的临床疗效及其对抑郁躁狂情绪的影响.方法 选择双相障碍患者80例,根据治疗方式不同分为研究组和对照组各40例.对照组采用碳酸锂治疗,研究组在对照组基础上加以五行音乐疗法,对比两组临床治疗效果、《中医五态情志问卷》评分,贝克-拉范森躁狂量表(BRMS)评分、汉密尔顿抑郁(HAMD)量表评分、症状自评量表(SCL-90)中各因子评分及不良反应发生率.结果 治疗后,观察组治疗总有效率显著高于对照组(P<0.05);观察组情绪五因子除喜外,其他4项评分均显著低于对照组(P<0.05);两组BRMS和HAMD评分差异显著(P<0.05);观察组SCL-90各维度评分显著低于对照组(P<0.05).结论 五行音乐疗法联合碳酸锂治疗能有效缓解双相情感障碍患者抑郁、躁狂等不良情绪,增强患者依从性,降低炎症水平,具有较好的临床疗效且不良反应少,安全性高.

Objective:To investigate the clinical efficacy of five-element music therapy in the treatment of bipolar disorder.Methods:Eighty patients with bipolar disorder admitted to Shandong Mental Health Center from January 2018 to December 2019 were included in this study. They were randomly divided into a study group and a control group ( n = 40/group). The control group was treated with conventional drug treatment. The study group was treated with five-element music therapy based on conventional drug treatment. Before, during and after treatment, mania and depression were evaluated. Symptom self-evaluation scale and the Traditional Chinese Medicine Five State Emotion Questionnaire were completed to evaluate the curative effect. Patients were followed up by telephone call. Recurrence at 3, 6 and 12 months was recorded. Results:Before treatment, there were no significant differences in the scores of the Bech-Rafaelsen Mania Rating Scale (BRMs), Hamilton Depression Rating Scale (HAMD), Traditional Chinese Medicine Five State Emotion Questionnaire, Symptom Checklist-90 (SCL-90) between the two groups (all P > 0.05). During and after treatment, BRMs, HAMD, Traditional Chinese Medicine Five State Emotion Questionnaire, and SCL-90 scores were significantly decreased in each group compared with before treatment [Control group: BRMs score during and after treatment: (11.52 ± 1.57) points, (9.43 ± 1.05) points; HAMD score during and after treatment: (16.75 ± 3.05) points, (13.61 ± 2.51) points; Traditional Chinese Medicine Five State Emotion Questionnaire: emotional vocabulary (67.25 ± 5.7) points, (56.38 ± 4.97) points, physical symptoms (29.52 ± 3.94) points, (24.19 ± 3.05) points, SCL-90 score: (100.52 ± 10.26) points, (68.85 ± 7.33) points. Study group: BRMs score during and after treatment: (9.33 ± 1.09) points, (7.85 ± 0.82) points; HAMD score: (13.74 ± 2.54) points, (10.17 ± 1.97) points; Traditional Chinese Medicine Five State Emotion Questionnaire: emotional vocabulary: (58.19 ± 5.06) points, (46.85 ± 4.06) points, physical symptoms (25.14 ± 3.54) points, (20.11 ± 2.57) points; SCL-90 scores: (90.85 ± 8.97) points, (56.87 ± 5.81) points]. During and after treatment, scores of BRMs, HAMD, Traditional Chinese Medicine Five State Emotion Questionnaire and SCL-90 in the study group were significantly lower than those in the control group ( t = 3.77, 7.01, 4.48, 6.99, 8.78, 4.89, 6.05, 4.19, 7.57, all P < 0.05). Total response rate in the study group was significantly higher than that in the control group (90.0% vs. 72.5%, χ2 = 4.02, P < 0.05). At 3, 6 and 12 months after treatment, recurrence rate in the study group was 2.5%, 15.0% and 30.0%, respectively, which were significantly lower than 17.5%, 35.0%, and 52.5% in the control group ( χ2 = 5.00, 4.26, 4.17, all P < 0.05). Conclusion:Five-element music therapy for the treatment of bipolar disorder can markedly alleviate depression and mania, restore patient's emotional state, improve clinical efficacy, and decrease recurrence rate.

Magnetic resonance-guided radiotherapy (MRgRT) not only offers real time magnetic resonance (MR) imags with high-resolution and good soft tissue contrast to guide the delineation of the target volume during simulation and daily radiotherapy, but also reveals the position and shape changes of the target volumes and organs at risk (OAR) during treatment dynamically, which provides the evidence for the individual-adptive planning revision. Thus, MRgRT has the potential to dramatically impact cancer research and treatment. And this treatment mode is theoretically more suitable for the disease with obvious tissue deformation, such as breast. In this review, application of MR scanner with a linear accelerator (MR-linac) in radiotherapy workflows for breast cancer patients was summarized, and its implications and opportunities on breast cancer irradiation were highlighted.

目的 探讨基于3DCT定位的乳腺癌保留乳房术后部分乳腺外照射(EB-PBI)调强放疗计划与4DCT模拟患者实际呼吸运动过程中靶区、危及器官(OARs)的剂量以及肿瘤控制概率(TCP)、正常组织并发症概率(NTCP)的差异.方法 纳入山东省肿瘤医院2016-06-12-2021-05-10收治的30例女性乳腺癌患者,基于3DCT图像和4DCT图像10个时相分别进行靶区勾画.基于3DCT图像进行EB-PBI放疗计划设计.然后将基于3DCT的EB-PBI计划(Plan-3D)分别配准到4DCT图像的0～90％10个相位上,将10个相位的计划基于0相位累加,得到4D累加计划Plan-4D.将Plan-3D和Plan-4D进行计划比较,并以Lyman-Kutcher-Burman(LKB)模型预测TCP和NTCP.结果 Plan-4D的临床靶区体积(CTV)、计划靶区体积(PTV)、D90、D95、Dmean、V90、V95均大于Plan-3D,差异均有统计学意义,Z=-4.783,P<0.001;Z=-4.615,P<0.001;Z=-4.720,P<0.001;Z=-4.741,P<0.001;Z=-3.569,P<0.001;Z=4.415,P=0.019;Z=-3.774,P<0.001.Plan-4D患乳同侧肺体积、V5、Dmean,患乳对侧肺体积、V5、Dmean和心脏体积均大于Plan-3D,差异均有统计学意义,Z=-4.679,P<0.001;Z=-4.782,P<0.001;Z=-4.638,P<0.001;Z=-4.103,P<0.001;Z=-2.223,P=0.026;Z=-3.137,P=0.002.左乳患者心脏的V5、V10、Dmean在Plan-4D时高于Plan-3D,差异有统计学意义,Z=-2.215,P=0.027;Z=-4.638,P<0.001;Z=-3.317,P=0.002.右乳患者心脏的V5、V10在Plan-4D时高于Plan-3D,差异均有统计学意义(Z=-3.296,P=0.001;Z=-2.660,P=0.008),二者Dmean差异无统计学意义,Z=-1.903,P=0.057.而Plan-3D的TCP高于Plan-4D,Plan-3D同侧肺的NTCP同样高于Plan-4D,差异均有统计学意义,Z=-4.782,P<0.001;Z=-4.477,P<0.001.结论 基于3DCT的静态计划会高估靶区剂量覆盖、TCP和患乳同侧肺的NTCP,而低估OARs的受照剂量.基于4DCT的EB-PBI动态累加计划更接近真实放疗过程,能够用于精确放疗剂量体积参数的准确评估.

Objective:To compare the differences of postoperative clinical target volume of internal mammary lymph node (CTV ImlN) by different delineation methods, and to explore the reasonable method of CTV ImlN delineation after internal mammary lymph node dissection (ImlND). Methods:A total of 20 breast cancer patients who had undergone modified radical mastectomy (MRM) with ImlND on the affected side and had complete preoperative and postoperative CT images were selected. The CTV (CTV pr-I, CTV pr-a) of both sides of ImlN were delineated on preoperative CT images according to RTOG guideline. On postoperative CT images, three different methods including deformation image registration (DIR) method, visual contrast method and precise measurement method, were employed to delineate the postoperative CTV ImlN of the affected side. The targets were named as CTV DIR, CTV V and CTV M, respectively. The central displacement, target volume, degree of inclusion (DI) and conformity index (CI) of CTV pr-a, CTV V, CTV M and CTV DIR were compared. Results:The central displacement of CTV V, CTV M and CTV DIR from CTV pr-a was 2.17 cm, 1.44 cm and 1.25 cm, respectively. The target volume of CTV pr-a, CTV pr-I, CTV V, CTV M and CTV DIR was 2.10 cm 3, 2.17 cm 3, 2.04 cm 3, 1.88 cm 3 and 2.07 cm 3 respectively. There was no significant difference in the target volume (all P>0.05). The CI values of CTV V-CTV pr-a and CTV M-CTV pr-a were both 0.16, and that of CTV DIR-CTV pr-a was 0.43. The CI value of CTV DIR was significantly higher than those of CTV V and CTV M (both P<0.01). The DI values of CTV V-CTV pr-a, CTV M-CTV pr-a and CTV DIR-CTV pr-a were 0.26, 0.24 and 0.58, respectively. The DI value of CTV DIR was significantly higher than those of CTV V and CTV M (both P<0.01). Conclusions:It is difficult to accurately delineate the CTV ImlN for patients after ImlND. However, the spatial position fitness of the target region delineated by DIR method is better than those by visual contrast and precise measurement methods.

Objective:To observe the feasibility of magnetic resonance (MR)-guided stereotactic body radiotherapy (SBRT) for non-small cell lung cancer, and analyze the dosimetric differences in the presence or absence of magnetic field.Methods:Three patients with non-small cell lung cancer were prospectively treated with MR-guided linac (MR linac) for SBRT, and the dose was calculated with or without magnetic field models. The differences of dose distribution with or without magnetic field models were compared. At the same time, the target coverage, plan pass rate and treatment time were described, and the complexity of the conventional accelerator backup plan and the magnetic field model were compared.Results:The treatment time of 3 patients was (36.67±6.11) min, and the average time of online adaptive planning was (14.4±1.7) min, which was basically tolerated by patients. The treatment plan pass rate (3%/3 mm) was 98.9%, the Gamma pass rate (3%/3 mm) of the online plan during treatment was 98.5% and the target coverage was 99.1%, which met the clinical needs. The dose in the low dose area of the lung was slightly lower than that in the case without magnetic field, whereas the dose in ribs and skin was slightly higher than that in the plan without magnetic field. The number of machine unit (MU) for online adaptive plan was slightly higher than that of the reference plan, and the number of MU for the conventional accelerator standby treatment plan was significantly lower than that of the MR linac plan under the same target coverage. The follow-up results showed that there was no adverse reaction, and the short-term efficacy was partially relieved.Conclusions:In the case of considering the influence of magnetic field, the treatment plan meeting the clinical needs can be obtained. It is proven that SBRT radiotherapy for lung cancer guided by magnetic resonance accelerator is feasible, whereas the treatment time and process are complex.

目的 系统评价中国青少年心理亚健康状态的检出率及分布特征,为了解我国青少年心理亚健康状态情况提供参考.方法 通过计算机检索中英文数据库,筛选2008年1月-2020年3月关于我国青少年心理亚健康状态检出率的文献,采用随机效应模型合并青少年心理亚健康状态的检出率,并对性别、年级、地区及时间分组指标进行亚组分析.结果 有17篇文献被纳入本研究,合计样本量为63060人,青少年心理亚健康状态检出率为15.50％ (95％CI:13.04％～18.31％).亚组分析显示,我国青少年心理亚健康状态,高中生的检出率最高(18.99％),大学生检出率最低(9.52％),初中生居中(14.03％).2016-2020年检出率最高(16.75％),2011-2015年检出率居中(16.38％),2008-2010年检出率最少(11.46％).结论 我国青少年心理亚健康状态检出率较高,且在年级及时间分布上存在差异,应引起重视.

目的:了解高中生家庭亲密度、适应性与心理亚健康的关系,为促进青少年心理健康提供依据.方法:抽取山东省某市1286名高中生,利用青少年亚健康多维评定问卷、家庭亲密度和适应性量表中文版进行问卷调查.结果:女生在家庭亲密度上显著高于男生(t=-2.38,P＜0.05),重点学校、城市学生及独生子女在家庭亲密度和适应性上均高于普通学校、农村学生及非独生子女(t = 3.76,3.22,2.75,2.68,2.21,2.39;P＜0.05);极端型家庭学生心理亚健康症状数最多,中间型家庭学生心理亚健康症状数次之,而平衡型家庭心理亚健康症状数最少;心理亚健康症状数与家庭亲密度和适应性得分呈显著负相关(r =-0.370,-0.349;P＜0.05).结论:心理亚健康状态与家庭亲密度和适应性存在关联.

Objective:To investigate the effects of clinical characteristics, irradiation techniques and dose-volume parameters on radiation pneumonitis(RP) in thoracic segment esophageal cancer patients, so as to provide reference for the formulation of radiotherapy protocol for thoracic esophageal cancer.Methods:The incidence of RP in 247 patients with thoracic segment esophageal cancer from June 2014 to June 2019 was analyzed retrospectively, then univariate and multivariate analyses were performed on the clinical characteristics, radiation techniques and lung dosimetry parameters of these patients. The area under receiver operating characteristic (ROC) curve was used to verify the diagnostic efficacy of RP≥grade 1, ≥grade 2 and ≥grade 3.Results:There were 118 cases (47.8%)with RP≥grade 1, 54 cases (21.9%)with RP≥grade 2, 17 cases (6.9%)with RP≥grade 3. The result of univariate analysis showed that lung V5- V40 and MLD were both related to the occurrence of RP≥grade 1( Z=-5.802 to -4.306, P<0.05). ≥grade 2, and≥grade 3, respectively( F=0.057 to 11.616、0.087 to 3.392, P<0.05). GTV volume, PTV volume, GTV/lung volume(%) and PTV/lung volume(%) were related to RP≥grade 1( Z=-3.377 to -2.041, P<0.05)and RP≥grade 2( F=3.600 to 9.801, P<0.05). Smoking index >400 was significantly correlated with RP≥grade 3( χ2=13.295, P<0.05), and chronic obstructive pulmonary disease (COPD) was significantly correlated with RP≥grade 1( χ2=9.146, P<0.05). However, there was no significant correlation between RP and different irradiation techniques, chemotherapy factors, radiotherapy dose, esophageal cancer stage and cancer location.The result of multivariate analysis showed that V5 and V40 were independent risk factors of RP≥grade 1(AUC 55.74%、4.13%)、MLD was independent risk factors of RP≥grade 2 (AUC 11.91 Gy), and V5 was independent risk factors of RP≥grade 3(AUC 57.60%). The smoking index>400 was the independent risk factor of RP≥grade 3 ( Wald=5.964, P<0.05), and COPD was the independent risk factor of RP≥1 grade ( Wald=6.110, P<0.05). Conclusions:The incidence of RP is low after radiotherapy for thoracic segment esophageal cancer. The dosimetric parameters such as lung V5, V40, MLD, smoking degree, COPD and other clinical characteristics are closely related to the occurrence of RP of corresponding grades.

Objective:To assess the feasibility of delayed-enhancement MRI in contouring the lumpectomy cavity (LC) for patients with invisible seroma or a low cavity visualization score (CVS≤2) in the excision cavity after breast-conserving surgery (BCS).Methods:Twenty-six patients with stage T 1-2N 0M 0 who underwent prone radiotherapy after BCS were recruited. The LC delineated on CT simulation images was denoted as LC CT. The LCs delineated on T 2WI, as well as on different delayed phases (2-, 5-and 10-minute) of delayed-enhancement T 1WI were defined as LC T2, LC 2T1, LC 5T1 and LC 10T1, respectively. Subsequently, the volumes and locations of the LCs were compared between CT simulation images and different sequences of MR simulation images using deformable image registration. Results:The volumes of LC T2, LC 2T1, LC 5T1 and LC 10T1 were all larger than that of LC CT. A statistical significance was found between the volume of LC CT and those of LC 2T1 or LC 5T1, respectively (both P<0.05). The conformal index (CI), degree of inclusion (DI), dice similarity coefficient (DSC) and the distance between the center of mass of the targets (COM) of LC CT-LC 10T1 were better than those of LC CT-LC T2, LC CT-LC 2T1 and LC CT-LC 5T1, however, there was no statistical difference among them (all P>0.05). Conclusions:It is feasible to delineate the LC based on prone delayed-enhancement MR simulation images in patients with low CVS after BCS. Meanwhile, the LCs derived from prone delayed-enhancement T 1WI of 10-minute are the most similar with those derived from prone CT simulation scans using titanium clips, regardless of the volumes and locations of LCs.

Objective:To compare positional and volumetric differences between the gross target volumes (GTV) delineated on three-dimensional CT (3D-CT) referencing 18F-FDG PET/CT and the GTV on the deformed image derived from 3D-CT and 18F-FDG PET/CT for primary thoracic esophageal cancer (EC). Methods:Seventy-two patients underwent chemoradiotherapy were enrolled. All the patients sequentially underwent 18F-FDG PET/CT scans for diagnosis and 3D-CT scans for simulation. The GTV 3D was delineated on 3D-CT without referencing 18F-FDG PET/CT. The GTV PET-ref was delineated on 3D-CT referencing 18F-FDG PET/CT. The GTV PET-regwas delineated on the deformed image derived from 3D-CT and 18F-FDG PET/CT by MIM deformable registration software. The differences in position, volume, length, conformity index (CI), and degree of inclusion (DI) of target volumes were compared, respectively. Results:The median volume of GTV 3D, GTV PET-ref, GTV PET-reg were 44.90, 40.36 and 41.15 cm 3, respectively. There was no statistical difference between the volumes of any two targets. The mean lengths of GTV 3D, GTV PET-ref, GTV PET-reg were 8.54, 9.29 and 8.38 cm, respectively. The length of GTV PET-ref was longer than that of GTV 3D ( t=2.134, P<0.05). The median DIs of GTV PET-ref, GTV PET-regin GTV 3D were 0.86, 0.82( Z=-2.741, P<0.05), and that of GTV 3D in GTV PET-ref, GTV PET-reg were 0.87, 0.84 ( Z=-1.429, P<0.05). The median CIs of GTV 3D in GTV PET-ref and GTV PET-reg were 0.72, 0.68 ( Z=2.756, P<0.05), and the difference was significant. The CIs of GTV 3D and GTV PET-ref, GTV 3D and GTV PET-reg, GTV PET-ref and GTV PET-reg had significant negative correlation with the distance of target centers. Conclusions:There was no significant difference between GTV contoured on three-dimensional CT (3D-CT) referencing 18F-FDG PET/CT and the GTV on the deformed image derived from 3D-CT and 18F-FDG PET/CT either in volume size or in spatial position. Therefore, it is recommended that radiation oncologists can refer to the recent diagnostic PET/CT when delineating the gross target volume for primary thoracic esophageal cancer.

Objective:To explore the interobserver variabilities in the delineation of the target volume using simulation three-dimensional computed tomography (3DCT) between the supine and prone positions for external-beam partial breast irradiation (EB-PBI) after breast-conserving surgery (BCS).Methods:Twenty-seven breast cancer patients who were scheduled to receive EB-PBI after BCS from July 2016 to April 2017 were enrolled in this study. All patients underwent axial 3DCT simulation scanning in the supine and prone positions during free breathing. Based on two different simulation 3DCT acquired, the gross target volume (TB) formed by using surgical clips and the clinical target volume (CTV) were delineated by five radiologists using specific guidelines. The following parameters including the target volume, coefficient of variations (COV) and matching degree (MD) were calculated to analyze the interobserver variability. Twenty-seven breast cancer patients who were scheduled to receive EB-PBI after BCS from July 2016 to April 2017 were enrolled in this study.Results:Whether in the supine or prone position, the interobserver variabilities for TB and CTV were statistically significant ( P<0.001, P=0.001, P<0.001, P=0.001). And the intersection of CTV in the prone position was 5.79 cm 3 greater than that in the supine position ( P=0.011). The interobserver variability of COV CTV in the prone positionwas significantly lower than that in the supine position ( P=0.014). And the interobserver variabilities of MDTB TB and MDTB CTV in the prone positionwere statistically greater than those in the supine position, respectively ( P<0.001, P= 0.001). Conclusions:When delineating the target volume of EB-PBI in the prone position, the interobsever variability can be reduced compared with that in the supine position. Hence, it is more reasonable to carry out EB-PBI in the prone position in free breathing.

Subject To compare the irradiation-induced injury and clinical efficacy between SIB-IMRT and LB-IMRT for early-stage breast cancer after breast-conserving surgery.Methods:From November 2002 to February 2012, 353 early breast cancer patients who underwent IMRT after breast-preserving surgery at Shandong Cancer Hospital were selected, of whom 218 patients receiving SIB-IMRT and 135 patients receiving LB-IMRT.The prescription dose of the SIB-IMRT group was the ipsilateral breast (PTV b ) 1.8-1.9 Gy, 27-28 times, and concurrent tumor bed (PTV t) 2.15-2.3 Gy, 27-28 times. In the LB-IMRT group, the prescription dose was PTV b 2.0 Gy, 25 times, followed by PTV t boost 2.0 Gy, 5-8 times. Results:The median follow-up time was 92 months. The excellent, good, fair, and poor cosmetic results in the SIB-IMRT and LB-IMRT groups were 10.1% and 12.6%, 85.8% and 80.7%, 3.7% and 5.2%, 0.5%, and 0.7%, respectively ( P=0.731). The 5-year locoregional recurrence rates (LRRs) in the SIB-IMRT and LB-IMRT groups were 3.21% and 5.93% and the 10-year LRRs were 4.13% and 6.67%, respectively ( P=0.209, 0.280). The 3-, 5-, 8-, and 10-year overall survival rate in the SIB-IMRT and LB-IMRT groups were 97.7% and 97.8%, 96.3% and 95.2%, 94.9% and 92.0%, 93.6% and 90.3%, respectively ( P=0.288). The 3-, 5-, 8-, and 10-year disease-free survival in the SIB-IMRT and LB-IMRT groups were 95.4% and 93.8%, 91.8% and 87.7%, 89.9% and 84.1%, 89.0% and 82.1%, respectively ( P=0.160). Conclusion:There is no significant difference in the cosmetic effect, local control rate, and survival rate between SIB-IMRT and LB-IMRT after breast-preserving surgery in patients with early-stage breast cancer. SIB-IMRT is a safe and feasible treatment.

目的:对抑郁障碍患者的疗效进行开放性、前瞻性研究,以期为临床早诊断提供筛查依据.方法:选取专科医院住院的符合ICD-10诊断标准诊断为抑郁障碍的患者.出院前1天进行自制一般情况调查表、汉密顿抑郁量表(HAMD)、心境障碍问卷(MDQ)评定.将MDQ量表评分≥7分定义为筛查阳性,视为高危组,其余视为低危组.出院后1年对两组患者进行随访,内容包括症状评估、社会功能状况、是否更改诊断为双相情感障碍等.结果:共入组168例患者,出院后1年共脱落3例,脱落率1.7％.高危组入组年龄、首次发病年龄均小于低危组(t=-4.28,-6.02;P＜0.05).低危组1年临床疗效优于高危组(x2=2.11,P＜0.05).高危组更改为双相障碍诊断例数显著高于低危组(x2=17.00,P＜0.05).出院1年疗效与首次发病年龄(P=0.047,OR=0.89,B=0.12)、更改诊断(P =-0.063,OR=0.91,B=0.16)、MDQ评分(P=-0.037,OR=0.78,B=0.11)关系密切.更改诊断与首次发病年龄(P=0.067,OR=0.91,B=0.12)、MDQ评分(P=-0.077,OR=0.81,B=0.19)关系密切.结论:首次发病年龄越早远期疗效越差.MDQ量表在抑郁障碍早期应用作为常规筛查工具值得在临床中推广使用.

目的 乳腺癌是严重危害女性健康的恶性肿瘤,放疗是乳腺癌治疗非常关键的一步.本研究比较正常呼吸(free breath,FB)和深吸气后屏气(deep inspiration breath hold,DIBH)两种呼吸模式在左侧乳腺癌保乳术后调强放疗(intensity modulated radiation therapy,IMRT)中剂量学差异,以寻求最适合于左侧乳腺癌保乳术后调强放疗的最佳呼吸模式.方法 选取2017-11-09-2018-11-08新疆医科大学第三临床医学院收治的18例左侧乳腺癌保乳手术后IMRT患者,同时采集FB和DIBH模式下的CT图像,在相同的优化条件下设计计划,比较DVH图中两种呼吸模式下剂量学差异,对靶区剂量和危及器官受量进行分析.结果 两种呼吸模式下,计划靶区(plan target area,PTV)的V95(Z=-0.816,P=0.414)、V98(t=0.223,P=0.826)及均匀性指数(homogeneity index,HI)值(Z=-0.832,P=0.405),差异无统计学意义;FB和DIBH两种呼吸模式下比较患侧肺V5(Z=-3.636,P<0.001)、V10(t=5.617,P<0.001)、V20(Z=-3.632,P<0.001)及Dmean(t=4.334,P<0.001);健侧肺V5(t=8.040,P<0.001)、Dmean(Z=-2.179,P=0.029);心脏V5(Z=-3.732,P<0.001)、V10(Z=-3.732,P<0.001)、V20(Z=-3.267,P=0.001)及Dmean(t=15.221,P<0.001);左冠状动脉左前降支(left anterior descending coronary artery,LAD)Dmean(t=20.957,P<0.001),差异均有统计学意义;健侧肺V10(t=1.179,P=0.255)、健侧乳腺V10(Z=-0.372,P=0.710)及Dmax(t=0.997,P=0.333),差异无统计学意义.结论 DIBH 呼吸模式可以降低左肺、健侧肺 V5 、心脏及 LAD 等危及器官的照射剂量,减轻放疗不良反应风险,且对放疗靶区剂量影响不大.

Internal mammary lymph node (IMLN) metastasis forms the part of the N-staging of breast cancer, and affects the treatment program and prognosis. At present, IMLN metastasis is clinically diagnosed by anatomical imaging, functional imaging and postoperative pathology. Anatomical imaging includes ultrasound, CT and MRI. Functional image includes positron emission computed tomography (PET-CT), PET-MRI, single photon emission computed tomography (SPECT) and SPECT-CT. Because of the special location of the internal mammary region and the complex anatomical structure around it, the imaging diagnosis rate and pathological diagnosis rate of IMLN are often different. Therefore, it is important to identify the relevant factors of IMLN metastasis for guiding the local treatment of internal mammary region, including the scope of surgery and radiotherapy.

Objective: To evaluated the unplanned coverage dose to the internal mammary chain (IMC) in patient treated with postmastectomy radiotherapy (PMRT). Methods: One hundred and thirty eight patients with breast cancer receiving radiotherapy (RT) in our hospital were retrospectively analyzed. Patients were divided into three groups: three-dimensional conformal radiotherapy (3D-CRT) group, forward intensity-modulated radiotherapy (F-IMRT) group and inverse IMRT (I-IMRT) group. The IMC were contoured according to Radiation Therapy Oncology Group (RTOG) consensus, and were not include into the planning target volume (PTV). The incidental irradiation dose to IMC among the three groups and the first three intercostal spaces IMC (ICS-IMC 1-3) were all compared, and explored the relationship between the mean doses (Dmean) of IMC and the OARs (ipsilateral lung and heart). Results: The dose delivered to IMC showed no difference in CRT, F-IMRT and I-IMRT(33.80 Gy, 29.65 Gy and 32.95 Gy). And 10.42%, 2.04%, and 9.76% patients achieved ≥45 Gy when treated with CRT, F-IMRT and I-IMRT. For the IMC dose in the first three intercostal spaces (ICS1-3), there was no difference to the three treatment plannings. The Dmean, V(20), V(30), V(40) and V(50) of the ICS-IMC2 and ICS-IMC3 were all obviously superior than ICS-IMC1 for all these three plannings. Moderate positive correlation was founded between Dmean for IMC and Dmean for heart for left breast cancer patients underwent CRT (r=0.338, P=0.01). Whereas for F-IMRT and I-IMRT groups, positive correlation were founded between Dmean for IMC and Dmean and V(20) for ipsilateral lung for all patients (F-IMRT: r=0.366, P=0.010; r=0.318, P=0.026; I-IMRT: r=0.427, P=0.005; r=0.411, P=0.008). Conclusions: In 3D-CRT, F-IMRT and I-IMRT planning methods, partial patients get IMC irradiated doses that could achieve therapeutic doses. Compared with 3D-CRT, F-IMRT and I-IMRT further reduced the dose of irradiated organs. However, there is no difference in the dose coverage of IMC for the three planned approaches when the IMC made an unplanned target.

Objective To explore the effects of polymorphisms detecting in cytochrome P450 (CYP450) enzymes relative to antipsychotics on treatment plan in schizophrenic inpatients.Methods All patients,observed and recorded in real state using real-world studies,were divided into allelic mutation group (n =42) and normal metabolism group (n =48) according to the genetic test results.They were assessed with Positive and Negative Syndrome Scale (PANSS),Treatment Emergent Symptoms Scale(TESS).The incidence rates of treatment plan changes in both groups were compared.Results 42 patients with 06CYP2D6* 10 were detected from 90 patients,and the remaining 48 cases were normal metabolic type;mutation rate of 06CYP2D6 * 10 was 46.7％.It was significantly different for both groups in the treatment plan changes after the genetic test(P ＜0.01).When discharged,the total scores of PANSS in both groups decreased significantly compared with those on admission (P ＜ 0.05).The incidence rate of adverse reactions in allelic mutation group was significantly higher than that in normal metabolism group after 1 week of admission(P ＜0.01).There was no significant difference in effective rates and incidence rates of adverse reactions between both groups when discharged (P ＞ 0.05).Conclusion The implementation of genetic test for schizophrenic inpatients can effectively assist the treatment system,which is worthy of promotion.

目的 糖尿病和肺癌均为常见病、多发病,发病率逐年升高,糖尿病合并肺癌的发病率亦明显升高.本研究通过制备裸鼠糖尿病、肺腺癌和糖尿病合并肺腺癌模型,探讨糖尿病和肺癌之间的关系.方法 选择4～6周龄雄性裸鼠54只,体质量18～22 g,随机分为正常对照组(12只)、糖尿病组(12只)、肺腺癌组(15只)和糖尿病合并肺腺癌组(15只)4组.制备糖尿病模型:裸鼠腹腔内注射链脲佐菌素(STZ) 150 mg/kg(根据预实验结果得出).制备肺腺癌模型:收集培养的A549细胞,计数,调整细胞悬液浓度为1×107个/mL,以每只0.2 mL接种于裸小鼠右侧腋窝皮下,正常对照组腹腔内及腋下均注射等量生理盐水.待糖尿病造模成功并稳定后,再在裸鼠腋部皮下注射人肺腺癌细胞株,制备糖尿病合并肺腺癌模型.结果 裸鼠糖尿病、肺腺癌、糖尿病合并肺腺癌模型均造模成功,其中体质量、血糖在正常对照组、肺腺癌组、糖尿病组及糖尿病合并肺腺癌组开始时差异无统计学意义;造模成功后,肺腺癌组、糖尿病组及糖尿病合并肺腺癌组体质量在放疗前、放疗后1和2个月明显低于正常对照组,P＜0.05;血糖在糖尿病组、糖尿病合并肺腺癌组明显高于正常对照组、肺腺癌组,P＜0.05;至放疗前,正常对照组、糖尿病组、肺腺癌组、糖尿病合并肺腺癌组各组自然死亡率差异无统计学意义,P＞0.05,均死亡1只.肿瘤标志物癌胚抗原(CEA)在肺腺癌组及糖尿病合并肺腺癌组放疗前后差异有统计学意义,P＜0.05;且明显高于正常对照组及糖尿病组,P＜0.05.结论 裸鼠糖尿病、肺腺癌和糖尿病合并肺腺癌模型的成功建立,为临床糖尿病、肺腺癌及糖尿病合并肺腺癌的治疗提供实验依据.

Objective: To investigate effect of Naikan therapy on patients with type 2 diabetes mellitus. Methods: 120 cases were randomly divided into study group (routine treatment combined Naikan therapy) and control group (routine treatment), 60 cases in each group. Blood biochemical indexes and self-management levels of the two groups were compared. Results: The two groups of the blood biochemical indexes decreased after the intervention than those before, and the study group was significantly lower than the control group (P<0. 05). The self-management levels of the two group increased after the intervention than those before, and the study group was significantly higher than the control group (P<0. 05 or P<0. 01). Conclusions: The implementation of Naikan therapy based on routine treatment could significantly improve the conditions of the diabetic patients, and improve diabetic patients understand-ing of their conditions and self-management level.