【摘要】 目的 探討急性腎缺氧復氧損傷過程中氧化侵襲與腎細胞凋亡在腎損傷發生機制中的作用。 方法 20只雄性新西蘭大白兔隨機分成兩組，每組10只。正常對照組（A組）：吸入空氣6 h。單純缺氧復氧組（B組）:經自制面罩吸入8% O2 3 h，缺氧結束后吸入空氣復氧3 h，制成全身缺氧復氧模型。復氧結束后立即處死動物，取出腎臟組織，一份行HE染色，觀察組織病理學改變，一份供半胱氨酸蛋白酶3（caspase-3）檢測，一份供檢測丙二醛（MDA）、超氧化物歧化酶（SOD）。 結果 病理學檢查結果顯示，A組腎臟組織結構基本正常，未見病理性改變，腎臟組織中極少的caspase-3陽性細胞表達。B組:腎小管上皮細胞腫脹，空泡變性；可見少量壞死，管腔明顯擴張；caspase陽性蛋白表達指數（29.3±5.7）%。B組和A組MDA分別為（28.05±1.92）、（7.88±1.69）nmol/g；SOD分別為（218±18.41）、（372±13.14）U/g，兩組比較，均有統計學意義（Plt;0.05）。 結論 兔腎臟缺氧復氧損傷與氧化侵襲與細胞凋亡密切相關。【Abstract】 Objective To investigate the effect of oxidative invasion and cellular apoptosis on the mechanism of kidney injury during the process of acute renal hypoxic-reoxygenation injury. Methods Twenty male white New Zealand rabbits were selected and randomly divided into two groups with 10 rabbits in each. The rabbits in normal control group inhaled air for 6 hours while the ones in hypoxic/reoxygenation (H/R) group breathing in air for 3 hours inhaled 8% O2 for 3 hours after. After the H/R mode was set up, the rabbits were executed, and the kidney tissues were removed in which the caspase-3 protein expression was assessed by immunohistochemical method. Superoxide dismutase (SOD) activity and malonical aldehyde (MDA) were also detected. Results The results of pathological examination showed that the structure of renal tissues was normal with little expression of caspase-3; while swelling of renal tubular epithelial cells, vacuolar degeneration, little necrosis, dilated vascular lacuna were found in H/R group. The positive expression of caspase-3 was (29.3±5.7)% in H/R group. The contents of MDA were (28.05±1.92) and (7.88±1.69) nmol/g and SOD were (218±18.41) and (372±13.14) U/g in H/R and control group, respectively; the differences between the two groups were significant (Plt;0.05). Conclusion The acute renal hypoxic/reoxygenation injury has a correlation with oxidative invasion and cellular apoptosis.
Objective To discuss the effect of continuous phenylephrine infusion and single-dose phenylephrine injection on puerpera undergoing spinal and epidural combined anesthesia and the infant outcomes. Methods A total of 50 patients scheduled for selective cesarean section under combined spinal and epidural anesthesia were selected as the study subjects between July 2015 and June 2016. They were randomly allocated into two groups with 25 in each. Group CII underwent continuous phenylephrine infusion [0.5 μg/(kg·min)] immediately after anesthesia to adjust the blood pressure, while group CON accepted single-dose phenylephrine injection (50 μg) after anesthesia when systolic pressure was lower than 90 mm Hg (1 mm Hg=0.133 kPa) or when the decrease of mean arterial pressure (MAP) was higher than 20% of the base value. The infusion of phenylephrine was stopped after the fetus was taken out. MAP, cardiac output, cardiac index (CI) at the time when the patient went into the delivery room (T1), before anesthesia (T2), 1 minute after anesthesia (T3), 3 minutes after anesthesia (T4), 10 minutes after anesthesia (T5), and delivery (T6) were recorded. Blood gas analysis of fetal umbilical arterial blood was carried out and neonatal Apgar score was recorded. Results Hemodynamics was more stable in group CII compared with group CON. Heart rate at T4 and T5, and cardiac output at T5 and T6 in group CON were significantly lower than those in group CII (P<0.05). The neonatal umbilical arterial blood pH value, base excess and HCO3－ were all significantly lower, while partial pressure of carbon dioxide was significantly higher in group CON than group CII (P<0.05). Conclusion Compared with single-dose phenylephrine injection, continuous phenylephrine infusion has more stable hemodynamics, and exert less effect on maternal and infant outcomes for patients undergoing cesarean section under combined spinal and epidural anesthesia.
Objective To study the effects of hemodilution on oxygenation during one-lung ventilation(OLV).Methods Forty patients undergoing lung surgery with or without chronic obstructive pulmonary disease（COPD）were enrolled.The study was performed in the supine position before surgery.The tracheas were intubated with a double-lumen tube.OLV was initiated for 15 min.After 15 min of OLV，arterial and venous blood gas samples were collected and analyzed.The cardiac output (CO) was measured.Two-lung ventilation was reinstituted，and hemodilution was performed (6% hydroxyethyl starch，10 mL/kg).Subsequently，OLV was performed again for 15 min.Then arterial and venous blood gas samples were collected and analyzed.The cardiac output (CO) was measured.Results Hemodilution resulted in a significant and similar decrease in HB concentration in patients both with or without COPD.However，hemodilution resulted in a significant decrease in PaO2 in COPD patients rather than subjects without COPD.Conclusion Mild hemodilution impairs gas exchange during OLV in COPD patients.
ObjectiveTo evaluate the effect of different rehydration strategies on the incidence of spinal anesthesia-induced hypotension and neonatal outcomes during elective cesarean section.MethodsWe searched PubMed, Embase, the Cochran Library, China National Knowledge Internet, VIP database, Wanfang database, and China Biology Medicine database from inception to January 2018, to collect randomized controlled trials (RCTs) about the incidence of spinal anesthesia-induced hypotension during elective cesarean section and neonatal outcomes of preloading or coloading. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias in the study. Meta-analysis was conducted using RevMan 5.3 software.ResultsA total of 11 RCTs were included, including 894 parturients, of whom 448 cases in the preload group and 446 cases in the coload group. Comparing with the preload group, the incidence of spinal anesthesia-induced hypotension during cesarean section in the coload group significantly decreased [risk ratio (RR)=1.27, 95% confidence interval (CI) (1.13, 1.43), P<0.000 1]. Subgroup analysis showed that in the crystalloid fluid group, the difference in the incidence of hypotension between the preload group and the coload group was statistically significant [RR=1.48, 95%CI (1.26, 1.73), P<0.000 01]; while in the colloidal fluid group, the difference in the the incidence of hypotension between the preload group and the coload group was not significant [RR=1.00, 95%CI (0.85, 1.17), P=0.96]. The lowest systolic blood pressure, the incidence of nausea and vomiting, and neonatal outcomes had no significant difference between the two groups.ConclusionsComparing with preloading crystalloid fluid, rapid infusion of crystalloid fluid at the same time implementation of spinal anesthesia could significantly reduce the incidence of hypotension during cesarean section while there was no superiority in infusion of colloid fluid. There was no significant effect on the severity of hypotension, nausea and vomiting, and neonatal outcomes. Due to the limitation of the quantity and quality of the included studies, the above conclusions need to be verified by more high-quality studies.
【摘要】 目的 調強放射治療（IMRT）能較好的保護危及器官并給予腫瘤足夠的致死劑量，基于多葉準直器（MLC）分步照射的IMRT技術對復雜病例需要更多子野。研究對直腸癌術后放射治療使用不同子野數目的IMRT計劃進行比對，選擇合理的子野數。 方法 選取2010年4-8月入院的直腸癌術后患者10例，保持射野入射角度及優化目標參數相同，僅改變MLC子野數目，設計不同IMRT對每一患者治療計劃的靶區適形指數（CI）、均勻性指數、最大劑量、最小劑量、平均劑量，危及器官關注體積的受照劑量，機器跳數及治療時間進行分析。 結果 所有治療計劃中靶區及危及器官的劑量學評估指標無統計學意義（Pgt;0.05），只有亞臨床計劃靶區（PTV）CI在15個子野的方案中（0.74±0.06）明顯差于25個子野方案（0.82±0.03）、40個子野方案（0.81±0.06）及60個子野方案（0.84±0.03），有統計學意義（Plt;0.05）；治療機器跳數（MU）隨子野數目增多明顯增大，15、20、40及60個子野方案所需MU分別為（458±56）、（559±62）、（614±74）、（622±82），有統計學意義（Plt;0.05），但40個子野方案與60個子野方案間無統計學意義。治療時間明顯隨子野數增加而增大。 結論 直腸癌術后IMRT計劃使用25個子野能滿足臨床劑量要求，同時能有效降低治療時間，可作為臨床應用參考值。【Abstract】 Objective The intensity modulated radiotherapy (IMRT) can deliver tumor enough doses and protect risk organs as much as possible at the same time. The MLC-based step and shoot IMRT(sIMRT) plan needs much more segment member to meet clinical aims. In this study, several sIMRT plans using different segment number for postoperative rectal cancer were compared to find out the most reasonable segment number setting. Methods Ten patients with rectal carcinoma underwent postoperative adjuvant radiotherapy for rectal cancer from April to August 2010 were selected. For each patient, the angle of field, the prescription expected and the physical parameters optimized were kept the same, while only the number of segments was changed in sIMRT plans. The dose volume histogram-based parameters [conformity index (CI) and homogeneous index (HI)] and other parameters concerned were compared and analyzed. Results The indexes of dosimetry associated with the targets and risk organs showed no significant statistical difference among the 4 sIMRT plans with different segment numbers. The index CI of PTV in the sIMRT plan with 15 segments (CI 0.74±0.06) was less than that in the sIMRT plan with 25 segments (CI 0.82±0.03), the sIMRT plan with 40 segments plan (CI 0.81±0.06), and the sIMRT plan with 60 segments (CI 0.84±0.03) (Plt;0.05). There were significant differences in MU among the sIMRT plans with 15 segments (average MU: 458±56) , with 25 segments (average MU: 559±62 ), and with 40 segments (average MU: 614±74)or with the 60 segments (average MU: 622±82 (Plt;0.05). The more segments meant more MU and more irradiation time. Conclusion The sIMRT plan for patients of rectal cancer to receive postoperative adjuvant radiotherapy may require at least 25 segments to balance the accepted dose results and efficient delivering.
目的 通過非小細胞肺癌（NSCLC）圖像引導放射治療（IGRT）過程中，每次治療前獲取的錐形束CT圖像，動態觀察腫瘤體積的變化。 方法 2009年2月－2010年8月18例周圍型NSCLC患者接受IGRT。每次治療前進行千伏級錐形束CT（KV-CBCT）圖像的采集。每周在KV-CBCT圖像上勾畫腫瘤靶區并計算靶區體積，經統計后分析腫瘤治療過程中體積的變化。 結果 治療開始時平均體積為28.5 cm3（2.5～109.1 cm3），治療結束時平均體積為17.1 cm3 （1.4～73.4 cm3）。平均退縮率為35.9%（3.9%～68.9%），平均每天的退縮率為1.5% （0.1%～5.4%）。治療結束時，0例病灶完全消退，1例部分消退，10例微小消退，7例穩定。 結論 治療過程中，NSCLC腫瘤的退縮可以通過KV-CBCT進行觀察。當病灶為周圍型時，能對腫瘤體積的變化進行客觀有效的評價。放射治療過程中腫瘤的體積改變具有很大的異質性，腫瘤在治療過程中體積均有一定的退縮，但治療結束時大多數病灶僅為微小消退或穩定。
【摘要】 目的 研究千伏級錐形束CT（kV-cone beam CT，kV-CBCT）影像用于鼻咽癌調強放射治療計劃劑量計算的可行性和精確度。 方法 2010年7-9月7例鼻咽癌患者 ，獲取每例患者的第1天放射治療時的kV-CBCT影像。用CIRS062密度模體和患者自身特定區域亨氏單位值（hounsfield unit，HU）映射的兩種方法重新刻度亨氏單位值-相對電子密度（HU-RED）表，分別進行劑量計算，并與在傳統扇形束CT（FBCT）影像上的原放射治療計劃結果進行對比，包括輻射劑量分布、靶區和危及器官的劑量體積直方圖（DVH）。 結果 kV-CBCT影像的治療計劃和原治療計劃在劑量分布和DVH上有較好的一致性。在劑量分布的比較上采用了γ分析（2%/2 mm標準的通過率），用基于模體的HU-RED表得到的治療計劃與原治療計劃對比，在經過等中心冠狀面、矢狀面和橫斷面的通過率分別為92.7%±3.5%、95.1%±3.1%和95.7%±3.4%，用基于患者的HU-RED表得到治療計劃與原治療計劃對比的通過率分別為94.8%±2.7%、96.6%±2.9%和97.4%±2.7%。DVH的統計數據表明，兩種方法得到的kV-CBCT治療計劃和原治療計劃相比較，靶區和危及器官劑量偏差大多數在2%以內。有1例因在橫斷面發生了明顯的旋轉誤差，導致在橫斷面的通過率很低，DVH統計數據較原計劃偏差較大。 結論 kV-CBCT影像可以用來做輻射劑量計算，基于患者自身影像生成的HU-RED表的治療計劃較原治療計劃有更高的符合度。【Abstract】 Objective To evaluate the feasibility and accuracy of dose calculation based on cone beam CT (CBCT) data sets for intensity modulated radiation therapy (IMRT) planning of nasopharyngeal cancer (NPC). Methods Seven NPC patients were selected. The kV-CBCT images for each patient were acquired on the first treatment day. Two correction strategies were used to generate the cone beam HU value vs relative electron density calibration tables which named CIRS062 phantom based HU-RED tables and patient specific HU-RED tables respectively for dose calculation. The dose distributions and dose volume histograms (DVHs) of the target and organs at risk (OAR) based on kV-CBCT images were compared to the plans based on the fan-beam CT (FBCT). Results The DVH and dose distribution comparison between plans based on the FBCT and those on the CBCT showed good agreements. The γ analysis with a criterion of 2 mm/2% was used for the comparison of dose distribution at the coronal plane, sagital plane and cross plane through the isocenter point. The passing rate from phantom based HU-RED tables were (92.7±3.5) %, (95.1±3.1) %, and (95.7±3.4)%, respectively. The passing rates from the patient specific HU-RED tables were (94.8±2.7) %, (96.6±2.9) %, and (97.4±2.7) %, respectively. The dose difference between plans based on CBCT and those based on FBCT was within 2% at most patients by analyzing DVH based parameters. Only one patient who had significant rotation setup error resulted in the low passing rate and disagreement in DVH. Conclusion The CBCT images can be used to do dose calculation in IMRT planning of NPC. The differences between plans based on HU-RED tables generated by specific patient and the original plans are less than those between plans based on CIRS062 phantom based HU-RED tables and the original plans.