医用加速器技术方式选择故障分析

英国飞利浦SL－14医用直线加速器在治疗时须按计算机屏幕要求输入相应参数，如病人姓名、照射野号、能量大小、技术方式、照射剂量、时间设置等。其中，技术方式（TECHNIQUE）选择为：1－STATIC（固定治疗）、2－CCW（逆时针旋转治疗）、3－CW（顺时针旋转治疗）。常规放射治疗和立体定向放射外科治疗（即X线刀）技术大量使用加速器的旋转和固定治疗方式。技术方式选择故障使治疗无法完成。1故障现象在T．C．T（治疗控制终端）上能正常输入病人姓名、照射野号、能量大小，但当正确选择TECHNIQUE项：1－STATIC或2－CCW、照…     

楔形滤过板在旋转放疗中的应用

目的:提出楔形旋转照射野的概念。方法:将人体体模的CT图像输入至Cadplan(6.4.7版)中,假定体部一侧有靶区,用传统的旋转照射野设计治疗计划和用楔形旋转照射野设计治疗计划,分别比较它们的剂量分布、剂量体积直方图等指标。结果:楔形旋转照射野计划的靶区剂量分布更均匀。结论:楔形板可以修正旋转照射野的剂量分布。     

放射治疗自动计划系统的研究

１概述１．１治疗计划放射治疗计划一般由医生、物理师在计算机计划工作站上完成。治疗计划实际上就是照射野的空间公布。在使用等中心旋转照射（例如X刀犤１，２，４犦治疗）时，一般使用照射弧代替照射野。在剂量计算模型中，一个照射弧也可用多个照射野近似。１．２射束视野     

检验治疗计划系统是否支持楔形旋转照射野一个方法

目的：验证治疗计划系统是否支持楔形旋转照射野（楔形旋转野）这一概念。方法：将楔形旋转照射野等效成多个固定楔形野，比较两者的剂量分布等。结果：用Varian公司的Cadplan（6．4．7版）三维治疗计划系统作的两计划比较，剂量分布几乎相同。结论：Cadplan（6，4．7版）等三维治疗计划系统支持这一概念。     

适形断层调强放疗光栅系统（YPSUN4000金雀系统）

适形断层调强放射治疗是最前沿的一种调强技术，采用类似CT的模式，分层沿环形对肿瘤进行照射治疗。适形断层调强光栅（MLC）是其关键设备。断层调强光栅直接外挂在各类加速器上，装拆方便，配合治疗床的旋转及移动．实现调强放疗。     

立体定向放疗治疗肺癌的临床护理

立体定向放疗是目前治疗小细胞肺癌或局部中晚期非小细胞肺癌的一种较为先进的放疗治疗手段,其特点是针对肿瘤区实行非共面多弧度中心旋转,该技术使高剂量区剂量分布的形状在三维立体方向上与靶区的实际形状一致,而周围正常组织照射剂量垂直下降,肿瘤靶区受到高剂量照射的同时,最大限度的保护周围正常组织。具有高精度、安全、可靠、并发症少等优点。     

容积旋转调强放射治疗技术行全骨髓照射的可行性研究

目的：探讨Rapid Arc容积旋转调强放射治疗技术（VMAT）行全骨髓照射（TMI）的可行性及其剂量学特点。方法：选取8例已行全身扫描的患者,照射靶区包括除前臂和手以外的全身骨髓,采用Eclipse 10.0计划系统自动勾画模块进行靶区勾画并外放3 mm生成PTV,处方剂量为12 Gy/10 F,采用单弧多中心衔接的方法设计旋转调强放射治疗计划。治疗计划的剂量验证采用Arc CHECK验证系统,通过剂量体积直方图（DVH）评价和分析靶区和危及器官的剂量分布,并评估治疗计划的总机器跳数（MU）和治疗时间,通过分析各部位剂量验证的通过率评估其临床实施的安全性及准确性。结果：容积旋转调强全骨髓照射计划的靶区平均Dmean、Dmax分别为12.85 Gy和14.85 Gy,平均D1、D99分别为11.25 Gy和13.77 Gy,除脑、眼球、口腔及腮腺等头颈部器官外,其他器官Dmean均〈6 Gy,平均机器跳数和计划实施时间为2608 MU、30 min,头颈、胸腹及盆腔3部分的计划验证通过率分别为（98.9±1.9）%、（98.4±1.8）%及（97.4±2.1）%。结论：Rapid Arc技术能较好地实现全骨髓照射且实现射野间的无缝衔接,具有较高的射线利用率,可以应用于全骨髓的临床照射。     

GMX-I型陀螺刀的日常保养和重要数据监测

GMX-I型陀螺刀采用单源陀螺旋转重复聚集的方式,治疗过程中放射源发射的射线束经准直器的引导射向靶点,放射源围绕靶点做有规律的球面扫描运动。整个治疗过程中靶点始终受到放射源的照射从而形成足够强的剂量场,靶点周围为梯度扩展的射线束,并且由于放射源的旋转,对穿透的肌体是瞬间扫描性照射,使正常的肌体组织仅受到最小的伤害,亦可及时恢复。     

ARC（弧形）治疗的工作原理和控制方法

ＡＲＣ（弧形）治疗功能是指医用加速器在照射过程中主机架的旋转速度与医用加速器的输出剂量率相配合,从而完成医生所给定的病人照射剂量和照射弧度。它是医用加速器所应具备的动态放射治疗功能中最基本和最关键功能。本文介绍了在国产ＢＪ—６Ｂ型医用驻波电子直线加速器上国内首次实现ＡＲＣ（弧形）治疗功能的情况。     

探讨旋转阳极在照射野面短轴方向的线量分布

目的探讨旋转阳极在照射野面的短轴方向的线量分布。方法将14×17inch的胶片置于摄影床上,以照射野的中心点为中心,利用三角函数分别计算出数个中心线外倾角所对应的短轴两侧的距离,采用相同的曝光条件,在旋转阳极为高、低两种转速的机器上,进行曝光,冲洗并采用密度计测量。结果高、低两种转速的旋转阳极X线机,在照射野面的短轴方向,比较对称点密度值,外侧缘大于内侧缘,峰值在中心点偏外侧缘。结论在旋转阳极照射野面的短轴方向,X线照射量的分布发生偏离,最大线量位于中心点偏外侧缘。     

长春新碱过量引起严重毒副反应1例的护理体会

报道1例霍奇金淋巴瘤患者因误用长春新碱（VCR）10mg一次性静脉推注后治疗护理情况。其出现间断性神志恍惚、眼睑闭合不全、言语不清、口腔黏膜糜烂、全身疼痛、麻痹性肠梗阻、尿潴留、手足麻木等症状,经积极解救,禁食,持续胃肠减压、胃管内注入麻油、开塞露、生理盐水灌肠,合理应用肠外营养,注重疼痛、心理护理,做好口腔、肛周护理,预防感染加重,患者病情得到控制好转出院。     

Correlates of stages of change of smoking among inhabitants of deprived neighbourhoods

BACKGROUND: This study examines the prevalence and correlates of stages of change of smoking, in terms of psychosocial, structural and sociodemographic factors, among inhabitants of deprived neighbourhoods. METHODS: Cross-sectional data were obtained from a survey on health related behaviour. Subjects were 2009 current and former smokers, aged 20-46, living in deprived neighbourhoods in Rotterdam, the second largest city in the Netherlands. Three groups of smokers were formed according to the stages of change-definitions of the Transtheoretical Model: smokers not planning to quit (precontemplators), smokers planning to quit (contemplators/preparators) and former smokers (actors/maintainers). Smokers planning to quit and smokers not planning to quit were compared regarding psychosocial factors (attitude, social norm, self-efficacy), structural factors (neighbourhood problems, material deprivation, financial problems, employment status) and sociodemographic factors (age, gender, marital status, cultural background, educational level). Former smokers were compared with smokers planning to quit regarding structural and sociodemographic factors. Logistic regression was used to assess correlates of stages of change. RESULTS: Smokers planning to quit (prevalence = 19%) reported a more positive attitude, stronger social norms and higher self-efficacy expectations in quitting smoking than smokers not planning to quit (prevalence = 57%). Smokers planning to quit less often were Dutch-born, more often had attended higher vocational schooling or university and more often reported experiencing two or more neighbourhood problems compared to smokers not planning to quit. Former smokers (prevalence = 24%) were older, more often Dutch-born, married, employed and higher educated, compared to smokers planning to quit. Furthermore, former smokers less often reported material deprivation and financial problems than smokers planning to quit. CONCLUSION: Among people living in deprived neighbourhoods, different factors correlate with different stages of change of smoking. Implications for health promotion are discussed.     

Choice of measures of vaccination and estimates of risk of pediatric pertussis

BackgroundVaccination uptake at the individual level can be assessed in a variety of ways, including traditional measures of being up-to-date (UTD), measures of UTD that consider dose timing, like age-appropriate vaccination, and risk reduction from individual doses. This analysis compared methods of operationalizing vaccination uptake and corresponding risk of pertussis infection.MethodsCity-wide case-control study of children in Philadelphia aged 3 months through 6 years, between 2001 and 2013. Multiple logistic regression was used to isolate the independent effects of each measure of vaccination uptake and the corresponding relative odds of pertussis.ResultsBeing UTD on vaccinations was associated with a 52% reduction in risk of pertussis (OR 0.48, 95% CI: 0.34, 0.69). Evaluation of delayed receipt of vaccine versus on-time UTD yielded similar results. There was a decrease in risk of pertussis for each additional dose received with the greatest reduction in pertussis infection observed from the first (OR 0.48, 95% CI: 0.28, 0.83) and second dose (OR 0.17, 95% CI: 0.08, 0.34). Additional doses conferred minimal additional protection in this age group.ConclusionExamining vaccination status by individual doses may offer improved predictive capacity for identifying children at risk for pertussis infection compared to the traditional UTD measure.     

两种不同肌瘤剔除术治疗子宫肌瘤的临床疗效比较

目的:比较腹腔镜子宫肌瘤剔除术与腹式子宫肌瘤剔除术的临床疗效。方法:回顾分析63例腹腔镜子宫肌瘤剔除术与61例腹式子宫肌瘤剔除术的临床资料,比较2种手术方式的手术时间、术中出血量、肛门排气时间、使用抗生素时间、术后感染率、体温恢复正常时间、住院时间等情况。结果:两组患者接受子宫肌瘤剔除术顺利完成,腹腔镜组手术时间长于开腹组(P0.05),腹腔镜组术中出血量及剔除肌瘤个数均少于开腹组(P0.05),术后腹腔镜组体温恢复正常时间、肛门排气时间、抗生素使用及住院时间均短于开腹组,两组患者最多随访6个月,腹腔镜组平均康复时间较开腹组短(P0.05),两组随访B超均未发现明显肌瘤结节。结论:腹腔镜子宫肌瘤剔除术损伤小,恢复快,住院时间短,是值得推广的微创手术。     

上海市某医院骨科平均住院日影响因素分析

对上海市某医院2003年-2007年骨科出院病人的住院日描述性分析．2003年-2007年骨科的床位利用指数与平均住院日相关性分析．2003年-2007年骨科床位与医护比例分析．2007年骨科前10大病种平均住院目影响因素分别进行单因素相关性分析和多因素逐步回归分析（STATA软件）。通过对骨科10大病种住院日影响因素分析,术前等待天数、手术类型、是否输血分别对10个、9个和8个病种的住院目有影响。输血因素和手术类型是医院不可控、由病人的病情决定的,术前等待天数是管理因素,是最值得医院重视的影响因素。     

性发育异常发病机制的研究进展

正常的性腺分化可分为3个过程：原始性腺形成、性别决定和卵巢/睾丸发育。在任一环节中,基因表达或调控发生异常均有可能导致性发育异常疾病的发生。性发育异常是指染色体、性腺和解剖性别不典型。随着分子生物学技术的发展,不断地发现新的基因或信号通路参与性腺分化和发育,如SRY、SF1、WT1、Sox9等基因与睾丸发育密切相关,Wnt/Rspo1/B连环蛋白通路、Dax1、Foxl2等基因在卵巢分化中发挥着重要作用,一些非编码RNA和转化生长因子也有重要的调节功能,且睾丸和卵巢发育均为主动过程,即使在出生后因某些基因的改变两者间也可出现横向分化。这些为揭示性分化异常的发病机制提供了可能。     

尘肺病患者145例死因调查

目的分析汉中市尘肺病的发生、发展和死亡原因，以提高尘肺病患者的生存质量。方法对145例尘肺病患者的死因进行回顾性分析，计算其平均发病年龄、死亡年龄及患尘肺病后的存活年限。结果矽肺的平均发病年龄和死亡年龄均早于煤工尘肺和石棉肺，尘肺病的主要死因为患肺部疾患，患尘肺病后的平均存活年限为12a。结论加强职业健康体检工作，对尘肺病人做到早发现早治疗和预防并发症的发生。     

One-year stability of the Measure of Processes of Care

BACKGROUND: The Measure of Processes of Care (MPOC) is a 56-item self-administered measure designed to examine what parents of a child with a chronic health problem think of the services they and their child receive, and to measure the extent to which these services are family-centred. Reliability and validity of the MPOC were established in prior studies. The aim of the present study was to assess the 1-year stability of the MPOC to justify its use as an evaluative tool. METHODS: Nine paediatric rehabilitation centres in the Netherlands participated in this short longitudinal survey study. Subjects were 205 parents (response rate 74.8%) of children aged 1-18 years who received care in one of the participating paediatric rehabilitation centres. All subjects filled out two MPOCs with a 1-year interval. RESULTS: All correlations between the scale scores of the MPOC at the first and second administration were relatively high and significant (range: 0.443-0.609, all P < 0.001), demonstrating high inter-individual stability. However, all mean scale scores, except for Providing General Information, significantly reduced after 1 year. CONCLUSIONS: The MPOC has a moderate 1-year stability. However, because of its tendency to score lower when repeated after 1 year, its use as an evaluative follow-up instrument to assess the effectiveness of a programme intervention is restricted.     

儿童皮质发育畸形的MRI诊断

目的探讨儿童皮质发育畸形(MCD)的MRI表现特点,为MCD的早期诊断提供依据。 方法选择2010年1月至2012年12月在四川省医学科学院·四川省人民医院放射科经MRI检查确诊为MCD的44例患儿为研究对象。回顾性分析及总结其MRI影像学特征。本研究遵循的程序符合四川省医学科学院·四川省人民医院人体试验委员会制定的伦理学标准,得到该委员会批准,征得受试对象及其监护人知情同意,并与监护人签署临床研究知情同意书。 结果本组44例经MRI确诊为MCD患儿中,巨脑回-无脑回为17例,多小脑回为14例,灰质异位为9例,脑裂畸形为4例。MCD的MRI特点中,巨脑回表现为脑回增宽、皮质增厚及白质变薄;无脑回表现为正常脑沟、脑回消失,皮质增厚及白质变薄;多小脑回表现为脑回增多、细小;灰质异位表现为皮质下及侧脑室周围深部白质区结节状、团块状或带状病灶,信号与灰质信号相同;脑裂畸形表现为从侧脑室到脑表面贯穿大脑半球的裂隙,表面覆盖灰质。 结论MRI是诊断儿童MCD的可靠影像学方法。     

244株真菌鉴定结果分析

目的 了解某院2000～2001年各类真菌的检出率。方法 用酵母样真菌同化试验编码鉴定板TH-15进行编码鉴定。结果 真菌分离率为8．85％；244株真菌分为10种，其中以白色念珠菌和热带念珠菌较高，分别占真菌总数的75．41％和11．47％；检出真菌的主要标本是痰和阴道分泌物。结论 及时进行真菌培养，有利于合理使用抗菌药物和控制真菌感染。