基于蒙特卡罗实现容积调强弧形治疗计划独立剂量验证的应用研究

目的 开发基于蒙特卡罗(MC)的验证平台实现容积调强弧形治疗(VMAT)计划的独立剂量验证。方法 利用EGSnrc/BEAMnrc构建Varian TrueBeam医用直线加速器的机头和准直器模型,并基于机头模型和自编程序搭建患者VMAT计划的独立剂量验证平台,通过平台模拟不同射野大小百分深度剂量(PDD)曲线和离轴比、两个不规则野以及头颈部、胸部和盆腔各1例患者剂量分布。比较不同射野大小PDD曲线和离轴比与蓝水箱测量结果差异,不规则射野与ArcCHECK实测的差异,再通过γ分析法、剂量体积直方图对比分析患者MC模拟剂量、计划系统计算剂量、ArcCHECK实测剂量之间差异,验证平台是否可用于独立剂量验证。结果 对4cm×4cm~40cm×40cm的PDD曲线和离轴比,MC模拟结果和测量结果一致性较好。不规则射野MC模拟结果与ArcCHECK实测相比,在3%/2mm、3%/3mm下γ通过率都在98.1%、99.1%以上;3例不同部位VMAT患者MC模拟剂量和ArcCheck实测剂量在3%/2mm、3%/3mm下γ通过率均好于93.8%、95.9%。通过三维γ分析计划系统计算剂量和MC模拟剂量在3%/3mm下鼻咽癌、肺癌、直肠癌的γ通过率分别为95.2%、98.6%、98.9%;在3%/2mm下依次为90.3%、95.1%、96.7%。结论 基于MC开发的验证平台模拟结果与实际测量结果一致性较好,其模拟结果更接近于患者体内真实剂量分布,初步结果显示可用于VMAT计划的精准独立剂量验证。     

鼻咽癌调强放疗对腮腺功能的影响

Objective To evaluate the effect of intensity-modulated radiation therapy(IMRT) on parotid function in nasopharyngeal carcinoma(NPC). Methods Eighty-three NPC patients received prima-ry IMRT between 2001 and 2003. Xerostomia before radiotherapy, at the end of radiotherapy, at 6-month, 1-,2-,3-,4- and 5-year after radiotherapy were investigated, respectively. The relation between xerostomia and parotid dose distribution was analyzed. Results Of all the patients,4,31,31 and 17 had stage Ⅰ,Ⅱ,Ⅲ and ⅣA disease, respectively. Sixteen patients received chemo-radiotherapy. The median followed-up time was 65 months. The 5-year local control and regional control rate were 96% and 95% ,respectively. The 5-year overall survival rate was 80%. The mild xerostomia rate at the seven time points was 42%, 51%, 71%, 77%, 58%, 38% and 26%. The corresponding moderate xerostomia rate was 52%, 53%, 21%,8%, 3%, 2% and 2%, respectively. No serious xerostomia was observed. The mean dose of the bilateral parotid glands was 34.34 Gy. Xerostomia at 6-month after radiotherapy was positively correlated with the mean dose of the parotid glands, and D50 was the independent factor in predicting the xerostomia. Parotid function was well protected when the mean dose and D50 were no more than 33 Gy and 29 Gy,respectively. Conclusions IMRT can improve the local-regional control of NPC and protect the parotid glands from radiation-induced in-jury.     

鼻咽癌调强放疗对腮腺功能的影响

Objective To evaluate the effect of intensity-modulated radiation therapy(IMRT) on parotid function in nasopharyngeal carcinoma(NPC). Methods Eighty-three NPC patients received prima-ry IMRT between 2001 and 2003. Xerostomia before radiotherapy, at the end of radiotherapy, at 6-month, 1-,2-,3-,4- and 5-year after radiotherapy were investigated, respectively. The relation between xerostomia and parotid dose distribution was analyzed. Results Of all the patients,4,31,31 and 17 had stage Ⅰ,Ⅱ,Ⅲ and ⅣA disease, respectively. Sixteen patients received chemo-radiotherapy. The median followed-up time was 65 months. The 5-year local control and regional control rate were 96% and 95% ,respectively. The 5-year overall survival rate was 80%. The mild xerostomia rate at the seven time points was 42%, 51%, 71%, 77%, 58%, 38% and 26%. The corresponding moderate xerostomia rate was 52%, 53%, 21%,8%, 3%, 2% and 2%, respectively. No serious xerostomia was observed. The mean dose of the bilateral parotid glands was 34.34 Gy. Xerostomia at 6-month after radiotherapy was positively correlated with the mean dose of the parotid glands, and D50 was the independent factor in predicting the xerostomia. Parotid function was well protected when the mean dose and D50 were no more than 33 Gy and 29 Gy,respectively. Conclusions IMRT can improve the local-regional control of NPC and protect the parotid glands from radiation-induced in-jury.     

GE1.5T磁共振成像诊断创伤性视神经损伤51例分析

目的：总结采用GE1.5T磁共振成像诊断创伤性视神经损伤的影像学特点及其临床价值。方法选取2014年5月—2016年2月来我院接受诊治的51例创伤性视神经损伤患者,回顾性分析其临床资料。结果在创伤性视神经损伤中,其磁共振成像在外观方面的特点是,眶内结构较为紊乱,且其损伤区域呈现出球形肿胀增粗,及椭圆状外观;视神经损伤区T2WI方面,呈现出条索状,及斑片状较高信号的变化;视神经损伤区内T1WI方面,其呈现出稍低信号的变化,或是等信号的变化。在其准矢状面,能够对信号改变情况及视神经整体形状,予以清晰呈现;在其冠状面,能够将信号变化情况以及双侧视神经断面粗细情况,予以有效对比。结论在创伤性视神经损伤的临床诊断中,采用GE1.5T磁共振成像具有良好的诊断价值,其软组织分辨率较高,可有效指导疾病的后续治疗,加快患者视力恢复。     

磁敏感加权成像（SWI）在早期诊断视神经损伤中的应用价值研究

目的探讨磁敏感加权成像（SWI）在早期诊断视神经损伤中的应用价值。方法选取46例颅脑损伤引发的视神经损伤患者作为研究对象,随机将患者分为对照组与实验组。对照组23例患者使用CT诊断,实验组使用SWI技术进行诊断。比较两组的检出率,后与临床手术病理结果进行对比,验证准确率。结果对照组的检出率为82.6%,观察组为95.7%,实验组的检出率高于对照组,但差异无统计学意义（P〉0.05）。经手术病理结果证实,对照组诊断准确率为57.9%,实验组为95.5%,实验组的诊断准确率明显更高（P〈0.05）。结论 SWI对视神经损伤患者的早期诊断具有良好的应用价值,但存在一定局限性。     

不同能量质子物理作用过程致DNA损伤的对比研究

目的 基于蒙特卡罗程序包Geant4研究布拉格峰附近能量质子在物理作用过程阶段对DNA损伤的特点规律。方法 利用Geant4构建细胞核及DNA模型,并基于Geant4-DNA物理过程模拟布拉格峰附近7档不同能量的质子在细胞核中传输过程,记录各相互作用位点相关信息,随机选取16%作用位点作为质子及其次级电子与DNA相互作用的位点,并将可导致DNA链断裂的位点信息写入新的文件,之后通过基于密度的空间聚类算法（DBSCAN）处理该文件,进而分析计算不同能量质子致DNA损伤的差异。结果 能量介于0.6～20.0 MeV之间的质子穿过细胞核时,随着能量的降低,单个质子致DNA损伤位点数由49.86增至549.88;损伤集簇数由2.92增至82.46;各尺寸集簇数增加显著,尺寸≥5的集簇增加329倍以上;平均集簇尺寸虽也有增加,但并不明显;简单单链断裂、复杂单链断裂、简单双链断裂和复杂双链断裂分别增加约7、25、23和63倍;单链断裂所占比例由96.69%减少到89.37%,双链断裂则由3.31%增加至10.63%。结论 质子能量越低,通过物理作用过程使DNA产生的损伤越复杂,DNA的修复越困难。     

鼻咽癌调强放疗对腮腺功能的影响

Objective To evaluate the effect of intensity-modulated radiation therapy(IMRT) on parotid function in nasopharyngeal carcinoma(NPC). Methods Eighty-three NPC patients received prima-ry IMRT between 2001 and 2003. Xerostomia before radiotherapy, at the end of radiotherapy, at 6-month, 1-,2-,3-,4- and 5-year after radiotherapy were investigated, respectively. The relation between xerostomia and parotid dose distribution was analyzed. Results Of all the patients,4,31,31 and 17 had stage Ⅰ,Ⅱ,Ⅲ and ⅣA disease, respectively. Sixteen patients received chemo-radiotherapy. The median followed-up time was 65 months. The 5-year local control and regional control rate were 96% and 95% ,respectively. The 5-year overall survival rate was 80%. The mild xerostomia rate at the seven time points was 42%, 51%, 71%, 77%, 58%, 38% and 26%. The corresponding moderate xerostomia rate was 52%, 53%, 21%,8%, 3%, 2% and 2%, respectively. No serious xerostomia was observed. The mean dose of the bilateral parotid glands was 34.34 Gy. Xerostomia at 6-month after radiotherapy was positively correlated with the mean dose of the parotid glands, and D50 was the independent factor in predicting the xerostomia. Parotid function was well protected when the mean dose and D50 were no more than 33 Gy and 29 Gy,respectively. Conclusions IMRT can improve the local-regional control of NPC and protect the parotid glands from radiation-induced in-jury.     

鼻咽癌调强放疗对腮腺功能的影响

Objective To evaluate the effect of intensity-modulated radiation therapy(IMRT) on parotid function in nasopharyngeal carcinoma(NPC). Methods Eighty-three NPC patients received prima-ry IMRT between 2001 and 2003. Xerostomia before radiotherapy, at the end of radiotherapy, at 6-month, 1-,2-,3-,4- and 5-year after radiotherapy were investigated, respectively. The relation between xerostomia and parotid dose distribution was analyzed. Results Of all the patients,4,31,31 and 17 had stage Ⅰ,Ⅱ,Ⅲ and ⅣA disease, respectively. Sixteen patients received chemo-radiotherapy. The median followed-up time was 65 months. The 5-year local control and regional control rate were 96% and 95% ,respectively. The 5-year overall survival rate was 80%. The mild xerostomia rate at the seven time points was 42%, 51%, 71%, 77%, 58%, 38% and 26%. The corresponding moderate xerostomia rate was 52%, 53%, 21%,8%, 3%, 2% and 2%, respectively. No serious xerostomia was observed. The mean dose of the bilateral parotid glands was 34.34 Gy. Xerostomia at 6-month after radiotherapy was positively correlated with the mean dose of the parotid glands, and D50 was the independent factor in predicting the xerostomia. Parotid function was well protected when the mean dose and D50 were no more than 33 Gy and 29 Gy,respectively. Conclusions IMRT can improve the local-regional control of NPC and protect the parotid glands from radiation-induced in-jury.     

鼻咽癌调强放疗对腮腺功能的影响

Objective To evaluate the effect of intensity-modulated radiation therapy(IMRT) on parotid function in nasopharyngeal carcinoma(NPC). Methods Eighty-three NPC patients received prima-ry IMRT between 2001 and 2003. Xerostomia before radiotherapy, at the end of radiotherapy, at 6-month, 1-,2-,3-,4- and 5-year after radiotherapy were investigated, respectively. The relation between xerostomia and parotid dose distribution was analyzed. Results Of all the patients,4,31,31 and 17 had stage Ⅰ,Ⅱ,Ⅲ and ⅣA disease, respectively. Sixteen patients received chemo-radiotherapy. The median followed-up time was 65 months. The 5-year local control and regional control rate were 96% and 95% ,respectively. The 5-year overall survival rate was 80%. The mild xerostomia rate at the seven time points was 42%, 51%, 71%, 77%, 58%, 38% and 26%. The corresponding moderate xerostomia rate was 52%, 53%, 21%,8%, 3%, 2% and 2%, respectively. No serious xerostomia was observed. The mean dose of the bilateral parotid glands was 34.34 Gy. Xerostomia at 6-month after radiotherapy was positively correlated with the mean dose of the parotid glands, and D50 was the independent factor in predicting the xerostomia. Parotid function was well protected when the mean dose and D50 were no more than 33 Gy and 29 Gy,respectively. Conclusions IMRT can improve the local-regional control of NPC and protect the parotid glands from radiation-induced in-jury.     

探究黑胡椒粉对SD大鼠肝脏七种主要P450酶亚型的影响

目的进行大鼠体内外实验探究黑胡椒粉对肝脏七种主要P450酶亚型的影响。方法采用体外探针底物孵育法结合LC-MS/MS技术测定黑胡椒粉乙醇提取物与大鼠肝微粒体共孵育各时间点七种酶亚型的酶活力;采用Cocktail探针法结合LC-MS/MS技术测定体内连续灌胃黑胡椒粉一、二和三天大鼠肝脏七种酶亚型的酶活力。结果与对照组相比,黑胡椒粉乙醇提取物在体外实验中对大鼠CYP2D2、CYP3A、CYP2C11、CYP2E1和CYP1A2具有抑制作用;与空白组相比,灌胃黑胡椒粉一天对大鼠CYP2A5、CYP2D2和CYP1A2具有明显的诱导作用,且诱导作用在连续灌胃二和三天随之减弱。结论黑胡椒粉对大鼠肝脏P450酶有诱导作用,且经P450酶代谢产生的代谢产物是其诱导作用的物质基础。