Objective:To analyze the application of deep inspiration breath hold technique in radiotherapy after breast-conserving surgery for left breast cancer and the improvement of cardiac dose.Methods:A total of 45 patients ...Objective:To analyze the application of deep inspiration breath hold technique in radiotherapy after breast-conserving surgery for left breast cancer and the improvement of cardiac dose.Methods:A total of 45 patients with left breast cancer treated in our hospital after breast-conserving surgery were selected,and the selection time was set from January 2020 to August 2022.All patients received radiotherapy.The right breast,heart,and lung volumes,and dose parameters of the heart,lungs,right breast,and left anterior descending coronary artery were compared under free breathing(FB)and deep inspiration breath hold(DIBH)technical modes.Results:The heart volume of the DIBH group was smaller than that of the FB group,and the left and right lung volumes were significantly larger than those of the FB group.In the DIBH group,the heart dose parameters V5,proper lung dose parameters,and left anterior descending coronary artery dose parameters were found lower than that of the FB group,and the differences were statistically significant(P<0.05).Conclusion:Compared with FB,the DIBH technique can reduce the heart’s size and increase the lung volume when used for radiotherapy after breast-conserving surgery for left breast cancer.It also reduces the dose to the heart,right lung,and left anterior descending coronary artery,thus protecting the heart and lungs.展开更多
Orthopedic clinicians frequently encounter patients with temporomandibular joint (TMJ) pain and associated sleep disordered breathing (SDB) that coexists with the patient’s orthopedic conditions. The systemic effects...Orthopedic clinicians frequently encounter patients with temporomandibular joint (TMJ) pain and associated sleep disordered breathing (SDB) that coexists with the patient’s orthopedic conditions. The systemic effects and associated comorbidities caused by TMJ and associated SDB are commonly not recognized as potential contributors to the patient’s long-term orthopedic outcome. This article describes a comprehensive and interdisciplinary medical dental treatment, which was able to successfully address patient’s severe chronic TMJ, head, neck and shoulder pain as well as other health concerns including SDB. Moreover, a new teledontic and telegnathic treatment protocol and principles utilizing total joint replacement for care of patients with chronic TMJ pain and SDB will be introduced describing a completed case.展开更多
Background Previous studies show that sleep-related breathing disorder （SRBD） is common in patients with heart failure （HF） and is associated with increased mortality. This study aimed to determine whether there w...Background Previous studies show that sleep-related breathing disorder （SRBD） is common in patients with heart failure （HF） and is associated with increased mortality. This study aimed to determine whether there was significant difference of subjective daytime sleepiness between HF patients with and without SRBD. Methods We enrolled, prospectively, 195 consecutive HF patients with left ventricular ejection fractions （LVEF） ≤45% and all subjects underwent polysomnography to measure the sleep structure between 2005 and 2008. Patients were then assigned to those with SRBD including obstructive and central sleep apnea （apnea-hypopnea index （AHI） ≥5/hour of sleep） and those without SRBD （AHI 〈5/hour） according to the sleep study. The subjective sleepiness was assessed with Epworth sleepiness scale （ESS）. Results Among 195 HF patients, the prevalence of obstructive sleep apnea （OSA） was 53% and of central sleep apnea （CSA） was 27%. There was no significant difference of ESS scores between patients without SRBD （NSA） and with SRBD （NSA vs OSA： 6.7±0.6 vs 7.6±0.4, P=0.105 and NSA vs CSA： 6.7±0.6 vs 7.4±K）.5, P=0.235, respectively）, indicating that SRBD patients had no more subjective daytime sleepiness. Compared with NSA, patients with SRBD had increased arousal index （Arl） （NSA vs OSA： 14.1±1.4 vs 26.3 ±1.5, P〈0.001 and NSAvs CSA： 14.1±1.4 vs 31.3±3.5, P 〈0.001, respectively）, more awake number after sleep onset （NSA vs OSA： 19.2±1.5 vs 26.2±1.4, P=0.01 and NSA vs CSA： 19.2±1.5 vs 36.9±4.4, P 〈0.001, respectively）, and reduced proportion of slow-wave sleep （SWS） （NSA vs OSA： 13.8±1.7 vs 9.3±0.7, P=0.024 and NSA vs CSA： 13.8±1.7 vs 8.9±0.9, P=0.024, respectively）. Conclusions OSA and CSA remain common in patients with HF on optimal contemporary therapy. Patients with both HF and SRBD have no significant subjective daytime sleepiness compared with patients without SRBD, despite of significantly increased awake number, arousal and decreased proportion of deep sleep stages. It is not a credible way and means to exclude SRBD in patients with HF according to the absence of subjective daytime sleepiness.展开更多
文摘Objective:To analyze the application of deep inspiration breath hold technique in radiotherapy after breast-conserving surgery for left breast cancer and the improvement of cardiac dose.Methods:A total of 45 patients with left breast cancer treated in our hospital after breast-conserving surgery were selected,and the selection time was set from January 2020 to August 2022.All patients received radiotherapy.The right breast,heart,and lung volumes,and dose parameters of the heart,lungs,right breast,and left anterior descending coronary artery were compared under free breathing(FB)and deep inspiration breath hold(DIBH)technical modes.Results:The heart volume of the DIBH group was smaller than that of the FB group,and the left and right lung volumes were significantly larger than those of the FB group.In the DIBH group,the heart dose parameters V5,proper lung dose parameters,and left anterior descending coronary artery dose parameters were found lower than that of the FB group,and the differences were statistically significant(P<0.05).Conclusion:Compared with FB,the DIBH technique can reduce the heart’s size and increase the lung volume when used for radiotherapy after breast-conserving surgery for left breast cancer.It also reduces the dose to the heart,right lung,and left anterior descending coronary artery,thus protecting the heart and lungs.
文摘Orthopedic clinicians frequently encounter patients with temporomandibular joint (TMJ) pain and associated sleep disordered breathing (SDB) that coexists with the patient’s orthopedic conditions. The systemic effects and associated comorbidities caused by TMJ and associated SDB are commonly not recognized as potential contributors to the patient’s long-term orthopedic outcome. This article describes a comprehensive and interdisciplinary medical dental treatment, which was able to successfully address patient’s severe chronic TMJ, head, neck and shoulder pain as well as other health concerns including SDB. Moreover, a new teledontic and telegnathic treatment protocol and principles utilizing total joint replacement for care of patients with chronic TMJ pain and SDB will be introduced describing a completed case.
文摘Background Previous studies show that sleep-related breathing disorder （SRBD） is common in patients with heart failure （HF） and is associated with increased mortality. This study aimed to determine whether there was significant difference of subjective daytime sleepiness between HF patients with and without SRBD. Methods We enrolled, prospectively, 195 consecutive HF patients with left ventricular ejection fractions （LVEF） ≤45% and all subjects underwent polysomnography to measure the sleep structure between 2005 and 2008. Patients were then assigned to those with SRBD including obstructive and central sleep apnea （apnea-hypopnea index （AHI） ≥5/hour of sleep） and those without SRBD （AHI 〈5/hour） according to the sleep study. The subjective sleepiness was assessed with Epworth sleepiness scale （ESS）. Results Among 195 HF patients, the prevalence of obstructive sleep apnea （OSA） was 53% and of central sleep apnea （CSA） was 27%. There was no significant difference of ESS scores between patients without SRBD （NSA） and with SRBD （NSA vs OSA： 6.7±0.6 vs 7.6±0.4, P=0.105 and NSA vs CSA： 6.7±0.6 vs 7.4±K）.5, P=0.235, respectively）, indicating that SRBD patients had no more subjective daytime sleepiness. Compared with NSA, patients with SRBD had increased arousal index （Arl） （NSA vs OSA： 14.1±1.4 vs 26.3 ±1.5, P〈0.001 and NSAvs CSA： 14.1±1.4 vs 31.3±3.5, P 〈0.001, respectively）, more awake number after sleep onset （NSA vs OSA： 19.2±1.5 vs 26.2±1.4, P=0.01 and NSA vs CSA： 19.2±1.5 vs 36.9±4.4, P 〈0.001, respectively）, and reduced proportion of slow-wave sleep （SWS） （NSA vs OSA： 13.8±1.7 vs 9.3±0.7, P=0.024 and NSA vs CSA： 13.8±1.7 vs 8.9±0.9, P=0.024, respectively）. Conclusions OSA and CSA remain common in patients with HF on optimal contemporary therapy. Patients with both HF and SRBD have no significant subjective daytime sleepiness compared with patients without SRBD, despite of significantly increased awake number, arousal and decreased proportion of deep sleep stages. It is not a credible way and means to exclude SRBD in patients with HF according to the absence of subjective daytime sleepiness.
