基于四维CT和TumorLoc软件测定肺下叶呼吸动度

目的:利用四维CT(4D-CT)和Tumor Loc软件,研究肺下叶(右膈肌层面)距离脊柱不同位置处的呼吸动度。方法:采用放疗专用Philips Brilliance 24排大孔径CT定位机对10例行真空垫固定的患者进行4D-CT模拟定位扫描,将每个呼吸周期的CT图像平均分为10个呼吸时相。通过Tumor Loc软件打开每例患者的10个呼吸时相图像,获得肺下叶内(右膈肌层面)距离脊柱40、50、60、70、80、90 mm处血管中心点在三维方向的位移,分析位移变化及左右距离脊柱相同距离位置处三维方向的相关性。结果:左肺下叶(右膈肌层面),距离脊柱40、50、60、70、80、90 mm位置处,呼吸动度在Z方向(头脚)分别为(9.5±2.5)mm、(9.7±2.6)mm、(9.5±2.5)mm、(9.3±2.3)mm、(9.7±2.5)mm、(9.5±2.6)mm;右肺下叶(右膈肌层面),距离脊柱40、50、60、70、80、90 mm位置处,呼吸动度在Z方向(头脚)分别为(10.5±2.7)mm、(11.4±3.1)mm、(11.3±3.2)mm、(11.5±3.0)mm、(11.6±4.0)mm、(11.7±4.3)mm;左右相同距离位置处,X方向(左右)、Y方向(前后)差异无统计学意义(P>0.05)。左右相同距离位置处,Z方向(头脚)在40、50、60 mm处差异有统计学意义(P分别为0.005、0.007、0.005);Z方向在70、80、90 mm处差异无统计学意义(P>0.05)。结论:应用4D-CT通过Tumor Loc软件可精确测量肺下叶(右膈肌层面)不同位置处在三维方向的呼吸运动度。

Long-term outcomes after radical gastrectomy in gastric cancer patients with overt bleeding

AIM: To investigate the difference in long-term outcomes between gastric cancer patients with and without a primary symptom of overt bleeding(OB).METHODS: Consecutive patients between January 1, 2007 and March 1, 2012 were identified retrospectively by reviewing a gastric cancer database at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. A follow-up examination was performed on patients who underwent a radical gastrectomy. OB due to gastric cancer included hematemesis, melena or hematochezia, and gastric cancer was confirmed as the source of bleeding by endoscopy. Patients without OB were defined as cases with occult bleeding and those with other initial presentations, including epigastric pain, weakness, weight loss and obstruction. The 3-year overall survival(OS) rate, age, gender, AJCC T stage, AJCC N stage, overall AJCC stage, tumor size, histological type, macroscopic(Borrmann) type, lymphovascular invasion and R status were compared between patients with and without OB. Moreover, we carried out a subgroup analysis based on tumor location(upper, middle and lower).RESULTS: We identified 939 patients. Of these, 695(74.0%) were hospitalized for potential radical gastrectomy and another 244 received palliative resection, rerouting of the gastrointestinal tract, chemotherapy, radiotherapy or no treatment due to the presence of unresectable tumors. Notably, there was no significant difference in the percentage of OB patients between resectable cases and unresectable cases(20.3 % vs 22.1 %, P = 0.541). Fo l l o w- u p examination was performed on 653 patients(94%) who underwent radical gastrectomy. We found no significant difference in 3-year OS rate(68.2% vs 61.2%, P = 0.143) or clinicopathological characteristics(P > 0.05) between these patients with and without OB. Subgroup analysis based on tumor location showed that the 3-year OS rate of upper gastric cancer was significantly higher in patients with OB(84.6%) than in those without OB(48.1%, P < 0.01) and that AJCC stagesⅠ-Ⅱ(56.4% vs 35.1%, P = 0.017) and T1-T2 category tumors(30.8% vs 13%, P = 0.010) were more frequent in patients with OB than in those without OB. There was no significant difference in 3-year OS rate or clinicopathological characteristics between patients with and without OB(P > 0.05) for middle or lower gastric cancer.CONCLUSION: Upper gastric cancer patients with OB exhibited tumors at less advanced pathological stages and had a better prognosis than upper gastric cancer patients without OB.

抗癌药局部注射治疗恶性肿癌的实验观察初步报告

抗癌药局部注射治疗小鼠实验性肿瘤,以寻找局部正常组织能耐受的最大有效浓度。①于小鼠腹壁皮下注射5-Fu、MMC、Epi-ADR的不同浓度级别溶液经1周观察结果,5-Fu10mg/ml、MMC50μg/ml、Epi-ADR50μg/ml为正常组织能耐受的安全高浓度;②小鼠腰椎旁皮下接种Ehrlich继代肿瘤,增长至1cm直径后均分4组,前3组分别在肿瘤局部注射抗癌药,第4组作对照,7d后对照组肿瘤增长显著大于前3组(P<0.01),病理切片见前3组肿瘤组织均有不同程度坏死和变性而瘤周正常组织无损害,对照组肿瘤则呈自然生长趋势。