Objective:Hepatocellular carcinoma(HCC)is the most common pathological subtype of primary liver cancer and is associated with high incidence and mortality.External beam radiation therapy(EBRT)is a widely used local tr...Objective:Hepatocellular carcinoma(HCC)is the most common pathological subtype of primary liver cancer and is associated with high incidence and mortality.External beam radiation therapy(EBRT)is a widely used local treatment modality for HCC across different disease stages.In the era of precision radiotherapy,standardized safety evaluation indicators for HCC radiotherapy remain lacking.Normal liver tissue surrounding the tumor may lose hepatic function after high-dose irradiation.In this study,remnant functional liver volume(RFLV)was defined as the volume of liver tissue that retains normal function after irradiation,and the residual remnant functional liver volume after x Gy irradiation(rRFLV_(x))was defined as the absolute liver volume receiving less than a given dose threshold(x Gy),and plans to explore the performance of rRFLV_(x) as a radiotherapy safety dose indicator based on real-world data,as well as to explore the safety and efficacy of EBRT in HCC.Methods:A total of 113 HCC patients who received stereotactic body radiotherapy(a SBRT group,n=35)or intensity-modulated radiation therapy(a IMRT group,n=78)for liver lesions at the Third Xiangya Hospital of Central South University between 2015 and 2023 were prospectively collected and selected.The occurrence of radiation-induced liver diseases(RILDs)was recorded.Dosimetric parameters potentially associated with RILDs were analyzed using binary logistic regression with Hosmer-Lemeshow test,mainly including mean liver dose(MLD),remnant liver volume(RLV),standard liver volume(SLV),and rRFLV_(x).Radiotherapy-related hepatitis virus reactivation and other radiotherapy-related toxicities were also observed.Progression-free survival(PFS)and overall survival(OS)were used to evaluate the efficacy of EBRT in HCC.Results:Among the 113 HCC patients,12 were diagnosed with RILDs,including 11 in the IMRT group and only 1 in the SBRT group.Binary logistic regression with Hosmer-Lemeshow test results suggested that rRFLV_(25),rRFLV_(20),rRFLV_(15),rRFLV_(25)/SLV,rRFLV_(20)/SLV,and rRFLV_(15)/SLV were significantly associated with the occurrence of RILDs in HCC patients in the IMRT group(all P<0.05),while MLD and RLV were not associated with the occurrence of RILDs(P=0.88).One patient without regular anti-hepatitis viral treatment was diagnosed with radiotherapy-related HBV clinical reactivation,and one patient was diagnosed with immunotherapy-related HBV clinical reactivation.The median PFS was 5.6 months in the IMRT group and 16.4 months in the SBRT group,and the best local control rates were 98.6%and 100.0%,respectively.The median OS was 12.2 months in the IMRT group and 33.5 months in the SBRT group.The 6-month,1-year,and 2-year OS rates in the IMRT group were 77.1%,52.6%,and 18.6%,respectively.The 1-year,2-year,3-year,4-year,and 5-year OS rates in the SBRT group were 86.1%,61.7%,39.2%,25.7%,and 18.3%,respectively.Conclusion:EBRT is safe and effective for HCC patients at different stages.Compared with MLD and RLV,rRFLV_(x) and rRFLV_(x)/SLV may be more reliable for evaluating the occurrence of RILDs after IMRT treatment.For patients with hepatitis background,concurrent antiviral therapy during radiotherapy is relatively safe,but serum viral load should be closely monitored.Further research is needed to explore the efficacy and safety of radiotherapy combined with targeted and immunotherapy.展开更多
燃耗补偿棒棒位是反应堆监测的一项重要参数,同时棒位移动会对堆芯物理参数分布造成影响。计算了固态燃料钍基熔盐实验堆(Thorium Molten Salt Reactor with Solid Fuel, TMSR-SF1)的补偿棒位变化,并分析其对功率、通量及燃耗分布的影...燃耗补偿棒棒位是反应堆监测的一项重要参数,同时棒位移动会对堆芯物理参数分布造成影响。计算了固态燃料钍基熔盐实验堆(Thorium Molten Salt Reactor with Solid Fuel, TMSR-SF1)的补偿棒位变化,并分析其对功率、通量及燃耗分布的影响。在一般蒙特卡罗燃耗软件基础上耦合了调棒临界搜索功能,计算表明大部分临界搜索只需三次,验证了算法收敛的有效性。对TMSR-SF1未分组补偿棒方案进行了计算,结果表明:补偿棒位在氙平衡及寿期末时刻有较大提升幅度,其余时刻近似线性上升;补偿棒初期在总行程一半偏上位置,增加了堆芯轴向功率及中子通量分布的不均匀性,相对寿期末功率峰因子偏大17%,最大中子通量偏大12%。该变化未对总体设计参数造成显著影响,证明补偿棒未分组方案具有设计可行性。展开更多
随着新型电力系统的建设要求和市场化的逐步推进,综合能源系统运营商(integrated energy operator,IEO)需要制定合理的价格策略向能源用户(energy user,EU)供能并获取运营收益。为了揭示信息不对称及其程度对IEO定价行为策略演化的影响...随着新型电力系统的建设要求和市场化的逐步推进,综合能源系统运营商(integrated energy operator,IEO)需要制定合理的价格策略向能源用户(energy user,EU)供能并获取运营收益。为了揭示信息不对称及其程度对IEO定价行为策略演化的影响规律,构建了以IEO为定价决策主导者、EU负荷调整为跟随者的Stackelberg主从博弈定价模型,引入信息间隙决策理论和鲁棒博弈方法来刻画并求解信息不对称度对IEO-EU定价博弈行为的影响。结合实际算例分析了信息不对称度对IEO定价收益和EU收益的影响,研究了信息不对称度与IEO最优定价的定量关系,提出了考虑信息不对称度的IEO鲁棒定价策略。算例分析表明在信息不对称的情况下IEO可以利用信息优势谋取过高定价,超额利润随信息不对称程度的增加而增大。政府监管部门应提高对IEO的信息公开和信息披露要求,提升EU对能源价格和能源成本的认知。展开更多
目的遴选并总结肿瘤靶向治疗患者皮肤不良反应预防及管理的最佳证据,为临床决策提供参考。方法计算机检索BMJ最佳临床实践、UpToDate临床决策系统、乔安娜布里格斯研究所循证卫生保健中心数据库、国际指南协作网、英国国家卫生与临床优...目的遴选并总结肿瘤靶向治疗患者皮肤不良反应预防及管理的最佳证据,为临床决策提供参考。方法计算机检索BMJ最佳临床实践、UpToDate临床决策系统、乔安娜布里格斯研究所循证卫生保健中心数据库、国际指南协作网、英国国家卫生与临床优化研究所、苏格兰院际指南网、医脉通指南网、美国国立临床诊疗指南数据库、美国医疗保健与研究质量局、加拿大安大略注册护士协会、世界肿瘤学网站、美国国家癌症综合网站、中国抗癌协会肺癌专业委员会、中国抗癌协会肿瘤护理专业委员协会、Cochrane Library、Embase、CHINAL、Web of Science、OVID、PubMed、SinoMed、中国知网、万方数据和维普数据库等相关网站,检索关于肿瘤靶向治疗患者皮肤不良反应预防及管理的指南、证据总结、最佳实践、专家共识、系统评价及原始研究。检索时限为2011年1月1日—2021年10月3日。由2名研究者进行文献质量评价和资料提取。结果共纳入15篇文献,其中3篇指南、4篇证据总结、1篇系统评价、3篇随机对照试验、1篇类实验研究和3篇专家共识,围绕皮肤评估、危险因素、药物治疗、皮肤护理、皮肤不良反应处理、健康教育等6个方面形成19条最佳证据。结论该研究总结了肿瘤靶向治疗患者皮肤不良反应预防及管理的最佳证据,为医护人员提供循证依据,医护人员应结合临床情景,充分评估患者皮肤状况,做好皮肤方面的健康教育、检查和护理,预防皮肤不良反应的发生。展开更多
基金supported by the National Natural Science Foundation(81872473)the Chen Xiaoping Foundation for the Development of Science and Technology of Hubei Province(CXPJJH12000001-2020216)the Wu Jieping Medical Foundation(320.6750.19094-30),China。
文摘Objective:Hepatocellular carcinoma(HCC)is the most common pathological subtype of primary liver cancer and is associated with high incidence and mortality.External beam radiation therapy(EBRT)is a widely used local treatment modality for HCC across different disease stages.In the era of precision radiotherapy,standardized safety evaluation indicators for HCC radiotherapy remain lacking.Normal liver tissue surrounding the tumor may lose hepatic function after high-dose irradiation.In this study,remnant functional liver volume(RFLV)was defined as the volume of liver tissue that retains normal function after irradiation,and the residual remnant functional liver volume after x Gy irradiation(rRFLV_(x))was defined as the absolute liver volume receiving less than a given dose threshold(x Gy),and plans to explore the performance of rRFLV_(x) as a radiotherapy safety dose indicator based on real-world data,as well as to explore the safety and efficacy of EBRT in HCC.Methods:A total of 113 HCC patients who received stereotactic body radiotherapy(a SBRT group,n=35)or intensity-modulated radiation therapy(a IMRT group,n=78)for liver lesions at the Third Xiangya Hospital of Central South University between 2015 and 2023 were prospectively collected and selected.The occurrence of radiation-induced liver diseases(RILDs)was recorded.Dosimetric parameters potentially associated with RILDs were analyzed using binary logistic regression with Hosmer-Lemeshow test,mainly including mean liver dose(MLD),remnant liver volume(RLV),standard liver volume(SLV),and rRFLV_(x).Radiotherapy-related hepatitis virus reactivation and other radiotherapy-related toxicities were also observed.Progression-free survival(PFS)and overall survival(OS)were used to evaluate the efficacy of EBRT in HCC.Results:Among the 113 HCC patients,12 were diagnosed with RILDs,including 11 in the IMRT group and only 1 in the SBRT group.Binary logistic regression with Hosmer-Lemeshow test results suggested that rRFLV_(25),rRFLV_(20),rRFLV_(15),rRFLV_(25)/SLV,rRFLV_(20)/SLV,and rRFLV_(15)/SLV were significantly associated with the occurrence of RILDs in HCC patients in the IMRT group(all P<0.05),while MLD and RLV were not associated with the occurrence of RILDs(P=0.88).One patient without regular anti-hepatitis viral treatment was diagnosed with radiotherapy-related HBV clinical reactivation,and one patient was diagnosed with immunotherapy-related HBV clinical reactivation.The median PFS was 5.6 months in the IMRT group and 16.4 months in the SBRT group,and the best local control rates were 98.6%and 100.0%,respectively.The median OS was 12.2 months in the IMRT group and 33.5 months in the SBRT group.The 6-month,1-year,and 2-year OS rates in the IMRT group were 77.1%,52.6%,and 18.6%,respectively.The 1-year,2-year,3-year,4-year,and 5-year OS rates in the SBRT group were 86.1%,61.7%,39.2%,25.7%,and 18.3%,respectively.Conclusion:EBRT is safe and effective for HCC patients at different stages.Compared with MLD and RLV,rRFLV_(x) and rRFLV_(x)/SLV may be more reliable for evaluating the occurrence of RILDs after IMRT treatment.For patients with hepatitis background,concurrent antiviral therapy during radiotherapy is relatively safe,but serum viral load should be closely monitored.Further research is needed to explore the efficacy and safety of radiotherapy combined with targeted and immunotherapy.
文摘燃耗补偿棒棒位是反应堆监测的一项重要参数,同时棒位移动会对堆芯物理参数分布造成影响。计算了固态燃料钍基熔盐实验堆(Thorium Molten Salt Reactor with Solid Fuel, TMSR-SF1)的补偿棒位变化,并分析其对功率、通量及燃耗分布的影响。在一般蒙特卡罗燃耗软件基础上耦合了调棒临界搜索功能,计算表明大部分临界搜索只需三次,验证了算法收敛的有效性。对TMSR-SF1未分组补偿棒方案进行了计算,结果表明:补偿棒位在氙平衡及寿期末时刻有较大提升幅度,其余时刻近似线性上升;补偿棒初期在总行程一半偏上位置,增加了堆芯轴向功率及中子通量分布的不均匀性,相对寿期末功率峰因子偏大17%,最大中子通量偏大12%。该变化未对总体设计参数造成显著影响,证明补偿棒未分组方案具有设计可行性。
文摘随着新型电力系统的建设要求和市场化的逐步推进,综合能源系统运营商(integrated energy operator,IEO)需要制定合理的价格策略向能源用户(energy user,EU)供能并获取运营收益。为了揭示信息不对称及其程度对IEO定价行为策略演化的影响规律,构建了以IEO为定价决策主导者、EU负荷调整为跟随者的Stackelberg主从博弈定价模型,引入信息间隙决策理论和鲁棒博弈方法来刻画并求解信息不对称度对IEO-EU定价博弈行为的影响。结合实际算例分析了信息不对称度对IEO定价收益和EU收益的影响,研究了信息不对称度与IEO最优定价的定量关系,提出了考虑信息不对称度的IEO鲁棒定价策略。算例分析表明在信息不对称的情况下IEO可以利用信息优势谋取过高定价,超额利润随信息不对称程度的增加而增大。政府监管部门应提高对IEO的信息公开和信息披露要求,提升EU对能源价格和能源成本的认知。
文摘目的遴选并总结肿瘤靶向治疗患者皮肤不良反应预防及管理的最佳证据,为临床决策提供参考。方法计算机检索BMJ最佳临床实践、UpToDate临床决策系统、乔安娜布里格斯研究所循证卫生保健中心数据库、国际指南协作网、英国国家卫生与临床优化研究所、苏格兰院际指南网、医脉通指南网、美国国立临床诊疗指南数据库、美国医疗保健与研究质量局、加拿大安大略注册护士协会、世界肿瘤学网站、美国国家癌症综合网站、中国抗癌协会肺癌专业委员会、中国抗癌协会肿瘤护理专业委员协会、Cochrane Library、Embase、CHINAL、Web of Science、OVID、PubMed、SinoMed、中国知网、万方数据和维普数据库等相关网站,检索关于肿瘤靶向治疗患者皮肤不良反应预防及管理的指南、证据总结、最佳实践、专家共识、系统评价及原始研究。检索时限为2011年1月1日—2021年10月3日。由2名研究者进行文献质量评价和资料提取。结果共纳入15篇文献,其中3篇指南、4篇证据总结、1篇系统评价、3篇随机对照试验、1篇类实验研究和3篇专家共识,围绕皮肤评估、危险因素、药物治疗、皮肤护理、皮肤不良反应处理、健康教育等6个方面形成19条最佳证据。结论该研究总结了肿瘤靶向治疗患者皮肤不良反应预防及管理的最佳证据,为医护人员提供循证依据,医护人员应结合临床情景,充分评估患者皮肤状况,做好皮肤方面的健康教育、检查和护理,预防皮肤不良反应的发生。
