Non-alcoholic fatty liver disease(NAFLD)is among the most frequent etiologies of cirrhosis worldwide,and it is associated with features of metabolic syndrome;the key factor influencing its prognosis is the progression...Non-alcoholic fatty liver disease(NAFLD)is among the most frequent etiologies of cirrhosis worldwide,and it is associated with features of metabolic syndrome;the key factor influencing its prognosis is the progression of liver fibrosis.This review aimed to propose a practical and stepwise approach to the evaluation and management of liver fibrosis in patients with NAFLD,analyzing the currently available literature.In the assessment of NAFLD patients,it is important to identify clinical,genetic,and environmental determinants of fibrosis development and its progression.To properly detect fibrosis,it is important to take into account the available methods and their supporting scientific evidence to guide the approach and the sequential selection of the best available biochemical scores,followed by a complementary imaging study(transient elastography,magnetic resonance elastography or acoustic radiation force impulse)and finally a liver biopsy,when needed.To help with the selection of the most appropriate method a Fagan′s nomogram analysis is provided in this review,describing the diagnostic yield of each method and their post-test probability of detecting liver fibrosis.Finally,treatment should always include diet and exercise,as well as controlling the components of the metabolic syndrome,+/-vitamin E,considering the presence of sleep apnea,and when available,allocate those patients with advanced fibrosis or high risk of progression into clinical trials.The final end of this approach should be to establish an opportune diagnosis and treatment of liver fibrosis in patients with NAFLD,aiming to decrease/stop its progression and improve their prognosis.展开更多
目的分析比较3种不同射野方法在宫颈癌术后放射治疗中的剂量学情况。方法选择30例宫颈癌术后放射治疗患者,年龄37~68岁,中位年龄54岁。对所有病例进行3种不同射野方法计划设计,分别为5野调强放射治疗(5FIMRT)、7野调强放射治疗(7FIMRT)...目的分析比较3种不同射野方法在宫颈癌术后放射治疗中的剂量学情况。方法选择30例宫颈癌术后放射治疗患者,年龄37~68岁,中位年龄54岁。对所有病例进行3种不同射野方法计划设计,分别为5野调强放射治疗(5FIMRT)、7野调强放射治疗(7FIMRT)、单弧容积旋转调强放射治疗(VMAT),处方剂量均设计为45 Gy/25 F。对比3组治疗计划的靶区剂量、适形度指数(CI)、均匀性指数(HI),以及危及器官的受照剂量、机器跳数和治疗时间等。结果靶区CI:VMAT优于7FIMRT(0.879±0.027 vs 0.859±0.032;t=5.759,P<0.05),而7FIMRT优于5FIMRT(0.859±0.032vs 0.835±0.033;t=4.739,P<0.05);靶区HI:VMAT与7FIMRT相当(0.119±0.019 vs 0.119±0.016;t=0.045,P=0.954),却优于5FIMRT(0.119±0.019 vs 0.123±0.017;t=6.587,P<0.05);但VMAT靶区内平均剂量[(47.73±0.56)Gy]略高于5FIMRT[(47.55±0.47)Gy]、7FIMRT[(47.51±0.43)Gy](t=6.753、8.613,P<0.05);在危及器官的保护上,VMAT计划的直肠和膀胱受照剂量尤其在高剂量区域(V_(30)、V_(40))比IMRT有所减少,股骨头受照剂量整体(V_(20)、V_(30)、V_(40))都有下降,脊髓最大剂量(D2%)明显下降,其他参数差异无统计学意义(P>0.05)。VMAT相比于5FIMRT、7FIMRT治疗时间缩短一半以上[VMAT:(3.38±0.20)min;5FIMRT:(6.22±0.31)min;7FIMRT:(8.11±0.23)min。t=7.231、9.478,P<0.05],机器跳数也有减少(VMAT:574±75;5FIMRT:606±74;7FIMRT:666±88。t=2.783、3.424,P<0.05)。结论需要接受放射治疗的宫颈癌患者,IMRT与VMAT两种技术均可达到靶区剂量要求。在机器条件及经济条件允许的前提下,推荐使用VMAT;它在治疗时间、治疗精度和危及器官的保护等方面优于IMRT,具有一定的临床优势。展开更多
文摘Non-alcoholic fatty liver disease(NAFLD)is among the most frequent etiologies of cirrhosis worldwide,and it is associated with features of metabolic syndrome;the key factor influencing its prognosis is the progression of liver fibrosis.This review aimed to propose a practical and stepwise approach to the evaluation and management of liver fibrosis in patients with NAFLD,analyzing the currently available literature.In the assessment of NAFLD patients,it is important to identify clinical,genetic,and environmental determinants of fibrosis development and its progression.To properly detect fibrosis,it is important to take into account the available methods and their supporting scientific evidence to guide the approach and the sequential selection of the best available biochemical scores,followed by a complementary imaging study(transient elastography,magnetic resonance elastography or acoustic radiation force impulse)and finally a liver biopsy,when needed.To help with the selection of the most appropriate method a Fagan′s nomogram analysis is provided in this review,describing the diagnostic yield of each method and their post-test probability of detecting liver fibrosis.Finally,treatment should always include diet and exercise,as well as controlling the components of the metabolic syndrome,+/-vitamin E,considering the presence of sleep apnea,and when available,allocate those patients with advanced fibrosis or high risk of progression into clinical trials.The final end of this approach should be to establish an opportune diagnosis and treatment of liver fibrosis in patients with NAFLD,aiming to decrease/stop its progression and improve their prognosis.
文摘目的分析比较3种不同射野方法在宫颈癌术后放射治疗中的剂量学情况。方法选择30例宫颈癌术后放射治疗患者,年龄37~68岁,中位年龄54岁。对所有病例进行3种不同射野方法计划设计,分别为5野调强放射治疗(5FIMRT)、7野调强放射治疗(7FIMRT)、单弧容积旋转调强放射治疗(VMAT),处方剂量均设计为45 Gy/25 F。对比3组治疗计划的靶区剂量、适形度指数(CI)、均匀性指数(HI),以及危及器官的受照剂量、机器跳数和治疗时间等。结果靶区CI:VMAT优于7FIMRT(0.879±0.027 vs 0.859±0.032;t=5.759,P<0.05),而7FIMRT优于5FIMRT(0.859±0.032vs 0.835±0.033;t=4.739,P<0.05);靶区HI:VMAT与7FIMRT相当(0.119±0.019 vs 0.119±0.016;t=0.045,P=0.954),却优于5FIMRT(0.119±0.019 vs 0.123±0.017;t=6.587,P<0.05);但VMAT靶区内平均剂量[(47.73±0.56)Gy]略高于5FIMRT[(47.55±0.47)Gy]、7FIMRT[(47.51±0.43)Gy](t=6.753、8.613,P<0.05);在危及器官的保护上,VMAT计划的直肠和膀胱受照剂量尤其在高剂量区域(V_(30)、V_(40))比IMRT有所减少,股骨头受照剂量整体(V_(20)、V_(30)、V_(40))都有下降,脊髓最大剂量(D2%)明显下降,其他参数差异无统计学意义(P>0.05)。VMAT相比于5FIMRT、7FIMRT治疗时间缩短一半以上[VMAT:(3.38±0.20)min;5FIMRT:(6.22±0.31)min;7FIMRT:(8.11±0.23)min。t=7.231、9.478,P<0.05],机器跳数也有减少(VMAT:574±75;5FIMRT:606±74;7FIMRT:666±88。t=2.783、3.424,P<0.05)。结论需要接受放射治疗的宫颈癌患者,IMRT与VMAT两种技术均可达到靶区剂量要求。在机器条件及经济条件允许的前提下,推荐使用VMAT;它在治疗时间、治疗精度和危及器官的保护等方面优于IMRT,具有一定的临床优势。
