BackgroundTo compare the differences in dose-volume data among coplanar intensity modulated radiotherapy (IMRT), noncoplanar IMRT, and helical tomotherapy (HT) among patients with hepatocellular carcinoma (HCC) and portal vein thrombosis (PVT).MethodsNine patients with unresectable HCC and PVT underwent step and shoot coplanar IMRT with intent to deliver 46 - 54 Gy to the tumor and portal vein. The volume of liver received 30Gy was set to keep less than 30% of whole normal liver (V30 < 30%). The mean dose to at least one side of kidney was kept below 23 Gy, and 50 Gy as for stomach. The maximum dose was kept below 47 Gy for spinal cord. Several parameters including mean hepatic dose, percent volume of normal liver with radiation dose at X Gy (Vx), uniformity index, conformal index, and doses to organs at risk were evaluated from the dose-volume histogram.ResultsHT provided better uniformity for the planning-target volume dose coverage than both IMRT techniques. The noncoplanar IMRT technique reduces the V10 to normal liver with a statistically significant level as compared to HT. The constraints for the liver in the V30 for coplanar IMRT vs. noncoplanar IMRT vs. HT could be reconsidered as 21% vs. 17% vs. 17%, respectively. When delivering 50 Gy and 60-66 Gy to the tumor bed, the constraints of mean dose to the normal liver could be less than 20 Gy and 25 Gy, respectively.ConclusionNoncoplanar IMRT and HT are potential techniques of radiation therapy for HCC patients with PVT. Constraints for the liver in IMRT and HT could be stricter than for 3DCRT.

Background and Objectives Dementia and central nervous system degeneration are common problems in aging societies with regard to the number of people affected and total medical expenses. Socially assistive robotic (SAR) technology has gradually matured; currently, most scholars believe it can be used as companions in long-term care facilities and worked as caregivers alongside staffs to improve the social interaction and mental state of older adults and patients with dementia. Therefore, this study measured the effect of the duration of exposure to SAR in older adults with dementia. Research Design and Methods Seven databases were searched up to February 2019 through the consultation of appropriate Internet sites and use of criteria lists recommended by relevant experts. Randomized controlled trials comparing SAR use with a control group in older adults with dementia and using at least one of the primary outcomes of agitation, depression, and quality of life were included. Results Thirteen RCTs were identified from 873 articles, 7 of which were included in the meta-analysis. The pooled effect estimate from 3 trials with 214 participants revealed that the pet-type robot improved patients’ agitation level, with a standardized mean difference of −0.37 (95% CI: −0.64 to −0.10, P &lt; .01) and no heterogeneity (I 2 = 0%). The results also revealed that length of each session and pet-type robot exposure time per week were associated with reduced depression levels (β = −0.06, Q = 21.213, df = 1, P = &lt; .001 and β = −0.019, Q = 7.532, df = 1, P &lt; .01, respectively). However, the results for quality of life were nonsignificant. Discussion and Implications Pet-type robot systems seem to be a potential activity in long-term care facilities for dementia care. Further research is warranted to establish a comprehensive intervention plan related to the use of pet-type robots.

Background: World Health Organization has communicated that dementia as a public health priority in 2012. Behavioral and psychological symptoms of dementia are the main reason results in hospitalization of dementia patients. Horticulture is one of the favorite activity for many peoples to relax their minds. Objectives: To investigate psychological health benefits of horticulture intervention in dementia patients. Methods: The databases including Cochrane Library, ProQuest, PubMed, EMBASE, EBSCO, Web of Science, and Ovid Medline were searched up to August 2017. Results: Twenty-three articles for systematic review, whereas 8 articles were included in meta-analysis. Meta-analysis verified the beneficial effect of horticultural therapy (HT) on agitation level (standard mean difference: −0.59; P < .00001); increase time spent on activity engagement (mean differences [MD]: 45.10%, P < .00001); decrease time for doing nothing (MD: −29.36%, P = .02). Conclusions: Patients with dementia benefit from horticultural by alleviating their degrees of agitate behaviors, increasing time of engaging in activities and decrease time of doing nothing.

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AimTo review the experience and to evaluate the results of stereotactic body radiation therapy (SBRT) via helical tomotherapy (HT), for the treatment of brachytherapy-unsuitable cervical cancer.MethodsBetween September 1, 2008 to January 31, 2012, nine cervical cancer patients unsuitable for brachytherapy were enrolled. All of the patients received definitive whole pelvic radiotherapy with or without chemotherapy, followed by SBRT via HT.ResultsThe actuarial locoregional control rate at 3 years was 78%. The mean biological equivalent dose in 2-Gy fractions of the tumor, rectum, bladder, and intestines was 76.0 ± 7.3, 73.8 ± 13.2, 70.5 ± 10.0, and 43.1 ± 7.1, respectively. Only two had residual tumors after treatment, and the others were tumor-free. Two patients experienced grade 3 acute toxicity: one had diarrhea; and another experienced thrombocytopenia. There were no grade 3 or 4 subacute toxicities. Three patients suffered from manageable rectal bleeding in months 11, 14, and 25, respectively. One stage I VA patient experienced fistula formation in month 3.ConclusionSBRT via HT provides the possibility for treatment of locally advanced cervical cancer in patients who are unsuitable for brachytherapy. Long-term follow up and enrollment of more such patients to receive SBRT via the HT technique are warranted.

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Non-ST-elevation acute coronary syndrome (NSTE ACS) includes unstable angina pectoris and non-ST-elevation myocardial infarction. The patient with NSTE ACS has a variable severity and prognosis. Early stratification of the patient is very important in reducing the incidence of sudden death and adverse events. The electrocardiogram (ECG) is a rapid and noninvasive diagnostic method, which exerts a critical role in the assessment of early risk stratification. Left main coronary artery (LMCA) is one of the major factors that affect the patient's prognosis. Atie found that most patients with LMCA lesions would appear to have ST-segment elevation (STE) in lead V1 and aVR and ST-segment depression in lead V3, V4, and V5 (especially in lead V4) when chest pain occurs (Atie et al., 1991).Lead aVR is often ignored in clinical practice. However, a number of studies have shown that the STE in lead aVR had a great significance on the prediction of vascular anticipation and clinical prognosis in patients with acute myocardial infarction (Nair & Glancy, 2002;Yamaji et al., 2001). As the research advanced, researchers commonly thought that STE in lead aVR suggested severe left main lesion or serious multivessel lesions (Li et al., 2009). But the results were not consistent among different stud-

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