| BackgroundThe 125I seed implantation (interstitial brachytherapy) is a method of treatment that implants the miniature radiation source into tumor and tissue with tumor infiltrating invasion according to tumor size and tumor morphology under the application of designs by treatment planning system (TPS) and the guidance of modern imaging technology. This therapy could make the tumor tissue suffer the greatest degree of destruction, and not damage normal tissue or only cause slight damage by the continued short-distance radiation from the I25I seeds.125I seed implantation is a method of brachytherapy. This technique has been progressing for 100 years overseas, and some major hospitals in China have been progressing it for more than ten years. Now the common radioactive source is 125I seed. Due to the radiation characteristics of the 125I seed and that the 125I seed implantation is minimally invasive, safe, effective and with many other advantages, it has been widely used in the treatment of various tumors, becoming a promising treatment in the clinical treatment of cancer. Radioactive source is divided into five categories according to the degree of damage for human body in International Atomic Energy Agency (IAEA).125I seed belongs to the 4th and 5th. The main damages on human body about 125I seed radiation are included as follow:thyroid and lens damage, the effect of sexual function and intelligence, reduction of sperm count, memory loss, genetic effect, increasing incidence of leukemia or tumor and so on.The biological mechanisms of low-energy ray injury to human body: ① direct effects:the ray can cause single strand break and double strand break in DNA molecular chains, making tumor cells to lose their ability to reproduce; ②ndirect effects:the ray makes ionization of internal water molecules in the body to produce free radicals (life of only 5-10s), then free radicals and biological macromolecular get interactions by abstraction of oxygen, causing tissue cell damage. A large number of epidemiological studies and statistics show that, the thyroid as a radiation-sensitive organ is susceptible to radiation damage.With the popularization and application of this treatment, the safety of radiation has attracted people’s attention. The interventional medical technicians began to study and monitor the surrounding radiation dose patients after 125I seed implantation. The clinical managers began to focus on radiation dose of nurses in 125I seed implantation ward per year whether or not exceeding the national standard, and even began to in-depth study the long-term chronic radiation would affect the health or not. The nurses are as a population of long-term closely contacting with patients after implantation in clinical first-line, but they are not included in the scope of standardized management of radiation staff. These nurses can only participate in the ordinary annual examination with limited examinations.During the clinical work, it found that there are some young short-working-aged nurses in 125I seed implantation ward on a physical examination of the thyroid problem. For example, a lot of nurses were examined multiple scattered nodules in thyroid, or the individual also found Hashimoto’s thyroiditis, and so on. Whether their thyroid is affected by radioactive particles has attracted the attention of our medical staff and clinical managers. However, the radiation of 125I seed would cause some degree of influence on their thyroid or chronic radiation injury or not has not been reported. The purpose of this study is to investigate thyroid health status of nurses in I25I seed implantation ward, and further research that working in 125I seed implantation ward would affect the nurse’s thyroid health or not with the current protective measures.PART I The investigation and analysis of thyroid health status of nurses in 12SI seed implantation ward1. ObjectiveInvestigate and understand the thyroid health status of nurses working in the 125 I seed implantation ward, and analyze the health status of the thyroid gland with age and length of service.2. Methods2.1 ObjectsNurses in department of minimally invasive interventional therapy (125I seed implantation ward), Sun Yat-sen University Cancer Center, Guangzhou. All nurses are currently engaged in clinical nursing work.2.2 Research methodsUltrasound scan was used for the thyroid of nurses in 125I seed implantation ward by doctors in department of ultrasound of physical examination center in our hospital. Thyroid disease diagnosed according to thyroid ultrasound report. Thyroid function was tested by venous blood that is taken by nurses of physical examination center in our hospital. Head and neck surgeons in our hospital evaluated thyroid function and determined the diagnosis of thyroid disease. The results were collected, recorded and collated by the third subjects who were not related to this study, and investigated whether the nurses had thyroid diseases and the treatment process to cure. Statistically analyzed the thyroid health status of nurses in 125I seed implantation ward according to the results.2.3 Statistical MethodsThe SPSS 17.0 is used to analysis. The result of measurement data is shown by mean ± standard deviation and count data by frequency and percentage, the two groups were compared with the t test or x2 test, P <0.05 is statistically significant.3. Results3.1 The incidence:The abnormal thyroid ultrasound examination number in 125I seed implantation ward and general ward are 24 (n= 54), and the incidence rates were 44.4%.3.2 Diseases Category:Nurses were diagnosed thyroid diseases, included nodular goiter, thyroid cyst, Hashimoto’s thyroiditis.3.3 Blood abnormalities of thyroid function:Seven cases were with abnormal thyroid function in blood.3.4 Relationship between age, working age and the incidence of thyroid:The occurrence of thyroid disease is concerned with age and working years. With age and working age of growth, the occurrence of thyroid disease tended to increase.4. Conclusions4.1 This study have shown that a higher incidence of thyroid disease in 125I seed implantation ward.4.2 With the growth of age and working age, occurrence of thyroid disease in nurses was significantly higher.PART II The comparison of thyroid health of nurses in 125I seed implantation ward and a general ward1. ObjectiveUnder the current protection measures, thyroid health of nurses is affected when working in 125I seed implantation ward or not.2. Methods2.1 Materials54 nurses in department of minimally invasive interventional therapy (125I seed implantation ward), Sun Yat-sen University Cancer Center, Guangzhou. All nurses are female,21-42 years old, mean 29.3 ± 6.7 years old, and working as nurses for 10.3 ±5.7 years,9.1 ±4.4 years in this ward.63 nurses in one general surgical ward (without 125I seed implantation), Sun Yat-sen University Cancer Center, Guangzhou. All nurses are female,22-46 years old, mean 30.7 ± 8.4 years old, and working as nurses for 11.3 ± 6.5 years. From June 2002 to December 2015, there were 5631 125I seed implantation cases in department of minimally invasive interventional therapy (125I seed implantation ward) in our hospital, the most number of 125I is 128 and the least 5, mean implantation 29.4 particles, mean hospital stay 7.8 days.Inclusion Criteria(1) Age 20-55 years engaged in clinical care, good health.(2) Minimally invasive implantation ward nurses worked for more than one year with occupational exposure. General surgical ward nurses worked for more than one year.(3) In this study, two groups of nurses are all female.(4) In this study, by Sun Yat-sen Cancer Center of the Medical Ethics Committee approval, all participants agreed to and signed informed consent.Exclusion Criteria(1) Pregnant women.(2) Thyroid disease before work.(3) Taking iodine preparations and related drugs affect thyroid function within six months.(4) High blood pressure, diabetes and other medical diseases and obesity, physical thin person.(5) Postmenopausal.(6) With smoking history.(7) Nurses who has left work.All nurses in two wards were with the inclusion criteria.2.2 Research methodsUltrasound scan was used for the thyroid of nurses in 125I seed implantation ward by doctors in department of ultrasound of physical examination center in our hospital. Thyroid disease diagnosed according to thyroid ultrasound report. Thyroid function was tested by venous blood that is taken by nurses of physical examination center in our hospital. Head and neck surgeons in our hospital evaluated thyroid function and determined the diagnosis of thyroid disease. The results were collected, recorded and collated by the third subjects who were not related to this study, and investigated whether the nurses had thyroid diseases and the treatment process to cure. Statistically analyzed the thyroid health status of nurses in 125I seed implantation ward according to the results.The SPSS 17.0 is used to analysis. The result of measurement data is shown by mean ± standard deviation and count data by frequency and percentage, the two groups were compared with the t test or y2 test, P <0.05 is statistically significant.3. ResultsThe abnormal thyroid ultrasound examination number between 125I seed implantation ward and general ward are 24 (n= 54) and 29 (n= 63), abnormal thyroid function test 7 cases and 6 cases, Abnormal index number 9 cases and 10 cases. There is no significant difference (P> 0.05) for thyroid function test in two groups.4. ConclusionsAt present,125I seed had no significant effect on the health of the thyroid in 125I seed implantation ward. |
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