Objective To evaluate the hematological toxicity of craniospinal irradiation,and determine the short-term clinical efficacy and prognostic factors in medulloblastoma.Methods Eightseven patients who underwent craniospinal irradiation were retrospectively analyzed with respect to the changes in hematology during craniospinal irradiation.The effect of sex,age,tumor location,interval between surgery and radiation,interval time during radiation and radiation sequence on survival were also studied.Results The 1,2,3-year overall survival (OS) and progress-free survival (PFS) rate were 95.0％,92.4％,84.9％ and 93.7％,89.8％,80.8％,respectively.The incidence of 2-3 grade leucopenia was 90.8％,while the incidence of 1-2 grade thrombocytopenia was 70.1％,and the incidence of 3 grade thrombocytopenia was 1.1％.The incidence of 1-2 grade hemoglobin reduction was 16.1％.No patient had grade 3-4 hemoglobin reduction.Kaplan-Meier analysis shows that more favorable prognoses in terms of 3-year PFS were evident for 0-1 grade thrombocytopenia compared with 2-4 grade thrombocytopenia (x2 =3.936,P ＜ 0.05).And 3-year PFS and 3-year OS were evident for 0 grade hemoglobin reduction compared with 1-4 grade hemoglobin reduction (x2 =10.269,9.336,P ＜ 0.05).The 3-year PFS between interval time during radiation ＜ 3 days and ≥ 3 days was 84.6％ and 68.6％ (x2 =4.413,P ＜ 0.05).Conclusions Hematological toxicity during craniospinal irradiation and the interval time during radiation were prognostic factors.

Objective To evaluate the prognostic factors and treatment results of intracranial ependymomas (EPs).Methods Thirty-one intracranial EPs patients who received postoperative radiotherapy in Beijing Shijitan Hospital between January 2009 and June 2012 were analyzed retrospectively.Twenty-two males and 9 females had an average age of 18 years (range 3-60 years).Seventeen patients received gross total resection (GTR) while fourteen received subtotal resection (STR).Median total radiation dose was 53.9 Gy (48.6-60 Gy).The three-year and five-year progress-free survival (PFS) and overall survival (OS) were estimated with the Kaplan-Meier method.Univariate analysis was performed using eight clinical and dosimetric factors by Log-Rank testing.Cox proportional hazards model was used to identify the independent prognostic factors correlated to EPs.Results The median time of follow-up was 51 months.At the endpoint of the follow-up period,7 patients experienced tumor recurrence:5 had a local recurrence (LR) and 2 had both LR and distant recurrence.Six patients died,4 of which had cases of pediatric infratentorial anaplastic EPs.The three and five-year progress-free survival (PFS) were 80.6％ and 75.9％.Overall survival (OS) at three-year and five-year were 83.9％ and 76.2％,respectively.Univariate analysis showed a more favorable prognoses in terms of three-year PFS,five-year PFS and OS for GTR compared to STR (x2 =4.685,6.311,4.238,P ＜ 0.05).Besides,a more favourable univariate outcome in terms of five-year PFS was evident in patients when the total radiotherapy dose was ＞ 55 Gy compared to ≤55 Gy (x2 =4.210,P ＜ 0.05),and no severe radiotherapy complications occurred.Conclusions Surgery is the major treatment method,while adjuvant radiotherapy is important for subtotal resection and anaplastic EPs patients.Surgical resection and radiotherapy dose were relevant to prognosis.

Type 17 T helper cells (Th17) are novel subsets of CD4+ effector T cells discovered recently which are different from the traditional type 1 and type 2.They are mainly differentiated from initial T cell precursor.Tumor microenvironmental cytokines can recruit CD4 + Th17 cells from the peripheral blood into tumor sites.And the differentiation of Th17 cells is also affected by tumor microenvironmental factors.Tumorinfiltrating Th17 cells play a dual role for tumor growth in both pro- and anti-tumourigenic processes.A further understanding of the activities of Th17 cells will provide a new breakthrough point for the researches of cancer immunotherapy.

Objective To evaluate the difference between CT and CT/MR DWI images for gross tumor volume (GTV) delineation in precision radiotherapy for esophageal squamous cell carcinoma.Methods 20 patients with pathologically confirmed as esophageal squamous cell carcinoma were selected for target delineation.The GTV based on CT and CT/MR DWI images of the patients were delineated by six radiation oncologists.The mean,standard deviation,coefficient of variation (CV =standard deviation/mean) of GTV volume,the ratio of minimum value and maximum value (ratio =maximum value/minimum value) of the GTV volume were calculated.And the CV and ratio of the GTV by the two methods were compared.Results The biggest difference of GTV volume on CT and on CT/MR DWI images was 55.71 and 13.89 cm3 (F =12.80,P ＜ 0.05).The CV on CT and CT/MR DWI images were 0.30 ± 0.08,0.11-±0.04 (Z =-3.92,P ＜ 0.05),and the ratio of GTV volume were 2.38 ± 0.62,1.34 ± 0.13,respectively (Z =-3.92,P ＜ 0.05).Conclusions CT/MR DWI images could display GTV more directly,which may help to increase consistency of GTV for esophageal squamous cell carcinoma delineation among different radiation oncologists.

Objective To study the role of bone morphogenetic protein-7 in the osteogenic differentiation of periosteal cellsin vitro. Methods Periosteal cells, obtained from adult tibial periosteum, were cultured by routine method in vitro, and divided into two groups. One group cultured with BMP7 and the supplements of 100 nmol dexametasone, 10 mmol b-glycerophosphate and 50 mg/mL L-ascorbic acid (BMP7 group), the other cultured with the supplements alone as the control (control group). Ultrastructure and morphological changes of periosteal cells were observed by contrast phase microscope and electron microscope. In order to test the expression of markers of osteoblastic differantiation in periosteal cells, involved mineralized node and alkaline phosphatase. Each group was tested at the time of 5 d, 10 d, 15 d, 20 d, respectively, using ALP kit stain and Von Kossa stain with 3 samples at each time. Results The periosteal cells cultured by routine method and induced into osteoblast differentiation with BMP7 were both growing well, in vitro. Microscope observations showed that the periosteal cells were spindle-shaped, well-stacked, transparent and three-dimensional in the early stage, and cube-shaped or puncheon shaped in the mitotic phase, gradually became wide shuttle and irregular shape with a lot secretion in telophase. The positive cells were visible by the ALP kit staining and Von Kossa staining of calcium nodules at 5 d, 10 d, 15 d and 20 d in both groups.A difference of positive rate at each time point was found between BMP7 group and control group at 5 d, 10 d, 15 d, 20 d, and the difference was statistically significant (P ＜ 0.01). Conclusion It displayed well regeneration and osteogenesis ability in the periosteal cell. BMP7 has definite osteo-inductive activity, which can obviously enhance the proliferation and ossifyng differentiation of periosteal cells.

Ectopic ACTH syndrome caused by adrenal pheochromocytoma is very rare.A case was herewith reported and the domestic and foreign literatures were reviewed.The correct diagnosis of the syndrome depends on clinical,biochemical,hormonal,radiographic,pathological investigations,as well as tumor immunohistochemistry for final comprehensive judgments.

Objective:To explore the efficacy of sequential and concurrent chemoradiotherapy in the treatment of advanced non-small cell lung cancer (NSCLC) in the elderly, and to analyze the influencing factors of prognosis and outcome.Methods:The clinical data of 195 elderly patients with advanced NSCLC admitted to Beijing Shijingshan Hospitaland and Beijing Shijitan Hospital from March 2015 to March 2018 were retrospectively analyzed. They were divided into the concurrent chemoradiotherapy (100 cases) and the sequential chemoradiotherapy (95 cases) according to different chemoradiotherapy regiments. The short-term efficacy, 3-year survival, influencing factors of prognosis and toxic and adverse effects of the two groups were compared.Results:The objective response rate in the concurrent chemoradiotherapy group was significantly higher than that in the sequential chemoradiotherapy group: 61.00%(61/100) vs. 44.21%(42/95), there was statistically difference ( χ2 = 5.51, P<0.05). The 2-year and 3-year survival rate in the concurrent chemoradiotherapy group were 52.00% and 23.00%, which were significantly higher than those in the sequential chemoradiotherapy group: 32.60%, 11.60%, there were statistically differences ( P<0.05). Multivariate analysis results showed that smoking, Karnofsky score<70, TNM stage Ⅲb, short-term efficacy and treatment methods/sequential chemoradiotherapy were independent risk factors ( P<0.05). The incidence of radiation esophagitis, bone marrow suppression and lung function damage in the concurrent chemoradiotherapy group were higher than those in the sequential chemoradiotherapy group: 45.00%(45/100) vs. 27.37% (26/95), 36.00%(36/100) vs. 22.11%(21/95), 48.00%(48/100) vs. 26.32%(25/95), there were statistically differences ( χ2 = 6.54, 4.55, 9.78; P<0.05). Conclusions:Concurrent chemoradiotherapy can improve the short-term efficacy, and improve the 2-year and 3-year survival rates in advanced NSCLC in elderly patients, but the adverse effects are significantly enhanced.

Objective: To investigate the clinical features and prognosis of intracranial embryonal tumors in children. Methods: Clinical data of 27 patients with intracranial embryonal tumors who were admitted to Beijing Shijitan Hospital, Capital Medical University be-tween May 2011 and December 2018 were retrospectively analyzed. Results: The study included 27 patients, comprising 17 male and 10 female children, with a median age of 7 years. Twelve patients underwent gross total resection, and 15 patients underwent subto-tal resection. After surgery, all 27 patients underwent craniospinal irradiation. The dose of craniospinal irradiation was 27-30.6 Gy, and the dose of the tumor bed was 55.8-60 Gy. Twenty-two patients underwent chemotherapy regimen composed of irinotecan, vtncris-tine, etoposide, nedaplatin after radiotherapy. The median follow-up period was 22 (4-93) months. Nine patients are alive without lo-cal or distant recurrence. Eighteen patients died; the causes of death were intracranial recurrence and spinal cord metastasis. The 1-, 3-, and 5-year survival rates were 79.4%, 50.2%, and 36.5%, respectively. Conclusions: Intracranial embryonal tumors in children are rare and malignant and can metastasize along the neuroaxis. Surgery, adjuvant radiotherapy, and chemotherapy are important for pa-tients with intracranial embryonal tumors. Moreover, the prognosis is poor.

Objective To investigate the effect of Kuanxiong Lifei decoction on inflammatory factors in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and turbid phlegm obstructing lung syndrome. Methods Two hundred patients with AECOPD and turbid phlegm obstructing lung syndrome diagnosed by traditional Chinese medicine (TCM) differentiation visiting four hospitals of Longhua Hospital Affiliated to Shanghai University of TCM, Shanghai Seventh People's Hospital, Punan Hospital of Shanghai Pudong New Area, Gongli Hospital of Shanghai Pudong New Area were selected from May 2017 to March 2018, and they were divided into a test group and a control group by a random number table, 100 cases per group. The patients in the two groups were treated with routine western medicine according to the guidelines, and in the test group, additionally Kuanxiong Lifei decoction (components: pinellia ternate 15 g, allium macrostemon 12 g, ephedra 9 g, trichosanthes 30 g, poria cocos 15 g, almond 12 g, lumbricus 12 g, citrus peels 12 g, peach kernel 12 g , roasted licorice 6 g) was used for 10 days, the decoction was uniformly made by Chinese Medicine Pharmacy of Longhua Hospital, 1 dose daily, 2 times a day orally taken, warm 200 mL each time, 0.5 hours before or after meal. The efficacy was evaluated after treatment for 10 days. The level changes of white blood cell count (WBC), neutrophils (N), C-reactive protein (CRP), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α) before and after treatment and the improvement of TCM syndrome scores and clinical efficacy were observed in two groups. Results After treatment, the levels of WBC, N, CRP, IL-8, TNF-α, TCM syndrome score of the patients in the two group were significantly decreased compared with those before treatment in the two groups (P < 0.05), and the above indexes in the test group were all significantly lower than those in the control group after treatment [WBC (×109/L): 6.58±1.41 vs.7.44±1.85, N: 0.58±0.08 vs. 0.64±0.08, CRP (mg/L): 7.3±1.8 vs. 9.6±1.7, IL-8 (ng/L): 23.5±6.2 vs. 27.8±9.8, TNF-α (ng/L): 9.45±2.18 vs. 10.25±1.67, TCM syndrome total score: 4.0 (3.0, 8.0) vs. 8.0 (5.0, 10.0), all P < 0.05]. The total effective rate of the test group was significantly higher than that of the control group [88% (88/100) vs. 84% (84/100), P < 0.05]. Conclusion Kuanxiong Lifei decoction can significantly reduce lung inflammatory factors, ameliorate overall symptoms and improve the prognosis of AECOPD patients with turbid phlegm obstructing lung syndrome.