Objective To evaluate the treatment efficacy and treatment-related toxicity of late course accelerated hyperfractionated radiotherapy (LCAHRT) combined with cisplatin-based chemotherapy (CHT) for locally advanced esophageal squamous cell carcinoma (ESCC).Methods A total of 46 patients with histologically confirmed ESCC,11 in the stage Ⅱa,3 in the stage Ⅱb,and 32 in the stage Ⅲ,underwent conventional fractioned radiation of 40 Gy in 20 fractions on the primary and metastatic lymph nodes,and high-risk lymph node drainage regions,and then the primary and metastatic lymph nodes were irradiated as boost with an additional dose of 19.6 Gy in 14 fractions (1.4 Gy twice a day),and the total prescribed dose was 59.6 Gy in 34 fractions.Two cycles of CHT were administered concurrently during the radiotherapy.The 1-,3-,and 5-year overall survival (OS) rates and local control rates (LCRs) were evaluated by Kaplan-Meier method,and treatment-related toxicity was analyzed based on the RTOG and CTCAE criteria 3.0.Results All patients received the whole course of treatment.The median followup time was 34.4 months (6-67 months).The overall response rate was 91.3％ (42/46).The median OS was 38.5 months (95％ CI 29.6-47.4 months).The 1-,3-,and 5-year OS rates and LCRs were 78.6％,49.4％,and 39.9％,and 84.3％,68.2％,and 61.4％ respectively.The incidence of ≥ G3 radiationinduced esophagitis was 23.9％.Three kinds of serious (≥G3) hematologic toxicities were recorded,including leucopenia (26.1％),thrombocytopenia (13.0％),and anemia (10.9％).Esophagotracheal fistula was recorded in 2 patients (4.3％).Conclusion LCAHRT plus CTH can be favorable for the patients with locally advanced ESCC,however,the treatment-related toxicities may be serious.

Objective To evaluate the clinical efficacy of percutaneous transhepatic biliary drainage (PTBD) and pcrcutaneous transhcpatic insertion of biliary stent (PTIBS) for malignant biliary obstruction.Methods PTBD or PTIBS were performed in 56 patients with malignant biliary obstruction, which were aused by hepatic carcinoma (n = 14), biliary duct carcinoma (n = 11), gallbladder carcinoma (n = 5),stomach carcinoma accompanied with metastasis of lymph node (n = 14), carcinoma of ampulla (n = 1 ) or carcinoma of pancreatic head (n = 11 ). The diagnosis was confirmed by ultrasonography, CT or MRI in all patients. The obstructed site was well identified, including high obstruction in 19 patients and lower obstruction in 37 patients. Based on the imaging findings, suitable interventional procedure was employed.Results PTBD or PTIBS were performed successfully in all 56 patients, of them PTBD was adopted in 11,PTIBS in 40 and both PTBD and PTIBS in 5. The serum total bilirubin decreased from (295.65±152.86)μmol/L before the procedure to (151.05 ± 107.36) μmol/L after the procedure, (P < 0.01 ). Postoperative infection could affect the fading of jaundice (P < 0.01 ), but the location of the obstruction carried no relationship with the fading of jaundice (P = 0.063). Conclusion Both PTBD and PTIBS are safe and effective palliative therapies for malignant biliary obstruction, which can markedly relieve patient of jaundice,improve the quality of life and elongate the survival period.

The asialoglycoprotein receptor (ASGPR) was used to mediate drug carrier for hepatic targeted drug delivery, this article showed the enzyme-catalyzed esterification of galactose and vinyl stearate and a kind of ASGPR ligand-targeted which was used to insert the surface of liposome has been synthesized. The structure of product has been confirmed by TLC, ESI-MS and 1H NMR. The factors of types and quantity of enzyme, organic solvents, molar ratio of substrate, temperature and time of reaction have been studied. Results showed when using acetone as reaction medium, the quantity of Novozym 435 immobilized lipase was 30 mg mL(-1), molar ratio of galactose to vinyl stearate was 1:5, and reacted at 60 degrees C for 12 h, the transformation of vinyl stearate reached more than 70%. This study provides a novel and efficient route to the synthesis of ligand-targeted modifier.

Objective To investigate the accuracy and reproducibility of multi echo data imagine combination (MEDIC) sequence with water excitation at 3. 0 T in swine knee cartilage. Methods Sagittal MEDIC sequences (0.6 mm slice thickness, isotropic) were acquired twice at 3. 0 T MRI in 30 swine knees. The knee cartilage was then removed and the volume was directly measured with water substitution method. The cartilage volume was also determined with a validated open source image software OsiriX by two observers ( A and B). The cartilage volumes obtained by two methods were compared. The reproducibility of MEDIC for quantitative measurement was accessed by the root-mean-square (RMS) of variation coefficient. Interobserver and intraobserver precision errors were compared using a paired students t-test. The accuracy of MEDIC for quantitative measurement was determined by the random pairwise differences, systematic pairwise differences and the Pearson correlation coefficients. Time of semiautomatic and manual segmentation were recorded. Results Time was saved about 75% by using semiautomatic segmentation methods [(4.0 ±1.5) min] versus manual segmentation [(16.0 ±0.9) min]. Interobserver precision errors (RMS CV%for paired analysis) between A and B for cartilage volume measurement were (2. 66 ±0. 82) ml and(2. 61 ±0.81) ml, t=0.24, P=0. 81 (patella); (2.40 ±0.69) ml and(2.49 ±0. 85) ml, t= -0.45,P =0. 65 (medial femoral condyle) ;(2. 28 ±0.74) ml and(2.41 ±0. 78) ml, t = -0. 66, P = 0. 51 (lateral femoral condyle);(3.43±1.28) ml and(3. 51 ±1. 08) ml, t= -0.26, P=0.79 (femora trochlea) with sagittal MEDIC. Intraobserver precision errors ( RMS CV% for paired analysis) of observer A for the first and second cartilage volume measurement were(2. 64 ±0. 62) ml and(2. 67 ±0. 60) ml, t = -0.19, P =0. 85(patella); (2.43 ±0.60) ml and(2. 39 ±0.59) ml, t =0.26, P = 0. 80 (medial femoral condyle);(2. 26 ±0. 56) ml and (2. 30 ±0. 57) ml, t = - 0.27, P = 0. 78 (lateral femoral condyle); (3.40 ±1.20) ml and(3.47 ±1. 11) ml, t = -0.23, P = 0. 82 (femora trochlea) with sagittal MEDIC. The cartilage volume of direct measurement were (2.73 ±0.97 ) ml ( patella ) , (2. 28 ±0. 66 ) ml ( medial femoral condyle) ,(2. 18 ±0. 55) ml (lateral femoral condyle) and (3. 39 ±1.31) ml (femora trochlea).Correlation coefficients between MEDIC and direct measurement for cartilage volume measurement were high [r = 0.95, t = 16. 10, P<0.05 ( patella); r=0.92, t = 12.42, P<0.05 (medial femoral condyle); r =0.94, t = 14.58, P < 0.05 (lateral femoral condyle) and r = 0.98, t = 26.06, P < 0. 05 (femora trochlea) ]. Conclusion Using image software OsiriX, sagittal MEDIC sequence permits accurate and precise measurement of cartilage volume at reasonable acquisition and segmentation time at 3.0 T MRI in swine knee.

Objective To observe the effect of extract from Branchlets roses on blood glucose and glucose tolerance in diabetes mice induced by alloxan.Methods Diabetes animal model was established by alloxan.Dividing the model mice into eight groups:model group,water extract high,middle,and low dose (3.70,1.85,and 0.93 g/kg) group,and ethanol extract high,middle,and low dose (2.75,1.37,and 0.70 g/kg) group,and metformin (positive drug,200 mg/kg) group,and normal mice were taken as control group.Drug was ig administered to mice 3 d after molding once daily.Blood glucose test paper was used to determine fasting blood glucose 0,10,20,and 28 d after modeling,and the glucose tolerance test was performed 30 d after modeling.Results The extract of Branchlets roses from all the groups could decrease the blood glucose and improve the glucose tolerance,and showed a certain dose-effect relationship.In all the extracts,the alcohol extract had the best effect,but the effect was not as good as the positive control drug metformin hydrochloride group.Conclusion The extract of Branchlets roses can reduce the blood sugar content of diabetic mice,and improve the glucose tolerance.

Objective To evaluate the repeatability and accuracy of semi-automated software OsiriX in the assessment of cartilage volume in normal knees on 3.0T MR. Methods Thirty right knees of healthy subjects were scanned twice with 3.0T MR using 3D-FLASH sequence with selective water excitation. Cartilage volume of the patellar compartment was determined with a validated open-source software OsiriX and manual segmentation separately by 3 observers using MRI data sets. After calculating the cartilage volumes, the segmentation processing times, the repeatability and volume results were compared between two segmentations. Results ①Compared with the manual segmentation, a time saving of at least 50% for cartilage volume measurement was achieved with OsiriX software segmentation. ②The interobserver repeatability error was 4.88% and 9.82% with OsiriX software segmentation and manual segmentation, respectively;the intraobserver repeatability error of high experienced observer was 0.77% and 1.29%, the interindividual repeatability range were 0.14%-1.11% and 0.52%-1.61%, respectively. The repeatability error of OsiriX software segmentaion was proved to be significantly smaller than manual segmentation (P＜0.05). ③System difference between results obtained with OsiriX software measurement and manual measurement was (-3.80±3.93)% and absolute pairwise difference was (4.68±2.70)%. There was no statistical difference between the volume results measured using two techniques (t=0.92, P=0.36). Conclusion Compared to manual segmentation, cartilage volume measurement with OsiriX semi-automated segmentation is faster and has higher inter- and intraobserver repeatability with relatively fixed standard. This technique may therefore be used for clinical and multi-center trials of large sample.

Stranging the communication between the clinical laboratory and clinical department,is useful to promote and enhance the quality of tests and clinical examination.The communication work organization and implementation has been effectively guaranteed by managing communication theories and multiple pathways of communication means to strengthen clinical laboratory and clinical department communication.

Objective To compare 18 F-FDG PET/CT and electronic endoscopy for measuring the length of esophageal squamous cell carcinoma (ESCC) and to evaluate the optimal SUV threshold for contour determination of the size of the lesion.Methods Twenty-four patients (19 males and 5 females,median age:59 years) with histologically confirmed ESCC were enrolled.Three patients had stage Ⅱ,14 had stage Ⅲ and 7 had stage Ⅳ diseases.PET studies were performed before treatment.The length of ESCC was measured on FDG PET imaging using different SUV thresholds of 2.0 (L2.0),2.5 (L2.5),3.0 (L3.0),3.5 (L3.5),and 35％(L35),40％(L40),45％(L45),50％(L50),55％(L55) of SUVmax.The length of ESCC on PET imaging was compared with the length of gross tumor in vivo measured by electronic endoscopy (Lst) to determine the optimal threshold of SUV using paired t test.Pearson correlation analysis was used to assess the correlation.Results The SUVmax of primary tumor was 14.51±5.72 and the Lst was (5.27± 2.45) cm.The length was in a descending order of L2.0,L2.5,Lst,L3.0,L3.5,L35,L40,L45,L50 and L55 when using different criteria.There were significant differences between the Lst and the lengths measured on PET except those by L2.5 and L3.0((5.65±2.69) cm,(5.11±2.51) cm; t=-1.74 and 0.76,both P＞0.05).The lengths measured on PET by all criteria were significandy correlated with the Lst,respectively,with the better r values by L3.5(0.935),L2.5(0.920) and L3.0(0.919) (all P＜0.01).When SUVm~＜15,there were no significant differences between the Lst ((4.82±2.14) cm) and L2.5((4.95±2.76) cm),L3.0((4.45±2.50) cm) and L35((4.42±1.85) cm),respectively (t=-0.439,1.299,2.011,all P＞0.05).The best correlation (r=0.953,P＜0.05) was between Lst and Lz5.When SUVmax ≥ 15,there was no significant difference between Lst ((5.67±2.64) cm) and L3.0((6.11±2.61) cm; t=-0.897,P＞0.05; r=0.791,P＜ 0.05).Conclusions For better correlation of ESCC lesion size,it is suggested that the optimal threshold of SUV for contouring is 2.5 for tumor SUVmax＜15,and 3.0 for tumor SUVmax ≥ 15.A larger sampling size is needed for further confirmation or modification.

Objective To evaluate the treatment outcomes and toxicities of intensity-modulated radiation therapy (IMRT) combined with chemotherapy for children and adolescents with nasopharyngeal carcinoma.Methods Forty-three nasopharyngeal carcinoma patients less than 19 years old were recruited between April 2010 and April 2016.All patients were treated with IMRT (total dose 61.2-76 Gy) combined with cisplatin based chemotherapy.The Kaplan-Meier test was used to calculate overall survival (OS) and progression-free survival (PFS).The patient's clinical characteristics,side effects and longterm effects of treatment were retrospectively analyzed.Results Among 43 patients,there were 29 (67.4％) male and 14 (32.6％) female,and the median age was 14 years old (range,6-18 years).According to AJCC 7thstaging system,2 patients were in stage Ⅱ,26 in stage Ⅲ,7 in stage ⅣA and 8 in stage Ⅳ B.All patients were confirmed as non-keratinizing carcinoma.The positive rates of EB virus VCAIgA was 53.8％ (7/13),and Rta-IgG was 60.0％ (6/10) before treatment.The median radiation dose was 70 Gy (range,61.2-76 Gy) to the primary tumor.Thirty-three (76.7％) patients received neoadjuvant chemotherapy,with 20 (46.5％) and 36 (83.7％) patients treated by concurrent and adjuvant chemotherapy,respectively.With a median follow-up of 24 months (range,3-76 months),the 5-year OS and PFS ratios were 75.3％ and 64.7％,respectively.There were 5 patients (11.6％) occurred to bone metastasis within 2 years after treatment.Hypothyroidism was reported in 47.4％ (9/19) patients after IMRT.Conclusions Nasopharyngeal carcinoma in childhood and adolescence is mostly locally advanced diseases with poor differentiation.IMRT combined with chemotherapy produce a well treatment outcome with good tolerance in children and adolescents patients.The most common treatment failure bone metastasis.Radiation-induced hypothyroidism is common.