Objective To explore the change in anatomical volume during intensity?modulated radiotherapy (IMRT) for different stages of nasopharyngeal carcinoma (NPC) and its influence on dose distribution, and to assess the necessity to modify the IMRT plan. Methods Twenty?four patients with newly diagnosed NPC who received IMRT and chemotherapy were enrolled in the study, and were divided into early?intermediate group ( 12 cases ) and locally advanced group ( 12 cases ) according to the 2008 staging system for NPC. Each patient had a repeated CT scan at week 5 of radiotherapy, and target volume and organs at risk ( OAR) were contoured. The dose distribution of the original plan shown on CT was calculated. Changes in target volume, OAR anatomical volume, and dose distribution were analyzed, and paired t?test and Spearman correlation analysis were performed. Results In the early?intermediate group, gross target volume of neck positive lymph nodes (GTVnd) was reduced during radiotherapy (P=0. 059), and gross target volume of nasopharynx ( GTVnx ) , high?risk clinical target volume ( CTV1 ) , and parotid volume were reduced significantly during radiotherapy ( P= 0. 001, 0. 012, 0. 002, and 0. 000, respectively) . In locally advanced group, GTVnx , GTVnd , CTV1 , and parotid volume were significantly reduced during IMRT (P=0. 000, 0. 000, 0. 003, 0. 003, and 0. 000, respectively). Compared with the values before radiotherapy, the parotid dose increased significantly in the two groups during IMRT ( P=0. 044, 0. 026, 0. 033, and 0. 026, respectively;P=0. 024, 0. 016, 0. 030, and 0. 015, respectively) , and the increase in GTVnd dose was observed in the locally advanced group ( P= 0. 029 and 0. 049 ) . Conclusions It is recommended to perform another CT scan for patients with locally advanced NPC at week 5 of radiotherapy and formulate a new IMRT plan to maintain target volume dose and guarantee a safe parotid dose.

Objective To investigate the level change and the significance of serum homocysteine(Hcy),endothelial nitric oxide synthase(NOS)and soluble thrombomodulin(STM)in the patients with acute cerebral infarction(ACI).Methods The values of serum Hcy,NOS and STM were detected in the 150 patients with ACI and the 50 healthy individuals and the detection results were performed the significance testing and the correlation analysis.Results Compared with the normal control group,the levels of ser-um Hcy,NOS and STM in the ACI patients were significantly increased with statistical differences(P <0.05).The increased level of NOS and HCY in the ACI patients was positively correlated with the increased Hcy level.Conclusion Hcy,NOS and STM are the markers of endothelial injury occurrence and their detection has certain significance for judging the disease condition and guiding treatment.

Objective To investigate the correlation between plasma homocysteine (Hcy) and high sensitivity C-reactive protein (hs-CRP) ,Hcy and von Willebrand factor(vWF) in patients with acute cerebral infarction ,and to analyze their clinical significance . Methods 150 patients with acute cerebral infarction were enrolled in the study ,and were divided into 3 groups according to their plasma Hcy concentrations .Meanwhile 50 healthy people were recruited as control group .Plasma hs-CRP ,vWF and Hcy concentra-tions were determined and compared between groups .Then data correlation analysis was performed .Results In patients with acute cerebral infarction plasma hs-CRP ,vWF and Hcy concentrations were significantly higher than those in healthy control group (P<0 .05) .Plasma Hcy concentrations in patients with acute cerebral infarction were positively correlated with plasma hs-CRP and vWF concentrations .Conclusion Hs-CRP ,vWF and Hcy are biomarkers of endothelial injury ,the combined detection of the three indica-tors might contribute to the early diagnosis and treatment of acute cerebral infarction .

Objective To observe the effect of Tingli-Dazao-Xiefei decoction combined with chemotherapy in the treatment of lung cancer with pleural effusion. Methods A total of 90 patients who met the inclusion criteria from January to June 2017, were randomly divided into treatment group and control group. All patients were treated with intrapleural administration of cisplatin chemotherapy once a week, while patients in treatment group received additional treatment of taking Tingli-Dazao-Xiefei decoction daily.Changes of clinical efficacy, traditional Chinese medical (TCM) symptom score and Karnofsky score were observed 4 weeks later. Results After 4 weeks of treatment, there was no difference in the total effective rate between the two groups (χ2=1.600, P=0.659). The total effective rate was 71.1% (32/45) in treatment group, including 11 cases of complete remission and 20 cases of partial remission, while it was 64.4% (29/45) in control group including 10 of complete remission and 19 of partial remission. After treatment, the TCM symptom scores in the treatment group(20.81 ± 1.92 vs.8.93 ± 1.27;t=34.619,P<0.001)and control group(20.28 ± 1.36 vs.13.22 ± 1.63; t=22.310, P<0.001) were significantly lower than those before the treatment. After treatment, the TCM symptom scores(8.93 ± 1.27 vs. 13.22 ± 1.63,t=13.927)in the treatment group were significantly lower than that in the control group(P<0.001).The Karnofsky score(95.6% vs. 80.0%,χ2=3.728)in the treatment group was significantly higher than that in the control group (P<0.05). There was no difference in the incidence of adverse reactions. Conclusions The theray of Tingli-Dazao-Xiefei decoction combined with chemotherapy could achieved the similar clinical effect of cisplatin chemotherapy treatment, while it showed the advantage of improving TCM syndrome score and the quality of life.