Micrometastasis is small metastasis at the cellular and molecular level. Early detection of micrometasis through tumor markers can improve the accuracy of TNM staging, prognosis and subsequently treatment for lung cancer patients. Currently, a number of markers with good specificity and sensitivity have been found, including CK19 mRNA, Lunx mRNA, MUC1 mRNA and GPRP mRNA. These markers can be detected using methods such as RT-PCR, immunohistochemistry and western blot.

Objective To prepare a radiofrequency (RF) ablation probe guided by endoscopic ultrasonography (EUS) and to evaluate its efficacy and safety. Methods A modified 19-gauge needle ( Olympus) was used, which was electrically insulated with shrink tubing, with the tip of lcm naked. The insulation was tested, and the current signal was stable. Three rabbits were anesthetized with 8% chloral hydrate ( 3 ml/kg) intraperitoneally, fixed on the dissecting table. A standard neutral pad was applied to the thigh of the rabbit to complete the electrical circuit, both the pad and the needle electrode connected with RF generator. After anesthesia was ready, the needle was advanced through the gastric wall into the liver. Ablations were performed three times in the same zone. Extent and tissue lesion were measured after ablation. Results Ablation could be successfully performed by the needle electrode, with brown lesions surrounded by normal hepatic tissue. The mean diameter of the ablated zone in the liver was 1.0 cm× 1.2 cm. After ablation,specimens along the passage were subjected to NADH staining, and no lesions were found. HE and NADH staining showed no viable cells in the central ablation area. Conclusion With the advance of the technology and selection of materials, an EUS-guided needle electrode can be made. This preliminary animal trial demonstrates that radiofrequency ablation can be performed effectively and safely by using this EUS-guided needle electrode.

Objective To discuss the optimal radiation dose in the treatment of the late course accelerated hyperfractionation(LCAH) radiotherapy for esophageal carcinoma by using two different treatment doses,focusing on the difference of the short term results,local control rates,treatment tolerance and long term survival rates between the two groups.Methods One hundred patients with esophageal carcinoma were randomly divided by the envelope method into two groups:the 60Gy group and the 75Gy group.Patients in 60Gy group received conventional fraction radiation for the first 3 weeks,and then hyperfractionation radiation(1.5Gy per fraction,two fractions a day with 6 hour interval,10 fractions per week) to the total dose of 60Gy/35 fractions/5 weeks.The radiation schedule of the 75Gy group was the same as the 60Gy group: conventional fractionation of radiation for the first 3 weeks and then hyperfractionation radiation for the rest 3 weeks to the total dose of 75Gy/45 fractions/6 weeks.Results There was no significant difference between the two groups in short term results.The 1-,3-,5-year local control rates were 86%,42%,32% in 60Gy group and 88%,52%,48% in 75Gy group,respectively.The 1-,3-,5-year survival rates were 86%,40%, 28% in 60Gy group and 72%,34%,16% in 75Gy group,with no significant difference(P= 0.283).The median survival time was 25 months for the 60Gy group and 19 months for the 75Gy group.Patients suffered from heavy radiation-induced esophagitis in the 75Gy group were significantly more than those in the 60Gy group(28% vs 10%,P= 0.022).But it was similar for patients who died of side effects in the two groups.Conclusions It is not suitable to pursue high dose in treating esophageal carcinoma with late course accelerated hyperfractionation radiotherapy as high incidence of side effects are unadvoidable if the dose is increased without changing the radiation fields and techniques.When escalating the dose to the esophagus,the radiated lung volume as well as the other normal tissues should be first subjected to meticulous and careful consideration.

Through reviewing ancient and modern literatures,the effect evolution and disease treatment changes of Belamcanda chinensis were understood.The pharmacological experiments were used to verify its main effects.The combination of featured advantages of traditional Chinese medicine (TCM) and modern science and technology contributed to the promotion of TCM modernization.It had important significance for the development of effective components,selection of disease types in the treatment for research and development of new TCM drugs.The indication of Belamcanda chinensis was verified from textual research.The treatment of disease types by Belamcanda chinensis was verified from medical books.The treatment of disease types by Belamcanda chinensis compound was analyzed based on the Pujifang database management system.Main indications of Belamcanda chinensis were summarized.Modern pharmacological studies on anti-inflammatory mechanism of main components of Belamcanda chinensis were combined to screen animal models and investigation indexes for the preliminary verification of the efficacy of Belamcanda chinensis.The comprehensive application of classical herbal medicine books and prescription database analysis results showed that removing phlegm and relieving sore throat were the efficacy of Belamcanda chinensis,which was an important medicine in the treatment of pharyngitis and sore throat.In the modern research,serum of experimental group,IL-4 in throat tissues,as well as IgE and LTC4 level in serum and lung tissues were significantly reduced compared to the model group (P＜0.05).It was concluded that the treatment effect of Belamcanda chinensis extract to chronic pharyngitis may be through the decreasing of IgE level in serum and lung tissues,inhibiting IL-4 expression in serum and throat tissues,and the LTC4 expression in serum.

BACKGROUND:The non-steroidal antiinflammatory drugs (NSAIDs) were widely used to prevent heterotopic bone formation following total hip arthroplasty (THA),however,its efficacy and safety is poorly understood.OBJECTIVE:To determine the efficacy and safety of postoperative NSAIDs therapy in patients undergoing THA using Meta analysis.METHODS:The databases of PubMed,Embase,Cochrane Library,Chinese biomedical literature,CNKI,VIP as well as bibliographies of retrieved articles were researched for randomized controlled trials comparing NSAID versus control after THA,and the data were analyzed using Review Manager 5.0.RESULTS AND CONCLUSION:A total of 13 randomized controlled trials totaling 4706 participants were included.The result of meta analysis showed that low dose aspirin did not significantly affect the incidence of heterotopic bone formation (HBF) [RR=0.99,95% CI (0.87,1.14) rather than medium to high dose NSAIDs [RR=0.44,95% CI(0.30,0.64),there was no significant difference between two group in hip pain and physical function,the incidence of HBF was 16.0% in NSAID-group and 11.1% in 7 Gy group.Apart from low dose aspirin,medium to high doses of postoperative NSAIDs produce a substantial reduction in the incidence of HBF at the cost of minor high gastrointestinal side effect.Limited evidence showed there were no significant differences between the groups for improvements in hip pain and physical function,7 Gy fraction is more effective than use of NSAID.

Objective To measure the setup errors of patients with esophageal carcinoma during the treatment of three dimensional conformal radiotherapy (3DCRT), and to analyze the impact of setup errors on dose distribution of GTV,CTV and normal tissues around. Methods Forty-two patients with esophageal cancer treated by 3DCRT were included. The setup errors of each patient were measured once a week for 6 times by electronic portal imaging device (EPID). The setup errors were integrated into the treatment plan-ning system by moving the isocenter. Then the dose distribution of GTV, CTV and normal tissues were recal-culated. Results The systematic setup errors of the 42 patients were - 2.31 mm, - 0.55 mm and - 0.16 mm, and the random errors were 4.42 mm, 4.35 mm and 4.48 mm in the directions of lef-fight, anterior-posterior,and superior-inferior, respectively. The dose covered 95% GTV( D95 ) was reduced by 32 cGy and by 88 cGy for CTV D95. The lung V20 in the original plan and the integrated plan was 22.49% and 22.02%, respectively. The average dose of the heart in the two plans was 2077.62 cGy and 2036.23 cGy, respectively. In the original plan, no patient had maximum dose of spinal cord over 4500 cGy; While in the intergrated plan there were 18 patients had the spinal cord dose more than 4500 cGy, with a maximum dose of 5503.90 cGy. Conclusions The setup errors cause significant dose reduction of GTV and CTV, but not of the lung and heart . The maximum dose of the spinal cord may exceed 4500 cGy due to the setup errors.

Objective:To investigate the value of atropine administration before tracheal intubation under general anesthesia in the elderly patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)biopsy.Methods:This was a case-control study.A total of 87 elderly hospitalized patients receiving chest enhanced CT test suggesting the risk of lung cancer with enlargement of mediastinal lymph nodes in 7 regions were scheduled to undergo endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)biopsy under general anesthesia.The patients were randomly divided into two groups by flipping a coin: the atropine group(n=40)and the control group(n=47). The indicators for evaluating the application values of atropine included preoperative, intra-operative and postoperative systolic blood pressure(SBP), diastolic blood pressure(DBP), heart rate, oropharyngeal and airway secretion volume, oxygen saturation, operation time, positive diagnosis rate and postoperative adverse reactions.Results:SBP and DBP were lower in the atropine group than in the control group before endotracheal intubation(131.7±15.3 mmHg vs.140.7±13.7 mmHg, 79.1±7.6 mmHg vs.85.6±7.4 mmHg, t=2.885 and 4.061, P<0.05). There was no significant difference in SBP and DBP 10 min after endoscopic operation and 10 min after tracheal extubation between the atropine group versus the control group(SBP: 109.1±11.2 mmHg vs.105.0±12.2 mmHg, 136.9±23.0 mmHg vs.129.9±11.2 mmHg, DBP: 66.9±7.5 mmHg vs.68.0±8.3 mmHg, 77.6±10.9 mmHg vs.78.5±6.4 mmHg, t=-1.617, 0.687, -1.751 and 0.448, P>0.05). There was no significant difference in HR between the two groups before endotracheal intubation( t=1.416, P>0.05), while HR was higher in the atropine group than in the control group 10 min after endoscopic operation and 10 min after tracheal extubation( t=-3.323 and -2.181, P<0.01 and P<0.05). The change rates of SBP and DBP were lower in the atropine group than in the control group 10 min after endoscopic operation and 10 min after tracheal extubation( t=7.947, -6.962, -3.187 and -3.232, P<0.01). The change rate of HR was lower in the atropine group 10 min after endoscopic operation and was higher 10 min after tracheal extubation than in the control group( t=-6.467 and -4.131, P<0.01). There were significant differences in the volume of oropharyngeal and airway secretions and fingertip oxygen saturation between the two groups before endotracheal intubation and 10 min after tracheal extubation( t=-2.334, 2.759, -3.314 and -2.767, P<0.01). The endoscopic operation time was less in the atropine group than in the control group with no statistically significant difference[(25.9±5.7)min vs.(26.4±4.7)min, t=0.391, P>0.05]. There was no significant difference in postoperative adverse reactions between the atropine group versus the control group(34 patients or 85.0% vs.43 patients or 91.5%, χ2=1.247, P>0.05). Conclusions:The application of atropine before tracheal intubation under general anesthesia is beneficial to stabilizing the intraoperative blood pressure and heart rate, and can reduce the production of postoperative oropharyngeal and airway secretions in elderly patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration biopsy.

ObjectiveTo investigate the long term clinical result of three-dimensional radiotherapy for esophageal carcinoma,discuss the effect of correlative factors to survival and local control.Methods From July 2003 to December 2008,792 patients with esophageal cancer were eligible.Patients were treated with three-dimensional radiotherapy (672 patients) or intensity-modulated (120 patients) radiotherapy.The radiotherapy was delivered in 1.8-2.0 Gy per fraction,5 fractions per week,total dose of 50-70 Gy,(median,60 Gy).142 patients were treated by concurrent radiochemotherapy,and the other 650 patients radiotherapy alone.The local control rate and survival rate were calculated by Kaplan-Meier method.Logrank method was used for univariate analyses.Cox regression model was used for multivariate analyses.ResultsThe follow-up rate was 95.8％.The number of patients with 5 years time followed-up was 133.The 1-year,3-year and 5-year local control rates were 76.6％,53.2％,48.6％,and the 1-year,3-year and 5-year overall survival rates were 70.1％,36.7％ and 28.0％,respectively.There were significant influence on the prognosis of T stage,N stage,TNM stage,tumor volume ( x2 =20.58-55.60,all P =0.000).The Cox multivariate model showed that N stage and tumor volume were independent prognostic factors (x2 =6.35,29.23,P =0.012,0.000).For the two groups of concurrent chemo-radiotherapy and radiotherapy alone,5-year local control rates were 57.0％ and 46.8％ ( x2 =7.34,P =0.007 ),the 5-year overall survival rate 32.8％ and 27.6％ ( x2 =3.42,P =0.064.ConclusionsThree-dimensional radiotherapy is effective for esophageal carcinoma.It might improve the local control rate and overall survival rate to some extent.T staging,N staging,TNM staging and tumor volume were important prognostic factors for long-term survival.The addition of concurrent radiochemotherapy could improve local control rates.

Objective To study the pattern of lymphatic metastasis in patients with thoracic esopha-geal carcinoma, and to determine the indication and the target volume for post-operative radiotherapy. Meth-ods 229 patients with thoracic esophageal carcinoma who had undergone radical esophagectomy and two-field lymph node dissection were included in this study. The pattern and ratio of lymph node metastasis were analyzed. The effect of the tumor length and pathology stage on lymph node metastasis was studied. Then the indication and target of post-operative radiotherapy for the thoracic esophageal carcinoma was determined. Results Regional lymph node metastasis was found in 57.1% patients with upper thoracic esophageal car-cinoma. For the middle thoracic esophageal carcinoma, the ratio of regional metastasis, skip, upward, down-ward and two-way spread were 39.0%, 19.5% ,5.2% ,28.6% and 7.8% ,respectively. For lower thoracic esophageal carcinoma,downward spread was found in 77.2% patients. For upper thoracie esophageal carci-noma,the proportions of patients with lymph node metastasis were 19.0% ,6.7% ,9.8% and 14.3% in the superior mediastinum, middle mediastinum, inferior mediastinum and abdominal cavity ( x2 = 2.75, P = 0.433). The corresponding figures were 26.1% ,7.4% ,11.8% and 11.9% (x2 = 17.98,P =0.000) for middle thoracic esophageal carcinoma,and 0%, 1.6% ,5.3% and 10.0% (x2= 5.96 ,P = 0. 051 ) for low-er thoracic esophageal carcinoma. The lymph node metastasis ratios were 9.1%, 11.6% and 11.7% in pa-tients with tumor ≤3 cm,3-5 cm and ≥5 cm,respectively (x2 =3.93,P=0. 140), and were much higher in stage Ⅲ disease than those in stage 0 to Ⅱ (19.3% vs4.8% ;x2 =131.06,P=0.000). Conclusions he pattern of lymph node metastasis is complex and extensive in patients with thoracic esophageal carcinoma. For upper and middle thoracic esophageal carcinoma, the extended prophylactic portal is suggested and the superior mediastinum is an important target area. For the lower thoracic esophageal carcinoma,it seems that regional fields could be applied. Post-operative radiotherapy should be performed in stage Ⅲ disease because of the high lymph node metastasis ratio.

BACKGROUNDTo study the apoptosis inducing effect of preoperative hyperfractionated accelerated radiation therapy (HART) and expression of Bcl-2, Bax proteins in non-small cell lung cancer.

METHODSFrom October 1999 to March 2001, 81 patients with non-small cell lung cancer were prospectively divided into preoperative HART group (20 patients) and surgical group (61 patients). The patients in preoperative HART group were given preoperative irradiation with 2.5 Gy/fraction, twice a day to a total dose of 25 Gy/10 fractions/5-7 days using anterior-posterior opposing parallel fields, then operation would be performed within 2 weeks. The patients in surgical group only received surgical treatment. Apoptotic index (AI), cell cycle distribution and expression of Bcl-2, Bax proteins were quantitatively analyzed by indirect-immunofluorescene and flow cytometry.

RESULTSAI was 4.6%±2.3% in surgical group and 12.8%±4.3% in preoperative HART group, respectively ( P < 0.001). There was no difference in S phase fraction (SPF) between the two groups ( P > 0.05). The fluorescence index (FI) for Bcl-2, Bax proteins and the ratio of Bcl-2/Bax were 1.33±0.21, 1.05±0.13 and 1.29±0.23 in surgical group, and 1.14±0.26, 1.19±0.16 and 0.96±0.23 in preoperative HART group respectively ( P < 0.01, P < 0.001 and P < 0.001 respectively). AI showed a positive correlation to Bax protein ( P < 0.001) and a negative correlation to the ratio of Bcl-2/Bax ( P < 0.01).

CONCLUSIONSPreoperative HART may induce a high-level apoptosis by decreasing the expression of Bcl-2 protein and increasing the expression of Bax protein. However, it is still necessary to further observe whether it can improve the long-term survival of patients with NSCLC.