Non-small cell lung cancer(NSCLC) is one of the most life-threatening human malignancies due to its high morbidity and mortality rates.Molecular targeted therapy is promising in treating some patients with NSCLC.However,it is still challenging to select proper candidates.The EML4-ALK fusion oncogene represents a novel molecular target which appears mainly in lung adenocarcinoma,and appears to be a potential biomarker associated with resistance to EGFR tyrosine kinase inhibitors.This review was intended to outline current status of preclinical and clinical research of this molecule.

Objective To investigate CT features of solitary fibrous tumor of the mediastinum(SFTM),and to analyze the causes of misdiagnosis of this disease.Methods CT features of 5 patients of SFTM confirmed operatively and pathologically were retrospec-tively analyzed.All patients underwent before operation but were misdiagnosed.Results 3 cases were located in right mediastinum with oval-shap,well-defined margin,and “pleural tail sign”,2 cases were located in right thoracis cavity with unwell-defined margin, and in the adjacent lung were oppressed.In all 5 patients,the mean median of tumors was 1 1.5 cm(8.6-1 5 cm),non-homogeneous density of tumors were seen on plain CT scans,and obvious non-homogeneous enhancement with“geographic pattern”on contrast-en-hanced CT.Conclusion CT can clearly reveal the size and the appearance of SFTM,adjacent architectures,the final diagnosis de-pends on histopathological and immunohistochemical findings of the tumors.To un-know is the main caused of misdiagnosis of medi-astinal SFT.

Objective To observed the effect of high-intensity focused ultrasound (HIFU) in combination of submicrobubble on ablation of breast tumor VX2 in rabbits.Methods Submicrobubble was prepared,and the appearance,distribution,diameter,and zeta potential were measured.The rabbits were injected with the tumor tissue suspension in bilateral breast tissues.HIFU(150 W,120 W,5 s,3 s) combined with submicrobubble to damage rabbit breast VX2 tumors.The coagulation necrosis was assessed by HE staining.The grayscale changes of the target area before and after HIFU irradiation were recorded automatically by computer.Results The diameter of the submicrobubble was 498.9 nm on average.HE staining showed the area of coagulation necrosis was significantly larger in the HIFU + submicrobubble group than the HIFU + PBS group.The injury range of 150 W irradiation was larger than that of 120 W irradiation,given the same irradiation time.The injury range of 5 s irradiation was larger than that of 3 s irradiation,given the same irradiation strength.The gray scale change in the target area was significantly higher in the HIFU + submicrobubble group than the HIFU + PBS group.Conclusions The submicrobubble exhibited sound imaging performance,and it can be use in the ultrasound therapeutics in the future.

ObjectiveTo explore the PBL mode in training students' ability,improve the quality of teaching effect,in the teaching of Clinical therapeutic ultrasound and the teaching method based on problems with discussion method.MethodsTo 31 subjects of study who were randomly divided into five groups,each 6 people,a PBL teaching mode was used for 12 periods by proposing and study,group discussion,the whole class exchange and commenting on summary.ResultsThe survey shows that 93.6％ students think the teachers' design has gained their ends,71％ students are impressed by the knowlege and 96.8％ of the students show the good learning attitude,64.5％ of the students raised their interest in learning,which shows teaching results are effective.ConclusionPBL mode is superior to LBL teaching mode in training students' ability,improving the quality of teaching effect.

Objective To evaluate remedy therapy for biliary restenosis after repair of bile duct injury.Methods Clinical data of 60 patients with bile duct injury including 16 patients with restenosis after repair admitted to Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine from January 2000 to December 2012 was retrospectively analyzed.Results 16 patients suffering from biliary duct restenosis included 3 cases of type Ⅱ 1 d,10 cases of type Ⅱ2 d,2 cases of type Ⅱ 3 d and 1 case of type Ⅱ 4 d.The reoperative procedures included hepatic hilar biliary plasty with bilioenteric anastomosis in 15 cases,right hemihepatectomy with left hepatic bilioenteric anastomosis in 1 case.Postoperative bile leakage in 3 cases and pleural effusion in 10 cases were cured by watchful therapy.All of the 16 cases were followed up with an average time of 5.2 years.No occurrence of cholangitis and elevated liver enzymes were observed up to now in 8 patients,increased γ-GT and ALP,no cholangitis but anastomotic stenosis as showed by MRCP in 6 patients with 2 patients neccesitating reoperation to address repeated cholangitis.Conclusions Restenosis after bile duct repair was closely associated with injury type,repair opportunity,repair methods and the surgeon's expertise.Precise preoperative evaluation,the choice of rational surgical approach,the clinging to mucosa-to-mucosa bilioenteric anastmosis principle and the establishment of postoperative long-term followup system centered on ALP,γ-GT and life quality score are required in the reoperation of stenosis after bile duct repair.

Background and purpose:Radiomics is an emerging field that generates large amounts of valuable clinical information through extracting quantitative imaging features. The purpose of this study was to use the radiomics approach to assess the value of features captured from PET and CT in predicting the therapeutic effect in stageⅠ non-small cell lung cancer (NSCLC) after stereotactic ablative radiotherapy (SABR).Methods:Patients with stageⅠ NSCLC conifrmed by pathology and treated with SABR were included retrospectively. The gross tumor volume (GTV) was deifned by two radiologists. PET and CT scan images were collected, and radiomic features were further extracted and analyzed. Non-negative matrix factorization was used to distinguish patients with or without local control.Results:Sixteen patients were eligible for analysis. This study identiifed two PET features (LL_GLCM_Maximal_Correlation_Coeffcient and HL_GLRMS_LRE) captured from PET/CT as having signiifcance in classifying patients with or without disease development. This study not ifnd similar results in CT scans.Conclusion:It seems feasible to use radiomics information effects from PET/CT to predict therapeutic effects of SABR in stageⅠ NSCLC. Further investigation is needed.

Background and purpose:We investigated whether lfuorine-18 lfuorodeoxyglucose (18F-FDG) maximal standard uptake value (SUVmax) of the primary tumor (SUV-T), SUVmax of the regional lymph nodes (SUV-N) or the overall loco-regional lesion SUVmax (SUV-TOTAL) was related to survival of patients with stage Ⅲ non-small cell lung cancer (NSCLC) who received Cetuximab and combined definitive chemoradiotherpay. Methods:From September 2009 to July 2012, seventeen patients with unresectable stageⅢNSCLC receiving cetuximab with cisplatin/vinorelbine (NP) followed by concomitant NP and intensity-modulated radiotherapy (IMRT) at the Fudan University Shanghai Cancer Center were enrolled onto a prospectively study. All patients received positron emission tomography/computerized tomography (PET/CT) scans within 2 weeks before enrolment. Univariate analysis were used to assess the correlation between SUV-T, SUV-N, SUV-TOTAL, gender, age, histology, tumour-node-metastasis (TNM) stage, performance status (PS) as well as smoking status and survival. The factors which showed statistical signiifcance entered into multivariate Cox-regression model. Survival functions of different populations were estimated by Kaplan-Meier method and compared by Log-rank test. Results:In the univariate analysis, SUV-T, SUV-N, SUV-TOTAL, PS and smoking status were prognostic factors. The best cut-off values for SUV-T, SUV-N and SUV-TOTAL were 11, 11 and 20, respectively. Multivariate analysis revealed that SUV-TOTAL (P=0.012), SUV-T (P=0.025), and SUV-N (P=0.033) were independent predictors of survival with hazard ratio (HR) of 14.7, 11.2, and 6.2, respectively. Conclusion:Local, regional and locoregional maximal SUVs deifned by 18F-FDG PET-CT scanning may have a strong correlation with survival in this patients setting, which merits further study.

Objective To evaluate the value of whole genome amplification (WGA) combined with array comparative genomic hybridization (aCGH) in prenatal diagnosis. Methods Array CGH were performed by the DNA of 18 prenatal specimens , which were amplified by WGA because of the low DNA yield. Result 3 of the 18 fetuses were 45, X0 and 9 of 15 fetuses with normal aCGH results showed healthy outcome. Conclusion It’ s feasible for prenatal diagnosis using WGA combined with aCGH which not only can shorten the reporting time but also keep the sensitivity and accuracy of detection.

Background and purpose:Clinical data show that Endostar, a recombinant human endostatin, has the therapeutic beneift for patients with non-small cell lung cancer (NSCLC) while combined with chemotherapy or ra-diotherapy. However, the microenvironment changes induced by Endostar monotherapy in NSCLC is not yet clear. The purpose of this study was to prospectively study tumor vascular effects of Endostar monotherapy in patients with locally advanced or advanced NSCLC by dynamic contrast-enhanced perfusion computed tomography (CT perfusion, CT-p). Methods:Previously untreated patients with histologically or cytologically conifrmed locally advanced or advanced NSCLC were eligible. All patients received daily Endostar (7.5 mg?m2) for 14 days. CT-p scans were acquired at the baseline and post-treatment. CT-p parameters, such as blood lfow (BF), blood volume (BV) and permeability surface PS (area product), were measured in all patients.Results:Of all 7 patients enrolled, four were staged asⅢB and three as stageⅣ (2 with malignant pleural effusion, 1 with brain metastasis). The median BF, BV and PS values of baseline and post-treatment were 27.1/48.9 mL/100 mL/min, 86.8/84.8 mL/100 mL and 45.0/54.0 mL/100 mL/min, respectively. After administration of Endostar for 14 days , BF showed a signiifcant increase compared with that at baseline (P=0.028), whereas no signiifcant changes were found in BV (P=0.398) and PS (P=0.237) values.Conclusion:Our results suggest that Endostar monotherapy induces a signiifcant increase in BF whereas no signiifcant difference in BV and PS.

Objective: To compare the efficiency between the transhepatic hilar approach and conventional approach for the surgical treatment of Bismuth type Ⅲ and Ⅳ hilar cholangiocarcinoma. Methods: There were 42 consecutive patients with hilar cholangiocarcinoma of Bismuth type Ⅲ and Ⅳ who underwent surgical treatment at Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University from January 2008 to December 2013.The transhepatic hilar approach was used in 19 patients and conventional approach was performed in 23 patients.There were no differences in clinical parameters between the two groups(all P>0.05). The t-test was used to analyze the measurement data, and the χ² test was used to analyze the count data.Kaplan-Meier analysis was used to analyze the survival period.Multivariate COX regression analysis was used to analyze the prognosis factors. Results: Among the 19 patients who underwent transhepatic hilar approach, 3 patients changed the operative planning after reevaluated by exposing the hepatic hilus.The intraoperative blood was 300(250-400)ml in the transhepatic hilar approach group, which was significantly less than the conventional approach group, 800(450-1 300)ml(t=4.276, P=0.00 1), meanwhile, the R0 resection rate was significantly higher in the transhepatic hilar approach group than in the conventional approach group(89.4% vs. 52.2; χ²=6.773, P=0.009) and the 3-year and 5-year cumulative survival rate was better in the transhepatic hilar approach group than in the conventional approach group(63.2% vs. 47.8%, 26.3% vs. 0; χ²=66.363, 127.185, P=0.000). On univariate analysis, transhepatic hilar approach, intraoperative blood loss, intraoperative blood transfusion, R0 resection and lymph node metastasis were significant risk factors for patient survival(all P<0.05). On multivariate analysis, use of transhepatic hilar approach, intraoperative blood loss, R0 resection and lymph node metastasis were significant independent risk factors for patient survival(all P<0.05). Conclusion The transhepatic hilar approach is the preferred technique for surgical treatment for hilar cholangiocarcinoma because it can improve accuracy of surgical planning, safety of operation, R0 resection rate and survival rate compared with the conventional approach.