Stereotactic body radiation therapy (SBRT) adopts different tumor-killing mechanisms from the conventional fractionated radiotherapy.In SBRT,a single high-dose radiation can destroy the membrane of tumor cells and induce the release of tumor-associated antigen,also named in situ tumor vaccine,which stimulates the immune system to kill the residual tumor;a single-fraction radiation with a dose larger than 8-10 Gy can induce rapid apoptosis of vascular endothelial cells via the acid sphingomyelinase pathway at 1-6 hours after radiation,which causes tumor vascular occlusion and secondary tumor-killing effects.In order to understand whether SBRT improves the clinical treatment outcomes via the above mechanisms,this paper reviews the clinical research advances in SBRT for primary liver cancer.

Objective: To evaluate the clinical value of positron emission tomography/ computed tomography(PET/CT) with fluorine-18-labeled fluorodeoxyglucose(18F-FDG) in dectecting and diagnosing the recurrence and metastasis of colorectal cancer.Methods: The results of whole-body PET/CT of 68 patients with colorectal cancer were analyzed retrospectively.The average follow-up time was 15.8 months.The diagnosis of recurrence tumor and/or metastasis was based on pathologic examination,colonoscopy,multi-modality imaging and clinical follow-up.Results: Fifty-five of the 68 patients had recurrence and /or metastasis but no recurrence was found in the other 13 cases.The sensitivity,specificity and accuracy of PET/CT in detecting recurrent and metastatic tumor were 96.4%,76.9% and 92.6% respectively.PET/CT successfully detected one or several malignant insidious lesions in 8 cases with negative findings by CT and /or ultrasonography,and it revaeled more malignant lesions than CT and ultrasonography in 30.9%(17/55)of the patients.The clinical therapeutic strategies were changed in 11 case duo to the results of PET/CT,and the influence rate of PET/CT was 16.2%.The metastasis was mainly confined in the liver,lung,peritoneal cavity and retroperitoneal region.In the examination of the 24 patients with increased serum CEA,the positive rate of PET/CT was 91.7%.Conlusion: PET/CT can detect the recurrence and metastasis of colorectal cancer with high sensitivity and accuracy.

Objective To investigate the apathy and neuropsychological characteristics of newly diagnosed Parkinson's disease (PD) patients.Methods Eighty-two newly diagnosed PD patients and 30 matched healthy controls by age,sex and education level were recruited in the present study.Apathy was assessed using Apathy Evaluation Scale (AES) and related factors,including age,sex,education level and disease duration were simultaneously evaluated.Unified Parkinson's Disease Rating Scale (UPDRS),Hamilton Depression Rating Scale (HAMD),as well as Montreal Cognitive Assessment (MoCA) were employed in order to respectively evaluate the motor function,depression and cognition.Results The AES scores in the PD patients were significantly higher when compared to the healthy controls.The prevalence of apathy and depression in the PD patients was 51.2％ (42/82) and 19.5％ (16/82),respectively.There were no statistically significant differences in age,sex,education level,UPDRS-Ⅱ/Ⅲ scores and MoCA scores between apathy (n =42) and no-apathy (n =40) PD patients (P ＞ 0.05),while the statistically significant difference in HAMD scores between apathy (n =42) and no-apathy (n =40) PD patients was shown (the HAMD scores of apathy PD patients were 10.61 ± 3.30,the HAMD scores of no-apathy PD patients were 5.96 ± 1.90,t =7.87,P ＜ 0.05).The correlation analysis indicated that there were no correlations between AES scores and the related factors,including age,education level,disease duration and UPDRS-Ⅱ / Ⅲ scores,but AES scores were positively correlated with HAMD scores.Conclusion In newly diagnosed PD patients,the apathy is independent of depression,motor dysfunction,as well as cognitive impairment,which may be an early signal for PD.

Objective To synthesize novel gold nanoparticles of GAL-PEG-GNPs,study its radiation effect on hepatocellular carcinoma cells HepG2 cells in vitro,and investigate the underlying mechanisms.Methods GAL-PEG-GNPs were synthesized and characterized successfully.HepG2 cells were divided into three groups of control,GNPs and GAL-PEG-GNPs.The cytotoxicities of these compounds were tested by the CCK-8 assay and their IC50 values of HepG2 cells were calculated.Cell uptake of nanoparticles was detected by TEM and ICP-MS.The radiosensitization effect of nanoparticles was tested by the colony formation assay.Cell cycle distribution was detected by FCM.The expressions of CAT,SOD,and total GSH were detected with a microplate reader,and the expressions of apoptosis-related proteins were tested by Western blot.Results The GNPs and GAL-PEG-GNPs had absorption peaks at 520 and 530 nm,respectively,and their diameters were (22.6-±2.12) and (32.0 ± 1.41) nm detected by ICP-MS.The GAL-PEG-GNPs and GNPs had similar cytotoxicity profiles (P ＞ 0.05),while GAL-PEG-GNPs could be more effectively uptaken by HepG2 cells than GNPs.The sensitive enhancement ratio (SER) of GNPs and GAL-PEG-GNPs to HepG2 cells were 1.46 和 1.95,respectively.The percentage of cells at phase of G2/M in HepG2 population treated with GNP was higher than that of untreated cells (t =14.20,P ＜0.05).The protein expressions of Cytochrome C,Bax,Caspase-3,and Caspase-9 were upregulated while Bcl-2 expression was down-regulated in the cells treated with GNPs/radiation or GAL-PEGGNPs/radiation.The expressions of CAT,SOD and total GSH in the GNP treated groups were significantly decreased compared with the control group(t =12.34,29.39,12.85,P ＜ 0.05).Conclusions GALPEG-GNPs has obvious radiosensitization effect on HepG2 cells,which is related to the induction of cell apoptosis and the generation of free radicals.

Objective: To investigate the value of positron emission tomography/computerized tomography(PET/CT) with fluorine-18-labeled fluorodeoxyglucose(18FDG) for gastric carcinoma.Methods: Thirty-two patients(25 males,7 females,aged 31-82 years) suspected of gastric carcinoma underwent whole-body PET/CT after taking in 600 ml of water to distend the gastral cavity.The maximal standard uptake value(SUVmax) of the region of interest(ROI) in PET and the maximum width of the gastric wall in CT were analyzed.Pathological specimens were obtained from all the patients during surgery or gastroscopy.Results: 18FDG PET/CT found gastric carcinoma in 24 of the patients.The rates of positive and negative prediction and the accuracy of PET/CT in the diagnosis of the disease were 92.3%,100% and 93.8%.SUVmax was positively correlated with the maximum width of the gastric wall,but they exhibited no statistically significant differences between the patients with involved lymph nodes and those without.Based on the PET/CT findings,the 24 gastric carcinoma patients were clinically classified as follows: 9 in stage Ⅰ,1 in stage Ⅰ-Ⅱ,3 in stage Ⅱ,1 in stage Ⅲ and 10 in stage Ⅳ.Conclusion: 18FDG PET/CT is highly valuable for gastric carcinoma in its diagnosis,the evaluation of its biological behavior and determination of its treatment strategies.

Objective:To investigate hemodynamic characteristics of the modified Blalock-Taussig shunt (MBTS) with the preservation or ligation of ductus arteriosus (DA) based on computational fluid dynamics (CFD), thus to help preoperative surgery design and postoperative prediction.Methods:A patient with pulmonary atresia and patent ductus arteriosus was included. Patient-specific three-dimensional model was reconstructed and virtual surgeries of shunt insertion and ductus ligation or preservation were performed via computer-aided design (CAD). CFD was utilized to analyze hemodynamic parameters preoperatively and postoperatively based on patient-specific anatomy and physiologic data.Results:The preservation of DA competitively reduced the shunt flow but increased total pulmonary perfusion. The shunt flow and ductal flow collided with each other, causing large and complicated turbulence in pulmonary artery where lower wall shear stress and higher oscillatory shear index were distributed, as well as higher energy loss.Conclusion:The preservation of DA is riskier in hemodynamics which may lead to pulmonary over-perfusion, inadequate systemic perfusion and heavier cardiac burden, thus increasing the risk of heart failure and it seems to bring no benefit in terms of reducing risks of thrombosis.

Objective To study the radiosensitizing effect of nano-gold nano-silver particles in hepatocellular carcinoma cells (HepG2) in vitro and the possible mechanisms.Methods MTT assay and clonogenic assay were performed to determine the killing effect of nano-gold and nano-silver particles in HepG2 cells.Flow-cytometry was used to measure cell apoptosis and cell cycle distribution.Western blotting was used to measure the expression of Caspase-3,Bax and Bcl-2.ELIASA was used to determine the content of catalase (CAT),superoxide dismutase (SOD),and total glutathione (GSH).Results Nano-gold and nano-silver particles inhibited the proliferation of HepG2 cells with IC50 of 6.51 μg/ml and 2.47 μg/ml,respectively.Nano-gold and nano-silver particles significantly enhanced the radiosensitivity of HepG2 cells.Obtained by Dq,the SER of 1/5 IC50 nano-gold and nano-silver particles were 1.37 and 1.48,and 1/10IC50 with 1.11 and 1.09.Nano-gold and nano-silver particles increased the expression of Caspase-3 and Bax and reduced the exprcssion of Bcl-2.CAT,SOD and total GSH were significantly reduced.Conclusions Nano-gold and nano-silver particles can enhance the radiation sensitivity of HepG2 cells.Specific sensitizing mechanism may be the activation of the mitochondrial apoptosis pathway and the induction of reactive oxygen species in apoptotic pathways,which ultimately induces apoptosis.

Objective To explore the association between PI3K polymorphisms in insulin signal transduction pathway and Alzheimer's disease (AD)risk.Methods There were three groups,including 112 cases for AD +T2D group,231 cases for only AD group,and 231 cases for healthy controls group.The polymorphisms in PI3K gene was sequenced by PCR and the concentration of PI3K in serum was tested by enzyme -linked immunosorbent assay (ELISA).Results Overall,there was significantly statistical difference in PI3K rs3730087 polymorphism among three groups (χ2 =20.99,P =0.000 3).The CC frequency of PI3K rs3730087 polymorphism in AD with T2D group and AD control group was significantly higher than that in the healthy control group.The PI3K protein level of differ-ent genotype was statistically significant (F =27.450,P <0.000 1).As for CC genotypes of PI3K rs3730087 poly-morphism,the PI3K protein level was statistically different among these three groups (F =8.096,P =0.000 6).Moreover,the PI3K protein level of the three groups was different (F =9.034,P =0.000 1),which in both AD group was lower as compared with healthy control group.Conclusion The study suggested that CC genotype of PI3K rs3730087 polymorphism in insulin signaling transduction pathway might be a risk factor for AD with T2D and it also affects the expression level of PI3K protein.However,the polymorphism is not shown to be exclusive in AD patients with T2D.

Purpose To investigate the dosimetric differences among RapidArc (RA) plans which were designed on different target volumes in hepatocellular carcinoma (HCC).Methods A total of 10 HCC patients underwent 3D-CT scan under free breathing ( FB),end inspiration hold ( EIH ) associated with active breath coordinator (ABC) and 4D-CT scan.The 4D-CT were sorted into 10 sets of CT images according to respiratory cycle.The gross tumor volume (GTV) was manually contoured on different CT images.The individual internal gross target volume ( IGTV1 ) was obtained from 4D-CT,and the individual margins from GTVFB to IGTV1.IGTV2 were obtained from GTVFB using individual margins.The planned target volumes (PTV-1,PTV-2,PTV-3 and PTV-4 ) were obtained from GTVFB,IGTV1,IGTV2 and GTVEIA applying different margins.The RA plans (RA1,RA2,RA3 and RA4 ) were designed from different PTVs,and for RA1,RA2 and RA3 the simple 358° arc were used,while three 135° arcs were used for RA4.The dosimetric differences were compared.Results The PTV-1 and PTV-3 were larger than PTV-2 and PTV-4; the mean values of PtV-1/PTV-2 and PTV-1/PTV-4 were 2.5 and 1.9,respectively.There were no significant differences in conformal index,homogeneity index,maximum dose,and minimum dose of PTV among 4 RA plans.The irradiation dose of normal liver of RA3 and RA4 were 8.23 Gy and 7.63 Gy respectively,both significantly lower than those of RA1 and RA2 (10.21 Gy,9.62 Gy,x2 =10.68,P ＜0.05 ),and the V30of RA3 and RA4 were 5.24％ and 5.05％ respectively,both significantly lower than those of RA1 and RA2 (7.76％,6.12％,x2 =14.76,P ＜ 0.05 ).There were no significant differences in irradiation doses of stomach and duodenum among different plans.Conclusions Using 4D-CT or ABC technology with RapidArc in HCC can define the target volume accurately and achieve prefect dose distribution sparing more normal liver volume,compared to the traditional margins.4D-CT and ABC play similar roles in sparing normal liver.

OBJECTIVETo investigate the clinical advantage of the application of modified Roux-en-Y reconstruction after totally laparoscopic total gastrectomy.

METHODSClinical data of 36 patients who underwent totally laparoscopic total gastrectomy with Roux-en-Y reconstruction by one medical team for gastric adenocarcinoma between January 2014 and December 2014 in the Second Hospital of Jilin University were retrospectively analyzed. Patients were divided into classic Roux-en-Y group (CRY, 16 cases) and modified Roux-en-Y group (MRY, 20 cases) according to reconstructive methods. The data concerning the intraoperative and postoperative situation in two groups were compared.

RESULTSOperation was successfully completed in all the cases without conversion to laparotomy. Compared to CRY group, MRY group had shorter mean operative time [(260.9 ± 21.2) min vs. (287.9 ± 19.0) min, P=0.000], shorter mean reconstruction duration [(32.4 ± 9.2] min vs. (45.4 ± 13.2) min, P=0.001] and less intraoperative bleeding [(50.9 ± 23.5) ml vs. (67.0 ± 20.5) ml, P=0.000]. Jejunum mesentery dissection and jejunum resection were not necessary in MRY group. However, there were no significant differences in lymph nodes harvested, time to flatus, hospital stay and postoperative complications between two groups.

CONCLUSIONSAs compared to classic Roux-en-Y reconstruction, the modified Roux-en-Y reconstruction can simplify the surgical procedures and achieve similar efficacy. It is feasible and safe, and worth further promotion in clinical practice.

Anastomosis, Roux-en-Y ; Humans ; Laparoscopy ; Lymph Nodes ; Mesentery ; Operative Time ; Postoperative Complications ; Postoperative Period ; Retrospective Studies ; Stomach Neoplasms