Objective To investigate clinical outcomes and side effects of 103Pd seed brachytherapy for malignant tumors. Methods Twenty patients with residual or recurrent unresectable malignancies were treated with 103Pd seed implantation under the guidance of ultrasonigraphy or CT scans. Three patients were given a local anesthesia and 17 patients, general anesthesia. The match peripheral doses ranged from 97.3 Gy to 182.78 Gy (mean, 123 Gy). The activity of each seed ranged from 1.4 mCi to 1.8 mCi. The planning target volume (PTV) included a 1 cm isotropic expansion margin around the clinical target volume (CTV). The seeds were retrogradely placed with a Mick applicator. External beam radiation was required 3～4 weeks after seed implantation in 6 patients, with a total dose of 45～50 Gy and 2 Gy each fraction. All of the patients received CT scanning after implantation for quality evaluation and underwent routine chest X-ray examination at 24～48 hours for seed observation. Results A complete response was achieved in 5 patients and a partial response in 12 patients. Two patients were assessed as having stable disease. In 1 patient with prostatic cancer, the serum PSA level was decreased significantly. The local control rate was 90% (18/20). The 20 patients were followed for 2～25 months (median,11 months).Two patients were lost to follow-up at 6 and 12 months after operation, respectively. Twelve patients died and 6 patients survived.No severe complications were recorded postoperatively. Conclusions 103Pd brachytherapy for malignant tumors gives a high local control rate and satisfactory reliability.

Background Acquired immune deficiency syndrome (AIDS) is an infectious disease caused by human immunodeficiency virus (HIV).Highly active antiretroviral therapy (HAART) is an effective treatment for AIDS,but it cannot completely eliminate the viral load in the body for the existence of HIV reservoir.Previous studies demonstrated that HIV could be detected in tears of virus load negative AIDS patients who received effective HAART,suggesting that lacrimal gland is another member of HIV reservoirs.Objective The aim of this study was to explore whether lacrimal gland has a molecular basis of HIV infection and the mechanism of lacrimal gland infection of HIV.Methods Fourteen specimens of lacrimal gland were collected during the surgery from 14 patients with lacrimal gland diseases in Peking Union Medical College Hospital from November 2013 to December 2015,including 13 non-HIV-infected patients and 1 HIV-infected patient.In 13 non-HIV infected patients,lacrimal glands prolapse was in 12 patients with the normal pathological tissue structure and dacryoadenitis was in 1 patient with the histopathological diagnosis of interstitial lymphoid tissue hyperplasia.The clinical manifestation of HIV-infected patient was dacryoadenitis with the histopathological diagnosis of interstitial lymphoid tissue hyperplasia.The paraffin sections of 12 non-HIV-infected specimens and 1 HIV-infected specimen were prepared,and the expressions of CD4,C-X-C chemokine receptor 4 (CXCR4) and C-C chemokine receptor type 5 (CCR5) in lacrimal gland specimens were detected by immunohistochemistry and verified in 1 specimen of non-HIV-infected specimen by immunofluorescence technology.Results Immunohistochemistry showed that CD4 was suspiciously positive expression in non-HIV-infected specimens with the strong background staining.CXCR4 was positively expressed in cytoplasm and nuclei of most lacrimal epithelial cells of lacrimal gland epithelial cells in each specimen,and CCR5 was focally expressed in few lacrimal gland epithelial cells in each specimen.In addition,CD4,CXCR4 and CCR5 were positively expressed in intercellular scattered lymphocytes on the specimens.Immunofluorescence assay showed that CD4,CXCR4 and CCR5 were expressed in the specimens with the red fluorescence,with the linear-and patchy-like distribution mainly in cellular membrane for CD4 or spot-like distribution for CXCR4 and CCR5 in the cytoplasm.Conclusions HIV receptor CD4 and accessory receptor CXCR4,CCR5 are positively expressed in the lacrimal gland epithelial cells,which is the molecular basis of HIV infection and become a potential HIV reservoir preventing HIV eradication.

Objective: To observe the therapeutic efficacy of astragalus polysaccharide (APS) in combination with three-dimensional conformal radiotherapy (3D-CRT) for elderly patients with non-small cell lung cancer (NSCLC). Methods: A total of 80 elderly patients with I～IV stage NSCLC were randomly divided into two groups. The 40 patients in the therapeutic group received radiotherapy in combination with APS. The 40 patients in the control group received radiotherapy alone. Both groups received 3D-CRT with a total dose of 50～ 70Gy, 2.0Gy/fraction, once a day, 5 times per week. The patients in the therapeutic group were treated with radiotherapy combined with injection of APS (250mg in 5% glucose) or normal saline (500 mL) intravenously once a day until the end of radiotherapy. The short-term efficacy and patients' quality of life were evaluated. The T-lymphocyte subpopulation and peripheral blood leukocyte count were also measured after treatment. Results: The short-term effective rates of the therapeutic group and the control group were 87.5% and 72.5%, respectively, without significant difference between the two groups (P＞0.05). The decrease of peripheral blood leukocyte count after treatment in the control group was significant (P＜0.05). In the therapeutic group, the T-lymphocyte subsets CD8 and CD4/CD8 were improved after treatment, with a significant difference (P＜ 0.05). But in the control group, no significant changes in T-lymphocyte subsets CD8 and CD4/CD8 were observed after treatment (P＞0.05). Patients' quality of life in the therapeutic group was superior to that in the control group, with a significant difference (P＜0.05). Conclusion: APS in combination with 3D-CRT can reduce the side effects of radiation and improve the quality of life of elderly patients with NSCLC.

Objective To observe the effect of DNA-PKCS antisense oligodeoxynucleotides (ASODN) on the radiosensitivity of lung cancer cell line A549 through transfecting DNA-PKcs ASODN into A549 cells.Methods DNA-PKCS ASODN and unrelated ODN were transfected into A549 cells (testing group and control group).These cells were irradiated with 0,0.5,1.0,2.0,4.0,6.0 or 8.0 Gy X-ray.Clo nogenic assay was performed to determine the survival fraction.The parameters Do,Dq and N for the multi target single-hit model,as well as the parameters a,13 and SF2 for the linear-quadratic model,were calculated to evaluate cell radiesensitivity.ResultsIn the control group and testing group,the α value was 0.14 and O.31 ,The βvalue was 0.030 and 0.018 ,the SF2 was 0.63 and 0.41 ,the Do was 2.38 and 2.09 ,the Dq was 1.43 and 0.60 ,respectively.In the testing group,the α value of A549 cells was increased,but the β value, SF2,DO and Dq were decreased.Conclusions DNA-PKCS ASODN can enhance the radiosensitivity of A549 cells and is a potential target in treating lung cancer.

Objective To investigate the differences of various two-stent techniques in vitro and virtual bench testing. Methods Stent implantation with classic crush, double kissing ( DK) crush and culotte stenting techniques were performed in the silicone simulation model of bifurcation vessels with various distal bifurcation angles. The whole processes were recorded by a micro-focus camera. Results Distal side branch (SB) re-crossing in classical crush technique left a significant gap without stent coverage near the carina in T type bifurcation model after final kissing balloon inflation (FKBI) . The gap was also noted in either classic crush with proximal SB re-crossing or DK crush with two times proximal SB re-crossing in T type bifurcation model. The size of the gap in DK crush technique was smaller than that of classic crush. In Y type bifurcation model, both DK crush and culotte stenting left no gap compared to T type bifurcation model. Two times proximal SB re-crossing in culotte stenting resulted in a new stent carina formation after FKBI. Conclusions Distal bifurcation angle was an anatomatic predictor of gap formation in two-stent technique. In T type bifurcation model, the size of gap in DK crush technique was smaller than that of classic crush. It was suggested to perform two times proximal SB re-crossing for DK crush technique and distal SB re-crossing for culotte stenting.

Objective To investigate the short-cycle repeated transurethral resection ( Re-TURBT) combined pirarubicin treatment of T2 muscle invasive bladder tumor efficacy and safety.Methods From October 2010 to December 2013, 56 clinically diagnosed cases of bladder cancer were divided into two groups;the experimental group was taken a short-cycle repeat transurethral resection surgery, and the con-trol group taken along open surgery to remove the tumor and its surrounding 2cm bladder tissue, postopera-tive patients were given pirarubicin infusion therapy.Results Each patient completed the trial.For the ex-perimental group, blood loss and operative time was significantly lower than the control group ( P <0.05). For experimental group after 3 months, 6 months, and 12 months, maximum bladder capacity ( MBC) and patient perception of bladder condition ( PPBC) were significantly higher than control group ( P <0.05 ) . For experimental group after 3 months and 6 months, maximum urinary flow rate ( Qmax) was significantly higher than control group ( P <0.05) , but no significant difference between two groups at 12 months.The incidence of adverse events, vascular endothelial growth factor ( VEGF) , and a total recurrence rate showed no significant difference ( P >0.05).For experimental group, bladder perforation in 1 case, 1 case was forced to open surgery, the incidence rate was about 6.7%.Conclusions The short-cycle repeated trans-urethral resection combined pirarubicin treatment of T2 invasive bladder tumor was simple, effective and se-curity.

Objective To study the efficacy,safety and correlative characteristics of Chinese herb as a vascular embolization agent.Methods Vascular embolization agent combined from several kinds of Chinese herb was manufactured and served as anticarcinogen and coagulant according to the chinese Pharmacopeia.The characteristics of the combination embolization agent through embolizing the hepatic arteries in eight pigs were studied. Results The combination agent was a non-homogenous suspension,easily to be injected through 5-F catheter with hyper attenuation under fluoroscopy;simultaneously with good histocompatibility and hemo-compatibility and without feverish response and toxicity.The combination agent mainly embolized the peripheral arteries with maintaining occlusion for 5 weeks and without formation of collateral circulation.Slight injuries of normal hepatic tissues with hepatic cytonecrosis and endochyloma focal necrosis were found through optical and electronic microscopy.Conclusions The Chinese herb combination agent is safe and effective in experimental application with good angioembolic function and a potential peripheral embolization agent.

Objective To assess the impact of additional cycles of temozolomide on the survival of glio-blastoma(GBM)patients after 6 months of maintenance temozolomide(TMZ)following concurrent TMZ chemo-therapy and radiation therapy. Methods Data of 51 GBM patients from 2009 to 2015 were retrospectively studied and the therapeutic effect was assessed according to whether receiving long-term treatment with TMZ. Results Sev-enteen of fifty-one GBM patients received 8 or more cycles and prolonged treatment improved progression-free sur-vival(P=0.011)and overall survival(P=0.004). Conclusions Extended use of TMZ is safe to GBM patients , which may improve response OS and PFS compared to conventional regimen. Prospective studies in larger popula-tions are needed to better-define the population to whom it can be proposed and its optimal duration.

Objective To evaluate the dosimetry accuracy and clinical efficacy of 125I radioactive seed implantation using coplanar template (CPT) in the treatment of metastatic or recurrent chest wall tumor.Methods Thirty-one patients with metastasis or recurrence of chest wall tumor,who had been diagnosed with pathology between July 2005 and July 2015,were retrospectively studied.All patients underwent CPT-assisted 125I radioactive seed implantation.Brachytherapy radiation treatment planning system (BTPS) was used to make preoperative plans,and the prescribed dose (PD) was 110 Gy.CPT was used to assist CT guided 125I radioactive seeds implantation.Dose evaluation was performed immediately after implantation.The difference of dose parameters was compared between preoperation and postoperation,including Dg0,D100,V90,V100 and the numbers of seeds.Postoperative chest CT was conducted regularly to assess the treatment efficacy based on the response evaluation criteria in solid tumors (RECIST Version 1.1).The patients were followed up till July 2016.Results All patients went through implantation procedure successfully and there was no significant statistical difference between preoperative and postoperative dose parameters (P ＞ 0.05).The conformal index (CI) was 0.951 ± 0.13,external index(EI) was 6.5％ ±0.9％.Six months after implantation,CR,PR,SD and PD were 25.8％ (8/31),51.6％ (16/31),6.5％ (2/31) and 16.1％ (5/31),respectively.The effective rate was 77.4％,and local control rate was 83.9％ (26/31).Skin pigmentation occurred in 13 patients during the follow-up period,without any special treatment.Conclusions The auxiliary of CPT in the treatment of metastatic or recurrent chest wall tumor under the guiding of CT could achieve quality control,safety and effectiveness.

Objective To evaluate the clinical effects of CT-guided 125I radioactive seed implantation in treatment of stage Ⅲ non-small cell lung cancer ( NSCLC ) and the influential factors of prognosis.Methods 247 patients of stage Ⅲa/Ⅲb NSCLC underwent CT-guided 125I radioactive seed implantation.The clinical effects and the factors affecting prognosis were analyzed by univariate and multivariate analyses.Results The 1-,3-,and 5- year overall survival rates were 82.8％,23.8％,and 11.5 ％,respectively.The median survival time was 24.8 months,and the local control rate was 92.2 ％,63.8％,and 25.7％,respectively.The 5- year overall survival rate was 14.7％,and the median survival time was 29.7 months of the stage Ⅲ,patients.And the 5- year overall survival rate was 11.2％,and the median survival time was 24.0 months at the stage Ⅲb.Univariate analysis showed that age,course of disease,hemoglobin before treatment,clinical stage,maximum diameter of tumor,prescribed dose (PD),post-operational mean dose,post-operational dose covering 100％ volume (D100),remedial model were the main prognostic factors; however,multivariate analysis revealed that hemoglobin ≥ 120 g/L before treatment,post-operational dose covering 100％ volume (D100) and maximum diameter of tumor were the independent risk factors for predicting the survival.Aerothorax was observed in 37 patients with an incidence rate of 14.9％,and hemothorax was observed in 22 patients with an incidence rate of 9％.Conclusions 125I radioactive seed implantation therapy is effective in the treatment of stage Ⅲ NSCLC.Hemoglobin level before treatment,post-operational dose covering 100％ volume (D100 ),and maximum diameter of tumor are the main prognostic factors for the NSCLC patients treated with radiotherapy for NSCLC.