Objective To apply lead block technology to the interdiction of X-ray destroy from linear accelerator to normal tissues and sensitive organs so as to treat large fields and irregular malignant lymphoma.Methods The steps were as follows:(1)immobilizing patients;(2)simulator photographing;(3)sketching targets;(4)tailoring lead block;(5)validating lead block.Results Problems of large fields and more targets were solved in radiotherapy for malignant lymphoma patients.Conclusion Based on clinical practice,new methods was found for realizing large irregular radiation fields.

Objective To investigate and carry out the function of the lead block validating instrument in the radiotherapy. Methods Based on clinical practice and the principle comparative steady STD and SAD of linear accelerator, the function of lead block validating instrument was developed in reason. Results The working quality and efficiency are greatly improved. Conclusion Not only the criterion extent of founded lead block and the proof of every kinds spume blocks in three-dimensional conformal radiotherapy and integer block radiotherapy and electron radiotherapy, but also the shadow tray centers and center reticle can be validated by the lead block validating instrument.

Objective To explore the methods and effects of body fractionated stereotactic radiotherapy(X-knife) in the treatment of lung metastases.Methods There were 50 cases with lung metastases were treated by fractionated stereotactic radiotherapy using CT orientation and WiMRT model body X-knife.The diameter of the metastases was 1.0cm-5.0cm.The linear accelerator was 6Mv X-ray.The dose per fraction was 5-12Gy,and the total prescribed dose was 30-52Gy at the margin of the PTV enveloped by 90% insodose curve.Results The metastases complete regression was found 21 fo-cus(18.3%)in CT image,partial regression in 70 focus(60.9%),and the overall effective rate was 79.1%.The effective rate for the focus with diameter less than 3cm was 88.5%,and 59.4% equal or more than 3cm,there was significan differ-ence(P

The quality assurance method for the medical linear accelerator of large-scale radiotherapy equipment is introduced,whose periodic detection and adjustment are discussed.

Objective To discuss the three-dimensional conformal radiotherapy(3D-CRT) plan for pancreatic tumors.Methods The 3D-CRT plan of 30 cases of primary pancreatic cancer were designed according to the request of the doctors for PTV and the restricted receiving dose of the peripheral normal sensitive organs.The best plan was chosen referring the dose-volume histogram.Results By using ICRU dose reference point(the central point of target)as theunitary dose,95% dose line could be surrounded above 95% of the PTV.Conclusion The focus in different localization can be treated with different design in treating the pancreatic tumors.The reaction to radiotherapy is directly influenced by the volume and dosage of radiation to the normal hepatic tissues.

Objective To investigate the safety of laparoscopic common bile duct exploration and lithotomy with primary closure and without placing drainage tube postoperatively.Methods Forty patients who received laparoscopic common bile duct exploration and lithotomy at the Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University from January 2011 to June 2013 were prospectively analyzed.All the patients were randomly divided into 2 groups according to the random number table.Twenty patients in the experimental group did not received drainage tube placement,and the other 20 patients in the control group had subhepatic drainage after operation.The operation time,duration of hospital stay and incidence of postoperative complications were compared between the 2 groups.Patients received computed tomography and B sonography at postoperative month 1 and 3,and then patients were reexamined every 6 months till postoperative year 3.The follow-up was ended on July 31,2013.The measurement data and the count data were analyzed using the independent sample t test and the Fisher exact probability,respectively.Results Patients in the 2 groups were cured after the operation.The operation time and duration of hospital stay were (117 ± 11) minutes and (5.6 ± 0.6) days in the experimental group,and (108 ± 12)minutes and (7.9 ± 0.7)days in the control group,with significant difference between the 2 groups (t =2.453,-ll.388,P ＜ 0.05).No complications including bile leakage,residual stones,obstructive jaundice,abdominal bleeding and subphrenic infection were detected after the operation.Thirty-one patients were followed up for 1 month to 2 years,no bile duct stone recurrence or biliary stricture were detected during the follow-up.Conclusion Laparoscopic common bile duct exploration and lithotomy with primary closure and without placing drainage tube postoperatively is safe and feasible.

Objective To investigate the characteristics of immunophenotyping and clinical significance of MRD analysis in MM patients. Methods Multi-parameter flow cytometry was applied to analyze the immunophenotyping of malignant plasma cells from 172 MM patients, and normal plasma cells from 16 healthy individuals. MRD was analyzed in 32 MM patients with remission. Meanwhile, the effects of MRD status on the disease relapse and patient disease free survival ( DFS ) time was evaluated by following up patients. Results The immunophenotyping of normal plasma cells were CD38, CD138, CD19 and CD45 positive, while the predominant phenotype of MM cells were CD+38( 100.0% ), CD+138( 100.0% ), CD-19 ( 167/172, 97. 1% ), CD+56( 152/172, 88.4% ) and CD-45( 166/172, 96. 5% ). The characteristic markers for MM cells were CD+38, CD-138, CD-19, CD-45 and CD+56. MRD analysis revealed that, among 32 MM patients with remission, 14 patients were MRD negative and 18 patients were MRD positive. During follow-up of 2 to 16 months, the relapse rate in MRD negative patients was significantly lower ( 4/14, 28.6% ) than that of MRD positive patients ( 13/18, 72. 2% ;χ2 =6. 03, P ＜0. 05 ). Furthermore, the DFS time was significantly longer in MRD negative patients[ 16. 23( 10. 37-21.62 )months ] than that of the MRD positive patients [ 10. 07( 3. 79-16. 20 )months,χ2 =7. 53,P ＜0. 05 ]. Conclusions CD+38, CD+138, CD-19, CD-45 and CD+56 are the characteristic markers of MM cells compared to those of the normal plasma cells. MRD analysis is a valuable prognostic factor for MM patients.

Objective To investigate the relationship between PTEN mRNA expression and Akt phospholylation in acute leukemia(AL)and explore its clinical significance in the development of acute leukemia.Methods PTEN mRNA expression and Akt phospholylation level in the leukemia cell line K562, HL-60,Jurkat,21 healthy persons and 68 patients with AL were analyzed with RT-PCR and Flow cytometry, respectively.Results(1)The significantly different PTEN mRNA expression was found between the controls and AL patients.85.70% of the normal controls and 26.47% AL patients show positive respectively (?~2=23.38,P

Objective To investigate expressions of CDev6 and p-ERK1/2 in AML patients and its clinical significance.Methods Expressions of CD44v6 and p-ERK1/2 on bone marrow blasts in 152 AML patients and 22 normal controls were determined by flow cytometry.Meanwhile,the effects of CD44v6 expression(CD+44v6 and CD-44v6) on relapse rate and survival time were analyzed by following up of 129 AML patients.Results Double positive expressions of CD44v6 and p-ERK1/2 were observed in 4.5%(1/22) of the normal bone marrow blasts while single positive expression of CD44v6 and p-ERK1/2 was observed in 36.2%(55/162) and 64.5%(97/162) of AML patients,respectively.The MFI of p-ERK1/2 expression on blast cells in AML patients was [14(7 -58)],which was higher than that in normal controls [8(6 - 10),U =4.2,P＜0.01].Furthermore,MFI of p-ERK1/2 expression on blast cells in CD+44v6 AML patients was [28(15-61)] ,which was significantly higher than that in CD-44v6 AML patients [18(6- 37),U =6.7,P＜0.01].A strong correlation was obtained between CD44v6 and p-ERK1/2 expression(rs = 0.7,P＜ 0.01).Among 129 patients followed up for 4 to 65 months,the data also revealed that the relapse rate of CD-44v6 AML patients was 32.1%(26/81) ,which was much lower than that in CD44v6 AML patients [81.3%(39/48),x2 = 29.13,P＜ 0.01).And the overall survival in CD44v6 AML patients was(28.5 ± 1.8)months,which was significantly worse than that of CD44v6 AML patients [(51.2±2.0) months,x2 =48.2,P＜ 0.01).Conclusion CD44v6 expression was associated with a poor survival in AML patients,and CD44v6 might promote the expansion of leukemic blast cells by up-regulating p-ERK1/2.

Objective To investigte the correlation between HLX expression level and AML's clinical variables and different risk stratification.Methods A rcal-time quantitative PCR was used to detect HLX expression in the bone marrow mononuclear cells of 32 de novo AML patients with initial treatment.The relationship between HLX expression level and clinical parameters (FAB classification,hemogram,bone marrow progenitor cells,differentiation and different risk stratification) was investigted.Results The HLX expression of patients with AML was significantly decreased in AML-M3 (P ＜ 0.01),and increased in AML-M5 (P ＜ 0.05).It was negatively correlated with bone marrow progenitor cells (P ＜ 0.01),and was positively correlated with the number of peripheral blood platelet (P ＜0.05).The expression of HLX in AML-M3 was positively correlated with peripheral blood leukocyte levels (P ＜ 0.05),and it was negatively correlated with leukocyte cell level in peripheral blood in AML-M5 (P ＜ 0.05).In AML-Ms groups,the expression levels of HLX of poorly differentiated group were significantly higher than those of the well-differentiated groups (P ＜ 0.05).In AML patients with initial treatment in patient group and non-M3 group,there was no significant difference between the low-risk group and the central risk group (P ＞0.05).Conclution HLX expression levels were elevated in some subtypes,such as AML-M5.and there were differences in different FAB types.HLX gene is associated with the proliferation,differentiation and maturation of leukemia cells.However there was no evidence that HLX is different in different AML risk stratification,which needs further experimental studies.