Targeted therapy of anti-angiogensis strategy is the standard treatment for metastatic renal cell cancer.In recent years,a number of new generation of anti-angiogensis agents have been tested in clinical trials,some of which have achieved promising outcomes.Other pathway inhibitors such as inhibitors of mamma-lian target of rapamycin and fibroblast growth factor receptor pathway have made progresses in some extent.

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 study the impact of the resolution of reference dose distribution and evaluated dose distribution to Gamma rate in the verification of IMRT. Methods Designed four fields, the resolution of dose distribution calculated in water phantom and exported from TPS are 1 ,2,3 ,4,5,6 mm. To calculate Gamma index by IBA's OmniPro-I'mRT software in different sampling resolution. Results When the resolution of evaluated dose distribution was fixed, the change of reference dose distribution's resolution has little effect on Gamma rate (5％ to IMRT field) ;When the resolution of reference dose distribution was fixed , the Gamma rate increased as the evaluated dose distribution's resolution ( ＞ 1 mm) raise ( the Gamma rate increase ( 15. 2 ±6. 2) ％ ( t = 11. 99 ,P < 0. 01 ) and ( 14. 9 ± 5. 5) ％ ( t = 13. 24 , P ＜ 0. 01 ) while the resolution of evaluated dose distribution changed from 6 mm t0 3 mm and from 3 mm to 1 mm　respectively) .Conclusions To use Camma method for verification of IMRT, the measured data can be as a reference dose distribution without　interpolation;the computed data by TPS can be as a evaluated dose distribution and it is more appropriate for the resolution of 1 mm.

Objective: To study the rational treatment course of proton pump inhibitor omeprazole for critical patients in order to improve the prognosis and reduce the hospital stay and treatment expense. Methods:Totally 180 critical patients with APACHEⅡ>10 and mechanical ventilation >48 hours in ICU were selected and randomly divided into 3 groups treated by omeprazole for 1 day, 3 days and 5 days , respectively. The incidence rate of stress ulcer, gastrointestinal hemorrhage and ventilator-associated pneumonia ( VAP) in the three groups was studied, and the ICU stay and expense were also investigated. Results:The incidence rate of stress ul-cer and gastrointestinal hemorrhage in the group with treatment course of 3 days and 5 days were significantly lower than those in the group with 1 day treatment(P<0. 05). The incidence rate of VAP with 3-days treatment was the lowest, compared with 1 day and 5 days treatment, the different was satatistically significant(P<0. 05). The ICU hospitalization time and treatment expense were also significantly different among the three groups, and that in 3-days, group was the lowest(P<0. 05). Conclusion:The 3-day treatment is the most reasonable, which can not only prevent stress ulcer and gastrointestinal bleeding in critical patients, but also reduce the in-cidence of VAP with lowered hospital stay and expense.

Objective To investigate the application significance of 3.0T MR three dimensional double-echo steady state(3D-DESS) and three dimensional-true fast imaging with steady-state procession(3D-True FISP) sequences in diagnosis of wrist cartilage of rheumatoid arthritis (RA).Methods 26 patients who were clinically diagnosed with RA underwent wrist MR scans with 3D-DESS and 3D-True FISP sequences, while both sequences' scanning were achieved on 20 of them.340 articular-surface morphological conditions' were observed,which were divided into level 0, level 1 and level 2 damages according to morphological performance,and recorded on 3D-DESS and 3D-True FISP sequence respectively.The diagnostic differences in the number of lesions were compared for two sequences.Results The numbers were 79 and 50 for level 1 damage and 23 and 33 for level 2 damage on 3D-DESS and 3D-True FISP sequence respectively (P<0.05).The artifacts were showed in 14 patients on 3D-True FISP,and only two patients on 3D-DESS.Conclusion 3D-DESS sequence does better than 3D-True FISP in displaying RA wrist cartilage,which is able to provide certain help for treatment and prognosis evaluation of RA.

Objective:To inspect the dosimetry characteristic of a 2-D ionization chamber array and its response to oblique incident electron beam.And to discuss feasibility to using it to validate the electron arc therapy plan.Materials and methods:(1)The 2-D ionization chamber array was calibrated referring to a themble chamber,comparing the response to electron beams with incidence angle ranged from-50°to 50°.(2)Phantom test plans of 6 and 10MeV electron beam arc therapy were designed,with the beam rotation arcs of 30°,60°and 90° respectively,symmetric to the Central axis of 0°gantry angle.Dose distribution of each plan was verifled with the 2-D array.Results:(1)Measurement differences between the central detector of the array and the thimble chamber were less than 2%,under the planned oblique inddent 6/10MeV electron beam.(2)For the all test plans,dose error was less than 3%at dmax in the symmetric axis of the electron beam arcs.Off-axis dose error was less than 2%within the central 70%area of the profile in non-rotating direction,and smaller than 1.5%in the rotational direction.The measured dose distribution had good agreement with the TPS calculation in isodose curves between 100%and 20%.The gammapass rates(△D=5%,△d=5cm)were 99.98%、99.89%、99.74%、98.64%、99.16%and 99.44%respectively for 6 and 10 MeV plans with electron beam arcs of 30°,60°and 90°.Conclusion:it is practicable using the tested 2-D ionization chamber array to verify and validate the electron beam arc therapy plan.

Objective To evaluate the effects of antitumor,toxicity and survival of second-line chemotherapy with docetaxel and capecitabine in patients with advanced esophageal squamous cell carcinoma.Methods Thirty eligible patients with measurable lesions received 1-hour intravenous treatment of docetaxel (60 mg/m2 on day 1) plus oral capecitabine (825 mg/m2 twice daily on days 1-14) every 3 weeks for up to 6 cycles.Results Patients received a median of two cycles of treatment (range 2-6).The median follow-up interview was 15.4 months (3.0-31.5 months).Intent-to-treat efficacy analysis demonstrated an overall response rate of 23.3 ％ (0 complete and 7 partial) and stability of 43.3 ％ (13 cases).The median time to progression was 3.0 months (95 ％ CI 1.929-4.071).The median survival was 8.3 months (95 ％ CI6.848-9.752).Severe adverse events (grade 3/4) reported were neutropenia (10 cases),anaemia (5 cases),thrombocytopenia (3 cases),hand-foot syndrome (4 cases),and fatigue (3 cases).Conclusion Docetaxel plus capecitabine have a manageable adverse event profile and promising activity in advance esophageal squamous cell carcinoma as a second-line treatment.

Objective: To establish a curve of dosage gradient-liver signal intensity of superparamagnetic iron oxide (SPIO) in normal rats and to find an appropriate dose for enhancement. Methods: Seventy-two SD rats, 4 rats a group at random, underwent MR enhancement with 0, 2, 5, 8, 10, 12, 15, 20, 30, 40, 50, 60, 70, 80, 100, 140, 210, 280 μmol/kg SPIO respectively after plane examination. The signal-to-noise ratio of liver was measured and a curve of dosage gradient-liver signal intensity was made. Results: (1)With the increase of SPIO dose, the signal intensity of both T1 and T2 weighted images of liver declined. (2)T2 weighted images was more sensitive than T1 weighted images in small dose, the ED50 of T1 weighted was 8 μmol/kg, and the ED50 of T2 weighted was 5 μmol/kg. (3)When the dose was greater than 15 μmol/kg, the signal intensity of T1 weighted images declined more rapidly than T2 weighted, the effect of enhanced T1 weighted images resembled T2 weighted ones, and its images was with more fine resolution. (4)At the dose of 40 μmol/kg, the signal intensity of T1 weighted images approached the background noise, and at the dose of 15 μmol/kg, the signal intensity of T2 weighted images approached the background noise. Conclusion: Good effect of T1 and T2 enhanced MR imaging can be acquired at the dose of 20-10 μmol/kg SPIO respectively, the best contrast-to-noise ratio is found on T2 weighted enhanced MR image.

Objective To study the dosimetric characteristics of flattened and flattening filter free (FFF) beams with 6 MV and 10 MV photon energy using a novel dual-energy medical linear accelerator (Elekta Versa HDTM),to identify the dosimetric characteristics and advantages of FFF beams,and to provide a basis for their clinical application.Methods The percentage depth dose (PDD),profiles/dose rate of off-axis ratio (OAR),field size,penumbral width,dose out of the fields,collimator scatter factor (Sc),and total scatter factor (Sc,p) were compared between flattened and FFF beams.Results (1) After beam energy matching,the FFF beams had the same beam energy with the flattened beams.The matching error of PDD at a depth of 10 cm was less than 1％ between fields.(2) The FFF beams had a smaller variation in dose rate of OAR with the depth than the flattened beams.(3) The FFF beams had smaller variations in field size and penumbral width than the flattened beams.Moreover,the penumbral width of the FFF beams increased with the increasing field size or depth.The FFF beams had a lower dose out of the fields than the flattened beams.(4) The FFF beams had smaller variations in Sc and Sc,p with the field size and depth than the flattened beams.Conclusions Removal of the flattening filter can substantially improve the dose rate,shorten radiotherapy time,and reduce leakage and scattering of the head.The dosimetric advantages make the FFF beams appropriate for clinical treatment.

Objective To evaluate the association between non-Hodgkin's lymphoma (NHL) and hepatitis B virus (HBV).Methods The positive rate of hepatitis B virus surface antigen (HBsAg) in 393 patients of NHL who were admitted. The colorectal cancer patients and healthy persons were also enrolled as control. Results The positive rate of HBsAg in NHL patients (26.5 ％) was significantly higher than that in colorectal cancer patients (14.5 ％) and healthy persons (8.8 ％),respectively (x2=55.713,P＜0.001).The characteristics of HBV-infected patients with NHL were similar to those who were HBV-uninfected in terms of sex,stage and B symptoms,whereas the HBV-infected patients were younger than the HBV-uninfected patients (the median age was 47ys vs 52ys,t =-1.911,P=0.021).In the HBsAg-positive NHL group,B-cell subtype was much more common than T-cell subtype (80.8 ％ vs 15.4 ％,P=0.043).Regarding colorectal cancer patients and healthy persons as control groups,the positive rate of HBsAg was significantly higher in B-cell NHL patients than that in the control groups, respectively ( 29.6 ％ vs15.5 ％ vs 8.8 ％,Wald value were 25.174 and 55.139,respectively,P＜0.001).The positive rate of HBsAg of HBV between T-cell NHL (16.7 ％) and control groups were not significantly different. Conclusions An association is present between HBV infection and NHL,especially in B-cell subtype.