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 X-ray manifestations of mammary hamartoma and its pathologic basis.Methods 19 cases were proved by surgery and pathology,X-ray and pathologic manifestations were analyzed.All cases were examined with full digital mammography.Results X-ray manifestations of mammary hamartomas were divided into three types,including fat type were in 5 cases;dense type were in 4 cases and mixed type were in 10 cases.The lumps were surrounded by a true capsule in pathology,they were made up of different amount of rambling mammary ducts,lobules,adipose and fibrous tissue.Conclusion X-ray manifestations of mammary hamartoma are varied,depending on the proportion of the adipose tissue,gland and fibrous tissue.Mixed density lump is the characteristic sign of this disease.

Objective To evaluate the association between B-cell non-Hodgkin lymphoma (NHL) and hepatitis B virus (HBV).Methods The positive rates of HBV markers in 284 patients of B-cell NHL who were admitted to our department between January 2003 and December 2009 were investigated.The positive rates of HBV markers in colorectal cancer patients were used as controls.Results The HBsAg-positive rates of patients aged 18～ 39 and stage m/Ⅳ patients were 42.6 ％ (26/61) and 37.0 ％ (50/135),which was higher than other groups.The x2 value and P value were 7.573 and 6.874,0.023 and 0.009,respectively.Compared with the control group, the B-cell NHL had significantly higher prevalence of positive HBsAg and positive HBeAg (29.6 ％ vs 14.5 ％,6.7 ％ vs 0.8 ％ ).The Wald values were 25.174 and 20.496,respectively.Both of the P value were ＜0.001 and lower prevalence of positive anti-HBs (45.4 ％ vs 58.0 ％,Wald =11.062,P =0.001).The coexpression of HBsAg, HBeAg and anti-HBc was higher in the B-NHL group than in the control group (6.0 ％ vs 0.8 ％,x2 =31.619,P ＜0.001).Similarly,the coexpression of HBsAg,anti-HBe,and anti-HBc was higher in the B-NHL group (16.2 ％ vs 11.5 ％,x2 =4.542,P =0.033).Significantly higher rate of positive anti-HBc and negative anti-HBs was observed in the B-NHL group (37.0 ％ vs 24.5 ％,Wald =17.708,P ＜ 0.001),whereas the same group showed a lower rate of negative anti-HBs compared with the control group (20.8 ％ vs 27.8 ％, Wald =5.646, P =0.017).Conclusion This finding of a positive association between HBV infection and B-NHL suggests that HBV may play an etiologic role in the induction of B-NHL.

Objective To evaluate the curative effect and toxicities of platinum-based double regimens for patients aged ≥ 65 with advanced non-small-cell lung cancer (NSCLC) and identify the prognosis factors. Methods 70 patients aged ≥65 with staged ⅢA-Ⅳ NSCLC, who received platinum-based double regimens as first line treatment, were emrolled.Response rates and toxicities were evaluated.Progression free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Cox regression analysis was used to identify the potential prognosis factors.Results The median chemotherapy cycles was 3.The overall response rate was 41.5 % (22/53), and there was no difference between patients aged ＜70 and ≥70 (χ2 =1.945, P =0.378).The median PFS and OS were 6.0 months and 12.5 months.The chemotherapyrelated hematologic toxicities were common.Multivariate analysis revealed that performance status, numbers of metastasis, chemotherapy cycles were significant independent predictive factors for OS. Conclusion In elderly advanced NSCLC, platinum-based doublets show inspiring efficacy, but with more adverse events, and could not be all well tolerated. It should be personalized. Patients with poor performance status and multiple organs metastasis are hard to benefit from combined chemotherapy.Three to six cycles of chemotherapy is the optimal duration for patients who could be well tolerated.

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.

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.

ObjectiveTo test a three-dimensional dose verification system,which reconstructing dose to anatomy based on modeling and online measurements ( RDBMOM ),and to evaluate the accuracy and feasibility of its application in clinical intensity-modulated radiotherapy (IMRT) quality assurance.Methods Phantom plans of regular and irregular fields were selected for the testing.All test plans were implemented and the dose distributions were measured using the thimble ion-chamber and two-dimensional ion-chamber array,the accuracy of RDBMOM were then evaluated by comparing the corresponding results.Two practical treated nasopharyngeal carcinoma IMRT plans were verified with RDBMOM and the clinic significancy were valued.ResultsCompared with measurements of the thimble ion-chamber,deviations of RDBMOM were within 1％ in all tested cases except small field of 3 cm ×3 cm.The largest deviation of reconstructed dose in IMRT cases was 2.12％.The dose profile reconstructed by RDBMOM coincided with the measurement using two-dimensional ion-chamber array.The γ rates (3％/3 mm) were 94.56％ - 100％.The RDBMOM verification of IMRT cases shown that the γ rate ＞ 99％ in total and ＞ 98％ in planning target volume,deviation in D95 ＜0.4％,but the largest deviations in mean dose of the parotids and lens were 2.97％ and 59.58％ respectively.ConclusionsAccuracy of the tested system satisfies the demand of IMRT dose verification.RDBMOM is able to provide information of volumetric dosimctry and anatomical location of dose error,which is benefit for evaluating the clinical value of verification results.

Objective To evaluate the efficacy of eszopiclone for patients with acute insomnia and the impact of premedication with eszopiclone on sleep structure of patients with acute insomnia.Methods In an open-label,self-control trial was conducted at Changzheng Hospital Sleep Centers,and patients (n =32) with acute insomnia (12 men,20 women; mean age,36.2 years) were administered eszopiclone 3 mg for three consecutive nights.Sleep was monitored via polysomnography.The insomnia severity index (ISI),and mini-mental state examination (MMSE) were used to assess the degree of insomnia and impact of drugs on cognitive function during the day.Results Eszopiclone can shorten sleep latency ( before treatment:(52.92 ± 11.71 ) min,after treatment:(28.2 ± 10.11 ) min; t =-4.376,P ＜0.01 ),prolong total sleep time(before treatment:(365.22 ±30.13) min,after treatment:(429.18 ±26.93 ) min; t =4.102,P ＜ 0.01 ),decrease wake up times( before treatment:( 5.00 ± 1.92 ) times,after treatment:( 2.73 ± 0.91 )times; t =- 4.592,P ＜ 0.01 ),improve sleep efficiency ( before treatment:72.69％ ± 6.32％,after treatment:82.67％ ± 4.16％ ; t =3.371,P ＜ 0.01 ),reduce awake time ( before treatment:( 88.51 ±17.48) min,after treatment:(65.93 ±21.l0)min; t =-4.592,P ＜0.01 ),decrease light sleep ( NREM1 period) the percentage of time ( before treatment:12.54％ ± 2.10％,after treatment:7.30％ ± 2.90％ ;t=-3.155,P ＜ 0.01 ),and increase the percentage of slow wave sleep (before treatment:8.03％ ±5.37％,after treatment:9.31％ ±5.29％; t =4.228,P ＜0.01).No effect was observed on the percentage of NERM2 period (t =0.731,P ＞0.05) and REM period (t =-0.813,P ＞0.05).Eszopiclone can improve the quality of subjective assessment of sleep ( ISI score decreased,t =- 2.551,P ＜ 0.05) and has no significant effect on cognitive function on first the morning after patients taking the medication.Conclusion Eszopiclone can positively regulate the sleep structure in patients with acute insomnia and improve subjective assessment of sleep quality.It is safe and has no significant effect on cognitive function.

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.

BACKGROUNDChemotherapy is one of the important treatment methods for advanced non-small cell lung cancer (NSCLC). The aim of this study is to evaluate the efficacy of the combination of vinorelbine (NVB) and cisplatin (DDP) in the treatment of advanced NSCLC.

METHODSForty-eight patients with stage IIIB and IV NSCLC were treated with NVB (25mg/m² ,iv,d1 and d8) and DDP (40mg/m², d1 and d2).

RESULTSThe overall response rate (RR) was 48%, median survival time was 10 months, and 1-year survival rate was 35%. The RR of patients with first-line chemotherapy was 55%, median survival time was 11 months, the RR of patients with second-line chemotherapy was 35%, median survival time was 8 months; the RR of patients with stage IIIB was 54%, median survival time was 10 months, the RR of patients with stage IV was 41%, median survival time was 9 months. The main toxicities were myelosuppression, nausea, vomiting and phlebitis.

CONCLUSIONSThe combination of NVB and DDP in the treatment of advanced NSCLC has a high response rate and tolerable side effects, which can be adopted as the first-line treatment of advanced NSCLC, or the second line treatment that still need further studies.