It has been shown that the PIK3CA mutation in HER2 positive breast cancer is up to 25%, and thus activates PI3K-Akt signaling pathway,promotes HER2 mediated tumor cell epithelial transformation, alters the intrinsic phenotype of HER2 overexpression breast cancer,and finally leads to resistance to anti HER2 targeted therapy.Some studies have shown that the PIK3CA gene mutation is associated with the efficacy of anti-HER2 targeted therapy.Therefore,real-time monitoring of PIK3CA gene mutation will promote indivi-dualized anti-HER2 targeted therapy.

Delphian lymph node is a part of Ⅵlymph node.According to the latest research ,the metasta-sis rate in papillary thyroid carcinoma ( PTC) is up to nearly 20%.Meanwhile ,the Ⅵlymph node is usually con-sidered as the sentinel lymph node of PTC metastasis .Most scholars believe that .Delphian lymph nodes may have certain clinical significance in the development process of PTC .This article aims to summarize the research pro-gress in clinical relations between the Delphian node and papillary thyroid carcinoma .

Objective To evaluate the value of extended latissimus dorsi flap (ELDF) in immediate breast reconstruction in patients with breast cancer after modified radical mastectomy.Methods Thirty-six patients with breast cancer who accepted modified radical mastectomy and 12 patients with breast cancer who accepted immediate breast reconstruction after modified radical mastectomy from January 2008 to June 2009 were included.The complications,cosmetical results and quality of life of these patients were compared.The shape of breast reconstruction was also evaluated.Results All of 12 patients succeeded in proceeding immediate breast reconstruction with ELDF.The evaluation of shape of breast reconstruction was good in 6 cases,secondary in 4 cases,and bad in 2 cases,which was beyond that in patients of radical operation group (P0.05).The patients in breast reconstruction group had a better quality of life compared with the patients in radical operation group (P

With the development and clinical use of the molecular targeted drugs and individualized treatment,cancer research has been focused on gene targeting diagnosis and treatment.Especially for the epidermal growth factor receptor (EGFR) signaling pathway-related genes,DNA replication-related genes,spindle apparatus format-related genes,cell metabolism-related genes and other molecular targeted detection and treatment,the polymorphism of targeting genes/molecules determines the clinical efficiency of the therapies.

Objective To analysis the application value and the existing problems of sentinel lymph node biopsy in breast cancer surgery.Methods Pathological findings were retrospectively analysised in 100 female cases of breast cancer,who were diagnosed with early breast cancer and used blue dye in sentinel lymph node biopsy.Results Among 100 cases,92 cases were found SLNS,that the detected rate was 92％.Detected 217 sentinel lymph node,every case has 1 to 6 node,with the average of 2.4.Nintg-two cases were performed ALND.Among them,the SLNS negative detected 58 cases of ALN feminine,SLNS negative ALN detected positive 4 cases,30 cases of SLNS positive ALN positive detected.All of the patients did not appear allergic reaction.SLNB false positive rate of O,the false negative rate was 11.8％,sensitivity 88.3％,specific degree of 100％,the diagnostic coincidence rate was 95.7％.Conclusions Compared with the conventional axillary lymph node dissection,the sentinel lymph node biopsy has obvious advantages in early breast cancer surgery.For the cases of sentinel lymph node negative,there was no necessary to do the axillary lymph node dissection.

Objective To study long-term outcome and prognostic factors of nasopharyngeal carcinoma treated by intensity modulated radiotherapy.Methods A total of 299 patients with nondisseminated nasopharyngeal carcinoma who received initial radiotherapy were analyzed retrospectively.The primary lesion and the upper neck received 70 Gy (5 fraction per week in all 30 fraction) by intensitymodulated radiotherapy (IMRT).The lower neck and the supraclavicular fossa was given 54 Gy (5 fraction per week in all 30 fraction) by a single anterior tangent field with spinal cord block.A median dose of 9.2 Gy (4-20.Gy) was given to the residual primary lesion by IMRT or X-knife.The Kaplan-Meier method was used for calculating the overall survival (OS),disease progression-free survival (DPFS),distant metastasisfree survival (DMFS),Log-rank test was used for evaluating the differences between groups.Multivariate prognostic factor was analyzcd by Cox method.Results The follow-up rate was 99.7％.119 patients were followed-up more than with 5 years.The 5-year OS for stage Ⅰ + Ⅱ,stage Ⅲ and stage Ⅳ were 97.1％,82.7％ and 52.2％(x2=46.19,P=0.000),the 5 years DPFS were 100％,77.6％ and 57.7％ (x2=23.29,P =0.000),DMFS were 100％,82.3％,63.7％ (x2 =16.57,P =0.000) respectively.The 5 year OS,DPFS and DMFS of male and female were 70.7％ vs 94.1％ (x2=16.82,P=0.000),71.5％ vs 87.3％ (x2 =4.74,P =0.029) and 77.2％ vs 89.7％ (x2 =4.38,P =0.036) respectively.For patients who were younger than 45-years,the male had a significantly unfavorable 5-year OS (66.8％ vs.91.2％,x2=7.07,P=0.008),DPFS (59.9％ vs.91.2％,x2=7.72,P=0.005) and DMFS (66.4％ vs.94.0％,x2 =8.46,P =0.004) ;For patients who were old than 45-years,only OS was significantly different between male and female (72.2％ vs.96.0％,x2 =10.19,P =0.001).Multivariate analysis showed the independent prognosticfactors for OS,DPFS,DMFS,were gender (x2 =14.27,5.72,17.64,P =0.000,0.017,0.000),TNM stage (x2 =5.33,15.70,10.57,P =0.021,0.000,0.001) and lymph nodes capsular invasion (x2 =4.30,11.08,21.24,P =0.038,0.001,0.000).Intracranial invasion and supraclavicular lymph node metastasis were independent prognostic factors for OS (x2 =13.32,5.38,P =O.000,0.020).Conclusions The TNM stage,lymph nodes capsular invasion and gender are independent prognostic factors for nasopharyngeal carcinoma treated by intensity-modulated radiotherapy.The patients of younger than 45years own a worse outcome.

Objective To investigate the late toxicities after intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma and analyze the risk factors for treatment complications.Methods A total of 299 patients with nasopharyngeal carcinoma were given initial IMRT.The nasopharyngeal lesion and cervical lymph nodes were given a prescribed dose of 70 Gy ; the dose was 60 Gy to subclinical region ; the prophylactic dose was 54 Gy to the lower neck and supraclavicular region;these doses were given in 30 fractions over 6 weeks.The clinical records of 176 patients followed up were analyzed.The hazard factors were analyzed with Logistic method.Results The median follow-up was 52 months,and the follow-up rate was 99.7％.The most common radiotherapy-induced toxicities were xerostomia and hearing loss,with incidence rates of 54.5％ and 61.4％.The incidences rate of grade 0-1 adverse reaction of skin,subcutaneous tissue,or nasopharyngeal mucosa was 91.5 ％,93.2％,or 97.2％ ;the incidence rate of grade 1-2 trismus was 3.4％.Severe complications included cranial nerve injury (5 patients) and epistaxis (2 patients,one dying due to profuse epistaxis).The hazard factors for xerostomia and hearing loss were chemotherapy (x2 =7.38,P =0.007 ; x2 =7.96,P =0.005) and median doses to the parotid gland and inner ear (x2 =4.09,P =0.043 ; x2 =7.96,P =0.005).Conclusions Most patients develop only mild toxicity of the skin,subcutaneous tissue,or nasopharyngeal mucosa after IMRT.The incidence rates of xerostomia and hearing loss remain high owing to radiotherapy dosage and chemotherapy.

Resveratrol, isorhapontigenin and pinosylvin, isolated from Gnetum parvifolium, and their analogues have been synthesized and tested for their inhibitory activity of HIV-1. Natural product 12a and analogues (12d, 12e, 12g) display significant inhibitory activity of HIV-1 replication. Among them, compound 12d (trans-3, 4, 5, 4'-tetrahydroxystilbene) exhibits the most potent anti-HIV-1 activity with an IC50 value of 1.84 micromol x L(-1).

Objective To determine long-term survival of 214 patients of lung cancer with brain metastases and to detect the potential prognostic factors.Methods A retrospective review was pedormed evaluating patients diagnosed as lung cancer with brain metastasis from Jan 1992 to Dec 2001 at Zhejiang Cancer Hospital.Two hundred and fourteen cases were enrolled.All hospital records were thoroughly reviewed in a retrospective manner.The management of the brain metastases were as follows: 8 patients underwent surgical resection and postoperative whole brain radiotherapy (WBRT); 2 cases received resection and chemotherapy; 10 had resection alone; 10 underwent WBRT alone,36 had chemotherapy alone; 15 received the combination of resection,chemotherapy and WBRT; 104 were performed with chemotherapy combined with WBRT; 29 had only supportive care.Survival time was measured from the date of the first treatment for malignancy to the date of death or the last follow-up.Seven further potential prognostic factors were investigated for survival including age,gender,T or N status,number of extra cranial metastases,pathological type and treatment modality.Statistical analysis was performed using the Kaplan-Meier method and Cox-regression analysis.Results The overall median survival time was 10 months (95% CI9.06--10.94) and the 1,3,5 year survival rates were 7.46%,1.14% and 0,respectively.In the univariate model,none of the following variables had effect on survival: age,gender,T stage of the tumor,nodal status,number of extra cranial metastases and histological type.Univariate analysis showed a better survival for the combination of surgical resection,chemotherapy and radiation (P=0.00).Based on Cox-regression analysis,treatment modality was the only independent predictor of survival Conclusions Aggressive combined therapy of brain metastases may achieve a survival advantage.Excellent overall survival of lung cancer with brain metastases has been achieved with a combination of WBRT with surgical resection and chemotherapy.

Objective To explore the prevention and treatment effect and its mechanism of Xuebijing injec-tion combined with dexamethasone on rats' paraqnat-induced acute and chronic pulmonary injury.Method One hundred and twenty of male Wistar rats were randomly divided into six groups:nomud group(A),administrated with saline;model group(B)and treatment groups(group C,D,E,F)were given 20%PQ(100 mg/kg.ip),and 2 hours later the normal and model groups were administrated with the same volume of saline for treatment,rats in group C and group D received 1.25 g/kg and 2.5 g/kg Xuebijing injection respectively.rdts in group E received 25,ng/kg dexamethasone,rats in group F receired 2.5 g/kg Xuebijing injection combined with 2.5 g/kg dexamethasone,one time per day till to be killed,while rats killed at 28 d were treated for 7 days.At 2 d,3 d,4 d after poisoned,five rats in each group were killed,serum SOD,MDA level and arterial gas(at 3 d)were measured.At 28 d,the rest of rats were killed,and serum TGF-β1,lung tissure HYP were measured.The pathology of the lung tissue was ob-served at 3 d and 28 d in guoup A,B,F.Results Compared with group B,poisoning symptoms in the treatment groups were milder and serum.SOD,MDA,TGV-β1,lung tissure HYP level were better,arterial oxygen content were higer.Among treatment groups,the treatment effects in group F were the best,SOD and MDA of 3 d,HYP and TGF-β1 of 28 d in group B and F were respectively(37.47±13.00,91.86±21.35)nmol/mL;(11.34±3.07,5.63±1.58)nmoL/mL;(2.54±0.63,1.32±0.07)mg/g;(484.13±63.79,202.22±49.83)pg/mL.The difference was significant(P＜0.05).The pathology of the lung tissue showed that acute lung hemorrhage,edema or chronic pulmonary fibrosis in group F were milder than that of group B.Conclusions In early stage,Xuebijing injection combined with dexamethasone has a stronger ability to clear out oxidized free radical and inhibit lipid super oxidized reaction.This may ameliorate acute pulmonary blooding and edema.In later stage,they could ameliorate chronic pulmonary fibrosis by inhibiting TGF-β1 secretion and HYP generation.