The application of PET-CT could not only play a part in the diagnosis of clinical stage for NSCLC on PET, but also make full use of the discrimination of anatomical structure on CT. The precision of target contouring could be increased and the normal tissue and risk organ are also protected efficiently.

Adenoma, Pleomorphic ; pathology ; Adult ; Ear Neoplasms ; pathology ; Humans ; Male

ObjectiveTo investigate the efficacy of combined therapy of mild hypothermia and hibernation to treat severe brain injury. Methods24 patients with severe brain injury were randomly divided into combined therapy group and normothermia group. Glasgow Coma Scale scores of all the patients were in the range of 3 to 8. No later than 10 hours after their injury, hypothermia patients were given half dosage of No.1 hibernation cocktail and had been cooled by cooling blankets to 32℃-34℃ (rectal temperature) for 5 days, then to 35℃ for 24 hours, and slowly increased to their normal level. 3 days and 7 days after their admission, intracranial pressure,creatine phosphate kinase,partial pressure of arterial O2 and CO2, platelet and Na+,K+ were measured.7 days after their admission, Glasgow Outcome Scale scores of each patient and mortality of each group were measured. ResultsThe mortality of combined therapy group(25.0%) was significantly lower than that of normothermia group (66.6%,P<0.05). The decreased values of intracranial pressure, creatine phosphate kinase and platelet number of combined therapy group were all significantly higher than that of normothermia group respectively (P<0.05). There were no significant difference in mean artery pressure, blood electrolyte, and partial pressure of arterial O2 and CO2 between these two groups(P>0.05). ConclusionThe combined therapy of mild hypothermia and hibernation can effectively reduce the mortality of patients with severe brain injury as it is much easier, less invasive and with less complications.

Pericellular matrix (PCM) is a narrow tissue region surrounding chondrocytes, which "chondron" with its enclosed cells. A number of studies suggested that PCM is rich in proteoglycans, collagen and fibronectin, and plays an important role in regulating microenvironment of chondrocytes. Direct measures of PCM properties through micropipette aspiration technique showed that PCM was different from mechanical property of chondrocytes and nature extracellular matrix. However, the function of PCM is not clear, and need further study.
Animals ; Biomechanical Phenomena ; Chondrocytes ; chemistry ; cytology ; metabolism ; Extracellular Matrix ; chemistry ; metabolism ; Humans

Objective To observe the long?term survival and adverse reactions in patients with stage T4 N (+) Ⅲ middle and lower thoracic esophageal carcinoma undergoing intensity?modulated radiotherapy ( IMRT) . Methods From 2004 to 2010, 300 patients with stage T4 N (+) Ⅲ middle and lower thoracic esophageal carcinoma, consisting of 202 treated with three?dimensional conformal radiotherapy ( 3DCRT ) and 98 treated with IMRT, were enrolled as subjects. All patients received conventionally fractionated radiotherapy with a prescribed dose of 60 Gy. The long?term survival and adverse reactions were compared between patients treated with the two different radiotherapy regimens. The survival rates were calculated by the Kaplan?Meier method and analyzed by the log?rank test. Results The 5?and 7?year sample sizes were 239 and 120, respectively. The 3DCRT group had significantly lower 1?, 3?, 5?, and 7?year local control (LC) and overall survival (OS) rates than the IMRT group (64. 4% vs. 68. 3%, 40. 6% vs. 55. 3%, 38. 3% vs. 51. 9%, 34. 2% vs. 51. 9%, P=0. 048;54. 5% vs. 63. 3%, 19. 8% vs. 34. 7%, 14. 7% vs. 24. 4%, 10. 9% vs. 20. 3%, P=0. 013) . The stratified analysis showed that for patients older than 65 years, with the length of esophageal lesion>8. 0 cm before radiotherapy, the largest diameter of esophageal lesion in computed tomography image>4. 6 cm, gross tumor volume ( GTV)>60 cm3 , metastases to adjacent tissues or organs, stage N2 , and without chemotherapy, the IMRT group had a significantly higher OS rate than the 3DCRT group (P=0. 022,0. 003,0. 022,0. 034,0. 016,0. 044,0. 047). The GTV Dmin and GTVD100 were significantly higher in the IMRT group than in the 3DCRT group ( P=0. 000,0. 000) , while the Dmax of the spinal cord was significantly lower in the IMRT group than in the 3DCRT group ( P=0. 000) . Compared with the 3DCRT group, the IMRT group had a significantly higher incidence of acute radiation?induced esophagitis, particularly grade 1?2 esophagitis (P=0. 000). The mortality rate caused by local tumor was significantly higher in the 3DCRT group than in the IMRT group ( P= 0. 039 ) . Conclusions In the treatment of locally advanced middle and lower thoracic esophageal carcinoma, IMRT is safe and effective;it significantly improves the LC rate and long?term survival without severe toxicity to normal tissues. The results of this retrospective study need to be confirmed by prospective randomized controlled studies.

Objective To compare the dosimetric difference between volumetric modulated arc therapy (VMAT) and static intensity modulated radiotherapy (IMRT) for esophageal carcinoma.Methods Thirty patients were selected in this study,including 5 cases in the cervical,5 the lower thorax,10 the upper thorax and 10 the middle thorax.VMAT plans with a single arc and IMRT plans with five fields designed for each patients.Planning target volume (PTV) were prescribed to 60 Gy in 30 fractions.Delta 4 was used to verifie the dosimetric of treatment plans.Using paired t-test or Wilcoxon signed-test to compare the dose distribution on planning and organs at risk (OAR).The monitor units and treatment time were also evaluated to measure the treatment efficiency.Results All the VMAT and IMRT plans can satisfy the clinical dosimetry requirements.VMAT had better conformal index for PTV than IMRT (P =0.008).VMAT was better than IMRT by reducing the Dmax of spinal cord (P =0.032),while the V30,V40 and Dmean of heart were significantly higher (P =0.041,0.012,0.002).For cervicals,the V5,V10,V15 and mean dose of lung were significant higher in VMAT than those in IMRT (P =0.002-O.002,0.002).For uppers,the values of heart V30 and Dmean were significantly larger in VMAT than IMRT (P =0.030,0.026).However,the Dmax of spinal cord in VMAT was lower than IMRT (P =0.006).For middles,VMAT reduced V10,V15,V20 of lung (P =0.015,0.028,0.041).There were no significant differences between VMAT and IMRT in the lowers (P =0.262-0.998).The 3 mm/3％ γ pass rate was 92.75％ for VMAT and 92.98％ for IMRT (P =0.826).The average MU of VMAT (460.66 MU) was reduced by 11.84％ compared with IMRT (522.55 MU) (P=0.001).The delivery time of VMAT (139.6s) compared with IMRT (298.73 s) was reduced by an average of 53.27％ (P =0.000).Conclusions Compared with IMRT,VMAT improved the OARs dose sparing and the target CI with similar dose distribution to the target.VMAT required fewer MU,shorten the treatment time significantly.The implementation of Synergy is stable and reliable.

Objective To observe the relationship between computed tomography-gross tumor volume (GTV) and non-surgical T stage in patients with esophageal squamous cell carcinoma (ESCC) and the survival rates of patients with different GTVs,and to investigate the impact of GTV on the prognosis of ESCC after three-dimensional radiotherapy.Methods A retrospective analysis was performed on 223 ESCC patients without lymph node metastasis and distant metastasis who were hospitalized from July 2003 to January 2009.The prescribed doses of three-dimensional radiotherapy ranged from 50-70 Gy.These patients were divided into 3 or 4 groups according to different percentile intervals of GTVs.The Spearman rank correlation analysis was used for investigating the relationship between non-surgical T stage and GTV.The Kaplan-Meier method was used for calculating survival rates,and the log-rank test was used for survival difference analysis.Results The follow-up rate was 98.2％.A total of 163 patients were followed up for at least 3 years.The median GTVs of patients with T1 +2 ESCC,T3 ESCC,and T4 ESCC were 19.31 cm3,33.69 cm3,and 41.25 cm3,respectively,exhibiting a positive correlation between non-surgical T stage and GTV (P =0.000).The 5-year survival rates were 59％,43％,and 24％ (P =0.000) in 3 GTV-based groups and were 55％,51％,31％,and 24％ (P =0.004) in 4 GTV-based groups.The primary cause of death for the patients with GTVs of ≤35 cm3 and ＞35 cm3 was failure of local control (57.9％ vs 52.1％) ; 21.9％ and 13.8％ of the patients with a GTV of ＞ 35 cm3 died of uncontrol and excessive bleeding,versus 9.4％ and 3.1％ of the patients with a GTV of ≤ 35 cm3 (P =0.046 ; P =0.029) ;2 of the patients with a GTV of ＞ 35 cm3 died of grade 5 radiation pneumonitis.Conclusions GTV is positively correlated with nonsurgical T stage in esophageal cancer patients who receive radiotherapy.The 3-level and 4-level grading of GTV can be used for prognostic evaluation,and the 3-level grading of GTV is more closely related to prognosis.The patients with a larger GTV have higher incidence of uncontrol and bleeding and risk of treatment-related death than those with a smaller GTV after radiotherapy.

ObjectiveTo analyze the prognosis of 784 patients according with clinical staging of esophageal carcinoma treated with non-surgical methods,investigate the predictive value and deficiency of the clinical staging.MethodsFrom July 2003 to January 2009,784 patients with esophageal carcinoma received 3DCRT treatment.The prescribed doses ranged from 50 Gy-70 Gy with median dose of 60 Gy,1.8-2.0 Gy/fraction,1 fraction/day,5 fractions/week.65 patients received prescription dose of＜60 Gy and all the others'≥60 Gy.All the patients were divided into subgroups according to different T,N and TNM stages.Therapeutic effect was evaluated.ResultsThe follow up rate was 97.1％,503 patients were followed up for more than 3 years and 122 were followed up for more than 5 years.The 1-,3-,5-year local control rates and overall survival rates were 77.2％,54.2％,46.5％ and 69.5％,34.9％,23.9％,respectively,with median survival time of 21 months.There were significant differences of survival curves for different T stages,N stages and TNM stages.For the groups of stage Ⅰ,Ⅱ and Ⅲ,the 1-,3-,5-year survival rates were 86.4％,47.6％,45.1％ ;84.7％,46.3％,36.4％ and 64.0％,30.9％,19.1％,respectively ( x2 =29.34,P =0.000).There were 752 patients with squamous cell carcinoma ( 95.9％ )and 32 patients with non-squamous cell carcinoma (4.1％ ),the median survival time were 21 and 16 months,respectively ( x2 =4.44,P =0.035 ).There were significant difference of survival rates for the subgroups whose GTV volume ≤20 cm3,20 -40 cm3,40 -60 cm3 and ＞60 cm3 (54 months,29 months,21months and 14months,x2 =68.71,P =0.000).ConclusionsThe clinical staging of esophageal carcinoma treated with non-surgical methods could predict the prognosis accurately,for patients with different pathology and GTV volumes,there were variance in the prognosis,so we advised the complement of the two factors in the draft of clinical stages.

Objective To investigate the effects of dosimetric differences in gross tumor volume ( GTV ) on local control and survival rates in patients with esophageal carcinoma undergoing three?dimensional ( 3D) radiotherapy,and to provide a basis for clinical treatment. Methods From January 2004 to December 2010, 548 patients with esophageal carcinoma received conventional fractionated 3D radiotherapy with a prescribed dose of 60 Gy. All patients were divided into low?dose group and high?dose group according to the dosimetric differences in GTV. The survival and local control rates were compared between the two groups. The survival rates were calculated using the Kaplan?Meier method and analyzed using the logrank test. The Cox regression model was used for the multivariate prognostic analysis. Results The number of sample were 456 and 216 patients at 5 and 7 years followed time. The 1?,3?,5?,and 7?year local control rates were significantly higher in the high?dose group than in the low?dose group ( 83?5% vs. 71?3%, 62?6% vs. 44?8%,57?5% vs. 41?7%,52?9% vs. 38?8%,P=0?000).The 1?,3?,5?,and 7?year survival rates were also significantly higher in the high?dose group than in the low?dose group ( 79?6% vs. 66?3%, 44?3% vs. 29?7%, 34?0% vs. 21?8%, 26?1% vs. 17?0%, P=0?000 ) . The univariate prognostic analysis using the Cox regression model showed that Dmin , Dmean , and D100 for GTV were prognostic factors ( P=0?000,0?001,0?000).In all the 548 patients,201 were assigned to the high?dose group and the others to the low?dose group. Compared with the high?dose group, the low?dose group showed significantly larger GTV (38?2 vs. 48?1 cm3,P=0?002) and more advanced T stages (P=0?035).The stratified analysis showed that the 1?,3?,5?,and 7?year local control and survival rates were significantly higher in the high?dose group than in the low?dose group,regardless of tumor location,GTV,TNM stage,or chemotherapy. The multivariate analysis using the Cox regression model indicated that tumor location and grouping based on the radiation dose to GTV were independent prognostic factors. Conclusions In 3D radiotherapy for treating esophageal carcinoma,a high?quality treatment plan and GTV dose assurance improve the survival rates in patients. The patients with lower Dmin ,Dmean ,and D100 for GTV than the prescribed dose have a poor prognosis.

Objective To investigate the effect of tea polyphenols (TP) on renal damage in rats model induced by D-galactose. Methods Rats were injected with D-galactose (150 mg/kg?d),ip for 8 w,to induce renal damage. From the 3rd week,TP (150,75,37.5 mg/kg?d),aminoguanidine (150 mg/kg) and vitamin E (150 mg/kg) were administered with D-galactose for 6 w. After treatment,fasting blood glucose and 2 h blood glucose in oral glucose tolerance test were measured. The levels of HbA1C and fructosamine in serum,the activity of aldose reductase and content of advanced glycation end products (AGEs) in plasma and in kidney tissues and the activity of SOD,GSH-Px,and the contents of MDA in kidney tissues were measured,and 24h urinary protein,blood urea nitrogen (BUN) and serum creatinine (Cr) were detected. The apoptosis of renal cells were detected by flow cytometer. Results After treatment of D-galactose for 8 w,2h glucose level in oral glucose talerance test was increased significantly,the activity of aldose reductase and the content of AGES were increased significantly in blood. The levels of AGEs and MDA in renal tissues were also enhanced significantly. However,the activities of SOD and GSH-Px decreased. Additionally,the contents of 24h urine protein,BUN,Cr and the apoptotic rate of renal cells were increased significantly. High and middle dose of TP could can decrease the activity of aldose reductase in red blood cells,and inhibit the formation of glycation products in model rats induced by D-galactose. Also,TP could enhance the antioxidative activities and decrease the contents of AGEs and MDA in renal tissues. Mesnwhile,24h urine protein,BUN and Cr and the apoptotic rate of renal cells were increased significantly. Conclusion TP can inhibit glycation reaction induced by D-galactose and then protect renal from damage caused by glycation.