As induction chemotherapy goes on,target volume,dose distribution in the surrounding organs at risk (OARs),and target dose conformity all change.Therefore,the question is how to develop reasonable radiotherapy plans in clinical practice.Induction chemotherapy followed by radiotherapy is commonly used around the world,but it is recommended to delineate the target volume based on the gross tumor volume before induction chemotherapy and not to reduce the dose.This point of view lacks the basis of evidence-based medicine.The experts and scholars in China clarify the advantages of radiotherapy plans after induction chemotherapy from the aspects of reducing the target volume,reducing the volume of high-dose region in the target volume,increasing the uniform dose coverage in target volume,reducing dose to OARs,and increasing dose conformity.However,at present,there are no objective data on its long-term efficacy and benefit.Besides,no consensus has been reached on how to delineate the target volume and determine the dose distribution after induction chemotherapy,and further studies are needed.

18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) is the integration of functional imaging and anatomic information,which is found to be particularly valuable in TNM staging,tumor volume delineating,post-treatment assessment,identification of recurrent and residual nasopharyngeal carcinoma (NPC).The combination of 18F-FDG PET-CT with other image technologies,different tracer agents,and specific molecular biomarkers can improve the application value of 18F-FDG PET-CT in NPC.

Objective To investigate the value of FDG PET-CT in the outcome assessment and prognostic evaluation for recurrent nasopharyngeal carcinoma (rNPC).Methods From January 2008 to December 2013,92 rNPC patients were treated in our center,who were histologically or radiologically diagnosed and re-staged according to the 2008 clinical staging system for nasopharyngeal carcinoma in China.The numbers of patients in stage Ⅰ,stage Ⅱ,stage Ⅲ,and stage Ⅳ were 8,11,39,and 34,respectively.According to the recurrent T stage (rT),the numbers of patients in rT1,rT2,rT3,and rT4 were 10,11,38,and 33,respectively.Twenty-eight patients had recurrence in the neck lymph nodes.All patients underwent pretreatment FDG PET-CT for the whole body or head/neck,and treated by radiotherapy with or without chemotherapy.The relationship of maximum standard uptake value (SUVmax) and clinical factors with clinical outcomes was analyzed.The Kaplan-Meier method was used to calculate overall survival (OS),disease-free survival (DFS),local recurrence-free survival (LRFS),regional recurrence-free survival (RRFS),and distant metastasis-free survival (DMFS).The log-rank test was used for survival difference analysis and univariate prognostic analysis.The Cox model was used for multivariate prognostic analysis.Results The 3-year OS,DFS,LRFS,RRFS,and DMFS were 33.6％,32.1％,32.8％,31.8％,and 33.7％,respectively.The median SUVmax was 8.35 (2.7-21.5).The SUVmax of 7.0 was taken as the optimal cut-off value for all patients.Patients with SUVmax ≤7.0 had a significantly higher 3-year OS rate than those with SUVm ax ＞7.0 (42.0％ vs.28.3％,P=0.019).The univariate analysis revealed that patient age,SUV and rN were significantly associated with OS (P=0.023,0.019,and 0.002).The multivariate analysis showed that SUVmax and rN were significant influencing factors for OS,DFS,and DMFS (HR=1.68,P=0.045 and HR=2.23,P=0.003;HR=1.67,P=0.042 and HR=2.39,P=0.001;HR=1.77,P=0.025 and HR=2.40,P=0.001).Conclusions SUVmax may be one of the useful prognostic factors for OS,DFS,and DMFS in rNPC patients.

Objective To investigate the diagnosis and treatment of the patients with lung cancer hospital-ized in affiliated hospital of Hainan Medical College.Methods A retrospective study was performed from January 1st 2005 to December 31th 2009 in the Hospital.201 patients were enrolled in this study.Results The average onset age of patients with lung cancer was 66 years old.No difference in different gender.The incidence of male was 72.1%, which was higher than of female(27.9%).Male to female ratio was 2.6:1.70.3% of male patients with lung cancer had a history of smoking.146 cases(72.6%)were diagnosed by clinical data,only 55 cases(27.4%)were diagnosed by histopathology.134 cases(66.7%)hadn′t indications for surgery.only 17 cases(25.4%)agreed to have surgery among 67 cases (33.3%)with indications for surgery,50 cases(74.6%)didn't agree to have surgery.34 cases (16.9%)had no indications for chemotherapy.40 cases(24.0%)agreed to have chemotherapy among 167 cases (83.1%)with indications for chemotherapy,but only 14 cases(35.0%)had completed 4 to 6 cycles of chemotherapy, and 26 cases(65.0%)hadn't completed 4 to 6 cycles.8 cases(4.0%)agreed to have radiotherapy.3 cases(1.5%) agreed to have targeted therapy.3 cases (1.5%)transfered to other hospital.Conclusion The ratio of lung cancer patients in male is higher than female in the hospital.smoking is closely related to male patients.Clinical diagnosis rate of patients is high,whereas histopathologic diagnosis rate is low.The rate of the intervention that patients accepted is low and many patients give up available management after the diagnosis is made.

The clinical values of coils embolization in the treatment of pulmonary arteriovenous malformations (PAVM) and related complications were investigated. Eleven patients with PAVMs verified by pulmonary arterial angiography were treated by transcatheter coils embolization. Chest X-ray (11 cases), computer tomography (7 cases) and/or magnetic resonance imaging (2 cases) were performed before embolization. Blood-gas analysis was done in 5 cases before and after embolization. The follow-up materials of 8 patients were collected to evaluate the effect of embolization with coils. The clinical manifestations included cerebral embolus, hemoptysis and decreased oxygenation in 9 patients and the remaining 2 had no symptoms. 9/11 cases were found by chest X-ray and 8 were diagnosed definitely. 7/7, 2/2 cases were diagnosed by CT or MR and diagnosis was made in all cases. Embolization was performed in 29 vessels. Partial pressure of oxygen in arterial blood of 5 cases changed significantly before and after embolization. Slight complications occurred in 6 patients, such as low fever, chest pain, pleurisy. The follow-up results showed that 7 cases were cured effectively. No primary and secondary device migration, and no medical paradoxical embolization occurred. It was concluded that coils embolization is a well-established method for treating PAVMs. It is a minimally invasive lung preserving treatment with high efficiency and less complication.
Angiography ; Arteriovenous Malformations/diagnosis ; Arteriovenous Malformations/*therapy ; Embolization, Therapeutic/*instrumentation ; Follow-Up Studies ; Magnetic Resonance Angiography ; Pulmonary Artery/*abnormalities ; Pulmonary Veins/*abnormalities ; Treatment Outcome

Objective To identity the risk factors for supine hypotension syndrome (SHS) after spinal anesthesia in parturients.Methods A total of 204 parturients,scheduled for elective cesarean section,were divided into either control group or SHS group depending on whether or not SHS (systolic blood pressure [SBP] in the upper extremity decreased by ＞ 30 mmHg or decreased to ＜ 80 mmHg) developed after spinal anesthesia.The baseline patient characteristics such as age,body height and weight,gestational weeks and biparietal diameter were recorded.Supine stress test (SST) was performed.Heart rate,blood pressure in upper and lower extremities,perfusion index,pleth variability index and intravesical pressure were recorded when patients were in supine position and in left lateral position before spinal anesthesia.The risk factors of which P values were less than 0.05 would enter the multi-factor logistic regression analysis to stratify the risk factors for SHS.Results Among the 204 patients,99 cases developed SHS after spinal anesthesia,and the incidence was 48.5％.Logistic regression analysis showed that maternal body weight,biparietal diameter,the difference in SBP between upper and lower extremities in supine position,the difference in SBP in upper extremities caused by changing position and positive SST were risk factors for SHS after spinal anesthesia (P＜0.05 or 0.01).Conclusion Maternal body weight,biparietal diameter,the difference in SBP between the upper and lower extremities in supine position,the difference in SBP in upper extremities caused by changing position and positive SST are risk factors for SHS after spinal anesthesia in parturients.

Objective To assess the prevalence of c-Kit and FLT3 gene mutations in core binding factor related acute myeloid leukemia (CBF-AML) and analyze the karyotype characteristics of the CBF-AML patients. Methods Mutations of c-Kit, FLT3-ITD and FLT3-TKD were detected by genomic DNA PCR and sequencing, and the karyotype changes were analyzed in 48 newly diagnosed CBF-AML patients. Results c-Kit aberrations were detected in 13(27.1 %) out of 48 patients, including 5 cases with exon 8 mutation and 8 cases with exon 17 mutation. c-Kit was more prominent in t(8;21) AML patients than in inv(16) AML patients [(33.3 %(9/27) vs 19.0 %(4/21), P<0.05]. Only 1 case (2.1 %) had FLT3-ITD mutation (FLT3-ITD+) and 3 cases (6.3 %) had FLT3-TKD mutation (FLT3-TKD +). Prevalence of RUNX1-RUNX1T1 with additional chromosome abnormality was as high as 25.9 %(7/27), in which sex chromosome elimination was the most common one, while prevalence of CBFβ-MYH11 with additional chromosome abnormality was low. Conclusion c-Kit gene mutations and RUNX1-RUNX1T1 additional chromosome abnormalities are common in patients with CBF-AML and would be helpful for individualized treatment studies.

Objective To explore the expression of PRR11(Proline-rich protein 11) in human osteosarcoma and investigate the effect of PRR11 on the proliferation of human osteosarcoma cells.Methods Immunohistochemical staining was applied to detect the PRR11 expression in 75 cases of osteosarcoma and corresponding normal tissues.Western blotting was used to examine PRR11 protein expression levels in osteosarcoma cell lines.We used siRNA to knock down the expression of PRR11 and tested the effects of PRR11 down-regulation on the proliferation in SaOS2 cells.Results PRR11 was overexpressed in osteosarcoma specimens compared to their paired normal tissues,the over expression rate of PRR11 in osteosarcoma and corresponding paracancerous tissues were 76％(57/75) and 9.33％(7/75) with statistical difference(P<0.05).The high expression of PRR11 was correlated with tumor pathological grade and lymphatic metastasis(P<0.05).PRR11 was expressed in 4 osteosarcoma cell lines which were SaOS2,143B,U2OS and MG63 respectively,the expression was highest in SaOS2 cells.Silencing PRR11 inhibited cell growth as compared with control cells(P<0.05).Conclusion PRR11 is overexpression in human osteosarcoma and promotes its progression by enhancing proliferation.The increased expression of PRR11 in osteosarcoma is a new target for treatment and early diagnosis of human osteosarcoma patients.

Objective To compare the contents in polysaccharide of aloe in gel of aloe with preparation in different processing methods on fresh aloe of outer cuticle and investigate their stability. It could provide technology of preparation of polysaccharide of aloe.Methods The aloe gel had been prepared through the fresh juicing method, and alcohol sinking was applied to abstract polysaccharides of aloe in proportion of sixty, seventy, eighty and ninety percent. The colorimetric method of anthracenone - thick sulfuric acid had been taken to determine contents of polysaccharide in different proportions by alcohol sinking. The contents of polysaccharide were compared among different processing methods in fresh aloe of outer cuticle, and then the stability on condition of different temperatures, pH and the reagent of reductant-oxidant with polysaccharides of aloe were investigated. Results The content abstracted from polysaccharide of aloe was the higher when the proportion was eighty percent and its character of powder was better. And content abstracted from polysaccharide of aloe with the outer cuticle was higher than that out of the outer cuticle. The powders from the polysaccharide of aloe with the outer cuticle were gray-green, gray-brown or gray-white. The powders from polysaccharide of aloe without the outer cuticle were partial-white, more well-distributed and delicate. The stability in polysaccharide of aloe was better with the condition of low temperature, reducing agent and the solution with pH from five to seven, while the stability was lower when in high temperature, oxidizing agent and the solution with strong acid and strong alkali. Conclusions The proportion of eighty percent with alcohol sinking, decorticating the outer cuticle of fresh aloe has the higher content and the better character in the polysaccharide of aloe.

Objective To explore the clinical application of microsurgical techniques to therapy the femoral neck fracture in younger patients and prevent the necrosis of femoral head.Methods Seventy-four younger adults,age from 23 to 50,with femoral neck fractures were treated by open veducition,internal fixa- tion and pedicled bone transplantation from Jan.1995 to Dec.2004.All of the 74 patients were reviewed clin- ically and radiologically after an average of 3.2 years.Results In this group,19/74 cases(25.68%)had avaseular necrosis of the femoral head,which were diagnosised after an average of 28.5 months following inju- ry.Despite these results,these patients assessment with Harris system had been very good or good in 55/74 patients(74.32%).Conclusion It's an effective method to decrease the incidence of necrosis of femoral head after management the femoral neck fracture in younger patients by microsurgical techniques.