Objective To investigate the set-up errors of super and middle part of esophageal cancer patients using cone-beam CT (CBCT) during intensity modulated radiotherapy (IMRT),hence determine various margins from CTV to PTV.The corresponding influence on the normal tissues (lung and spinal cord) was also discussed.Methods From December 2012 to December 2013,12 patients with upper and middle segment of esophageal cancer were chosen.Using their 60 sets of weekly acquired CBCT images prior to the treatment,the lateral,longitudinal,and vertical set-up errors of each patient were obtained.Based on these measured errors and the target motions,we adopted new margins to create new PTV.Then IMRT plans were created for the original PTV (5 mm margin in all directions on CTV) and new PTV respectively.On condition of the same target coverage (V95 ≥ 95％),the doses to lungs (V5,V20,V30,D) and spinal cord (D1 cm3) were compared statistically between the original and new plans.Results According to the 60 CBCT scans,the average left-right (RL),superior-inferior (SI),anterior-posterior (AP) set-up errors were (2.02 ± 1.74),(2.03 ± 1.93),and (2.02 ± 1.89) mm respectively.The margins were 5.6 mm (RL),8.5 mm (SI),and 4.7 mm (AP) for the upper esophagus and 6.2 mm (RL),11 mm (SI),and 5.0 mm (AP) for the middle esophagus.Comparison of both lungs and spinal cord suggested significant differences between the two plans (t =-8.23,-5.55,-4.66,-6.87,-4.67,P ＜0.05).Conclusions The margins from CTV to PTV should be created via CBCT-measured set-up errors and previous reports,which can be helpful for clinical treatment.

Objective To study corrective method for displacement in the procedure of electronic portal imaging device (EPID)-based intensity-modulated radiotherapy dose valuation by studying the relative mechanical displacement of different vendor EPID (aS1000,Varian; aS500,Varian; iViewGT,Elekta).Methods A 5 cm × 5 cm field was set up to acquire portal images for three kinds of EPID,then a in house software was used to analysis the portal images.The relative displacement was acquired via analyzing a series of comparation between center positions of gantry angle ranging from 0° to 360° and gantry angle at 0°.Results In the lateral direction,the maximum relative displacement of EPID with aS1000,S500 and iViewGT were (-0.23 ±0.17) mm,(2.94±0.17) mm and (0.35 ±0.09) mm,respectively.In the longitude direction,the displacements were (-4.16 ± 0.20) mm,(-4.15 ± 0.25) mm and (-1.66 ±0.11) mm,respectively.As to longitude direction,the displacements could be well fitted with the usage of quadruplicate empiric function.Conclusions There is a significant difference at the aspect of relative displacement between different vendors EPID at different gantry angles.And the displacement in the longitude direction is obviously larger than in the lateral direction.The relative displacement should be corrected when applying EPID to the intensity-modulated radiotherapy dose verification at different gantry angles.

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 The anterior-lateral defect of foot that lost one of the three supporting point of foot can lead to collapse of the lateral longitudinal arch, overload of the first metatarsal heads, and painful callus formation. It is meaningful to investigate the effect of reconstructing the lateral forefoot defect with pedical fibular osteoseptocutaneous flap. Methods From March 1989 to June 2008, there were 38 patients with anterior-lateral defect of foot were constructed. The supporting point with the local distal based pedical fibular osteoseptocutaneous flap was constracted. Results All the 38 flaps survived. All 38 patients had been followed up from 6 months to 10 years (mean 23.5 months) postoperatively. The constructed supporting point of the foot was functional. The patients could walk freely with no pain, and was satisfied with the operation. Assessed with the rating system for foot and ankle established by the American Orthopaedic Foot And Anke Society, 8 patients got a score above 85, 23 patients between 75 to 85, 7 patients between 60 to 75. Conclusion It is effective that transferring local distal based pedical fibular osteoseptocutaneous flap to repair the anterior-lateral defect of foot.

Objective:To investigate the role of growth arrest specific protein 6 (Gas6) in regulating macrophage polarization in wound healing.Methods:Clean male B6 mice were randomly(random number) divided into the normal group, skin defect group, skin defect group + normal saline group (PBS group), skin defect + Gas6 (1 μg) group, skin defect + Gas6 (5 μg) group, and skin defect + Gas6 (10 μg) group. Ten mice in each group were used to observe the healing of skin wounds. Macrophages were isolated from the wound tissues of the remaining 6 mice on the fifth day after modeling. The levels of IL-6 and IL-10 were detected by enzyme-linked immunosorbent assay (ELISA), the mRNA expression levels of arginase-1 (Arg-1) and inducible nitric oxide synthase (iNOS) were detected by RT-PCR, and flow cytometry was used to detect the expression of M1 marker CD197, M2 marker CD163 and F4/80. HE staining was used to detect the pathological changes of skin wounds. Masson staining was used to analyze the granulation tissue and collagen deposition.Results:Scab began to form on the surface of the wound on the third day after the skin defect model was established. The wound area of the Gas6 treatment group was smaller than that of the PBS group, and the wound healing was better than that of the PBS group. Compared with the normal group, the proportion of CD197 in macrophages of the skin defect group was significantly increased ( P=0.00 49), the proportion of CD163 and F4/80 double positive was significantly decreased ( P=0.00 86), the level of IL-6 was significantly increased ( P=0.00 13), the level of IL-10 was significantly increased ( P=0.00 14), the level of iNOS mRNA was significantly increased ( P=0.00 8), and Arg-1 was significantly increased in the skin defect group The mRNA level was significantly decreased ( P=0.01 21), and the inflammatory infiltration was aggravated. Compared with the PBS group, the proportion of CD197 in the Gas6 treatment group was significantly decreased ( P=0.00 0), the double positive rates of CD163 and F4/80 were significantly increased ( P = 0.00 0), the level of IL-6 was significantly decreased (P = 0.00 0), the level of IL-10 was significantly increased ( P=0.00 03), the level of iNOS mRNA was significantly decreased ( P=0.00 18), the level of Arg-1 mRNA was significantly increased ( P=0.00 1), and the number of inflammatory cells and the number of collagen fibers were increased. Conclusions:Gas6 can promote the transformation of macrophages from M1 to M2 in mice with skin defect, which is beneficial to the wound healing of skin defect.

Objective To observe the motions of the rectum and bladder by image?guided radiotherapy ( IGRT) and to analyze their impact on treatment. Methods Eighteen patients with prostate cancer undergoing intensity?modulated radiotherapy ( IMRT) were enrolled in the study and 247 cone?beam computed tomography ( CBCT) images were obtained from this study. The clinical target volume, bladder, and rectum were contoured on all simulated CT and CBCT to examine their volume and position changes. The dose distributions were recalculated based on the data of the x?, y?, and z?axis setup errors. The doses to planning target volume ( PTV) and organs at risk were calculated in the replanning, and their impact on treatment was analyzed. Comparison of the planning and replanning results was made by paired t?test. The effects of displacements and volumes of the bladder and rectum on target doses were analyzed by Pearson correlation method. Results Great changes in the volumes of the bladder and rectum were observed during the treatment. For the planning and replanning results, PTVD95% was 7777. 37 cGy vs. 7628. 56 cGy ( P=0. 027), PTV Dmin was 87. 91 cGy vs. 83. 35 cGy (P=0. 000), and RVP was 5. 89% vs. 8. 31%(P=0. 000). There were correlations between PTVD95% and the motions of the bladder and rectum, with correlation coefficients of 0. 296 and 0. 177, respectively. The correlation coefficient between rectal volume and PTVD95% was 0. 115, indicating a certain correlation. There is a certain correlation between and PTV Dmin and bladder volume, with a correlation coefficient of?0. 128. Conclusions The recovery of the state during localization for the bladder and rectum, especially the latter, has great significance to ensure the target dose and reduce exposure of the rectum in the IMRT for prostate cancer.

Objective To analyze the data from intensity-modulated radiotherapy ( IMRT) for prostate cancer guided by kilovoltage cone-beam computed tomography (CBCT), and to provide a clinical basis for selecting the optimal image registration method and reasonable target volume margins.Methods A total of 16 patients with prostate cancer who received radical IMRT were enrolled, and CBCT for online position verification was performed 214 times.The images were obtained after conventional skin marking and laser alignment, and automatic registration, bone registration, soft tissue registration, and manual registration were performed for CBCT images and planned CT images.The differences between these four registration methods were evaluated, and the margins for extending clinical target volume into planning target volume (PTV) were calculated.Results The setup errors in left-right, anterior-posterior, and cranial-caudal directions for automatic registration, bone registration, soft tissue registration, and manual registration were-0.6±2.8 mm/-0.6±4.5 mm/-0.6±3.8 mm,-0.7±2.7 mm/-0.9±4.5 mm/-0.8±4.1 mm,-0.8± 2.6 mm/-0.3±4.4 mm/-1.1±4.0 mm, and-0.6±2.9 mm/-0.7±5.1 mm/-0.9±3.9 mm, respectively. There were no significant differences between the four registration methods.The margins for extension in the left-right, anterior-posterior, and cranial-caudal directions were calculated as 4.7 mm, 5.2 mm, and 6.5 mm, respectively.Conclusions With a comprehensive consideration of various factors, a default setting of automatic registration and manual fine adjustment is appropriate for CBCT-guided radiotherapy for prostate cancer.The margins for extension in the left-right, anterior-posterior, and cranial-caudal directions are 4.7 mm, 5.2 mm, and 6.5 mm, respectively.

Wnt signaling is implicated in the control of cell growth and differentiation during neural stem cell(CNS) development.Wnt3a, one of wnt gene family members, has effect on regeneration neurospheres and differentiation into neurons.Wnt3a inhibits regeneration of neurospheres, and promotes its differentiation. In vitro neurosphere was cultured in a serum-free defined medium DMEM/F12 supplemented with bFGF and EGF. Dissociated cells were plated onto poly-d-lysine-coated coverslips and propagated in medium containing recombined Wnt3a-adenovirus. Plenty of Nurr1 were detected by RT-PCR after 3 days. Wnt3a combined AA would improve NSC differentiation into dopaminergic (DA) neuron. The quantity of DA neuron is obviously more than the AA alone group's. Moreover, the expression of TH mRNA is 1.86 fold in Wnt3a combined AA group. Induced cells were immunostained for TH and DAT. The proportion of TH-positive was (37.42 ? 2.54) % (P

Objective: To investigate the clinicopathological features of indolent T-cell lymphoproliferative disorder of the gastrointestinal tract. Methods: Five cases of indolent T-cell lymphoproliferative disorder of the gastrointestinal tract from the Affiliated Hospital of Qingdao University from 2016 to 2019 were retrospectively reviewed. The clinical and pathological parameters were analyzed by combining clinical data and reviewing the available literature of 35 cases (34 cases abroad and 1 case in China). Results: There were 4 males and 1 female with a median age of 47 years (18-66 years). All patients had abdominal pain and constitutional symptoms including diarrhea, emaciation, intermittent mucous stool or oral and epiglottic ulcers. Endoscopic manifestations included multiple punctate congestion, erosion and ulcer at the terminal ileum and colorectum. Two cases had congestion and erosion of antrum and angle of stomach, and the lesions did not fuse and form tumors. Histologically, the lamina propria was expanded by a dense, medium to small lymphocyte infiltration, which was monomorphic, with slightly irregular nuclei without prominent nucleolus or lymphoepithelial lesions. There were admixed small amount of plasma cells and eosinophils. In 4 cases, immunohistochemistry showed the lesional cells were positive for CD3, CD8, TIA1, and negative for CD4, CD56, granzyme B and Ki-67 index was ≤10%. In situ hybridization showed that EBER was negative and clonal TCR gene rearrangement was detected. One consultation case was CD3⁺, CD5^- and Ki-67 index of 10%, although other indicators were not done. All five patients were treated with symptomatic support. In follow-up observation for 2 to 25 months, all patients were alive with the disease. Conclusions Indolent T-cell lymphoproliferative disorder of the gastrointestinal tract is a newly classified monoclonal T-cell proliferative disease, with low incidence, clinical inertia and long-term survival. It has unique clinicopathological features but pathologically it is easily misdiagnosed as inflammatory bowel disease or T-cell lymphoma. Correct diagnosis is of great important clinical significance.

Objective: To explore the clinical effects of split-thickness scalp and allogenic acellular dermal matrix (ADM) in repairing deep wounds of hands in patients with extremely extensive burns. Methods: Six patients with extremely extensive burns complicated by deep burn in hands were admitted to our department from December 2014 to December 2017, including 4 males and 2 females, aged 21 to 58 years. Their total burn areas were from 85% to 95% total body surface area (TBSA), and the sum of deep-partial thickness and full-thickness wounds was larger than 50% TBSA. Under general anesthesia, deep wounds of 10 dorsal hands were repaired by combined transplantation of split-thickness scalp and allogenic ADM in 4 to 6 weeks after injury. The skin grafting range was beyond the metacarpophalangeal joint, including partial dorsal digital deep wounds. Survival of skin grafts on dorsal hands, follow-up of hand shape and functional recovery were observed and recorded. Results: Six patients were successfully treated. There was no infection on the dorsal deep wounds of 10 hands after surgery, and the grafts survived well. During follow-up of 1 to 2 years after operation, there were no recurrent tension blisters or dorsal extension deformity of the metacarpophalangeal joints in 10 hands, the shape and function of hands recovered well, and hand Carroll scores were from 90 to 99 points, with functional levels of Ⅴ and Ⅵ. Conclusions The combined transplantation of split-thickness scalp and allogenic ADM is a good method for repairing deep hand wounds in patients with extremely extensive burns, which can alleviate the cicatrix hyperplasia and contracture of healed hand wounds, and improve the shape and function of hands.