Objective To analyze the prognosis of advanced esophageal carcinoma treated with paclitaxel and different platinum?based chemotherapy regimens plus intensity?modulated radiotherapy ( IMRT) , and to explore an optimal chemotherapy regimen. Methods A total of 242 patients with advanced esophageal carcinoma who were admitted to our hospital and treated with paclitaxel and cisplatin ( 68 patients), nedaplatin (85 patients), lobaplatin (58 patients), or oxaliplatin (31 patients) plus IMRT from 2008 to 2014 were enrolled as subjects. The prognosis of the four groups was analyzed after 2, 3, and ≥4 cycles of chemotherapy. The survival rates were calculated by the Kaplan?Meier method and analyzed by the log?rank test. The Cox model was used for the multivariate prognostic analysis. Results The sample number of 3 years was 168 cases. In all the 242 patients, the medium survival time was 31. 1 months and the 3?year overall survival ( OS) rate was 47. 4%. There was no significant difference in the 3?year OS rate between the cispaltin, nedaplatin, lobaplatin, and oxaliplatin groups ( 46. 2% vs. 56. 4% vs. 45. 7% vs. 29. 0%, P=0. 090) . The stratified analysis showed that the cisplatin, nedaplatin, and lobaplatin groups had a significantly higher OS rate than the oxaliplatin group ( 50. 1% vs. 29. 0%, P=0. 021 ) . There was no significant difference in the 3?year OS rate between patients receiving 2, 3, and≥4 cycles of chemotherapy ( 40. 1% vs. 49. 5% vs. 50. 8%, P=0. 264) . The multivariate analysis showed that esophageal tumor volume and the maximal size of metastatic lymph node were independent prognostic factors. Conclusions Combined with IMRT, paclitaxel plus cisplatin, nedaplatin, or lobaplatin?based chemotherapy achieves improved survival rates than paclitaxel plus oxaliplatin?based chemotherapy. Esophageal tumor volume and the maximal size of metastatic lymph node are independent prognostic factors.

Aim Toanalyzethekeyqualityandestablishmeth-ods for essential quality control of human recombinant ASPP2 adenovirus.Methods TheviralstructuralgeneofE2Bandtar-get gene of ASPP2 were identified by PCR;The number of virus particles was measured by UV-SDS methods;Infectious titer was determined by TCID50 assay;Target protein of ASPP2 was ob-served by Western blot assay;The biological effects of recombi-nant adenovirus on liver cancer cells were evaluated by MTT as-say;A549 cells were used to check replication of the competent adenovirus(RCA)by the observation of the cytopathic effect. Results PCRanalysisofE2BandASPP2wasinconsistent with theoretical values;Particle numbers of virus were 5. 6 × 1012 VP/mL,infectious titer was 2 ×1011 IU/mL and specific activity was 3. 5%;ASPP2 protein expression could be detected when cells were infected with virus for 24 h;Growth inhibition of liver cancer cells could be found by adding recombinant ASPP 2 adenovirus;The level of RCA was less than 1 RCA/3. 0 ×1010 VP,in line with the standards of China Food and Drug Adminis-tration(SFDA).Conclusion Thequalitycontrolmethodswere established aiming at key characters of human recombinant AS-PP2 adenovirus,which may provide foundations for its quality standard and future applications.

Objective To investigate the relationship of the serum level of IL-23 and MMP-9 with the clinicopathologic features in patients with esophageal squamous cell carcinoma (ESCC). Methods 48 pathologically confirmed ESCC patients and 30 Endoscopic biopsy of benign were included in this study. The serum levels of IL-23 and MMP-9 were examined by enzyme-linked immunosorbent assay (ELISA). Results Serum IL-23 level in patients with ESCC was significantly higher than that in controls (t = 26.66, 16.89, P<0.05). Furthermore, Pearson′s correlation analysis revealed that serum IL-23 was positively correlated with the serum MMP-9 level in ESCC patients (r = 0.790, P < 0.05). Statistical analysis showed that enhanced serum IL-23 significantly correlated with the degree of differentiation and lymph node metastasis. Conclusion Overexpression of IL-23 may involve in the occurrence and development of ESCC. IL-23 may contribute to tumorinvasion and metastasis by stimulating the expression of MMP-9.

Objective To evaluate the effectiveness of immediate quantitative coronary angiography (QCA) analysis in percutaneous coronary intervention (PCI). Methods The parameters of QCA and conventional methods before and after PCI were compared and statistics was performed by using t test or ANOVA methods. Results One hundred and two patients were enrolled in our study. Significant differences between QCA and conventional methods were found in evaluation of lesion length [ ( 22.9 ± 8.9 ) mm vs (24. 8 ± 10. 6) mm,t = 9. 63, P < 0. 05 ], stenosis diameter [ (3.0 ± 0.4 ) mm vs (2. 9 ± 0. 7) mm, t = 6. 31, P < 0. 05 ] and stenosis area [ ( 87. 8 ± 10. 7 ) mm2 vs ( 85.0 ± 12.9 ) mm2, t = 2. 54, P < 0.05 ], and also in different vessels. Stenosis diameter and stenosis area after stenting in target lesion were lower than the international standards. Conclusion Immediate QCA analysis can be effective in directing stent implantation.

Objective To explore six-degree-of-freedom (6-DF) registration methods between planning and cone beam computed tomography (CBCT) during image-guided radiation therapy (IGRT) in esophageal cancer.Methods Thirty pairs of CBCT images acquired before radiation and the corresponding planning computed tomography (CT) images of esophageal cancer were selected for further investigation.Registration markers for 6-DF image registration were determined and contoured in those images.The results of registration as well as time cost were compared among different registration methods of bone match, gray value match, manual match, and bone plus manual match.Results Contouring bone and spinal canal posterior to the target volume of esophageal carcinoma as registration marker could make 6-DF registration quick and precise.Compared with manual match, set-up errors of v rotation in bone plus manual match (-0.55° vs.-0.88°, t=2.55, P=0.020), of x-axis and v rotation in bone match (0.12 mm vs.-2.33 mm, t=5.75, P=0.000; -0.35° vs.-0.88°, t=3.00, P=0.007), and of x-axis and w rotation in gray value match (7.20 mm vs.-2.33 mm, t=3.10, P=0.006; -0.10° vs.-0.59°, t=2.81, P =0.011) were significantly different.Compared with manual match, the coincidence rate of bone plus manual match was the highest (85.55%), followed by bone match and gray value match (74.45% and 74.45%).The time cost of each registration method from longest to shortest was:6.00 -10.00 minutes for manual match, 1.00 - 5.00 minutes for bone plus manual match, 0.75 - 1.50 minutes for gray value match, and 0.50 - 0.83 minutes for bone match.Conclusions Registration marker is useful for image registration of CBCT and planning CT in patients with esophageal cancer.Bone plus manual match may be the best registration method considering both registration time and accuracy.

BACKGROUND:In the treatment of tibial plateau fractures, because of the variety of fracture, the complexity of anatomical changes, X-ray films or three-dimensional CT scan limited by two-dimensional plane, increases the difficulty in preoperative plan and surgical treatment. The application of three-dimensional (3D) printing technology has attracted attention in the department of orthopedics. OBJECTIVE:To explore the auxiliary role of 3D printing technique in preoperative plan and treatment for tibial plateau fractures. METHODS:Thirty patients with tibial plateau comminuted fractures were enroled in this study and divided into two groups: experimental and control groups, with 15 patients in each group. In the experimental group, patients underwent 3D CT scan, which was stored in DICOM format, and processed by Mimics software. Data were converted into STL format, entered 3D printer, and a 1:1 entity size of the fracture model was made, in accordance with repair plan of 3D fracture model. Operation time and intraoperative blood loss were compared between the two groups. At 12 months after treatment, their outcomes were assessed using Rasmussen evaluation criteria. RESULTS AND CONCLUSION: The 3D printing fracture models of 1:1 ratio identified fracture type and made a repair program before surgery in the experimental group. Operation time and intraoperative blood loss were significantly less in the experimental group than in the control group (P < 0.05). After surgery, patients were folowed up for 12 to 18 months. The healing time was 3-5 months, averagely 4.3 months. At 12 months after treatment, the Rasmussen evaluation criteria results showed that the excelent and good rate was significantly higher in the experimental group than in the control group (P < 0.05). These results suggest that the fracture model of 3D can help to make the operation plan. The treatment of tibial plateau fractures is more precise, personalized and visual.

BACKGROUND:The output of computed tomography (CT) is Digital Imaging and Communications in Medicine (DICOM), whereas the input of three-dimensional (3D) printing is an object Standard Template Library model represented by a triangular mesh. The process of data handing and forrmat conversion are keys to the combination of these two techniques. OBJECTIVE:To explore how to convert CT data into a stereoscopic 3D model efficiently. METHODS:The DICOM in Medicine format data of the patients with femoral fractures were edited and produced by Mimics. We made a 3D model by adjusting the parameters of the 3D printer slicing software, and discussed the significance of 3D model in medical field, especially orthopedics. RESULTS AND CONCLUSION:Mimics software is the bridge to connect two-dimensional CT scan images and 3D images, to create a 3D model by editing the data of DICOM which comes from the CT scanner, with a 3D printing technology. The 3D Model can help doctors for routine clinical diagnosis and treatment, to improve the communication between doctors and patients and the quality of clinical medical teaching. 3D printing also makes medicine more personalized, remote, minimally invasive, and promote the development of medicine to the direction of digital medicine.

Objective To evaluate the effect of radiotherapy(RT)combined with arterial infusion chemotherapy(AIC) in the treatment of locally advanced or recurrent rectal cancer. Methods From May.1994 to Dec.2000, 62 patients with locally advanced or recurrent rectal cancer were randomized into two groups: RT alone group(31 patients)and the combined group(RT+AIC, 31 patients). All patients were treated with conventional radiotherapy by 8 18 ?MV X ray to a total dose of D T40 50 ?Gy in 4 to 5 weeks for the resectable disease, or to a dose of 60 70 ?Gy in 6 to 7 weeks for the unresectable disease. However, the combined group received concurrent arterial infusion chemotherapy by DDP 70?mg/m 2 and 5 FU 600 ?mg/m 2 in 2 3 cycles. Results The response rates were 83.9% and 54.8% in combined group and RT alone group, respectively (P

Objective To investigate the factors related to death of thoracic trauma emergency in children.Methods Total 528 children and infants aged 0-14 years with thoracic injuries , including 317 boys and 211 girls, admitted in emergency department from January 2010 to January 2014 were included in the study.The factors related to emergency death were investigated by using conditional logistic analysis.Results Among 528 cases, emergency death occurred in 34 cases with an emergency mortality rate of 6.44%.Single-factor analysis showed that emergency death was correlated with complication with other organ trauma, the time of first medical intervention , the time of arriving at first contact hospital , the rank of first contact hospital , hypoxemia and causes of injuries ( all P<0.05 ); however , not correlated with the gender, age, of patients, areas of residence, family economic status and seasons of injury occurring (all P>0.05).Logistic analysis showed that the time of first medical interventio n>30 min ( B=1.467,95%CI:0.412-0.975), complication with other organ trauma (B=2.342,95%CI:0.415-0.943), hypoxemia (B=2.915,95%CI:0.749-0.819), and first visiting to tertiary hospital (B=-1.861,95%CI:1.023-1.742) were influencing factors of emergency death.Conclusion The results indicate that to improve the success rate of emergency treatment of thoracic trauma in children , it is necessary to reduce the time of first medical intervention and to correct the hypoxemia promptly.

Objective To measure the set-up errors of patients with head and neck (H&N) cancer during the image guided intensity-modulated radiotherapy (IMRT) treatment and analyze the impact of setup errors on dose distribution ; then to further investigate the necessity of adjustment online for H&N cancer during IMRT treatment.Methods Cone-beam CT (CBCT) scanning of thirty patients with H&N cancer were acquired by once weekly with a total of 6 times during IMRT treatment.The CBCT images and the original planning CT images were matched by the bony structure and worked out the translational errors of the x,y,z axis,as well as rotational errors.The dose distributions were recalculated based on the data of each setup error.The dose of planning target volume (PTV) and organs at risk were calculated in the replanning,and than compared with the original plan by paired t-test.Results The mean value of x,y,z axis translational set-up errors were ( 1.06 ± 0.95 ) mm,( 0.95 ± 0.77 ) mm and ( 1.31 ± 1.07 ) mm,respectively.The rotational error of x,y,z axis were ( 1.04 ±0.791 ),( 1.06 ±0.89) and (0.81 ±0.61 ),respectively.PTV 95％ volume dose ( D95 ) and PTV minimal dose of replanning for 6 times set-up were lower than original plan (6526.6 cGy:6630.3 cGy,t =3.98,P =0.000 and 5632.6 cGy:5792.5 cGy,t =- 2.89,P =0.007).Brain stem received 45 Gydose volume ( V45 ) and 1％ brain stem volume dose ( D01 )were higher than original plan ( 3.54％:2.75％,t =3.84,P =0.001 and 5129.7 cGy:4919.3 cGy,t =4.36,P =0.000).Conclusions The set-up errors led to the dose of PTV D95 obviously insufficient and significantly increased V45,D01 of the brainstem.So,adjustment online is necessary for H&N cancer during IMRT treatment.