in order to maintain a normal temperature range.

Objective To investigate the possibility and accuracy of predicting malignant middle cerebral artery infarction (mMCAI) with bedside electroencephalography (EEG). Methods Thirty-five patients with massive hemispheric infarction (MHI) underwent bedside EEG monitoring within 48 h of onset. The EEG indicators were interpreted blindly, and the clinical, laboratory and imaging parameters were analyzed. The patients were divided into mMCAI group and non-mMCAI group according to whether they had occurred mMCAI or not within 7 days of onset. The differences of EEG indicators, clinical, laboratory and imaging parameters between the 2 groups were compared. When the parameters of significant difference and statistical significance appeared the odds ratio (OR) of occurring mMCAI were analyzed, and their accuracy of predicting mMCAI was calculated. Results Of the 35 patients with MHI, 20 were in the mMCAI group and 15 were in the non-mMCAI group. There were significant differences in the EEG indicators (infarction on the contralateral side, including disintegration of occipital α rhythm, generalized slow-wave, dominant frequency wave low amplitude, regional attenuation without delta [RAWOD]pattern, and absence of EEG reactivity), clinical parameters (nausea accompanied with vomiting), and imaging parameters (the infracted area more than the entire MCA territory, and midline shifting 3 to 5 mm at the level of septum pellucidum) between the 2 groups (P < 0. 05). Of those, the risk of mMCAI was the highest in patients with disintegration of occipital a rhythm on the contralateral side of infarction (P = 22. 67, 95% CI 3. 89-132. 10). The sensitivity of predicting mMCAI was 85. 0%, the specificity was 80.0%, the positive predictive value was 85.0%, and the negative predictive value was 80. 0%, which were superior to other EEG indicators and clinical or imaging parameters. Conclusions Bedside EEG indicators can early predict mMCAI, moreover, the predictive accuracy is superior to the clinical and imaging parameters.

Objective To investigate the value of prophylactic irradiation to the lymphatic drainage area in radical three-dimensional conformal radiotherapy (3DCRT) and to evaluate the efficacy and adverse effects of 3DCRT with different clinical target volumes.Methods A retrospective analysis was performed on the records of 219 esophageal cancer patients without distant metastasis who received 3DCRT from January 2005 to December 2010.One hundred and five patients received involved-field irradiation (IFI) with a total dose of 54-66 Gy;114 patients received elective nodal irradiation (ENI) with a total dose of 46-52 Gy; the prescribed dose to the primary lesion was 56-70 Gy.The Kaplan-Meier method was used to calculate local control (LC) and overall survival (OS) rates,and the log-rank test was used for univariate prognostic analysis.Results The 1-,3-,and 5-year sample sizes were 219,172 and 67,respectively.The 1-,3-,and 5-year LC rates for IFI group were 63.0％,39.1％,and 27.2％,respectively,versus 70.5％,53.3％,and 51.7％ for ENI group (x2 =6.22,P =0.013) ;the 1-,3-,and 5-year OS rates for IFI group were 67.6％,24.9％,and 15.0％,respectively,versus 73.7％,45.1％,and 26.0％ for ENI group (x2=5.04,P =0.025).The univariate stratified analysis showed that the LC and OS rates were significantly higher in the ENI group than in the IFI group for patients with middle-or lower-thoracic primary lesion or N0 disease (P=0.007,0.015;P=0.054,0.013).Conclusions For esophageal cancer patients with middle-or lower-thoracic primary lesion or without lymph node metastasis,prophylactic irradiation to the lymphatic drainage area can increase LC and OS rates.

Objective To investigate the effects of inhibition of MDC1 protein expression on xenografted tumors in nude mice,and to observe the histopathological and cellular changes in nude mice.Methods Three pairs of effective and control short hairpin RNA targeting MDC1 mRNA were designed and cloned into the pSIH1-H1-copGFP vector.Real-time PCR and Western blot were used to determine the mRNA and protein expression of MDC1.After selection by copGFP reporter gene,cells were divided into negative transfection group (ECA109-N) and MDC1 transfection group (ECA109-M).The transfected cells were injected into nude mice.The mice were divided into ECA109 group,ECA109-N group,and ECA109-M group.Each group was divided into irradiation subgroup and non-irradiation subgroup.The changes in tumor size after irradiation were evaluated in each group.Western blot was used to measure the expression of CHK1,CHK2,and CHK2T68 in xenografted tumors.Flow cytometry was used to analyze the cell cycle distribution and apoptosis of tumor cells in nude mice.The variance analysis was used to compare the mean of multiple groups,and the SNK-q test was used in the two two groups.Results The pMDC1-shRNA plasmid was successfully constructed and used to transfect ECA109 cells.ECA109-M cells were obtained by stable transfection with the recombinant plasmid.All inoculated nude mice survived with visible xenografted tumors at the underside of the paw in about one week.There was no swelling and wound in inoculation sites.There was no significant difference in tumor size between different groups (P＞0.05).The tumor growth in the ECA109 group and the ECA109-N group significantly slowed down after irradiation with a dose of 15 Gy (P＜0.05).Compared with the other two groups,the ECA109-M group had a significant smaller tumor size,significantly slower relative tumor growth,and significantly higher growth inhibition (all P＜0.05).The q value of the ECA109-M group was 1.36.In the ECA109-M group,there were no significant changes in the protein expression of CHK1 and CHK2 after irradiation (P＞ 0.05);however,the phosphorylation of CHK2T68 protein was significantly reduced after irradiation (P＜0.05).There were no significant differences in cell cycle distribution or the proportion of apoptotic cells in tumor tissue between the three groups (P＞0.05).Conclusions Inhibition of MDC1 protein expression by RNA interference can effectively inhibit the growth of xenografted tumors after irradiation in the nude mice by increasing their radiosensitivity.

Objective To apply RNA interference technique for reducing the expression of MDC1 gene in esophageal carcinoma cell line ECA109, observe the changes in cell cycle and radiosensitivity after radiation, and discuss related mechanisms. Methods Three pairs of effective interference sequences and negative control sequences were synthesized for MDC1 mRNA sequence, and a recombinant plasmid was constructed with the vector pSIH1?H1?copGFP. RT?PCR and Western blot were used to determine the expression levels of MDC1 mRNA and protein. Colony?forming assay was applied to measure radiosensitivity, flow cytometry to determine cell cycle, Western blot to determine the expression of CHK1 and CHK2 proteins, and laser scanning confocal microscope to observe the number of MDC1 blotches inside the nucleus. One?way analysis of variance was used to analyze the differences between groups. Results The pSIH1?H1?copGFP plasmid was constructed successfully and ECA109 cells were infected to obtain ECA109M cells with stable transfection. The expression levels of MDC1 mRNA and protein in ECA109M cells were lower than those in ECA109N and ECA109 cells ( P= 0. 032 and 0. 041, respectively ) . After 5?Gy radiation, ECA109M cells had a lower proportion of G2+M cells than ECA109N and ECA109 cells ( P=0. 026) . After 5?Gy radiation, ECA109, ECA109N, and ECA109M cells had similar expression levels of CHK1 and CHK2 proteins ( P= 0. 345 and 0. 451, respectively ) , and ECA109M cells had a lower expression level of CHK2 T68 protein than ECA109 and ECA109N cells ( P=0. 012) . ECA109 cells had a D0 value of 3. 06 Gy and an SF2 value of 0. 91;the D0 values for ECA109N and ECA109M cells were 2. 90 Gy and 1. 88 Gy, respectively, and the SF2 values for them were 0. 89 and 0. 84, respectively ( P=0. 021 and 0. 037, respectively ) . Conclusions RNA interference can reduce the expression levels of MDC1 protein and cell cycle?related proteins, release cell cycle arrest, and enhance radiosensitivity in esophageal carcinoma ECA109 cells.

Objective: To identify the relationship between the expression of protein tyrosine phosphatase non-receptor type 12 (PTPN12) and radiotherapy effect in non-small cell lung cancer (NSCLC) tissues and to determine whether PTPN12 deficiency can sensi-tize lung cancer cells to irradiation. Methods: From September 2013 to October 2014, 92 NSCLC patients undergoing radiotherapy with or without platinum-based combination chemotherapy were analyzed retrospectively. Before the treatment, PTPN12 expression was detected through immunohistochemistry. After the completion of radiotherapy, the patients' responses were assessed and radio-therapeutic efficacy analyzed. The human NSCLC cell line H1299 was infected with shPTPN12 knockdown, and colony survival assay was analyzed after irradiation. Chi-square test was used to examine the correlation between PTPN12 expression and clinicopathologi-cal characteristics. Univariate analyses and Logistic regression test were used to analyze the relationship between clinicopathological characteristics and radiotherapeutic response. Results: Patients with low PTPN12 expression were more sensitive to radiotherapy than those with high PTPN12 expression (80.0%vs. 57.1%, P=0.018). Multivariate analysis showed that PTPN12 expression was the on-ly independent predictor of radiotherapeutic response in NSCLC. The H1299-shPTPN12-knockdown cells were sensitive to irradiation. Conclusions:The results of the study indicated that downregulation of PTPN12 improved the radiosensitivity of NSCLC cells.

Objective To compare the failure pattern between esophageal cancer patients receiving definitive elective nodal irradiation (ENI) and involved-field irradiation (IFI) and to investigate the reasons and influential factors for locoregional recurrence and metastasis.Methods A retrospective analysis was performed on the clinical data of 245 patients with esophageal cancer who received definitive radiotherapy in our hospital from January 2006 to December 2012.One hundred and twenty-six patients received ENI,and the other 119 patients received IFI.Failure patterns were analyzed after treatment.Locoregional failures included local esophageal lesion uncontrol or recurrence and regional lymph node recurrence or metastasis.Distant metastases included distant organ metastasis and distant lymph node metastasis.Comparison of failure pattern between the two therapies was made by chi-square test.Results One hundred and sixty-three patients had failure after treatment.Locoregional failure was observed in 92 patients,distant metastasis in 36 patients,and locoregional failure plus distant metastasis in 35 patients.The 1-,3-,and 5-year overall failure rate for the ENI group were 35.4％,62.5％,and 69.0％,respectively,versus 46.5％,71.5％,and 81.5％ for the IFI group (P =0.036).The 1-,3-,and 5-year locoregional failure rates for the ENI group were 29.9％,48.4％,and 50.0％,respectively,versus 39.6％,62.1％,and 71.4％ for the IFI group (P =0.003).Conclusions For esophageal cancer patients receiving definitive radiotherapy,ENI can significantly reduce locoregional failures and increase locoregional control,thus improving the long-term survival.

Objective The aim of this study was to evaluate the prognosis of resection followed by chemotherapy compared with chemoradiotherapy for limited-stage small cell lung cancer .Methods The clinical data of 230 limited-stage small cell lung cancer patients with curative treatment between January 2006 and December 2011 were retrospectively analyzed .All patients divided to two group: the resection plus chemotherapy ( S +C ) and chemoradiotherapy ( R +C ) .And the prognostic factors were further analyzed with limited stage small cell lung cancer .The Kaplan-Meier method was used for the survival analysis.Results The overall survival rates of 1-year, 3-year and 5-year were 87.0%, 38.9%, 25.4%, respectively and the media survival time ( MST) 26.0 months.When patients were stratified by clinical stageⅠ+Ⅱ, the 1-year , 3-year and 5-year overall survival rates of S +C group and R +C group were 92.6%, 63.2%, 47.3%and 76.2%, 42.9%, 30.6%, respectively (χ2 =7.851, P<0.05), while those were 88.5%, 26.9%, 10.6% and 86.0%, 25.1%, 25.1%, respectively in stage ⅢA with no significant difference ( P >0.05).In univariate analysis, tumor location, tumor stage, lymph node metastasis, TNM stage, the cycle of chemotherapy , treatment modalities were significantly associated with survival ( RR=1.735, P<0.05).The multivariate analysis only showed TNM stage were independent factors of prognosis .Conclusions The results suggested that resection plus chemotherapy could improve the prognosis of early-stage(stageⅠ+Ⅱ) small cell lung cancer, but patients in ⅢA stage should received the definitive chemoradiotherapy .The TNM stage was still the independent factor of prognosis .

ObjectiveTo analyze the outcomes and prognostic factors of advanced esophageal carcinoma treated by three-dimensional conformal radiotherapy (3DCRT).MethodsFrom Jul 2001 to Dec 2006.375 patients with esophageal carcinoma treated by 3DCRT were retrospectively analyzed of which Ⅰ stage 9,Ⅱ stage 106,Ⅲ stage 158,Ⅳstage 102.The short-term effect,1-,3-,5-year local regional control rates and survival rates were investigated.The local regional control rates and survival rate were calculated by the Kaplan-Meier method. Univariate prognostic factor was analyzed by Logrank method.Multivariate prognostic factor was analyzed using Cox regression model.ResultsThe follow-up rate was 94.7％.The numbers of patients followed-up with 5 years was 191.The 1-,3-and 5-year local control rates were 80.5％,53.7％,44.9％respectively.The 1-, 3-and 5-year survival rates were 67.2％,29.4％,19.0％respectively.Univariate analysis showed the significant prognostic factors included the degree of dysphagia,tumor length,the largest diameter of lesion in CT image,T stage,N stage,clinical TNM stage,grades of acute radiation-induced esophagitis and grades of acute radiation-induced pneumonery ( x2 =46.75,18.52,30.24,42.53,32.71,75.68,7.13,4.64,P =0.000,0.000,0.000,0.000,0.000,0.000,0.008,0.031 ).Multivariate analysis revealed tumor length,clinical TNM stage,chemotherapy and grades of acute radiationinduced esophagitis were independent prognostic factors (x2 =6.70,18.00,4.87,1.1 8,P =0.030,0.000,0.027,0.011 ).Conclusions3DCRT is effective and feasible in treatment of the advanced esophageal carcinoma.Tumor lesion length,clinical TNM stage,chemotherapy and grades of acute radiation-induced esophagitis are independent prognostic factors for survival of patients.

This study aims to determine a reasonable clinical staging standard for patients with esophageal carcinoma who were receiving non-surgical treatment. The patients were staged on the basis of the (2004 and 2009 editions of clinical staging stan-dards. The prognosis of patients with different staging standards, as well as the effect of gross tumor volume-tumor (GTV-T) on clinical T stage and prognosis, was observed. Methods:Data on 219 patients with esophageal carcinoma who were receiving radical radiothera-py were retrospectively analyzed. Prior to radiotherapy, all patients underwent examinations, including esophageal barium meal and po-sitioning CT scan, for use in the radiation treatment planning system to outline the target range and to calculate the volume of GTV-T. All patients were staged with the use of the aforementioned clinical staging standards. Prognostic outcomes of the patients were ob-served. Results:For all patients, the one-, three-, and five-year overall survival rates were 70.8%, 35.6%, and 20.7%, respectively. The survival curve resolution of patients who were staged with the use of the 2009 edition of clinical staging standards was better than that of the patients who were staged with the use of the 2004 edition. Survival difference was significant (χ2=29.497, P<0.001). The clinical T stage positively correlated with GTV-T (r=0.615, P<0.001). GTV-T could thus affect prognosis at different T stages. Conclusion:Both esophageal carcinoma clinical staging standards could reflect the prognosis of patients undergoing radiotherapy, but the 2009 edi-tion appeared more accurate than the 2004 edition.