Objective To evaluate the efficacy and safety of S-1 combined with synchronous three-dimensional conformal radiotherapy in the treatment of elderly patients with esophageal cancer.Methods 80 elderly patients with esophageal cancer were randomly divided into control group and the combination group,40 cases in each group.Three-dimensional conformal radiotherapy was applied in the two groups with a total dose of DT 60-64 Gy/ 30-32f.Patients in the combination group received S-1 chemotherapy concurrent with the radiotherapy on the first day.S-1 was orally given 80mg/m2 daily after meals from d1 to d14,21 days as a cycle and treated for 2 cycles.Results The total effective rate (CR + PR) of the combination group was 87.5％,that was 62.5％ of the control group,and there was statistically significant difference between the two groups (x2 =6.667,P =0.01).The one year overall survival rate of the two groups was 77.5 ％ and 57.5 ％,respectively,the difference was not significant (P =0.056).The incidence rate of hematological toxicity was higher in the combination group than that in the control group,but the toxic reaction was mild and tolerable.Conclusion The short-term curative effect of S-1 combined with three-dimensional conformal radiotherapy is feasible for elderly patients with esophageal cancer,and the toxicity is tolerable.

The radioactive iodine uptake(RAIU) has great value in determining the 131I treatment dosage of patients suffered from hyperthyroidism and judging thyroid function. Many factors which could interfere the results of RAIU were as follows: instrumental factors, thyroid radioactivity counts measurement, counts of a calibrated standard in a neck phantom and counts of room background, iodinated drugs and food, anti-thyroid medication, among other causes, have shown to induce varying degrees of errors in RAIU measurements. Irregular measurements which may interfere with radioactive iodine uptake are commonly seen in clinical practice, yet its actual influence has not been reported. Optimization, regularization and quality control of the radioiodine uptake measurement are essentials for clinical routine practice to guarantee appropriate values for clinical hyperthyroidism diagnosis and treatment. All the above factors affecting the measurement of thyroid function instrument for radioactive iodine uptake are analyzed and then put forward the corresponding solutions.

Objective To investigate the potential of AFP-targeted ultrasmall superparamagnetic particles of iron oxide (USPIO) molecular probe in specific detection of hepatocellular carcinoma (HCC) with MRI.Methods The targeted probe was synthesized by conjugating AFP antibody with modified USPIO.Two groups treated with AFP-USPIO and USPIO were set up in the study.The HepG2 cells were incubated with AFP-USPIO or USPIO (100 μg/ml) respectively with the dosage of 50 μ1,100 μl or 150 μl for 4 hours,followed by MR imaging in vitro.The signal-noise ratio (SNR) of the cells on T2-weighted image (T2WI) was measured.The rat models with orthotopic HCC were divided into two groups with 5 rats for each group at random.Pre-and post-contrast enhanced (after 1 hour) MR imaging were performed with caudal vein injection at a dosage of 20μg/ml.The contrast noise ratio (CNR) on T2WI and the difference of CNR between pre-and post-enhancement or between both groups were calculated.The relationship of SNR or CNR with the iron particles in cells or tumors was confirmed by Prussian blue iron staining.Results Cytology experiment showed the SNR in both groups was decreased with the increase of the dosage of AFP-USPIO or USPIO,indicating statistically significantdifference in SNR among three different doseage groups (P＜0.05).Prussian blue iron staining showed that the iron particles in cells were increased with the increase of AFP-USPIO dosage,and was negatively correlated with SNR (P=0.00,r=-0.926).However,the iron particles were less in cells in USPIO group.The CNRs of liver tumors in Wistar rat of pre-and post-AFP-USPIO injection were 2.05±0.88 and 0.96±0.31 respectively,indicating a significant difference (P=0.028,t=3.380).However,the CNRs in USPIO group,2.25±1.50 and 2.57±1.49,showed no statistical difference (P=0.275,t=1.263).The CNR after enhancement also had a statistical difference between both groups(P=0.042,t=3.487).Pathological results confirmed more iron particles in tumor tissues in AFP-USPIO group,whereas less in USPIO group.Conclusion AFP-USPIO molecular probes can initiatively target to the HepG2 cells and the liver cancer of rat models expressing AFP,which may help to achieve the specificity of MR imaging in the diagnosis of HCC.

Objective To investigate the biological effects of insulin resistance(IR)on the porcine granulosa cells which iS induced by wortmannin,the PI-3K inhibitor and mediated by key molecules including GLUT4 and MAPK during insulin signaling.Methods The model of IR porcine granulosa cell was established in in vitro culture by treatment of wortmannin,and was assessed the amount of3H glucose uptake as well as medium glucose levels by glucose oxidase method.The protein and mRNA expression of GLUT4 and MAPK were evaluated by immunofluorescence and RT-PCR respectively.Resuits The glucose intake was decreased by 40% with treatment of wortmannin at 1.5 μmol/L(P＜0.05).GLUT4 and MAPK were localized mainly to cytoplasm of grantdose cells.When granulosa cells were insulin resistant,the expression of GLUT4 was down-regulated whereas MAPK was up-regulated as compared with the controls.Conclusions Wortmannin treatment can lcad to decreased expression of GLUT4 and increase of IR granulose cells.This metabolic phenotype could induce increased expression of MAPK and mitogenic potential,indicating the cross-talk between two pathways of insulin signaling within ovarian cells.

Objective To evaluate the influence of inappropriate position deviation on radioactive iodine uptake (RAIU),effective half-life (Teff) and the corresponding dose variances in patients suffering from Graves hyperthyroidism.Methods RAIU was examined in 20 patients with Graves hyperthyroidism (7 males,13 females,average age (46.60 ±9.55) years) 2,4,6,and 24 h after intake of the radioiodine capsule.A scintillation probe was positioned at the center of the inferior edge of the thyroid cartilage 25 cm away for 2 min,which was defined as the standard manipulation (test 1).Then,the probe was moved either 5 cm backward (test 2) or 5 cm higher (test 3) compared with test 1.Variants of RAIU,Teff as well as dose calculations were acquired by different combinations (CⅠ-Ⅸ) of 4 h and 24 h-RAIU,according to the above 3 manipulations (C Ⅰ-Ⅲ:test 1 for RAIU4 h,test 1,2,3 for RAIU24 h respectively ; C Ⅳ-Ⅵ:test 2 for RAIU4h,test 1,2,3 for RAIU24h respectively; CⅦ-Ⅸ:test 3 for RAIU4h,test 1,2,3 for RAIU24h respectively).Paired t test was used to compare the statistical differences between C H-Ⅸ to C Ⅰ.Results RAIU24 h of test 2 (68.08％ ± 7.88％) and test 3 (62.18％ ± 7.45％) were significantly lower than that of test 1 (78.05％ ± 8.31％ ;t =12.15,14.37,respectively,both P ＜ 0.01).Teffs of C Ⅱ (4.42 ± 0.73) d,CⅢ(3.76 ±0.53) d,CⅤ(5.59 ±0.46) d,CⅥ(4.47 ±0.44) d,CⅧ(5.94 ±0.54) d and CⅨ (5.45 ±0.66) d were significantly different from that of C Ⅰ (5.04 ±0.56) d which was defined as standard (t:3.86-13.64,all P ＜0.01).Among the 180 131I dose values calculated by different Teff and RAIU values induced from C Ⅰ-Ⅸ combinations,74.4％ (119/160) were over-calculated while 9.4％ (15/160) were under-calculated.Taking one patient as an example,the changes of RAIU24 h (decreased up to 26.0％) and the percentage of Teff deviation(66.9％,ranged from-47.5％ to 19.4％)led to an over-calculated 131 I dosage by as high as 129.8％ compared with CⅠ.Conclusions Incorrect positioning in RAIU detection could result in various false RAIU,Teff and 131I dose calculations.Such deviations could possibly exert an impact on the patients' therapeutic outcomes,thus influencing the efficacy of the iodine therapy.Optimization of RAIU positioning is essential for clinical practice to guarantee radioiodine dose management.

Purpose To exp1ore the c1inicopatho1ogica1 features,diagnosis and differentia1 diagnosis of mu1ti1ocu1ar cystic rena1 ce11 carcinoma( MCRCC). Methods 18 cases of MCRCC were reported by microscopy,immunohistochemistry,differentia1 diagnosis and were fo11owed-up. Results A11 patients were adu1ts inc1uding twe1ve ma1es and six fema1es who aged from 26 to 68 years(mean 55. 6 years). Imaging studies revea1ed a po1ycystic mass,with c1ear boundary. Gross1y,the cut surface of the tumors had more cysts of va-rying sizes,containing serous or b1oody f1uid. Microscopica11y,the cyst wa11s of tumors were often covered with a few simp1e c1ear ce11s,stratified epithe1ium or devoid of epithe1ium. The septa contained aggregates of epithe1ia1 ce11s with transparent cytop1asm which showed gradeⅠ nuc1ear features,these characteristics were diagnostic c1ues of MCRCC. Immunohistochemica11y the c1ear ce11 was positive for CD10,vimentin,EMA and Ki-67 showed 1ow pro1iferative activity. 18 case were fo11owed up,mean fo11ow-up 43 months, no case recurred or with metastasis. Conclusion MCRCC is a rare histo1ogica1 subtype of rena1 ce11 carcinoma with more favorab1e prognosis. It shou1d be distinguished from cystic change of c1ear ce11 rena1 carcinoma and cysts of kidney 1esion.

Objective:To evaluate 131I adjuvant therapy in B-Raf proto-oncogene, serine/threonine kinase (BRAF) V600E mutant patients with non-distant metastatic papillary thyroid cancer (PTC). Methods:From January 2008 to January 2019, a total of 181 PTC patients (65 males, 116 females, age: (38.9±11.8) years) with non-distant metastases from Peking Union Medical College Hospital were retrospectively enrolled. All patients received only one time 131I therapy with complete clinicopathological information, data of follow-up (median time: 63 months) and assessment of response to therapy. Patients were divided into mutant and wild type group in terms of BRAF V600E status or ablation group (1.1 GBq) and adjuvant therapy group (3.7-5.5 GBq) in terms of different 131I dosage. Clinicopathological features and the response to therapy were compared between different groups by using independent-sample t test, Mann-Whitney U test and χ2 test. Results:The levels of preablative stimulated thyroglobulin (ps-Tg) in the BRAF V600E mutant type group ( n=150) was significantly higher than that in the wild type group ( n=31; 6.32(0.90, 8.70) vs 3.92(0.40, 4.40) μg/L; z=-2.413, P=0.016), however, there were no significant differences in other clinicopathological characteristics (including age, sex, tumor size, multifocality, capsule invasion and N staging) between the two groups ( t=-0.663, z=-1.151, χ2 values: 0.003-1.491, all P>0.05) and the therapeutic response was also not different between the two groups( χ2=1.094, P=0.778). Of 81 patients who received 131I adjuvant therapy, the ps-Tg level of BRAF V600E mutant type group ( n=69) was higher than that of the wild type group( n=12; 8.70(1.30, 11.80) vs 3.40(0.30, 4.50) μg/L; z=-2.194, P=0.028), while the therapeutic response was not different between the two groups ( χ2=1.792, P=0.617). Compared with BRAF V600E mutant patients received 131I ablation ( n=81), BRAF V600E mutant patients received 131I adjuvant therapy ( n=69) had larger tumors (1.52(0.95, 2.00) vs 1.21(0.60, 1.50) cm; z=-2.728, P=0.006), more advanced N staging ( χ2=11.460, P=0.003) and higher ps-Tg level (8.70(1.30, 11.80) vs 4.34(0.50, 5.30) μg/L; z=-3.314, P=0.001), but the therapeutic response was not different between the two groups ( χ2=6.478, P=0.091). Conclusion:131I adjuvant therapy may improve the longer-term response to therapy in BRAF V600E mutant PTC patients with lager tumors, more advanced N staging and higher ps-Tg level.

Objective To investigate the clinical effect of ropivacaine hydrochloride at 0.25%, 0.375% and 0.5% concentration for lower limb nerve block anesthesia.Methods75 cases of lower extremity nerve block anesthesia from Ningbo Zhenhai District Hospital of traditional Chinese Medicine from September 2014 to February 2015 were enrolled in the course of the study, they were divided into three groups: group 0.25%, the equivalent number of 0.375% and 0.5% groups, and three groups of patients were made with a concentration of 0.25%, 0.375%, 0.5% ropivacaine hydrochloride for lower extremity nerve block anesthesia;the clinical data of three groups were analyzed retrospectively, observation of three groups of patients with lower limb nerve block effect.ResultsThe results showed that 0.25% groups of patients in the motor block time was (36.8±5.9) minutes, motor block in patients with a total of 7 cases, with nerve block in patients with a total of 11 cases.0.375% groups of patients in the motor block time was (23.1±4.3) minutes, motor block in patients with a total of 14 cases, with nerve block in patients with a total of 18 cases.0.5% groups of patients in the motor block time was (20.6±5.7) minutes, motor block in patients with a total of 16 cases, with nerve block in patients with a total of 18 cases.Available block time of 0.375% groups of more than 0.5% groups, less than 0.25% groups;0.375% motor block group was 56.0%, higher than the 0.25% group, lower than the 0.5% group;the 0.375% group and 0.5% group of nerve block ratio is same, higher than the 0.25% group, the difference was statistically significant (P<0.05).ConclusionThe effect of anesthesia using concentration of 0.375% ropivacaine hydrochloride is relatively good, can reduce the dosage of anesthetic drugs, but also ensure the anesthetic effect, meet the clinical requirement, this method will be applied to.

Objetctive To summarize the associated complications with circulatory support device,and provide reference for chnical practice.Method A total of 8306 consecutive patients who underwent open heart surgery,in Department of Post-operation Intensive Care Unit of the Cardiac Surgery,Anzhen Hospital,Capital Medical University,was retrospectively studied from January 2005 to February 2007.And the clinical data of 246 patients including 63 female and 183 male patients with mean age 56.7±14.2 years supported with various circulatory support devices for perioperative cardiorespiratory function failure in ICU were analyzed.Left ventricular assist device (LVAD) was used in 3 patients by the cannulation of the left alritan and ascending aorta.The extracorporeal membrane oxygenation(ECMO) was established in 48 patients for postoperative cardiorespiratory function failure.The vencarterial bypass was established by cannulation of the right atrium in 41 patients and femoral artery and of venovenons in 2 patients,and of the right atrium and ascending aorta in 5 cases,lntra-aortic balloon pumping(I-ABP)was performed via the femoral artery either percutaneonsly by the Seldinger technique in 195 patients.The cardiac operations included coronary artery bypass grafting (n=170),coronary artery bypass grafting with romoldingof left ventricle (n = 22),coronary artery bypass grafting with valvular operation (n=10),valvular operation (n=27),heart transplantation(n=8),correction of congenital heart defects(n=6),aortic operations(n=2).The duration of circulatory support ranged from 4 to 451 hours.Correlative complications of 3 kinds of circulatory support device were compared and repair of ventricular septal perforation in the wake of acute myocardial infarction (n=1).Results Seventy-eight (31.7%) patients died.Seventy-one(28.9% ) patients devdoped various complications including infection(n=27),renal failure required renal rephcement therapy (n=27),re-exploration for bleeding(n=24),haemolysis(n=6),limb ischemia(n=15),neurological complications(n=6),oxygenator failure(n=7) Conchusions The improvement of management to reduce complications may result in improved outcomes of patients supported with circulatory support devices.

Objective To observe the effect of sodium butyrate on the invasion and migration of human salivary gland ade‐noid cystic carcinoma cell line ACC‐2 in vitro and to investigate the underlying mechanisms .Methods The cultured ACC‐2 cells were treated with different concentrations of sodium butyrate for 24 h ,and detected the viability rate of the cells by methyl thiazolyl tetrazolium(MTT) assay ;the drug′s influence on invasion and migration on ACC‐2 were detected by Transwell experiment ,while the protein and mRNA expression of HMGB1 and TLR4 explored by Western‐blot and RT‐PCR assay ;the relationship between TLR4 expression and HMGB1 was investigated .Results Compared with control group ,0 .625 ,1 .250 ,2 .500 ,5 .000 ,10 .000 mmol/L groups of sodium butyrate inhibited the proliferation of ACC‐2 cells(P<0 .05);the influence of sodium butyrate on the in‐vasion of ACC‐2 cells of all groups had no significant difference(P>0 .05);only 2 .500 ,5 .000 and 10 .000 mmol/L groups inhibited ACC‐2 cells migration and down‐regulated the protein and mRNA of HMGB1 and TLR4(P<0 .05) .Correlation analysis showed a positive correlation between the TLR4 protein and HMGB1 protein(r=0 .810 ,P<0 .05) .Conclusion Sodium butyrate could inhib‐it ACC‐2 cells proliferation and high concentration gropes inhibit ACC‐2 cells migration ,while reducing HMGB1 and TLR4 mRNA and protein expression ,suggesting that NaB might inhibite ACC‐2 cells migration through down‐regulated the mRNA and protein expression .