Objective To explore the therapic effect of the combination of endovascular embolization and clinical hormone in treatment of Kasabach-Merritt phenomenon (KMP),and analyze the advantages.Methods Six cases with KMP from May 2010 to June 2012 were retrospectively analyzed.All the patients underwent large dose hormone shock therapy after admission for 7-10 d.Subsequently,selective endovascular embolization was performed using Seldinger technique under general anesthesia Then,the hormone therapy was continued for 2 weeks after embolization.The platelet count and the effect were recorded.If the area of the tumor reduction is less than 50％,3-4 courses of local hardening treatment was conducted for the residual tumor.The local treatment used multipoint puncturing of the tumor and injection drugs under X-ray fluoroscopic monitoring until the tension of local vascular increased.Results On DSA,the lesions of all the 6 cases showed rich blood supply with a large number of hybrid distribution of tumor blood vessels.The lesions disappeared in 4 cases after 1-2 weeks combination therapy and no recurrence for 0.5-1.0 year follow-up.Two cases whose tumor reduced less than 50％ after combination therapy received local hardening treatment,and faded after 3-4 courses.The number of platelet for all patients kept normal and the spirit of the patients showed great improvement,the bleeding tendency and local soft tissue swelling was in remission.Subcutaneous blood stasis and petechiae disappeared.There were no serious adverse reaction and complications.Conclusion Combination therapy with endovascular embolization and clinical hormone for Kasabach-Merritt phenomenon has a good curative effect.

Objective To study the geometric difference between six different ITV generation methods from 4DCT for patients with non?small cell lung cancer ( NSCLC) treated with stereotactic ablative radiotherapy technique ( SABR) . Methods Between Dec. 2013 and Mar. 2014,16 patients were enrolled in this retrospective study. All patients underwent imaging with 4DCT scans. The MI and DI index were evaluated between six ITV generation methods:combining GTV from all 10 respiratory phases ( ITV10 );combining GTV from four respiratory phases, including two extreme phases ( 0% and 50%) plus two intermediate phases ( 20% and 70%) ( ITVYeo ) which was proposed by Seung?Gu Yeo of Soonchunhyang University;combining GTV from two extreme phases ( ITVEI+EE ) . And combining GTV from five odd phases (10%,30%,50%,70%,90%)(ITVodd).Accordingly the ITVEVEN which was combined from the remaining five even phases (20%,40%,60%,80%,0%),and ITVAVG,ITVMIP were contoured from two reconstructed 4DCT sequences,finally,a method which was not sensitive to the tumor volume and motion characteristic was selected for clinical use. Data were compared using a variance analysis followed by Student?Newman?Keulsa test both in same group or between groups. At the same time, the volume and the three dimensional movements of the tumor, the relativity of MI and DI were analyzed by Multi?parameter regression analysis. Results The mean (range) tumor motion (RLR,RAP,RCC,and R3D) are 3. 5 mm (1. 4?8. 4 mm),4. 5 mm (1. 1?8. 6 mm),9. 5 mm (0?10 mm),12. 3 mm (2. 5?55. 3 mm) respectively. The IGTVx volume are Underestimated by 25. 7%,35. 6%,17. 9%,12. 8%,3. 6%,4. 8%( P=0. 000) respectively. The MI index comparisons between six ITV generation methods and ITV10 showed statistical significance:0. 69,0. 62,0. 80, 0. 86,0. 93,0. 91 ( P=0. 006 ) . The DI index showed no statistical significance:0. 98, 0. 98, 0. 97, 0. 97, 0. 99,0. 98(P=0. 130).The tumor size and motion amplitude were certified not the independent factors for the MI index of ITVodd and ITVEVEN . Conclusions IGTVODD/EVEN based on odd or even 4DCT phases is not sensitive to the tumor size or motion characteristic and is proved to have a good marching with ITV10 meanwhile maintaining a reasonable contouring efficiency,it can be recommend to the institutions which was not equipped with the deformable registration systems.

Objective To explore the relationship between serum nerve growth factor(NGF)and neurofil-amentlight-chain(NF-L)levels with the severity and prognosis of traumatic brain injury(TBI)patients,as well as their predictive value through a prospective research.Methods A total of 132 TBI patients and 132 ordinary trauma patients were collected as the observation group and the control group,respectively.TBI pa-tients in the observation group were divided into three subgroups of mild,moderate,and severe according to Glasgow Coma Scale(GCS)scores,and they were also divided into good and poor subgroups according to Glasgow Outcome Scale(GOS)scores at 6-month follow-up.Enzyme-linked immuno sorbent assay(ELISA)was used to detect serum NGF and NF-L levels in all patients after admission.Through comparison between the observation group and the control group,the relationship between TBI and serum NGF and NF-L levels was clarified.By comparing the differences between different subgroups of the observation group,the relation-ship between serum NGF and NF-L levels and the severity and prognosis of TBI was determined.Through correlation analysis,receiver operating characteristic(ROC)curve and multivariate Logistic regression analy-sis,and the predictive value of serum NGF and NF-L levels for TBI was clarified.Results Compared with the control group,serum NGF and NF-L levels were significantly increased while GCS scores were significantly decreased in the observation group(P＜0.01).In addition,serum NGF and NF-L levels gradually increased a-mong subgroups of mild,moderate,and severe groups in the observation group(P＜0.01).The area under the curve(AUC)of serum NGF and NF-L levels for predicting mild TBI were 0.924(95％CI:0.889-0.986)and 0.991(95％CI:0.982-1.000),and the cut off values were 12.5 ng/mL and 66.5 μg/mL,respectively.AUC of serum NGF and NF-L levels for predicting moderate TBI were 0.776(95％CI:0.686-0.862)and 0.837(95％CI:0.763-0.911),respectively,and AUC for predicting severe TBI was 0.950(95％CI:0.900-0.987)and 0.988(95％CI:0.971-1.000),respectively,with cut off values of 14.5 ng/mL and 157.0 μg/mL,respec-tively.Spearman correlation analysis showed that serum NGF and NF-L levels were negatively correlated with GOS scores of TBI patients(P＜0.01).AUC for predicting the prognosis of TBI patients with serum NGF and NF-L levels were 0.858(95％CI:0.776-0.932)and 0.909(95％CI:0.824-0.978),respectively,with cut off values of 13.5 ng/mL and 71.5 μg/mL,respectively.Logistic regression analysis showed that serum NGF and NF-L levels were risk factors affecting the prognosis of TBI patients.Conclusion Serum NGF and NF-L levels are significantly elevated in TBI patients and could provide reference for early assessment of inju-ry severity in clinical practice.Furthermore,elevated serum NGF and NF-L levels are associated with poor prognosis of TBI patients and are good biological indicators for predicting prognosis.

Purpose To explore the pathological features of angioimmunoblastic T-cell lymphoma(AITL)with bone marrow involvement and to improve awareness of bone marrow infiltration in AITL.Methods The tissue morphology of 32 cases of AITL with bone marrow involvement was retrospectively analyzed.Im-munohistochemistry using the EnVision method and ten-color flow cytometry were conducted to detect AITL-related immune markers.T cell clonality was analyzed through T cell receptor(TCR)gene rearrangement.Results The predominant pat-terns of tumor cell infiltration were nodular(20/32,62.5％)and interstitial or small clusters(10/32,31.3％).The nodules showed a mixture of cellular components.In some cases,the fo-ci contained a mixture of cells with characteristic"granuloma-toid"changes.The tumor cells were mainly small to medium-sized lymphocytes with inconspicuous atypia.Some cases showed plasma cell proliferation.19 cases were subject to immunohisto-chemical staining,which revealed a low count of CD4-positive T cells,with an average of 8.4％.The positive rates of T follic-ular helper cells(TFH)markers were as follows:CD10(7/14,50.0％),BCL6(6/19,31.6％),PD-1(13/19,68.4％),and CXCL13(13/19,68.4％).In most cases,tumor cells showed co-expression of PD-1 and CXCL13,but the number of positive cells was less than 1％.Flow cytometry analysis was performed in 24 cases,among which 22 cases all consistently expressed cytoplasmic CD3(cCD3),CD5,CD4,and CD2,with varying degrees of CD10 expression.In some cases,there was a lack of expression of surface CD3(sCD3)(12/22,54.5％),while there was a lack of expression of CD7(8/22,36.4％).and no abnormal T cells were found in 2 cases.TCR gene rearrangement analysis was performed in 7 cases,with 3 cases showing TCR clonality.Conclusion AITL with bone marrow involvement exhibits a lower proportion of tumor cells and less atypia,making it prone to misdiagnosis.The presence of lymphocytic foci with mixed cellular components in the bone marrow can indicate bone marrow involvement in AITL.Flow cy-tometry detection of abnormal T cells(double positive for CD4 and CD10)strongly suggests bone marrow infiltration in AITL.A comprehensive diagnosis of bone marrow involvement in AITL re-quires consideration of bone marrow biopsy,flow cytometry,and TCR gene rearrangement analysis.