Objective To study the relation between Child Turcotte classification and pathology, diagonsis, prognosis and fibrosis index as well as its significance. Methods The levels of hyaluronic acid(HA), type Ⅲ procollagen(PCⅢ), Laminin(LN) and type Ⅳ collagen(Ⅳ C) were detected by enzyme linked immunoadsordent assay(ELISA) or radioimmunoassay(RIA). Pathomorphology was observed in 68 patients with cirrhosis. Results Level of HA in serum was positively correlated with cirrhotic severity, but other fibrosis indexes could not reflect cirrhotic severity. Child Turcotte classification was concordant with the pathological changes. The concordance rate of Child Turcotte classification B or C patients with pathologic diagnosis was up to 97.8%. The recovery rate of Child Turcotte classification A patients was up to 95.5%. Fatality rate of Child Turcotte classification C patients was up to 96.9%. Conclusion Child Turcotte classification is closely correlated with the severity of hepatic fibrosis, severity of pathological changes in liver and prognosis of patients. It is of clinical value in the reflection of severity of hepatic cirrhosis.

Chemotherapy, molecular targeted therapy, and hormonal therapy are essential components of medical oncology. Al-though cancer patients significantly benefit from the emergence of various new anticancer drugs, none of these treatments can directly address drug resistance. Radiation therapy is one of the three conventional cancer treatment methods. Nearly two-thirds of cancer pa-tients accept radiation therapy during treatment. However, radiation resistance is a significant barrier affecting the therapeutic effect of this procedure. Epithelial–mesenchymal transition (EMT) is a biologic process that enables a polarized epithelial cell to undergo multi-ple biochemical changes. These changes enable the cell to assume the functions of a mesenchymal cell phenotype. These functions have been extensively studied and are related to embryogenesis, tumor invasiveness, and metastasis. In recent years, increasing evidence sug-gests that EMT is closely linked with tumor treatment resistance. The study of the relation between EMT and tumor treatment resistance is expected to contribute to the prevention of drug resistance and radiation resistance and thus improve treatment efficacy to provide benefit to cancer patients. This article explores this issue.

Small cell lung cancer ( SCLC ) is one common type of lung cancer in China. No remarkable progress has been made in systemic therapy for SCLC since the 90’ s. However, there are some advances in radiotherapy ( RT) for SCLC, which make it possible to improve treatment outcomes of SCLC. Those advances are mainly made in thoracic RT and prophylactic cranial irradiation for extensive?stage SCLC, radiation dose and technology of thoracic RT for limited?stage SCLC, and significance of prophylactic cranial irradiation for early?stage SCLC. The paper reviews the research advances in the East and West to provide some help and references for readers.

Objective To evaluate the potential role of the separately p73 gene polymorphism on hepatocellular carcinoma(HCC) susceptibility.Methods A hospital-based case-control study was conducted in 100 cases HCC patients and 100 cases age,sex-matched cancer-free controls in the same region.The matrix-assisted laser desorption ionization time-of-flight mass spectrometry and DNA sequencing methods were used to analyze polymorphisms of p73 genetic polymorphisms (G4C14-A4T14).Using χ2 test to exam the differences of genotype between the HCC group and control group,logistic regression was used to analysis odds ratio(Oddsratios,OR) and 95%CI(Confidence Intervals,CI),adjusted for age and sex,analysis the association between SNPs of P73 polymorphisms and HCC.All the results were analyzed by SPSS 18.0.Results (1)The differences of age(χ2=0.185,P=0.667),gender(χ2=0.026,P=0.873),drinking status(χ2=0.427,P=0.514),and family history (χ2=0.058,P=0.809)of cancer composition between HCC group and control group were not statistically significant.(2)There were CC,CT and TT three genotypes in p73 rs1801173 C/T.The frequencies of CC,CT and TT genotypes of P73 C/T in controls and HCC cases were 65.0%,28.2%,6.8 % and 62.2%,31.1%,6.7%,respectively,and there was no significant difference between the two groups(χ2=0.326,P=0.568).(3)When stratifying by age,gender,smoking status,alcohol consumption,HBV carrier status and family history of cancer we found that the variant genotypes of GC/AT + AT/AT in P73 was associated with a significantly increased risk of HCC among HbsAg-positive individuals(χ2=3.916,P=0.048) and female(χ2=6.545,P=0.01),and there were no significant correlation with age,smoking,alcohol consumption,family history of cancer.Conclusion (1)p73 G4C14-to-A4T14 dinucleotide polymorphism may play a role in the development of chronic HBV-infected HCC in the Chinese population.(2)p73 G4C14-to-A4T14 dinucleotide polymorphism may play a role in the development of chronic HCC in female of Chinese population.

Objective To investigate the prevalence of dyslipidemia in elderly population.Methods In 2004,862 elderly population in medical examination were studied.Serum cholesterol,triglyceride,high-density lipoproteins(HDL) and low-density lipoproteins(LDL) were measured.Results Cholesterol,triglycerides,HDL cholesterol and LDL cholesterol levels in women were significantly higher than men(P

Objective To evaluate the therapeutic effects of endoscopic biliary double stents for advanced malignant hilar biliary obstruction.Methods From January 2007 to December 2010,double stents was attempted in 28 patients (15 men and 13 women,median age 66.4 years (44-88 years),including 9 with Bismuth Ⅱ,8 with type Ⅲa,5 with type Ⅲb and 6 with type Ⅳ.A total of 23 consecutive patients ( 11 men and 12 women,median age 65.8 years (42-83 years) with malignant hilar obstruction undergoing a therapy with single stent were recruited as the control group,including 7 with Bismuth Ⅱ,5 with Ⅲa,6 with Ⅲlb and 5 with Ⅳ.The rates of successful drainage,complications,mean survival time of patients and the average duration of biliary stent patency were compared between the two groups.Results Successful rate of cannulation was both 100％ in the two groups.Successful rate of drainage and complications of double stent group were 96.4％ (27/28) and 17.9％ (5/28),and these two variables of single stent group were 87.0％ (20/23) and 13.0％ (3/23),which were not significantly different (P ＞0.05).23 patients (82.1％ ) in double stent and 19 ( 82.6％ ) in single stent group were followed up.The average duration of stent patency and mean survival time of double stent group were ( 129 ±48.5) d and ( 187 ±94.5) d,which were superior to those of the single stent group,i.e.( 102 ±37.8) d and ( 103 ±98.5) d.Conclusion Double stenting is an effective therapy for malignant hilar obstruction of Bismuth Ⅱ and above.It is superior to single stent method in the mean duration of patency and mean survival time.

Objective To evaluate the clinical efficacy and toxicities of radical intensity-modulated radiotherapy (IMRT) combined with reduction in dose of prophylactic irradiation in the treatment of stage Ⅲ small cell lung cancer (SCLC).Methods A retrospective analysis was performed on the clinical data of 40 patients with stage Ⅲ SCLC who were admitted from January 2010 to August 2012.The prescribed dose was 60 Gy in 30 fractions to the primary gross tumor volume and was 54 Gy in 30 fractions to the planning target volume.All patients received induction chemotherapy,31 patients received adjuvant chemotherapy,and 22 patients received concurrent chemoradiotherapy;the platinum-based chemotherapy combined with etoposide or teniposide was adopted.Prophylactic cranial irradiation (25 Gy in 10 fractions) was administered to 17 patients.The short-term tumor response was evaluated by RECIST 1.0,and radiation-related toxicities were assessed by CTCAE 4.0.Overall survival (OS),local recurrence-free survival (LRFS),and progression-free survival (PFS) were calculated by Kaplan-Meier method.Results The short-term tumor response rate was 98％.The follow-up rate was 100％.Twenty-two patients were followed up for at least 2 years.The 1-and 2-year OS rates were 84％ and 48％,respectively; the LRFS rates were 89％ and 85％,respectively; the PFS rates were 61％ and 41％,respectively.Grade 0-1 radiation-related pneumonia was observed in 65％(26/40) of all patients,grade 2 in 25％ (10/40),grade 3 in 5％ (2/40),and grade 5 in 5％ (2/40).Grade 0-1 radiation-related esophagitis was observed in 53％ (21/40) of all patients,grade 2 in 43％ (17/40),and grade 3 in 5 ％ (2/40).Conclusions Preliminary results from this study suggested that IMRT combined with reduction in dose of prophylactic irradiation is safe and effective in patients with stage Ⅲ SCLC and is worth further evaluation in a large,prospective,randomized study.

Objective To quantify the incidental irradiation dose (ⅡD) to lymph node stations of esophagus when treating patients with T1-4N0 M0 thoracic esophageal squamous cell carcinoma (ESCC) with a dose of 60 Gy/30f.Methods Twenty-nine patients with medically inoperable T1-4N0M0 thoracic ESCC were treated with three-dimensional radiotherapy on involved-field.The conformal CTV was re-created using a 3 cm margin in the proximal and distal direction (following the course of the esophagus) beyond the barium esophagogram,endoscopic examination and CT defined GTV and a 0.5 cm margin in the lateral and anteroposterior directions of the CT defined GTV.The PTV encompassed 1 cm proximal and distal margins,0.5 cm radiaI margin on the basis of CTV.Cervical,mediastinal and abdominal lymph nodes were delineated respectively.Equivalent uniform dose (EUD) and other dosimetric paraneters were calculated for each nodal station.Nodal region whose metastasis rate is greater than 5％ was considered a high risk lymph node subgroups.Results Under a 60 Gy dose prescription,the median Dmean and EUD,V40 and V50 were ≥40 Gy,≥85％ and ≥75％ in most of the high risk nodal regions.For the subgroups whose EUD were less than 40 Gy,most of the ⅡD of these regions was significantly associated with the length and location of esophageal tumor (r =0.892,P =0.000).Conclusions Lymph node stations nearby of ESCC received considerable ⅡD with involved-field irradiation which could control subclinical lesions.But more clinical studies should be needed.

Objective To explore the reasonable radiotherapy range by analyzing the patterns and characteristics of intra-thoracic lymph node metastasis in small cell lung cancer (SCLC).Methods One hundred and fifty patients with limited-stage SCLC who received radical resection of primary tumor and systemic intra-thoracic lymph node dissection were included in the study.All the lymph nodes in each area were recorded and examined pathologically to analyze the patterns and characteristics of intra-thoracic lymph node metastasis.Results A total of 2372 lymph nodes were found in 631 areas,and a total of 413 positive lymph nodes (17.4％) were found in 188 lymph node areas (29.8％ ).Intra-thoracic lymph node metastasis were found in 88 patients,with a positive rate of 58.7％.The frequencies of metastasis in the area 11,10,7,5,4 were much higher than those in the other areas,and central located lesions and the higher T-stage lung tumors were more likely to develop intra-thoracic lymph node metastasis (x2 =15.32,39.72;P =0.000,0.000,respectively).Tumors located in the right upper lobe and right middle/lower lobe had a higher tendency of metastasis to the areas 4,7,10 and 4,7,10,11,respectively.Tumors located in the left upper lobe and left lower lobe had a higher tendency of metastasis to the areas 4,5,6,10 and 4,7,9,10,11,respectively.Mediastinal lymph node metastasis (N2 ) were found in 72 patients,among whom 29 patients (40.3％ ) had skipping N2 metastasis without hilar metastasis.Tumors located in the upper lobe had a tendency of skipping metastasis to the upper mediastinum,while tumors located in the middle/lower lobe had a tendency of skipping metastasis to the upper and lower mediastinum.Conclusions The lymph node metastases in SCLC follow the lymphatic drainage routes,that is,from intrapulmonary to the hilar and then to the mediastinum,but with some skipping metastases.Tumors located in different lobes have different high risk lymph node areas for metastasis,and elective irradiation to these lymph node areas maybe increase radiotherapy gain ratio in SCLC.

Although it has been frequently used to treat thoraxic tumors,radiation induced lung injury (RILI) is the major factor of dose limitation in thoracic radiotherapy.Amount of endogenous and exogenous reactive oxygen / nitrogen species (ROS/RNOS) could be generated in the radiated organisms and further cause molecular damage of DNA,protein and membrane lipids,which results in celluar structure damage,dysfunction and RILI.In addition,a series of cytokines could also induce chronic oxidative stresses that contribute to increases in cell membrane permeability,tissue edema and extracellular matrix proteins accumulation and even further result in pulmonary fibrosis.Oxidative stress theory offers new clues and strategies for further understanding the mechanism of RILI,and some anti-oxidative stress drugs may have potential clincial application in RILI treatment.