Objective To investigate the efficacy,toxicity and cosmetic outcome of short-course radiotherapy with concomitant tumor bed boost after breast-conserving surgery for early stage breast cancer.Methods A total of 306 patients with T1-2 N0-1 M0 breast cancer after breast-conserving surgery were included.160 patients received whole-breast radiation to 45 Gy in 25 fractions followed by tumor bed boost of 14 Gy in 7 fractions (C group).146 patients received whole-breast radiation to 46 Gy in 23 fractions with concomitant tumor bed boost to 60 Gy in 23 fractions (S group).Kaplan-Meier method was used to calculate the local recurrence and overall survival rates and the differences were compared by Logrank test.Chi-square test was used to compared the differences of the clinical characteristics,toxicity and cosmetic outcome between the two groups.Results The follow-up rate was 100％.After a median follow up of 26 months,the 1-,2-and 3-year overall survival rates were 100％.No patient developed local recurrence.In C and S group,the incidence of grade 1 acute skin toxicity was 46.9％ and 45.1％ (x2 =0.73,P =0.695),grade 2was 16.3％ and 13.7％ (x2 =0.73,P =0.695).Grade 1 late skin and subcutaneous tissue toxicity developed in 16.9％ and 17.1％ of patients in C and S group (x2 =0.00,P =0.954).Grade 1 neutropenia occurred in 11.9％ and 13.7％ of patients in C and S group (x2 =0.23,P =0.633).In C and S group,66.2％ and 65.5％ of patients had excellent and good cosmetic outcome (x2 =0.01,P =0.927).Conclusions Short-course radiotherapy with concomitant tumor bed boost provides similar results to conventional radiotherapy in local control,toxicity and cosmetic outcome.Long-term follow up is warranted to confirm this finding.

Objective To understand and compare the proportion of neural stem cells (NSCs) in the whole brain and cerebral cortex of mice at different embryonic days, and provide quantitative data for the later optimization of NSCs isolation and culture.Methods The whole brains (at embryonic 12.5, 14, 16 and 18 days) and cerebral cortex (at embryonic14, 16 and 18 days) were isolated and digested into single cell suspension, and were adherently cultured for 3-4 h.Immunofluorescence staining of Nestin, a NSCs specific marker, was used to statistically analyze the proportion of NSCs in each group.Expression of Nestin mRNA in the cerebral cortex of mice at E12.5, E14, E16, and E18 was detected by real-time fluorescence quantitative PCR.Results The result of immunofluorescence assay showed that there were Nestin-positive cells in the whole brain and cerebral cortex of mice at different embryonic days.In the whole brain,the proportion of NSCs was highest at E12.5 (53.42±1.57%) and lowest at E18(25.96±1.31%), and the proportions at E14 and E16 were placed in the middle among the groups.In the cerebral cortex, the highest proportion of NSCs was at E14 (33.65±0.29%), and the lowest at E18(25.29±0.28%), and the middle at E16 (26.82±0.30%).The result of real-time PCR showed that when the mRNA expression of Nestin in the cerebral cortex was set to 1, the relative mRNA expression of Nestin was 0.83±0.04 at E14, 0.77±0.05 at E16, and 0.44 ±0.05 at E18.Thus, the mRNA expression level of Nestin in the mouse cerebral cortex was gradually decreasing with the increase of embryonic days.Conclusions During the brain development, the proportion of NSCs is gradually decreasing in the whole brain and cerebral cortex of mice with the increase of embryonic days.

ObjectiveTo investigate the application of non-contrast and contrast-enhanced 18FDG PET/CT in the delineation of gross tumor volume ( GTV ) of pancreatic cancer.MethodsBetween Jan.2008 and Dec.2009,twenty-one patients with unresectable locally advanced pancreatic cancer or recurrent pancreatic cancer after surgery in our hospital had both non-contrast CT and PET images acquired at the same body position.Among the whole group,eleven patients also had contrast CT images.The image data sets were transferred to the treatment planning workstation for registration.Then gross tumor volumes ( GTV )were delineated independently using the information of PET images,contrast/non-contrast CT scan and contrast/non-contrast PET-CT fusion images.The differences of mean volume in these different sets of GTV were analyzed.Results For the whole group,the mean volume of non-contrast GTVCT,GTVPET,noncontrast GTVPET-CT were 76.9 cm3,47.0 cm3 and 44.5 cm3,respectively.The mean volume of non-contrast GTVPET-CT was significantly smaller than non-contrast GTVCT ( z =-3.91,P =0.000 ).For the eleven patients with contrast CT,the mean volume of contrast GTVCT,GTVPET,contrast GTVPET-CT were 64.1 cm3,45.1 cm3 and 49.3 cm3,respectively.The mean volume of contrast GTVPET-CT was significantly smaller than contrast GTVCT (z =-2.13,P =0.033 ).No significant differences were found between contrast PET-CT and non-contrast PET-CT (z =-0.80,P =0.424).ConclusionsCo-registration of PET and contrast/noncontrast CT information in pancreatic cancer may improve the accuracy of GTV delineation,and possibly reduce the adverse effect of irradiation.

Objective To evaluate the treatment of gastroentero-pancreatic neuroendcorine neoplasms with liver metastasis.Methods Two gastroentero-pancreatic neuroendcorine neoplasms with liver metastases treated at Anhui Provincial Hospital Affliated of Anhui Medical University were analyzed retrospectively.Results In first patient liver metastases from duodenal papilla neuroendocrine neoplasm was treated by four courses of TACE until the liver metastases completely disappeared.The patient then underwent pancreaticoduodenectomy to eradicate the primary tumor.The patient was followed up for 2 years and was doing well.In second patient, liver metastasis, noted four years after distal pancreatectomy for a neuroendocrine tumor, was initially managed by high dosage of octreotide and sunitinib.After these attempts failed, the patient received a liver transplantation four years ago and was followed up until March 1, 2015 without tumor recurrence.Conclusion Liver metastasis of gastroenteropancreatic neuroendcorine neoplasms responds positively to liver transplant with pretty good prognosis.

Objective To evaluated the role of postoperative radiotherapy (PR) after surgery in patients with uterine sarcoma,and analyzed the prognostic factors.Methods A total of 182 patients with uterine sarcoma were included between June 1994 and October 2014.Radiotherapy dose were 30-50 Gy/10-25 fractions/5 fractions/week.The LRFFS and OS were calculated with Kaplan-Meier method,and difference was analyzed with log-rank method.Cox regression analyses were used to determine prognosticators.Results There were 114 patients which survived more than 5-years in this whole group,including PR 24 cases and no PR 90 cases.The 5-year LRRFS and OS were 62.1％ and 56.2％,respectively.The 5-year LRRFS were 78.0％ and 55.3％ on PR and no PR (P=0.013);with OS 64.1％ and 51.7％ on PR and no PR (P=0.070).A multivariate analysis showed that pathological types,histological grade and clinical stage were associated with LRRFS and OS (P=0.032,0.008,0.000 and 0.046,0.000,0.000).PR was significant influencing factor for OS (P=0.013).Conclusions Uterine sarcoma patients treated with PR after surgery had an improved LRRFS compared to those treated with surgery,especially those with leiomyosarcoma.The role of PR personalized radiation for uterine sarcoma still needs to be further discussed.

Objective To investigate the consensus and controversies on the delineation of radiotherapy target volume for patients with locally advanced non-small cell lung cancer (LA-NSCLC).Methods Questionnaires including 15 questions on the delineation of radiotherapy target volume of NSCLC were sent to 12 radiation departments in China in November 2015.A patient with LA-NSCLC was selected by Fudan University Shanghai Cancer Center, and simulation CT images and medical history data were sent to the 12 radiation departments.Twelve radiation oncologists from the 12 radiation departments showed and explained the delineation of radiotherapy target volume of their own, and the patient was discussed by all experts in the sixth multidisciplinary summit forum of precise radiotherapy and chemotherapy for tumor and lung cancer.Results All receivers of the questionnaire answered the questions.The standard lung window width/level for the delineation of lung cancer was 800-1600/-600 to-750 HU, and the mediastinum window was 350-400/20-40 HU.Respiratory movement was measured by stimulator, 4D-CT, and stimulator+4D-CT with 2-5 mm expansion based on experience.The primary clinical target volume (CTV) was defined as gross target volume (GTV) plus 5-6 mm for squamous carcinoma/5-8 mm for adenocarcinoma.The metastatic lesion of mediastinal lymph nodes was delineated as 5 mm plus primary lesion in 6 departments and as primary lesion in another 6 departments.Of the 12 departments, 10 applied 5 mm of set-up error, 1 applied 3 mm, and 1 applied 4-6 mm.For V20 of the lungs, 10 departments defined it as<30%, 1 as<35%, and 1 as 28%.Nine departments defined the radiation dose of concurrent chemoradiotherapy (CCRT) for LA-NSCLC as 60 Gy in 30 fractions, 62.7 Gy in 33 fractions in 1 department, 50-60 Gy in 25-30 fractions in 1 department, and 60-70 Gy in 25-30 fractions in 1 department.For the delineation of target volume for the LA-NSCLC patient treated with CCRT, the primary planning target volume (PTV) was defined as GTV plus organ movement (IGTV) and set-up error (GTV→IGTV→PTV) in 3 departments, as CTV plus organ movement (ITV) and set-up error (GTV→CTV→ITV→PTV) in 8 departments, and as CTV plus set-up error/IGTV plus 5-6 mm for squamous carcinoma/5-8 mm for adenocarcinoma (CTV) and set-up error (GTV→CTV→PTV/GTV→IGTV→CTV→PTV) in 1 department.For the delineation of PTV in the mediastinal lymph node, GTV→IGTV→PTV was performed in 3 departments, GTV→CTV→ITV→PTV in 8 departments, and GTV→CTV→PTV in 1 department.For 10%-100% patients with LA-NSCLC, the radiation field needed to be replanned when 38-50 Gy was completed.There was no unified standard for the optimal standardized uptake value (SUV) of positron emission tomography (PET)-computed tomography (CT) simulation and delineation.Seven departments had applied magnetic resonance imaging (MRI) simulation and 10 departments had applied stereotactic body radiation therapy (SBRT) for the treatment of early-stage NSCLC.For the delineation of PTV for early-stage NSCLC (T1-2N0M0), GTV→IGTV→PTV was performed in 5 departments, IGTV→PTV in 3 departments, and GTV→CTV→ITV→PTV in 2 departments.In all the 12 departments, peripheral early-stage NSCLC was given 6.0-12.5 Gy/fraction, 3-12 fractions and central early-stage NSCLC was given 4.6-10.0 Gy/fraction, 5-10 fractions.The results of discussion on the delineation of target volume for the patient were as follows:respiratory movements should be measured by 4D-CT or simulator;the lung window width/level is 1600/-600 HU and the mediastinal window width/level is 400/20 HU;the primary controversy is whether the involved-field irradiation or elective nodal irradiation should be used for the delineation of CTVnd in the mediastinal lymph node.Conclusions Basic consensus is reached for the delineation of target volume in LANSCLC in these aspects:lung window width/level, respiratory movements and set-up error, primary lesion delineation, the radiation dose in CCRT, and the optimal time for replanning the radiation field.There are controversies on the optimal SUV in the delineation of target volume based on PET-CT simulation, the optimal dose fractionation in SBRT for early-stage NSCLC, and the delineation of CTVnd.

Effectively assessing oxygen delivery and demand is one of the key targets for fluid resuscitation in sepsis. Clinical signs and symptoms, blood lactic acid levels, and mixed venous oxygen saturation (S O 2) or central venous oxygen saturation (ScvO 2) all have their limitations. In recent years, these limitations have been overcome through the use of derived indicators from carbon dioxide (CO 2) such as mixed veno-arterial carbon dioxide partial pressure difference (P -aCO 2, PCO 2 gap, or ΔPCO 2), the ratio of mixed veno-arterial carbon dioxide partial pressure difference to arterial-mixed venous oxygen content difference (P -aCO 2/Ca- O 2). P -aCO 2, PCO 2 gap or ΔPCO 2 is not a purely anaerobic metabolism indicator as it is influenced by oxygen consumption. However, it reliably indicates whether blood flow is sufficient to carry CO 2 from peripheral tissues to the lungs for clearance, thus reflecting the adequacy of cardiac output and metabolism. The P -aCO 2/Ca- O 2 may serve as a marker of hypoxia. S O 2 and ScvO 2 represent venous oxygen saturation, reflecting tissue oxygen utilization. When oxygen delivery decreases but tissues still require more oxygen, oxygen extraction rate usually increases to meet tissue demands, resulting in decreased S O 2 and ScvO 2. But in some cases, even if the oxygen delivery rate and tissue utilization rate of oxygen are reduced, it may still lead to a decrease in S O 2 and ScvO 2. Sepsis is a classic example where tissue oxygen utilization decreases due to factors such as microcirculatory dysfunction, even when oxygen delivery is sufficient, leading to decrease in S O 2 and ScvO 2. Additionally, the solubility of CO 2 in plasma is approximately 20 times that of oxygen. Therefore, during sepsis or septic shock, derived variables of CO 2 may serve as sensitive markers for monitoring tissue perfusion and microcirculatory hemodynamics. Its main advantage over blood lactic acid is its ability to rapidly change and provide real-time monitoring of tissue hypoxia. This review aims to demonstrate the principles of CO 2-derived variables in sepsis, assess the available techniques for evaluating CO 2-derived variables during the sepsis process, and discuss their clinical relevance.

Objective:To investigate the radiation dose and fractionation regimens for limited stage small cell lung cancer (LS-SCLC) in Chinese radiation oncologists.Methods:Over 500 radiation oncologists were surveyed through questionnaire for radiation dose and fractionation regimens for LS-SCLC and 216 valid samples were collected for further analysis. All data were collected by online questionnaire designed by WJX software. Data collection and statistical analysis were performed by SPSS 25.0 statistical software. The differences in categorical variables among different groups were analyzed by Chi-square test and Fisher's exact test. Results:Among 216 participants, 94.9% preferred early concurrent chemoradiotherapy, 69.4% recommended conventional fractionation, 70.8% preferred a total dose of 60 Gy when delivering conventional radiotherapy and 78.7% recommended 45 Gy when administering hyperfractionated radiotherapy.Conclusions:Despite differences in LS-SCLC treatment plans, most of Chinese radiation oncologists prefer to choose 60 Gy conventional fractionated radiotherapy as the main treatment strategy for LS-SCLC patients. Chinese Society of Clinical Oncology (CSCO), National Comprehensive Cancer Network (NCCN) and Chinese Medical Association guidelines or expert consensus play a critical role in guiding treatment decision-making.

The classical prescription Yangweitang， derived from Zhengzhi Zhunsheng， is specialized in treating syndromes of chill and fever due to exogenous pathogens， inner-cooling， and malaria， and it has been included in the Catalogue of Ancient Classical Formulas （the First Batch） published by the National Administration of Traditional Chinese Medicine （TCM） in 2018. Through bibliographical research， the relevant ancient books and modern documents were systematically sorted out， and it was found that there were many prescriptions related to the Yangweitang from Zhengzhi Zhunsheng. They were interwoven with Yangweitang from Zhengzhi Zhunsheng and widely used in clinical practice. In order to clarify their history and evolution， this paper combed the historical origin of Yangweitang and its related prescriptions and conducted textual analysis on key information such as semantic composition， herb origin， processing method， and efficacy. A total of 896 pieces of data on Yangweitang from Zhengzhi Zhunsheng were collected. 26 pieces of effective data were included after the screening， involving 17 ancient TCM books. Then， a total of 28 pieces of data on prescriptions related to the Yangweitang from Zhengzhi Zhunsheng were included， involving 23 ancient TCM books for reference. The textual analysis showed that Yangweitang originated from the Renshen Yangweitang recorded in Taiping Huimin Heji Jufang in the Song dynasty. Based on the original formula， medical experts from later generations have modified it into many different versions. A comparative analysis showed that Yangweitang from different generations had similar compositions， and the herb origin and processing method were basically clear. The recommended prescriptions are as follows： 37.3 g of Pinelliae Rhizoma Praeparatum Cum Alumine， Magnoliae Officinalis Cortex（fried with ginger juice）， and frying with rice water Atractlodis Rhizoma， 27.98 g of Citri Exocarpium Rubrum， 18.65 g of Pogostemon cablin leaf， Tsaoko Fructus， Poria， and Ginseng Radix et Rhizoma， and 9.33 g of Glycyrrhizae Radix et Rhizoma. They could be ground into a coarse powder， with 14.92 g for every dose， and they could be orally taken after being decocted with 450 mL of water， 7 g of fresh ginger， and 2 g of Mume Fructus to 270 mL in warm conditions. Yangweitang from Zhengzhi Zhunsheng has the effect of warming the middle and releasing the external， and it can treat many syndromes including spleen and stomach disharmony caused by chill and fever due to exogenous pathogens and inner-cooling， as well as all kinds of malaria. Modern clinical applications mainly focus on chronic atrophic gastritis and other digestive system diseases.