Objective To investigate the difference of standard tangential field and multiple fileld radiotherapy in axillary lymph node after conserving surgery,to provide a reference for clinical treatment.Methods 20 cases of left breast cancer patients were selected,all patients underwent breast -conserving surgery,postoperative radiothera-py.All patients used standard radiotherapy wild tangent based and reverse -intensity modulated radiation therapy optimization.Armpit I,Ⅱ lymph nodes were used to calculate the extent of coverage of the original plan,target dose uniformity HI,dose conformal CI,dosimetric parameters were calculated.Results Under standard tangential field irradiation,I stand mean dose was (33.95 ±8.24)Gy,which was significantly higher than Ⅱ station (22.13 ± 6.67)Gy,and V50,V45,V40 were (22.45 ±6.32)%,(39.83 ±7.54)%,(49.65 ±8.31)%,which were higher than Ⅱ stand,I stand irradiation was significantly more,the differences were statistically significant (t =5.632,P =0.009;t =7.214,P =0.000;t =8.954,P =0.000;t =6.121,P =0.002).The whole breast irradiation armpit IMRT plan,19 patients (95.00%)reached 95% by volume APTV≥50Gy,coverage was better;but HI,CI were (1.11 ± 0.03),(1.36 ±0.07)respectively,which were significantly worse than the standard wild tangent,the differences were statistically significant (t =6.584,P =0.001;t =9.144,P =0.000).Under Hatano IMRT irradiation ipsilateral lung,heart suffered an average dose of (1 694.58 ±102.31)cGy,(645.54 ±74.44)cGy,which were significantly more than the standard tangential field irradiation,the differences were statistically significant (t =7.654,P =0.000;t =6.654,P =0.001).Conclusion Standard tangential field irradiation has poor coverage in Ⅱ axillary lymph node station,irradiation intensity modulated radiation has better coverage,but significantly increased the dose to normal tissues.

Objective To analyze non -small cell lung cancer patients with platinum -based chemotherapy excision repair cross -complementing 1 (ERCC1)and breast cancer susceptibility gene 1 (BRCA1 )gene polymor-phism,to examine the correlation of ERCC1 and BRCA1 gene polymorphism and non -small cell lung cancer platinum chemotherapy drugs sensitivity and chemotherapy prognosis.Methods 140 cases of non -small cell lung cancer were selected as subjects of this study.All patients were given platnum -based chemotherapy,peripheral blood ERCC1 and BRCA1 genes polymorphism were determined.The distribution of ERCC1 Asn118Asn genotype and BRCA1 Ser1613Gly genotype was observed.The relationship between different genotypes and the effect of chemotherapy and survival time after chemotherapy was compared.Results The proportions of ERCC1 Asn118Asn TT genotype,CT genotype and CC genotype were 5.7%,30.7% and 63.6%.The proportions of BRCA1 Ser1613Gly GG genotype,AG genotype and AA genotype were 8.6%,52.9% and 38.6%.In 140 patients,completely cured,partial response,stable disease and progressive disease patients were 0 case,33 cases,61 cases and 46 cases,the proportions were 0.0%, 23.6%,43.6% and 32.9%,the chemotherapy effective rate was 33.8%.ERCC1 Asn118Asn genotype was signifi-cantly correlated with the effect of non -small cell lung cancer chemotherapy (χ2 =4.416,P <0.05 ).BRCA1 Ser1613Gly genotype was significantly correlated with the effect of non -small cell lung cancer chemotherapy (χ2 =13.256,P <0.05).By Cox regression analysis and Log -rank test analysis,the average survival time of BRCA1 Ser1613Gly gene CC genotype non -small cell lung cancer after chemotherapy was longer than the CT +TT genotype (OR =2.946,χ2 =5.136,P <0.05).The average survival time of BRCA1 Ser1613Gly gene AA genotype non -small cell lung cancer after chemotherapy was shorter than the AG +GG genotype (OR =3.124,χ2 =5.136,P <0.05).Conclusion ERCC1 Asn118Asn genotype and BRCA1 Ser1613Gly genotype was significantly correlated with non -small cell lung cancer platinum -based chemosensitivity and chemotherapy prognosis.

Objective:To observe the incidence and risk factors of acute kidney injury (AKI) in patients with acute myocardial infarction (AMI), and explore the effect of AKI on the adverse cardiovascular events during hospitalization.Methods:The clinical data of 1 286 first-episode patients with AMI from December 2014 to December 2017 in Xuanwu Hospital, Capital Medical University were retrospectively analyzed. The basic information, laboratory test results and used drug were collected, the incidences of AKI and adverse cardiovascular events during hospitalization were recorded.Results:Among 1 286 patients with AMI, 113 cases had AKI, the incidence of AKI was 8.79%. There were statistical differences in gender composition, age, Killip classification>1 grade, hypertension, diabetes, smoking history, left ventricular ejection fraction (LVEF)<56%, baseline estimated glomerular filtration rate (eGFR)<71.5 ml/(min·1.73 m 2), global registry of acute coronary events score (GRACE score) ≥176 scores, hemoglobin<128 g/L, interleukin-6 (IL-6) ≥35.74 ng/L, brain natriuretic peptide (BNP) ≥981 ng/L, thrombolysis in myocardial infarction score (TIMI score) ≥5 scores, high-sensitivity C-reactive protein (hs-CRP) ≥8.44 mg/L, serum creatinine at admission ≥90 μmol/L, heart rate ≥75 times/min and contrast agent dosage/eGFR ≥1.92 between patients with AKI and patients without AKI ( P<0.01 or<0.05). Multivariate Logistic regression analysis result showed that diabetes, LVEF<56%, baseline eGFR< 71.5 ml/(min·1.73 m 2) and hs-CRP ≥8.44 mg/L were the independent risk factors of AKI in patients with AMI ( OR = 2.99, 0.38, 0.30 and 2.48; 95% CI 1.31 to 6.84, 0.16 to 0.88, 0.12 to 0.78 and 1.07 to 5.75; P = 0.010, 0.024, 0.013 and 0.035). The hospital mortality, incidence of adverse cardiovascular events during hospitalization and length of hospital stay in patients with AKI were significantly higher than those in patients without AKI: 11.50% (13/113) vs. 2.39% (28/1 173), 22.12% (25/113) vs. 8.40% (99/1 173) and (12±8) d vs. (10±6) d, and there were statistical differences ( P<0.01). Multivariate Logistic regression analysis result showed that AKI was the independent risk factors of death and adverse cardiovascular events during hospitalization in patients with AMI ( OR = 5.32 and 3.08, 95% CI 2.67 to 10.59 and 1.89 to 5.03, P<0.01). Conclusions:The incidence of AKI is high in patients with AMI, and previous diabetes history, LVEF<56%, eGFR<71.5 ml/(min·1.73 m 2), hs-CRP≥8.44 mg/L are the independent risk factors of AKI in patients with AMI. The occurrence of AKI after AMI can increase incidence of adverse cardiovascular events during hospitalization and hospital mortality, and prolong the hospital stay.