Cystic neoplasms of the pancreas are rare lesions,usually without typical clinical manifestations.This article summarizes the clin-icopathological features and surgical treatment of common cystic neoplasms of the pancreas,including serous cystic neoplasm (SCN),mu-cinous cystic neoplasm (MCN),intraductal papillary mucinous neoplasm (IPMN),and solid pseudopapillary neoplasm (SPN).The clini-copathological features are independent prognostic factors for patients.More attention should be paid to correct diagnosis and appropriate sur-gical strategy for each cystic neoplasm of the pancreas.

Objective To understand laboratory diagnosis and clinical characteristics of human immunodeficiency virus (HIV ) infection and AIDS patients in three comprehensive hospitals .Methods Laboratory diagnosis and clinical characteristics dates of people living with HIV/AIDS patients consulted in Chongqing Emergency Medical Center between 2007 to 2013 were retrospective‐ly analyzed .Results Totally 47 355 cases were carried HIV antibody screening during 7 years ,179 cases of HIV antibody were positive in preliminary screening ,171 cases were confirmed as positive .Among 5 cases of HIV antibodies result unconfirmed ,2 ca‐ses were followed up ,1 case was ruled out HIV infection ,1 case was converted to HIV antibody positive .People living with HIV al‐ways merging double or multiple infection with hepatitis b virus (HBV) ,hepatitis c virus (HCV) and treponema pallidum (TP) and so on .People living with HIV aged from 18 to 86 years old ,9 .36% was over 60 years old .Most patient has two or more clinical manifestations when consulted a doctor .Conclusion There were false‐positive of HIV antibody preliminary screening ,HIV anti‐body positive results must be confirmed by Western blot confirmatory test .Uncertainty of HIV antibody results should be judged by regularly follow‐up or combining with other detection methods ,epidemiological data .Routine HIV antibody screening should be adopt for HBV ,HCV and TP infection .Elder patients should not be ignored .Clinical specificity of HIV/AIDS is not strong ,it is need to be valued and identified from other cause similar symptoms of diseases caused by phase identification ,in order to reduce missed diagnosis and misdiagnosis .

Objective To study a series of tests to the IMRT planning system RayStation,and verify the feasibility of this Standard.Referring to the standard Performance and test methods for intensity modulated radiation therapy (IMRT) treatment planning system (Standard).Methods Referring to the Standard,the tests include:dose goals used for planning,point dose calculation accuracy and dose distribution calculation accuracy.And test phantoms include:AAPM TG119 report's test cases and solid water phantom for verification,and IMRT test cases include:multitarget,mock prostate,head/neck and CTshape (easier version and harder version) and so on.Referring to the Standard,we optimize and calculate doses of interest in RayStation,and use the common measurement equipments and tools,such as an ionization chamber,films,a detector array,and etc,to measure the doses on the accelerator,then calculate and analyze the errors between them.Results The results of dose goals for five different mock plans meet the requirements of the Standard.And the point dose ionization chamber measurements are in line with the requirements of the Standard,and the total error of the mock plans was (0.83 ± 1.65) ％.The γpass rates of per-field measurements using detector array are all greater than 99.0％,and the γpass rates of composite film measurements are all greater than 92.5％.Conclusions The results of three trials to IMRT performance of RayStation are in full compliance with the requirements of the Standard.And also it is an evidence for the feasibility of this Standard.

Objective To analyze the clinical efficacy of daily online cone-beam computed tomography (CBCT)-guided stereotactic body radiation therapy (SBRT) for primary and metastatic lung cancer and its related factors.Methods From May 2009 to May 2013,36 patients with lung cancer were treated with SBRT,including 24 patients with primary lung cancer and 12 patients with metastatic lung cancer.The biologically effective dose at 10 Gy was ≥ 100 Gy in 85.7％ of 42 lesions.Before each delivery,CBCT was acquired,and online automatic or manual registration was performed to make the tumors on CBCT within the planning target volume/primary gross tumor volume;the setup threshold was not set,and the couch was moved for correction.Results The 1-,2-,and 3-year sample sizes were 36,29,and 26,respectively.The 1-,2-,and 3-year local control (LC) rates were 96％,89％,and 72％,respectively.The 1-,2-,and 3-year cancer-specific survival (CCS) rates were 82％,74％,and 64％,respectively.The 1-,2-,and 3-year overall survival (OS) rates were 78％,64％,and 53％,respectively.Univariate analysis found no factors associated with LC.Multivariate analysis revealed no factors associated with OS.Both univariate and multivariate analyses showed that only tumor location (central type or peripheral type) was associated with CCS;the mean values (95％ confidence intervals) of CCS in patients with central-type and peripheral-type lesions were 21.4 months (13.2-29.6 months) and 42.3 months (35.7-49.0months),respectively (P=0.024).Conclusions Daily online image-guided SBRT for primary or metastatic lung cancer can lead to a satisfactory LC.

Objective To evaluate the prognosis and side-effects of three-dimensional conformal radiotherapy (3 DCRT) and intensity modulated radiotherapy (IMRT) for prostate carcinoma. Methods From 2001 to 2009, 62 patients with prostate carcinoma treated with radiotherapy were included in the retrospective analysis. Among them, 60 patients received IMRT while the other two received 3DCRT. There were 56 patients receiving androgen deprivation therapy before radiotherapy. The median dose was 78 Gy to 95% planning target volume (PTV) of the prostate and seminal vesicles, and the median dose to 95% PTV of the pelvic lymph nodes was 48 Gy. Results The median follow-up was 15.4 months. The 3-and 5-year overall survival (OS) rates were 92% and 83%, with the corresponding biochemical disease-free survival rates of 87% and 69%, and the distant metastasis-free survival (DMFS) rate of 77% and 55%, respectively. Patients with a PSA nadir ≤ 2 ng/ml had a 3-year OS of 94% and DMFS of 88%, compared with 56% and 11% (χ~2 = 16. 39, P < 0.01 for OS ; χ~2 = 28. 87, P < 0. 01 for DMFS) for those with a PSA nadir > 2 ng/ml. The incidence of grade 1 and 2 urinary toxicity was 32% and 0% for acute damage, 10% and 0% for late damage, respectively. The incidence of grade 1 and 2 intestinal toxicity was 19% and 3%. for acute damage, 5% and 3% for late damage, respectively. Conclusions Radiation therapy for patients with prostate carcinoma shows satisfactory outcomes with a good toleration. Monitor of PSA after radiotherapy has benefit for prognosis evaluation.

Objective To restrospectively investigate clinical outcomes and prognositic factors in localized prostate cancer treated with neoadjuvant endocrine therapy followed by intensity modulated radiotherapy (IMRT). Methods Between March 2003 and October 2008, 54 localized prostate cancer treated by IMRT were recruited. All patients had received endocrine therapy before IMRT. The endocrine therapy included surgical castration or medical castration in combination with antiandrogens. The target of IMRT was the prostate and seminal vesicles with or without pelvis. The biochemical failure was defined according to the phoenix definition. By using the risk grouping standard proposed by D'Amico, patients were divided into three groups: low-risk group (n = 5), intermediate-risk group (n = 12), and high-risk group (n = 37). Kaplan-Meier method was used to calculate the overall survival rate. Prognostic factors were analyzed by univariate and multiple Cox regression analysis. Results The follow-up rate was 98%. The number of patients under follow-up was 39 at 3 years and 25 at 5 years. Potential prognostic factors, including risk groups, mode of endocrine therapy, time of endocrine therapy, phoenix grouping before IMRT, the prostate specific antigen doubling time (PSADT) before radiotherapy, PSA value before IMRT, interval of endocrine therapy and IMRT, irradiation region, and irradiation dose were analyzed by survival analysis. In univariate analysis, time of endocrine therapy (75 % vs 95 %, χ~2= 6. 45, P = 0. 011), phoenix grouping before IMRT (87% vs 96%, χ~2 = 4. 36, P = 0. 037), interval of endocrine therapy and IMRT (80% vs 95% ,χ~2= 11.60,P= 0. 001) ,irradiationdose(75% vs 91% ,χ~2=5.92,P= 0. 015) were statisticallysignificant prognostic factors for3 - year overall survival , and risk groups (85 vs 53 vs 29 , χ~2= 6. 40,P =0. 041) and PSADT before IMRT (62 vs 120, U =24. 50,P =0. 003) were significant factors for the median survival time. In the multiple Cox regression model, only time of endocrine therapy and phoenix grouping before IMRT were significantly related to the overall survival. The 3-year overall survival rates in patients with endocrine therapy less than 3 months versus more than 3 months were 75% versus 95% (χ~2= 5.45, P= 0.020). The 5-year overall survival rates in patients with biochemical failure versus nobiochemieal failure was 71% versus 92% (χ~2= 8.83 , P= 0.003) Conclusions Neoadjuvant endocrine therapy should last at least three months. Intensity modulate radiotherapy should start before biochemical failure after the endocrine therapy.

Objective To compare the planning systems of the simplified manual intensity modulated (SMIM) irradiation and standard tangential (ST) irradiation,in order to explore the application of SMIM technique in clinic.Methods In 64 cases of breast cancers after breast conserving surgery,each underwent both SMIM and ST planning systems.SMIM planning was designed by copying additional fields for shielding the high dose areas from internal or lateral tangential field.The high dose areas were reduced by adjusting the size of the additional field and open tangential field.To optimize the SMIM planning,3 high dose areas (＞ 103% ,＞ 105% and ＞ 107%) were shielded and 3 protocols carried out.The wedges were also optimized in ST plan.The target coverage and dose homogeneity and dose of organ at risk were compared between SMIM and ST planning systems.Results When the dose was normalized to cover the volume of 95% CTV,85% of the shielded areas in optimal SMIM planning were that of ＞ 103% high dose area,and 94% of target area was covered.The study on the volume of breast CTV showed that,in the large breast group,SMIM could not only significantly reduce the high dose areas,and the maximum dose as well as the dose of organ at risk,but also enhance the dose homogeneity index.However,no such effect was not significant in the small breast group.Conclusions The simplified manual intensity modulated technique can improve target dose homogeneity in the large breast cases instead of the standard tangential technique.

Objective To study the expressions and correlation of cyclooxygenase-2 (COX-2) and epidermal growth factor receptor (EGFR) in human transitional cell carcinoma of bladder (TCC) tissues and explore the correlation of their expressions in the incidence and development of TCC. MethodsThe expressions of COX-2 and EGFR were detected by immunohistochemical technique in 48 cases of TCC and in 10 cases of normal bladder mucosa tissues. ResultsThe expressions of COX-2 and EGFR in TCC was significantly higher than those in normal bladder mucosa tissues (P

Objective To compare the dose to the contralateral breast, ipsilateral lung, and the whole lung in the tangential field radiotherapy for primary breast cancer using the dynamic wedge or physical wedge. Methods With thirteen breast cancer patients chosen, the dose distribution was computed for the plan used in practical treatment with the dynamic wedge and physical wedge. Plans were compared using dose volume histograms for the contralateral breast, ipsilateral lung and the whole lung. As for the contralateral breast, the dose distributions were not computed for the whole breast but computed for the two regions similar to a rectangular area in the axial slice and parts of the whole breast. The mean dose was used to evaluate CB1, CB2 and ipsilateral lung, and V_ 20 was used to evaluate the whole lung. The treatment planning system used was Varian CadPlan. An ionization chamber in a water phantom was used to measure some point doses to simulate the dose to the contralateral breast. Results When using the 30? dynamic wedge, the mean dose to CB1 and CB2 was 1.5%-3.9% and 1.1%- 2.6% , and the mean dose to the ipsilateral lung was 4.1%-14.7%. When using the 30? physical wedge, the mean dose to CB1 and CB2 were 1.5%-4.4% and 1.2%-3.0%, respectively, and the mean dose to the ipsilateral lung was 4.4%-15.2%. The values of V_ 20 were equal. When using the 15? dynamic wedge, the mean dose to CB1 and CB2 decreased compared to 15? physical wedge, but the value reduced was smaller than when using 30? wedge. Also, the measured results verified that the dose to the normal tissue is reduced using the dynamic wedge. Conclusions The mean dose to the contralateral breast was reduced by using the dynamic wedge instead of the physical wedge, and the mean dose to the ipsilateral lung or V_ 20 is reduced or equal to each other. So the probability of normal tissue complication such as a second breast malignancy or pneumonitis associated with radiotherapy are likely to be reduced.

Objective To evaluate the clinical feasibility of quality assurance of intensity modulated radiation therapy(IMRT) through a series of clinical case studies. Methods Helios inverse planning system was used to provide optimized IMRT treatment plans for brain tumor, nasopharyngeal carcinoma, pancreatic cancer, spinal metastatic tumor and prostatic cancer. To verify the conformation between the fluence map of each beam predicted by the planning system and that actually delivered, a piece of film under a homogeneous polystyrene phantom was irradiated vertically with each of the beams to record the deposited dose. This measured fluence map was compared with that predicted by the planning. The dose distribution was recorded by irradiating the film in an anthropomorphic phantom using patients' treatment plan, then compared with that predicted by the planning. An ionization chamber in a water phantom was used to measure the central point dose and another eccentric point dose. Results The fluence map measured by the film was well consistent with that predicted by the planning. The error between the measured dose and predicted dose in the central point was less than 3%, whereas the error of the dose in another eccentric point varied greatly. The isodose distribution (on axial plane) measured by the film was consisent with the predicted one. Conclusions The procedures for quality assurance of IMRT are feasible in our experience.