Objective To study the effect of gemcitabine combined with cisplatin in the treatment of non-small cell lung cancer.Methods 100 cases of non-small cell lung cancer patients who were treated in our hospital from March 2015 to August 2016 were selected as the subjects in this study.They were randomly divided into the control group and the experimental group, with 50 cases in each group.The control group were treated with gemcitabine combined with cisplatin, and routine nursing care was used.The experimental group were given psychological intervention on the basis of gemcitabine combined with cisplatin treatment, pay attention to the psychological status of patients, medical staff should strengthen communication, inform the relevant knowledge of disease, eliminate the negative emotions, improve the treatment compliance.Anxiety scores and satisfaction between the experimental group and the control group were compared.Results After the corresponding nursing, the treatment satisfaction of the control group was 72.0%, which was lower than that of the experimental group, and the satisfaction rate was 92.0%, the difference was statistically significant (P<0.05).After the intervention, the anxiety score of the experimental group(36.83±4.23)was significantly lower than that of the control group(42.12±3.41), and the difference was statistically significant (P<0.05).There was no significant difference in survival rate between the two groups after a follow-up of 1 years.Conclusion Gemcitabine Combined with cisplatin in the treatment of non-small cell lung cancer, the application of psychological intervention nursing can help patients to eliminate anxiety in a large extent, improve patient satisfaction, with further clinical promotion and application significance.

Objective To study the analysis of non-small cell lung cancer patients with multiple brain metastases with erlotinib combined with whole brain radiation therapy clinical observation and effect of C on vascular endothelial growth factor level. Methods 40 cases of non - small cell lung cancer patients with multiple brain metastases treated in Taizhou tumor hospital from January 2015 to April 2016 were selected and randomly divided into the control group and the experimental group, with 20 patients in each group. The control group and the experimental group patients were given clinical treatment of whole brain radiotherapy, the control group was given routine treatment, the experimental group received erlotinib. The clinical effects of the 2 groups were compared and analyzed. Results After the corresponding treatment, the experimental group of 20 patients, 8 cases of complete remission, 7 cases of partial remission, the number of effective treatment for 15 cases, the treatment rate was 75.0％. Of the patients in the control group, 6patients had complete remission, and 4 patients had partial remission. The effective rate was 50％. Available, the effective rate of the treatment group (75.0％) was significantly higher than that of the control group (50.0％), with statistical difference (P<0.05). The survival rate of the experimental group after one year (80.0％) was significantly higher than that of the control group (60.0％), with statistical difference (P<0.05). The level of vascular endothelial growth factor (C) in the experimental group was significantly lower than that in the control group (P<0.05). Conclusion Non small cell lung cancer patients with multiple brain metastases with erlotinib combined with radiotherapy in the clinical treatment effect of whole brain is better, can improve the survival rate in a large extent, improve the endothelial growth factor C levels, with the further promotion of the clinical significance.

Objective To analyze and discuss the clinical effect of sequential radiotherapy and chemotherapy in 40 patients with advanced gastric cancer after operation.Methods 80 postoperative gastric cancer patients who received sequential radiotherapy and chemotherapy in our hospital were prospectively analyzed.According to the order of admission,80 patients were divided into two groups,40 cases of the control group(chemotherapy)and 40 cases of the observation group(sequential chemotherapy).The clinical effects of the two groups were compared.Results In the observation group,1 year survival rate and 2-year survival rate(77.50%,47.50%)were higher than those in the control group(50.00%,25.00%),there were statistically significant differences between the two groups(x2=19.20,32.65,all P<0.05).The incidence rate of adverse reactions of the control group was 12.50%,which was lower than 30.00% of the observation group,there was statistically significant difference between the two groups(x2=9.15,P<0.05).The mortality rate of the observation group was 32.50%,which was lower than 45.00% of the control group,the difference was statistically significant(x2=5.29,P<0.05).Conclusion Compared with the simple chemotherapy after the operation of gastric cancer,sequential radiotherapy and chemotherapy can effectively improve the clinical efficacy,significantly reduce the rate of postoperative metastasis and recurrence of gastric cancer,and it is worthy of promoting.

Objective To explore the clinical effect of concurrent radiotherapy and chemotherapy in the treatment of advanced cervical cancer.Methods From January 2010 to January 2011,sixty patients with cervical cancer in Taizhou Cancer Hospital were randomly divided into two groups ,with 30 cases in each group.The control group was given radiotherapy alone ,the observation group was given concurrent radiotherapy and chemotherapy .The adverse reaction,curative effect,long -term effect of 5 -year follow -up were compared between the two groups. Results The total effective rate of the observation group was 93.33%,which was significantly higher than 73.33%of the control group,the difference was statistically significant (χ2＝14.397,P＜0.05).The 5-year survival rate of the observation group was 76.67%,which was significantly higher than 53.33% of the control group,the difference was statistically significant ( χ2＝11.922,P ＜0.05).The local recurrence rate and distant metastasis rate of the observation group were 16.67%,13.33%,respectively,which were significantly lower than those of the control group , the differences were statistically significant (χ2＝7.401,5.115,all P＜0.05).The incidence rate of adverse reaction of the control group was 13.33%,which of in the observation group was 23.33%,the difference was not statistically significant(χ2＝3.340,P ＞0.05).Conclusion The efficacy of concurrent radiotherapy and chemotherapy for patients with advanced cervical cancer is better ,and the survival rate of patients with advanced cervical cancer is better.

Objective To analyze the efficacy and safety of hypofractionated stereotactic radiotherapy ( FSRT ) combined with temozolomide ( TMZ ) for large brain metastases ( BMs ) in a prospective phaseⅡclinical trial.Methods From 2010 to 2015, a total of 33 patients were enrolled as subjects.The median Karnofsky Performance Status scores before and after treatment were 70 and 80, respectively.The major primary tumor was non-small cell lung cancer (57.6%).The brain metastasis had a diameter of≥3 cm or a volume of ≥6 cm3 .The radiation dose was 52 Gy in 13 fractions or 52.2 Gy in 15 fractions.Patients received TMZ at a dose of 75 mg/m2 per day concurrently.The radiotherapy was followed by 6 cycles of adjuvant treatment with TMZ (150 mg/m2, days 1-5, 28 days per cycle).Patients were reexamined by magnetic resonance imaging ( MRI) during the treatment.The radiation field would be shrunk if the gross target volume ( GTV) was reduced by≥20%.The treatment outcomes were evaluated by MRI at 2-3 months after treatment.Results The total numbers of tumors and GTVs were 95 and 38, respectively. Twenty-four (63%) out of the 38 GTVs had a volume larger than 10 cm3 and the median GTV was 15.3 cm3 (5.7-142.8 cm3).Twenty-two (67%) out of the 33 patients achieved field shrinking during the treatment, and the median reduction rate of GTV was 44%( 21%-88%) .The median total dose was 59.5 Gy, and 100%and 21.2%of patients completed the concurrent and adjuvant treatment with TMZ, respectively.In all patients, the overall response rate was 97.0%;the 1-year local control, intracranial progression-free
survival, and overall survival rates were 97%, 70%, and 62%, respectively;the median survival time was 15.3 months.The main adverse reactions were grade 1-2 nausea and vomiting.One patient got grade 3 liver function impairment.Conclusions FSRT combined with TMZ is a safe and effective approach for treating large BMs.More than 50%of patients can achieve field shrinking to shorten treatment duration and reduce toxicity.Clinical Trial Registry ClinicalTrials.gov,registration number:NCT02654106.

Objective:To evaluate the psychological pain of patients with head and neck cancer aged ≥60 years old before and after intensity-modulated radiotherapy (IMRT).Methods:Distress Thermometer (DT)(Chinese version) was used to investigate the degree and problems of psychological pain before and after IMRT for 85 elderly patients with head and neck cancer. The results before and after IMRT were compared by paired t-test. Relevant factors were identified by Logistic regression analysis. Results:The median age in the cohort was 66 years old (60-85 years old). The incidence rates of psychological pain were 73% and 87% before and after IMRT ( P<0.001). The corresponding incidence rates of severe distress were 6% and 34%( P<0.001). The main distress problems before IMRT were memory loss/attention deficit, worry, oral pain, economic problems, stress, sleep problems, and dry nose. The significantly-increased distress problems after IMRT were oral pain, constipation, eating, nausea, and dry nose. Logistic regression analysis showed gender ( OR=5.520, 95% CI 1.437-21.212, P=0.013), pre-treatment PG-SGA score ( OR=1.220, 95% CI 1.048-1.421, P=0.010) and medical insurance ( OR=0.230, 95% CI 0.053-0.995, P=0.049) were the relevant factors of the severe psychological distress before IMRT. Occupation ( OR=2.286, 95% CI 1.291-4.050, P=0.005) and medical insurance ( OR=0.089, 95% CI 0.029-0.276, P<0.001) were the relevant factors of severe psychological distress after IMRT. Conclusion:The incidence rate of distress is high in elderly patients with head and neck cancer before IMRT, which can be aggravated after IMRT, primarily the treatment-related physical pain problems.

Genistein and its monoglucoside derivatives play important roles in food and pharmaceuticals fields, whereas their applications are limited by the low water solubility. Glycosylation is regarded as one of the effective approaches to improve water solubility. In this paper, the glycosylation of sophoricoside (genistein monoglucoside) was investigated using a cyclodextrin glucosyltransferase from Penibacillus macerans (PmCGTase). Saturation mutagenesis of D182 from PmCGTase was carried out. Compared with the wild-type (WT), the variant D182C showed a 13.42% higher conversion ratio. Moreover, the main products sophoricoside monoglucoside, sophoricoside diglucoside, and sophoricoside triglucoside of the variant D182C increased by 39.35%, 56.05% and 64.81% compared with that of the WT, respectively. Enzymatic characterization showed that the enzyme activities (cyclization, hydrolysis, disproportionation) of the variant D182C were higher than that of the WT, and the optimal pH and temperature of the variant D182C were 6 and 40℃, respectively. Kinetics analysis showed the variant D182C has a lower K_m value and a higher k_cat/K_m value than that of the WT, indicating the variant D182C has enhanced affinity to substrate. Structure modeling and docking analysis demonstrated that the improved glycosylation efficiency of the variant D182C may be attributed to the increased interactions between residues and substrate.
Cyclodextrins ; Genistein ; Glucosyltransferases/metabolism* ; Glycosylation ; Kinetics

Objective To retrospectively analyze and compare the clinical efficacy and safety between fractionated stereotactic radiotherapy (FSRT) combined with and without temozolomide in the treatment of large brain metastases.Methods Between 2009 and 2017,84 patients with large brain metastases (tumor size ≥ 6 cm3) were recruited and assigned into the CRT group (concurrent TMZ and FSRT,n=42) and RT group (FSRT alone,n=42).The radiation dose was 52.0 Gy in 13 fractions or 52.5 Gy in 15 fractions.Patients were reexamined by magnetic resonance imaging (MRI) during treatment.The radiation field would be shrunk if the gross target volume (GTV) was reduced.The clinical efficacy was evaluated at postoperative 2 to 3 months.The primary end-point event was local recurrence-free survival (LRFS) and the secondary end-point events included intracranial progression-free survival (IPFS),progression-free survival (PFS),overall survival (OS),brain metastasis-specific survival (BMSS) and adverse events.The survival rates were assessed with Kaplan-Meier method and log-rank test and monovariate analysis.Results The median GTV in the CRT and RT groups was 16.9 cm3 and 15.7 cm3.During the treatment,75％ of the lesions in the CRT group were reduced compared with 34％ in the RT group (P=0.000).The local control (LC) rate in the CRT and RT groups was 100％ and 98％.The median follow-up time was 16.1 months (range,2.1-105.7 months).In the CRT group,the LRFS (P=0.040),IPFS (P=0.022),PFS (P=0.045),OS (P=0.013) and BMSS (P=0.006) were significantly better than those in the RT group,respectively.In the CRT group,the incidence of grade Ⅰ-Ⅱ gastrointestinal adverse events was 33％,significantly higher compared with 26％ in the RT group (P=0.006).No grade Ⅳ-Ⅴ adverse events occurred in both groups.Conclusion Combined application of temozolomide and FSRT can further enhance the LC and survival rates and do not increase the risk of severe adverse events in patients diagnosed with large brain metastases.

Objective To retrospectively analyze the dosimetry and efficacy of whole-brain irradiation (WBRT) with simultaneous integrated boost (SIB) by helical tomotherapy (HT) in the treatment of multiple brain metastases (BMs),and to evaluate the feasibility,efficacy,and safety of HT.Methods From 2014 to 2017,a total of 43 patients with multiple BMs (no less than 3 lesions) were enrolled as subjects.A dose of 40 Gy was delivered to the whole brain in 20 fractions,while a dose of 60 Gy was delivered to the gross target volume (GTV) in 20 fractions.Patients were reexamined by magnetic resonance imaging during treatment.The radiation field would be shrunk if GTV was reduced.Target coverage (TC),conformity index (CI),prescription isodose/target volume (PITV) ratio,and homogeneity index (HI) were assessed.Clinical indices included local recurrence-free survival (LRFS),intracranial progression-free survival (IPFS),progression-free survival (PFS),overall survival (OS),and toxicities.Results The median lesion number was 6(3-36) and the median total volume of GTV was 8.74 cm3.The TC,CI,PITV,and HI for GTV were 0.96±0.028,0.51±0.164,2.09±1.245,and 0.12±0.066,respectively,while the TC and HI for the whole brain were 0.95±0.033 and 0.43±0.161,respectively.In all the patients,26％ had replarming during treatment.The two-stage treatment reduced the radiation dose to organs at risk.The 1-year LRFS,IPFS,PFS,and OS rates were 96％,80％,39％,and 86％,respectively.No grade ≥3 toxicities were observed.Conclusions WBRT with SIB by HT achieves satisfactory conformity,homogeneity,efficacy,and safety,which is a recommended treatment plan for multiple BMs.Replanning during treatment can better protect normal tissue.

Objectives To evaluate the clinical efficacy and safety of hypofractionated radiotherapy for cancer patients with hepatic metastases. Methods From May 2007 to November 2016,45 patients ( male:female=20:25) with inoperable hepatic metastases were enrolled in this investigation. The median age was 58 years old ( range:25-83).The median Karnofsky performance score ( KPS) was 80.Primary colorectal cancer was detected in 14 patients,primary breast cancer in 9 and primary lung cancer in 6 cases. Twenty-one patients had extrahepatic metastases. A total of 52 lesions were treated. Thirty-four cases received radiotherapy for one single lesion. The fractional dose was 45 Gy/3 fractions and 60 Gy/10-15 fractions. The median gross tumor volume (GTV) was 10. 1 cm3(0. 3-175. 2 cm3) and 29. 8 cm3(5. 0-209. 6 cm3) for planning target volume ( PTV).Seventeen CT images were fused with MRI and IMRT was adopted in 43 cases. The median dose of PTV was 60 Gy (40-60 Gy) and 90 Gy (60-132 Gy) for bioequivalent dose (BED). Results The median follow-up time was 23. 5 months and the median survival time was 26. 0 months (95%CI:21.4-30.6 months).The 1-year local control (LC),disease-free survival (DFS) and overall survival ( OS ) were 94%, 27% and 91%, respectively. Six cases died of liver metastases and abnormal liver function. Conclusion Hypofractionated radiotherapy is an efficacious and safe local treatment for inoperable hepatic metastases.