Objective To evaluate the prognostic factors of brain metastasis from non-small cell lung cancer and suggest a individualized treatment method proposal with prognostic estimation. Methods From Dec. 2003 to Jan.2007, 183 patients received whole brain radiation therapy (WBRT) were retrospectively analyzed. Kaplan-Meier method was used to analyze the survival. Logrank test was used to evaluate the difference between the groups. Multivariate survival analysis was conducted using a Cox proportional hazard regression model with a backward stepwise procedure. Results The overall l-, 2- and 3-year survival rate was 40.6%, 16.6% and 11.3%, respectively, but with a median survival time of 10.0 months (95% CI 8.6-11.4 months). In multivariate analysis, RAP grouping, weight loss, LDH in blood serum and treatment method were independent prognostic factors. The median survival time of WBRT alone, WBRT with chemotherapy, surgery with chemoradiotherapy and WBRT with Gefitinib was 9.0, 9.0, 22.0 and 13.0 months, respectively, but their difference were statistical significant (X2 = 10.37, P = 0.016). Conclusions The main prognostic factors of brain metastasis from non-small cell lung cancer are RAP grouping, weight loss, LDH in blood serum and treatment method. The survival time is prolonged by proper multidiseiplinary management than WBRT alone. The effect of combined treatment of surgery with chemoradiotherapy is favorable for the patients operated with single region of metastasis.

Objective To analyze the risk factors of post-ERCP pancreatitis (PEP) and to evaluate the relationship between cannulation time and PEP.Methods The data of cannulation time in 1 625 patients who underwent ERCP from 2010 to 2012 were retrospectively studied.The risk factors associated with PEP were analyzed by univariate and multivariate Logistic regression analysis.The effect of different cannulation time on PEP was evaluated.Results The incidence of overall PEP was 4.6％ (75/1 625) including 4.1％ (67/1 625)of mild and 0.5％ (8/1 625)of moderate-to-severe.Univariate analysis revealed that diabetes mellitus (P =0.02),choledocholithiasis (P =0.02),malignant biliary stenosis (P =0.007),duodenal stenosis (P =0.029),precut (P＜0.01),cannulation time ≥ 8 min (P＜0.01),blood platelet count ≥ 180× 109/L(P =0.089),alkaline phosphatase ≥ 120 U/L (P =0.083) and total bilirubin ≥ 17.1 μmol/L (P =0.094)were associated with PEP.Multivariate analysis revealed that precut (OR=1.93,95％CI:1.10-3.39,P=0.022),cannulation time ≥8 min (OR =3.50,95％CI:2.00-6.13,P＜0.01) and duodenum stenosis (OR=2.92,95％CI:1.08-7.86,P=0.034) were independent risk factors of PEP.Within 30 min of cannulation,longer cannulation time was accompanied with higher PEP rate.Conclusion The cannulation time is an independent risk factor of PEP.Overall PEP is increased when cannulation time is more than 8 min.

Objective:To investigate effect of reperfusion injury following different ischemic duration on skeletal muscle in rats.Methods:A model of ischemia/reperfusion injury (IRI) was established by unilateral clamping femoral artery and additional application of tourniquet in skeletal muscle of hind limbs in 35 male Wsitar rats. According to different ischemia time, the animals were assigned to 2-hour ischemia and 24-hour reperfusion (I2R24 group), 2.5-hour ischemia and 24-hour reperfusion (I2.5R24 group), 3-hour ischemia and 24-hour reperfusion (I3R24 group), 4-hour ischemia and 24-hour reperfusion (I4R24 group) and sham group, with 7 rats per group. At the end of reperfusion, gastrocnemious tissues and plasma samples were collected and analyzed. The ratio of wet ∶ dry weight (W/D) was used to measure muscle edema. The assay of 3-(4, 5-Dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) was conducted to evaluate muscle viability. HE staining was executed to observe histopathological changes. Immunofluorescence staining was performed to assess the levels of C1q, C3b/c, tissue factor (TF), fibrinogen (FN), bradykinin receptor 1 (BR1), BR2, vascular cell adhesion molecule-1 (VCAM-1), E-selectin, fibrinogen-like protein-2 (FGL-2) and myeloperoxidase (MPO) in muscle tissues. ELISA method was used to determine the concentrations of interferonγ (IFN-γ), interleukin7 (IL-7), IL-18, macrophage inflammatory1α (MIP-1α) and monocyte chemotactic protein 1 (MCP-1) in plasma.Results:With prolongation of ischemia time and subsequent reperfusion, tissue edema became severe gradually. The ratio of W/D was 5.3±0.2, 6.1±0.3, 6.9±0.2, 7.6±0.3 in I2R24, I2.5R24, I3R24 and I4R24 groups, higher than that in sham group (4.5±0.1) (all P<0.01). Muscle viability got decreased gradually. Muscle viability was (62.4±3.5)%, (45.3±3.3)%, (35.4±3.4)%, (27.1±5.9)% in I2R24, I2.5R24, I3R24 and I4R24 groups, lower than that in sham group［(93.8±7.2)%］(all P<0.01). Histopathological changes became aggravated gradually. The most severe group was I4R24 group, with the most severe myocyte injury, interstitial edema and extensive inflammatory infiltration, followed by I3R24, I2.5R24 and I2R24 groups in order. There was normal structure integrity and neatly arranged myocyte in sham group. Meanwhile, levels of C1q, C3b, FN, BR1, VCAM-1, E-selectin and FGL-2 got increased gradually. The highest levels for these factors were seen in I4R24 group, followed by I3R24 group, I2.5R24 group, I2R24 group and sham group in order. The rough ratio of the number of positive MPO cells/total cell number under high lens (×200) were increased gradually, with the highest level in I4R24 group, followed by I3R24 group, I2.5R24 group, I2R24 group and sham group in order. However, expression of TF and BR2 were not altered significantly among the groups. Plasma levels of INF-γ, IL-7, IL-18, MIP-1α and MCP-1 elevated gradually with prolongation of ischemia time (all P<0.01). The sequence was the sham group, I2R24 group, I2.5R24 group, I3R24 group and I4R24 groups for levels of these factors from low to high (all P<0.01). Conclusion:Reperfusion after prolongation of ischemia duration can increase the activation of complement, coagulation, kinin and endothelial cells as well as the release of inflammatory factors, and thus aggravate the degree of skeletal muscle tissue injury.

Objective:To explore a three-dimensional dose distribution prediction method for the left breast cancer radiotherapy planning based on full convolution network (FCN), and to evaluate the accuracy of the prediction model.Methods:FCN was utilized to achieve three-dimensional dose distribution prediction. First, a volumetric modulated arc therapy (VMAT) plan dataset with 60 cases of left breast cancer was built. Ten cases were randomly chosen from the dataset as the test set, and the remaining 50 cases were used as the training set. Then, a U-Net model was built with the organ structure matrix as inputs and dose distribution matrix as outputs. Finally, the model was adopted to predict the dose distribution of the cases in the test set, and the predicted 3D doses were compared with actual planned results.Results:The mean absolute differences of PTV, ipsilateral lung, heart, whole lung and spinal cord for 10 cases were (119.95±9.04) cGy, (214.02±9.04) cGy, (116.23±30.96) cGy, (127.67±69.19) cGy, and (37.28±18.66) cGy, respectively. The Dice similarity coefficient (DSC) of the prediction dose and the planned dose in the 80% and 100% prescription dose range were 0.92±0.01 and 0.92±0.01. The γ rate of 3 mm/3% in the area of 80% and 10% prescription dose range were 0.85±0.03 and 0.84±0.02. Conclusion:FCN can be used to predict the three-dimensional dose distribution of left breast cancer patients undergoing VMAT.