Objective:This work aimed to compare the three-year results, prognostic analysis, and adverse reactions of intensi-ty-modulated radiation therapy (IMRT) positioned by PET-CT and conventional radiotherapy in locally advanced non-small cell lung cancer (NSCLC) patients who underwent concurrent chemotherapy. Methods:A clinical trial was carried out in Qingdao Cancer Hospi-tal. The patients who joined our study were divided into IMRT and conventional radiotherapy (CRT) groups. A total of 48 patients were in the IMRT group and another 40 were in the CRT group. The total dose was 60 Gy throughout the 6-week treatment. The plati-num-based concurrent chemotherapy, combined with regimens such as docetaxel, navelbine, and pemetrexed, was conducted for two cy-cles followed by two to four cycles of consolidation chemotherapy. Results:Significant differences were observed between the curative ratio of the IMRT (77.1%) and CRT (52.5%) groups (P=0.015). No significant difference existed between the short-term survival rates of the two groups. The 1-, 2-and 3-year survival rates were 77.1%, 54.2%, and 22.9%in the IMRT group, as well as 65.0%, 47.5%, and 17.5%in the CRT group, respectively. Significant differences existed in some adverse reactions between the two groups, such as radia-tion gastrointestinal reactions, esophagitis, and pneumonia. More patients died of local recurrence and radiation pneumonia in the CRT group than in the IMRT group. The local recurrence rate was also lower in the IMRT group than in the CRT group. Conclusion:IMRT has obvious advantages in improving the short-term curative effect and reducing adverse reactions. Regarding the survival rate, a long-term follow-up of the two groups is required in the future.

Objective: To investigate the changes in serum CD44v6/v EGF(sCD44v6/sVEGF)levels after concurrent chemoradiotherapy in patients with inoperable non-small cell lung cancer(NSCLC)patients and to analyze the correlation of serum markers with patients'prognosis. Methods: The sCD44v6/v EGF levels were detected by ELISA in 50 inoperable NSCLC patients before and after concurrent chemorediotherapy. Results: The sCD44v6 and sVEGF levels before treatment was significantly higher than that in the control group.The pre-treatment sVEGF level was closely related to cTNM stage.metastasis,cell differentiation and primary tumor size,but was not correlated with histological classification,lymph node status,age or gender.The pre-treatment sCD44v6 level was closely correlated with cTNM stage,metastasis,cell differentiation,and primary tumor size,but was not correlated with histological classification,age or gender.Patients'sCD44v6 before treatment(570.89±63.30 ng/L)was significantly higher than that after treatment(281.44±74.28 ng/L).Patients'sVEGF before treatment(241.09±85.96 ng/L)was significantly higher than that after treatment(133.64±67.69 ng/L).PD patients had the highest level of sCD44v6 and sVEGF and CR patients had the lowest sCD44v6 and sVEGF level.The sVEGF level was highly correlated with sCD44v6(r=0.291,P<0.05).Conclusion:The sCD44v6 and sVEGF levels might be helpful for evaluation of the biological behavior and prognosis of NSCLC.

0.05). Conclusions For patients with locally advanced non-small cell lung cancer, concurrent conformal radiotherapy and chemotherapy followed by consolidation chemotherapy can improve the progression-free survival, but have few effects on overall survival and toxicity. Multicenter clinical trial with more patients should be carried out to confirm the benefit from the additional consolidation chemotherapy.

Anti-angiogenic drugs such as bevacizumab can effectively alleviate the patients′brain edema and clinical symptoms and improve the patients′life quality by reducing vascular permeability and the blood-brain barrier damage.Bevacizumab has got positive efficacy in the clinical,so that it is considered as an effective and safe treatment for malignant brain edema.

Objective To investigate the efficacy and the side-effects of concurrent chemoradiotherapy combined with consolidation or induction chemotherapy for locally advanced non-small cell lung cancer(NSCLC).Methods64 patients with stage ⅢA and ⅢB NSCLC were divided randomly into the CCT group(concurrent chemoradiotherapy followed by consolidation chemotherapy) and the ICT group(induction chemotherapy followed by concurrent chemoradiotherapy).All patients were deliverd to thoracic planning target with total dose of 54~66Gy(median dose 60Gy)in 6~7 weeks.CCT group started to irradiate by conformal radiotherapy technique on day 1,and ICT started on day 43 with single fraction dose 200 cGy and 5 fractions every week.ResultsThe response rate in CCT and ICT group was 60.0% and 58.8% respectively(P=0.924),with no statistic significance between the CCT and ICT group.The side-effects were mainly granulo-cytopernia,radiation espohagitis and radiation pneumonitis.ConclusionConcurrent chemoradiotherapy combined with consolidation or induction chemotherapy for locally advanced NSCLC is well tolerated.The sequence of adjuvant chemothreapy to concurrent chemoradiotherapy produced no significant difference for NSCLC in recent response.

Objective To retrospectively analyze the complications and management of complications during percutaneous implementation of biliary stents in 17 patients. Methods Percutaneous biliary drainage and implementation of biliary stents for malignant biliary obstruction under fluoroscopic guidance was performed in 64 patients. 17 cases developed complications. Bradycardia and hypotension was seen in 5 cases, slipping of the stent into the duodenum in 1, bile duct perforation in 2, the fine guidewire broken in the hepatic parenchyma in 2, malposition of the stent in 3, hepato renal failure leading to hemorrhage in 2, exchanging guidewire broken in the duodenum in 1, and balloon broken leading to stent dislocation in 1, respectively. Results Bradycardia and hypotension in the 5 cases was treated medically and the procedure was interrupted. Slipping of the stent into the duodenum was passed off spontaneously. Broken of the fine guidewire in the liver did not present any complaints until the death of the patients. Perforation of bile duct was treated conservatively with a clinical successful outcome. Malposition of the stent was treated by reimplementation of shorter stents. The broken exchanging guidewire in the duodenum during implementation was removed with the gastroscope. The hepato renal failure leading to hemorrhage had poor prognosis. The broken balloon caused stent dislocation was treated by reimplementation of stent. Conclusion Percutaneous implementation of stent is effective and safe for elderly patients with proximal stenosis of the biliary tract. However, one must be very careful to avoid the complications.

Objective To investigate the efficacy and side-effect of docetaxel and cisplatin induction chemotherapy followed by concurrent chemoradiotherapy in locally advanced non-small cell lung cancer (NSCLC).MethodsEighty-six patients with histologically confirmed locally advanced NSCLC were randomized into induction chemotherapy followed by concurrent chemoradiotherapy (ICCRT)arm or concurrent chemoradiotherapy (CCRT) arm. Both arms were treated with intensity-modulated radiation therapy. Induction and concurrent chemotherapy regimen consist of docetaxel and cisplatin. Results Follow-up rate of the whole group is 100％.The response rate in the CCRT arm and ICCRT arm is 70％ and 80％ ( χ2 =1.26,P =0.261 ),respectively; and 1-,2-,3-year survival rate is 65％ and 85％,40％ and 50％,33％ and 44％ (χ2 =3.90,P=0.048),respectively; the median survival time and time to progression is 17.5 and 22.0 months and 14.0 and 19.0 months respectively.Major adverse effects are leukopenia (43 and 32 cases,χ2 =3.48,P =0.062),radiation esophagutis (26 and 20 cases,χ2 =0.12,P =0.730),anemia (26 and 16 cases,χ2 =2.34,P =0.126) and radiation pneumonitis (13 and 9 cases,χ2 =0.37,P =0.541 ).ConclusionsICCRT for locally advanced NSCLC can improve the overall survival rate and time to progression,induction chemotherapy did not increase side-effects.There was no difference in response rate between CCRT and ICCRT arm.

Objective To study the diagnostic value of susceptibility weighted imaging (SWI) in diffuse axonal injury (DAI) and investigate the relationship between SWI and clinical prognosis. MethodsTwenty patients (15 males and 5 females) with DAI were included in this study. Routine sequences (T1WI, T2WI and FLAIR) and SWI were performed on a 3.0 T MRI scanner. There were 8 cases whose Glasgow score scale (GCS) ranged from 3.0 to 5.0, 4 cases from 6.0 to 8.0 and 8 from 9.0 to 12.0. The interval time between injury and examination were from 3 hours to 20 days. The number and volume of lesions observed on SWI and routine sequence were compared using Mann-Whitney U-test and paired t-test. Pearson correlation was used to analyze the relationship between the number and volume of all lesions and GCS. Results The lesions showed punctate, beaded, patchy and cord-like hypointense signal with various size on SWI (lesion diameter <2.0 cm). Distribution of lesions was multifocal with clear boundary. Routine MRI scan found a total of 78 lesions, while SWI sequence detected 424 lesions. The number of the lesions found on SWI was more than that on conventional MRI (U=-15.447,P＜0.01). The total volume of the lesions measured on routine MRI and SWI were 19 340 mm3 and 38 042 mm3, respectively. The total volume measured on SWI was more than that on routine MR (t=5.870,P＜0.01). The number and volume of all lesions were negatively correlated with GCS (r=-0.802, -0.767, P＜0.01). Conclusion SWI sequence could find more bleeding lesions than the routine MRI sequences. The number and the volume of the lesions were closely related to GCS. SWI showed high value in the diagnosis and prediction of the prognosis of DAI.

Objective To investigate the correlation among expression of serum VEGF without operation between pre-and post-chemoradiotherapy in non-small cell lung cancer (NSCLC) patients, to explore the correlation of markers on prognosis and effect. Methods The serum vascular endothelial growth factor (VEGF) were detected in 50 patients without operation between pre-and post-chemoradiotherapy with NSCLC by ELISA method. The group t-test was played into before concurrent chemoradiotherapy and normal control. The paired t-test was played into before and after concurrent chemoradiotherapy. Results The prechemoradiotherapy serum VEGF ( 241.09 ± 52.45 ) ng/L in NSCLC patients was significantly higher than those in normal control patients (103.72 ± 39. 22) ng/L (t = 2. 50,P ＜0. 05 ). The pre-chemoradiotherapy serum VEGF in NSCLC patients was closely related to pTNM stage, distant metastasis, grade of cell differentiation and the size of the primary tumors ( t = 9. 61 - 14. 94, all P ＜ 0. 05 ), but not to the histological classification, type of the tumor, lymph node status, age, gender of the patients or smoking or not (t =0. 58 - 1.84, all P ＞ 0. 05 ). The pre-chemoradiotherapy serum VEGF ( 24 1.09 ± 52. 45 ) ng/L was significantly higher than that of the post-chemoradiotherapy ( 133.64 ± 33.62) ng/L ( t = 12. 20, P ＜ 0. 01 ). The post-chemoradiotherapy serum VEGF decreases to the pre-was the biggest in the CR patients (( 92.35 ± 37.48ng/L) ,t =3.79,P ＜0. 01 ) ,the smallest in the PA patients ( (276.32 ±47.98) ng/L,t = 1.32,P ＞0. 05) ) ,and bigger in the PR patients and the NC patientspatients ( ( 113.10 ± 39. 20) ng/L,t = 13.58,P ＜0. 01 and ( 198.10 ± 42.68 ) ng/L, t = 4. 78, P ＜ 0. 05 ) ), respectively. Conclusions Elevation of serum VEGF exists in patients with NSCLC . The serum VEGF in patients with NSCLC might be helpful to evaluate the biological behavior of lung cancer. Detection of VEGF expression maybe helpful for predicting the prognosis of NSCLC patients.

Objective To determine if preventive antibiotics is effective in stroke associated pneumonia in patients with acute stroke.Methods Medline (January 1950 to January 2017),EMBASE (January 1974 to January 2017),Cochrane Library (January 2009 to January 2017),CNKI (January 1979 to January 2017)and Wanfang data (January 1998 to January 2017) were searched for randomized controlled trial comparing preventive antibiotics with placebo/blank controls for stroke associated pneumonia in patients with acute stroke.The included studies were screened out strictly based on the criterion of inclusion and exclusion.The quality of included studies was evaluated and the data were extracted by two researchers independently.RevMan 5.1 was used for Meta analysis.Results A total of 4 studies involving 3894 patients were included.The results of Meta-analysis indicated that there was no significant difference in the incidence of stroke associated pneumonia between preventive antibiotics and control groups (OR=0.96,95％CI:0.72-1.29,P=0.810);and there were no statistically significant differences in mortality (OR=1.05,95％CI:0.88-1.25,P=0.570) and good outcome (modified Rankin scale ≤ 2,OR=1.02,95％CI:0.89-1.17,P=0.780).There were no serious adverse reactions related to the studied drugs in 4 studies.Conclusion Preventive antibiotics could neither reduce the incidence of stroke associated pneumonia nor decrease the mortality or improve the proportion of good outcome.