Background and purpose:The incidence of lung cancer with brain metastasis tends to go up. The technique of intensity-modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) for tumor bed is a new treatment choice for patients with brain metastasis. This study aimed to investigate the feasibility of IMRT combined with SIB for tumor bed in the treatment of brain metastases of lung cancer by exploring its short-term clinical effect and treatment-related toxicities.Methods:Thirty-two patients who were diagnosed as having lung cancer with 1-4 brain metastases were prospectively collected. All the brain metastases were treated with whole brain 5 ifelds IMRT (40 Gy/20 f) combined with SIB (50 Gy/20 f). The dosage distribution within the target volume and dose-volume histogram were evaluated. Meanwhile, the overall response rate of radiotherapy, thelocal tumor control rate, 1-year survival rate, treatment-related acute and late toxicities were also calculated.Results:All patients were treated with IMRT successfully. The rate of Grade 2 vomitting, nausea, epilepsy was 9.4%, 15.6%, and 12.5%, respectively. Two cases had Grade 2 cognitive impairment, 4 cases had Grade 2 memory injury, and 2 cases had Grade 3 memory injury. There were no any Grade 4 events of acute and late toxicities. The overall response rate of radiotherapy was 71.9%. The local tumor control rate was 96.9%, and 1-year survival rate was 44%.Conclusion:It is feasible to use 5 ifelds IMRT (40 Gy/20 f) combined with SIB (boosting 10 Gy, i.e. total dose 50 Gy/20 f) for the treatment of brain metastases of lung cancer.

Objective To explore the diagnosis and treatment for pancreatic cystic neoplasms.Methods The clinical data of 10 cases with pancrestic cystic neoplasms treated from 2004 to 2008 was reviewed and both domestic and internal pertinent literatures were summarized.Results The pancreatic cystic neoplasms mostly happened in middle-aged women.The clinical manifestations showed no specificity.Ultrasonography, CT and MRI could offer important sign for diagnosis.The rate of surgical resection was high and the prognosis was satis-factory.Conclusions The pancreatic cystic neoplasms is being muh with the development of imagings.It is dif-ficuh to distinguish the feature of the cystic neoplasms before surgery, so surgerical resection should be done for all cystic tumors found.

Objective To obtain the full-length cDNA sequences of CYP2E1,CYP2D5,ECHS1,which may be related with non-alcoholic fatty liver disease,from Microtus fortis.Methods To construct Microtus fortis liver cDNA plasmid library using SMART technique,to get the purposed colonies through screening libraries by PCR,and to obtain their full-length cDNA sequences by sequencing with pBluescript II SK universal primers M13R.Results Three full-length cDNA sequences of Microtus fortis,CYP2E1,CYP2D5 and ECHS1 were obtained.The CYP2E1 cDNA was 1685 bp in length and contained a 1482 bp open reading frame(ORF) encoding a 494 amino acids.The CYP2D5 cDNA was 1690 bp in length,and contained a 1514 bp ORF encoding 504 amino acids.The ECHS1 cDNA was 1013 bp in length,and containsed an 873 bp ORF encoding 290 amino acids.Sequence analysis revealed that the identity of the three cDNA sequences and deduced amino acids among Microtus fortis,Homo sapiens,Mus musculus and Rattus norvegicus was high.Conclusion The full-length cDNA sequences of CYP2E1,CYP2D5,ECHS1 were obtained from Microtus forti,liver cDNA library.and the gene sequences have been deposited in GenBank (GQ507485,GQ507486,GQ845171),which may lay the foundation for researchies of pathogenesis of non-alcoholic fatty liver disease in Microtus fortis models.

Objective To study the clinicopathologic features of thyroid-like follicular renal cell carcinoma.Methods Clinical data were collected in 5 cases of thyroid-like follicular renal cell carcinoma.HE staining and immunohistochemistry were carried out in surgically-removed specimen to analyze the clinical and pathological features with review of the literatures.Results The patients aged 20-55 years, with one male and four females;the tumor occurred in the left kidney in three cases and right kidney in two cases.One case had a history of thyroid papillary carcinoma 3 years ago, and the patient had left flank pain, macroscopic haematuria for 2 weeks.The rest four cases had no consciousness of clinical symptoms and signs, without history of thyroid gland surgery; the physical examination found a mass in the kidney and normal thyroid glands.Three patients underwent radical nephrectomy, and the other two patients underwent tumor partial nephrectomy.The tumors were 2-4 cm in size.They showed a solitary nodular mass of well circumscribed with taupe and gray on cut surface.Microscopically,most of tumor cells arranged in thyroid follicular pattern in different sizes, with papillary configuration in a small portion,in four cases;the follicular structure was intermixed with the papillary each half in one case.A large amount of thyroid colloid was deposited within follicule-like structure or papillary axis, lined by simple columnar cells or cubic cells, with obvious atypia, ground-glass nuclei, nuclear groove and rare mitosis.Immunohistochemical staining showed tumor cells were positive for PAX8,and negative for thyroid transcription factor 1 (TTF1) and thyroglobulin ( Tg).One of five patients presented with lymph node metastases (4/4) of renal hilum the same time in the diagnosis.Five cases were followed up for 5 -84 months after operation, and no tumor progression was found.Conclusions Thyroid-like follicular renal cell carcinoma is primary renal epithelial malignant tumor.The diagnosis mainly depends on its characteristics of histological appearance,namely similar to the histological morphology of well-differentiated thyroid follicular carcinoma and papillary carcinoma, and the metastasis from the thyroid papillary or follicular carcinoma must be excluded.On the premise of clinical history, immunohistochemical markers TTF1 and Tg have certain value in the differential diagnosis.

Objective:To access the effectiveness and safety of the intrauterine balloon tamponade verse gauze packing combined with temporary abdominal aortic balloon occlusion in the management of placenta accreta spectrum (PAS).Methods:This was an open-label, randomized controlled trial conducted in Nanjing Drum Tower Hospital. The patients suspected with PAS for uterine preservation surgery under the multidisciplinary team care were recruited between Aug 2015 and Jan 2018. When bleeding could not be achieved after fetus delivered, and a temporary abdominal aortic balloon occlusion and the compression sutures as needed, the women were randomly allocated 1∶1 into balloon tamponade ( n=81) or gauze packing ( n=80) group. The primary outcome was successful bleeding arrests by avoiding second line surgeries. The secondary outcomes included the volume of blood loss during and after cesarean section, the rate of PPH, incidence and amount of blood transfusion, hysterectomy, postpartum pain, ICU admission, need for re-laparotomy, and the length of hospital stay, readmission, and interventional radiology complications. Results:All the women [100% (81/81)] in the balloon group were obtained hemostasis without further intervention, significantly higher than 88% (70/80) in the gauze group ( P=0.001). Before uterine tamponade, blood loss were 820 ml (620-1 230) ml and 850 ml (605-1 442) ml, while placenta bed were sutured in 96%（78/81, 77/80） respectively ( P>0.05).The proportion of blood loss≥1 000 ml was higher in the gauze group than that in the balloon group ( P=0.006). Maternal adverse events involving total blood loss, puerperal morbidity and postpartum pain occurred more frequently in the gauze group ( P<0.05). The following outcome showed no statistically significant difference between the two groups: the vascular occlusion time, the dose of radiation, and interventional radiology complication ( P>0.05). The median volume infused into the lower and upper balloons is 70 ml (50-100 ml) and 180 ml (100-240 ml). Conclusions:Incrauterine balloon tamponade is as effective as gauze packing in hemostasis following the placenta delivery in PAS. Compared with gauze packing, the uterine balloon tamponade is more effective.