Background and purpose:It may improve local control to increase radiation dose for esophageal cancer.The purpose of the study is to obtain the maximum tolerance dose(MTD)and assess toxicity of 3-D conformal radiation therapy(3-DCRT)for esophageal cancer.Methods:The scheduled dose escalation ranged from 70 Gy to 76 Gy.All patients received conventional fractionation irradiation to a dose of 46 Gy/23 Fx/4.5 weeks,followed by accelerated hyperfractionation irradiation using reduced fields,1.5 Gy twice a day,to a dose of 24 Gy/16 Fx.The criteria for stopping dose escalation was grade ≥3 radiation-induced toxicity in ≥15% patients.Results:From July,2000 to July,2001,18 patients were enrolled.Five patients completed a total dose of 70 Gy and an additional 5 patients received 73 Gy.Eight patients completed a total dose of 76 Gy.No patient occurred grade ≥3 radiation-induced toxicity at the level of 70 Gy.Four patients(80%)experienced grade ≥3 radiation-induced late toxicity(2 patients died of late radiation-induced pneumonitis)at the level of 73 Gy.Five patients(62.5%)experienced grade ≥3 radiation-induced acute toxicity and 6 patients(75%)had grade≥3 late toxicity(1 patients died of late radiation-induced esophagitis,and 2 patients died of late radiation-induced pneumonitis)at the level of 76 Gy.Conclusions:Based on the clinical trial,there were more severe radiation-induced toxicities when the patients with esophageal cancer received more than 70 Gy.

The hypotensive effect of PAMC and its mechanism were studied.In conscious renal hypertensive rats, intraperitonal injection of PAMC once a day for 7d at the dosage of 11 mg/kg ( 1 time/day ) and oral administration of the drug 3 times a day for 14 d at the dosage of 12 mg/kg/d, the arterial pressure decreased 29.0?2.8% and 20.3 ? 1.4%, respectively.In normal anesthetized dogs and rats, intravenous injection of PAMC at the dosage of 0.4 mg/kg, the mean arterial pressure deceased 43.7 ? 7.9 and 39.7 ? 2.3%. In anesthetized rabbits and rats, intraduodenal injection of PAMC at the dosage of 4 mg/kg, the mean arterial pressure decreased 24.5 ? 3.8% and 38.2 ? 11.4%, respectively.The experiments suggested that inhibition of the (?) -adrenal receptors may be the principal mechanism of the hypotensive action of PAMC. Ganglion blockade, vasodilation as Well as excitation of ?2-adrenal receptors may also be involved.The acuts iv PAMC LD50 in mice were 25.5?5.0 mg/kg.

AIM:To study the effect of neuregulin-1 ( NRG-1β) or captopril alone and their combination on myocardial cell apoptosis and related gene expression in rats with chronic heart failure .METHODS:Young male Sprague-Dawley rats were randomly divided into sham-operated group, heart failure group, NRG-1βgroup, captopril group and combined treatment group .The volume overloaded heart failure model in the rats was established by aortocaval fistula .The cardiac function was evaluated by determining the changes of hemodynamics and plasma BNP level .The apoptotic index ( AI) of myocardial cells was assayed by TUNEL .The protein levels of p-Akt, Bax and Bcl-2 in left ventricular tissue were detected by Western blot .RESULTS: The LVEDP, AI and the expression of Bax were significantly lower in NRG-1βgroup, captopril group and combined treatment group than those in heart failure group ( P<0.05 ) , while the values of ±dp/dtmax and the protein levels of p-Akt and Bcl-2 were significantly higher in NRG-1βgroup, captopril group and com-bined treatment group than those in heart failure group (P<0.05).The effect of combined treatment group was more signifi-cant ( P<0.05) than that in NRG-1βgroup and captopril group .CONCLUSION: Neuregulin-1βor captopril alone and the combination of them effectively improve the cardiac function and inhibit myocardial cell apoptosis in chronic heart failure rats.The therapeutic effect of combination of NRG-1βand captopril is better than that of NRG-1βor captopril alone .

Objective To define the prognostic factors and local failure in late course accelerated hyperfractionation radiotherapy(LCAHR) for esophageal carcinoma.Methods A retrospective study was conducted in 201 esophageal squamous cell carcinoma patients treated by LCAHR during the period between August 1994 to January 2000.The radiotherapeutic portals were set and based on CT scan and esophagograms. All patients received a mean dose of 41.4 Gy /23 F/4～5 WK. With conventional fractionation regimen during the first two thirds of the course,and followed by LCAHR with reduced fields, at dose of 27 Gy/18 d,1.5 Gy per fraction,twice daily. The total dose varied up to 67～70 Gy/40～43 F/40～49 d. Results The 1 ,3 and 5 year actuarial survivals were 72.5% ,35.6% and 31.1%. The 1 ,3 and 5 year local control rates were 82.2%, 71.3% and 71.3%,respectively. Of the 95 patients who died, 34(35.8%) did so from local failure , 32(33.7%) from distant metastasis(33.7 %), 13(3.7%) from lymphatic metastasis, 4(4.2%) frome both local and distant metastasis and 12(12.7%) from complications.Conclusions It is showed that significant improvement in local control and survival are observed after LCAHR for esophageal carcinoma in comparison to conventional fractionated regimen. The prevention and management of distant metastasis and lymphatic spread have become the major problems in the future.

Objective To study the clinical results and prognostic factors of late course accelerated hyperfractionation radiotherapy (LCAHR) in the treatment of esophageal carcinoma in the elderly. Methods 105 over 60 year-old patients with esophageal carcinoma who received radical LCAHR, were retrospectively analysed. Radical tumoricidal dose of 67.9～72.0?Gy was delivered in 39～43 fractions over 42～53 days. Results The 5-year local control rate was 63.7%. The 5-year disease-free survival and overall survival rate were 22.6% and 34.4%. Acute esophagitis and bronchitis were the most common but acceptable radioreactions Grade 1～2. No significant differences were found either in the clinical response or complication, between the 60～69 year and 70～80 year groups. By multivariate analysis, T stage and KPS score were two independent prognostic factors. Of 67 death cases, 31 died of local relapse, 23 of distant metastases, 8 of both and 5 of other causes. Conclusions LCAHR toxicity ,being tolerable for the older esophageal carcinoma patients,may improve their survival and quality of life.

With the development of molecular biology,the study of biological markers will probably help to predict the prognosis and to improve the method of treatment and the survival. Advances in biological markers of esophageal cancer prognosis were reviewed. [

The surveillance of schistosomiasis in Sanzhou Village, Dantu District, Zhenjiang City, a national schistosomiasis surveillance site, showed that in 2008, the area with snails was 27 hm~2, among which the area with infected snails was 14 hm~2, the densities of living snails and infected snails were 0. 86 and 0.002 1 snails/0. 1 m~2, respectively. The infection rate of snails was 0.25% , the positive rate of IHA was 3. 10% and the infection rate of schistosome in human populations was 1%. There were no infected domestic animals found, and there were no acute schistosomiasis and newly advanced schistosomiasis cases found in the surveillance site in 2008. It is indicated that the endemic situation of schistosomiasis is stable. The comprehensive control, including molluciciding and environmental modification, should be implemented for snail control. The comprehensive measures with emphasis on infectious source control should be further strengthened.

Objective To analyze the clinical features of patients with hemophagocytic syndrome (HPS) in autoimmune diseases (AID). Methods We collected the data of 11 patients with AID complicated with HPS in Peking Union Medical College Hospital from 2004 to 2009. The underlying diseases, clinical features, laboratory findings and treatment outcomes were retrospectively analyzed. Results Of the 11 patients,3 were male,8 were female. Mean age was (30. 7 ± 18. 3) years. The underlying diseases included Still disease ( n = 4 ), systemic lupus erythematosus ( n = 3 ), and rheumatoid arthritis, primary Sj(o)gren's syndrome, Wegener granulomatosis and Crohn disease in each one case. HPS was associated with the onset of AID ( n = 4), active infection alone ( n = 1 ) and both factors ( n = 6 ). HPS was clinically characterized by high fever ( 100% ), hepatosplenomegaly ( 72. 7% ) , lymphadenopathy ( 63.3% ) and central nervous system involvement (36. 3% ). 4 patients presented with disseminated intravascular coagulation(DIC) (36. 3% ). Laboratory data mainly manifested with cytopenia ( 100% ), liver dysfunction ( 100% ), hypofibrinogenemia ( 62. 5% ), hypertriglyceridemia ( 81.8% ), serum ferritin ＞ 500 μg/L (100%), low NK-cell activity(80% ) and hemophagocytosis in bone marrow( 100% ). Based on treating underlying infections and use of corticosteroids and immunosuppressive agents in combination with intravenous immunoglobulins(IVIG) therapy, 5 patients recovered , 6 patients died. The mortality rate was 54. 5%. DIC were associated with mortality ( r = 0. 69, P = 0. 019 ). Conclusion The episode of HPS always occurs simultaneously with multiple system involvement that was often difficult to distinguish from active AID. The present of DIC on HPS related with poor prognosis and high mortality. Corticosteroids and immunodepressant and IVIG may improve the prognosis of HPS, while anti-infection therapy is very important and necessary for the patients accompany with active infection.

Objective:To explore value of 256-slice spiral CT pulmonary artery angiography (CTPA)evaluating right heart function in patients with acute pulmonary embolism (APE).Methods:According to death risk assessment of APE patients, a total of 67 APE patients were divided into high risk APE group (n=41)and non-high risk APE group (n=35).CTPA was used to analyze and compare CTPA obstructive index and right heart function indexes between two groups.Correlations among CTPA obstructive index and right heart function indexes were also analyzed.Results:Compared with non-high risk APE group,there were significant rise in CTPA constructive index [8.58% vs.24.69%],percentages of straight or left protruded ventricular septum (31.46% vs.73.17%)and bronchial artery dilation (5.71% vs.24.69%);Except the supe- rior vena cava diameter,the rest right heart function parameters had difference significance in two groups,P<0.05 or<0.01. Spearman correlation analysis indicated that CTPA obstructive index was significant positively correlated with right ventricular maximal short axis (RVMSA),RV:LV,diameters of main pulmonary artery,superior vena cava and azygos (r=0.684~0.954),and significant inversely correlated with LVMSA (r=-0.786),P<0.01 all.ROC curve analysis indicated that AUCs of CTPA RV:LV (0.949)was the biggest diagnosing APE severity.Conclusion:Right heart func- tion indexes measured by multi-detector CT are accurate and practical indexes evaluating APE severity,and it possesses im- portant significance.

Objective To investigate the inflammation levels of 2-diabetes patients before and after 3 months of improving glycemic control.Methods A longitudinal study was performed in a subgroup of 48 subjects with T2D and poor glycemic control.Forty-four healthy individuals were taken as control group.The serum concentration of C-reactionprotein (CRP),interleukin-6 (IL-6),interleukin-6 (IL-8),transforming growth factor-β1 (TGF-β1) and transforming growth factor-β1 (MCP1) in all participants were measured simultaneously by multiplexed Luminex assay.Results The serum levels of CRP,MCP-1 of 2-diabetes patients were 3.96 (3.45,5.58) mg/L and (195.0± 129.8) ng/L,significant higher than those in control group (2.25 (1.24,3.22) mg/L,(148.5±85.7) ng/L),and the differences were significant(t=-2.580,P=0.010;t=-2.118,P =0.047).No significant difference was found in the serum levels of IL-6,IL-8,TGF-β lbetween the two groups (P＞0.05).TGF-β1 level in patients with good glycemic control decreased to 26.85 (23.17-31.12) ng/l,significant lower than that before glycemic control (43.5(26.5-62.25) g/L;Z=-2.191,P=0.028),and there were no significant differences among the other 4 kinds of inflammatory factors before and after blood glucose control(CRP:Z =-0.937P =0.372;IL-6:Z =-0.875,P =0.396;IL-8:Z =-1.215,P =0.286;MCP-1:t =-1.846,P=0.065).Conclusion Low grade systemic inflammation status in T2D patients.Improvement of glycemic control reduces TGF-β1 levels and plays a key role in delaying the development of diabetic nephropathy.