Skeletal muscle extracellular matrix (ECM) is the microenvironment for muscle cells to survive and function. Changes in ECM components and structure directly affect the activity and function of muscle cells. Pathological remodeling occurs to skeletal muscle ECM in insulin resistance, including collagen deposition, hyaluronan accumulation, activation of membrane protein integrin signaling path-way, and the imbalance of matrix metalloproteinases and tissue inhibitors of metalloproteinases, while all those would impair the tissue insu-lin sensitivity.

Objective To measure the volumetric changes precisely during stereotactic ablative radiotherapy for early-stage and oligo-metastatic lung tumors and optimize the treatment plan timely.Methods From October 2011 to October 2014, 66 patients with 71 early-stage or oligo-metastatic lung tumors received SABR.Median age was 66 years.To measure the volume of tumors, the verification images were registered before each treatment fraction with stimulation images by reference to bone structure.Tumors volume was measured by the first verification images, and were defined as the reference when evaluating the trend of tumors volume change during SABR treatment.Generalized estimated equations were used to analyze the trend of the change of tumors volume over time with several possible predictors.The primary plan (P-plan) was modified when the biological effective dose (BED) of a tumor reached 60 Gy and volume change reached 25％.The modified plan was named as M-plan.Paired t-test was used to compare the dose of organs at risk (OAR) between M-plan and P-plan.Results In 71 tumors, 49 (69％) tumors showed volumetric shrinkage, 21 (30％) tumors showed enlargement and 1 tumor showed invariance.Generalized estimated equation showed no statistical significance (P =0.281) for the volumetric shrinkage of lung tumors.M-plan was made in 26 tumors.Of these tumors, 21 tumors decreased over 25 ％ and the result of paired t-test showed V5 of lung, Dmax and D1.2 cm3 of spinal cord, Dmax and D5 cm3 of esophagus and D30 cm3 of chest wall were statistically different between two plans(t =3.139 ～11.939 ,P＜0.05).5 tumors enlarged over 25％ and the result of paired t-test showed V5 and V20 of lung,Dmax and D1.2cm3 of spinal cord, Dmax of esophagus and D30cm3 of chest wall were statistically different between the two plans(t =-10.436--2.518, P ＜ 0.05).Conclusions Size of lung tumors changed dynamically during SABR, but it is unnecessary to modify treatment plans for all tumors.The tumors which showed obvious volumetric change may benefit from modifying treatment plans.

Objective:To analyze the invasion characteristics and prognostic factors of patients with Masaoka-Koga stage Ⅲ thymoma.Methods:The tumor invasion characteristics of 179 patients who were diagnosed with Masaoka-Koga stage Ⅲ thymoma and treated in Affiliated Cancer Hospital of Zhengzhou University from January 2000 to June 2018 were analyzed retrospectively. According to the treatment methods, all patients were divided into the radical operation group ( n=94), palliative operation group ( n=39) and simple biopsy group ( n=46). The χ2 test was used to compare the classified variables, Kaplan- Meier method was utilized to calculate the cumulative survival rate, log-rank method was used for group comparison and univariate analysis, and Cox’s regression model was used for multivariate analysis. Results:Mediastinal pleural invasion (86.0%) was the most common site, followed by pericardium (50.8%), great vessel (40.8%) and lung (36.3%). The proportion of macrovascular invasion in the radical operation group was 14.9%, significantly lower than 79.5% and 60.9% in the palliative surgery group and biopsy group (both P<0.001). Multivariate analysis showed that the nature of operation ( P<0.001), age ( P=0.011), radiotherapy ( P=0.020) were the independent factors affecting overall survival (OS), while nature of operation ( P<0.001), age ( P=0.004), radiotherapy ( P=0.020), number of invasive organs ( P=0.023) and pathological type ( P=0.016) were the independent factors affecting progress-free survival (PFS). Conclusions:For patients with Masaoka-Koga stage Ⅲ thymoma, mediastinal pleura is the most common site of invasion, pericardium, lung and great vessels are also commonly invaded. The invasion of mediastinal pleura, pericardium and lung exerts slight effect on surgical resectability, whereas great vessel involvement can significantly affect surgical resectability. OS and PFS in patients undergoing radical resection are significantly better than those in patients treated with palliative resection and biopsy. Radical resection is the most important factor affecting prognosis.

Objective To investigate the relationship of the cytogenetic abnormalities detected by FISH in patients with MM and their clinical features. Methods FISH on bone marrow (BM) cells was performed in 57 enrolled MM patients. Relationships between cytogenetic abnormalities and clinical features were analyzed. Results By statistical analysis , both D13S319 deletion and RB1 deletion were associated with high level of serum LDH (P = 0.024; P = 0.018) and BM plasma cells index (P = 0.027; P = 0.013). 1q21 amplification was significantly associated with high level of LDH (P = 0.030 ) and the occurence of light chain type myeloma (P = 0.023). IgH rearrangement was associated with renal function damage (P = 0.009). There were correlations among D13S319 deletion, RB1 deletion, 1q21 amplification and IgH rearrangement (P<0.01). Conclusion The genetic abnormalities detected by FISH in patients with MM were correlated with various clinical poor prognostic indicators, which can evaluate the condition and prognosis of patients more efficiently.

OBJECTIVETo explore the value of preoperative evaluation with three-dimensional endoanal ultrasonography (3D-EAUS) for anal fistula in order to provide preoperative assessment for anal fistula.

METHODSOne hundred patients diagnosed with anal fistula undergoing surgery between March 2012 and March 2013 in our department were prospectively enrolled. All the patients were randomly divided into the ultrasound group and the control group with fifty patients in each group. The ultrasound group received 3D-EAUS and the control group received routine examinations (digital examination and probe) to assess the position of the internal opening, the type of fistula and secondary tracks, respectively. The concordance rate of the preoperative assessment and intraoperative exploration was evaluated between the two groups.

RESULTSThe accuracy of identifying internal opening was 96.0% for the ultrasound group and 82.0% for the control group with statistically significant difference (P=0.02). The accuracy of identifying internal opening for simple anal fistula was similar (95.0% vs. 91.3%, P=1). For complex anal fistula, the accuracy was also higher in the ultrasound group (96.7% vs. 74.1%, P=0.025). The accuracy of fistula classification was 78.0% for the ultrasound group and 96.0% for the control group with significant difference (P=0.01). The accuracy of identifying a second track was higher in the ultrasound group (96.0% vs. 82.0%, P=0.025).

CONCLUSIONSIt is significantly superior for 3D-EAUS to detect the internal opening, fistula classification and identification of a second track in complex anal fistulas as compared to conventional examination. 3D-EAUS should be recommended as a preoperative assessment for anal fistula, especially for complex one.

AIM:To establish and characterize the patient-derived esophageal squamous-cell carcinoma xeno-graft (PDECX) in mice.METHODS:The samples of human esophageal cancer were grafted into severe combined immu-nodeficient ( SCID) mice.The xenografts were transferred to SCID mice when the first passage of xenografts grew up .The growth of tumors in the first, second and third passages was observed .HE staining was performed.The expression of CK5/6, p63 and p40 in the patient samples , and the first and third passages of the xenografts were detected by immunohisto-chemical analysis.The expression of mTOR, p-mTOR, p70S6K, p-p70S6K, Akt1, p-Akt (Ser473), Erk1/2 and p-Erk1/2 were determined by Western blot .RESULTS:The PDECX was successfully established .The positive expression of CK5/6, p63 and p40 in the xenografts was consistent with that in the patients ’ samples.The levels of phosphorylated and total proteins of proliferation-related signaling pathways were different in the xenografts from different patients .CONCLU-SION:The PDECX model adequately reflects the tumal heterogeneity that is observed in the patients .

Objective To investigate the protective effect and mechanism of garlicin on oxidative stress injury of human melanocytes.Methods There were blank group,control group,hydrogen peroxide group,garlicin group,experiment 1,2 and 3 groups.No cells in the blank group were only added with complete culture medium.The control group was added with complete medium;0.4 mmol/L hydrogen peroxide complete medium was added to the hydrogen peroxide group.Garlicin group was added with freshly prepared garlicin complete culture medium with concentration of 40 μmol/L;Experiment groups 1,2,and 3 were treated with different concentrations of garlicin (80,40,and 20 μmol/L garlicin complete medium,respectively) to interfere with melanocytes treated with 0.4 mmol/ L hydrogen peroxide during logarithmic growth period.After 24 h of drug intervention,the cell morphology was observed under an inverted microscope.The protective effect of garlicin on melanocytes damaged by oxidative stress was measured by MTT colorimetric method.Results Different concentrations of garlicin had different protective effects on melanocytes induced by hydrogen peroxide.It could be concluded that the activity of melanocytes in hydrogen peroxide group decreased significantly (43.610 ± 3.872)％ (P＜0.05),but there was no statistical difference between the two groups (P=0.345).The activity of melanocytes in experimental group 1 was significantly decreased (58.223 ± 2.806) ％ but higher than that in experimental groups 2 and 3 (P＜0.05).Conclusions Allicin inhibits the production of intracellular ROS in human melanocytes induced by H2 O2,regulates oxidative stress in human melanocytes,and counteracts H2O2-induced apoptosis.Therefore,allicin may be a protective factor in mediating oxidative stress in the body.

Objective:To evaluate the efficacy and safety of stereotactic ablative radiotherapy (SABR) in patients with pulmonary oligometastases.Methods:Clinical data of patients with pulmonary metastases treated with SABR from 2011 to 2018 were retrospectively analyzed. The local control rate (LCR) and overall survival (OS) were calculated by Kaplan- Meier method. log-rank test was used for univariate analysis and Cox’s regression model for multivariate analysis. Results:A total of 214 lung metastases were detected in 159 patients, and the median follow-up time was 43 months. The 1-, 3-and 5-year LCR were 90.1%, 73.9% and 65.8%, respectively. The 1-, 3-and 5-year OS were 73.8%, 43.6% and 11.9%, respectively. Univariate analysis showed that biological effective dose (BED)≥100 Gy was significantly correlated with LCR ( P=0.033). Cox’s multivariate analysis showed that BED and primary tumor source were the independent prognostic factors of LCR ( P=0.023, P=0.043). No>grade 3 adverse events were observed in all patients during treatment. Conclusions:SABR is a safe and effective treatment of lung oligometastases. SABR should be actively aD ministered for pulmonary oligometastases, especially for those with lesions from lung cancer and the radiation dose should be selected as BED ≥100 Gy.

Objective To discuss the safety and efficacy of arterial embolization combined with local ablation in the treatment of recurrent and refractory chest wall tumors.Methods The clinical data of 11 patients with chest wall tumor that recurred after surgery and progressed after treatment were retrospectively analyzed.On the basis of the original treatment regimen,DSA-guided arterial embolization and CT-guided local ablation were employed.VAS score of pain relief and postoperative complications were recorded,and the therapeutic efficacy was evaluated Results All the patients were follow up for a median time of 18.5 months.Successful DSA-guided arterial embolization was accomplished in all patients.Seven patients(9 lesions in total)initially received CT-guided radiofrequency ablation(RFA),and tumor reoccurred in 2 patients,who had to receive RFA once more.Four patients(5 lesions in total)initially received CT-guided microwave ablation(MWA),and tumor reoccurred in one patient,who had to receive MWA again.According to mRECIST criteria,the 6-month,12-month and 18-month objective response rates(ORR)were 72.7%(8/11),45.5%(5/11)and 18.2%(2/11)respectively,the 6-month,12-month and 18-month overall survival rates were 81.8%(9/11),63.6%(7/11)and 27.3%(3/11)respectively,with a median survival time of 13.2 months.The postoperative one-month and 3-month VAS scores were(2.42±1.25)points and(1.91±1.24)points respectively,which were strikingly lower than preoperative(6.78±1.13)points,the differences were statistically significant(P＜0.05).After surgery,3 patients developed pleural effusion,which disappeared after puncture and drainage treatment,and 2 patients developed fever,which was improved after symptomatic treatment.One patient died of respiratory failure six months after treatment.Conclusion Arterial embolization combined with local ablation can improve the symptoms of pain and prolong the survival time of patients with chest wall tumors.This combination therapy is less traumatic and clinically safe,and it can be used as an effective treatment for patients with recurrent and refractory chest wall tumors.

Objective To evaluate the prognostic value of a novel prediction model based on fibrinogen concentration in combination with neutrophil-to-lymphocyte ratio (F-NLR score) in patients with esophageal squamous cell carcinoma (ESCC) receiving neoadjuvant therapy and investigate their relationship with pathologic complete response (pCR).Methods Clinical data of 218 eligible ESCC patients treated with neoadjuvant therapy in the Affiliated Cancer Hospital of Zhengzhou University between 2012 and 2015 were retrospectively analyzed.The cut-off values for fibrinogen and neutrophil-to-lymphocyte ratio (NLR)were defined by the receiver operating characteristic (ROC) curve.The effects of different F-NLR scores on survival and pCR were evaluated.The survival rate was analyzed using the Kaplan-Meier method.The relationship among fibrinogen,NLR and pCR was analyzed by using Wilcoxon rank sum test.Results The 3-year overall survival (OS) rates with F-NLR scores of 0,1 and 2 were 72.1％,66.5％ and 50.2％(P=0.010),respectively.The corresponding 3-year disease-free survival (DFS) rates were 64.1％,60.2％ and 45.4％ (P=0.012),respectively.The clinical prognosis of patients with an F-NLR score of 2 was significantly worse compared with those of their counterparts with an F-NLR score of 0-1 (P=0.003).Multivariate analysis demonstrated that the F-NLR score (P=0.004) and TNM stage (P=0.000) were the independent prognostic factors.Conclusions The F-NLR score can be used as an independent prognostic factor for ESCC patients treated with neoadjuvant therapy,which is promising supplement to current TNM staging system,thereby facilitating more accurate risk stratification analysis and achieving individualized multidisciplinary treatment for ESCC patients.