The growth of cervicothoracic spine exhibits morphological quantitative changes,which is the support for the growth of whole spinal and thoracic cage.Research concerning regularity of longitudinal growth is conductive to understanding spinal pathological changes,especially for spinal deformity therapy.Techniques for thoracic vertebral pedicle fixation comprises Roy-Camilla,steffee,Dick,RF and Atlas Fixator (AF).Compared to other methods,AF is characterized by small trauma,strong axial bracing load,with satisfactory rectification results,which can avoid crankshaft phenomenon in a certain extent.In order to increase accuracy and safety of thoracic vertebral pedicle implantation,the implants positioning,imbedding method,as well as biomechanic characteristics were studied,and CT scanning was used as assistants.However,the thoracic vertebral pedicle implantation is unsatisfied to children,which may deprive partly of spinal growth capability or result in thoracic deformity.

Cancer stem cell niche provides a relatively stable microenvironment for cancer stem cell (CSC)existence,proliferation and differentiation.This microenvironment consists of kinds of cells,stroma and cytokines, etc. Within it , CSC can resist chemoradiotherapy. It has been shown that destruction of the microen vironment can significantly enhance the effect of chemoradiotherapy and improve prognosis of cancer patients.

Because of the lymphatic drainage of the neck area level-Ⅰb of nasopharyngeal carcinoma is particular,and skip metastasis in the cervical lymph node is rare,the involved region of level-Ⅰb lymph node metastasis rate is low in nasopharyngeal carcinoma.In the three-dimensional radiotherapy era of precision radiotherapy,there is no consensus on whether level-Ⅰb need to be prophylactic irradiated in the clinic.

Salivary gland damnification is one of the most common complication in head and neck cancer radiotherapy.Because of their unique anatomical positions,salivary glands usually receive high irradiation dose.Studies on radiation damage and dysfunction of salivary glands include injury mechanisms,relationship between dosimetrics and volumn changes and secretion,as well as prevention and treatment of damage.

Objective To evaluate clinical characteristics and prognostic factors of synchronous multiple primary esophageal carcinomas (SMPEC).Methods Clinical data including sex,age,smoking history,regions,lymph node status,length of tumor,therapeutic methods and survival data of 52 patients with SMPEC were analyzed.The rates of OS depending on the different factors were calculated using the method of Kaplan-Meier analysis.Log-rank test was used for univariate survival analysis and Cox's proportional hazards regression model was used for multivariate survival analysis.Results The 1-,3-,5-year OS rates and the median survival time (MST) were 65.4 ％,17.3 ％,7.7 ％ and 15.0 months for the whole cohort,75.0 ％,33.3 ％,16.7 ％ and 19.5 months for the surgery subgroup,62.5 ％,10.0 ％,5.0 ％ and 14.5 months for the 40 non-operative patients.Multivariate analysis of prognostic factors identified that tumor length and M stage were independent prognostic factors for the whole cohort,while tumor length,M stage and chemotherapy were independent prognostic factors for the radiotherapy subgroup patients.Conclusion The tumor length and M stage are independent prognostic factors for the SMPEC patients.Combined radiotherapy with chemotherapy seems to bring survival benefit and maybe a better management choice for unresectable and non-operative SMPEC.

Objective To review the effect of endothelial cells in the tumoral invasion miroecosystem(TIMES) and the progress of recent research in this field. Methods The relative references of TIMES, including investigative background, main components, differences compared with the tumor microenvironment, and effect of endothelial cell are studied systematically. Results The TIMES is considered as a naturally integreted functional unit which is composed of cell communities and host environment during the process of tumoral cells invading, it is an ecosystem at both cellular and molecular level. Being different from TIMES, the term of tumoral microenvironment means the environment conditions for the existence of tumor cells, it is a kind of constructive system, not including tumor cell itself, and not possessing the regulation of ecosystem. The main elements of TIMES include tumor cell communities, host cell communities, and their enviroment(extracellular matrix), among them the endothelial cell communities are the most important host communities. The main effect of endothelial cells on the TIMES is the trophic links between tumor cell communities and endothelial communities, which froms a material cycle, including nutritional and matrix cycyles. The tumoral invasion and metastasis result from the continuous rebuilding of trophic links between tumor cell communities and endthelial cell communities.Conclusions The endothelial cell regulates TIMES by its trophic links with tumor cell communities. To block the links between tumor cell communities and endothelial cell communities might be the one of the key factors in tumoral treatment.

The resistance mechanism of gliomas to chemotherapy and radiotherapy is a complex network of many signaling pathways. It remains unclearhow the pathways interact with each other and how they were regulated. Recent studies have shown that DNA damage checkpoint pathway ( ATM、 ATR、 Chk1、 Chk2、 Rad17、 Radl 、Rad9、Hus1 et al. ) plays an important role in cell proliferation、genomic stability、tumorigenesis and the resistance to chemoradiotherapy of tumors. Inhibiting DNA damage checkpoint can increase tumor sensitivity to chemoradiotherapy and therefore improve the therapeutic effect. We review here the role of ATM in chemoradiotherapy resistance of gliomas and its associated mechanisms.

Objective To investigate the clinical significance of serum amyloid A protein in patients with chronic hepatitis C (HCV) infection. Methods Serum amyloid A (SAA) levels were detected by ELISA in 131 patients with HCV infection and 20 normal controls. The expression of SAA-mRNA in peripheral blood mononuclear cells (PBMC) was detected by RT-PCR from some blood samples of HCV patients and normal controls. Results The SAA levels in the patients with chronic HCV infection were markedly higher than those in normal controls (t = 17. 14, P < 0. 01 ). The expression of SAA-mRNA detected by RT-PCR was closely correlated with concentrations of SAA measured by ELISA ( r = 0.86, P <0.01 ). No correlation was found between SAA expression and serum HCV RNA titers, as well as between SAA and serum ALT in patients with chronic HCV infection. Conclusion SAA levels are increased in patients with chronic HCV infection, which is not correlated with HCV RNA titers and serum ALT levels.

Objective To evaluate the role of radiotherapy in the management of dermatofibrosarcoma protuberans. Methods Between 1995 and 1999, 18 patients with pathologically confirmed dermatofibrosarcoma protuberans were retrospectively analyzed. Nine patients were referred to our hospital for primary treatment and the remaining 9 patients came with recurrent disease. Fifteen of 18 patients received surgery followed by radiotherapy. Among them, 14 patients underwent complete resection and 1 partial resection. Majority of patients received 50～60 ?Gy. One patient received 37.5 ?Gy because he refrained from further treatment. Two patients received 52 ?Gy and 50 ?Gy due to unresectable extensive lesion. One of 18 patients was treated by total resection alone.Results The median of follow up time was 26 months with a range of 0.5～5 years. Sixteen patients (8.9%) are disease free. One patient developed local recurrence and one died of malignant progression. These two patients were treated with radiotherapy alone or surgery only. The local control rates were 100% (15/15) for patients who were treated with surgery and radiotherapy. Conclusions Postoperative radiotherapy is able to decrease the local recurrence rate in dermatofibrosarcoma protuberans.

Objective To compare and evaluate dose at optic structures (eyeballs, optic nerves and chiasma) between conventional and CT simulated treatment planning for nasopharyngeal carcinoma. Methods Thirty three patients with T1 to T4 nasopharyngeal carcinoma underwent simulated spiral CT with picker PQ 5000 and AcQ plan 4.1.1 software system. At first irradiation portals were delinated by the simulation films taken on the conventional X ray simulator using the digital reconstruction (DRR) of the treatment planning system (TPS) supplemented by the patient's CT (or MRI) and clinical findings. Then, the gross tumor volume (GTV),clinical target volume (CTV) and planned target volume (PTV) were delineated on every section of the CT scans. At the same time, the silhouette of the nearby important organs was drawn out ,paying special attention to the backward passage of the retrobulbar optic nerves up to the optic chiasma. The final portals were designed by the 3 dimensional relation between the tumor and its surrounding organs. Then dose distribution was separately calculated by two independent TPSs,with 100% at the target center. Finally,the maximum dose (D max ),average dose (D ave ) and median dose (D med ) of the tumor target area, eye ball,optic nerve and also the length of optic nerve included within the portal of these two technics were compared.Results The dose distribution in nasopharyngeal GTV and CTV were satisfactory both in CT simulated and conventional planning. However, the D max ,D ave and D med all showed significant differences. Those by CT simulated planning were obviously lower than those by conventional planning. CT simulated planning was able to spare more optic nerve by leaving it out of the irradiation portal,thereby,avoiding unwanted radiation.Conclusion CT simulated treatment planning is able to reduce the superfluous radiation to the optic nerve in external irradiation of nasophargngeal carcinoma.