There is no unified international guidelines or consensus on seizures and epilepsy following acute stroke reperfusion therapy so far.In this review,we briefly summarize its definitions and mechanisms.Post stroke epilepsy after reperfusion treatment is defined as patients with ischemic stroke who have received intravenous thrombolysis and/or endovascular therapy,without other definitive causes or epilepsy history before stroke,have at least two epileptic seizures occurred within 7 days of stroke onset,or at least one epileptic seizures occurred within 30 days of stroke onset.The incidence rate of epilepsy after intravenous thrombolysis is about 6.4%-20.6%,and arterial thrombectomy is about 5%.The pathophysiological mechanism of post stroke epilepsy after reperfusion treatment may be related to local hyperfusion,epileptogenic properties of tPA and hemorrhagic transformation.Higher stroke severity,cortical involvement,middle cerebral artery infarction,and early post-stroke seizures may be predictive factors for post-stroke epilepsy after reperfusion therapy.Levetiracetam and lamotrigine may be effective drugs for post-stroke epilepsy after reperfusion therapy.Sustained seizures after thrombolysis may increase the risk of death.

In 2020, two formulations of botulinum toxin type A (BoNT-A)named AbobotulinumtoxinA(Dysport ?) and LetibotulinumtoxinA(Letybo ?) have been officially approved by National Medical Products Administration to come on the market. To compare BoNT-As with different formulations, three BoNT-As[AbobotulinumtoxinA, OnabotulinumtoxinA(Botox ?), IncobotulinumtoxinA(Xeomin ?)] with relatively more clinical evidences internationally and two domestic BoNT-As[LanbotulinumtoxinA(Prosigne ?), LetibotulinumtoxinA] were included. Diffusion scale, conversion ratio, onset, duration and immunogenicity of different BoNT-As were reviewed in detail to provide reference for clinical practice.

In 2020, two formulations of botulinum toxin type A (BoNT-A)named AbobotulinumtoxinA(Dysport ?) and LetibotulinumtoxinA(Letybo ?) have been officially approved by National Medical Products Administration to come on the market. To compare BoNT-As with different formulations, three BoNT-As[AbobotulinumtoxinA, OnabotulinumtoxinA(Botox ?), IncobotulinumtoxinA(Xeomin ?)] with relatively more clinical evidences internationally and two domestic BoNT-As[LanbotulinumtoxinA(Prosigne ?), LetibotulinumtoxinA] were included. Diffusion scale, conversion ratio, onset, duration and immunogenicity of different BoNT-As were reviewed in detail to provide reference for clinical practice.

Objective: To explore the ability of computed-tomography (CT) radiomic features to predict the Epidermal growth factor receptor (EGFR) mutation status and the therapeutic response of advanced lung adenocarcinoma to EGFR- Tyrosine kinase inhibitors (TKIs) treatment. Methods: A retrospective analysis was performed on 253 patients diagnosed as advanced lung adenocarcinoma, who underwent EGFR mutation detection, and those with EGFR sensitive mutation were treated with TKIs. Using the Lasso regression model and the 10 fold cross-validation method, the radiomic features of predicted EGFR mutation status and the screening of TKIs for sensitive populations were obtained. 715 radiomic features were extracted from unenhanced, arterial phase and venous phase, respectively. Results: The area under curve (AUC) values of the multi-phases including unenhanced, arterial phase and venous phase of the EGFR mutation status validation group were 0.763, 0.807 and 0.808, respectively. The number of radiomic features extracted from the multi-phases were 5, 18 and 23, respectively, which could distinguish the EGFR mutation status. The AUC values of the multi-phases of the EGFR-TKIs sensitive validation group were 0.730, 0.833 and 0.895, respectively. The number of radiomic features extracted from the multi-phases were 3, 7 and 22, respectively, which can be used to screen the superior population for TKIs treatment. The efficiency of radiomic features extracted from venous phase in predicting EGFR mutant status and EGFR-TKIs sensitivity was significantly superior than those of unenhanced and arterial phase. Conclusions The radiomic features of CT scanning can be used as the radiomics biomarker to predict the EGFR mutation status of lung adenocarcinoma and to further screen the dominant population in TKIs therapy, which provides the basis for targeted therapy.

Objective To explore the ability of computed?tomography ( CT) radiomic features to predict the Epidermal growth factor receptor ( EGFR ) mutation status and the therapeutic response of advanced lung adenocarcinoma to EGFR? Tyrosine kinase inhibitors ( TKIs ) treatment. Methods A retrospective analysis was performed on 253 patients diagnosed as advanced lung adenocarcinoma, who underwent EGFR mutation detection, and those with EGFR sensitive mutation were treated with TKIs. Using the Lasso regression model and the 10 fold cross?validation method, the radiomic features of predicted EGFR mutation status and the screening of TKIs for sensitive populations were obtained.715 radiomic features were extracted from unenhanced, arterial phase and venous phase, respectively. Results The area under curve (AUC) values of the multi?phases including unenhanced, arterial phase and venous phase of the EGFR mutation status validation group were 0.763, 0.807 and 0.808, respectively. The number of radiomic features extracted from the multi?phases were 5, 18 and 23, respectively, which could distinguish the EGFR mutation status. The AUC values of the multi?phases of the EGFR?TKIs sensitive validation group were 0.730, 0.833 and 0.895, respectively. The number of radiomic features extracted from the multi?phases were 3, 7 and 22, respectively, which can be used to screen the superior population for TKIs treatment. The efficiency of radiomic features extracted from venous phase in predicting EGFR mutant status and EGFR?TKIs sensitivity was significantly superior than those of unenhanced and arterial phase. Conclusions The radiomic features of CT scanning can be used as the radiomics biomarker to predict the EGFR mutation status of lung adenocarcinoma and to further screen the dominant population in TKIs therapy, which provides the basis for targeted therapy.

Objective To explore the ability of computed?tomography ( CT) radiomic features to predict the Epidermal growth factor receptor ( EGFR ) mutation status and the therapeutic response of advanced lung adenocarcinoma to EGFR? Tyrosine kinase inhibitors ( TKIs ) treatment. Methods A retrospective analysis was performed on 253 patients diagnosed as advanced lung adenocarcinoma, who underwent EGFR mutation detection, and those with EGFR sensitive mutation were treated with TKIs. Using the Lasso regression model and the 10 fold cross?validation method, the radiomic features of predicted EGFR mutation status and the screening of TKIs for sensitive populations were obtained.715 radiomic features were extracted from unenhanced, arterial phase and venous phase, respectively. Results The area under curve (AUC) values of the multi?phases including unenhanced, arterial phase and venous phase of the EGFR mutation status validation group were 0.763, 0.807 and 0.808, respectively. The number of radiomic features extracted from the multi?phases were 5, 18 and 23, respectively, which could distinguish the EGFR mutation status. The AUC values of the multi?phases of the EGFR?TKIs sensitive validation group were 0.730, 0.833 and 0.895, respectively. The number of radiomic features extracted from the multi?phases were 3, 7 and 22, respectively, which can be used to screen the superior population for TKIs treatment. The efficiency of radiomic features extracted from venous phase in predicting EGFR mutant status and EGFR?TKIs sensitivity was significantly superior than those of unenhanced and arterial phase. Conclusions The radiomic features of CT scanning can be used as the radiomics biomarker to predict the EGFR mutation status of lung adenocarcinoma and to further screen the dominant population in TKIs therapy, which provides the basis for targeted therapy.

Objective To investigate the changes of the parameters related to planning and re-planning CT imaging features in lung cancer patients presenting with radiation pneumonitis ( RP) by using radiomics technique,and identify the parameters intimately related to the incidence of RP. Methods A total of 31 lung cancer patients who were diagnosed with grade ≥ 2 RP after receiving radiation therapy were selected in this study. For each patient, planning CT images before radiation therapy and re-planning CT images after 40 Gy radiation therapy were obtained. The affected and contralateral lungs were considered as the region of interest (ROI).After the automatic segmentation of normal lung tissues,the parameters related to radiomics features were extracted from ROI by using radiomics software. The differences of these parameters between planning and re-planning CT images were statistically compared. Results ( 1 ) For unilateral lung within each time interval,86 parameters related to radiomics features were extracted; ( 2) Twenty-two parameters significantly differed between the affected and contralateral lungs prior to radiotherapy;(3) Twelve parameters significantly differed between the affected and contralateral lungs on re-planning CT images;(4) Twenty-eight parameters significantly differed in the affected lung before and after radiation therapy;(5) Twenty-eight parameters significantly differed in the contralateral lung before and after radiation therapy. Conclusions The CT imaging radiomics features significantly differ between planning and re-planning CT scan in partial lung cancer patients presenting with RP.Monitoring the dynamic changes of these parameters plays a potential role in predicting the incidence of RP.

Objective To evaluate the dynamic variation of the dose-volume parameters of the left ventricular myocardium following heart beat in radiotherapy for esophageal cancer. Methods The left ventricular myocardium of 22 patients was contoured on 20 phases (0％-95％) of electrocardiography (ECG) gated heart 4DCT images. The radiotherapy plan was designed on the simulation CT images,and then the dose distribution of radiotherapy plan was imported into MIM Maestro system and 4D dose-volume histogram (DVH) was reconstructed. The variations of position,volume and dice similarity coefficient (DSC) of the left ventricular myocardium were analyzed. The changing ranges of Dmean ,V10,V20 ,V30 and V40 of the left ventricular myocardium during different phases were statistically compared. Results ( 1 ) The biggest displacement of the left ventricular myocardium was in Y axes. The maximum variation rate of volume and DSC of the left ventricular myocardium were (24.23±11. 35)％ and (184.33±128. 61)％ in different phases with statistical significance (both P<0. 05).(2) The maximum variation rate of Dmean of the left ventricular myocardium was (87.05± 38. 34)％ in different phases with the highest rate of 163. 52％ with statistical significance (P<0. 05).(3) The maximum variation values of V10,V20,V30 and V40 of the left ventricular myocardium were (13.64±4. 33)％,(12.84±4. 55)％,(11.62±4. 85)％ and (3.63±2. 56)％ with statistical significance (all P<0. 05). Conclusions The impact of heart beat on the dose-volume parameters of the left ventricular myocardium should be considered during esophageal cancer radiotherapy. Traditional static 3DCT-based assessment of the dose-volume parameters of the left ventricular myocardium can yield relatively large errors, which is probably reduces the prediction efficiency of the dose-volume parameters for radiation-induced heart injury.

Objective To investigate the distribution rules of setup errors in different locations for tomotherapy.Methods 151 patients induding 53 head and neck tumors,45 thoracic tumors,20 abdominal tumors,and 33 pelvic tumors,who accepted tomotherapy were retrospectively analyzed in this study.The planning CT images of patients were obtained in simulation,and all patients underwent megavoltage CT (MVCT) scan before radiotherapy.And the setup errors were calculated by rigid registering MVCT images to planning CT images,and setup errors on + x(left),-x(right),+ y(in),-y(out),+z(ventral),-z (dorsal)axes were analyzed respectively.Results A total of 3 281 MVCT scans were performed on 151 patients,The setup errors on +x (left),-x(right),+y(in),-y(out),+z (ventral),-z (dorsal)axes were (1.61 ± 1.21),(1.76 ±2.11),(2.26 ± 1.74),(1.83 ± 1.47),(3.24±1.76) and (1.75 ± 1.61)mm for head and neck tumors;(2.43 ±1.88),(2.55 ± 1.92),(3.06 ±2.64),(3.90 ±2.91),(6.71 ±3.46) and (2.64 ±2.77)mm for thoracic tumors;(3.67±3.06),(2.37±1.77),(3.18±1.96),(3.98±3.01),(6.74±3.25) and (1.92±2.00) mm for abdominal tumors;(2.92 ±2.13),(2.17±1.68),(3.50±2.61),(3.72±2.66),(7.18± 3.43) and (1.92 ± 1.61)mm for pelvic tumors,respectively.The setup errors were different between +z and-z with statistically significant in all tumors (t =-4.119、-5.033、-3.763、-5.057,P ＜ 0.05).The setup errors on + z direction of patients immobilized with thermoplastic mask were smaller than those immobilized with vacuum cushions for thoracic tumors (t =-2.357,P ＜ 0.05).Conclusions The setup errors of head and neck tumors are less than other parts tumor in tomotherapy.The patients immobilized with thermoplastic mask can reduce the setup errors for thoracic tumors.The heterogeneity of setup errors on ventral-dorsal directions for the all parts of tumors should not be ignored.

Objective To investigate dose escalation by metabolic sub-volume based on standard uptake values ( SUV) gradient of pre-treatment positron emission tomography/computed tomography ( PET/CT) for locally advanced non-small cell lung cancer ( NSCLC) radiotherapy. Methods The pre-treatment 18 F-FDG PET/CT images of 29 patients with locally advanced NSCLC were analyzed retrospectively. Gross tumor volume ( GTV) was delineated on the PET/CT fusion images. Tumor metabolic sub-volume was segmented according to the threshold of 50% and 75% maximum standard uptake values ( SUVmax ) . The region that under 50% SUVmax was defined as GTV1. From 50% to 75% SUVmax was defined as GTV2,and over 75% SUVmax was defined as GTV3. PTV (planning target volume), PTV1, PTV2 and PTV3 were extended from GTV, GTV1, GTV2 and GTV3, and different plans were designed subsequently. Plan 1 was designed for PTV with prescription dose 60 Gy, and Plan 2 was designed for PTV1, PTV2 and PTV3 with prescription dose 60-66 Gy, 66-72 Gy and≥72 Gy, respectively. The dosimetric parameters between tumor target and organs at risk (OARs) were compared. Results Compared to Plan 1, the absorbed dose in Plan 2 that covers 2% volume of the PTV ( D2 ) was increased from 66. 5 Gy to 78. 5 Gy and the dose was escalated by about 23. 2%. The average dose of PTV1, PTV2 and PTV3 increased by 2. 8% (62. 7-64. 4 Gy), 10. 3% (63. 5 -70. 0 Gy), 18. 7% (63. 8 -75. 8 Gy), and the average dose of PTV increased by 8. 9% (63. 2-68. 8 Gy). The sub-regional dose had been effectively improved. There was no significant difference in target coverage between Plan 1 and Plan 2 ( P >0. 05 ) . Homogeneity index (HI) was decreased with the escalation of maximum dose for Plan 2(t=23. 3, P<0. 05). There was no statistically significant difference in radiation dose of OARs between two plans ( P>0. 05 ) . Conclusions Dose escalation based on metabolic sub-volume from 18 F-FDG PET/CT was feasible, and radiation dose escalation of sub-volume with high metabolic activity can be achieved without increasing the OARs dose.