Objective:To assess the preliminary efficacy and safety of modified Société Internationale d′Oncologie Pédiatrique Epithelial Liver Tumor Study Group (SIOPEL)-4 protocol for pediatric hepatoblastoma (HB) with lung metastases.Methods:This prospective cohort study enrolled 27 newly diagnosed pediatric HB with lung metastases who received the modified SIOPEL-4 protocol at Shanghai Children′s Medical Center, Shanghai Jiao Tong University School of Medicine, and Shanghai Children′s Hospital between January 2020 to December 2023. Clinical characteristics, lung response rates to induction chemotherapy, treatment outcomes, prognostic factors and sever chemotherapy toxicities at different stages were analyzed. Survival analysis was performed by Kaplan-Meier method. Univariate prognostic analysis was conducted by Log-Rank test.Results:Of the 27 patients, there were 17 males and 10 females, with the age of 21 (15, 33) months. During the follow-up of 31 (12, 45) months for 17 continuous complete remission patients, 4 cases disease progression (2 cases death) and 6 cases relapse were observed. The 2-year event free survival (EFS) and overall survival (OS) rate was (58±11)% and (89±7)%, respectively. All the 27 patients had response to block 1-3 induction chemotherapy (cisplatin+doxorubicin), with 14 cases (52%) achieving complete response and 13 cases (48%) achieving partial response of lung metastatic lesions, the 2-year EFS rate was (81±12)% and (34±14)%, respectively ( χ 2=6.76, P=0.009), the 2-year OS rate was 100% and (79±13)%, respectively ( χ2=2.12, P=0.145). Patients with caudate lobe tumors or ≥10 pulmonary metastatic nodules had significantly lower EFS rates ( χ2=5.36, 7.84, P=0.021, 0.005, respectively). The incidence of grade 3/4 neutropenia after block 1-3 induction chemotherapy, CD (carboplatin+doxorubicin), and VI (vincristine+irinotecan) consolidation chemotherapy was 90% (73/81), 75% (58/77), and 31% (11/35), respectively. The incidence of grade 3/4 thrombocytopenia was 77% (62/81), 69% (53/77), and 14% (5/35), respectively. The incidence of grade 3/4 infections was 64% (52/81), 25% (19/77), and 20% (7/35), respectively. The differences between the groups were statistically significant ( χ2=43.51, 42.69, 33.00, all P<0.001). Two patients (10%) of the 20 evaluable patients for ototoxicity occurred grade 3 and higher hearing impairment, with 1 patient requiring a hearing aid. Conclusions:The modified SIOPEL-4 regimen shows good preliminary efficacy and safety in treating pediatric HB with lung metastases. The prognosis for patients with residual lesions in the lungs after induction chemotherapy needs to be improved. Attention should be given to the ototoxicity induced by high-dose cisplatin chemotherapy.

Objective:To assess the preliminary efficacy and safety of modified Société Internationale d′Oncologie Pédiatrique Epithelial Liver Tumor Study Group (SIOPEL)-4 protocol for pediatric hepatoblastoma (HB) with lung metastases.Methods:This prospective cohort study enrolled 27 newly diagnosed pediatric HB with lung metastases who received the modified SIOPEL-4 protocol at Shanghai Children′s Medical Center, Shanghai Jiao Tong University School of Medicine, and Shanghai Children′s Hospital between January 2020 to December 2023. Clinical characteristics, lung response rates to induction chemotherapy, treatment outcomes, prognostic factors and sever chemotherapy toxicities at different stages were analyzed. Survival analysis was performed by Kaplan-Meier method. Univariate prognostic analysis was conducted by Log-Rank test.Results:Of the 27 patients, there were 17 males and 10 females, with the age of 21 (15, 33) months. During the follow-up of 31 (12, 45) months for 17 continuous complete remission patients, 4 cases disease progression (2 cases death) and 6 cases relapse were observed. The 2-year event free survival (EFS) and overall survival (OS) rate was (58±11)% and (89±7)%, respectively. All the 27 patients had response to block 1-3 induction chemotherapy (cisplatin+doxorubicin), with 14 cases (52%) achieving complete response and 13 cases (48%) achieving partial response of lung metastatic lesions, the 2-year EFS rate was (81±12)% and (34±14)%, respectively ( χ 2=6.76, P=0.009), the 2-year OS rate was 100% and (79±13)%, respectively ( χ2=2.12, P=0.145). Patients with caudate lobe tumors or ≥10 pulmonary metastatic nodules had significantly lower EFS rates ( χ2=5.36, 7.84, P=0.021, 0.005, respectively). The incidence of grade 3/4 neutropenia after block 1-3 induction chemotherapy, CD (carboplatin+doxorubicin), and VI (vincristine+irinotecan) consolidation chemotherapy was 90% (73/81), 75% (58/77), and 31% (11/35), respectively. The incidence of grade 3/4 thrombocytopenia was 77% (62/81), 69% (53/77), and 14% (5/35), respectively. The incidence of grade 3/4 infections was 64% (52/81), 25% (19/77), and 20% (7/35), respectively. The differences between the groups were statistically significant ( χ2=43.51, 42.69, 33.00, all P<0.001). Two patients (10%) of the 20 evaluable patients for ototoxicity occurred grade 3 and higher hearing impairment, with 1 patient requiring a hearing aid. Conclusions:The modified SIOPEL-4 regimen shows good preliminary efficacy and safety in treating pediatric HB with lung metastases. The prognosis for patients with residual lesions in the lungs after induction chemotherapy needs to be improved. Attention should be given to the ototoxicity induced by high-dose cisplatin chemotherapy.

Objective To observe the effect of preoperative enteral nutritional support combined with modified Ivor-Lewis surgery for esophageal cancer on lung function and mRNA expression of GATA-binding protein 3(GATA3)and forkhead protein P3(Foxp3)in peripheral blood.Methods Sixty esophageal cancer patients who underwent modified Ivor-Lewis surgery in our hospital from January 2022 to October 2023 were selected and divided into two groups by simple random method.The control group was given conventional diet before operation,and the observation group was given enteral nutrition support before operation.The two groups were compared in terms of nutritional support.Results Both groups showed significantly decreases in one-second exertion expiratory volume/exertion lung volume(FEV1/FVC)(P<0.05),FVC(P<0.05),FEV1(P<0.05)and the levels of peripheral blood GATA3(P<0.05),Foxp3 mRNA(P<0.05)expression compared with those at admission(P<0.05),but no significant differences in pulmonary function(P>0.05),peripheral blood GATA3(P>0.05),and Foxp3 mRNA(P>0.05)expression between them at 1 week postoperatively.Both groups exhibited significantly lower levels of albumin,prealbumin,haemoglobin,transferrin,PNI and body mass and body mass index at admis-sion as compared to those at one week after surgery(P<0.05).The observation group showed significantly higher levels of albumin,prealbumin,haemoglobin,transferrin,and PNI at 1 week postoperatively(P<0.05),but no significant differences in ventilation time,defecation time,drain retention time,hospitalisation time,and compli-cation rate as compared to the control group(P>0.05).Conclusion Preoperative enteral nutritional support combined with modified Ivor-Lewis surgery for esophageal cancer improves postoperative nutritional status,and ren-ders less effect on postoperative lung function and peripheral blood GATA3 and Foxp3 mRNA expression.

Objective To investigate the impact of adopting different dose grid resolution during volumetric modulated arc therapy (VMAT) planning on COMPASS pass rate.Methods A total of 10 patients with cervical cancer were enrolled.Four types of VMAT plans (plan1,plan2,plan3,plan4) were designed for each patient,with dose grid resolution of 0.2 cm × 0.2 cm × 0.2 cm,0.3 cm × 0.3 cm ×0.3 cm,0.4 cm ×0.4 cm ×0.4 cm and 0.5 cm ×0.5 cm ×0.5 cm,respectively.The plans were exported to Linac and conducted,then measured by COMPASS.The discrepancies were analyzed,which were obtained by comparing reconstructed dose from COMPASS and dose from TPS optimization.Results For tumor volume,the mean value of Dmean and D95 were ＜ 0.5％ and ＜ 1.3％ respectively,and the standard deviation were both ＜ 1.0％.For organs at risk (OAR),the max discrepancies were Dmean of femur with-6.7％,-7.0％,-8.0％,-5.8％,and V35 of rectum with 4.9％,-6.3％,-6.1％,-5.7％ in four types of VMAT plans.The γ (3％,3 am) rate of tumor volume was ＞95％ with standard deviation ＜ 2.5％,with no statistically significant difference among the four types of plans (P ＞0.05).The γ (3％,3 mm) rate of OARs were ＞ 98％ except femur (＞ 95％),and the standard deviations were within 1.9％-6.1％,with no statistical significance (P ＞0.05).The average γ rate of tumor volume and OARs were ＜ 0.4 except femur (＞ 0.4),with no statistically significant difference among four types of VMAT plans (P ＞ 0.05).Conclusions COMPASS pass rate was not influenced by the dose grid resolution between 0.2 ～ 0.5 cm for VMAT plan.

A new-type digital electric plum-blossom needle instrument of controllable and adjustable parameters was developed to achieve an automatic tapping instead of manual tapping technique and integrate the function of plum-blossom needle with that of micropulse electrical phase. The alternating current of periodic variation changes the direction of magnetic field around, induces the vibration of the cone head and tapping movement, outputs the micropulse current and acts on the affected area in treatment. The new-type digital electric plum-blossom needle instrument achieves the automatic tapping movement, precisely adjusts the stimulating strength and frequency according to diseases and integrates the tapping stimulation with pulse current to form circulation loop on the skin and intensify the therapeutic effects. This instrument is the big innovation of traditional plum-blossom needle. It is not only applicable for clinical treatment or family healthcare, but also for scientific research with the adoptable digital therapeutic parameters, which benefits the application and development of plum-blossom needle therapy.

BACKGROUND:There is no effective treatment for muscle atrophy caused by peripheral nerve damage. Skeletal muscle cel s, a structural unit of muscle contraction, can be used for studies on muscle atrophy when cultured in vitro.
OBJECTIVE:To investigate the promotion effect of neuron-secreted factors on the growth of skeletal muscle cel s in vitro.
METHODS:Skeletal muscle cel s primary cultured in vitro were divided into two groups:experimental group with neuron-secreted factors, and control group with common culture medium, respectively. Afterwards, the number of skeletal muscle cel s and expression level of alpha actin were detected by hematoxylin-eosin staining and immunohistochemical staining, respectively.
RESULTS AND CONCLUSION:The number of skeletal muscle cel s and expression level of alpha actin in the experimental group were significantly higher than those in the control group (P<0.05). In conclusion, neuron-secreted factors have the ability of promoting the growth of skeletal muscle cel s and may be helpful for denervated muscle atrophy.

Objective To observe the effects of Hedan tablet on cytokines and oxidation factors in APOE-/-mouse, and to explore its effect on atherosclerosis and to explore its behind mechanism. Methods APOE-/-mice (n=50) were randomly divided into control group, model group, low dose Hedan tablet treatment group, high dose Hedan tablet treatment group and simvastatin treatment group. Mice in control group were given normal feed while mice in other groups were fed with high cho?lesterol diet. Hedan or Simvastatin was administrated intra-gastrically while normal saline was given to model group in the same route. After 12 weeks, mice were sacrificed to observe the mRNA level of tumor necrosis factor-α(TNF-αmRNA) in aorta by RT-PCR. Mean while, serum levels of interleukin-1 (IL-1), interleukin-10 (IL-10), malonaldehyde (MDA) and su?peroxide dismutase (SOD) were determined in different groups. Results Compared with control group, TNF-αmRNA tran?scription level as well as serum levels of IL-1 and MDA significantly increase while serum levels of IL-10 and SOD de?creased remarkably in model group, (P<0.01). Compared with model group, mRNA levels of TNF-αas well as serum levels of IL-1 and MDA were significantly decreased while serum levels of IL-10, SOD were greatly increased in low dose and high dose Hedan tablet treatment groups as well as in simvastatin treatment group (P<0.01). Conclusion Hedan tablet inhibit the formation of atherosclerosis through its anti-oxidation role and anti-inflammation role.

Objective To investigate the radiographic classification and presentation of atypical spinal tuberculosis in adults.Methods Data of 45 consecutive patients who had suffered from atypical spinal tuberculosis confirmed by surgical interventions and pathologic examinations at our department from February 2000 to August 2012 were retrospectively analyzed.There were 29 males and 16 females,aged from 20 to 71 years (mean,46.2 years).Twenty-five patients presented with low-grade fever,lassitude and loss of weight,and the other 20 patients denied the constitutional symptoms of tuberculosis.An increased erythrocyte sedimentation rate (range,25-107 mm/1 h) was found in 37 patients.All patients were investigated by the following imaging resources:plain X-rays,CT scan and MRI.3D reconstruction CT was performed in 12 patients and PET-CT was performed in 2 patients.All patients were treated surgically and confirmed by pathologic examinations and 3 patients had undergone CT-guided biopsy.Results Atypical spinal tuberculosis presented in different radiographic presentation forms.Nine patients had involvement of a single vertebral body,which was depicted with nonuniformly increased signal intensity on T2-weighted MR images.CT scan showed irregular bony destruction in old patients and solitary osteolytic lesion with well-defined margins in young adults.There were 2 cases of isolated affection in the posterior elements (vertebral appendages type),and the involved vertebral appendages demonstrated hyperintense signal on T2-weighted MR images and bony destruction on CT scan.There were 8 cases of simultaneous affection in the anterior and posterior element of one vertebra (circumferential vertebral involvement type),and CT scan showed multiple bony destruction in vertebral body and neural arch.There were 5 cases of affection in disc (intervertebral disc involvement type),which presented decreased signal in MRI and protruding disc pressing the dural sac could be found.There were 14 cases of multiple vertebral tuberculosis in continuity (contiguous spinal tuberculosis),which presented multiple tuberculosis lesions on 3D-CT.There were 7 cases of multiple vertebral tuberculosis in noncontinuity (noncontiguous spinal tuberculosis),which presented destructive tubercular lesions affected different levels in different regions of the spine on MRI.Conclusion Atypical spinal tuberculosis had multiply radiographic presentation forms and atypical radiographic features.Worm-eaten destruction of bone or vertebral endplate,marrow edema and increased signal intensity of paraspinal ligament are features of radiographic presentation in diagnosis of atypical spinal tuberculosis.

Objective To evaluate the peripheral dose (PD) from megavoltage cone-beam CT (MVCBCT) imaging for head-and-neck region image-guided radiation therapy,to determine the correlation of PD with monitor unit (MU),and to investigate the impact of imaging field size on the PD.Methods Measurements of PD from MVCBCT were made with a 0.65 cm3 ionization chamber placed in a specially designed phantom at various depths and distances from the field edges.The PD at reference point inside the phantom was measured with the same ionization chamber to investigate the linearity between MU used for MVCBCT and the PD.The homogeneity of PD in the axial plane of the phantom were measured.Results PD from MVCBCT increased with increasing number of MU used for imaging and with increasing the field size.The measured PD in the phantom decreased exponentially as distance from the field edges increased.PD also decreased as the depth from the phantom surface increased.There was a strong linear relationship between PD and MUs used for MVCBCT.The PD was heterogeneous,with higher dose at the anterior than the posterior.Conclusions The PD from MVCBCT depend much on the MVCBCT delivery MU and the scan field size.In clinic,using the smallest number of MU allowable and reducing MVCBCT scanning field size without compromising acquired image quality is an effective method of reducing the PD.

Objective To investigate the intensity modulated radiation therapy (IMRT) planning optimization method to reduce the additional dose resulting from megavoltage cone-beam CT (MVCBCT) imaging for nasopharyngeal carcinoma IMRT treatment. Methods MVCBCT images collection process was simulated using XiO treatment planning system. The mean doses of MVCBCT ( DMVCBCT ) were calculated in gross tumor volume ( GTV), clinical target volume ( CTV ) and risk at organ or tissue using 27. 4 cm× 27.4 cm portal radiation 8 MU,5 MU (A,C) and 27.4 cm× 15.0 cm portal radiation 8 MU,5 MU (B,D). The dose correct factor of MVCBCT (CFMVCBCT) according to IMRT TPS and DMVCBCT ,but CFMVCBCT plus MVCBCT imaging process for radiotherapy planning optimization. The paired t-test was play for A∶ B,C∶ D,A∶ C,B∶ D of DMVCBCT. Results The DMVCBCT and CFMVCBCT of A, B, C, D were 7. 78,5. 78,4. 88,3.55 cGy ( A∶ C, t =24.41,P＜0.01) and 0.993 -0.997 in GTV,with 7.88,6.95,4.88,4.38 cGy (A∶ B,A∶ C,B∶ C,t=3. 85, -31.82, -8.52, all P＜0. 01) and 0.992 -0.996 in CTV1 ,with 8.28,6.67,5. 17,4. 17 cGy (A ∶B,A∶C,B∶C,B∶D,t=6.41 -18.24,all P＜0. 01) and 0.991 -0.996 in CTV2;with 6.88,5.00,4.28,3. 50 cGy ( A∶ B, A∶ C,t = 2. 83,11.03, all P ＜ 0. 05 ) and 0. 989 - 0. 995 in spinal cord, with 7.88,7. 38,4. 95,4. 62 cGy and 0. 984 -0. 990 in left parotid, with 8. 67,0. 28,5. 33,0. 28 cGy and 0. 963 -0. 999 in left optic nerve,with 9. 17,0.22,5.72,0. 17 cGy and 0.821 -0.997 in left eye lens,with 6.95,2. 17,4. 38,1.38 cGy and 0. 987 -0. 997 in brain stem, with 7.78,0.45,4. 95,0. 28 cGy and 0. 978 -0. 999 ( A ∶ B,A∶ C,B∶ C,B∶ D for five organ or tissue,t =5. 06 -335. 16 ,all P ＜0. 01 ) in optic chiasm. Conclusions The MVCBCT imaging process resulted in radiation doses to patient. The impact of MVCBCT image acquired dose on IMRT treatment plan for NPC was eliminated by a compensation method.