Objective:To explore effective schemes for improving cognitive function in patients with subjective cognitive decline (SCD) by EEG neurofeedback (NF) technique.Methods:Ten SCD patients recruited in Department of Neurology, Xuanwu Hospital, Capital Medical University from April 2019 to August 2019, were chosen in our study; all patients were subjected to neuro-regulation of mismatched negativity (MMN) for 5 times in 2 weeks by EEG NF technique. By using the midlines of frontal zone (Fz), central zone (Cz) and peak zone (Pz) as training electrodes, auditory tones (1000 Hz as standard stimulus, individual hearing discrimination threshold as deviation stimulus) were used to induce MMN characteristics of event-related potential (ERP) via Oddball paradigm. SCD patients received visual disc stimulation feedback with dynamic neural signal activity. ERP waveforms and standard MMN characteristics (amplitude and latency) before and after training were used to evaluate the changes in neural activity of these patients; nine N-Back working memory tasks (three types×three gradients) and hearing discrimination ability tests were used in these patients to evaluate the improvement of cognitive competence.Results:ERP analysis showed that the MMN waveforms in SCD patients after training were obviously different as compared with those before training; their standard stimulus and deviant stimulus in the point-by-point paired t-test analysis were significant different ( P<0.05). The MMN amplitudes at the Fz, Cz and Pz electrodes in these patients after training were significantly higher than those before training ( P<0.05). The accuracy of auditory tone 3-Back task in SCD patients was statistically significant before and after training ( P<0.05). Conclusion:NF based on MMN can significantly improve the MMN amplitude and accuracy of auditory working memory task in patients with SCD, which might provide a potentially effective cognitive intervention method for patients with early AD and the elderly with normal memory decline.

Objective To analyze clinical significance of failure patterns and combined radiotherapy for advanced non-small cell lung cancer after EGFR-TKIs treatment.Methods A total of 111 patients who were treated with EGFR-TKIs for advanced non-small cell lung cancer (NSCLC) with EGFR exon mutation in Peking University Cancer Hospital from January 2009 to June 2013 were retrospectively analyzed.The impact of various failure patterns and combined radiotherapy on survial were analyzed with Kaplan-Meier method.Results Totally 111 patients were enrolled in the study.The median follow-up was 27.7 months (6.6-85.3 months).The median age,median PFS andmedian OS were 59 years (35-80 years old),10.3 months (6.2-30.5 months),and 29.8 months (7.1-90.7 months),respectively.The main failure mode was the progress of the original lesion (65 cases,58.6％) and the main failure site was the progress of intrathoracic lesions (57 cases,51.4％).The survival time of patients with oligoprogress (1-3 lesions during drug resistance) was significantly extended compared with the ones whose lesions were ≥ 4.The median OS were 32.5 months and 26.7 months,respectively (x2 =4.888,P＜0.05).For 43 patients with only intrathoracic progressed,there were 9 patients treated with radiotherapy and 34 patients treated without radiotherapy.The median PFS was 9.6 and 5.7 months,respectively.The median PFS of combined radiotherapy group was significantly prolonged (x2 =9.013,P＜0.05).And the median OS of retreatment after failure were 28.1 and 13.2 months,respectively,with no significant difference between two groups (P＞0.05).For 48 patients with oligo-progress,there were 12 patients treated with radiotherapy and 36 patients treated without radiotherapy.The median PFS were 9.6 and 4.2 months,respectively.The median PFS of the group treated with combined radiotherapy was significantly longer than that of the group without combined radiotherapy treatment (x2 =5.482,P＜0.05).And the median OS of retreatment after failure were 26.0 and 11.8 months,respectively.There was no significant difference between the two groups(P＞0.05).Conclusions Combined local radiotherapy can improve the PFS of patients who had only intrathoracic progress or oligo-progress after EGFR-TKIs treatment.Therefore,the patients whose T790 M mutation indicates negative or who are not in the position to perform coressoponding detection under the intrathoracic/oligo progress stage.The local intervention plays a very critical role for patients who have primary drug restisitance to GEN 1 EGFR-TKIs.

Objective: To explore the effects and mechanism of humble leadership on organizational trust and voice behavior of nursing staff. Methods: A total of 249 questionnaires were collected with a questionnaire survey, the effective response rate was 91.54%. The structural equation model was used to test the relationship between variables. Results: The humble leadership had a significantly positive influence on the organizational trust (β= 0.46, P<0.01) and voice behavior (β= 0.63, P<0.01) of nursing staffs, organizational trust played the partial mediating effect (β= 0.29, P<0.01). Conclusion A nursing manager who is good at humble behavior can promote organizational trust among the subordinate nursing team, which in turn, directly and indirectly enhances their positive voice behavior.

Background and objective Twice-daily radiation concurrent with chemotherapy is one of the standard methods for limited-stage small cell lung cancer. hTe study was to evaluate the feasibility of chemotherapy concurrent with dose-escalating twice-daily radiotherapy by simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT) approach in patients with limited-stage small cell lung cancer. Methods Patients with limited-stage small cell lung cancer were included, treated with twice-daily radiotherapy by SIB-IMRT concurrent with chemotherapy of etoposide plus cisplatin. Dose escalation was conducted by“classical”3+3 methods with three patients enrolled in each dose level. The therapeutic gross tumor volume (GTV) was treated according to three consecutive dose levels i.e., 45 Gy at 1.5 Gy twice daily, 50 Gy at 1.67 Gy twice daily and 54 Gy at 1.8 Gy twice daily. hTe planning target volume (PTV) received a dose of 45 Gy delivered in 30 fractions of 1.5 Gy. hTe primary endpoints were acute toxicities. hTe secondary endpoints included overall survival (OS), pro-gression-free survival (PFS) and loco-regional failure-free survival (LRFFS) at 1-year of follow-up. Results Twenty men and six women were included. hTe median age was 52 (30-68) months. 12 patients experienced grade 2 acute esophagitis, and 1 patient developed grade 3 acute esophagitis. Only 3 patients developed Grade 2 pneumonitis. Grade 3 or higher radiation-related pneumonia was not observed. None died of treatment-related causes. With median follow-up of 11.2 months (3.2-36.2 months), 1-year OS, PFS and LRFFS were 89.0%, 51.0%and 85.0%, respectively. Conclusion Dose escalation for twice-daily radiation concurrent with chemotherapy in LS-SCLC has been safely achieved up to 54 Gy for GTV using SIB-IMRT technique.

Background and objective Concurrent twice-daily radiotherapy with chemotherapy of EP regimen is one of the current standard treatments for limited-stage small cell lung cancer. However, the safely tolerated dose of standard chemotherapy for Chinese patients is not decided. hTis study was to evaluate the toxicity and the maximum tolerated dose (MTD) of etoposide and cisplatin concurrent with thoracic radiation therapy for patients with limited-stage small cell lung cancer. Methods Patients with histologically proven limited-stage small cell lung cancer (LS-SCLC) were eligible. hTe pa-tients underwent thoracic radiotherapy (45 Gy, 1.5 Gy bid, 30 fractions for 3 weeks) delivered concurrently with etoposide (100 mg/m2 iv, days 1-3) and cisplatin dose escalating from the two levels ( 70 mg/m2 and 75 mg/m2 on d1). hTe primary end-points were hematologic toxicities during treatment. hTe secondary endpoints were non-hematologic toxicities, overall survival (OS) and progression-free survival (PFS). According to Common Terminology Criteria for Adverse Events 4.0 (CTC-AE 4.0), maximum tolerant dosage (MTD) was deifned as the highest safely tolerated dose at which no more than one patient out of six experiences dose-limiting toxicity (Grades 4 hematologic), with the next higher dose having at least two out of six patients experience dose-limiting toxicity. Results From January 2013 to August 2016, 20 patients were enrolled in this study. hTe median age was 49.5 (30-68). Atfer the ifrst 6 patients were enrolled in Arm 1 (70 mg/m2 on d1), one patient had Grade 4 neu-tropenia. Another 14 patients were enrolled in Arm 2 (75 mg/m2 on d1), one patient had Grade 4 neutropenia. hTe MTD was determined to be etoposide (100 mg/m2 iv, d1-d3) and cisplatin dose (75 mg/m2 on d1). 4 patients had≥Grade 3 neutropenia and 1 patients had≥Grade 3 acute esophagitis in Arm 1. 10 patients had≥Grade 3 neutropenia and no patient had≥Grade 3 acute esophagitis in Arm 2. All patients with a median follow-up time was 9.0 months, median OS and PFS were not achieved, 1-year OS and PFS were 91%and 61%, respectively. Conclusion hTe MTD of RT with concurrent chemotherapy of EP regi-men for patients with LS-SCLC was etoposide (100 mg/m2 iv, d1-d3) and cisplatin dose (75 mg/m2 on d1).

Objective To analyze relevant clinical and dosimetric factors associated with radiation pneumonitis in patients with stage Ⅲ non-small cell lung cancer after they received radical radiotherapy.Methods A total of 126 patients with stage Ⅲ non-small cell lung cancer who received precision radiotherapy in Peking University Cancer Hospital were analyzed from January 2013 to December 2014.Data were collected including various clinical factors (including sex,age,histological type,tumor location,history of diabetes,history of hypertension,history of smoking,the season patients received treatment,ECOG performance status before treatment,chemotherapy before radiotherapy,concurrent chemotherapy and the classification of radiation pneumonitis),as well as related dosimetric parameters [including GTV,lung volume (LV),bilateral V5,V10,V20,V30 and MLD].SPSS 19.0 software was used to analyze the relation between correlation factors and radiation pneumonitis (RP≥2).Results Among the patients,31 cases (24.6％) had occurrance of radiation pneumonitis ≥ 2.Univariate analysis showed that age,ECOG performance status before treatment,concurrent chemotherapy and GTV/LV ratio were significantly correlated with RP ≥ 2 (R =0.157-0.222,P ＜ 0.05).Further multivariate Logistic regression showed that age,concurrent chemotherapy and GTV/LV ratio were significantly correlated (Wald =4.754,6.422,14.79,P ＜ 0.05).Conclusions In patients with stage Ⅲ non-small cell lung cancer after receiving thoracic radical radiotherapy,increasing age and GTV/LV ratio≥3.2％ are risk factors of RP≥2.The concurrent chemotherapy with low-dose paclitaxel might also increase the risk of RP≥2.

High level evidence from randomized studies comparing stereotactic ablative radiotherapy (SABR) to surgery is lacking. Although the results of pooled analysis of two randomized trials for STARS and ROSEL showed that SABR is better tolerated and might lead to better overall survival than surgery for operable clinical stage I non-small cell lung cancer (NSCLC), SABR, however, is only recommended as a preferred treatment option for early stage NSCLC patients who cannot or will not undergo surgery. We, therefore, are waiting for the results of the ongoing randomized studies [Veterans af-fairs lung cancer surgery or stereotactic radiotherapy in the US (VALOR) and the SABRTooth study in the United Kingdom (SABRTooths)]. Many retrospective and case control studies showed that SABR is safe and effective (local control rate higher than 90%, 5 years survival rate reached 70%), but there are considerable variations in the deifnitions and staging of lung cancer, operability determination, and surgical approaches to operable lung cancer (open vs video-assisted). hTerefore, it is diffcult to compare the superiority of radiotherapy and surgery in the treatment of early staged lung cancer. Most studies demonstrated that the effcacy of the two modalities for early staged lung cancer is equivalent;however, due to the limited data, the conclu-sions from those studies are diffcult to be evidence based. hTerefore, the controversies will be focusing on the safety and inva-siveness of the two treatment modalities. hTis article will review the ongoing debate in light of these goals.

ObjectiveTo investigate the immunological improvement effects of different doses of ursodeoxycholic acid (UDCA) on patients with different stages of primary biliary cirrhosis (PBC) and enhance the understanding of the roles of the immune system in the disease, and to provide evidence for the standardized clinical treatment of PBC. MethodsOne hundred and eighty patients with PBC who were admitted to our hospital from March 2012 to Janurary 2014 were enrolled and equally divided into three classes according to the stage of PBC: early stage, cirrhotic stage, and poor biochemical response stage. Patients in each class were equally divided into three groups according to the dose of UDCA: 8-10, 13-15, and 20-25 mg·kg-1·d-1. The general information, clinical symptoms, biochemical indices, and changes in T lymphocyte subsets and cytokines in peripheral blood after the treatment with different doses of UDCA were analyzed. Comparison of continuous data was performed by t test, and comparison of categorical data was performed by χ2 test. ResultsIn patients with early-stage PBC who were treated with 13-15 mg·kg-1·d-1 UDCA, the percentage of CD3+CD4+ T cells, CD4+/CD8+ ratio, and expression of interferon-gamma were significantly reduced after treatment (54.8%±11.6% vs 34.7%±7.7 %, t=6.5, P＜0.05; 2.3±1.0 vs 1.6±0.6, t=2.7, P＜0.05; 33.0±12.3 vs 23.7±7.2 ng/L, t=2.9, P＜0.05), while the secretion of interleukin-4 was significantly increased after treatment (29.0±4.6 vs 38.5±7.1 ng/L, t=5.0, P＜0.05). ConclusionThe UDCA with a dose of 13-15 mg·kg-1·d-1 can substantially improve the immune status in patients with early-stage PBC. The application of UDCA should be standardized in order to achieve the desired response.

Background and objective With the rapid development of technology, stereotactic radiotherapy has been widely used. In a cohort of medically operable non-small cell lung cancer patients receiving stereotactic body radiation therapy (SBRT) survival rates“potentially equivalent to those of surgery”have been reported. Removing the ifeld lfattening iflter, Clinac is capable of delivering dose rates much higher than conventional linac as well as reducing the treatment time. hTe goals of this work were to report safety and effcacy of SBRT treatment using a lfattening iflter-free model for non-small cell lung cancer (NSCLC) with small lesions. Methods From December 2011 to December 2013, 31 NSCLC patients who were T1-2N0M0, solitary pulmonary recurrence atfer surgery, and stage IV with oligo metastasis were enrolled, receiving SBRT treatment (60 Gy/8 f or 48 Gy/4 f ) applying a lfattening iflter-free model. Results Compared with conventional technique, lfat-tening iflter-free model shortened the treating time with equivalent target dose and normal tissue dose. hTe median follow-up time is 19.4 mo. hTe 1-yr local control, regional control, distant control, progression free survival and overall survival rates were 96.8%, 96.8%, 83.9%, 77.4%and 96.8%. hTe most common side effects were radiation pneumonitis (29%grade 1, 3.2%grade 2) and chest pain (12.9%grade 1, 6.5%grade 2). Conclusion hTe use of lfattening iflter-free model in SBRT for small lesions of NSCLC patients is safe and effective. Long time follow-up and additional studies are still needed to validate our conclusions.