Brain metastasis is very rare in esophageal squamous cell carcinoma (ESCC). We retrospectively analyzed 4494 patients diagnosed with ESCC between 2010 and 2015 at a single institute; 15 of these patients developed brain metastases. All 15 patients had neurologic symptoms and were diagnosed by imaging or biology. Of the 15 patients, 67% had a solitary brain lesion and 73% had lesions larger than 3 cm. After treatment of the brain lesions, including surgery (53%) or stereotactic radiotherapy with or without whole brain radiation (20%), the median progression free survival time and the 2-year overall survival rate calculated from diagnosis of brain metastasis were 14.4 months and 36%, respectively. A graded prognostic assessment (GPA) score > 2.0 was associated with significantly better overall survival. Patients with brain metastases from ESCC achieve good overall survival after appropriate treatment of the brain lesion(s); GPA score may represent a prognostic factor for treatment decision-making.
【Objective】 A planning study was performed to compare volumetric modulated arc therapy(VMAT),static intensity-modulated radiotherapy(sIMRT),and three-dimensional conformal radiotherapy(3DCRT) for upper thoracic esophageal cancer.【Methods】 Seven patients with loco-regionally advanced upper thoracic esophageal cancer were included.Based on the identical CT and planning target volume(PTV),three plans(3DCRT,sIMRT with seven fields,VMAT with a single arc) were generated.Dose prescription was set to 60Gy in 30 fractions.Dose volume histograms,MU and delivery time were evaluated to assess plan quality.【Results】 In comparison to 3DCRT,both VMAT and IMRT provided a systematic improvement in PTV coverage.For normal tissues,equivalent sparing of lung and heart were achieved with three plans.However,IMRT and VMAT showed a superior sparing compared with 3DCRT for spinal cord.The MU/fraction was as follows: 537 ± 92 for 3DCRT,601 ± 122 for IMRT,and 682 ± 139 for VMAT.Effective treatment time for 3DCRT,IMRT and VMAT were(3.9 ± 0.3) min,(6.0 ± 0.7) min and(4.7 ± 0.7)min,respectively(P 0.05).【Conclusions】 Compared with 3DCRT,IMRT and VMAT showed better dosimetric quality and superior spinal cord sparing.However,VMAT improved delivery efficiency significantly than IMRT.
To observe the effect of oblique needling at Ashi-point on behavior, and cell morphology, myogenic differentiation antigen (MyoD1) and paired box transcription factor Pax7 (Pax7) of quadriceps femoris tissue in quadriceps femoris injured mice.A total of 24 C57BL/6 male mice were randomly divided into control, model, shallow insertion and deep insertion groups, with 6 mice in each group. The quadriceps femoris injury model was established by single intramuscular injection of 0.5% bupivacaine (BPVC). Twenty-four hours after modeling, mice of the two acupuncture groups were received oblique needling on the surface or through the muscle belly of quadriceps femoris for once, the oblique needling was lifted and inserted 3 times. The climbing pole test was conducted 24 h after modeling and 24 h after EA. Histopathological changes of quadriceps femoris was observed by H.E. staining. The expressions of MyoD1 and Pax7 were detected by immunohistochemistry.Compared with the control group, the score of climbing pole test was lower (P<0.01), and the expressions of MyoD1 and Pax7 significantly increased (P<0.01) in the model group. After the intervention and compared with the model group, the score of climbing pole test was higher (P<0.01), and the expressions of MyoD1 and Pax7 obviously increased (P<0.01) in the two acupuncture groups. The therapeutic effect of deep insertion group was apparently superior to that of shallow insertion group in up-regulating the climbing pole test score and expressions of MyoD1 and Pax7 (P<0.05, P<0.01). H.E. stain showed large areas of inflammatory infiltration, muscle cells swelling, atrophy, rupture, degeneration and necrosis, different cell sizes and morphologies, enlarged intervals, nuclear aggregation, deep nuclear staining, nuclear pyknosis, and hemorrhage in the model group, which was relatively milder in both needling groups.Oblique needling at Ashi-point can effectively promote the benign repair of injured quadriceps muscle and promote the recovery of exercise ability in mice, which may be associated with its effect in up-regulating the expression of MyoD1 and Pax7 protein. The role of deep insertion is superior to that of shallow insertion.目的：观察斜刺阿是穴对股四头肌损伤小鼠自主活动、细胞形态及肌卫星细胞成肌分化抗原(MyoD1)、生肌转录因子(Pax7)的影响。方法：24只C57BL/6雄性小鼠随机分为空白组、模型组、浅刺组、深刺组，每组6只。采用单次肌注0.5%布比卡因制备股四头肌损伤小鼠模型。造模后24 h两治疗组采用斜刺阿是穴干预治疗，浅刺组入针至触碰到受损肌肉表面，深刺组顺着肌纤维穿过股四头肌损伤肌腹，均提插3次，不留针，治疗1次。造模24 h后和治疗24 h后对各组小鼠进行爬杆实验，HE染色法观察小鼠股四头肌组织病理形态变化，免疫组织化学法观察小鼠股四头肌组织中MyoD1、Pax7的阳性表达。结果：与本组治疗前比较，两斜刺组小鼠治疗后爬杆实验得分明显升高(P<0.01)。与空白组比较，模型组小鼠爬杆实验得分明显降低(P<0.01)，股四头肌MyoD1、Pax7表达明显升高(P<0.01)。与模型组比较，两斜刺组小鼠爬杆实验得分及股四头肌MyoD1、Pax7表达明显升高(P<0.01)。与浅刺组比较，深刺组爬杆实验得分及股四头肌MyoD1、Pax7表达明显升高(P<0.05，P<0.01)。模型组出现大面积炎性浸润，肌细胞肿大、萎缩、破裂、变性坏死，细胞大小不一、形态各异，间隔变大，核聚集、深染、固缩，伴出血；两斜刺组有不同程度的改善。结论：斜刺阿是穴能有效促进损伤股四头肌的良性修复，促进小鼠运动能力的恢复，且深刺较浅刺效果更佳，其机制可能与上调MyoD1和Pax7的表达有关。.
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