Thoracic radiotherapy is an important means of local treatment for non -small cell lung cancer (NSCLC).Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs)have the effect of systemic therapy.Studies have shown that NSCLC patients with EGFR exons 19,21 mutation have a synergistic effect in the combination therapy .Radiotherapy activates EGFR signaling pathway ,inducing cell proliferation and DNA damage repair,leading to radiation resistance .Therefore,EGFR-TKIs have the effect in increasing radiosensitivity .Lung injury is one of the most common side effects when the two therapies combined .Studies suggest that radiotherapy combined with EGFR-TKIs may have conflicting functions in the development of pulmonary fibrosis ,the discrep-ancy between these studies may depend on the differences in the experimental systems ,the differences in pulmo-nary fibrosis models,as well as the differences between different species and individuals .Therefore,a more com-plete understanding of the etiology for pulmonary fibrosis is necessary to the development of improved treatments .

Cancer of digestive system is one of the most common worldwidely cancers and seriously threats to human health. However its etiology and pathogenesis are still not clear. Toll-like receptor (TLR), a newly discovered transmembrane receptor, plays an important role in innate immunity. Recent researches suggested that TLRs had extensive relationship with inflammation, autoimmune diseases and cancer. A large number of researches indicated that TLRs not only participated in the occurrence, development and immune escape of cancer, but also acted in immunotherapy in digestive system. Further investigation of TLRs may re-veal the effects of TLRs in the development of malignant tumors of digestive system, moreover may find new therputic target for the treatment of cancers. We reviewed the relationship between TLRs and cancers of di-gestive system.

Objective To evaluate the causes,prevention and treatment of mesh infection after abdominal wall hernia mesh repair.Methods The clinical data of 14 mesh infections admitted from De-cember 1997 to December 2013 were analyzed retrospectively.There were one case of inguinal hernia with Lichtenstein repair,eleven cases of inguinal hernia with preperitoneal repair,one case of incisional hernia with Bard Composix Mesh and 1 case of parastomal hernia with mesh repair above the abdominal muscle. Based on prothetic materials and infection status,the infection meshes were removed in 4 cases and open dressing change were operated in 10 cases.Results All patients were healed and discharged without peri-operative death.There was no hemorrhage and bladder injury during the procedures.The time of dressing change ranged from 3 weeks to 6 months,with a median of 4 weeks.All patients were followed up for 8 to 64 months.One patient had a recurrence of abdominal incisional hernia.Conclusion There are many fac-tors related to mesh infection after mesh repair and preventing mesh infection is the most important.Once the infection occurs,the management should be individualized.Antibiotic treatment and surgical drainage can be effective in most polypropylene mesh(PPM)infection However,infected expanded polytetrafluoro-ethylene(ePTFE)mesh should be removed completely.

Radiation therapy is one of the main therapeutic means of thoracic malignant tumors .When re-ceived certain radiation ,lung may cause the common complication of chest tumor radiotherapy -Radiation -in-duced Lung Injury ( RILI) ,which restricts the radiation dose for the tumor region and may affect patient outcomes . RILI is closely associated with multiple cytokines ,such as interleukin family,tumor necrosis factor,transforming growth factor,etc.Currently,research on RILI control methods has also made some breakthrough ,this article elab-orates on this individually .

Objective To explore the role of focus intervention mode in improving the self-efficacy and subjective well-being of newly-contracted nurses. Methods A total of 100 nurses selected as the survey subjects by means of convenient sampling method, were numbered consecutively and divided into observation group and control group by random digit number table. The observation group was intervened with conventional mental consultation and the observation group with the WeChat-based focus intervention mode, which included the use of past-oriented questions and answers for understanding their strength and sources, future-oriented presuppositions and miracle-oriented questions for their thinking of resolutions to future problems. The two groups were compared in terms of general self-efficacy and well-being by the general self-efficacy scale (GSES) and the overall well-being scale (GWB). Results Before intervention , the total scores on GSES and GWB of the observation groups were insignificantly higher than those of the control group (P > 0.05). After intervention, the scores of observation group were significantly higher than those in the control group (P < 0.01). Conclusion The We-Chat-based focus intervention mode can effectively improve the self-efficacy and subjective well-being of newly-contracted nurses.

Objective To identify clinicopathologic factors which predict survival following hepatectomy in HBV-related cirrhotic patients with early hepatocellular carcinoma (HCC).Methods A database was used to identify patients with histologically confirmed early HCC (≤5 cm,no nodal involvement,metastases,or major vascular invasion) who underwent surgical resection (excluding ablation or transplantation).Among 20 700 patients with HCC who were diagnosed at the Eastern Hepatobiliary Surgery Hospital from April 2005 to November 2010,537 (2.6％) patients with early HCC were studied retrospectively.Prognostic factors were evaluated using the Kaplan-Meier curves,Cox proportional hazards models and the receiver operating characteristic (ROC) curves.Results The study included 537 patients.The median tumor size was 2.9 cm,and 33％ of patients had tumors ≤2 cm.Most HCC lesions were solitary (63％) and had no evidence of vascular invasion (64％).Following surgery,the overall median and 5-year survival were 45 months and 33％ respectively.After adjusting for demographic factors and histological grade,tumor size ＞2 cm (hazard ratio [HR]:1.56),multifocal tumors (HR:1.34),and vascular invasion (HR:2.03) remained independent predictors of poor survival (all P ＜ 0.05).Based on these findings,a prognostic scoring system was developed that allotted 1 point each for these factors.Patients with early HCC could be stratified into 4 distinct prognostic groups (median and 5-year survival,respectively):0 points (97 months,96％),1 point (85 months,76％),2 points (76 months,54％),3 points (56 months,39％) (P ＜0.01).Conclusions The present study emphasized the importance of pathologic staging even in patients with small HCC.Anatomical resection of HCC should be the preferred surgical procedure in cirrhotic patients.

Objective To study the relationship of the university students' procrastination and big five personality factors.Methods 461 university students were assessed by the simple edition of tuckman procrastination scale(TPS) and the big five personality inventory short form(NEO-FFI).Results TPS score of the student was (48.51 ± 7.66).There were 89.4% students respectively had different level of procrastination behavior.There were no significant differences in university students by the gender(47.95 ±7.84 vs 48.95 ± 7.43 ) ,whether one-child students(48.64 ± 7.49 vs 48.45 ± 7.81 ) and grades.There were significant positive correlation between procrastination and the personality factor of neuroticism( r=0.235, P＜0.01 ) and significant negative correlation with extraversion ( r=-0.180, P ＜ 0.01 ) and conscientiousness ( r =-0.198, P ＜ 0.01 ).The big five personality factors of neuroticism,extraversion and conscientiousness could explain the 14.0% variation of procrastination of university students.Conclusion Procrastination is a very common phenomenon in the university students.The students with higher neuroticism, lower extraversion and conscientiousness of big five personality have more procrastination behavior.

Objective To systematically evaluate the efficacy and safety of combined hepatectomy and splenectomy in hepatocellular carcinoma complicated with hepatic cirrhosis and hypersplenism.Methods Medline (1966-August 2009), Embase (1974-August 2009), Cochrane Library, CBMdisc (1978-August 2009), and Wanfang Database were searched without language limitation. All relevant studies were screened and the data were extracted by two independent reviewers, and the methodological qualities of the included studies were evaluated by the Minors scale. The data were analyzed with the RevMan5 software. Results Five non-randomized comparative studies (NRCs) involving 476 patients (232 in HS group, 244 in control group) were enrolled into the analysis. There was no significant difference in the operative mortalities (OR=0. 57, 95%CI 0. 12-2. 66, P=0. 47) and postoperative morbidities (OR= 0. 93, 95 % CI 0.59- 1.46, P = 0.75) between the two groups. Compared with hepatectomy only, CD4+ T cell (WMD=7.90, 95%CI 7.01-8.79, P＜0.01), CD4+ T cell/CD8+ T cell ratio (WMD=0. 75, 95%CI 0. 70-0.80, P＜0.01), white blood cell count (WMD=5.47, 95%CI 5.13-5.82, P＜0.01) and platelet count (WMD=174.89, 95%CI 116.61-233.18,P＜0.01) were significantly higher, but CD8+ T cell (WMD = - 7.66, 95%CI - 8. 53～ - 6. 79,P＜0. 01) was lower compared with combined hepatectomy and splenectomy. There was no significant difference in the 5-year survival rates (OR= 1.37, 95%CI 0.86-2.18, P=0. 18). Conclusion Combined hepatectomy and splenectomy did not increase the operative mortalities and postoperative morbidities in hepatocellular carcinoma complicated with hepatic cirrhosis and hypersplenism. The white blood cell and platelet counts markedly increased after surgery. There was no evidence to show any improvement in the 5-year survival.

Objective To investigate the natural history and growth pattern of hepatic hemangioma in adults.Methods From April 2010 to March 2013, adult patients with hepatic hemangioma who had no prior treatment were enrolled.A routine follow-up was performed to observe the natural history and complications of these lesions.Results 236 patients were enrolled in the study.The median size of the hemangiomas was 4.5 cm (range 0.6 ～ 19.2 cm).During a median follow-up of 48 months (range 3 ～ 266 months), the hemangiomas increased in size in 61.0％ of patients, remained stable in size in 23.7％, decreased in size in 8.5％.The peak growth period was in patients ＜ 30 years age (0.46 ± 0.41 cm/year) and the growth rate decreased significantly after 50 years of age (0.21 ±0.40 cm/year).Hemangiomas with a size ＜2.0 cm had the lowest growth rate (0.16 ± 0.42 cm/year).The peak growth rate was in hemangiomas 8.0 ～ 10.0 cm (0.80 ± 0.62 cm/year) , but for hemangiomas ＞ 10.0 cm, the growth rate was only (0.47 ±0.91)cm per year.Only 9 patients had severe symptoms caused by the hemangioma.No patients presented with hemangioma-related complications.Conclusions The majority of hepatic hemangiomas have the tendency to increase in size but they rarely caused complications.All the hemangiomas could be safely managed by observation, and surgery should only be considered in patients with complications.

BACKGROUND: Many studies have shown that different types of anterior cervical surgery in the treatment of two-level contiguous cervical disc herniation can obtain satisfactory results, but which method is the best has not yet reached a consensus. OBJECTIVE: To compare the efficacy and safety of three types of anterior cervical surgery for treating two-level contiguous cervical disc herniation. METHODS: We retrospectively analyzed clinical data of 62 patients with two-level contiguous cervical disc herniation who underwent anterior decompression and fusion. These patients were assigned to three groups. Bone graft group received anterior cervical discectomy with autogenous iliac bone graft fusion. Titanium mesh group received anterior cervical corpectomy with titanium mesh fusion. Cage group received anterior cervical discectomy with cage fusion. Fusion rate of bone graft and improvement of neurological function (Japanese Orthopaedic Association Scores) were evaluated and compared after treatment in the three groups. Cervical vertebra anteroposterior and lateral images were used to measure height of anterior and posterior margin of vertebral body and Cobb angle changes of fusion segment. RESULTS AND CONCLUSION: Al 62 patients were fol owed up and the fol ow-up time was ranged from 8 to 30 months. Operation time was significantly longer in the bone graft group than in the titanium mesh and Cage groups (P < 0.05). Intraoperative blood loss was larger in the bone graft group than in the titanium mesh and Cage groups (P < 0.05). Japanese Orthopaedic Association Scores were significantly improved after treatment (P < 0.05). No significant difference was found at different time points (P > 0.05). The fusion rate of bone graft was higher in the bone graft group than in the titanium mesh and Cage groups (P < 0.05) at 3 months after treatment, and bone union was found in the final fol ow-up. Height of anterior and posterior margin of vertebral body was significantly increased after treatment (P < 0.05). No significant difference in the increase of the height of anterior margin was detected among the three groups (P > 0.05). The increase in the height of posterior margin was higher in the Cage group than in the bone graft group and titanium mesh group (P < 0.05). Vertebral height loss of the anterior margin was higher in the bone graft group than in the titanium mesh and Cage groups, but vertebral height loss of the posterior margin was highest in the bone graft group, fol owed by titanium mesh group and Cage group at 3 months after treatment (P < 0.05). The increase value of Cobb angle was higher in the titanium mesh group than in the bone graft group and Cage group (P < 0.05). At 3 months after treatment, the altered value of Cobb angle was highest in the bone graft group, fol owed by titanium mesh group and Cage group (P < 0.05). No significant difference in the height of anterior and posterior margins of the vertebral body and Cobb angle was detectable between final fol ow-up and 3 months post-treatment (P > 0.05). These findings indicated that the three kinds of fusion method for treating two-level contiguous cervical disc herniation could obviously lessen nervous systems and improve cervical vertebra functions. In the bone graft group, operation time was long. Intraoperative blood loss was more. Postoperative height loss of the posterior margin of the vertebral body was visible. Cervical lordosis could be easily induced. Compared with the bone graft group, titanium mesh and Cage groups could better maintain the height and curvature of the cervical vertebra, but the Cage group had apparent advantages.