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 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.

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 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.

Objective To evaluate detection effect of three methods on monitoring microbes in dialysate and dialysis water for hemodialysis.Methods Seventy-two dialysate and dialysis water specimens were collected from 36 medical institutions,specimens were cultured with three methods: blood agar plate incubated at 35℃ for 72 hours,Tryptic soy agar(TSA)plate incubated at 35℃ for 72 hours,and Reasoner's 2A agar(R2A agar)plate incubated at 23℃ for 168 hours,colony counts,isolation of colony,and detection rate of colony exceeding action level(≥50 CFU/mL)were compared among three methods.Results The colony isolation rates of microbes in dialysate and dialysis water detected by blood agar plate,TSA plate and R2A plate were 40.28%,63.89%,and 69.44%respectively,difference was significant(x2=14.16,P<0.05);pairwise comparison showed that isolation rates of colony on R2A agar plate and TSA plate were higher than blood agar plate.There was significant difference in isolated colony count between blood agar plate and R2A agar plate,TSA plate and R2A agar plate respectively(Z=-4.515,-6.970 respectively,both P<0.05).The rates of isolated colony exceeding action level in dialysate and dialysis water detected by blood agar plate,TSA plate,and R2A agar plate were 1.39%,4.17%,and 20.83%respectively,difference was significant(x2=19.83,P<0.05),detection rate of R2A agar plate was higher than the other two methods.Conclusion The detection rate of colony by R2A agar plate and TSA plate are better than blood agar plate,detection rate of colony exceeding action level by R2A agar plate is higher than TSA plate and blood agar plate,R2A agar plate for microbial monitoring(23℃,168 h)on dialysate and dialysis water is superior to the other two methods.

Objective To investigate the clinical distribution of carbapenem-resistant Enterobacteriaceae(CRE)strains separated in this hospital and the situation of its production of carbapenem enzyme.Methods The production of carbapenem enzyme by CRE strains was confirmed by using modified Hodge test,the situation of the production of metallo-beta-lactamases by CRE strains was screened by using imipenem-EDTA double-disk synergy test,and the clinical distribution of CRE strains was retrospectively ana-lysed.Results 37 strains of CRE isolated in this laboratory were screened by using instrument method and verified by using disk diffusion (K-B)method.It showed an increasing trend from 2012 to 2014 in the amount of CRE strains.In terms of bacterial spe-cies,K.pneumonia(1 6 strains)was the main kind of carbopenems-resistant strains,followed by E.coli(6 strains),Ser.marcescens(6 strains)and E.cloacae(4 strains).CRE strains were mainly isolated from geriatric ward and intensive care unit(ICU).Sputum,u-rine and blood specimen were key sources of CRE strains.Modified Hodge test confirmed that 36 strains of CRE were the strains that can produce carbapenemase,including 4 strains of K.pneumonia,3 strains of E.cloacae,and 1 strain of E.asburiae,and strains producing metallo-beta-lactamases were confirmed by using imipenem-EDTA double-disk synergy test.Conclusion Elderly patients with underlying diseases are susceptible population of CRE hospital infection and are primary preventive targets.The principal mechanism of carbapenem-resistant CRE strains in this hospital is the production of carbapenemase and production of metallo-β-lac-tamases in a small number of strains.

Objective To evaluate the value of ultrasonic elastography for diagnosis of chronic nonspecific low back pain. Methods From March to September, 2016, 32 patients diagnosed as chronic nonspecific low back pain and other 32 healthy people (controls) were measured lumbar erector spinae with ultrasonic elastography, and calculated Yang's modulus. The correlation between Yang's modulus and Visual Analogue Scale (VAS) or Japanese Orthopaedic Association (JOA) score in the patients were investigated with Pearson's analysis. Re-sults There was no significant difference in Yang's modulus between bilateral lumbar erector spinae in both the patients and the controls (t<1.849, P>0.05), but it was more in the patients than in the controls (t=9.931, P<0.001). The Yang's modulus was positively correlated with VAS score in the patients (r=0.614, P<0.001), but not with the JOA score (r=-0.243, P=0.180). Conclusion Ultrasonic elastography can be applied to differentiate low back pain from the healthy, and measure the intensity of pain.

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 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.