Targeted therapy of anti-angiogensis strategy is the standard treatment for metastatic renal cell cancer.In recent years,a number of new generation of anti-angiogensis agents have been tested in clinical trials,some of which have achieved promising outcomes.Other pathway inhibitors such as inhibitors of mamma-lian target of rapamycin and fibroblast growth factor receptor pathway have made progresses in some extent.

Objective To investigate CT features of solitary fibrous tumor of the mediastinum(SFTM),and to analyze the causes of misdiagnosis of this disease.Methods CT features of 5 patients of SFTM confirmed operatively and pathologically were retrospec-tively analyzed.All patients underwent before operation but were misdiagnosed.Results 3 cases were located in right mediastinum with oval-shap,well-defined margin,and “pleural tail sign”,2 cases were located in right thoracis cavity with unwell-defined margin, and in the adjacent lung were oppressed.In all 5 patients,the mean median of tumors was 1 1.5 cm(8.6-1 5 cm),non-homogeneous density of tumors were seen on plain CT scans,and obvious non-homogeneous enhancement with“geographic pattern”on contrast-en-hanced CT.Conclusion CT can clearly reveal the size and the appearance of SFTM,adjacent architectures,the final diagnosis de-pends on histopathological and immunohistochemical findings of the tumors.To un-know is the main caused of misdiagnosis of medi-astinal SFT.

Objective: To study the rational treatment course of proton pump inhibitor omeprazole for critical patients in order to improve the prognosis and reduce the hospital stay and treatment expense. Methods:Totally 180 critical patients with APACHEⅡ>10 and mechanical ventilation >48 hours in ICU were selected and randomly divided into 3 groups treated by omeprazole for 1 day, 3 days and 5 days , respectively. The incidence rate of stress ulcer, gastrointestinal hemorrhage and ventilator-associated pneumonia ( VAP) in the three groups was studied, and the ICU stay and expense were also investigated. Results:The incidence rate of stress ul-cer and gastrointestinal hemorrhage in the group with treatment course of 3 days and 5 days were significantly lower than those in the group with 1 day treatment(P<0. 05). The incidence rate of VAP with 3-days treatment was the lowest, compared with 1 day and 5 days treatment, the different was satatistically significant(P<0. 05). The ICU hospitalization time and treatment expense were also significantly different among the three groups, and that in 3-days, group was the lowest(P<0. 05). Conclusion:The 3-day treatment is the most reasonable, which can not only prevent stress ulcer and gastrointestinal bleeding in critical patients, but also reduce the in-cidence of VAP with lowered hospital stay and expense.

Objective To study the impact of the resolution of reference dose distribution and evaluated dose distribution to Gamma rate in the verification of IMRT. Methods Designed four fields, the resolution of dose distribution calculated in water phantom and exported from TPS are 1 ,2,3 ,4,5,6 mm. To calculate Gamma index by IBA's OmniPro-I'mRT software in different sampling resolution. Results When the resolution of evaluated dose distribution was fixed, the change of reference dose distribution's resolution has little effect on Gamma rate (5％ to IMRT field) ;When the resolution of reference dose distribution was fixed , the Gamma rate increased as the evaluated dose distribution's resolution ( ＞ 1 mm) raise ( the Gamma rate increase ( 15. 2 ±6. 2) ％ ( t = 11. 99 ,P < 0. 01 ) and ( 14. 9 ± 5. 5) ％ ( t = 13. 24 , P ＜ 0. 01 ) while the resolution of evaluated dose distribution changed from 6 mm t0 3 mm and from 3 mm to 1 mm　respectively) .Conclusions To use Camma method for verification of IMRT, the measured data can be as a reference dose distribution without　interpolation;the computed data by TPS can be as a evaluated dose distribution and it is more appropriate for the resolution of 1 mm.

Objective To study the imaging performance and mechanism of acute patellofemoral joint impingent syndrome.Meth-ods The MR images and clinical data of acute patellofemoral joint impingent syndrome were analysed retrospectively in 10 patients, which were confirmed by clinic .MRI and DR examination were performed in all patients,in which 6 patients had complete knee ar-throscopy material.The imaging performance and mechanism of acute patellofemoral joint impingent syndrome were summarized re-spectively.Results All cases had clear history of buckling ectropion trauma;Patellar dislocation or subluxation were detected in 9 cases on DR examination,10 cases on MRI;Patellar medial fracture or osteochondral fracture caused by acute slipped patella was de-tected in 1 case on DR examination,2 cases (3 places)on MRI;Medial patellar retinaculum injury were detected in 10 cases on MRI,which were corresponding to that on surgery.Articular injury and subchondral marrow edema in particular parts of joint (an-terolateral of lateral femoral and medial patellar)were detected in 9 cases on MRI.MRI features of articular cartilage injury were confirmed by arthroscopy.MRI showed ACL or PCL injury in 3 cases,meniscus tear in 4 cases,which were quite consistent with the arthroscopy findings.Conclusion MRI can effective display joint cartilage damage,subchondral marrow edema in particular parts of the joint,which is useful to clinical prediction and treatment at early stage.

Objective To evaluate the association between B-cell non-Hodgkin lymphoma (NHL) and hepatitis B virus (HBV).Methods The positive rates of HBV markers in 284 patients of B-cell NHL who were admitted to our department between January 2003 and December 2009 were investigated.The positive rates of HBV markers in colorectal cancer patients were used as controls.Results The HBsAg-positive rates of patients aged 18～ 39 and stage m/Ⅳ patients were 42.6 ％ (26/61) and 37.0 ％ (50/135),which was higher than other groups.The x2 value and P value were 7.573 and 6.874,0.023 and 0.009,respectively.Compared with the control group, the B-cell NHL had significantly higher prevalence of positive HBsAg and positive HBeAg (29.6 ％ vs 14.5 ％,6.7 ％ vs 0.8 ％ ).The Wald values were 25.174 and 20.496,respectively.Both of the P value were ＜0.001 and lower prevalence of positive anti-HBs (45.4 ％ vs 58.0 ％,Wald =11.062,P =0.001).The coexpression of HBsAg, HBeAg and anti-HBc was higher in the B-NHL group than in the control group (6.0 ％ vs 0.8 ％,x2 =31.619,P ＜0.001).Similarly,the coexpression of HBsAg,anti-HBe,and anti-HBc was higher in the B-NHL group (16.2 ％ vs 11.5 ％,x2 =4.542,P =0.033).Significantly higher rate of positive anti-HBc and negative anti-HBs was observed in the B-NHL group (37.0 ％ vs 24.5 ％,Wald =17.708,P ＜ 0.001),whereas the same group showed a lower rate of negative anti-HBs compared with the control group (20.8 ％ vs 27.8 ％, Wald =5.646, P =0.017).Conclusion This finding of a positive association between HBV infection and B-NHL suggests that HBV may play an etiologic role in the induction of B-NHL.

Objective To study the dosimetric characteristics of flattened and flattening filter free (FFF) beams with 6 MV and 10 MV photon energy using a novel dual-energy medical linear accelerator (Elekta Versa HDTM),to identify the dosimetric characteristics and advantages of FFF beams,and to provide a basis for their clinical application.Methods The percentage depth dose (PDD),profiles/dose rate of off-axis ratio (OAR),field size,penumbral width,dose out of the fields,collimator scatter factor (Sc),and total scatter factor (Sc,p) were compared between flattened and FFF beams.Results (1) After beam energy matching,the FFF beams had the same beam energy with the flattened beams.The matching error of PDD at a depth of 10 cm was less than 1％ between fields.(2) The FFF beams had a smaller variation in dose rate of OAR with the depth than the flattened beams.(3) The FFF beams had smaller variations in field size and penumbral width than the flattened beams.Moreover,the penumbral width of the FFF beams increased with the increasing field size or depth.The FFF beams had a lower dose out of the fields than the flattened beams.(4) The FFF beams had smaller variations in Sc and Sc,p with the field size and depth than the flattened beams.Conclusions Removal of the flattening filter can substantially improve the dose rate,shorten radiotherapy time,and reduce leakage and scattering of the head.The dosimetric advantages make the FFF beams appropriate for clinical treatment.

Objective To evaluate the association between non-Hodgkin's lymphoma (NHL) and hepatitis B virus (HBV).Methods The positive rate of hepatitis B virus surface antigen (HBsAg) in 393 patients of NHL who were admitted. The colorectal cancer patients and healthy persons were also enrolled as control. Results The positive rate of HBsAg in NHL patients (26.5 ％) was significantly higher than that in colorectal cancer patients (14.5 ％) and healthy persons (8.8 ％),respectively (x2=55.713,P＜0.001).The characteristics of HBV-infected patients with NHL were similar to those who were HBV-uninfected in terms of sex,stage and B symptoms,whereas the HBV-infected patients were younger than the HBV-uninfected patients (the median age was 47ys vs 52ys,t =-1.911,P=0.021).In the HBsAg-positive NHL group,B-cell subtype was much more common than T-cell subtype (80.8 ％ vs 15.4 ％,P=0.043).Regarding colorectal cancer patients and healthy persons as control groups,the positive rate of HBsAg was significantly higher in B-cell NHL patients than that in the control groups, respectively ( 29.6 ％ vs15.5 ％ vs 8.8 ％,Wald value were 25.174 and 55.139,respectively,P＜0.001).The positive rate of HBsAg of HBV between T-cell NHL (16.7 ％) and control groups were not significantly different. Conclusions An association is present between HBV infection and NHL,especially in B-cell subtype.

Objective To explore the clinical application value of transcatheter arterial chemoembolization (TACE) combined with CT-guided percutaneous acetic acid injection (PAI) in treatment of huge hepatocellular carcinoma (HCC). Methods Forty-three patients with huge HCC were randomly divided into two group. Twenty-one patients in group A underwent routine one course for TACE (three times), and the interval of TACEs was one month. Twenty-two patients in group B underwent TACE combined with PAI, and CT-guided PAI was performed once a week since 2-3 weeks after first TACE, and one course included 6-9 times of PAI. Postoperative follow-up was conducted (including AFP, the size of tumor, etc.). One course of treatment was repeated in case of tumor recurred. Results At the 1st month after treatment, no statistical difference was found of AFP positive rate between two groups. Statistical difference of total effective rate was found between two groups (38.10% vs 77.27%). The 1-, 2- and 3-year survival rate In group A was 47.62%, 23.81% and 9.52%, respectively, while in group B was 81.82%, 54.55% and 36.36%, respectively, and significant differences were found between the two groups for the same period. Conclusion TACE combined with PAI is safe and more effective than TACE alone in the treatment of huge HCC.

Objective To investigate the clinical efficacy and safety of testosterone supplement and Mreceptor blockers in the treatment of patients with lower urinary tract symptoms(LUTS)in late -onset hypogonadism(LOH). Methods 28 cases diagnosed as LOH with mild to moderate LUTS were collected.They were given testosterone supplementation (oral testosterone undecanoate capsules,80mg,2 times/d)and M receptor blocker (oral succinate solifenacin tablet,5mg,1 time /d)treatment for 1 -3 months.After treatment for 1 month and 3 months respectively, reviewd PSA,serum total testosterone (TT),international prostate of urinary storage symptoms score (urinary storage IPSS),quality of life (QOL)score,international index of erectile function (IIEF -5)score,maximum urinary flow rate (Qmax),residual urine (Ru)and rectal examination (DRE).The improvement of LUTS before and after treatment was evaluated.Results 1 month after treatment,1 patient was difficult to tolerate the solifenacin side effects and took testosterone supplementation alone.The rest 27 patients were able to take medicine for 3 months.After 1 month and 3 months treatment,the IPSS score had significant differences compared with before treatment[(10.3 ±2.1)points vs (14.2 ±3.3)points and (9.42 ±1.8)points vs (14.2 ±3.3)points,t =13.67,14.72,all P <0.05 ].After 3 months treatment,the QOL and IIEF -5 scores were (2.1 ±0.7)points vs (4.3 ±0.6)points and (16.8 ± 3.6)points vs (11.9 ±2.5)points,Qmax was (12.5 ±5.6)mL/s vs (9.8 ±4.8)mL/s(t =6.42,5.64,14.92,all P <0.05 ),the difference was statistically significant compared with before treatment.There were no significant changes in PSA and RU before and after treatment.All patients had no severe complications such as acute urinary retention.Conclusion Combination of testosterone and testosterone in the treatment of LUTS patients in LOH is safe and effective,and can significantly improve the LUTS and quality of life.