Objective To analyze the clinical characteristics,treatment and prognosis of primary esophageal small cell carcinoma (PESC).Methods Fifty-five patients with PESC were analyzed retrospectively.The survival rate was calculated by the Kaplan-Meier method and the Log-rank test using SPSS 17.0 software.Results The median survival time of 55 patients was 12 months.The 6,12,24.36months survival rates of these patients were 87.3 ％ (48/55),50.9 ％ (32/55),12.7 ％ (7/55),7.3 ％ (4/55),respectively.In multivariate analysis,stage and type of treatment were shown to be independent predictive.Conclusion PESC is a malignant tumor with early metastasis and poor prognosis.Combined therapy may improve the survival time of PESC patients.

Objective To investigate the cognitive function of patients with prostate cancer after maximal androgen blockade therapy and its influenced factors,and to provide a new way for early prevention strategy.Methods Montreal cognitive assessment (MoCA),hospital anxiety depression scale (HAD),social support rating scale (SSRS) and self-designed questionnaire were used in 56 cases treated with maximum androgen blockade therapy for more than six months and 37 cases who underwent radical prostatectomy treatment to evaluate their cognitive function and collect the observation indexes between January 2013 and October 2015.Based on MoCA score,all patients were divided into cognitive dysfunction group (n =40) and normal cognitive function group (n =53).The observation indexes in two groups were compared and cognitive function with different treatment in two groups were analyzed.The changes on the influencing factors of cognitive function in patients were filtered using multivariable logistic regression analysis.Results In the cognitive dysfunction group and normal group,the proportion of MAB treatment was 80.0％ (32/40) vs.45.3％ (24/53),the age was 73.7 vs.73.7 years,the proportion of solitary was 32.5％ (13/40) vs.13.2％ (7/53),the proportion of depressive symptoms was 87.5％ (35/40) vs.62.3％ (33/53),the social support level was 32.5 vs.41.1 and the proportion of testosterone decreased was 95.0％ (38/40) vs.45.3％ (24/53).All events showed statistically significant differences (P ＜0.05).Compared MAB treatment group with radical surgical treatment group,the testosterone level was (0.27-±O.15) vs.(12.14 ± 1.86) nmol/L,visual space and executive function score was 4.18 ±0.79 vs.4.54 ±0.56,attention score was 4.73 ±0.99 vs.5.16 ±0.79,delayed memory score was 3.75 ± 1.21 vs.4.30 ± 1.05 and MoCA score was 26.13 ± 1.48 vs.27.27 ± 1.39,which all showed the statistically significant difference (P ＜ 0.05).The results of multiple regression analysis showed that age (OR =1.183,95％ CI 1.135-1.223),depressive symptoms (OR =1.092,95％ CI 1.047-1.149),social support (OR =0.897,95％ CI O.838-0.956),testosterone (OR =2.105,95％ CI 1.369-4.083) were the influenced factors of cognitive dysfunction.Conclusions The incidence of cognitive dysfunction in patients with prostate cancer after maximal androgen blockade therapy more than six months was higher than others.Age,depression,social support level and testosterone levels were related to the occurrence of cognitive dysfunction.

Objective:To observe the feasibility of magnetic resonance (MR)-guided stereotactic body radiotherapy (SBRT) for non-small cell lung cancer, and analyze the dosimetric differences in the presence or absence of magnetic field.Methods:Three patients with non-small cell lung cancer were prospectively treated with MR-guided linac (MR linac) for SBRT, and the dose was calculated with or without magnetic field models. The differences of dose distribution with or without magnetic field models were compared. At the same time, the target coverage, plan pass rate and treatment time were described, and the complexity of the conventional accelerator backup plan and the magnetic field model were compared.Results:The treatment time of 3 patients was (36.67±6.11) min, and the average time of online adaptive planning was (14.4±1.7) min, which was basically tolerated by patients. The treatment plan pass rate (3%/3 mm) was 98.9%, the Gamma pass rate (3%/3 mm) of the online plan during treatment was 98.5% and the target coverage was 99.1%, which met the clinical needs. The dose in the low dose area of the lung was slightly lower than that in the case without magnetic field, whereas the dose in ribs and skin was slightly higher than that in the plan without magnetic field. The number of machine unit (MU) for online adaptive plan was slightly higher than that of the reference plan, and the number of MU for the conventional accelerator standby treatment plan was significantly lower than that of the MR linac plan under the same target coverage. The follow-up results showed that there was no adverse reaction, and the short-term efficacy was partially relieved.Conclusions:In the case of considering the influence of magnetic field, the treatment plan meeting the clinical needs can be obtained. It is proven that SBRT radiotherapy for lung cancer guided by magnetic resonance accelerator is feasible, whereas the treatment time and process are complex.

Objective: To explore the relationship among grit, self-identity and self-esteem and the mediating role of self-identity between grit and self-esteemin middle school students, so as to provide evidence for the study of grit of middle school students. Methods: In March 2019,1 476 middle school students were selected from two ordinary middle schools in a county of Fujian Province. 12-Ttem Grit-scale, Selt-identity Scale and Selt-esteem Scale were used to conduct the questionnaire survey. Results: Relevant analysis showed that perseverance of efforts, consistency of interests were positively correlated with self-identity (r=0.40, 0.31,P<0.01) and self-esteem (r=0.46, 0.18, P<0.01). Self-identity and self-esteem were positively correlated (r=0.67,P<0.01).The results of the mediation test showed that self-identity partially mediates the relationship between perseverance of efforts and self-esteem,mediation effect accounted for 50.38% of the total effect.Self-identity fullymediatesthe relationshipbetween consistency of interests and self-esteem. Conclusion The self-identity of middle school students partially mediates the relationship between perseverance of efforts and self-esteem, and completely mediates the relationship between consistency of interests and self-esteem.

Objective To investigate the clinical efficacy of modified open-door laminoplasty with preservation ofthe unilateral paraspinal muscle ligament complex in treating ossification of posterior longitudinal ligament (OPLL) of the cervical spine.Methods From June 2015 to July 2017,thirty-two patients with OPLL of the cervical spine who underwent modified open-door laminoplasty with preservation of the unilateral paraspinal muscle ligament complex were retrospectively analyzed(modified group).There were 20 males and 12 females with the average age of 61.72±8.41 years (range 46-75 years).The decompression segment range included three cases of C2-C6,seven cases of C2-C7,eight cases of C3-C6,and fourteen cases of C3-C7.Moreover,twenty-three patients with OPLL of the cervical spine who underwent traditional unilateral open-door laminoplasty at the same time were included as controls (control group).The demographics,operation duration,and blood loss volume was recorded.The visual analogue scale (VAS),Japanese Orthopaedic Association scores (JOA),improvement rate of JOA score and neck disability index (NDI) were recorded and analyzed at preoperation,three months after operation,six months after operation and at the final follow-up.The cervical curvature,cervical curvature index (CCI),range of motion (ROM) were measured and statistically analyzed on the lateral X-ray film of the cervical spine.The union rate of the lamina hinge and that of spinous process-lamina was measured on the cross section of the CT scan.Bilateral cervical posterior muscle volume was recorded and analyzed at cross-section plane on MRI.Axial symptoms,C5 nerve root palsy and other complications were also recorded.Results All the patients were followed-up for 6 to 18 months (mean,13.04±4.67 months in control group,11.81±4.93 months in modified group).At the final follow-up,the JOA,VAS and NDI scores improved from preoperatively 6.09±0.79 to 13.43± 1.53,4.22±1.04 to 2.83±1.15 and 25.48％±3.20％ to 8.83％±5.41％ in the control group,versus 6.28±1.05 to 13.88±1.48,4.09± 1.00 to 1.16±0.57 and 25.06％±3.24％ to 5.66％±2.46％ in the modified group.The postoperative JOA score and recovery rate of the two groups was not significantly different,whereas the VAS and NDI scores were significantly reduced in the modified group compared to the control group.The maximum cervical flexion angle,cervical curvature,ROM and CCI of control group were 6.26°± 3.31°,30.17°±4.56°,11.39°±1.95° and 9.74％±4.05％ at the final follow-up,which were reduced significantly compared to pre-operation.The maximum cervical flexion angle,cervical curvature,ROM and CCI of modified group were 10.06°± 1.93°,35.03°± 5.01°,17.03°±2.86° and 14.22％±5.00％,and there were no significant differences compared to pre-operation.There were significant differences among two groups.At the final follow-up,the posterior muscle volume of the two groups at open side was decreased compared to preoperation,but there was no significant difference between the two groups.At the last follow-up,the posterior muscle volume at hinge side was not changed compared to preoperation in modified open-door laminoplasty group,while the volume of the posterior muscle at hinge side in the traditional control group decreased compared to preoperation.The difference was statistically significant.A total of eight patients with axial symptom were present after operation.There were two patients (6％,2/ 32) in the modified group and six patients (26％,6/23) in the control group.The difference of axial symptoms incidence was statistically significant between the two groups.Conclusion Modified open-door laminoplasty with preservation of the unilateral paraspinal muscle ligament complex is an effective technique in treating OPLL of the cervical spine.The technique not only guaranteed to have good recovery of neurological function and to maintain cervical curvature and range of motion,but also contributed to decrease the occurrence of postoperative axial symptoms.

Objective To investigate the changes of the parameters related to planning and re-planning CT imaging features in lung cancer patients presenting with radiation pneumonitis ( RP) by using radiomics technique,and identify the parameters intimately related to the incidence of RP. Methods A total of 31 lung cancer patients who were diagnosed with grade ≥ 2 RP after receiving radiation therapy were selected in this study. For each patient, planning CT images before radiation therapy and re-planning CT images after 40 Gy radiation therapy were obtained. The affected and contralateral lungs were considered as the region of interest (ROI).After the automatic segmentation of normal lung tissues,the parameters related to radiomics features were extracted from ROI by using radiomics software. The differences of these parameters between planning and re-planning CT images were statistically compared. Results ( 1 ) For unilateral lung within each time interval,86 parameters related to radiomics features were extracted; ( 2) Twenty-two parameters significantly differed between the affected and contralateral lungs prior to radiotherapy;(3) Twelve parameters significantly differed between the affected and contralateral lungs on re-planning CT images;(4) Twenty-eight parameters significantly differed in the affected lung before and after radiation therapy;(5) Twenty-eight parameters significantly differed in the contralateral lung before and after radiation therapy. Conclusions The CT imaging radiomics features significantly differ between planning and re-planning CT scan in partial lung cancer patients presenting with RP.Monitoring the dynamic changes of these parameters plays a potential role in predicting the incidence of RP.

The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.