Objective To explore the relationship of plasma level of B-type natriuretic peptide (BNP) with cardiovascular risk,the severity of coronary heart disease(CHD),and the short-term prognosis in patients with type 2 diabetes. Methods 154 patients with type 2 diabetes,of them 95 cases complicated with CHD and 65 with hyper-tension were selected in this study. The CHD patients were diveded into 3 groups: AMI(n=32), UAP(n=33) and SAP(n=30). The relationship of the plasma BNP levels with cardiovascular risks, with each coronary heart disea-ses,were observed. The patients were followed up for 6 months to study the predicting role of BNP on the death in pa-tients accompanied with CHD. Results The plasma BNP level was (397.34±217.79) ng/L, which was correlated with age, CRP, hypertension and CHD (r=0.631,0.672, 0.762,0.857, P<0.05 for each);the plasma BNP levels increased with age(r=0.896,P<0.01):(57.6±12.3) ng/L in patients <50 years old,(146.2±53.4)ng/L in patients 50≤and < 59 years old, (388.4±67.5) ng/in patients 60≤and < 69 years old, and (423.8±132.6) ng/L in patients≥70 years old (P<0.01 or P<0.05). The plasma BNP levels, was higher in patients with hyper-tension than that in patients without hypertension [(314.7±125.3) ng/L vs (136.8±98.7) ng/L, P<0.01];Higher in patients with CHD than that in patients without CHD [(425.03±200.80)ng/L vs (37.64±21.57) ng/L,P<0.01)]. The short-term prognosis of patients with CHD was correlated with the levels of BNP, and BNP levels≥485 ng/L may be an independent predicting factor for cardiac death within one month. Conclusions Plas-ma levels of BNP were associated with some cardiovascular risks,which may be one of biomarkers for cardiovascular risks in patient complicated with CHD.

Objective To establish a method based on 3D printing radiology equivalent phantom for individual radiotherapy dose verification,and to offer an assurance for the safety of 3D conformal radiotherapy.Methods Two patients' CT data was collected,reconstructing the first patient's skull and brain tissue to generate a skull-brain phantom for the purpose of testing the equivalent material.The second patient's data was used for whole head tissue reconstruction to produce a head phantom with equivalent material.By inserting ionization chamber dosimeters to target region for radiotherapy program,equivalent phantom dose distribution of lesions location was obtained in order to verify and calibrate the actual radiation treatment planning for patients.Results DR,CT images of the phantoms revealed that the difference of X-ray gray value between brain skull phantom and patient's skull was 13 721,CT value difference between equivalent tissue of brain skull phantom and that part of the patient was 35-40 HU,and CT difference between head phantom temporalis and that of the patient tissue was 18-28 HU.The imaging data indicated that the radiation equivalence of 3D printing phantom was similar to that of human body tissue,and the equivalent dose distribution accorded well with the normal range of treatment.The dose verification of phantom model can effectively improve the accuracy of the radiotherapy system.Conclusions The personalized radiotherapy phantom which based on the 3D printing and tissue equivalent technology is suitable for personalized radiation therapy validation.With advantages of easy accessibility,highly-personalized degree and high precision,this technology provides a reliable and safe way for radiation therapy.

Objective:To investigate the clinical characteristics of choledocholithiasis com-bined with periampullary diverticulum and influencing factor for difficult cannulation of endoscopic retrograde cholangiopancreatography (ERCP).Methods:The retrospective case-control study was conducted. The clinical data of 1 920 patients who underwent ERCP for choledocholithiasis in 15 medical centers, including the First Hospital of Lanzhou University, et al, from July 2015 to December 2017 were collected. There were 915 males and 1 005 females, aged (63±16)years. Of 1 920 patients, there were 228 cases with periampullary diverticulum and 1 692 cases without periampullary diverticulum. Observation indicators: (1) clinical characteristics of patients with choledocholithiasis; (2) intraoperative and postoperative situations of patients undergoing ERCP for choledocholithiasis; (3) influencing factor analysis for difficult cannulation in patients undergoing ERCP for choledocholithiasis. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M(range) or M( Q1, Q3), and com-parison between groups was conducted using the Wilcoxon rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. The Logistic regression model was used for univariate and multivariate analyses. Results:(1) Clinical characteristics of patients with choledocholithiasis. Age, body mass index, cases with complications as chronic obstructive pulmonary disease, diameter of common bile duct, cases with diameter of common bile duct as <8 mm, 8?12 mm, >12 mm, diameter of stone, cases with number of stones as single and multiple were (69±12)years, (23.3±3.0)kg/m 2, 16, (14±4)mm, 11, 95, 122, (12±4)mm, 89, 139 in patients with choledocholithiasis combined with periampullary diverticulum, versus (62±16)years, (23.8±2.8)kg/m 2, 67, (12±4)mm, 159, 892, 641, (10±4)mm, 817, 875 in patients with choledocholithiasis not combined with periampullary diver-ticulum, showing significant differences in the above indicators between the two groups ( t=?7.55, 2.45, χ2=4.54, t=?4.92, Z=4.66, t=?7.31, χ2=6.90, P<0.05). (2) Intraoperative and postoperative situations of patients undergoing ERCP for choledocholithiasis. The balloon expansion diameter, cases with intraoperative bleeding, cases with hemorrhage management of submucosal injection, hemostatic clip, spray hemostasis, electrocoagulation hemostasis and other treatment, cases with endoscopic plastic stent placement, cases with endoscopic nasal bile duct drainage, cases with mechanical lithotripsy, cases with stone complete clearing, cases with difficult cannulation, cases with delayed intubation, cases undergoing >5 times of cannulation attempts, cannulation time, X-ray exposure time, operation time were 10.0(range, 8.5?12.0)mm, 56, 6, 5, 43, 1, 1, 52, 177, 67, 201, 74, 38, 74, (7.4±3.1)minutes, (6±3)minutes, (46±19)minutes in patients with choledocholithiasis combined with periampullary diverticulum, versus 9.0(range, 8.0?11.0)mm, 243, 35, 14, 109, 73, 12, 230, 1 457, 167, 1 565, 395, 171, 395, (6.6±2.9)minutes, (6±5)minutes, (41±17)minutes in patients with choledocholithiasis not combined with periampullary diverticulum, showing significant differences in the above indicators between the two groups ( Z=6.31, χ2=15.90, 26.02, 13.61, 11.40, 71.51, 5.12, 9.04, 8.92, 9.04, t=?3.89, 2.67, ?3.61, P<0.05). (3) Influencing factor analysis for difficult cannulation in patients undergoing ERCP for choledocholithiasis. Results of multivariate analysis showed total bilirubin >30 umol/L, number of stones >1, combined with periampullary diverticulum were indepen-dent risk factors for difficult cannulation in patients with periampullary diverticulum who underwent ERCP for choledocholithiasis ( odds ratio=1.31, 1.48, 1.44, 95% confidence interval as 1.06?1.61, 1.20?1.84, 1.06?1.95, P<0.05). Results of further analysis showed that, of 1 920 patients undergoing ERCP for choledocholithiasis, the incidence of postoperative pancreatitis was 17.271%(81/469) and 8.132%(118/1 451) in the 469 cases with difficult cannulation and 1 451 cases without difficult cannula-tion, respectively, showing a significant difference between them ( χ2=31.86, P<0.05). In the 1 692 patients with choledocholithiasis not combined with periampullary diverticulum, the incidence of postopera-tive pancreatitis was 17.722%(70/395) and 8.250%(107/1 297) in 395 cases with difficult cannula-tion and 1 297 cases without difficult cannulation, respectively, showing a significant difference between them ( χ2=29.00, P<0.05). In the 228 patients with choledocholithiasis combined with peri-ampullary diverticulum, the incidence of postoperative pancreatitis was 14.865%(11/74) and 7.143%(11/154) in 74 cases with difficult cannulation and 154 cases without difficult cannulation, respectively, showing no significant difference between them ( χ2=3.42, P>0.05). Conclusions:Compared with patients with choledocholithiasis not combined with periampullary divertioulum, periampullary divertioulum often occurs in choledocholithiasis patients of elderly and low body mass index. The proportion of chronic obstructive pulmonary disease is high in choledocholithiasis patients with periampullary diverticulum, and the diameter of stone is large, the number of stone is more in these patients. Combined with periampullary diverticulum will increase the difficult of cannulation and the ratio of patient with mechanical lithotripsy, and reduce the ratio of patient with stone complete clearing without increasing postoperative complications of choledocholithiasis patients undergoing ERCP. Total bilirubin >30 μmol/L, number of stones >1, combined with periampullary diverticulum are independent risk factors for difficult cannulation in patients of periampullary diverticulum who underwent ERCP for choledocholithiasis.