Objective To analyse CT findings of pleural mensothelioma caused by crocodolite in their living environment.Methods CT findings of malignant pleural mensothelioma in 55 cases were reviewed and analyzed retrospectively.Results Of 55 cases there were localized pleural mensothelioma in 1 accompanied with less pleural effusion and malignant diffuse pleural mensothelioma in 54 ,of which 13 cases had no pleural effusion,30 cases had less or more effusion and 11 cases had a large amount of pleural effusion.In 4 cases,mensotheliomas localized in low-right thorax accompanied pleural effusion in left thorax.The CT findings of these four patients were pleural thickening more than 2 cm.The lesion was manifested as decorative border,nodule and mass of soft tissue and there was much enhancement.Conclusion CT scan is very helpful in detecting the location,extent of pleural mensothelioma and follow-up of patients.

Objective To investigate the MR imaging features of chondroblastoma,and to address the correlation with findings of X-ray radiography and CT.Methods The imaging findings including MRI,X-ray radiography and CT of 16 chondroblastomas proved by surgery and pathology were analyzed and correlated with each other. Results All sixteen chondroblastomas involved the epiphyses of long bones,with varying sizes from 0.8 cm to 5.1 cm and lobulation. They were iso- and hypo-intense on T1WI and had heterogeneous signals on T2WI.They were of soft tissue density on CT,and had areas of calcifications and low density.The rims were hypointense on both T1 WI and T2 WI and showed hyperdensity on CT. The lesions were surrounded by edema of bone marrow which was hypointense on T1 WI and hyperintense on fat suppressed T2WI,while on X-Ray film and CT it was hyperdense sclerotic area.The adjacent soft tissues were swelling.Nine cases had periosteal abnormalities on MRI in which 8 of 9 periosteal abnormalities were distant from the primary lesions,and 6 of them showed hyperdense perosteal new bone on CT.Twelve cases had joint effusion on MRI and CT detected 6 of them.The lesions had heterogeneous enhancement,and there was enhancement in areas of edema within bone marrow,periosteal reaction and adjacent soft tissue.Chondroblastoma was intermediate and hyperintense on DWI,and the intermediate areas on both T1 WI and T2WI,together with areas of bone marrow edema,periosteal reaction and soft tissue swelling,were hyperintense on DWI.Conclusions The MRI,X-ray and CT can reflect the pathological changes of chondroblastoma from different aspects.The characteristics of chondroblastoma can be better appreciated by combining different imaging methods.

Objective To explore the relationship between quality of life and knowledge,beliefs,behavioral,pulmonary function outcomes in stable-stage patients with chronic obsturctive pulmonary disease (COPD).Methods Using the general data questionnaire,COPD assessment test (CAT),knowledge,attitude and behavior questionnaire to investigate 93 stable-stage COPD patients in urban and rural areas,and measure the level of forced expiratory volume in one second (FEV1％).Results CAT total score was (22.56 ± 6.40) points which was in severe level;knowledge,beliefs,behavior total score was (41.94 ± 8.20) points,and FEV1％ was (59.81 ± 7.64) ％.The CAT was negatively correlated with knowledge,beliefs,behavior total score and two dimensions of beliefs,behavior and FEV1％,r values were-0.262,-0.288,-0.217,-0.256 respectively,P ＜ 0.05.Conclusions The COPD patients in stable-stage have a high level of CAT.Targeted invention should be combined with the status of the knowledge,beliefs and behavior to improve the level of air flow,and quality of life of patients.

Objective To analyze the significance of postoperative radiotherapy for lymph node positive patients after radical resection of esophageal carcinoma.Methods Two hundred and sixty patients with esophageal squamous cell cancer,aged ≤70,with the performance status score of0 -1,who had undergone radical resection were divided into 2 equal groups:surgery alone group (Group A ) and surgery plus radiotherapy group (Group B).Group A was classified into 3 sub-groups:Group A1 (n =42)without lymph node involvement,Group A2 (n =43 ) with 1 to 3 involved lymph nodes,and Group A3(n =45) with ≥4 involved lymph nodes.Group B was classified into 3 sub-groups:Group B1 (n =43 )without lymph node involvement,Group B2 (n =44) with 1 to 3 involved lymph nodes,and Group B3(n =43 ) with ≥4 involved lymph nodes.The patients were followed up till death.Results The 1-,3-,and 5-year overall survival rates of Group A were 71.5％,35.4％ and 20％,respectively,all significantly lower than those in Group B (76.2％,48.5％ and 36.2％,respectively,x2 =7.822,P ＜0.05).The 1-,3-,and 5-year survival rates of Groups A1 were 83.3％,52.3％,and 38.1％,respectively,all not significantly different from those of Group B1 (81.3％,58.1％,and 46.5％,respectively,x2 =0.283,P ＞ 0.05 ).The 1-,3-,and 5-year survival rates of Groups A2 were 69.8％,34.9％,and 18.6％,respectively,all significantly lower than those of Group B2 (77.3％,47.7％,and 40.9％,respectively,x2 =4.188,P ＜ 0.05).The 1-,3-,and 5-year survival rates of Groups A3 were 62.2％,20％,and 4.4％,respectively,all significantly lower than those of Group B3 ( 69.8％,39.5％,and 20.9％,respectively,x2 =6.168,P ＜ 0.05).The 5-year metastatic lymph node rates of Groups A1 to A3 were 30.9％,53.4％,and 66.7％,respectively,all significantly higher than those of Groups B1 to B3 ( 11.6％,22.7％,and 30.2％,respectively,x2 =4.753,8.741,and 11.682,respectively,all P ＜0.05).The 5-year distant metastasis rates of Groups A1 to A3 were 11.9％,20.9％,and 31.1％,respectively,all not significantly different from those of Groups B1 to B3 (13.9％,20.4％,and 25.6％,respectively,x2 =0.079,0.003,and 0.203,respectively,all P ＞ 0.05 ).Conclusions Postoperative radiotherapy increases the survival rate of lymph node positive patients,but shows little efficacy on the lymph node negative patients.It reduces the occurrence of lymph node metastasis,even in the lymph node negative patients,and does not increase the morbidity of complications,especially that of anastomotic stenosis.The number of metastatic lymph node is one of the important factors affecting the survival of esophageal carcinoma.Distant metastasis increases along with the number of metastatic lymph nodes.

Objective To investigate the feasibility of simplified intensity-modulated radiotherapy (sIMRT) and concurrent chemotherapy against neck and upper thoracic esophageal carcinoma with lymph node metastasis.Methods sIMRT plans were designed for 44 patients of neck and upper thoracic esophageal carcinoma with lymph node metastasis, 20 of which underwent high dose sIMRT (hsIMRT group) and 24 underwent conventional dose sIM RT (csIMRT group).Three target volumes were defined:PGTVnd, target volume of lymph node lesion, irradiated to 68.1 Gy ( 2.27 Gy × 30 fractions ) for the hsIMRT group, and 60 Gy (2.0 Gy ×30 fractions) the csIMRT group; PTV1, the target volume of primary lesion, to be irradiate to 63.9 Gy (2.13 Gy × 30 fractions) for the hsIMRT group and 60 Gy (2.0 Gy × 30fractions) for the csIMRT group; PTV2 , the prophylacticly irradiated volume, to be irradiated to 54 Gy (1.8 Gy ×30) for both groups.The sIMRT plan included 5 equiangular coplanar beams.All patients received DDP + 5-FU regimen concurrently with radiotherapy at 1 -5 d and 29- 33 d, respectively.Chemotherapy was repeated for two cycles 28 days after the radiotherapy was finished.Results The treatment was completed for all patients within 6 weeks.During the treatment only one patient with grade 3 acute bronchitis was observed in the hsIMRT group.The complete response (CR) rate for the lymph node lesion of the hsIMRT group was 75% ( 15/20 ), significantly higher than that of the csIMRT group [45.8% ( 11/24), x2 = 3.84, P ＜ 0.05].The 1-, 2-, and 3-year progression-free survival rates of the hsIMRT group were 60%, 40%, and 25% , respectively,all significantly higher than those of the csIMRT group (41.7%, 25%, and 8.3% respectively, x2 = 4.11,P ＜ 0.05).However, there were not significant differences in the total survival rate, and the CR and PR of the esophageal lesion between these 2 groups.The major toxicity observed was grade Ⅰ -Ⅱ leukoctyopenia.Conclusions sIMRT generates desirable dose distribution for neck and upper thoracic esophageal carcinoma.hsIMRT has a better short-term efficacy than csIMRT.High dose radiotherapy toward metastatic lymph nodes helps increase progression-free survival.

Objective To evaluate the feasibility , toxicity and clinical efficacy of intensity-modulated radiotherapy using the simultaneous integrated boost (SIB- IMRT) and concurrent chemotherapy for advanced nasopharyngeal carcinoma. Methods Thirty nsopharyngeal carcinoma were treated with full course IMRT including nasopharynx and full neck to supraclavicle. The radiotherapy dosage is 68 Gy to the target. Concurrent chemotherapy was given, and the regimen was DDP 40 mg/m2/weekly.Results The mean dose of covering gross tumor volume(PGTV) (D95) in the nasopharynx was 70.48 Gy, and the mean volume of PGTV1 receiving the 95 % dose(V95) was 98. 46 %. The mean dose of PGTV1, PGTV2, PCTV1 and PCTV2 in the targets were 70.8 Gy, 66.4 Gy, 62.3 Gy and 54.8 Gy. According to the evaluation, the acute skin,mucositis and salivary toxicity with grade Ⅲ in those patients were 3.3 %, 10 %, 6.6 %. The patients developed different blood toxicity, but didn't affect their treatment. The median follow-up time was 6.5 months, and disease free survival rate was 100 %. Conclusion SIB-IMRT yields well dose distribution and acceptable toxicity in advanced stage nasopharyngeal carcinoma. The preliminary clinical result is encouraging.

Objective To compare the dosimetric difference on organ at risk (OAR) in intensitymodulated radiotherapy (IMRT) with three-dimensional conformal radiotherapy (3D-CRT) in treatment with cervical carcinoma. Methods 36 cases of cervical cancer patients accepted radiotherapy both on IMRT and 3D-CRT in the same time,clinical target volume (CTV) focused on primary tumor and its lymphatic drainage area.Lymphatic drainage area was determined as follows:1.0 cm extension were added to the margin of pelvic vessels,the obturator lymph nodes region was extended by 1.8 cm from the pelvis inner margin.CTV does not include pelvic tissue. Data of dose distribution and irradiation volume of OAR on the basis of distributing on 45 Gy and 50 Gy were analyzed individually. The margins of planning target volume (PTV) was obtained based on CTV margins by which added 1.0 cm extension in inferior and superior directions,0.7 cm were added in all other directions. Results With the comparison of variety on irradiation volume of organs at risk (OAR) by DVH in both groups,underlying the treatment dose 45 Gy,the individual volume of D30,D40 and D45 were all lesser in IMRT plan than that of 3D-CRT plan. Even on the dose 50 Gy at pelvic wall lymph nodes regions,the volume of OAR was lesser than that in 3D-CRT plan.Conclusion In the radiotherapy of cervical cancer,IMRT should have improved protections for tumor surrounding OAR which has domestic superiority in clinical application.

Objective To observe changes of erythropoietin (EPO) and rheology in moderate and severe obstructive sleep apnea hypopnea syndrome (OSAHS) patients after the noninvasive positive pressure ventilation (NPPV) treatment. Methods Healthy adults were selected as control group (n=40) while moderate to severe OSAHS patients were selected as OSAHS group. OSAHS group was underwent NPPV treatment then, Levels of sleep apnea hypopnea index (AHI), sleep mean minimum oxygen saturation (LSaO2) and serum erythropoietin (EPO) were assessed, routine blood test and hemodynam-ic indexes were also checked before treatment and 1 and 3 months after treatment in both groups. Results In both groups serum EPO, blood, blood rheology indexes, AHI, LSaO2 were analysised at each time point by ANOVA repeated measures, all of which show significant different between groups and between each time points within the same group. Indexes in OSAHS group improved with prolonged treatment , but they are in the normal range in the control. Conclusion OSAHS pa-tients with NPPV therapy can significantly relieve hypoxia, reduce serum EPO level and blood viscosity. So NPPV has impor-tant clinical significance in prevention and treatment of OSAHS.

Objective:To explore the mediating effect of self-esteem and resilience,and the moderating role of left-behind experience on negative life events and depression in college students.Methods:Totally 879 college students were selected from 3 universities in Sichuan and Chongqing (396 college students with left-behind experience,483 college students without left-behind experience).The Adolescent Self-Rating Life Events Check List (ASLEC),Self-esteem Scale (SES),Resilience Scale of Chinese Adolescent (RSCA) and Self-Rating Depression Scale (SDS) were used to measure the negative life events,self-esteem,resilience and depression.The Bootstrap program and multiple-group analysis were used to test mediation effect and moderation effect.Results:Scores of ASLEC were higher in those with left-behind experience than in those without left-behind experience [(9.0 ± 3.8)vs.(6.8 ± 3.1),P ＜ 0.001].College students'left-behind experience was positively correlated with scores of ASLEC and SDS (r ＝0.22-0.22,Ps ＜0.01),while negatively correlated with scores of RSCA and SES (r ＝-0.29--0.56,Ps ＜0.01).The complete mediating effect of the scores of SES and RSCA between ASLEC score and SDS score was significant (mediating effect ＝ 0.08,0.13,0.07;Ps ＜ 0.01).It was significant that the mediaring roles of self-esteem and resilience (95％ CI:0.13-0.68).Left-behind experience played the moderating effect on self-esteem and resilience (the constraint model fitting degree of variation was △x2 ＝ 2120.68,△df＝ 8,P ＜ 0.001).Conclusions:Self-esteem and resilience completely mediates college students'negative events and depression,which is moderated by their previous left-behind experience.

Objective To explore the correlation between the pathogenesis of coronary heart disease and the polymorphism of methylenetetrahydrofolate reductase ( MTHFR ) .Methods 130 cases of coronary heart disease diagnosed and treated in Heze Municiple Hospital from July 2015 to July 2017 were selected as observation group .At the same time,130 healthy people were selected as control group .The serum folate and homocysteine ( HCY) levels were compared between the two groups .At the same time, polymerase chain reaction -restriction fragment length polymorphism was used to analyze the MTHFR gene polymorphisms .The distribution of MTHFR gene polymorphism was compared between the two groups .Results The level of serum folic acid in the observation group was (5.76 ± 2.14)g/L,which was significantly lower than (7.34 ±2.43)g/L in the control group (t=5.64,P<0.05).The level of serum HCY in the observation group was (15.46 ±5.74)μmol/L,which was significantly higher than (10.28 ± 4.38)μmol/L in the control group (t=6.43,P<0.05).The frequencies of TT type,TC type and CC type of MTHFR gene in the observation group were 36.92％,46.92％and 16.15％,respectively.The frequencies of TT type,TC type and CC type of MTHFR gene in the control group were 21.54％,55.38％ and 23.08％,respectively.The frequency of TT type in the observation group was significantly higher than that of the control group (χ2 =8.25,P<0.05). There were no statistically significant differences in folic acid levels among different gene types in the observationgroup(t=1.31,0.55,0.73,all P>0.05),but the serum HCY level of TT type was significantly higher than that of CT type and CC type in the observation group (t=5.33,4.62,all P<0.05).Conclusion Serum folic acid level, HCY level and homozygous mutations of MTHFR gene type have certain relationship with the occurrence of coronary heart disease ,the body serum folic acid level and the distribution of MTHFR genotypes can affect the concentration of HCY,thus affecting the occurrence of coronary heart disease .