Objective:To investigate the value of prenatal ultrasound combined with MRI in the diagnosis and differential diagnosis of fetal pulmonary sequestration.Methods: The prenatal examination data of 9 cases with pulmonary sequestration confirmed by autopsy and postnatal follow-up was analyzed retrospectively. All fetuses were examined by MR examination performed within 24 hours after ultrasound examination. The results of prenatal ultrasound and MRI were analyzed, and the results were compared with the follow up results.Results: The diagnostic accuracy of ultrasound was 77.78%(7/9), 2 cases were misdiagnosed(one case was misdiagnosed as abdominal mass and one case as pulmonary cystadenoma). The diagnostic accuracy of MRI was 100%.Conclusion: Prenatal ultrasound is the primary method for pulmonary sequestration. As the supplement, MR can display directly the location, shape, size of the lesion. There is high value in diagnosis and differential diagnosis of fetal pulmonary sequestration. The combination of ultrasound and MRI can further improve the diagnostic accuracy of the disease.

Endogenous beta retroviruses (enJSRV) are highly homologous with Jaagsiekte sheep retrovirus (exJSRV),this exogenous retrovirus is the aetiological agent of ovine pulmonary adenocarcinoma (OPA).The aim of this study was to clarify the function of enJSRV and the immunological mechanisms of its corresponding antibody,that is undetectable in JSRV-infected ovine serum.The expression of enJSRV envelope protein and Hyal-2 mRNA in immune organs and lungs of ovine fetuses and lambs were analyzed by Real-Time reverse transcription PCR and In Situ Hybridization using specific probes.In Situ Hybridization results indicated that the enJSRV envelope protein and Hyal-2 mRNA were expressed in thymus,spleen,mesenteric lymph nodes and lungs at different times,while no positive signals were detected in the negative controls.On the other hand,results from Real-Time reverse transcription PCR analysis showed that in 130d fetuses and 3d newborn lambs the enJSRV mRNA levels were much higher in organs associated with the immune system than that in lungs,especially in the thymus and spleen,but levels of Hyal-2 mRNA expression was not significantly different in all collected tissue.These results provided evidence from an immunology point of view to understand why the circulating antibodies against exJSRV are undetectable in JSRV-infected ovine,and will help to unravel the pathogenesis of JSRV-infected ovine.

Objective To investigate the clinical features,treatment outcome and prognosis of pa tients with nasopharyngeal adenoid cystic carcinoma(ACC).Methods From March 1963 to August 2002, 33 patients with ACC were retrospectively reviewed.Among them,13 received multimedality therapy(S + R in 9 and R +S in 4) and the remaining 20 received radiotherapy alone.The interval between the first visit and clinical diagnosis was 12 months(1.0-36.4 months).The misdiagnosis rate was 55% (18/33),with the most common error of otitis media.The clinical symptoms of ACC were similar to those of squamous carcino ma in nasopharynx,though the cervical lymph node metastasis was rare(12%) and cranial nerve invasion was common (58%). ResultsAfter a median follow-up of 60.8 months (5.0-245.2 months),the 5-and 10-year overall survival rates,free-disease survival rates,local regional control rates and metastasis-free sur vival rates were 66% and 29% ,41% and 27% ,61% and 40% ,62% and 62% ,respectively.Among the 20 patients(61%) with recurrence,15 had local regional failure(13 in situ and 2 in cervical lymph node) ,and 9 had distant metastasis(5 in the lung,2 in the lung and bone,1 in the liver and I in the bone).Univariate analysis showed that clinical stage was a prognostic factor(Ⅰ + II vs Ⅲ + Ⅳ,P = 0.009),while treatment modality(radiotherapy alone vs multimodality therapy) was not. ConclusionsNasopharyngeal ACC is a locally aggressive disease with a long course.Either radiotherapy alone or muhimodality therapy(S + R/R + S) is effective in the treatment.

Objective To study the dynamic change of anatomy and dosimetry distribution and its influence during intensity modulated radiation therapy(IMRT) for nasopharyngeal carcinoma(NPC). Methods From June 2006 to August 2007,12 patients with stage Ⅲ-Ⅳ NPC receiving initial IMRT concurrently combined with chemotherapy were included in the study. The target volumes and,involving organs were contoured on the first set of spiral CT images. When IMRT planning was finished,a second CT scans was acquired to rectify the treatment center. Weekly spiral CT images acquired during the treatment period according to the same treatment center were fused with the first CT images. In order to determine the best time of replanning, modified plan target volume( PTV1 ) and normal organs( parotids and outline) were contoured on the fusion interface by a single physician. Changes of each structure throughout treatment period were measured by a system software. Then the dose distributions were computed and evaluated for replanning CT using the same beams arrangement in the original plan. Cumulative dose was estimated compared with the original plan. Results The volume of outlines and parotids decreased gradually, and the change came to peak in the fifth week. So the fifth and first week CT scans were selected as research objectives. No significant changes in maximal and mean dose was observed in the brainstem, spinal cord or mandible. Despite volume changes,D99 and D95 of the PTV1 did not change siguificantly(P＞0.05). D95 of the bilateral parotids increased significantly ( PL = 0.03,PR = 0.01 ). Conclusions During IMRT for NPC, the volume of PTV1, the outlines and parotids decrease,and the change come to peak in the fifth week. Comparing to the first treatment plan, the dose parameters of the parotids increase significantly in the second plan based on the fifth week CT,but those of the brainstem,cord,mandible and PTV1 change slightly.

Objective To study seasonal variation of blood pressure (BP) in patients with essential hypertension (EH) and its association with meteorological elements. Methods In total, 1800 patients with essential hypertension were recruited by cluster sampling from three townships and towns in Qingzhou,Shandong province, 1155 men and 645 women, with an average age of 61.3 years (ranging from 29 to 85years). BP was measured for all of them in sitting position at 8:00 in the morning every seven to 14 days during July 2008 to June 2009. Local meteorological data were collected accordingly such as temperature,humidity and atmospheric pressure, and multivariate regression analysis was performed to show their association. Results In general, BP in patients with EH presented a decreasing trend during the first half year of observation, with the lowest in the summer ( May to August). From September to October, their BP began to increase gradually, and reached the peak in the winter ( November to February nest year). There was significant difference in systolic BP (SBP) and diastolic BP (DBP) between various seasons (Pspring-summer = 0.002 and 0.000, Pwinter-spring = 0.001 and 0.000, Psummer-autumn = 0.045 and 0.000,Psummer-winter =0. 000 and 0. 000, Pautumn-winter =0. 000 and 0. 000, respectively), except for those between the spring and autumn. Both SBP and DBP reversely associated with outdoor air temperature and room temperature(beta= -0.08, t = -2.39, P ＜0.05 and beta = -0.24, t = -6.21, P ＜0.01,respectively), (beta = -0.08, t = -2.39, P ＜0.05 and beta = -0.24, t = -6.21, P ＜0.01,respectively). Conclusions BP in patients with EH reveals seasonal variation, with the lowest in the summer and the highest in the winter and evident fluctuation in the spring and autumn, especially in SBP,which associates with room temperature and their blood vessel elasticity.

OBJECTIVE:To study the impacts of Zishenyutai pills on the ovarian tissue oxidative damage and Nrf2 protein ex-pression in rats exposed by electromagnetic radiation (EMR). METHODS:Accordiny to their weight,30 SD rats were randomly divided into normal group,radiated group and radiated-treated group with 10 rats in each group. Normal group were not radiated, and other 2 groups were exposed by 900 MHz radiation for 4 h every day;radiated-treated group was given Zishenyutai pills sus-pension [0.25 g intragstrically(medicinal materials)/ml] after radiation;normal group and radiated group were given constant vol-ume of normal saline intragastrically for consecutive 20 d. The rats were killed when they were at the estrum. The Nrf2 proteins ex-pression of ovary were detected by immunohistochemical method,the content of ovary MDA(malondialdehyde),and activity of to-tal superoxide dismutase (T-SOD) and superoxide dismutase (GSH-Px) were detected by biochemical method. RESULTS:Com-pared with the rats in normal group,the Nrf2 protein expression was higher in the rats of the radiated group;the content of ovary MDA was higher and activity of ovary T-SOD and GSH-Px were lower significantly(P<0.05). While compared with the rats in ra-diated group,the Nrf2 protein expression didn’t obviously change in the rats of the radiated-treated group(P>0.05),the content of ovary MDA was lower and activity of ovary T-SOD and GSH-Px were higher significantly (P<0.05). CONCLUSIONS:Zish-enyutai pills can prevent and cure ovary tissue oxidative injury induced by 900 MHz radiation,but have no effect on the expression of Nrf2 protein.

Objective To analyze the clinical characteristics , therapeutic outcomes , and prognostic factors of primary salivary gland type nasopharyngeal carcinoma ( SNPC) . Methods The medical records of 54 patients with SNPC at single institution between 1963 and 2006 were reviewed, 2 patients received surgery alone, 30 patients received radiotherapy alone and 22 patients received combined modality therapy consisting of surgery (S) and radiotherapy ( RT) ( S + RT in 15 and RT + S in 7). Of them, 8 patients received chemotherapy , including post-operative adjuvant chemotherapy in 1 patient, palliative chemotherapy in 6 patients and concurrent chemotherapy in 1 patient. 36 patients had adenoid cystic carcinoma ( ACC) ,11 mucoepidermoid carcinoma ( MEC) , and 7 primary traditional adenocarcinoma ( AC) . The Kaplan-Meier method was used to calculate the overall sunival ( OS) , locoregional failure-free survival ( LRFFS) , and distant failure-free survival ( DFFS) rates. Univariate analyses were performed using the Log-rank method.Comparisons of variables between cases were performed using Pearson chi-square test. Results The follow-up was 89％ . The 2-, and 5-year overall survival rates, loco-regional failure free survival rates and distant failure free survival rates were 85％ and 61％ , 74％ and 55％ , 92％ and 70％, respectively. Among the 35 patients with treatment failure, 26 patients had locoregional failure (1 in primary site and cervical lymph node ,23 in primary site and 2 in cervical lymph node) ,and 13 had distant metastasis. The lung was the most common site of metastasis ( n =10) , followed by liver (n = 3), bone ( n = 2) , brain ( n = 1) , and subcutaneous tissue ( n = 1) . Univariate analyses indicated that histological subtypes correlated with overall survival ( X2 = 15. 29, P = 0. 000) and cervial lymph node metastases correlated with distant failure-free survival ( X2 =9. 08 ,P = 0. 003) . Conclusions Primary salivary gland type nasopharyngeal carcinoma is a locally aggressive disease with a long course. The optimal treatment policy for patients with SNPC may be surgery plus radiotherapy.

Objective To evaluate the treatment results of the patients with nasopharyngeal mucoe-pidermoid carcinoma (MEC), and explore an appropriate treatment method. Methods Eleven patients with pathologically confirmed nasopharyngeal MEC were included in this study. The number of patients with pathologically well-, medium-and poorly-differentiated tumor were 1, 2 and 7, respectively. Radiotherapy (RT) alone and surgery (S) alone were given to 1 patient each. Combined modality treatment was RT + S in 6 patients and S + RT in 3 patients. Results After a median follow-up of 41.5 months (range, 8 to 153 months), one patient died of heart disease and one was lost follow-up. The remaining 9 patients were alive, including 6 with disease-free and 3 with residual tumors. None of them had cervical lymphatic spread or dis-tant metastasis. Conclusions Nasopharyngeal MEC progresses slowly and has good prognosis, which should be followed up for a long time. Primary surgery followed by radiotherapy is recommended.

Objective To investigate the association of local factors with local recurrence (LR) and distant metastasis ( DM) in patients with esophageal squamous cell carcinoma ( ESCC) who do not experience clinical metastasis.Methods A total of 236 eligible ESCC patients were analyzed retrospectively, and the association of lesion length on esophagography, maximum tumor diameter, and tumor volume with survival and treatment failure pattern was analyzed.Kaplan-Meier test and Cox regression were used for survival analysis and to identify prognostic factors.Results The 1-, 3-, and 5-year overall survival rates, LR rates, and DM rates were 88.6%,52.4%,30.2%, 15.5%,35.6%,45.8%, and 9.0%,22.2%, 30.6%, respectively.The multivariate analysis showed that short-term treatment outcome and maximum tumor diameter were independent prognostic factors for overall survival rate ( P=0.000, 0.019); sex, maximum tumor diameter, irradiation method, and short-term treatment outcome were independent prognostic factors for LR (P=0.039,0.003,0.045,0.000);maximum tumor diameter was the independence factor for DM (P=0.035).In the patients receiving elective nodal irradiation and involved-field irradiation, the maximum tumor diameter was the prognostic factor for LR (P=0.008,0.001), and the lesion length on esophagography, maximum tumor diameter, and tumor volume were prognostic factors for DM (P=0.009, 0.023,0.014).Conclusions In ESCC patients without clinical metastasis, local factors are significantly associated with LR and DM, among which maximum tumor diameter is the most important factor.

Objective To analyze the dose distributions of changing target volumes during intensity modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC). Methods Twenty-one NPC patients received definitive IMRT. A total of 126 computed tomography (CT) planning images were acquired, including the first CT scan for the primary plan and a series of scans taken weekly from the start of treatment to the fifth week. The images were registered to the planning images. Target volumes (GTV_(nx), CTV_1 ,CTV_2 ,PTV, and PTV_2) and normal structures (the parotid, brain stem and spinal cord) were re-contoured on the fusion CT images. Results The D_(mean) D_(95), D_(90), D_(10), D_5 and V_(100) of GTV_(nx) were 15.44 -15.60 Gy (F=0.07,P=0.996),14.66 -14.92 Gy (F=0. 11,P=0.990),14.81 -15.06 Gy (F= 0. 12,P=0.988),15.88 -16.29 Gy (F =0.28,P=0.924),16.00 -16.38 Gy (F=0.25,P =0. 940) and 98. 1% -99. 5 % (F = 0. 08, P = 0. 995), CTV_1 with 14. 75 -14. 98 Gy (F = 0. 07,P = 0. 997), 13.39 -13.73 Gy (F=0.20,P=0.964),13.74 -13.96 Gy (F=0.08,P=0.995), 15.65 -15.90 Gy (F= 0.09,P=0.994),15.91 -16.05 Gy (F=0. 10,P=0.992), 98.2% -99.5% (F=0.02,P= 1.000), and CTV_2 with 13.34 -13.64 Gy (F=0. 18,P=0.970),12.71 -13. 18 Gy (F=0.32,P=0.898), 12.89 -13.28Gy(F=0.23,P=0. 949) ,13.79 -14.03Gy(F=0. 12,P=0. 987) ,13.92 -14. 16 Gy (F=0. 12,P=0.987), 94.4% -99.6% (F=0.25,P=0.937), respectively. Conclusions No significantly different dose distributions exists with the changes of the target volumes, even on the largest variations of external contours. The primary plan could ensure adequate doses to the changing target volumes. The replanning is unnecessary in terms of the change of target volumes during radiotherapy.