The prognosis of patients with pancreatic cancer is dismal, especially at the advanced stage of the disease. Surgery is considered as the only curative treatment modality for pancreatic cancer;however, less than 20% of patients are candidates for curative surgical resection. Multidisciplinary management, including radiation therapy with concurrent chemotherapy, followed by systemic chemotherapy, is the treatment of choice for locally advanced pancreatic cancer. An early phase Ⅲ clinical trial conducted by GITSG (GI Tumor Study Group) has demonstrated a survival benefit for concurrent chemoradiation as compared to radiation alone in locally advanced disease. 5-FU,capacitabine and gemcitabine are the most investigated chemotherapy agents used with radiation. Currently thecombined use of gemcitabine and radiation therapy is under active investigation, and may provide substantial clinical advantage over other regimens. Multi-agent chemotherapy regimen used in concurrence with radiation has not demonstrated any significant effect but with severe toxicities. Conformal radiotherapy should be routinely used to treat locally advanced pancreatic cancer with doses of 45-50.4 Gy. The target of locally advanced pancreatic cancer is focussed on the gross tumor with safe margins. The use of IMRT is highly recommended for unresectable tumor, and makes further dose escalation possible.

Objective To compare the efficacy of and adverse reactions to a fractional micro-plasma radio-frequency technology versus fractional ultrapulsed CO2 laser in the treatment of atrophic acne scars.Methods Twenty-one patients with atrophic acne scars were enrolled in this study.Half of each subject's face was treated with micro-plasma,and the other half with fractional ultrapulsed CO2 laser,for one session.Treatments were randomly administered in a split-face manner.The efficacy and adverse effects were evaluated 6 months after the treatment by using the following outcome parameters:ECCA grading scale (échelle d' évaluation clinique des cicatrices d'acné),degrees of post-treatment pain and edema,time taken for crusting and durations of inflammatory erythema,patients' subjective rating of improvement in scar by using a quartile grading scale.A non-parametric rank test was conducted to compare the efficacy and adverse effects between the two treatments.A scar model was established on both ears of a New Zealand big ear rabbit,and treated with the CO2 laser and micro-plasma respectively,immediately followed by the resection of scar tissue for the observation of histological changes.Results A decrease of ECCAscore was observed in 90.5％ (19/21) of the patients after micro-plasma treatment,and in 86.7％ (18/21) after CO2 laser treatment; no significant difference was observed in the response rate (P ＞ 0.05).In detail,ECCA score decreased by 31.5％ (from 50.71 to 34.76 ) after micro-plasma treatment,compared to 29.9％ (from 53.57 to 38.10) after CO2 laser treatmet.Mild edema was observed after micro-plasma treatment,with the duration of erythema and crusting being 13.95 days and 6.95 days,respectively,compared to 45.81 days and 10.10 days respectively,after CO2 laser treatment.Pigmentation occurred in none of the patients after micro-plasma treatment,but in 19％ after CO2 laser treatment.Animal experiment showed that microscopic ablation zones were broad and shallow after micro-plasma treatment,but narrow and deep after CO2 laser treatment.Conclusions Fractional micro-plasma and CO2 laser are both effective for the treatment of atrophic acne scars,but the former seems to have less side effects with a lower incidence of pigmentation.

Objective To evaluate the efficacy and safety of long pulsed Nd:YAG laser in the treatment of onychomycosis.Methods Thirty-five patients with onychomycosis were treated by long pulsed Nd:YAG laser with a wavelength of 1064 nm,power of 30-40 J/cm2,pulse width of 35 milliseconds,diameter of light spot of 4 mm.One treatment session included 4 times of irradiation at an interval of 2 minutes.Patients were treated once a week for 4 weeks followed by once a month for 6 months.Clinical and mycological efficacy was evaluated 9 months after the beginning of treatment.Side effects were recorded and analyzed.Nails were divided into various groups according to causative fungal species,clinical phenotypes,and distribution of affected nails.Data were processed by using SPSS 17.0 software.Chi-square test was performed to compare the response and recurrence rate between these groups.Results A total of 79 nails were treated by long pulsed Nd:YAG laser in this study.At 9 months after the first treatment,clinical response was observed in 67.1％ of these nails,mycological response in 73.4％,and recurrence in 19.0％.The Trichophyton rubrum group showed a better clinical (x2 =10.913,P ＜ 0.05) and mycological response (x2=13.532,P ＜ 0.05),but a lower recurrence/reinfection rate (x2 =10.980,P ＜ 0.05) compared with the other-species group.No significant difference was observed between the Trichophyton rubrum group and Candida albicans group in the clinical and mycological response rate or recurrence/reinfection rate.The clinical response in the distal lateral subungual onychomycosis (DLSO) group was significantly poorer than that in the white superficial onychomycosis (WSO) group (x2 =11.935,P ＜ 0.05),but better than that in the proximal subungual onychomycosis (PSO)/total dystrophic onychomycosis (TDO) group (x2 =17.515,P ＜ 0.05).Increased clinical response rate was observed in the second-fifth finger nail group compared with the thumb nail/second-fifth toe nail group (x2 =13.437,P ＜ 0.05)and hallux nail group (x2 =10.595,P＜ 0.05),while no statistical difference was observed in clinical response rate between the hallux nail group and thumb nail/second-fifth toe nail group (x2 =3.030,P＞ 0.05),or in mycological response rate or recurrence/reinfection rate among the second-fifth finger nail group,thumb nail/second-fifth toe nail group and hallux nail group.There was no obvious adverse reaction but pain during the treatment.Conclusions Long pulsed Nd:YAG laser appears to be an effective and safe approach to the treatment of onychomycosis,and the treatment outcome is affected by clinical types,location,and causative fungal species of onychomycosis.

Objective To observe the efficacy and adverse reaction of raltitrexed combined with irino-tecan as first-line chemotherapy for recurrent or metastatic gastric cancer.Methods From January 201 4 to March 201 5,39 patients of recurrent or metastatic gastric cancer who received treatment in the First People′s Hospital of Zhangjiagang of Jiangsu Province were collected.All patients received raltitrexed (3.0 mg/m2 , 1 5 min intravenous drip)on the first day and irinotecan (1 80.0 mg/m2 ,90 min intravenous drip)on the first day.One cycle lasted 21 days.The efficacies were evaluated every 2-cycle.Adverse reactions were evaluated every cycle.Results The efficacies and adverse reactions could be evaluated in 39 patients.The study received 0 complete remission,1 6 partial remission,1 1 stable disease,1 2 progression disease.The objective response rate was 41 .03% (1 6 /39).The disease control rate was 69.23% (27 /39).The median overall sur-vival time was 9.3 months (95%CI:8.8-1 1 .1 months).The median progression-free survival time was 6.0 months (95%CI:5.1 -6.8 months).The adverse reactions were mainly neutropenia,anemia,liver dysfunc-tion,the incidence of them were 35.90%,33.33% and 28.21 % respectively.Conlusion Raltitrexed com-bined with irinotecan as first-line chemotherapy for recurrent or metastatic gastric cancer acquires an definite efficacy,and the adverse reactions can be tolerated,which is worthy of further clinical research.

Objective To determine whether the incidence of pseudolesions of the liver caused by falciform ligament was correlated with liver function.Methods MRI of 150 consecutive cases were evaluated for the presence of pseudolesions caused by ligament compression.All cases were divided into two groups according to the Child-Pugh classification of liver function: Group I-normal liver function and Grade A(98 cases);Group II-Grades B and C(52 cases).Results The incidence of pseudolesions was 31.63% in groups I and no artifacts in Group II.The incidence of pseudolesions was significantly higher in Group I compared with those in Group II.Conclusion The artifacts in the liver caused by falciform compression on MR contrast-enhanced scan images may be seen more frequently in the patients with well liver function than in those with impaired function.

Objective To evaluate the correlation between the irradiation dose and superparamagnetic iron oxide (SPIO) enhanced MR imaging of the irradiated liver. Methods 25 rabbits were separated randomly into 5 groups. 3 days after focal irradiation (0, 10, 20, 30 and 40Gy), MR imaging was performed before and after SPIO injection with TSE-T 2W sequence, and the number of Kupffer cell containing SPIO particles was counted. The characteristics of MR enhancement were evaluated according to the pathological findings.Results The liver injury induced by no less than 30Gy irradiation can be detected by SPIO-enhanced T 2 weighted imaging (P

The conception,sources and research focus on environmental estrogens of effluent from sewage treatment plants were briefly introduced and the advances on environmental estrogens of effluent from sewage treatment plants were reviewed in the present paper.The study and applications of biomarker-vitellogenin (Vtg) was also discussed.The future research direction of environmental estrogens was proposed.

Objective To investigate and analyze the efficacy of Cervus and Cucumis Polypeptide for Injection in the treatment of osteoarthritis of the knee. Methods 100 patients with osteoarthritis of knee joint treated in Xinchang people's hospital from February 2015 to May 2017 were selected and randomly divided into the control group and the experimental group, with 50 patients in each group. The control group were treated with oral glucosamine capsules in the treatment of the experimental group, Cervus and Cucumis Polypeptide for Injection palliative treatment, 250 mL saline plus 25g guguatiquwu, oral Nimeilishu capsule. The treatment time of the 2 groups was one month. The therapeutic effects of the experimental group and the control group were compared and analyzed. Results After the corresponding treatment, 4 patients in the experimental group were invalid, 20 cases were effective, and 26 cases were effective. In the control group, 13 patients were ineffective. The effective rate of the experimental group was 92％, which was significantly higher than that of the control group (P<0.05). The IL-1 of the knee joint fluid in the experimental group was (8.01±1.72), and the IL-1 of the knee fluid in the control group was (7.08±0.97). The level of IL-1 in the knee joint fluid of the experimental group was significantly higher than that of the control group, with statistical difference (P<0.05). Conclusion Cervus and Cucumis Polypeptide for Injection is effective in the treatment of osteoarthritis of the knee, and can significantly improve the efficiency of treatment,.

Objective To investigate the clinicopathologic features,diagnosis,differential diagnosis and treatment of sclerosing angiomatoid nodular transformation(SANT). Methods The clinical data,pathologic characteristics,immunophenotype and postoperative follow-up of SANT were analysed. Results There were no specific findings in the clinical manifestations of the 4 cases of SANT.Grossly,the cut surface of the masses was gray-white and vague nodularity was observed.Microscopically,it was characterized by the multinodular angiomatoid appearance in a fibrosclerotic stroma.The nodules were composed of slit-like,sinusoid-like vascular spaces and were interspersed with a population of spindly or ovoid cells.It was revealed by immunohistochemistry that the expression of CD34 in some vessels' endothelial cells was positive,and CD8 was negative.While in another vessels' endothelial cells,CD8 was positive and CD34 was negative.The expression of SMA,Actin,Vimentin,Collage IV and CD68 was positive in all of the 4 cases,while that of CD21,Desmin and NSE was negative.No relapse or metastasis was found during the follow-up.Conclusion SANT is a rarely encountered benign lesion of the spleen,which should be distinguished from the malignant tumor of the spleen.The diagnosis counts on the pathologic and immunohistochemical findings.It could be cured by splenectomy with a favourable prognosis.

Objective:To investigate the status of women′s psychological security and quality of life in poverty-stricken areas, and analyze their interrelation and influencing factors.Methods:With the method of convenient sampling, 368 women from poor families who participated in the poverty alleviation vocational training course were investigated with self-designed questionnaire, Psychological Safety Scale (SQ) and World Health Organization Quality of Life-Brief (WHOQOL-BREF).Results:The average total score of women's psychological security in poverty-stricken families was 48.66 ± 12.75, which was in the middle level. Multivariate linear regression analysis showed that family income and religious beliefs had an impact on interpersonal security ( F value was 16.509, P<0.05); ethnicity and religious beliefs had an impact on the certainty of control ( F value was 17.546, p<0.05); religious beliefs had an impact on the total value of security ( F value was 20.911, P<0.05). The overall quality of life and health status scores of females from poor families (13.38±2.91) were significantly lower than the norm ( t value was -3.27, P<0.05). Multiple linear regression analysis showed that personal annual income and religious beliefs had an impact on physiological domain( F value was 2.694, P<0.05); marital status and religious beliefs had an impact on the psychological domain ( F value was 3.305, P<0.05); family annual income and religious beliefs had an impact on the environmental domain ( F value was 2.866, P<0.05) while they had no impact on the social domain. There was a significant positive correlation between psychological security and quality of life. Conclusions:There is a significant positive correlation between the level of psychological security and the quality of life of poor family women. Improving the quality of life of poverty-stricken family women can improve their psychological security.