Although immune checkpoint inhibitors(ICIs)enhance the immune system's capacity to destroy tumor cells,they can also induce a range of toxic responses that lead to cardiovascular damage.Among these adverse effects,ICI-associated myocarditis(ICI-M)has the highest morbidity and mortality rates,presenting a significant challenge in clinical practice.Cardiovascular magnetic resonance(CMR)is re-garded as the"gold standard"for noninvasive assessment of cardiac structure,function,and tissue characteristics.While this imaging tech-nique has advanced rapidly in recent years,with both domestic and international guidelines recognizing it as a crucial tool for evaluating ICI-M.This article provides a comprehensive overview of the pathological mechanisms underlying ICI-M,its diagnostic criteria,and the latest re-search developments in CMR and its clinical applications;it also discusses the most recent domestic and international guidelines and re-search findings.

Although immune checkpoint inhibitors(ICIs)enhance the immune system's capacity to destroy tumor cells,they can also induce a range of toxic responses that lead to cardiovascular damage.Among these adverse effects,ICI-associated myocarditis(ICI-M)has the highest morbidity and mortality rates,presenting a significant challenge in clinical practice.Cardiovascular magnetic resonance(CMR)is re-garded as the"gold standard"for noninvasive assessment of cardiac structure,function,and tissue characteristics.While this imaging tech-nique has advanced rapidly in recent years,with both domestic and international guidelines recognizing it as a crucial tool for evaluating ICI-M.This article provides a comprehensive overview of the pathological mechanisms underlying ICI-M,its diagnostic criteria,and the latest re-search developments in CMR and its clinical applications;it also discusses the most recent domestic and international guidelines and re-search findings.

Objective:To investigate the changes of liver spin-lattice relaxation time (T 1rho) values in the rotating frame in the progression and regression of carbon tetrachloride (CCl 4)-induced model rats with liver fibrosis and the diagnostic values for staging liver fibrosis. Methods:Eighty rats were prospectively enrolled and randomly divided into the CCl 4 group ( n=49), the regression group ( n=20) and the control group ( n=11). All rats were labeled and then examined using MRI at baseline. The liver fibrosis model was established by subcutaneous injection of 40% CCl 4 in hackles. The CCl 4 group underwent black-blood T 1rho imaging at the end of the 4th, 6th, 8th, 10th, 12th week post CCl 4 injection. The regression group underwent black-blood T 1rho imaging at the end of the 4th, 6th week post CCl 4 injection and the end of 1st, 2nd, 4th, 6th week post CCl 4 withdrawal (the injection was stopped at the end of the 6th week). The control group was injected with the same amount of corn oil at the same time point and underwent black-blood T 1rho imaging at the end of 4th, 6th, 8th, 10th, 12th week. The liver T 1rho values were measured in each group over time. Independent-samples t test was used to analyze the differences of liver T 1rho values in adjacent time points. The experimental mice were divided into no liver fibrosis group (S0), mild liver fibrosis group (S1, 2) and moderate or severe liver fibrosis group (S3, 4). The differences of liver T 1rho values were analyzed in different fibrosis stages by Kruskal-Wallis H test. The receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic ability of T 1rho values in staging liver fibrosis. The correlation between liver T 1rho values and fibrosis stages was analyzed using Spearman correlation coefficient. Results:Fifty-nine rats completed the whole experiment, including 28 rats in the CCl 4 group, 20 rats in the recovery group and 11 rats in the control group. In the CCl 4 group, the liver T 1rho values gradually increased, reached the maximum at the end of week 8, and then gradually decreased. There was statistically significance in liver T 1rho values at the adjacent time points ( P<0.05) except at the 4th to 6th week ( P=0.112) and 10th to 12th week ( P=0.487) in the CCl 4 group. In regression group, the liver T 1rho values gradually increased post CCl 4 injection and decreased post CCl 4 injection withdrawal. There was statistically significance in liver T 1rho values at the adjacent time points ( P<0.05) in regression group. There was no statistically significance in liver T 1rho values at the adjacent time points ( P>0.05) in control group. The T 1rho values in the no liver fibrosis group (S0, n=15), the mild liver fibrosis group (S1, 2, n=23) and the moderate or severe liver fibrosis group (S3, 4, n=21) were [36.3(34.4,41.4)], (47.2±8.4), (48.8±9.0) ms, respectively. The liver T 1rho values increased with the aggravation of the liver fibrosis, and there was a low positive correlation between them ( r=0.402, P=0.001). There were statistically significant differences in T 1rho values among the three groups ( P<0.01).The area under the curve values to distinguish no liver fibrosis (S0) from liver fibrosis (S1 to 4) and no or mild liver fibrosis (S0 to 2) from moderately or severe liver fibrosis (S3,4) were 0.825 (95% confidence intervals is 0.720 to 0.931) and 0.668 (95% confidence intervals is 0.540 to 0.796), separately. Conclusion:The liver T 1rho values are useful for evaluating the progression and regression of liver fibrosis. It has a moderate diagnostic value to assess the presence of liver fibrosis, but a low diagnostic value to differentiate no or mild liver fibrosis from moderately to severe liver fibrosis.

Objective: To study the more safe and accurate guidance scheme of cone beam computed tomography (CBCT) in nasopharyngeal carcinoma. Methods: CBCT was regularly performed on 87 patients with nasopharyngeal carcinoma in Meizhou People's Hospital from November 2014 to August 2015. For each patient, 10 times CBCT scans were obtained pre-treatment. All the setup errors were obtained and analysed on the orientation X (left and right), Y (head and foot) and Z (vertical) axis. Results: With the increase of the number of CBCT scans, there was no statistically significant difference among the mean setup errors of the 10 times scans in X (left and right) and Y (head and foot) directions (all P > 0.05). And there was no statistically significant difference among the mean setup errors of 6 times scans in Z (vertical) direction, but from the beginning of the 7th, the systematic error in Z direction was increasing, the system error of the 7th, 8th, 9th, 10th time was 0.140, 0.292, 0.461, and 0.640 mm. Moreover, the difference of the mean systematic errors among the first 7 times was statistically significant (H = 15.232, P = 0.019), and the differences of the mean systematic errors among the first 8, 9 and 10 times were statistically significant (all P < 0.05). Conclusions Non-consecutive scans of CBCT could reduce the systematic and random errors. The appropriate frequency of application of CBCT based on the change law of setup errors is an ideal CBCT guidance scheme for nasopharyngeal carcinoma.

Objective To analyze set-up errors for irradiation of nasopharyngeal carcinoma by using kilo-voltage cone beam computed tomography (kV-KBCT) scanning, and to calculate the external margin from planning target volume (PTV) of nasopharyngeal carcinoma. Methods A total of 150 nasopharyngeal carcinoma patients in Meizhou People's Hospital from December 2014 to November 2016 were treated by image-guided radiation therapy (IGRT), kV-KBCT, CT image scanning matcthed by bone and grey alignment. PTV of nasopharyngeal carcinoma was also calculated. Results According to PTV formula, the external distance before radiotherapy guided by grey alignment was 0.5 mm in X-axis, 0.4 mm in Y-axis, 0.8 mm in Z-axis. While the distance was 0.1 mm in X-axis, 0.5 mm in Y-axis, 1.7 mm in Z-axis guided by bone alignment. After radiotherapy, the external distance guided by grey alignment was 0.4 mm in X-axis, 0.5 mm in Y-axis, 0.9 mm in Z-axis. While the distance was 0.1 mm in X-axis, 0.9 mm in Y-axis, 2.0 mm in Z-axis guided by bone alignment. There was no significant difference in set-up errors of 3 directions and 2 aligned ways before and after treatment.Conclusions The PTV within 3 mm is safe when IGRT is used for directing radiotherapy of nasopharyngeal carcinoma,and kV-KBCT is an effective image equipment.

Objective To observe the value of three-dimensional arterial spin labeling (3D-ASL) PWI in evaluating postoperative cerebral perfusion changes in patients with Moyamoya disease.Methods Totally 19 patients of Moyamoya disease confirmed with DSA were enrolled.All the patients received revascularization.Before and after operation,3D-ASL PWI and dynamic susceptibility contrast perfusion weighted imaging (DSC-PWI) were performed.ROI was located in the region with obvious perfusion changes supplied by middle cerebral artery on the operating side.Then the cerebral blood flow (CBF) was measured on 3D-ASL images,and time to peak (TTP) was measured on DSC-PWI images before and after operation.The differences of CBF and TTP before and after operation were compared,as well as the improvement rate of CBF,TTP and clinical symptoms.Results Before and after operation,CBF was (41.40±11.36) ml/(100 g · min) and (54.10±16.69) ml/(100 g · min),respectively,and the difference was statistically significant (t=-4.273,P＜0.01).TTP was (28.66 ± 3.21) s and (26.44 ± 3.93) s,respectively,and the difference was also statistically significant (t =-2.936,P＜0.01).The improvement rate of clinical symptoms was 84.21％ (16/19),of CBF was 78.95％ (15/19) and of TTP was 68.42％ (13/19),the differences of improvement rate had no statistically significant (P=0.625).Conclusion 3D-ASL PWI is noninvasive,no contrast agent need to be used,and can be used to evaluate perfusion changes after operation of revascularization in patients with Moyamoya disease.

Objective To explore the effects of combination of capecitabine and docetaxel for the treatment on advanced breast cancer and their influence on tumor biomarkers.Methods The 75 cases with advanced breast cancer were randomly recruited from December 2010 to December 2015 in our hospital,and they were divided into the observation group (38 cases) and control group (37 cases) according to the admission time,the patients in control group were treated with docetaxel,while patients in the observation group were treated with combination of capecitabine and docetaxel,the clinical efficacy before and after treatment was observed,and the changes of serum CEA,glucose CA125,CA15-3 and adverse reaction were compared between two groups.Results The effective rate (RR) of the control group was 40.54% (15/37),and the disease control rate (DCR) was 67.57% (25/37).The RR was 63.16% (24/38) and DCR was 86.84% (33/38)in the observation group.There was significant difference between the two groups (P<0.05).No statistically significant difference was observed between the two groups on the the levels of serum tumor biomarker,CEA,CA125 and CA15-3 before treatment (P>0.05);After treatment,the levels of CEA,CA125 and CA15-3 in both two groups were significantly lower than those before treatment (P<0.05);Moreover,after treatment,the observation group of three tumor biomarkers were significantly lower than those of the control group (P<0.05).Conclusion Combination of capecitabine and docetaxel in the treatment of advanced breast cancer can reduce the serum tumor biomarkers significantly,attenuate the side effects,and the patients are in the good tolerance,it can be widely recommended in clinical use.

Objective To study long-term outcome and prog nostic factors of esophageal squamous cell carcinoma patients treated by three dimensional conformal radiation therapy (3DCRT). Methods 169 patients with unresectable esophageal squamous cell carcinoma treated by 3DCRT were enrolled in the study. The survival rates of 1 year, 3 years and 5 years were estimated by life-table method. Univariate prognostic factor was tested by Log-rank method. Multivariate prognostic factor was analyzed by Cox model. Results The 1 year, 3 years and 5 years survival rates were 63.2%, 34.1%and 21.3%, respectively. Univariate analyses showed that the length of tumor, the site of lesion, chemotherapy, the dose of plan gross tumor volume (PGTV) and the short-term outcomes after treatment were the important prognostic factors for the long-term survival (P< 0.05), and multivariate analyses showed that the length of tumor, chemotherapy and the short-term outcomes after treatment were the independent prognostic factors for the long-term survival (P< 0.05). Conclusions The patients with unresectable esophageal squamous cell carcinoma treated by 3DCRT have a good long-term prognosis. The length of tumor, chemotherapy and the short-term outcomes after treatment are the important prognostic factors for the long-term survival of the patients. Chemotherapy can improve the long-term prognosis significantly.

Objective:To observe the effect of hemp seed oil on the blood lipid and its hepatoprotective efficacy in hyperlipidemic rats. Methods:High fat diet was used to make the hyperlipidemia model in SD rats,and the rats were randomly divided into 6 groups:the normal control group,high fat model group,high dose group(1. 5 g·kg-1 ),medium dose group(1. 0 g·kg-1 ),low dose group (0. 5 g·kg-1 )and Xuezhikang group(0. 5 g·kg-1 ). After 35-day treatment,serum TC,TG,HDL-C,LDL-C,SOD,MDA,ALT, AST and liver SOD were detected. Results:Compared with the model group,hemp seed oil at different dosages could significantly de-crease the contents of serum TC,TG,ALT and the atherogenic index(AI)( P<0. 05 or P<0. 01),and significantly increase the SOD activity in serum and liver(P<0. 01). The contents of serum MDA and AST in the medium and high dose groups were signifi-cantly decreased(P<0. 01),and the content of LDL-C in serum and the content of MDA in liver in the high dose group were signifi-cantly reduced(P<0. 01). Conclusion:Hemp seed oil shows promising blood lipid reducing ability and liver protective effect in hy-perlipidemic rats,and the mechanism may be related with liver lipid metabolism improvement and antioxidant function enhancement.

Objective To analysis of the efficacy and toxicity of multiple primary cancer of esophagus in three-dimensional conformal radiotherapy and concomitant chemotherapy.Methods Fifteen cases of multiple primary carcinoma of esophagus who refused the operation were collected.The Elekta linac 6 MV/10 MV X ray was used to conformal irradiation in three-four coplanar wild,2 Gy/time,1 time/day,5 times/week.The dose to the target area,CTV 40-50 Gy/4-5 weeks,GTV 60 Gy/6 weeks.TP scheme (paclitaxel+cisplatin) was used in the first day and 29th day,three-dimensional conformal radiation therapy initiated in the second day after chemotherapy.Results 1,3 year local control and overall survival were 86.7 ％ (13/15),33.4 ％ (5/15) and 73.3 ％ (11/15),26.6 ％ (4/15).Class 1-2 and class 3-4 acute radiation esophagitis and leukopenia occurred rates were 86.7 ％ (13/15),13.3 ％ (2/15) and 80 ％ (12/15),20 ％ (3/15).Conclusion Radiation therapy is the better treatment method for multiple primary carcinoma of esophagus when proximal lesions located in upper thoracic and cervical high.Toxic and side-effects can be tolerated of three dimensional conformal radiation therapy combined with chemotherapy in the treatment of multiple esophageal cancer.