Objective: To investigate the correlation between skin elasticity and setup error in optical surface image-guided radiotherapy. Methods: The skin elasticity (R7) data of the head, chest and abdomen were extracted and analyzed its correlation with age by systematic literature review. Fifty-four patients diagnosed with nasopharyngeal carcinoma, breast cancer and cervical cancer were recruited in this study. Firstly, the patients were positioned based on the room laser and markers. Subsequently, the patient position was verified by the Varian On-Board Imager, and then C-Rad Catalyst was adopted to obtain surface images in two states (mask or non-mask) as reference images. In the subsequent fraction treatment, after initial positioning, the local calibration was performed by Catalyst, and setup errors in three directions were recorded. Meanwhile, the patient setup was verified by CBCT twice a week. The Pearson correlation analysis was performed to analyze the correlation between setup error and age. Results: The skin elasticity was negatively correlated with aging (P<0.01). The correlation coefficient between random error and age in head-and-neck cancer were 0.645, 0.624 and 0.866 in the AP, SI and LR directions (all P<0.05) for male patients without mask, respectively. The system error was significantly correlated with age in the LR direction (P<0.05) for male patients, and in the AP direction (P<0.05) for female patients with head-and-neck cancer without mask. The setup error had a significant correlation with skin elasticity in male patients with head-and-neck cancer, and the sequence of absolute value of correlation coefficient was LR>SI>AP. Conclusion In optical surface-guided radiotherapy of head and neck cancer, skin elasticity may be a significant index for assessing the setup errors in male patients.

Objective To evaluate the clinical application of Catalyst system in positioning patients during cervical cancer radiotherapy,and to analyze its correlation with the bladder volume and body mass index (BMI) of patients.Methods A total of 33 patients diagnosed with cervical cancer from July to December 2017 in our hospital were included in the study.All patients were auxiliary positioned by an optical surface imaging system (C-Pad Catalyst) before each treatment.The CBCT imaging was executed twice a week.The setup errors from Catalyst and CBCT in the anterior-posterior (AP),superior-inferior (SI) and leg-fight (LR) directions were recorded.Each patient's bladder volume and BMI were also recorded.Results The setup errors between Catalyst with masks and CBCT had the significant difference in SI (P＜0.05) and LR (P＜0.05).For Catalyst without masks,the setup errors with the bladder volume of 200-300 ml had the significant association in SI (R=-0.316,P＜0.05).For the bladder volume of＞300 ml,the setup errors for Catalyst with masks had the significant association in AP (R=-0.493,P＜0.05),and that without masks had the significant association in SI and LR (R=0.335,P＜0.05,R=-0.348,P＜0.05).For patients of＜25 kg/m2,setup errors for Catalyst with masks had the significant association with the BMI in LR (R=0.197,P＜0.05);for ≥ 25 kg/m2,that with masks had the significant association in AP and SI (R =0.818,P＜0.05;R=-0.498,P＜0.05),that without masks had the significant association in AP and LR (R=0.652,P＜0.05;R=-0.558,P＜0.05).Conclusion Unlike CBCT system,the patient positioning by Catalyst system was easily affected by the bladder volume and BMI of patients.

Objective To retrospectively investigate the value of contrast enhanced ultrasound ( CEUS) in breast cancer biopsy . Methods A total of 49 consecutive patients with biopsy confirmed breast cancer were retrospectively analyzed . All patients underwent CEUS and biopsies were thus performed targeting both the high perfusion and low/non‐perfusion regions on CEUS . T he diagnostic performance and core cancer involvement of the biopsy cores taken from the high perfusion regions were compared with those from the low/non‐perfusion . Results A total of 53 breast cancer lesions were biopsy confirmed in 49 patients .CEUS revealed homogeneous enhancement in 8 lesions ( 15 .1% ) ,and heterogeneous enhancement in 45 lesions ( 84 .9% ) . T he diagnostic accuracy rate for biopsy cores taken from the high perfusion regions was significantly higher than that from the low/non‐perfusion regions ( 98 .5% vs 72 .9% , P ＜0 .01) . T he core cancer involvement was also higher in high perfusion lesions ( 55% vs 30% , P ＜0 .01) . Conclusions CEUS can differentiate the active area and necrotic fibrosis area of breast tumors by displaying the microvessels ,thus contributing to the selection of biopsy sites .

Objective: To retrospectively investigate the value of contrast enhanced ultrasound (CEUS) in breast cancer biopsy. Methods: A total of 49 consecutive patients with biopsy confirmed breast cancer were retrospectively analyzed. All patients underwent CEUS and biopsies were thus performed targeting both the high perfusion and low/non-perfusion regions on CEUS. The diagnostic performance and core cancer involvement of the biopsy cores taken from the high perfusion regions were compared with those from the low/non-perfusion. Results: A total of 53 breast cancer lesions were biopsy confirmed in 49 patients.CEUS revealed homogeneous enhancement in 8 lesions (15.1%), and heterogeneous enhancement in 45 lesions (84.9%). The diagnostic accuracy rate for biopsy cores taken from the high perfusion regions was significantly higher than that from the low/non-perfusion regions (98.5% vs 72.9%, P<0.01). The core cancer involvement was also higher in high perfusion lesions (55% vs 30%, P<0.01). Conclusions CEUS can differentiate the active area and necrotic fibrosis area of breast tumors by displaying the microvessels, thus contributing to the selection of biopsy sites.

Objective: The genetic characteristics of the human adenovirus type 53 (HAdV-53) strains isolated from Taiyuan city of Shanxi Province were studied to obtain the baseline data of their molecular characteristics. Methods: Conjunctival swabs (n=79) were collected from epidemic keratoconjunctivitis (EKC) patients in Shanxi eye Hospital in 2016, and five HAdV-53 strains were obtained after virus isolation and identification based on the three major capsid genes sequences including Penton base, Hexon and Fiber gene. And the corresponding sequences of global epidemic HAdV-53 strains and the strains with the same genetic origin as HAdV-53 were also downloaded from GenBank database, and then the three gene database were established, respectively. With the database, phylogenetic tree was constructed, and the genetic and molecular evolutionary characteristics were analyzed with bioinformatics software. Results: Five HAdV-53 strains in Shanxi Province in 2016 showed high consistency with the HAdV-53 strains prevalent in other countries in 1996-2014 (>99.8%). All HAdV-53 strains were in the same evolutionary branch with their recombinant source genotypes (HAdV-37 and HAdV-8) in Penton base and Fiber gene, respectively, and maintained a high degree of consistency in gene sequences. In Hexon gene, HAdV-53 strains were more closed to its recombinant source genotype HAdV-22, the nucleotide and amino acid sequences between two types were highly homologous, while HAdV-53 and HAdV-22 belonged to different evolutionary branches, and the evolution rate of HAdV-53 based on Hexon gene was 3.51×10^-5 substitution/site/year. Conclusion HAdV-53 has become an important new ocular infectious pathogen of Taiyuan. HAdV-53 strain are relatively conservative and stable based on Penton base, Hexon, and Fiber gene.

Chemoradiation has been the standard treatment of stage Ⅲ unresectable non-small cell lung cancer (NSCLC) for a long period of time. However, the clinical efficacy of chemoradiation has not been significantly improved in recent two decades. In the past 2-3 years, the role of immune-checkpoint inhibitors in metastatic NSCLC has been persistently strengthened. Moreover, the synergistic effect between radiotherapy and immune-checkpoint blockade has been conformed in pre-clinical and clinical studies. Recent clinical trials have demonstrated that the combination of radiotherapy and immune-checkpoint blockade has been proven to be more effective in the treatment of stage Ⅲ unresectable NSCLC. In this article, the latest clinical studies since 2017 regarding the application value of this combined treatment of stage Ⅲ unresectable NSCLC were summarized.

Objective: To investigate the clinical value of quantitative detection of DNA aneuploidy in the diagnosis and treatment of cervical lesions in middle-aged and senile women. Methods: A total of 1 404 middle-aged and elderly women who underwent screening for early cervical lesions were retrospectively studied.Patients were divided into the two groups: the 40-49 years old group(n=897)and the 50-78 years old group(n=507). Cervical lesions were screened by DNA ploidy analysis and the results were compared with those screened by liquid-based cytology, colposcopy and high-risk human papillomavirus(HPV). Results: The positive detection rate of HPV by DNA ploidy analysis was 54.4%(764/1 404). Of 1 404 patients, HPV16/18 infection accounted for 21.3%(299/1 404). The detection rate of heteroploid cells was 50.92%(715/1 404). There was a significant positive correlation between HPV infection type and cervical epithelial cell ploidy changes(r=870, P=0.001). The detection rate of HPV by liquid-based cytology was 45.08%, which was lower than that by DNA aneuploidy(χ²=9.594, P=0.002). The differences in the incidences of low-grade squamous intraepithelial lesion(LSIL)and high-grade squamous intraepithelial lesion(HSIL)and above categories of lesions were statistically significant(χ²=289.598, P=0.000)between patients with and without DNA aneuploidy.The statistically significant differences were found between the 40-49 years old group and 50-78 years old group(P<0.05)in the occurrence of abnormal DNA ploidy cells, HPV infection rate, the proportion of LSIL, HSIL and above categories of lesions. Conclusions Compared with the conventional cytology, DNA aneuploidy quantitative detection has higher sensitivity and better specificity, and has no significant difference from the high-risk HPV detection.It can be used as one of methods for screening cervical lesions in middle-aged and elderly women, especially those with high-risk HPV infection.

Objective To investigate the pathological features of ovarian tumors in elderly women.Methods We retrospectively analyzed clinical data of 124 elderly patients with ovarian cancer who were admitted to our hospital from January 2015 to December 2017.Results Among the 124 elderly patients with ovarian tumors,there were 6 borderline tumors,19 malignant tumors,and 99 benign tumors.Postmenopausal vaginal bleeding and lower abdominal pain were the main symptoms of ovarian cancer in elderly patients.The incidence of abdominal pain in patients with benign ovarian tumors was significantly higher than in patients with malignant tumors (x2 =5.813,P ＜0.05);the incidence of postmenopausal vaginal bleeding in malignant tumors was significantly higher than in benign tumors(x2=8.123,P ＜0.05);the major pathological type of benign ovarian tumors was mucinous cystadenoma,while serous cystadenoma was the most common type of malignant tumors.Analysis of related factors showed that menopausal age was positively correlated with,and menarche age and number of pregnancies were negatively correlated with ovarian tumors;and there was no correlation with number of abortions.Conclusions Malignant ovarian tumors are common in elderly women.Clinically,attention to risk factors,early detection and diagnosis will help further reduce the malignant transformation rate and improve the quality of life for patients.

Objective To investigate the distribution about TCM constitution types and quality of life of the elderly patients with high incidence of tumor in Changning district of Shanghai, and analyze the correlation of them, in order to provide reference for follow-up management and rehabilitation of the patients.Methods The data about lung cancer, gastric cancer, and colorectal cancer was collected from Changning District of Shanghai from Jan. 2013 to Oct. 2015. The classification of TCM constitution was for the TCM constitution identified, and the Karnofsky Performance Status (KPS) was used for the assessment of life quality. Data was analyzed by SPSS 23.0. Results This study had collected 673 patients with tumor, and the average age was 75.82 ± 6.73. The colorectal cancer accounted 56.6%, the lung cancer 26.9%, and the gastric cancer 16.5%. The 88.3% of the patients were Qi-deficiency, and 41.4% belonged to compound constitution. The 53.3% of the patients had 80 scores on the first follow-up KPS value and 54.6% of them had the same scores on the last follow-up KPS value. There was a significant difference in KPS scores between the two follow-ups (rs=0.112, P=0.002). There was a negative correlation between the Yang-deficiency constitution and the Blood-stasis constitution of gastric patients with its first KPS value. Conclusions The TCM constitution types of the elderly patients with high incidence of tumor was Qi-deficiency type, which its KPS value of the two follow-ups were all high. There was a certain correlation between TCM constitution and KPS. Therefore, during the follow-up management of tumor patients, according to the types of TCM constitution, the Chinese medicine rehabilitation program could be set in order to improve their quality of life.

Objective To test the reliability and validity of the Chinese Version of the Student Nurse Stress Index Scale ( SNSI-CHI ) among Chinese nursing students. Methods A random sampling method was used to collect 1100 nursing students who were from two medical universities of Henan Province, China,and SPSS 17. 0 and AMOS 17. 0 software were used. Results The average total score of SNSI-CHI was 58. 46±13. 90. The Cronbach's α was 0. 886,the test-retest intra-class correlation coefficient( ICC) of SNSI-CHI was 0. 996 (95％CI:0. 992-1. 000,P<0. 01). The item-to-total correlations ranged from 0. 351 to 0. 664 ( all P<0. 01) . The content validity index( CVI) was 0. 954. The result of exploratory factor analysis ( EFA) was that three factors together explained 75. 013％ of the total variances,and the confirmatory factory analysis( CFA) also indicated a good fit (χ2/df=1. 347,GFI=0. 956,AGFI=0. 945,RMR=0. 032,RMSEA= 0. 025, NFI=0. 974, IFI=0. 993, TLI=0. 992, CFI=0. 993 ) . Criterion-related validity was between 0. 330 and 0. 903 ( all P<0. 01) . Conclusion The SNSI-CHI is proved to be reliable and valid in China, and it can be used to measure the stress of Chinese nursing students.