Objective To study the DSA hepatoarteriography manifestations in hepatic carcinoma after endocare cryocare system (ECS)treatment for improving the comprehensive therapy of hepatic carcinoma.Methods Thirty eight male patients with primary liver cancer ( n =32) and hepatic metastasis (n=6) were enrolled in this study. Common hepatic arteriography or super-selection angiography was performed in all patients after ECS treatment in 7 days and 30-60 days.Results The foci covered with ice ball were shown as round or ovoid. Single tumor less than 5 cm was covered completely, while the shape of focus covered with more ice ball showed irregularity, mass-like and diffuse nodulss with diseminated tumor vessels and tumor stains. The shortcoming of ECS included 18 missed areas, hepatic A-V shunt and hepatic A-portal V shunt in 4, bleeding in puncture tract 5, and extravasation of contrast material in 6 cases. Delineated margin existed between the frozon area and surrounding tissues.Conclusions ①ECS is effective on liver tumor 5 cm. ③ Tendency of missed areas in huge tumor and widespread nodes accurs after ECS. ④Complication occurs easily during ECS performance near the hepatic capsule and porta hepatis. ⑤TACE would improve comprehensive therapy effect of liver cancer about7 days after cryotherapy.

This paper introduced the training system in obstetrics and gynecology(O&G) in the UK and the MRCOG exam organized by the Royal College of Obstetricians and Gynecologists.Comparisons between the O&G specialists training systems of China and UK found that China should better link the resident training and specialists training for a better posteducational medical education system.China should also try to build a China-UK O&G specialist training program to keep pace with the time,for more O&G specialists of international perspectives in China.

Objective To investigate the epidemiology characteristics of crawfish related rhabdomyolysis (RM) in Nanjing, 2016.Methods Outpatient and inpatient electronic medical system of 21 hospitals in Nanjing during 2016 were retrospectively searched, and all the patients diagnosed with RM were selected. The patients with none crayfish-related RM was excluded. The epidemiology characteristics were depicted. The geographic information system (GIS) was used to collect, manage and analyze the spatial data, to visualize it, to analyze the spatial distribution features of the disease, and to explore the cause of disease prediction. GeoDa 1.8 software was used to analyze the global and local spatial auto-correlation.Results A total of 1183 patients with crawfish related RM were initially screened, excluding 59 patients with RM caused by trauma, severe exercise, heat stroke, myositis, poisoning, drugs, and genetic diseases, and 1124 patients were enrolled. The proportion of men was 36.48% (410/1124) with an incidence of 12.54/100 thousands; while of women was 63.52% (714/1124) with an incidence of 21.86/100 thousands. The median age at onset was 34 (28, 43) years. From July to August, the incidence of crawfish related RM was the highest, accounting for 96.53% of the total number of cases. The top four incidence areas were Pukou (41.54/100 thousands), Jianye (25.94/100 thousands), Qixia (25.73/100 thousands), Gulou (25.04/100 thousands), all of which were adjacent to the Yangtze River. Global spatial autocorrelation analysis showed: MoranI = 0.427,Z = 2.646,P = 0.003, suggesting that the crawfish related RM had positive spatial autocorrelation. The results showed that the spatial structure of crawfish related RM existed in Nanjing in 2016. Local spatial autocorrelation analysis showed that the high-high concentration areas were Pukou, Jianye and Liuhe. The incidences of above three areas which were the Nanjing section of the lower reaches of the Yangtze River flowed through the region and surrounding areas were higher than the overall incidence of Nanjing.Conclusion The prevalence of crawfish related RM in Nanjing during 2016 had an obvious region-concentrated character and global spatial autocorrelation with the high prevalent regions mainly concentrated in the urban areas adjacent to the Yangtze River.