Objective To study the clinical manifestations,etiology,magnetic resonance imaging features,prognosis of patients with bilateral medial medullary infarction.Methods The clinical information of two case reports were summarized with review of the literature.Results The 2 patients with bilateral medial medullary infarction reported here were manifested with progressive quadriplegia,both complicated with respiratory disorders.On etiology,both were due to atherosclerosis,and one was combined with congenital vascular variation.The Y shaped hyperintense signals were seen in diffusion weighted imaging (DWI) cross-section in the medulla oblongata level.And both had poor outcomes that one was dead and the other was discharged with tracheotomy and severe sequela.Conclusions Bilateral medial medullary infarction is presented with complicated symptoms such as quadriplegia,dysarthria,hypoglossoplegia,even respiratory failure,in which quadriplegia is most often seen,and it is associated with a poor clinical prognosis.DWI appears the characteristic Y Shaped sign.

Objective To observe the near future curative effect and toxicity of the combination of weekly dose of cisplatin in the treatment of elderly patients with esophageal cancer intensity-modulated radiotherapy observa-tion.Methods 60 patients with locally advanced esophageal cancer patients aged by method randomly were divided into synchronous chemotherapy group( CRT group) and 30 cases of radiotherapy alone group( RT group) 30 cases,the two groups using 6MV-X ray intensity modulated radiotherapy,radiotherapy dose:DT 60 Gy/30/6 week.The CRT treated group was given cisplatin 20-25mg/m2 in the radiotherapy of second day,1 times per week,a total of 6 times. Results Radiotherapy and chemotherapy, radiotherapy group recent effective rate were 80.0% and 63.3%, the difference was statistically significant(χ2 =5.934,P<0.05),P< 0.05).The main toxicity was myelosuppres-sion,radiation esophagitis,basically I and II,no statistically significant difference between the two groups(P>0.05). Conclusion Intensity modulated radiotherapy combined with weekly dose of cisplatin in the treatment of elderly patients with esophageal cancer significant short-term effect,less adverse reactions,patient tolerance is good,which is worth the clinical promotion.

Twenty-three secondary and higher level hospitals in Nantong City were selected from June 3 to June 19, 2019, and the anesthesia safety and quality control surveys were conducted by using "Supervision and Evaluation Scale of Medical Quality Control Index System in a Department of Anesthesiology in Nantong City (2019 edition)" and "Special Supervision and Evaluation Scale of Perioperative Management and Information Construction in a Department of Anesthesiology in Nantong City (2019 edition)" . The results showed that the total score for medical quality control was 90.2±1.3, and the rate of reaching the standard was 87%.The department configuration score was (12.4±0.7), with the rate of reaching the standard 100%, 87% hospitals had anesthesia recovery rooms, but only 2 hospitals had anesthesia clinics.The staffing score was (15.50±0.23), with the rate of reaching the standard 74%, Nantong City had 0.67 anesthesiologists per 10 000 population, the ratio between the number of anesthesiologists and the number of operating rooms was (1.55±0.10), the ratio between the number of nurse anesthetists and the number of operating room was (0.30±0.04), and three hospitals even had no nurses in the department of anesthesiology.The department management and system score was (28.6±0.5), the rate of reaching the standard was 91%, and the operation safety verification system was not implemented in place in 87% hospitals.The medical technique score was (33.6±0.7), the rate of reaching the standard was 83%, and anesthesiology department was not equipped with anesthesia depth monitor, muscle relaxation monitor, body temperature monitor and other equipment in 35% hospitals.The perioperative management and information construction score was (40.2±1.7), the rate of reaching the standard was 48%, standardized post-operative ward round system was not carried out in 43% hospitals, and the surgical anesthesia information system was not used in 65% hospitals.In conclusion, the current status of anesthesia safety and quality control in secondary and higher level hospitals in Nantong City mainly manifests in the urgent need to improve the awareness of anesthesia safety and quality control, lack of doctors and nurses in a department of anesthesiology and lag of anesthesia information construction.