Objective To investigate the correlation of the the positive rate and necrosis rate of retropharyngeal lymph nodes with the clinical effects of intensity modulated radiotherapy (IMRT) in treatment of nasopharyngeal carcinoma (PNC).Methods Seventy-two patients with PNC,50 males and 22 females,with the median age of 50,underwent IMRT delivered into 33 times.The retropharyngeal lymph nodes involved and positive lymph nodes of neck were delineated on the CT image.The median dose and median fractionated dose for gross tumor volume (GTV) were 70.0 and 2.12 Gy respectively,and the median dose and median fractionated dose for clinical target volume (CTV) were 70.0 and 2.12 Gy respectively.The patients were followed up for 36 (5-54) months.Results The metastasis rate of the neck lymph nodes was 90.3％,the metastasis rates in the regions Ⅰ-Ⅴ were 2.8％,86.0％,51.4％,20.8％,and 37.5％,respectively.The metastasis rate of the retropharyngeal lymph nodes was 79.2％,and specifically the metastasis rates of the left,right,and bilateral retropharyngeal lymph nodes were 51.4％,45.9％,and 18.1％,respectively.The cross metastasis rate was 6.9％.Necrosis of the retropharyngeal lymph nodes was found in 15 cases.The necrosis rates of the left,right,and bilateral retropharyngeal lymph nodes were 21.6％,27.2％,15.4％,respectively.Retropharyngeal lymph nodes metastasis was significantly correlated with N stage and clinical stage(Fuzhou 92:r =-0.383,-0.314,P ＜ 0.05 ; UICC:r =-0.434,-0.306,P ＜ 0.05).Local recurrence was observed in 4 patients,6 patients had distant metastasis,and 7 patients died.The positiveness of retropharyngeal lymph nodes was significantly correlated with the recurrence rate,distant metastasis rate,survival rate,and disease free survival rate (r =0.085,0.138,-0.140,-0.124,P ＜ 0.05),and the necrosis of the retropharyngeal lymph nodes was significantly correlated with the recurrence rate and distant metastasis rate (r =0.256,-0.057,P ＜ 0.05),and not significantly correlated with the survival rate and disease free survival rate.Conclusions Retropharyngeal lymph nodes metastasis in NPC is correlated with the N stage and clinical stage.The positiveness of retropharyngeal lymph nodes is significantly correlated with local recurrence,distant metastasis,and survival.Necrosis of retropharyngeal lymph nodes in NPC is significantly correlated with local recurrence and distant metastasis after IMRT.

Objective To observe MRI features of the localized intra-articular form of pigmented villonodular synovitis (PVNS) within the knee joint. Methods Fifteen patients with pathologically proved localized intra-articular form of PVNS were retrospectively reviewed, and the MRI appearances were observed. Results Solitary nodule or mass within the knee joint was detected in all 15 patients. The lesion located in the infra-patellar fat pads in 11 patients. Most lesions were round or oval, with a well-defined margin. The maximum diameters ranged from 2.0 cm to 6.0 cm, with a mean value of 3.1 cm. The signal intensity of these lesions was characteristically heterogeneous on SE T1WI, TSE PDWI, and TSE T2WI, and the whole signal was similar to that of muscles on SE T1WI and TSE PDWI, but a little higher on TSE T2WI. Prominent low signal intensity on T2WI because of deposition of hemosiderin was found within 14 lesions, and 9 of 15 lesions showed characteristically low signal marginal rim. Conclusion MRI features of the localized intra-articular form of PVNS include a well-defined solitary nodule or mass locating in the infra-patellar fat pad, heterogeneous signal intensity, and prominent interior focal low signal or peripheral low signal rim on T2WI.

Taking the Second Affiliated Hospital of Zhejiang University School of Medicine as an example,the paper discussed its practices in optimizing outpatient service process.These practices include innovating convenient outpatient service process,establishing a coordination center of hospital's beds to strengthen pre-hospital one-stop management,implementing day surgery to improve inpatient service,implementing professional and humanized hospital clinical care,introducing the concept of fast tract surgery to promote accelerated rehabilitation after surgery,and establishing a follow-up center for inpatients discharged.Such efforts have improved the medical services' efficiency and quality,and improved the patients' satisfaction.

Objective To explore the cause and effective management and prevention of septic shock after minimally invasive percutaneous nephrolithotomy (MPCNL) in the elderly.Methods Clinical data of 13 patients with septic shock after MPCNL in our hospital were retrospectively analyzed,and the cause,prevention and treatment of septic shock were investigated.Results The incidence of septic shock in patients undergoing MPCNL was 3.54％ in this study.Single-factor analysis and logistic regression analysis showed that the risk factors for post-MPCNL septic shock were female and the history of diabetes (both P＜0.05).Conclusions Septic shock is a serious complication after MPCNL.Intensive perioperative prevention measures can reduce the incidence of septic shock.Early diagnosis and proper treatment are the keys to successful treatment of septic shock.

Objective To explore the diagnostic value of ADC values in fetus with mild ventriculomegaly.Methods Fifteen fetuses with mild ventriculomegaly (mild ventriculomegaly group) and fifteen healthy controls (control group) were scanned with DWI.The ADC values in bilateral frontal lobes,parietal lobes,temporal lobes,occipital lobes,basal ganglia,thalamus and cerebella were measured.The ADC values of mild ventriculomegaly group were compared with those of control group.And the ADC values in left regions were compared with those in right regions of fetuses with mild ventriculomegaly.The correlation between ADC values of all fetuses and gestational age,as well as the correlation between the diameters of ventriculomegaly in feutes with mild ventriculomegaly and gestational age were analyzed.Results Compared with control group,ADC values were lower in bilateral frontal lobes and parictal lobes in mild ventriculomegaly group (all P＜ 0.05).There were no significant differences of ADC values between left regions and right regions (all P＞0.05).Correlation analysis showed that ADC values of all fetuses in bilateral occipital lobes,basal ganglia,thalamus,cerebella and left temporal lobe were negatively correlated with gestational age.The diameters of ventriculomegaly were positively correlated with gestational age (r=0.635,P=0.011).Conclusion The ADC values decrease in frontal lobes and parietal lobes in fetuses with mild ventriculomegaly.The ADC value may be more sensitive for detecting potential damage of brain,which is helpful for the diagnosis of fetus ventriculomegaly.

Objective To detect the application value of the apparent diffusion coefficient (ADC) values using diffusion weighted imaging (DWI) in detection of fetus with enlargement of cisterna magna.Methods Sixteen fetuses with enlargement of cisterna magna (group 1) and other sixteen healthy controls (group 2) were scanned by DWI.The ADC values were measured and compared between two groups at the same regions, and between left and right brain in group 1.The correlations between ADC values,the enlarged degree of cisterna magna and gestational age were calculated respectively.Results The ADC values were lower in the white matters of bilateral frontal lobes and parietal lobes, bilateral thalami and cerebellum in group 1 than those in group 2.There were no significant differences in ADC values between left areas and right areas in group 1 (P>0.05).The ADC values in bilateral basal ganglia and thalami were negatively correlated with the gestational age (P<0.05).There was no correlation between the enlarged degree of cisterna magna and gestational age (P>0.05).Conclusion The ADC values were decreased in certain regions in fetuses with enlargement of cisterna magna, which suggested that ADC value might be more sensitive for detecting potential damage of brain.Combined with conventional MRI, DWI and ADC values could be regarded as accurate protocols for the detection of fetus abnormalities.

The etiology of rotated maxillary central incisor is unclear, but it has a clear familial tendency. Except for the environmental factors, gene expression directly influences craniofacial growth and the types of malocclusion deformity. In this article, a case of 180° rotated left maxillary central incisor of a male with family history of the deformity was reported. Relevant literature was also reviewed.
Humans ; Incisor ; Male ; Malocclusion ; diagnosis ; Maxilla

Objective:To observe the effects of soybean isoflavones(SI) on uteri and uterine Er?,ER? expression in perimenopausal rats. Method:Female SD rats in age of 7-month-old were used as control and 11-month-old SD rats were divided into 5 groups,model group,diethylstilbestrol group and 3 test groups exposed to three doses of SI(ig:30,12,4.6 mg/kg?d) respectively for 35 d. Serum concentrations of estradiol(E2) ,testosterone(T) ,follicle-stimulating hormone(FSH) and luteinizing hormone(LH) were determined. Ultrastructure of uterine luminal surface was observed by scanning electron microscopy and hematoxylin-eosin staining. Expression of ER? and ER? in the uteri were determined by immunohistochemistry. Results:Low dose SI significantly increased serum E2(P

Objective To research patients with ophthalmologic perioperative information systems, strengthening the information management of nursing work, achieving consensus and sharing of health care information resources, and then to explore the clinical application effects of this ophthalmologic peri- opera-tive information systems. Methods The convenient sampling method was used in the study. The control group was consisted of 1 740 patients in our hospital from January to March 2013 (before the application of ophthalmologic perioperative information systems). The observation group included 2 078 patients of the same hospital (after the application of ophthalmologic perioperative information systems). The control group adopted routine pre- operative information acquisition method, the observation group applied ophthalmologic perioperative information systems, which included input function, reading function and statistical function. The incidence rate of canceled operation and satisfaction were compared between two groups. Results Ophthalmologic peri- operative information systems provided patients with information gathering, query and analysis in different periods. The rate of the canceled operation reduced in the observation group from 3.74% (65/1 740) to 2.69% (56/2 078) in the control group, χ2=3.91, P<0.05. The satisfaction degree increased from 91.84 % (1 598/1 740) in the observation group to 96.78% (2 011/2 078) in the control group, χ2=44.60, P<0.05, the difference was statistically different. The hospitalization days from April to September in 2013 shortened compared with those of the same period in 2012. Conclusions Ophthalmologic peri- operative information systems promotes the scientific and informatization of nursing information, which is worthy of wide clinic application.