Objective To study MRI characteristics and value in the diagnosis of nasopharyngeal carcinoma with skull base erosion. Methods 86 cases of nasopharygeal carcinoma with positive nasopharyngeal pathology and symptoms of skull base erosion were selected. Axial T1WI, T2WI and coronal, sagital T1WI were performed. 47 cases had axial, coronal and sagital T1WI examination post Gd-DTPA injection. Results Areas of skull base involvement were as follow: 56 cases with pterygoid process, 54 with clivus, 28 with foramen ovale (including sphenoid wing), 27 with petrous apex, 1 with occiptal bone. 71 cases had more than one area involvement. There are four patterns in our group: ①Defect in the signal avoid cortex of skull base; ②High signal intensity of marrow was replaced by tumor; ③Contrast enhancement in abnormal bone; ④String like enhancement passing nerve foramen in skull base. 44 cases included intracranial abnormal. Conclusion MRI is the preferred technique in dementstrating skull base involvemetn of nasopharyngeal carcinoman.

Objective To investigate the value of MRI combined with serum CA125 test in the diagnose of ovarian tumor.Methods To investigate the MRI and serum CA125 level of healthy control group (40 cases),benign tumor group (52 cases),and the malignant tumor group (43 cases).Results Of 95 patients with ovarian masses,CA125 was detected in the malignant patients with the sensitivity of 79.3 ％,specificity of 72.6 ％ and accuracy of 75.1％.MRI was 73.8 ％,81.2 ％,and 82.6 ％ respectively.Combined with CA125 and MRI was 69.4 ％,97.3 ％,and 88.6 ％.Youden' s index of combined detection was significantly higher than single detection (MRI combined with CA125 and single MRI u =1.97,P =0.012 5,and CA125 u =1.96,P =0.012 0).Conclusion MRI combined with CA125 could improve the accuracy of diagnosis ovarian neoplasm in clinic.

Objective To assess the diagnostic performance of CT for detecting anastomotic leak after esophagectomy.Methods A total of 50 patients who underwent both CT and fluoroscopy after esophagectomy in our hospital from September 2013 to December 2015 were enrolled in this study.The fluoroscopy features and CT findings were analyzed retrospectively.Results The sensitivity,specificity,positive and negative predictive values were 100%,86.67%,83.33%,100%,respectively,for CT,and 85%,100%,100%,90.91%,respectively,for fluoroscopy.The differences in CT features,including leak of contrast,wall discontinuity and air-fluid collection in the mediastinum were statistically significant between leak and no leak(P=0.000,P=0.000,P=0.005,retrospectively),while no statistically significant in air collection in the mediastinum,hydropneumothorax,pleural effusion and pneumatosis.The maximum diameter of air collection in leak was(1.54±0.97)cm,while the maximum diameter of air collection in no leak was (0.56±0.20)cm,the difference in the maximum diameter of air collection between leak and no leak was statistically significant(P=0.007).Conclusion CT is more sensitive but less specific than fluoroscopy for detecting anastomotic leak.CT can be a better choice for the patients who can not tolerate the fluoroscopy or the fluoroscopy results is negative but anastomotic leak is still suspected.

Objective To investigate the dosimetric characteristics of hippocampal?avoidance prophylactic cranial irradiation ( HA?PCI ) in fixed?field intensity?modulated radiotherapy ( IMRT ) and volumetric modulated arc therapy ( VMAT) and the feasibility and risks of hippocampal avoidance. Methods Prophylactic cranial irradiation (PCI) was performed for 16 patients with localized small cell lung cancer ( SCLC) who were treated in our hospital from January to August, 2014, and achieved complete response ( CR) after chemoradiotherapy, with a prescribed dose of 25 Gy in 10 fractions. CT localization image was fused with brain MRI image to contour the hippocampus on the fused image, and the boundary of the hippocampus was extended 5 mm outward to form the area for reduced dose. IMRT and VMAT plans with hippocampal avoidance were developed separately, and the dose distribution in the whole brain, the hippocampus, and the 5?mm area outside the hippocampus was evaluated for these two plans. Independent?samples t test was applied to evaluate the difference between the two groups. Results The mean hippocampal volume in the 16 patients was 2. 76 cm3 ( range 2. 56 ?3. 01 cm3 ) . The mean radiation dose ( Dmean ) in the hippocampus during IMRT and VMAT was 9. 04± 0. 20 Gy and 10. 32± 0. 28 Gy, respectively, reduced by 66. 0% and 61. 2%, respectively, compared with the prescribed dose ( P=0. 55);Dmean in the area for reduced dose during IMRT and VMAT was 13. 57± 0. 90 Gy and 14. 86± 0. 60 Gy, respectively, reduced by 49. 0% and 44. 1%, respectively, compared with the prescribed dose (P=0. 88). Conclusions HA?PCI in IMRT and VMAT meets the clinical requirements, and can reduce the dose in the hippocampus while ensuring the whole?brain radiation dose, and therefore can be applied in PCI and provide a technical support to protect the patient’ s neurocognitive function.

Objective To measure and calculate the dose distribution (tissue absorbed dose) of mouth floor area while using 125I to treat sublingual gland carcinoma.Methods Phantom of head and neck was used to place the 125I radioactive seeds to simulate the sublingual gland carcinoma treatment.125I radioactive seeds of 29.6 and 25.9 MBq per seed were used as two groups,with 31 seeds in each group,and prescribed dose (peripheral matched dose) was 120 Gy.Thermoluminescence dosimetry (TLD) was used to measure the absorbed dose value in the simulated target and adjacent area.Gafchromic Eriochrome Black T (EBT) film was used to draw the dose distribution curve.Results Dose absorbed in the target area,target area center and the adjacent area one centimeter away from target reached 160 Gy,390-500 Gy,and 90-170 Gy,respectively.Dose of the skin ranged from 25 to 81 Gy,dose of mandible ranged from 7.9 to 67 Gy.No radiation cold spot was found.Conclusions 125I seeds could achieve an effective therapeutic dose distribution of the target area for sublingual gland carcinoma.Dose absorbed in the adjacent tissue is under safety limit.The radiation dose at mandible is lower,reducing the possibility of radiation damage to the bone.

Objective:To investigate the relevant situation of the emergency departments (ED) of general hospitals at all levels in Zhejiang Province participating in the prevention and control of Corona Virus Disease 2019 (COVID-19), and to provide a reference for further improving the capacity of emergency services.Methods:A multi-center cross-sectional investigation study was jointly initiated by the Zhejiang Provincial Emergency Medicine Quality Control Center, the Emergency Medicine Branch of Zhejiang Medical Association, and the Emergency Physicians Branch of Zhejiang Medical Doctors Association. Before investigation, experts were organized to develop a special questionnaire. Then the ED of general people's hospitals or Chinese Medicine hospitals at the county/district-level or above were included and their participations in the prevention and control of COVID-19 epidemic between March 9, 2020 and March 15, 2020 were investigated. The collected information included: basic information of the hospitals; participation of ED in fever clinics; the number of COVID-19 patients admitted to ED; the situation of ED support to the anti-epidemic front-line; and the epidemic prevention facilities of ED, and the early supply of medical protective equipments.Results:A total of 181 hospitals from 11 prefectures and cities across the province were finally included, including 52 (28.7%) Grade-A tertiary hospitals, 45 (24.9%) Grade-B tertiary hospitals, 64(35.4%) Grade-A secondary hospitals, and 20 (11.0%) Grade-B secondary or lower hospitals. Among them, 93 (51.4%) were COVID-19 designated hospitals, and 49 (27.1%) had the ability to detect COVID-19 nucleic acid; 177 (97.8%) set up independent fever clinics and 33 (18.6%) were managed by ED alone or mainly. The medical staffs of 65 (36.7%) fever clinics were all or mainly from ED. A total of 213 cases of COVID-19 were received/treated in 40.3% ED, accounting for 17.3% of the total number of cases in Zhejiang Province. A total of 3 848 doctors and nurses supported the front-line of epidemic prevention, of them, 253 supported Hubei Province (accounting for 12.5% ??of the total number). There were 68.5% and 76.8% ED having spare separate clinic and ordinary rescue single room to deal with the COVID-19. In addition, at the early days of anti-epidemic, more than 50% ED were in short supply or even had no medical protective equipment.Conclusions:The ED of Zhejiang Province plays an important role and has made a great contribution to the prevention and control of the COVID-19 epidemic. It is necessary to improve the conditions of ED to effectively respond to the prevention and control of daily infectious diseases.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.