Hepatic angiomyolipoma （HAML） is a rare benign mesenchymal tumor frequently observed in middle-aged women. Due to the absence of prominent symptoms in the early stage and the lack of specific imaging findings， the diagnosis of this disease can be challenging， leading to a high rate of misdiagnosis. This article reports a case of giant HAML with subcapsular rupture that was misdiagnosed as hepatocellular carcinoma and introduces the characteristics of the case and its diagnosis and treatment process， in order to provide a reference for the diagnosis and treatment of this type of disease.

Botulinum toxin(BoNT)is currently the first-line method for treating focal dystonia,which causes muscle paralysis by chemical denervation.Recent neuroimaging studies have found that BoNT treatment could alter neuroplasticity in the brain of patients with focal dystonia.However,the specific central nervous system mechanisms have not been fully elucidated.To this end,here we review the neuroimaging studies on BoNT treatment for dystonia from three aspects:functional magnetic resonance imaging,structural magnetic resonance imaging,and positron emission tomography imaging.It suggests that BoNT may improve the symptoms of dystonia patients by affecting functional connectivity,microstructure,and metabolic levels of the cortex,basal ganglia,thalamus,and cerebellum,etc.Therefore,this review will provide a theoretical reference for further exploring the mechanism and developing potential therapeutic targets of dystonia.

China is a country with a high prevalence of myopia,and the incidence of myopia among adolescents is in-creasing year by year.The usage rate of orthokeratology is also increasing year by year.In order to improve the effectiveness of myopia control,ophthalmologists have adopted plans such as optimizing lens design and combined treatment to provide protection for adolescent myopia control.This article reviews the diverse clinical applications of orthokeratology and their effectiveness based on national and international literature.

It is necessary to place bolus on skin to increase the surface dose when using high-energy rays to treat superficial lesions because of its build-up effect. It is well known that the set-up reproducibility of hand-made bolus is poor, and the main concern of commercialized bolus is the inadvertent air gap between the bolus and irregular skin. Owing to the advantage of making individualized and complex-shaped bolus, 3D-printing technology is playing an important role in making the bolus. The aim of this review is to summarize the current research status of hand-made, commercialized and 3D-printed bolus materials and future development trend of the bolus, providing reference for clinical application.

Objective To analyze the quality control data of linear accelerator detected by Daily QA3 and to evaluate this quality control process using statistical process control.Methods After the calibrations of the accelerator and Daily QA3,Daily QA3 device was used to perform daily quality control by technicians and physicists and 100 groups and 30 groups of daily quality control data were collected.After the accelerator and Daily QA3 were re-calibrated,Daily QA3 device was utilized to perform daily quality control by technicians and 100 groups of the daily quality control data were repeatedly collected.The variations of normalized signal-to-noise ratio of quality control data collected after two calibrations were analyzed.The first 30 groups of daily quality control data measured by technicians and physicists were adopted to calculate the I-MR control chartsand compare the location of CL and the range of UCL and LCL.The process capability indices were calculated for three different quality control processes bytechnicians and physicists,respectively.Results For twice calibrations,normalized signal-to-noise ratio of quality control data significantly changed before 6 weeks,became stable between 6 and 8 weeks,and the changes became smaller after 8 weeks.For dose output measured by physicists,the rang of UCL and LCL was more narrow.In terms of flatness and symmetry,the location of CL was closer to zero.Regarding dose output and flatness,the process capability indices of three different quality control process were all satisfied ≥ 1,whereas unsatisfied for transverse symmetry.Conclusions The first 30-40 data points should be adopted to delineate I-MR control chart of the linear accelerator in daily quality control process.The quality control process should be completed by a fixed and small group of personnel and an optimal tolerance level should be customized.

Objective To investigate the safety,feasibility and clinical application effect of upper arm totally implantable venous access port (TIVAP) inserted by the combination of oncologists and nurses in patients with tumor.Methods A total of 34 patients,who needed long-term transfusion treatment,were included in this study with upper arm TIVAP from March 2017 and December 2017.There were 20 males and 14 females.The median age was 63 (35 ～ 83) years.Upper arm TIVAP was implanted by both doctors and nurses into the patients with tumor,and the TIVAP related success rate,complications and patients satisfaction were recorded.Results 34 patients all succeeded in TIVAP implantation with the operation success rate of 100％.The average operation time was about 40 minutes (30 to 60 minutes) from the disinfecting cloth to the end of the suture.The operations of all patients were successful.After the operation two patients died of cancer progression,one patient had soft tissue infection around capsular bag,None of the patients had other complications such as blocked infusion,catheter shift,port reversal,and so on,and the incidence of complication was 2.94％ (1/34).Conclusions Upper arm TIVAP has the advantages of safe puncture,shorter operation time,few intra-operative and post-operative complications and higher feasibility for operation by both oncologist and nurse,which can supplement the limitations and deficiencies of the chest wall port and PICC in a certain extent,therefore is a good choice for clinical application.

Objective To learn the satisfaction and influencing factors of medical insurance for urban residents in Taiyuan city.Methods The multi-stage random sampling method was used to survey the satisfaction of medical insurance for urban residents so covered in 4 districts of Taiyuan city. The questionnaire covered basic personal information, and comments of the residents on the three dimensions of medical insurance regarding the stakeholders. The data solicited were subject to descriptive analysis, Kruskal-Wallis test and ordered multi-class logistic regression analysis. Results The rate of overall satisfaction of urban residents′ medical insurance in Taiyuan city was 44.6% , that of average satisfaction was 48.3% , and that of dissatisfaction was 7.1%.For residents of different family size and physical health status, the differences of their satisfaction were statistically different(P<0.05).Ordered multi-class logistic regression analysis showed that the proportion of reimbursement, the scope of drug treatment and the efficiency of treatment were top factors affecting their satisfaction ( OR > 1 ). Conclusions The rate of overall satisfaction of medical insurance by urban residents in Taiyuan city is low. To improve their satisfaction, it is important to increase the proportion of reimbursement, expand the scope of reimbursement for diagnosis and treatment along with drugs, simplify the reimbursement procedures, and improve the service attitude of the service agencies.

Objective To evaluate the clinical effects of Cyclic Cryotherapy system on early symptoms after total knee arthroplasty (TKA). Methods The randomized controlled trial(RCT) articles on Cyclic Cryotherapy system after TKA were retrieved from Cochrane Library, JBI, PubMed, Web of Science, EBSCO, CNKI, Wanfang database and China Biology Medicine disc (CBMdisca), with the time limitation from the establishment of the database to 31st May 2018. Two researchers screened the literature according to the criteria of inclusion and exclusion, extracted the data, and used RevMan 5.3.3 software for statistical analysis. Results A total of 12 studies (976 cases) were included. The results of Meta analysis showed that, comparing between the Cyclic Cryotherapy and ice pack, the differences on pain score 24 hours after operation [MD=-0.70, 95%CI (-0.97, -0.43), P＜ 0.000 01], volume of drainage 48 hours after operation [MD=-143.04, 95%CI (-166.51, -119.57), P＜0.000 01]and swelling 1 week after operation [MD=-0.22, 95%CI(-0.32, -0.13), P＜0.000 01]were all statistically significant. Conclusions The existing evidence shows that compared with the ice pack, the Cyclic Cryotherapy system has the advantages of early postoperative analgesia, hemostasis, later detumescence, promoting recovery, improving comfort and no adverse reactions of cryotherapy.

Objective? To explore the effects of aromatherapy on ameliorating nausea and emesis in orthopedic patients after surgery under general anesthesia. Methods? Totally 180 patients treated in the Department of Orthopedic Trauma, Suzhou Hospital of Traditional Chinese Medicine from November 2017 to July 2018 by convenient sampling, and the orthopedic patients receiving general anesthesia were divided into the treatment group (n=90) and the control group (n=90) according to the random serial generated by SPSS. Patients in the control group sniffed saline and received conventional nursing care, while patients in the treatment group received aromatherapy with essential oil and conventional nursing care. The incidence and severity of postoperative nausea and emesis was compared between the two groups. Results? The incidence rate of nausea and emesis in the treatment group within 24 hours post operation was 13.33%, lower than that in the control group, which was 51.11%, and there was statistically significant difference (χ2=29.406,P＜0.05). The number of patients showing nausea and emesis with different degrees in the treatment group within 24 hours post operation was Class 0 of 78 cases,8 cases of ClassⅠ, 4 of ClassⅡ and 0 of ClassⅢ,respectively. The number of patients showing nausea and emesis with different degrees in the control group within 24 hours post operation was Class 0 of 44 cases, 15 cases of Class Ⅰ, 27 of Class Ⅱ and 4 of Class Ⅲ,respectively. The severity of nausea and emesis in the treatment group was lower than that in the control group, and there was statistically significant difference (Z=-5.656,P＜ 0.05). Conclusions? Aromatherapy can effectively reduce the incidence rate and severity of nausea and emesis in orthopedic patients after surgery under general anesthesia.

Objective To explore the feasibility to set the breast board support plate angle to 0° for breast cancer patient in the intensity modulated radiation therapy. Methods A total of 60 patients with breast cancer who received the simultaneous integrated boost intensity-modulated radiation therapy ( SIB-IMRT) after breast-conserving surgery were enrolled form Oct 2015 to Feb 2017. They were randomly divided into three groups that the angle of the breast board support plate was 12°, 7° and 0° respectively. The ipsilateral lung V20 , V5 , Dmean , the heart V10 , V30 , Dmean and the collimator angle were compared among three groups. In addition, the distribution of the setup error was analyzed and the group system error and random error were calculated. Results There were no statistically significant differences in the ipsilateral lung V20, V5, Dmean and the heart V10, V30, Dmean among the three groups(P >0. 05). The sum of the collimator angle and the angle of the support plate was about 13. 4° for each group. Only the setup error of z (vertical) direction was statistically different (χ2 =78. 32, P<0. 001) and the median of the 0° group was closest to the value 0 and the quartile spacing was the smallest. The absolute error of y ( longitudinal) , z directions was statistically different (χ2 =7. 63, 22. 61,P<0. 05). In the z direction, the absolute error was reduced as the angle of the support plate decreased and 0°group was the smallest. In the y direction, the absolute error at 12° was the smallest, but had little difference with that at 0°. Among three groups, the smallest system error of the x(lateral) direction and y direction was at 0°, while that of the z direction was at 12°. Conclusions To set the breast board support plate 0° is feasible. The angle of the support plate can be replaced by the collimator angle, while the setup error of z direction could be significantly reduced.