Objective To summarize the experience for diagnosis and treatment of parathyroid carcinoma(PTC).Methods The clinical data of 6 patients with PTC were retrospectively analyzed.Results Five patients complained of primary hyperparathyroidism,3 patients had manifestations of palpable neck mass,4 patients were admitted for hypercalcemia with calcium level of(3.62?0.56)mmol/L,and in 4 patients the parathyroid hormone(PTH) level was higher than two fold of the normal upper limit.Frozen section histopathology established diagnosis in 3 patients,routine histopathology combined with immunohistochemistry established the diagnosis in 2 patients,and routine histopathology combined with immunohistochemistry and clinical data established the diagnosis in 1 patient.Parathyroidectomy and ipsilateral subtotal thyroidectomy was performed in 5 patients,who were followed up for 1-5 years,recurrence in 1 patient 3 years after operation;tumor resection alone was performed in 1 patient with parathyroid cancer complicated with multiple bone metastasis,and the patient died of MOF 16 days postoperation.Conclusions The diagnosis of PTC is difficult before operation.Routine blood examinations,blood PTH,99mTc-MIBI scintigraphy,ultrasonography,CT,observation of specimen,and frozen section histopathology during operation are helpful to diagnosis.The surgical procedure of choice is parathyroidectomy and ipsilateral subtotal thyroidectomy.

Objective:To evaluate the effects of opioid-sparing analgesia on the incidence of sepsis in severely burned patients in the retrospective cohort study.Methods:The clinical data from patients with severe burns admitted to three teaching hospitals in Guangdong from 2011 to 2020 were retrospectively extracted and analyzed. The patients were divided into 2 groups based on the analgesic regimen within 30 days after injury: continuous opioids analgesia group (continuous opioid infusion at a relative constant rate for more than 72 h) and opioid-sparing analgesia group (patient-controlled intravenous analgesia/intermittent administration/opioid-free analgesia). Patient′s age, severity of burn, inhalation injury and basal pain score at rest were matched by the propensity score at a 1∶1 ratio. The primary outcome measure was the occurrence of sepsis within 90 days of admission. Secondary outcome measures included 30-day and 90-day all-cause mortality, clinical diagnosis of multiple organ dysfunction syndrome, and prevalence of burn wound infection. The amount of opioid used was also recorded.Results:A total of 328 severely burned patients were finally enrolled, with 145 patients in continuous opioid analgesia group and 183 patients in opioid-sparing analgesia group, and 110 pairs of patients (220 cases) were finally matched by the propensity score.Compared with continuous opioid analgesia group, the total consumption of opioid, daily consumption per analgesia, and consumption per burn area were significantly decreased, and the incidence of sepsis and wound infection was decreased( P<0.05), and no significant change was found in the incidence of multiple organ dysfunction syndrome, 30-day and 90-day all-cause mortality in opioid-sparing analgesia group( P>0.05). Conclusions:Compared with the continuous opioid analgesia regimen, opioid-sparing analgesia can reduce the risk of sepsis in severely burned patients.

Compared with conventional radiotherapy fields, small field has unique dosimetry characteristics such as high dose gradient, charged particle imbalance, and dose effect caused by source occlusion. These characteristics increase the difficulty of dose measurement and thus the uncertainty of clinical dose measurement, far exceeding the requirement of < 5% measurement error in ICRU 24 report. In recent years, with the development of new radiotherapy technologies, the minimum radiotherapy field can reach the millimeter level, and the single irradiation dose of hypofractionated radiotherapy can exceed 6 Gy. The larger dose gradient at the edge of radiotherapy field requires higher accuracy of dose measurement, and accurate small field dosimetry technologies have gradually become a research hotspot in the field of precision radiotherapy. In order to ensure the high accuracy of measurement, this paper reviews the research on small field dosimetry worldwide, and summarizes the key points of small field dosimetry. In this paper, the characteristics of small field dosimetry are introduced, and the current small field dosimetry technologies and optimization methods are summarized, including the optimization of detector selection and detector sensitive volume. The field output correction factor technologies are analyzed. In view of the difficulty in small field dosimetry, this paper provides suggestions on dosimetry based on clinical needs and the characteristics of medical linear accelerators. Our suggestions provide a scientific reference for small field dosimetry in clinical practice in radiotherapy institutions, and facilitate the development of radiotherapy dose verification.