This paper aims to discuss the ideas and experience about the radiology residency training system of Canada with a presentation of its base accreditation standards for five aspects, competency goals for seven roles, four stages of training arrangement, and two types of final assessment questions. Although the Canada's radiology residency program differs from China's standardized resident and specialist training programs for radiology, there are still several points that are worth referencing, including emphasizing the training priority of competency goals, providing a specific basis for the stratification of training, offering clear guidance for the implementation of training content, and improving assessment methods to focus on competency goals. These points are of great value for improving the standardized radiology resident and specialist training programs in China, so as to provide a reference for the training of excellent radiologists in China.

Objective:To preliminarily explore the role and mechanism of diacylglycerol kinase(DGK)involved in the regulation of persistent inflammatory pain in rats.Methods:Complete Freund's adjuvant(CFA)was injected into the left soles of rats to establish the pain model,and the DGK inhibitor R59949 was given for intervention.The behav-ioral changes about pain were detected by the paw withdrawal thermal latency(PWTL)and paw withdrawal mechanical threshold(PWMT),the expressions of DGKα,DGKβ,DGKγ mRNA in the dorsal horn of spinal cord of rats were ana-lyzed by RT-qPCR,the expression changes of inflammatory factors TNF-α and IL-6 in the spinal cord of rats were examed by Western Blot,and the expression and cell localization of DGKα was observed by immunofluorescence stai-ning.Results:Compared with control group,the PWTL and PWMT of CFA-induced rats were decreased significantly(P＜0.001),Notably,DGKα mRNA(P＜0.001)and protein(P＜0.05)expression levels were significantly elevat-ed in the spinal cord,as were the protein expressions of TNF-α and IL-6(all P＜0.001).After the model rats were treated with DGK inhibitor R59949,PWTL and PWMT decreased significantly(both P＜0.01).while the expressions of TNF-α and IL-6 in the spinal cord increased significantly(P＜0.05,P＜0.001).Immunofluorescence results showed that DGKα was expressed in spinal cord neurons of model rats.Conclusion:DGK inhibitor R59949 enhances the inflammatory pain and promotes the expression of TNF-α and IL-6 in the model rats,and DGKα is involved in the regulation of inflammatory pain.

The incidence of augmented renal clearance (ARC) in intensive care patients (ICU) is exceptionally high, and these patients are often co-morbid with infection. The occurrence of ARC will significantly increase the clearance rate of antibiotics, making it difficult for conventional doses to reach effective therapeutic concentrations and affect the patient's anti-infective treatment effect and prognosis. It can be seen that it is crucial to formulate a reasonable dosing regimen for ICU patients with ARC. Regrettably, few reports in China about the adjustment strategy of antibiotic dosing regimens for ARC patients. Therefore, this article reviews the domestic and foreign literature for reference to provide evidence for medical personnel to adjust the dose of antibacterial drugs for such patients.

Objective:To evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) on sleep quality in patients with post-stroke sleep disorder (PSSD).Methods:The clinical randomized controlled trials involving PSSD patients who received rTMS were retrieved from nine medical databases. After excluding duplicated references, screening for independent references and risk evaluation, the remaining references were input into RevMan5.4 software for meta-analysis.Results:Twelve eligible literatures were included in the final analysis. Meta-analysis results revealed that after rTMS intervention, there were significant differences in the following terms between the treatment and control groups (all P < 0.05): Pittsburgh sleep quality index score [MD = -2.60, 95% CI (-3.03, -2.17), P < 0.000 01]; sleep latency [MD = -9.69, 95% CI (- 16.87, - 2.50), P < 0.01], sleep efficiency [MD = 8.90, 95% CI (5.41, 12.39), P < 0.01], number of awakenings [MD = -1.15, 95% CI (- 2.26, - 0.04), P = 0.04], awakening duration [MD = -10.95, 95% CI (- 13.30, -8.61), P < 0.01], and rapid eye movement [MD = 4.54, 95% CI (2.24, 6.85), P < 0.01] in polysomnography; brain-derived neurotrophic factor score [MD = 5.29, 95% CI (2.47, 8.11), P = 0.0002]; clinical curative rate [ OR = 4.46, 95% CI (2.75, 7.23), P < 0.000 01]. Conclusion:rTMS can improve the sleep quality in patients with PSSD, which is worthy of clinical promotion.

Objective:To study the survival outcomes in patients with Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC) treated with sorafenib combined with transcatheter arterial chemoembolization (TACE) versus sorafenib alone.Methods:The data of 92 patients with BCLC stage C HCC at Tianjin Medical University Cancer Institute& Hospital from January 2008 to December 2015 were retrospectively studied. There were 82 males and 10 females. The average age was 56.3 years. Classified according to whether there were vascular invasion and/or distant metastasis, patients were divided into the vascular invasion group ( n=24), the metastasis group ( n=48), and the vascular invasion combined with metastasis group ( n=20). All patients were treated with sorafenib, but some patients received combined treatment with TACE. The survival data of these patients on follow-up was collected. The Kaplan-Meier method was used for survival analysis, and the survival rates were compared by the log-rank test. Univariate and multivariate Cox analyses were used to determine the prognostic factors of patients’ survival. Results:There were no significant differences in the baseline clinical data among the three groups (all P>0.05). Multivariate Cox regression analysis showed that pre-treatment alpha fetal protein >20 μg/L ( HR=1.90, 95% CI: 1.13-3.12), alkaline phosphatase >125 U/L ( HR=1.60, 95% CI: 1.03-2.49) and sorafenib alone ( HR=2.11, 95% CI: 1.23-3.54) were independent risk factors of survival for these patients. There were no significant differences in the cumulative survival rates among the three groups ( P>0.05). In the vascular invasion group, the cumulative survival rates of patients treated with combined sorafenib and TACE ( n=4) were significantly higher than those treated with sorafenib alone ( n=20) ( P<0.05). Conclusion:Compared with sorafenib alone, sorafenib combined with TACE resulted in better prognosis for patients with BCLC stage C HCC. Subgroup analysis showed that patients with vascular invasion had significantly better survival treated with combined sorafenib and TACE than sorafenib alone.

With the development of technology and instruments, more and more giant liver tumors have been resected under laparoscopy. Compared with traditional approach hepatectomy, anterior hepatectomy is more suitable for laparoscopic resection of huge liver tumors, and it is also more in line with the " tumor-free principle" when it is used in the resection of liver malignant tumors. Our team summarized the experiences and lessons of laparoscopic hepatectomy and communicated with domestic and foreign experts to form a set of single center standardized process of laparoscopic anterior right hepatectomy, which is summarized as follows.

To meet the requirement of pathological practice and development, we systematically analyzed the situation of pathological residents training and the importance of initiating the clinical scientific research training. Additionally, we proposed the principle and implementation strategy for clinical scientific research training. According to features of pathological practice, we employed the modularized teaching to divide the training courses into several modules: discussion module for clinical pathology, lecture module for advanced research, and training modules for basic scientific theory, technology and writing skill. With these approaches, the systematic and structured system of standardized residents training is implemented to improve the clinical research ability of pathological residents.

Objective: To investigate the clinical efficacy of radical resection for stage T3 gallbladder cancer and prognostic factors. Methods: The retrospective case-control study was conducted. The clinico-pathological data of 87 patients with T3 gallbladder cancer who were admitted to Tianjin Medical University Cancer Institute and Hospital from January 2005 to June 2016 were collected. There were 44 males and 43 females, aged 29-79 years, with a median age of 61 years. According to the different preoperative pathological classification and intraoperative exploration of gallbladder cancer, corresponding surgeries were performed. Observation indicators: (1) surgical and postoperative conditions; (2) clinical efficacy of stage T3 gallbladder cancer and prognostic factors analysis; (3) clinical efficacy of stage T3 gallbladder adenocarcinoma and prognostic factors analysis; (4) clinical efficacy of stage T3 gallbladder adenosquamous carcinoma and prognostic factors analysis. Follow-up by outpatient examination or telephone interview was performed to detect the postoperative survival of patients up to June 2018. Measurement data with skewed distribution were represented as M (range), and count data were described as absolute numbers. Survival curve, survival time and survival rate were drawn and calculated by the Kaplan-Meier method. Survival analysis was performed by the Log-rank test. Univariate analysis was performed using the Log-rank test and multivariate analysis using the COX proportional hazard model. Results: (1) Surgical and postoperative conditions: all the 87 patients underwent radical resection of gallbladder cancer, including 29 cases of hepatic wedge resection and 58 cases of extended hepatectomy. Of the 87 patients, 42 underwent standard lymph node dissection and 45 underwent enlarged lymph node dissection. There were 27 cases receiving extrahepatic bile duct reconstruction. The postoperative pathological results of 87 patients showed that 64 were diagnosed with gallbladder adenocarcinoma and 23 were diagnosed with gallbladder adenosquamous carcinoma. There were 59 cases comorbid with liver invasion and 3 cases comorbid with vascular invasion. The marginal histopathological examination showed negative margin in 63 cases and positive margin in 24 cases. The degree of tumor differentiation: there were 23 patients with highly differentiated tumor and 64 with poorly differentiated tumor. Of the 87 patients, 43 received postoperative adjuvant therapy and 44 didn′t receive adjuvant therapy. (2) Clinical efficacy of stage T3 gallbladder cancer and prognostic factors analysis. ① All the 87 patients were followed up for 1.8-128.0 months, with a median follow-up time of 26.3 months. All the 87 patients had survived for 1.1-82.7 months, with a median time of 20.1 months. The 2-year overall survival rate of patients was 59.8%, and the 2-year disease-free survival rate was 49.4%. ② Univariate analysis showed that preoperative alkaline phosphatase (ALP) level, tumor diameter, pathological type of tumor, lymph node metastasis, and range of hepatectomy were associated factors for the postoperative 2-year overall survival rate of patients (χ²=5.451, 4.900, 8.256, 4.419, 5.858, P<0.05), and pathological type of tumor, lymph node metastasis, and range of hepatectomy were associated factors for the postoperative 2-year disease-free survival rate of patients (χ²=5.828, 6.968, 4.077, P<0.05). Multivariate analysis showed that preoperative ALP level, tumor diameter, and lymph node metastasis were independent factors influencing the postoperative 2-year overall survival rate of patients [hazard ratio (HR)=2.539, 2.619, 2.201, 95% confidence interval (CI) : 1.174-5.491, 1.209-5.673, 1.104-4.391, P<0.05)]; pathological type of tumor and lymph node metastasis were independent factors influencing the postoperative 2-year disease-free survival rate of patients (HR=2.254, 2.296, 95%CI: 1.170-4.344, 1.206-4.374, P<0.05). ③ Survival analysis: pathological type of tumor was an associated factor for the postoperative 2-year overall survival rate and 2-year disease-free survival rate of patients. Of the 87 patients with T3 gallbladder cancer, there was no significant difference in the postoperative 2-year overall survival rate between the 64 patients with gallbladder adenocarcinoma and 23 with gallbladder adenosquamous carcinoma (68.8% vs. 34.8%, χ²=8.256, P>0.05), but a significant difference in the postoperative 2-year disease-free survival rate between them (56.3% vs. 30.4%, χ²=5.828, P<0.05). (3) Clinical efficacy of stage T3 gallbladder adenocarcinoma and prognostic factors analysis. ① Sixty-four patients with gallbladder adenocarcinoma had the median survival time of 23.1 months, with a range from 3.2 to 82.7 months. The postoperative 2-year overall survival rate was 68.8%, and the postoperative 2-year disease-free survival rate was 56.3%. ② For the 64 patients with T3 stage gallbladder adenocarcinoma, univariate analysis showed that preoperative CA19-9 level and range of lymph node dissection were associated factors for the postoperative 2-year overall survival rate (χ²=4.012, 8.837, P<0.05). The range of lymph node dissection was an associated factor for the postoperative 2-year disease-free survival rate (χ²=6.361, P<0.05). Multivariate analysis showed that range of lymph node dissection was an independant factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate (HR=0.244, 0.382, 95%CI: 0.088-0.674, 0.176-0.831, P<0.05). ③ Survival analysis: range of lymph node dissection was an associated factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients. Of the 64 patients with T3 stage gallbladder adenocarcinoma, the postoperative 2-year overall survival rate and disease-free survival rate of patients undergoing enlarged lymph node dissection were 84.8% and 69.7%, versus 51.6% and 41.9% of the patients undergoing standard lymph node dissection (χ²=8.837, 6.361, P<0.05). (4)Clinical efficacy of stage T3 gallbladder adenosquamous carcinoma and prognostic factors analysis. ① Twenty-three patients with gallbladder adenosquamous carcinoma had the median survival time of 13.2 months, with a range from 1.1 to 70.3 months. The postoperative 2-year overall survival rate was 34.8%, and the postoperative 2-year disease-free survival rate was 30.4%. ② For the 23 patients with T3 stage gallbladder adenosquamous carcinoma, univariate analysis showed that preoperative ALP level, lymph node metastasis, range of hepatectomy, and extrahepatic bile duct reconstruction were associated factors for the postoperative 2-year overall survival rate of patients (χ²=5.288, 4.574, 12.960, 4.106, P<0.05). The lymph node metastasis and range of hepatectomy were associated factors for the postoperative 2-year disease-free survival rate of patients (χ²=7.364, 10.582, P<0.05). Multivariate analysis showed that range of hepatectomy was an independant factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate (HR=0.102, 0.153, 95%CI: 0.012-0.880, 0.033-0.718, P<0.05). ③ Survival analysis: range of hepatectomy was an independant factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients. Of the 23 patients with T3 stage gallbladder adenosquamous carcinoma, the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients undergoing extended hepatectomy were 87.5% and 75.0%, versus 6.7% and 6.7% of the patients undergoing hepatic wedge resection (χ²=12.960, 10.528, P<0.05). Conclusions Lymph node metastasis is an independent factor influencing the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients with T3 stage gallbladder cancer. The range of lymph node dissection is an independent factor for the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients with stage T3 gallbladder adenocarcinoma. Range of hepatectomy is an independent factor for the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients with stage T3 gallbladder adenosquamous carcinoma. Patients with gallbladder adenocarcinoma should undergo enlarged lymph node dissection, and patients with gallbladder adenosquamous carcinoma need to undergo extended hepatectomy.

OBJECTIVEThrough comparative study on pulmonary function damage of coke oven workers exposed to coke oven emissions with the same group before and after five years, and further explore the relationship between the coke oven emissions and injury in pulmonary function of coke oven worker.

METHODSSelect a coking plant in Shanxi 165 coke oven workers (exposed group) and 52 auxiliary workers (control group) for the study, using a uniform questionnaire to collect workers' personal information. Fixed workplace air samples collected periodically. Air samples of benzo (a) pyrene concentrations was measured by high pressure liquid chromatograph. Pulmonary function of research object was measured by portable spirometer respectively in 2009 and 2013, and comparative analysis on it.

RESULTSThe concentration of B(a)P was no significant difference in the same area between 5 years in 2009-2013. Compared with 2009, 2013 control workers lung function index and the abnormal rate had no significant difference (P > 0.05). But FVC%, FEV1.0%, MVV%, VC% and FEF25% of exposed workers in 2013 was significantly lower than in 2009, FVC%, FEV1.0%, VC% and FEF25% pulmonary dysfunction rate in 2013 was also significantly higher than in 2009, difference was statistically significant (P < 0.05). Workers emerging pulmonary function abnormalities mainly distributed in furnace roof and side. furnace roof group FVC%, FEV1.0%, VC% additional abnormal number (rate) was significantly higher than furnace floor and the control group (P < 0.05), and furnace side groop was significantly higher than the control group, the difference was statistically significant (P < 0.05). Multivariate Logistic regression analysis showed that after 5 years FVC%, FEV1% and VC% of abnormal lung function emerging adjusted OR of furnace roof workers were 7.939, 5.966 and 4.956. For abnormal of FVC%, FEV1%, VC% and MVV%, the contacting coke seniority is a risk factor. There is a positive interaction between contacting coke seniority and furnace roof (P < 0.05).

CONCLUSIONCoke oven workers lung function damage associated with exposureing to coke oven emissions, coke oven emissions exposure level and exposure time are the main factors of coke oven workers in lung function damage, there is a positive interaction between the two factors.

Air Pollutants, Occupational ; adverse effects ; analysis ; Benzo(a)pyrene ; adverse effects ; analysis ; Cohort Studies ; Coke ; Humans ; Lung ; drug effects ; physiopathology ; Occupational Exposure ; adverse effects ; Respiratory Function Tests ; Risk Factors ; Surveys and Questionnaires

Ataxins ; Humans ; Male ; Middle Aged ; Nerve Tissue Proteins ; genetics ; Spinocerebellar Ataxias ; genetics ; Trinucleotide Repeats