Clinicians need to focus on various points in the diagnosis and treatment of insomnia.This article prescribed the treatment protocol based on the unique features,such as insomnia in the elderly,women experiencing specific physiologi-cal periods,children insomnia,insomnia in sleep-breathing disorder patients,insomnia in patients with chronic liver and kidney dysfunction.It pro-vides some reference for clinicians while they make decision on diagnosis,differentiation and treat-ment methods.

Pain not only affects the physical and mental health of individuals, but also imposes a huge burden on society as a whole. Traditional pain management measures are diverse, but each has its limitations. Therefore, there is an urgent need for new tools. Digital therapies are booming, and virtual reality (VR) has been widely used, especially in the field of pain management. VR uses assistive tools, such as headsets, to build a three-dimensional virtual world with the participation of multiple senses, including vision, hearing, and smell, so that it can make user feel being there. This review aims to summarize the application and mechanism of VR in the field of pain management, with the hope of making VR a new choice for pain management.

Infant, Newborn ; Humans ; Infant, Premature ; Infant, Low Birth Weight ; Blood Transfusion ; Infant, Premature, Diseases

Gastrointestinal stromal tumor(GIST) is the most common mesenchymal tumor in the digestive system, with potential malignant tendency.With the change of living habits and the update of instruments and equipments, the morbidity and detection rate of GIST have been increased year by year, attracting much attention.However, its clinical manifestations are not characteristic.At present, primary diagnosis is mainly made by imaging techniques such as CT and MRI, and pathological diagnosis is the gold index.In recent years, with the development of immunohistochemical technology and gene technology, immune markers and gene detection play an increasingly important role in the diagnosis of GIST.This paper reviews the progress of GIST diagnostic techniques.

Objective:To explore the effect of conducting core stability training (CST) on an unstable supporting surface using thoracolumbar fracture patients with an incomplete spinal cord injury.Methods:Forty thoracolumbar fracture patients with incomplete spinal cord injury were randomly divided into an experiment group and a control group, each of twenty. Both groups received 30 minutes of CST five times per week for 8 weeks. The patients in the control group were trained on a stable supporting surface while those in the experiment group used an unstable surface. Evaluations were conducted before and after the 8-week intervention. Gait and static balance data were collected and analyzed using 3D motion analysis software and an EAB-100 active balancer.Results:After the intervention, the average stride length and comfortable walking speed of the experimental group were both significantly better than the control group′s averages. Moreover, the path length, circumferential area, rectangular area and effective value area of the Romberg rate were all significantly better, on average, in the experiment group, as was the average displacement of the deflection center with the eyes closed in static balance.Conclusions:An unstable supporting surface is superior to a stable one for conducting CST after thoracolumbar fracture with incomplete spinal cord injury. The effect may be due to improved nonvisual postural control.

Objective:To explore the laboratory characteristics and diagnostic methods for therapy-related acute megakaryocytic leukemia (t-AMKL).Methods:The data of one child with acute lymphoblastic leukemia (ALL) in the Blood Disease Hospital of Chinese Academy of Medical Sciences & Peking Union Medical College in September 2014 was retrospectively analyzed. After inducing remission for more than 43 months, the child was diagnosed as t-AMKL.Results:After the diagnosis of ALL, the child was given chemotherapy with standard childhood ALL regimen. After 43 months, t-AMKL was diagnosed by comprehensive morphology, cytogenetics, and molecular biology. Bone marrow morphology showed that the proportion of primitive cells was 0.44; flow cytometry showed the phenotype was abnormal myeloid primitive cells; the pathology result showed that the abnormal cells weakly expressed CD42b and CD61; the electron microscopy showed platelet peroxidase (PPO)-positive and myeloperoxidase (MPO)-negative; the bone marrow immunohistochemistry showed the positive rate of CD41 was 34%; the child had a complex karyotype. After reviewing his medical history, he was diagnosed as t-AMKL.Conclusion:The t-AMKL is relatively rare, and it is helpful to improve the prognosis of patients by completing the relevant examinations for early diagnosis.

Objective To retrospectively analyze the setup error in radiotherapy of somal tumors and body metastases using the ExacTrac X-ray portal image,and to evaluate the feasibility and effectiveness of 6D setup error correction in body radiotherapy.Methods The translational and rotational setup errors were calculated by registering the bony structures on the ExacTrac X-setup images to that of the digitally reconstructed setup images,and the corresponding residual errors were calculated together.Results The translational and rotational setup errors in the x (left-right),y (superior-inferior),z (anterior-posterior) and Rx (sagittal),Ry (transverse),Rz (coronal) directions were(2.27±2.02) mm,(4.49±2.52) mm,(2.27± 1.37) mm and (1.02 ± 0.73) °,(0.67 ± 0.68) °,(0.76 ± 0.84) °,respectively.The residual translational and rotational setup errors in the x(r),y(r),z(r) and Rx(r),Ry(r),Rz(r) directions were(0.27±0.48)mm,(0.37±0.45)mm,(0.22±0.30)mm and (0.17±0.33)°,(0.14±0.34)°,(0.16± 0.28) ° respectively.Conclusions Besides the translational setup errors,a certain amount of rotational setup errors exist in radiotherapy of somal tumors and body metastases.By using the 6D setup error correction of the ExacTrac system,a translational less than 0.4 mm and rotational setup errors less than 0.2° could be achieved.

Objective To evaluate the effect of setup errors upon the target area and the organs at risk (OAR) during radiotherapy for prostate cancer.Methods Twelve prostate cancer patients receiving treatment in the recent 1 year were randomly recruited in this study.The position of each patient was verified by using cone beam CT (CBCT) for 6-10 times during the treatment.In treatment planning system (TPS),the isocenter position was moved along the setup errors with averaging error value (Plan_A) and each CBCT value (Plan_F).The dose distribution was recalculated without changing the beam setting,weight factors and monitor units (MUs).The dose difference was statistically compared between the simulation and original plans (Plan_O).Results For clinical target volume (CTV) D95,there was a significant difference between Plan_A and Plan_O (P =0.008),whereas no significant difference was observed between Plan_F and Plan_O.There were significant differences between Plan_F and Plan_O,Plan_A and Plan_O (P=0.004,and 0.041) for the planned target volume (PTV) D95.For OAR,rectal V60,Dmax,left femoral V20,Dmax and right femoral Dmax significantly differed between Plan_F and Plan_O (P=0.026,0.015,0.041,0.049,0.003).However,only left femoral Dmax significantly differed between Plan_A and Plan_O (P=0.045).The movement in the superior-inferior (SI) direction was significantly correlated with the changes in the rectal V40,V50 and V60 and PTV D95 (r=-0.785,-0.887,-0.833,0.682).The movement in the anterior-posterior (AP) direction was significantly associated with the variations in the bladder V20,V30,V40,V50 and V60(r=-0.945,-0.823,-0.853,-0.818,-0.774).The evaluation indexes of all normal tissues in the re-plan could meet the clinical requirements.However,the volume of target prescription volume had different levels of deficit,and the deficit of Plan_F was greater than that of Plan_A.Conclusions The simulation results of averaging into the TPS underestimates the effect of daily setup errors on the dose distribution.The effect of setup errors on the dose distribution in target area is greater than that of normal tissues.Y-direction errors are more likely to cause the variations of the rectal and PTV dose,and the errors in the z-direction are inclined to cause the changes in the bladder dose.

Objective To explore integrated teaching based on small private online course (SPOC) in lymphoma clinical courses for medical undergraduates.Methods A total of 60 medical undergraduates in the department of hematology were randomly allocated to SPOC teaching group (n=30) and problem-based learning (PBL) teaching group (n=30) according to scores of the basic medical theoretical examination for lymphoma clinical courses education.After teaching activities,personal experiences were evaluated by anonymous questionnaires from medical undergraduates and instructors.Besides teaching efficacies assessed by objectively measurable score system including academic examination scores,clinical skill and capabilities in analyzing clinical problems of students,were systematically analyzed and compared between two groups by SPSS 19.0.Results The survey results showed that compared with PBL teaching group,SPOC teaching group had higher teaching feedback evaluation and better teaching experience,and SPOC were widely recognized by teachers and students.The SPOC teaching group's scores of the three items in the exam were better than those of the PBL teaching group,with the academic achievement [(84.03 ± 7.66) vs.(77.60 ± 8.22),P=0.005],the performance of practical skills [(87.83 ± 8.17) vs.(81.97 ± 6.13),P=0.001],and case analysis results [(88.17 ± 6.53) vs.(80.10 ± 6.91),P=0.000],and the difference was statistically significant.Conclusion Integrated teaching based on SPOC is feasible for lymphoma clinical courses,which can trigger interest of students,enhance learning abilities and their clinical capabilities.Moreover,this novel medical education approach may provide new ideas and theoretical basis in training qualified and talent doctors.

In order to improve the quality of medical records written by interns of clinical medicine in hematology department,we evaluated and analyzed 100 medical records written by the interns.The main reasons that affect the quality of medical record written by interns are the writing defects that are history of present illness,past history,personal history,the record of the clinical operation,blood transfusion and chemotherapy.There are other reasons for affecting the quality of medical records,such as students in clinical practice not paying attention to the writing of medical records,the relative lag of teaching management,the particularity of the diseases in the department of hematology and the weak legal consciousness.Therefore,we should strengthen the teaching management,improve the comprehensive quality of the clinical teaching teachers,carry out the pre job training of the medical records for the interns,train the interns' inquiries and the ability to communicate with the doctors and patients,and make use of the typical medical records of the Department of Hematology to combine the discussion and other ways,so as to strengthen the interns' clinical disease writing skills and legal consciousness as well as the quality of their writing medical records.