Objective To analyze the characteristics of nystagmus during the Dix-Hallpike and Roll tests in patients with benign paroxysmal positional vertigo (BPPV) using three-dimensional videonystagmography (3D-VNG), in order to to optimize diagnostic and therapeutic strategies of BPPV. Methods A retrospective analysis was conducted on 68 patients with posterior semicircular canal (PSC)-BPPV and 26 patients with horizontal semicircular canal (HSC)-BPPV. Nystagmus data obtained from 3D-VNG were reviewed for all patients, with a focus on the eye movement components during the Dix-Hallpike test in PSC-BPPV patients and the Roll test in HSC-BPPV patients. The direction and reversal rates of the vertical, horizontal, and torsional components were recorded and analyzed. Results All PSC-BPPV patients exhibited highly consistent three-dimensional nystagmus characteristics during the Dix-Hallpike test: vertical nystagmus was uniformly upward, torsional nystagmus was predominantly clockwise in left-side BPPV patients (17/23) and counterclockwise in right-side BPPV patients (44/45), while the horizontal component was mostly directed contralaterally (50/68); upon transitioning from the head-hanging to the sit-up position, vertical nystagmus components in all patients reversed, and torsional and horizontal nystagmus components reversed in approximately 50.0% or more patients. Among HSC-BPPV patients, right-side BPPV patients all showed right-beating (geotropic) horizontal nystagmus with predominantly upward vertical component (16/19), while most left-side BPPV patients showed left-beating horizontal nystagmus (6/7) with predominantly downward vertical component (6/7). During head rotation toward the healthy side, most (25/26) HSC-BPPV patients exhibited a reversal in the horizontal nystagmus direction, reduced intensity compared to the affected side, with a reversal in vertical components in 3 patients, and atypical torsional components. Conclusions 3D-VNG could precisely quantitative analyze three-dimensional features of nystagmus in BPPV patients, improve diagnostic accuracy in canal and side localization, particularly in PSC-BPPV patients.

Background Because of high working intensity, high responsibility, and unexpected situations, health care workers may suffer great work pressure, which may lead to health damage. Objective To explore the self-rated health status and its influencing factors such as demographic and occupational-related factors of medical staff in Lanzhou. Methods In-service medical staff were selected by using cluster random sampling method from 18 public hospitals in Lanzhou City and were investigated with a self-made questionnaire and the Self-rated Health Measurement Scale (SRHMS). SRHMS includes 48 items in 10 dimensions, which are divided into three sub-scales of physical health, mental health, and social health, and another independent dimension is overall health. The scores were converted into a percentage scale and expressed as the percentage of measured score to full score; a higher score indicated better health, and >70% was considered good health status. t test, Kruskal-Wallis H test, and Spearman correlation were used to analyze the scores of SRHMS and the demographic and occupational-related factors affecting the scores of physical, mental, and social health sub-scales. Results A total of 2989 valid questionnaires were recovered. There were statistically significant differences in total score and the scores of physical, mental, and social health among medical staff of different age, educational background, length of service, and weekly working hours groups (P < 0.05). The percentage of total score to full score in the medical staff was 71.41%, but the scores of physical, mental, and social health sub-scales and total scale of selected participants were all lower than the corresponding domestic norms (t=−3.323, −12.283, −7.157, −9.659, P < 0.05); the percentage of psychological symptoms and negative emotions in mental health scale to full score was the lowest, only 58.39%. Educational background, length of service, and weekly working hours were negatively correlated with physical health score (r=−0.061, −0.060, −0.165, P < 0.05); professional title was positively correlated with mental health score (r=0.045, P < 0.05), while educational background and weekly working hours were negatively correlated with it (r=−0.051, −0.172, P < 0.05). Monthly income, professional title, and length of service were positively correlated with social health score (r=0.040, 0.049, 0.071, P < 0.05), while educational background and weekly working hours were negatively correlated with it (r=−0.038, −0.110, P < 0.05). Conclusion The self-rated health status of selected medical staff in Lanzhou is generally good, but lower than that of the norm, especially the mental health score is the lowest. The self-rated health score of total scale is correlated with education, length of service, professional title, and working time per week.

Objective:To explore the effect of the application of hierarchical and special quality control in the quality control management of an ultrasound department.Methods:The hierarchical and special quality control method was used to control ultrasonic reports that were related to four quality control areas: basic quality control, deep quality control, obstetrical quality control, and critical value quality control. Changes in the qualified reporting and comprehensive clinical satisfaction rates before and after the implementation of hierarchical and special quality control were examined.Results:After the implementation of hierarchical and special quality control, the qualified rates of basic quality control, deep quality control, obstetrical quality control, and critical value quality control increased significantly. The comprehensive clinical satisfaction score was (90.58±1.79) points, which was higher than before the model was applied [(80.37±2.72) points], and the difference was statistically significant ( P<0.01). Conclusion:The implementation of hierarchical and special quality control measure can effectively improve the quality of ultrasonic diagnoses and comprehensive clinical satisfaction.

Objective To understand preliminaryly the epidemiological trend of lung cancer in recent years by retrospective analysis of 2 403 cases of lung cancer in Zhongnan Hospital of Wuhan University from 2013 to 2017.Methods The clinical data of patients with primary bronchogenic cancer diagnosed in Zhongnan Hospital of Wuhan University from 2013 to 2017 were collected.The clinical data such as gender,age,history of tobacco and alcohol,operation,pathological type,clinical stage and epidermal growth factor receptor (EGFR) gene mutation were analyzed statistically.Results A total of 2 403 cases of lung cancer were collected,including 1 766 males and 637 females.There was no significant difference in gender ratio between male and female in five years (x2 =8.481,P =0.075).There were 2 398 cases with age information,the male-to-female ratios of lung cancer patients aged less than 40,40-49,50-59,60-69,70-79,80 and over were 0.9 ∶ 1.0,1.4 ∶ 1.0,2.4 ∶ 1.0,3.6 ∶ 1.0,3.4 ∶ 1.0 and 3.3 ∶ 1.0 respectively,and the difference was statistically significant (x2 =59.004,P ＜ 0.001).The composition difference of adenocarcinoma was not statistically significant in five years (x2 =2.165,P =0.705).There was no statistically significant difference in the composition ratio of squamous cell carcinoma (x2 =4.788,P =0.310).Adenocarcinoma accounted for 43.15％ (762/1 766) and 81.95％ (522/637) of the pathological types of male and female patients respectively,and the difference was statistically significant (P ＜ 0.001).Squamous cell carcinoma accounted for 39.01％ (689/1 766) and 7.28％ (47/637) respectively,and the difference was statistically significant (P ＜ 0.001).The proportion of squamous cell carcinoma in smoking patients was 42.99％ (583/1 356),which was significantly higher than that in non-smoking patients (14.61％,153/1 047);the proportion of squamous cell carcinoma in drinking patients was 40.56％ (277/683),which was higher than that in nondrinking patients (26.69％,459/1 720),and the differences were statistically significant (both P ＜ 0.001).A total of 1 252 patients underwent surgery,accounting for 52.10％ (1 252/2 403) of the total cases.The surgical rate of small cell carcinoma was 21.72％ (48/221),and that of non-small cell carcinoma was 55.18％ (1 204/2 182).In five years,the surgical rates of lung cancer patients were 55.11％ (221/401),51.53％ (252/489),58.23％ (244/419),53.18％ (276/519) and 45.04％ (259/575) respectively,and there was significant difference in the proportion of surgical and non-surgical patients in each year (x2 =19.553,P =0.001).A total of 483 patients were tested for E GFR mutation,the EGFR mutation rate was 58.8％ (251/ 427) in adenocarcinoma patients and 15.6％ (5/32) in squamous cell carcinoma patients.Among lung cancer patients aged less than 40,40-49,50-59,60-69,70-79,80 and over,the proportions of adenocarcinoma were 76.74％ (33/43),62.39％ (136/218),57.73％ (381/660),47.95％ (455/949),52.22％ (235/450) and 52.56％ (41/78) respectively,and the difference was statistically significant (x2 =33.078,P ＜ 0.001);the proportions of squamous cell carcinoma were 9.30％ (4/43),21.56％ (47/218),28.03 ％ (185/660),34.14％ (324/949),32.44％ (146/450) and 35.90％ (28/78) respectively,and the difference was statistically significant (x2 =26.977,P ＜ 0.001).The difference of composition ratio of TNM staging was statistically significant in five years (x2 =21.003,P =0.034).Conclusion There has been no significant change of male-to-female ratio in patients with lung cancer in the past five years.With the increase of age,the male-to-female ratio increases first and then decreases.The proportion of adenocarcinoma and squamous cell carcinoma has not increased or decreased significantly in the past five years.Adenocarcinoma and squamous cell carcinoma are both common in male lung cancer patients,while the pathological type of female patients is mainly adenocarcinoma.Squamous cell carcinoma is highly prevalent in smokers and drinkers.The surgical rate of squamous cell carcinoma is higher than that of adenocarcinoma,and the surgical rate of non-small cell lung cancer is higher than that of small cell lung cancer.The EGFR mutation rate is higher in adenocarcinoma.With the increase of age,the proportion of adenocarcinoma in all pathological types tends to decrease,while that of squamous cell carcinoma tends to increase.The patients' TNM staging has a downward trend,and the operation rate decreases slightly.

Objective To explore the application value of maximum projection method of lesion area in CT-guided percutaneous microwave ablation of liver tumor. Methods CT-guided percutaneous microwave ablation was performed on 23 patients with liver tumor. All patients were divided into two groups. Fifteen patients underwent CT-guided percutaneous microwave ablation with maximum projection method of lesion area in study group, wihle 8 patients underwent CT-guided percutaneous microwave ablation with conventional method in control group. The times of puncture during operation, complications and the short-term efficacy of microwave ablation were compared between the two groups. Results Compared with control group, the times of puncture during operation decreased in study group ([1.27±0.46] times vs [3.62±0.74] times; t=-9.461, P<0.001). No complication occurred after ablation except for subcapsular hemorrhage in both of the two groups, and the incidence of subcapsular hemorrhage in study group was lower than that in control group (6.67% [1/15] vs 37.50% [3/8]; χ2=3.976, P=0.041). Furthermore, the complete ablation rate of liver tumor in study group was higher than that in control group within 6 months after operation (93.33% [14/15] vs 50.00% [4/8]; χ2=5.647, P=0.017). Conclusion Maximum projection method of lesion area can be used to guide puncture and predict the ablation range during CT-guided percutaneous microwave ablation of liver tumors, which is helpful for the improvement of complete ablation rate and reducing complications.

Objective To evaluate the clinical efficacy between stereotactic body radiotherapy (SBRT) and surgical treatment for stage Ⅰ-Ⅱ non-small cell lung cancer (NSCLC).Methods Clinical data of 120 patients with early-stage NSCLC who underwent SBRT or surgical treatment in Zhejiang Cancer Hospital from 2012 to 2015 were retrospectively analyzed.Propensity score matching was carried out between two groups.Sixty eligible patients were enrolled in each group.In the SBRT group,the 80％ isodose line covered 95％ of the planning target volume,and the 100％ isodose line covered 100％ of the internal gross tumor volume.The fractional dose was 5-15 Gy and the median biologically equivalent dose was 100 Gy (range:57.6-150.0 Gy).In the operation group,32 patients underwent video-assisted thoracoscopic lobectomy and 9 patients underwent wedge resection or segmentectomy.Results All patients successfully completed corresponding treatment and were followed up.The median follow-up was 32.3 months (range:8.6-68.4 months).In the operation group,3 patients died from infection within postoperative 90 d,whereas no case died in the SBRT group (P=0.079).In the SBRT group,3 patients died of other factors besides tumor (cerebral infarction,heart disease,etc.) during follow-up.Local-regional recurrence occurred in 12 patients including 5 cases in the operation group and 7 in the SBRT group (P=0.543).In the operation group,11 patients experienced distant metastases with a median disease-free survival (DFS) of 33.5 months.In the SBRT group,6 patients had distant metastases and the median DFS was 38.4 months (P=0.835,P=0.178).In the SBRT group,the 1-and 3-year overall survival rates were 93％ and 83％,and 95％ and 83％ in the operation group (P=0.993).Conclusions The 1-and 3-year overall survival rates and local control rate do not significantly differ between SBRT and operation for patients with early-stage NSCLC.

Objective To evaluate the safety and clinical efficacy of stereotactic body radiation therapy (SBRT) for lung cancer.Methods A retrospective analysis was performed on 200 patients with primary non-small cell lung cancer (NSCLC)(118 patients) or solitary pulmonary metastasis (82 patients) who underwent SBRT in Zhejiang Cancer Hospital from January 2012 to September 2015.The 80% isodose line covered 95% of the planning target volume,and the 100% isodose line covered 100% of the internal gross tumor volume.The fractional dose was 4.0-18.0 Gy daily or every other day,and the biologically equivalent dose ranged from 40.0 to 151.2 Gy (median 100 Gy).Results All patients completed treatment.The follow-up rate was 96.0%.The complete response and partial response rates were 14.8%(17/115) and 65.2%(75/115) for the primary tumor group,versus 25%(19/77) and 38%(29/77) for the metastasis group.The incidence rates of grade Ⅱ and Ⅲ acute radiation pneumonitis were 4.7% and 3.1%,respectively.The median follow-up was 14.9 months.The 1-and 2-year local control rates were 95.7% and 84.3% for the primary tumor group,versus 92% and 73% for the metastasis group.The 1-and 2-year overall survival rates were 94.5% and 92.0% for the primary tumor group,versus 85% and 62% for the metastasis group.Conclusions SBRT is a safe and effective treatment for early primary NSCLC and solitary pulmonary metastasis,resulting in high 1-and 2-year local control and overall survival rates and low rate of complications.

Objective To explore the effect of proliferation and apoptosis,and research its mechanism associated with RAS/extracellular signal regulated kinase/mitogen-activated protein kinase (RAS/ ERK/MAPK) in Fms-like tyrosine kinase 3-internal tandem duplication (FLT3-ITD) mutation acute lymphocytic leukemia cell line MV4-11 cells treated by triptolide (TP).Methods MV4-11 cells were respectively treated by triptolide with diverse concentrations and different times.The proliferation inhibition rate was measured by methyl thiazolyl tetrazolium,the apoptosis rate was detected by flow cytometry,the mRNA expressions of FLT3,RAS,ERK,forkhead box protein M1 (FOXM1),and c-Myc were analyzed by realtime fluorescent quantitative polymerase chain reaction (PCR).Results The proliferation inhibition rate markedly increased in a dose-time dependent manner after MV4-11 cells were treated by TP.After cells were treated with 10,and 20 nmol/L TP,respectively,the apoptosis rates at 48 h were (17.30 ± 0.56) ％,(35.77 ±0.55)％,and those at 72 h were (49.83 ±0.45)％,(68.90 ±0.75)％ correspondingly.PCR data showed that the mRNA level of FLT3 mRNA decreased obviously,and that of RAS,ERK,FOXM1,and c-Myc also decreased.Conclusions Triptolide could significantly inhibit the MV4-11 cells proliferation and induce cell apoptosis,and its mechanism might be through inhibiting the expression of related genes on RAS/ERK/MAPK signaling pathway.

Objective To explore the application value of near infrared spectrum (NIRS) in the detection of epidural and subdural hematoma in clinic.Methods Thirty-four patients with subdural and epidural hematomas (study group) confirmed by CT or MRI and 14 healthy volunteers (contrast group) were selected.The NIRS equipment which was produced by Institute of Automation of Chinese Academy of Sciences were used to assess the intracranial hematomas.Taking CT or MRI results as the golden standard,the diagnostic efficiency of NIRS for subdural and epidural hematomas were evaluated.Results For the diagnosis of subdural and epidural hematomas,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 91.18％(31/34),71.43％ (10/14),85.42％(41/48),88.57％(31/35) and 76.92％ (10/13),respectively.Conclusion NIRS is a good device to predict intracranial subdural and epidural hematomas with high sensitivity and positive predictive value,which is helpful for early diagnosis and therapy in clinic.

Objective To apply Nutritional Risk Screening-2002(NRS-2002) to perform primary screening for nutritional risk in patients with esophageal cancer who undergo radiotherapy, and assess their nutritional status, and to investigate the value of NRS-2002 in such patients.Methods A total of 97 patients who were diagnosed with esophageal cancer and underwent radiotherapy in Zhejiang Cancer Hospital from January 2010 to April 2014 were analyzed retrospectively.The Kaplan-Meier method was applied to analyze the difference in survival, and the chi-square test and the Pearson correlation analysis were applied to analyze the correlation between NRS-2002 score and blood parameters.Results Of all patients, 26.8%had nutritional risk before radiotherapy, which gradually increased with the progress of radiotherapy.The 1-year overall survival rates of the patients with NRS-2002scores of ≤3 and ≥4 on admission were 91.1%and 61.9%, respectively (P=0.010).As for the patients with the highest NRS-2002 scores of ≤2 and ≥3 during treatment, the 1-year overall survival rates were 94.2% and 77.5%, respectively (P=0.012).As for the patients with the lowest NRS-2002 scores of ≤3 and ≥4 during treatment, the 1-year overall survival rates were 91.3% and 54.5%, respectively ( P=0.018).The NRS-2002 score was correlated with prealbumin on admission and at week 1 of radiotherapy (P=0.000 and 0.002), and the NRS-2002 score was correlated with albumin at week 3 of radiotherapy (P=0.036).The multivariate analysis showed that the TNM stage of esophageal cancer and the highest NRS-2002 score during treatment were the independent prognostic factors in esophageal cancer (P=0.001 and 0.005).Conclusions The patients with esophageal cancer undergoing radiotherapy have high nutritional risk, and NRS-2002 score is the independent prognostic factor in these patients and can be used as a tool for primary screening for nutritional risk.