Radiotherapy is the most common treatment for nasopharyngeal carcinoma, and the radiotherapy technique is essential for the prognosis of nasopharyngeal carcinoma. Due to the complexity of the structure of the intensity-modulated device and the accuracy of the clinical requirements of radiotherapy, it is inevitable that higher requirements will be imposed on the process of intensity-modulated radiotherapy. Currently, gaps exist in the radiotherapy equipment and personnel qualification among radiotherapy units, and thus the homogenization in the radiotherapy remains to be strengthened in China. With the application of radiotherapy information management system, digital medicine and artificial intelligence technologies in the field of radiotherapy, the original process fails to meet the application needs of the new precise radiotherapy technology. Therefore, this process is designed based on the existing radiotherapy procedures for nasopharyngeal carcinoma in combination with the latest developments in the field of radiotherapy, aiming to establish a novel standard process recommendation, ensuring the standardization and homogenization of radiotherapy and achieve the individualized intensity-modulated radiotherapy for nasopharyngeal carcinoma patients.

OBJECTIVES: To explore the psychological status of medical staff in the epidemic period of coronavirus disease 2019 (COVID-19), and to analyze its influential factors. METHODS: A total of 373 medical staff from Xiangya Hospital and the Second Xiangya Hospital of Central South University were enrolled for this study. The General Sociological Data Questionnaire, Symptom Check-List 90 (SCL-90), and self-designed public opinion response questionnaire were used to assess general sociological data, mental health scores, and ability to respond to COVID-19 related public opinion information of medical staff. The mental health scores of medical staff with different general sociological data and public opinion information coping abilities were compared. Influential factors of mental health were analyzed. RESULTS: The average score of 10 factors in SCL-90 of 373 medical staff was less than 2 points. 14.21% medical staff had one or more factor scores more than two points, including 11.26% with terror symptoms, 7.77% with compulsive symptoms, and 5.63% with anxiety. The main sources of COVID-19 information for medical staff included WeChat, microblog, Jinri toutiao, TV and radio. 66.22% medical staff regularly verified information about COVID-19 through official websites or formal channels. A great deal of COVID-19 information in WeChat could make medical staff nervous (34.05%), anxious (30.29%), and insecure (29.22%). 68.63% medical staff sometimes were worried about getting infected because they knew information about COVID-19. Different departments of medical staff, getting cough or having a fever recently, and the degree of fear of infection had an impact on the SCL-90 score of medical staff, the differences were all statistically significant (all <0.05). Stepwise regression analysis showed that the impact of COVID-19 information on their life in WeChat, getting cough or having a fever recently, insomnia-early caused by COVID-19 information in WeChat, different departments, and the degree of fear of infection COVID-19 were the influential factors for the mental health of medical staff (all <0.05). CONCLUSIONS During the epidemic of COVID-19, medical staff suffered from psychological problems to various degrees. It is necessary to establish a psychological assistance platform and guide the direction of public opinion correctly to promote the mental health of medical staff.
Anxiety ; Betacoronavirus ; China ; Compulsive Behavior ; Coronavirus Infections ; epidemiology ; psychology ; Fear ; Health Status ; Humans ; Medical Staff ; psychology ; Mental Health ; Pandemics ; Pneumonia, Viral ; epidemiology ; psychology ; Surveys and Questionnaires

Objective To explore the feasibility and safety of kidney transplantation for pre-sensitized infants using deceased donors and summarize the relevant literature reports .Methods A second kidney transplantation was successfully performed for an 8-month-old pre-sensitized girl in July 2017 .She had a low level of donor specific antibody (DSA ) against human leucocyte antigen (HLA ) B62 due to severe acute rejection (AR) after her first kidney transplantation .For desensitization , plasmapheresis and intravenous immunoglobulin plus anti-CD20 antibodies were offered on operative day .Clinical data and outcomes were retrospectively analyzed .Results Renal graft regained immediate function after transplantation .Preformed DSA could be detected at 1 week .However ,there was no de novo DSA .At 1 year post-transplantation ,preformed DSA turned negative .During a follow-up period of 2 years ,renal graft showed an excellent function with a serum creatinine of 31 μmol/l and eGFR of 110 ml/min/1 .73m2 .No AR episode or proteinuria occurred .DSA stayed negative .Simultaneously physical development also caught up .Her height of 93 cm tall and weight of 13 .5 kg at month 24 & 8 months corresponded to normal grow th curve of her age .Conclusions Pre-sensitized infant could tolerate desensitization therapy well and achieve satisfactory outcomes .With surgical precisions and optimized managements ,kidney transplantation provides excellent renal functions and survivals for infants with organs from deceased donors .

Objective: To summarize experience and result in surgical treatment of Stanford type A intramural hematoma. Methods: 60 patients with Stanford type A intramural hematoma were operated from February 2015 to August 2017. Surgery was indicated in complicated cases with penetrating ulcer or ulcer-like projection in ascending aorta, maximum aorta diameter≥50 mm, progressive maximum aortic wall thickness≥10 mm, pericardial or pleural effusion, persistent or recurrent pain. Aortic valve regurgitation. In our group, 46 patients recieved ascending aorta replacement+ Sun' s procedure. 6 patients recieved Bentall+ Sun' s procedure. 4 patients recieved asceding aorta+ hemiarch replacement. 2 patients recieved Bentall+ hemiarch replacement. 2 patients recieved asceding aorta replacement. Results: In the whole group, there was 1(1.7%)operative death because of multiple organ failure after operation. Hyoxemiaoccured in 5(8.3%) patients, 2(3.3%) patients occurred new renal failure and required CRRT treatment, cerebrovascular complication occurred in 1 (1.7%)patient, re-sternotomy due to bleeeding occured in 1 (1.7%)patient and paraplegia occured in 1(1.7%) patient after operation. but they recoved quickly after proper treatment. During follow up period, there were 4 cases need reintervention, including TEVAR for type B dissection at 3 months and distal stent-graft new entry at 1 year. Two other reinterventions were performed for endoleak by interventional occlusion. During the follow-up, hematoma absorption rates after treatment 1、3 and 6 months were 68.6%, 84.7% and 94.8%. Conclusion Given the dynamic evolution of acute type A IMH pre-operative accurate indications and the proper surgical strategy maybe the keys for success.

Objective To discuss the correlation between serum uric acid (SUA) level and the severity of coronary borderline lesions in acute coronary syndrome (ACS) and the prognosis of percutaneous coronary intervention (PCI).Methods The 192 patients who were diagnosed as coronary borderline lesions in ACS and PCI were measured.All Patients were divided into two groups:hyperuricemia group and normal SUA group.The severity of coronary arterial lesions and flow in PCI was compared.The cardiac function changes and incidence of major adverse cardiovascular events (MACE) were recorded.Results The results of correlation analysis showed the positive correlation of SUA level and Gensini score (r =0.710,P ＜ 0.05).Patients with hyperuricemia group had a significantly higher prevalence of no-reflow on angiography,in-hospital and six-month prevalence of MACEs compared with the normal SUA group (P ＜ 0.05).The UA on admission has an independent association with coronary slow flow following primary PCI and in-hospital MACEs among patients with ACS (P ＜ 0.05).Conclusion The patients has higher the level of SUA of ACS borderline lesions patients will has more serious the coronary arterial lesions.The risk of coronary slow flow increased in the patients complicated with hyperuricemia who underwent PCI.

Paraneoplastic pemphigus is a rare autoimmune bullous dermatosis, which is caused by potential neoplasm, especially the Castleman's disease. Castleman's disease associated with paraneoplastic pemphigus is misdiagnosed frequently and easily in clinical practices. Furthermore, it is reported that the mortality rate for this disease is very high. Bronchiolitis obliterans is the most common complication and the most important cause of death. There was a female patient presenting recalcitrant mucocutaneous erosions, ulcers and scattered erythemas in the body. The patient was diagnosed and treated for pemphigus vulgaris with little success in Xiangya Hospital, Central South University in January 2015. Further investigations confirmed the diagnosis of paraneoplastic pemphigus with retroperitoneal tumor. Subsequently, the patient was treated with tumor resection in combination with intravenous immunoglobulin and corticosteroids. The pathology revealed that it was the Castleman's disease. Her mucocutaneous performance recovered obviously and the bronchiolitis obliteran did not appear in the follow-up. Castleman's disease associated with paraneoplastic pemphigus should be considered when mucosal and skin lesions showing no improvement under corticosteroids. Early and complete removal of the tumor together with immunotherapy could be beneficial to the patient's prognosis.
Adrenal Cortex Hormones ; therapeutic use ; Castleman Disease ; complications ; therapy ; Female ; Humans ; Immunoglobulins, Intravenous ; therapeutic use ; Paraneoplastic Syndromes ; complications ; therapy ; Pemphigus ; complications ; therapy ; Retroperitoneal Space ; pathology

Objective To observe the change of serum smooth muscle myosin heavy chain (smMHC) level in the patients with aortic dissection (AD),and evaluate the effect of smMHC in the early diagnosis and prognosis of AD.Methods Forty-two patients with AD were selected as AD group,30 healthy subjects were selected as control group.Blood samples were collected at four time periods (within 3 h of onset,6 h,12 h,24 h),and serum smMHC level were measured by enzyme-linked immunosorbent assay.Results Serum smMHC level of AD group,which collected (within 3 h of onset,6 h,12 h) were significantly higher than that of control group [(88.6 ±21.7),(59.4 ± 18.7),(41.3 ± 10.7) ng/L vs.(17.2 ± 8.3) ng/L,P ＜ 0.01].There was no significant difference between the serum smMHC level of AD group and control group at 24 h after onset [(18.9 ±9.5) ng/L vs.(17.2 ±8.3) ng/L,P ＞ 0.05].Serum smMHC level of Stanford A type group (25 cases) was higher than that of Stanford B type group (17 cases) within 3 h of onset [(95.4 ± 17.8) ng/L vs.(78.5 ± 18.3) ng/L,P＜0.01],and there was no significant difference bewteen the two groups which collected at 6,12 h and 24 h after onset (P ＞ 0.05).Preoperative serum smMHC level was significantly higher than that after intracavitary isolation operation [(58.6 ± 15.9) ng/L vs.(30.1 ± 12.5) ng/L,P ＜ 0.01].Serum smMHC level decreased rapidly after the operation,and there was no significant difference between the two grougs when 12 h after operation [(18.7 ± 8.9) ng/L vs.(17.2 ± 8.3) ng/L,P ＞ 0.05].The serum smMHC level of the deaths (7 cases),which collected within 3 h of onset,6 h,12 h,was significantly higher than that of the survivors (35 cases) [(101.2 ± 20.7) ng/L vs.(86.1 ± 18.9) ng/L,(65.2 ± 16.7) ng/L vs.(58.2 ± 14.2) ng/L,(50.4 ± 10.8) ng/L vs.(39.5 ± 8.3) ng/L,P ＜ 0.05],and there was no significant difference at 24 h after onset (P ＞ 0.05).Detecting serum smMHC level within 3 h of onset,the area under the receiver operating characteristic curve was 0.913,with 51.7 ng/L as a diagnostic critical value,sensitivity and specificity respectively was 88.1％ (37/42) and 96.7％ (29/30).When detecting at 6 h after onset,the area under the curve was 0.865,with 38.5 ng/L as a diagnostic critical value,sensitivity and specificity respectively was 90.4％(38/42) and 90.0％ (27/30).Conclusions The level of serum smMHC in patients with AD increase rapidly after onset,and detecting serum smMHC level within 6 h of onset have important clinical significance in early diagnosis and prognosis of AD.

Objective To evaluate the effect of the noxious stimulation factor on γ-aminobutyric acid (GABA) distribution in dog spinal cord during propofol anesthesia.Methods Sixteen healthy mongrel dogs of both sexes,aged 12-18 months,weighing 10-12 kg,were randomly divided into 2 groups (n =8 each):noxious stimulation group (S group) and control group (C group).Anesthesia was induced with propofol 7 mg/kg.The animals were mechanically ventilated after tracheal intubation.Right femoral artery was cannulated for mean arterial pressure (MAP) and pulse rate monitoring.Anesthesia was maintained with propofol infusion at a constant rate of 70 mg· kg-1 · h-1.5 ％ formalin 300 μl was subcutaneously injected into the central region of tails in group S,while the equal volume of normal saline was injected instead of formalin in group C.MAP and pulse rate were recorded before injection of formalin or normal saline (T1) and after injection of formalin or normal saline (T2).The dogs were scarified by decapitation at 50 min of continuous propofol infusion and cervical 2-3 segments of the spinal cord were removed for determination of GABA level in different regions of the spinal cord (frontal horn,posterior horn,intermediate zone,frontal funiculus,posterior funiculus and lateral funiculus) by HPLC.Results MAP and pulse rate were significantly higher at T2 than at T1 in S group (P ＜ 0.05).There were no significant differences in GABA level among the different regions of the spinal cord in C group (P ＞ 0.05).Compared with C group,GABA level in the frontal horn and posterior horn was significantly increased (P ＜ 0.05),and no significant change was found in the other regions of the spinal cord in S group (P ＞ 0.05).Conclusion The noxious stimulation factor can induce an increase in GABA level in the frontal horn and posterior horn of dog spinal cord during propofol anesthesia.

OBJECTIVE: To investigate the application of identification techniques of the recurrent laryngeal nerve (RLN) in endothyroidectomies. METHODS: Routine identification of the RLN was performed in a series of 20 consecutive endothyroidectomies, and the clinical data were reviewed. RESULTS: Totally 20 RLNs were dissected. Neither transient nor permanent RLN injury occurred. CONCLUSION To expose RLN, both sharp and blunt dissection should be applied skillfully. Thorough liberation of the thyroid lobe is essential for the identification of RLN. It is safe and feasible to remove the thyroid and identify the RLN simultaneously.
Adult ; Endoscopy ; methods ; Female ; Humans ; Intraoperative Complications ; prevention & control ; Male ; Middle Aged ; Recurrent Laryngeal Nerve ; Recurrent Laryngeal Nerve Injuries ; Thyroid Neoplasms ; surgery ; Thyroid Nodule ; surgery ; Thyroidectomy ; methods ; Vocal Cord Paralysis ; prevention & control

Objective To investigate the value of magnetic resonance (MR) imaging for diagnosing typeⅠ congenital choledochocele and its complications. Methods The MR imaging data of 13 cases with proved typeⅠ congenital choledochocele associated with complications were retrospectively reviewed and compared with operative findings. MR imaging sequences included axial T2W and T1W plain scan, true-FISP coronal images, 2D-MRCP, and Gd-enhanced T1W images. Results All patients had cystic dilatation of the common bile ducts to various degrees. In 6 patients complicated with stone and infection, the bile duct showed uniform wall thickening with marked enhancement, and calculus were depicted within the duct lumen with dilatation of the proximal biliary duct. In 7 cases complicated with carcinoma of biliary duct, a polypoid soft tissue mass or nodule was seen inside the ductal lumen in 3 cases, or the duct wall was irregularly thickened in 4 patients. Six cases received curative operation, but one patient with extensive local infiltration, vascular encasement and lymphadenopathy had only palliative treatment. MR imaging observations were verified by surgery findings in all 13 patients. Conclusion MR imaging is very valuable not only in diagnosing typeⅠ congenital choledochocele, but also in revealing its complications.