To analyze the clinical data and imaging examination data of a patient with metallic mercury poisoning from subcutaneous injection. The abdominal B-ultrasonograph results of the patient indicated multiple scattered hyperechoic spots accompanied by "comet tail" sign in the liver and right renal sinus, the nature of which was not clear and it was considered crystal deposition. The chest X-ray revealed scattered and multiple spot-like, snowflake-like and tree-cast-like high-density shadows in both lung fields. The chest computed tomography scan revealed multiple spot and patchy high-density shadows distributed in both lungs, considering hematogenous distribution deposits, and possible mercury poisoning. Laboratory test results showed that blood mercury level was 4.16 μmol/L and urine mercury level was 6 545.5 μg/g Cr. After 28 days of mercury chelation therapy, the abdominal ultrasound examination showed that the hyperechoic spots in the liver and right renal sinus were reduced compared with the previous examination. Metallic mercury poisoning from subcutaneous injection has specific manifestations in abdominal B-ultrasound imaging, which can provide a basis for the early diagnosis of metallic mercury poisoning in clinical practice and can be used to observe the efficacy of mercury chelation therapy.

Objective:To explore the application and preliminary evaluation of multidisciplinary rounds (MDRs) in the clinical teaching of urology.Methods:A total of 20 pediatrics medical students in the clinical medicine were selected as the control group, and the traditional single department teaching rounds were used. Another 20 clinical medical students in the same grade were taken as the experimental group, and MDRs were used. The teaching officer of urology served as the general ward round teacher, combined with nephrology physicians and imaging ultrasound physicians to conduct bedside teaching rounds, and the length of the rounds was about 60 to 90 minutes. Through the teaching evaluation form and the test scores, the effect of teaching ward rounds was evaluated. SPSS 21.0 was used for statistical evaluation data, and the unpaired t-test was performed to make comparison between groups. Results:In terms of theoretical test, the average score of students in the experimental group was (92.15±0.60), which was higher than that in the control group (90.05±0.71), and the difference was statistically significant ( P=0.030). In the experimental group, 95.0%(19/20) of the medical students affirmed the MDRs model, and 100% of them thought it was necessary to introduce this model in clinical teaching. Conclusion:MDRs are patient-centered, emphasize interdisciplinary cooperation, and are operable, which deepens the understanding of medical students on urological diseases, promotes the exchange of clinical teaching experience between urology and interdisciplinary research, and improves the quality of teaching.

Objective:To summarize the experience of radiation oncology residency training programs in western coutries, and provide evidence to improve the present Phase-I Radiation Oncology Residency Training Programs in China.Methods:An electronic questionnaire-based survey was conducted among residents and staffs in 6 top cancer centers in China and 5 centers from Europe and North America to collect their feedback regarding the description and comparison of different programs.Results:A total of 70 responses and 4 papers explaining relevant training programs from 26 residents and 23 teachers in Chinese hopsitals and 20 residents and 1 teacher from Europe and North America were received. The Radiation Oncology Residency Training Programs in China were designed into 2 phases, and the results in the current study were involved with the first phase. Program designs were similar in the following aspects: goal, clinical practice-based training, rotation curriculum, interim and final assessment. However, the total timeframe in the investigated Chinese Phase-I programs was shorter than that in western hospitals (2 to 3 years vs. 4 to 5 years). Chinese programs covered major common diseases, whereas rotation design was performed based on each individual disease in western programs. In Chinese programs, the working hours were mainly 40-60 h every week. Although the working hours were commensurate with local workforce regulations, the residents from MSK program had an outstanding longer working time of 60-80 h every week and treated more patients compared with other programs. Conclusions:The investigated Phase-I Radiation Oncology Residency Training Programs in 6 top cancer centers in China share common features in goals, training modes and assessments with western programs. However, our programs have shorter timeframe and less detailed requirements in individual disease than the western programs.

PURPOSE: The aim of this study is to evaluate the prognostic significance of paranasal sinus invasion for nasopharyngeal carcinoma (NPC) and its suitable position in the T classification. MATERIALS AND METHODS: The magnetic resonance imaging (MRI) scans of 695 patients with previously untreated, biopsy-proven, non-metastatic NPC that was treated with intensity-modulated radiotherapy (IMRT) were reviewed retrospectively. RESULTS: The incidence of paranasal sinus invasion was 39.4% (274 of 695 patients). Multivariate analysis showed that paranasal sinus invasion was an independent negative prognostic factor for local failure-free survival (LFFS) (p < 0.05). According to the eighth American Joint Committee on Cancer (AJCC) staging system, 275 patients were classified as T3 classification. Of these, 78 patients (28.4%) developed paranasal sinus invasion (T3b) and 197 (71.6%) didn't (T3a). The estimated 5-year LFFS and overall survival (OS) rates for the patients with T3b and T3a classification were 88.6% versus 95.0% (p=0.047), and 84.5% versus 93.3% (p=0.183), respectively. The estimated 5-year LFFS and OS rates for the patientswith T4 classificationwere 89.5% and 83.2%,whichwere similarwith the outcomes of patients with T3b classification. CONCLUSION: MRI-determined paranasal sinus invasion is an independent prognostic factor of NPC treated by IMRT. Paranasal sinus invasion is recommended to classify as T4 classification in the 8th AJCC staging system for NPC.
Classification ; Humans ; Incidence ; Joints ; Magnetic Resonance Imaging ; Multivariate Analysis ; Paranasal Sinuses ; Radiotherapy, Intensity-Modulated* ; Retrospective Studies

Objective To explore the impact of oral nutritional supplements in the local advanced nasopharyngeal carcinoma patients receiving chemoradiotherapy. Methods From 2016 to 2018, we prospectively collected 114 patients into our study, including intervention group ( n=58) and control group ( n=56) . Patients in the intervention group were given oral nutritional supplements from the beginning of radiotherapy, while the control group patients were receiving usual diet care. We collected data of weight, hematological index and nutrition related information before, during and after treatments. Results All patients experienced weight loss during radiotherapy. The declining trend was more obvious in intervention group but with no statistical difference ( P>0.05) . Radiotherapy interruption was lower, completion rate of 2 cycles of concurrent chemotherapy was higher( 78% vs 64%, P=0.02) and level of total serum protein and albumin was more stable ( P=0.003, 0.001) in the intervention group. No difference was found in acute toxicities between the two groups ( P>0.05) . During the treatment period, the nutrition risk screening score declined, more patients with NRS 2002 ≥3 in the control group than the intervention group ( P<0.05) , while no statistically significant difference was found in PG-SGA between the two groups ( P>0.05 ) . Conclusions Oral nutritional supplements can improve treatment tolerance and keep the stability of serum protein level, nevertheless, it has no obvious advantage in maintenance of weight and short-term nutritional status

Background and purpose:The application of intensity-modulated radiotherapy (IMRT) has improved the local control rate of nasopharyngeal carcinoma greatly, which changed the predictive value of T classiifca-tions of TNM staging system. This study aimed to validate the predictive effect of T classiifcations in the 7th Union for International Cancer Control (UICC) staging system and discuss the simpliifcation of T classiifcations.Methods:We retrospectively reviewed the clinical data of 641 primary nasopharyngeal carcinoma patients at our center from January 2007 to June 2011. We evaluated the predictive effect of T classiifcations by Kaplan-Meier method and Cox regression model.Results:The 5-year overall survival (OS), local relapse-free survival (LRFS), progression-free survival (PFS) and distant metastasis free survival (DMFS) were 85.4%, 88.5%, 78% and 87.1%, respectively. The 5-year OS of T1, T2, T3 and T4 categories were 91.6%, 85.3%, 90.1% and 76.5%, respectively; LRFS were 93%, 85.3%, 91.5% and 84.4%; PFS were 88.2%, 77.3%, 80.8% and 70.9%; DMFS were 95.1%, 88.9%, 88.2% and 81.3%, respectively. The difference in survival curves between T1, T2 and T3 were not signiifcant (P>0.05). However, several prognostic indexes were signiifcantly different between T4 and T1, T2, T3. We merged the T1, T2 and T3 classiifcations as new T1, and the T4 classiifcation as new T2. The 5-year OS of new T1 and T2 were 89.1% and 76.5% (P=0.001); LRFS were 90.1% and 84.4% (P=0.028); PFS were 81% and 70.9% (P=0.001); DMFS were 90.8% and 81.2% (P=0.002). The survival curves were substantially separated. The simpliifed T classiifcations had obvious advantages when separately analyzed in different N stages.Conclusion:In the era of IMRT, the predictive effect of T classiifcations of the 7th UICC staging system has diminished. The simpliifcation of T classiifcations can ift with the new treatment and provide a better surviv-al prediction.

We herein overviewed the history,achievement and plan of the twelfth-five program for the development of key medical disciplines in Zhejiang Province.We summarized the practice and characteristics of establishing of the key medical discipline in the Zhejiang Province,and a systemic survey was conducted on the effectiveness of the program.We then proposed several improvements strategies including academic training,multidiscipline coordination,and fund managements to eventually establish the new pattern of discipline development.

Objective To evaluate the changes of right ventricular (RV) volume and function by using single beat real-time three dimensional (3-D) echocardiography in patients with atrial septal defect (ASD) before and after percutaneous closure. Methods During the period from July 2011 to Oct. 2013, a total of 45 patients with pure ostium secundum defect were admitted to authors’ hospital to receive percutaneous transcatheter closer. The patients were divided into ASD without pulmonary hypertension (PH) group (group A, n = 28) and ASD with PH group (group B, n = 17). By using 3-D echocardiography and right cardiac catheterization, the right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume (RVESV), right ventricular stroke volume (RVSV), right ventricular ejection fraction (RVEF), right ventricular cardiac output (RVCO), pulmonary artery systolic pressure (PASP) and the mean pulmonary artery pressure (mPAP) were determined before and after the percutaneous transcatheter closer. The results were compared between the two groups. Results After the treatment a statistically significant reduction in RVEDV, RVESV, RVSV and RVCO were seen in all patients (P < 0.05). In group A, RVEF decreased significantly after ASD closure when compared with that determined before transcatheter closer (P < 0.05), while no significant reduction in RVEF was seen in group B (P > 0.05). Pulmonary artery pressure (PAP) decreased significantly in group B after ASD closure when compared with that obtained before Objective To evaluate the changes of right ventricular (RV) volume and function by using single beat real-time three dimensional (3-D) echocardiography in patients with atrial septal defect (ASD) before and after percutaneous closure. Methods During the period from July 2011 to Oct. 2013, a total of 45 patients with pure ostium secundum defect were admitted to authors’ hospital to receive percutaneous transcatheter closer. The patients were divided into ASD without pulmonary hypertension (PH) group (group A, n = 28) and ASD with PH group (group B, n = 17). By using 3-D echocardiography and right cardiac catheterization, the right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume (RVESV), right ventricular stroke volume (RVSV), right ventricular ejection fraction (RVEF), right ventricular cardiac output (RVCO), pulmonary artery systolic pressure (PASP) and the mean pulmonary artery pressure (mPAP) were determined before and after the percutaneous transcatheter closer. The results were compared between the two groups. Results After the treatment a statistically significant reduction in RVEDV, RVESV, RVSV and RVCO were seen in all patients (P < 0.05). In group A, RVEF decreased significantly after ASD closure when compared with that determined before transcatheter closer (P < 0.05), while no significant reduction in RVEF was seen in group B (P > 0.05). Pulmonary artery pressure (PAP) decreased significantly in group B after ASD closure when compared with that obtained before transcatheter closer (P < 0.05). Conclusion Single beat real-time 3-D echocardiography is a newly-developed technique. This technique can quickly and accurately assess the right ventricular volume and function. Right ventricular volume will decrease after ASD closer. In ASD patients without PH the right ventricular function will decrease after ASD closer, while in ASD patients with PH the right ventricular function shows no changes after ASD closer although their PAP will decrease.

Objective To discuss curative effect of comprehensive nursing intervention on patients with chronic heart failure (CHF) during rehabilitation. Methods Eighty-four cases of patients with CHF were selected and divided into routine nursing group and nursing intervention group at random. The patients in two groups were given routine drug medical treatment in Department of Medicine,and the patients in routine nursing group and nursing intervention group were given routine nursing and comprehensive nursing respectively for 6 months. The changes of compliance, heart function improvement and nursing satisfactory of patients in two groups were observed. Results After 6 months' inter-vention,the total treatment compliance rate of patients in nursing intervention group was much higher than that in rou-tine nursing group (95.24% vs 78.57%),the difference was significant(χ2=5.13, P<0.05). The total treatment compli-ance rates of patients in two groups obviously rose than before after 6 minutes' walking test (P<0.05 or P<0.01),and the rising rate in nursing intervention group was much higher than that in control group (P<0.05). The service at-titude,technique level,health education,caring for patients,mental support and other nursing satisfactory of patients in nursing intervention group were all much higher than those in routine nursing group (P<0.05 or P<0.01). Conclusion Comprehensive nursing intervention has reliable curative effect on patients with CHF during rehabilitation, which can enhance the treatment compliance of patients, improve the heart function,stabilize the condition of illness, motivate the early rehabilitation and increase the nursing satisfaction.

Objective To investigate the changes of right ventricular(RV) volume and function in patients with atrial septal de-fect(ASD) .Methods 31 patients with ASD-type secundum(ASD group) and 30 age-matched controls(control group) were includ-ed .Single beat real-time three dimensional echocardiography (sbRT3DE) were performed in all to evaluate right ventricular volume and function ,then right venrtricular cardiac output(RVCO) were calculated with heart rate .Further correlative analysis was calcu-lated between right ventricular volume and function parameters of the ASD group and ASD size and the patient′s age .Results Right ventricular end-systolic volume(RVESV) ,right ventricular end-diastolic volume(RVEDV) ,right ventricular stroke volume (RVSV) ,right ventricular ejection fraction(RVEF) ,RVCO of the ASD group were significantly higher than that of control group (P<0 .001) .The maximum diameter of ASD had positive relation with RVESV ,RVEDV ,RVSV ,RVCO(r=0 .55 ,P<0 .01 ;r=0 .61 ,P<0 .01 ;r=0 .63 ,P<0 .01;r=0 .61 ,P<0 .01 ,respectively ) ,and was best correlation with RVSV .But ,there was no signifi-cant correlation between the maximum diameter of ASD and RVEF (r=0 .00 ,P>0 .05) .The patients′age had positive relation with RVESV ,RVEDV ,RVSV(r=0 .53 ,P<0 .01 ;r=0 .48 ,P<0 .01 ;r=0 .41 ,P<0 .01 ,respectively) ,had negtive relation with RVEF (r= -0 .44 ,P<0 .05) ,while there was no significant correlation between the patient′s age and RVCO(r=0 .26 ,P>0 .05) .Conclu-sion sbRT3DE is a fast and accurate new technology in evaluating RV volume and function .Atrial level left-to-right shunt leading to an increase in RV volume ,RV enlargement produces myocardial contractility .RV volume increases with ASD size ,then RV func-tion was enhanced .RV volume increases with patient′s age ,RV function is relatively lower .