Objective:To evaluate the efficacy of compound chamomile and lidocaine hydrochloride gel in prevention of complications related to laryngeal mask airway (LMA) insertion.Methods:Ninety American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 18-60 yr, undergoing elective surgery with ventilation using LMA under general anesthesia, were divided into 3 groups ( n=30 each) using a random number table method: paraffin oil group (group A), compound lidocaine cream group (group B), and compound chamomile and lidocaine hydrochloride gel group (group C). The paraffin oil, compound lidocaine cream, and compound chamomile and lidocaine hydrochloride gel were evenly applied on the front, shoulder and back of the LMA before inserting the LMA in A, B and C groups, respectively.The severity of sore throat, oropharyngeal mucositis score, hoarseness score and occurrence in each time period (0-1 h, >1-6 h, >6-24 h, > 24-48 h) were recorded at 1, 6, 24 and 48 h after removal of the laryngeal mask.The stress responses during removal of the LMA and occurrence of drug-related adverse reactions within 48 h after removal of LMA were recorded. Results:Twenty-nine cases in group A, 28 cases in group B and 27 cases in group C completed the trial.Compared with group A, the severity of sore throat at each time point after removal of the LMA and incidence of sore throat in each time period were significantly decreased, the oropharyngeal mucositis score at 6, 24 and 48 h after removal of the LMA and the incidence of oropharyngeal mucositis in the time period >1-48 h were decreased, and the incidence of drug-related adverse reactions was increased in group C ( P<0.05). Compared with group B, the severity of sore throat at 6 h after removal of the LMA and incidence of sore throat > 1-48 h after removal of the LMA were significantly decreased, the oropharyngeal mucositis score at 6, 24 and 48 h after removal of the LMA and incidence of oropharyngeal mucositis in the time period >1-48 h after LMA removal were reduced, and the incidence of drug-related adverse reactions was decreased in group C ( P<0.05). There was no significant difference in the hoarseness score and incidence of hoarseness after removal of the LMA and incidence of stress responses during removal of the LMA among the three groups ( P>0.05). Conclusions:Compound chamomile and lidocaine hydrochloride gel has a certain efficacy in preventing complications related to LMA placement.

Objective:To investigate the feasibility and clinical value of MRI quantitative evaluation technique in detecting sternocleidomastoid muscle fibrosis in patients with nasopharyngeal carcinoma (NPC) after radiotherapy.Methods:From August 2019 to March 2021, 45 patients with clinically confirmed NPC after radiotherapy and 30 healthy controls who underwent physical examination in Lishui Hospital of Zhejiang University were enrolled in our study. According to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC) classification criteria of late radiation reactions respectively, the sternocleidomastoid muscle injury in the NPC group was divided into grade Ⅰ, Ⅱ and Ⅲ, which included 8, 32 and 5 patients respectively. All patients underwent T 1 mapping and T 2 mapping imaging of the neck. Firstly, the mapping images of sternocleidomastoid muscle between the two groups were analyzed and compared. Using NUMARIS/4 software of Siemens image post-processing workstation, the region of interest was manually drawn along the edge of sternocleidomastoid muscle at the level of laryngeal chamber in axial mapping diagram. Then, T 1 and T 2 values and the long and short diameters of sternocleidomastoid muscle were measured respectively. Finally, the differences of the parameters between the two groups were compared by independent sample t-test, Spearman rank correlation was used to analyze the relationship between the average T 1 and T 2 values of bilateral sternocleidomastoid muscles and the grade of late radiation injury. Results:Compared with the control group, the shape of sternocleidomastoid muscle in the NPC group was smaller in shape, with irregular edge and uneven increase of T 1 mapping color scale. There was no significant difference in muscle signal in T 2 mapping. The T 1 values of left and right sternocleidomastoid muscles in the NPC group were (1 524.7±97.6) and (1 496.5±93.2) ms respectively, which were significantly higher than those in the normal control group [(1 231.5±85.3) and (1 275.9±90.9) ms] ( P<0.05), and the T 2 values of left and right sternocleidomastoid muscles in the NPC group were (28.4±4.8) and (28.4±3.6) ms respectively, which were lower than those in the normal control group [(30.4±3.5) and (30.4±3.5) ms] ( P<0.05). The long and short diameters of bilateral sternocleidomastoid muscles in the NPC group were shorter than those in the control group ( P<0.05). The average T 1 and T 2 values of bilateral sternocleidomastoid muscles in NPC patients after radiotherapy were (1 510.6±95.4) and (28.4±4.2) ms respectively, The T 1 value was positively correlated with the classification of advanced radiation injury ( r=0.78, P<0.001), and T 2 value was negatively correlated with the level of advanced radiation injury ( r=-0.87, P<0.001). Conclusion:Mapping quantitative evaluation technique can noninvasively and objectively detect and evaluate sternocleidomastoid muscle fibrosis after NPC radiotherapy, which has potential clinical application value.

Objective:To provide references for encouraging translation of medical and pharmaceutical research outcomes from a policy perspective.Methods:In view of characteristics of such translation and using policy tools, the authors introduced the innovation value chain and innovation entity chain to create a three-dimensional analysis framework. The three dimensions refer to policy tools(supply side, environment side and demand side), innovation value chain(research and development, clinical research and pilot application, and commercial industrialization), and innovation entity chain(colleges, medial institutions, enterprises, government, and third parties). A three-dimensional framework was introduced for textual quantitative analysis, centering on 70 policy documents on such translation released from 2015 to 2019.Results:Excessiveness was found in the environment side and supply side policy tools usage, while the demand side was deficient relatively; clinical research and pilot applications constitute the policy support weakness in innovation value chain; policy frequency on medical institutions and third parties was weak in the innovation entity chain dimension.Conclusions:Based on the three-dimensional framework analysis results and sector specifics, the paper proposed such policy recommendations as highlighting features of medical and pharmaceutical sector, activating incentives of hospitals and colleges, and expanding resources for clinical research.

Objective:To explore the differences in clinical and imaging features between pancreatic adenosquamous carcinoma (PASC) and pancreatic ductal adenocarcinoma (PDAC).Methods:The clinical data, imaging and pathological data of 171 patients pathologically diagnosed with PASC after surgical resection (PASC group) (from February 2011 to October 2020, 148 patients from the First Affiliated Hospital of Naval Medical University and 23 patients from the Second Affiliated Hospital of Zhejiang University School of Medicine) and 100 patients pathologically diagnosed with PDAC after surgical resection (PDAC group) (from January to June, 2018, at the First Affiliated Hospital of Naval Medical University) were retrospectively analyzed. Computed tomography and magnetic resonance imaging features were analyzed by two associate chief physician of department of radiology. Independent sample t test, rank sum test, chi-square test or Fisher exact probability test were used for statistical analysis. Multivariate logistic regression analysis was used to analyze independent predictors of PASC. Results:The longest diameter of tumor of PASC group was larger than that of PDAC group (35.0 mm (28.0 mm to 45.0 mm) vs. 29.5 mm (23.0 mm to 36.0 mm)), and the rates of cystic necrosis, ring-enhancement, normal distal main pancreatic duct and normal pancreatic parenchyma of PASC group were higher than those of PDAC group (62.0%, 106/171 vs. 12.0%, 12/100; 66.1%, 113/171 vs. 25.0%, 25/100; 52.0%, 89/171 vs. 12.0%, 12/100; 70.2%, 120/171 vs. 29.0%, 29/100, respectively); and the differences were statistically significant ( Z=-4.001, χ2=72.183, 42.612, 43.284 and 43.221, all P<0.01). The results of multivariate logistic regression analysis showed that the cystic necrosis, ring-enhancement, normal distal main pancreatic duct and normal pancreatic parenchyma were indenpendent predictors of PASC (odds ratio=10.083, 2.361, 3.086 and 2.632, 95% confidence interval 8.736 to 11.639, 2.096 to 2.660, 2.605 to 3.656 and 2.267 to 3.057, all P<0.01); and the sensitivity for PASC diagnosis was 62.0%, 66.1%, 51.7% and 70.3%, respectively; the specificity was 88.0%, 75.0%, 88.0% and 71.0%, respectively; the positive predictive value was 89.3%, 81.9%, 88.1% and 80.5%, respectively. Conclusions:PASC and PDAC have similar clinical features. The imaging features of cystic necrosis, ring-enhancement, normal distal main pancreatic duct and normal pancreatic parenchyma are independent predictive factors of PASC.

Pancreatic cancer is a highly malignant tumor and surgical resection is the only curative treatment option. In order to improve the prognosis of patients with pancreatic cancer, it is very important to diagnose and evaluate pancreatic cancer accurately and early. Imaging examinations play an important role in tumor detection, staging and surgical resectability evaluation, which can provide reliable evidences for diagnosis and treatment of pancreatic cancer. At present, the imaging techniques commonly used for diagnosis of pancreatic cancer include conventional ultrasound, endoscopic ultrasonography, PET-CT, multi-detector row CT (MDCT), magnetic resonance imaging (MRI), in which MDCT and MRI are the most widely used. In this article, the application and research progress of imaging in accurate diagnosis and evaluation of pancreatic cancer are reviewed.

Objective To investigate the application value of percutaneous sinus-tract cholangioscopy in the diagnosis and treatment of residual intra-and extra-hepatic bile duct stones.Methods The retrospective cross-sectional study was conducted.The clinical data of 1 045 patients with intra-and extra-hepatic bile duct stones who underwent percutaneous sinus-tract cholangioscopy or stone extraction in the Second Affiliated Hospital of Zhejiang University from January 2003 to June 2016 were collected.Patients received percutaneous sinus-tract cholangioscopy or stone extraction at 6-8 weeks after T tube drainage.Observation indicators:(1) diagnosis and stone extraction situstions:cases with residual stones,stone extraction frequency and clearance rate;the critics of clearance rate are no residual stone dnring operation combined with B ultrasound or T-tube cholangiography;(2) postoperative complications:incidence and management of postoperative complications,prognosis and ClavienDindo classification for postoperative complication;(3) follow-up situation.T-tube was removed when there was no residual stone.Patients were followed up by outpatient examination up to April 2017.B ultrasound reexamination was performed to detect the recurrence of stone once every 3-6 months.Results (1) Diagnosis and stone extraction situstions:among 1 045 patients,results of cholangioscopy showed 147 wihout bile duct stones and 898with bile duct stones.Of 898 patients,2 618 times cholangioscopic explorations for stone extraction were performed,with a maximum frequency of 16 times,and 851 had stones clearance,with a overall clearance rate of 94.77％(851/898).The clearance rates of extra-and intra-hepatic bile duct stones were 100.00％(221/221) and 93.06％(630/677).Of 47 patients with residual stones,16 didn't receive cholangioscopy due to branches stricture or occlusion of intrahepatic duct,13 failed to take out stone due to T-tube dislodgement (9 cases) and improper placement (4 cases) induced closed T-tube sinus tract,7 had T-tube sinus tract duodenal fistula,6 gave up stone extraction,3 was due to longer sinus tract induced bending and 2 was due to T-tube sinus tract fracture.(2)Postoperative complications:among 1 045 patients,297 had level Ⅰ-Ⅱ mild complications and 13 had level Ⅲand above severe complications.The common complications included fever,vomiting,diarrhea and so on;the special complications included T-tube sinus tract duodenal fistula of 13 patients,T-tube sinus tract fracture of 4 patients,rupture of broken stones pole of 3 patients,massive hemobilia of 2 patients,acute pancreatitis of 2patients and cardiac arrest of 1 patient.The above complications were improved by symptomatic and supportive treatments.(3) Follow-up situation:among 1 045 patients,558 received long-term follow-up,with follow-up time of 10-171 months and a median time of 79 months.Eight-four patients had stone recurrence.Of 13 patients with recurrence of extrahepatic bile duct stones,7 took out stones by endoscopic retrograde cholangio pancreatography (ERCP) and 6 underwent reoperations.Of 71 patients with recurrence of intrahepatic bile duct stones,43underwent reoperations and 28 received conservative treatment.Conclusions Percutaneous sinus-tract cholangioscopy for residual intra-and extra-hepatic bile duct stones is safe and effective,with good diagnosis and treatment values and a high clerance rate.The integrity of T-tube sinus-tract is a key of complete stones removal.

Pancreatic cancer is an invasive malignant tumor with a high mortality rate. As the preferred imaging method for pancreatic imaging, multi-slice CT angiography can evaluate the presence or absence, extent, and degree of invasion of peripancreatic major vessels to provide reliable evidence for tumor staging and surgical resectability evaluation. As an important supplementary method of CT, magnetic resonance imaging has an important guiding value in disease diagnosis, liver metastasis, and prognostic evaluation. Vascular invasion of pancreatic cancer is the main indicator for preoperative evaluation of respectability. Lymph node metastasis, distant metastasis, neural invasion of pancreatic cancer, and hepatic artery abnormalities are influencing factors for patients′ prognosis. It is pointed out that preoperative imaging evaluation for patients with pancreatic cancer has guiding significance for the development of treatment regimens, selection of surgical procedures, and prognostic evaluation.

Objective To investigate the manifestations and diagnostic value of imaging examinations in pancreatic cystic neoplasm. Methods Clinical data of 95 patients with pancreatic cystic neoplasm who were admitted to the Second Affiliated Hospital, College of Medical Sciences, Zhejiang University between January 2014 and December 2015 were retrospectively analyzed. Among the patients, 37 were males and 58 were females, aged 10-80 years old with a median age of 54 years old. Sixteen cases were diagnosed with serous cystic neoplasm (SCN), 11 with mutinous cystic neoplasm (MCN), 21 with intraductal papillary mucinous neoplasm (IPMN), 12 with cystic solid pseudopapillary neoplasm (SPN), 24 with cystic pancreatic neuroendocrine neoplasm (PNEN) and 11 with cystic pancreatic adenocarcinoma. The informed consents of all patients were obtained and the local ethical committee approval was received. Computed tomography (CT) and magnetic resonance imaging (MRI) manifestations of the patients with pancreatic cystic neoplasm were analyzed, and the diagnostic accuracy was calculated. Results SCN was characterized with multiple small cysts. MCN was characterized with a clear border, single lumen and thick wall lesion, mainly occurred in the pancreatic body and tail. IPMN was characterized with lesions connected to the main pancreatic duct. Dilation of varying degrees in the main and branch pancreatic duct dilation were observed. Cystic SPN was characterized with gradual enhancement, but the enhancement intensity was lower than that of pancreatic parenchyma. Cystic PNEN was characterized with evident enhancement in arterial phase. Cystic pancreatic adenocarcinoma was characterized with insufficient blood supply complicated with surrounding tissue invasiveness or distal metastasis. The diagnostic accuracy of CT and MRI was the lowest for SCN (29% for CT and 14% for MRI), and highest for cystic PNEN (89%for CT and 100% for MRI). Conclusions Due to the nonspecific clinical manifestations of pancreatic cystic neoplasm, imaging examination remains the main method for the diagnosis. It has high value for the diagnosis of most pancreatic cystic neoplasms and the differential diagnosis between benign and malignant tumors.

Objective To determine the expression of sodium-hydrogen exchanger (NHE) 1 in gastric carcinoma tissue,and investigate the relationship between NHE1 expression and clinicopathological characteristics.Methods The expression levels of NHE1 mRNA and protein were detected in both gastric carcinoma tissue (48 cases) and paraneoplastic tissue (40 cases) by reverse transcription polymerase chain reaction (RT-PCR) and Western blot.The relationship between the expression levels of NHE1 mRNA and protein and the clinicopathological characteristics was analyzed.Results The relative expression levels of NHE1 mRNA and protein in gastric carcinoma tissue were 0.791 ± 0.286 and 1.475 ± 0.142,in paraneoplastic tissue were 0.352 ± 0.069 and 0.329 ± 0.048,and there were statistical differences (P ＜ 0.01).The expression level of NHE1 mRNA was positively correlated with NHE 1 protein in the gastric carcinoma tissue (r =0.375,P ＜ 0.05).The expression levels of NHE1 mRNA and protein were associated with the depth of invasion,lymph node metastasis and TNM staging (P ＜ 0.05).However,the expression levels of NHE1 mRNA and protein were no associated with age,gender and tumor differentiation (P ＞ 0.05).Conclusion The expression levels of NHE1 mRNA and protein are significantly up-regulated in gastric carcinoma tissue,which may be involved in the development of gastric carcinoma.

To summarize the imaging characteristic of parotid lymphoepithelial carcinoma (LEC) by retrospective analyses of computed tomography (CT) and magnetic resonance imaging (MRI) findings for 6 cases of parotid LEC confirmed by operation and pathology and review the relevant literatures.All lesions were located in unilateral parotid.There were single (n =5) and multi-module fusion (n =1).All were located in superficial lobe of parotid gland.And deep lobe (3/6) was involved.An infiltration of casting shape was found along superficial parotid (4/6).There was an irregular margin with small spines,uniform density and signal and above moderate enhancement.An infiltration of casting shape along superficial lobe,uniform density and signal and rich blood supply suggest a diagnosis of LEC.