Objective:To investigate the feasibility of MRI measurement for normal fetal aortic arch isthmus diameter and ductus arteriosus diameter between 20 to 36 weeks of gestation and analyze its relationship with gestational age.Methods:This retrospective study enrolled 257 pregnant women with an unclear fetal four-chamber view in prenatal ultrasonography, whose following fetal MRI examination results showed no structural cardiac abnormalities, in Shanghai Children's Medical Center Affiliated to the Medical College of Shanghai Jiaotong University from June 2018 to June 2020. Postnatal echocardiography confirmed cardiac structures were normal in all cases. MRI images were reviewed to measure the diameter of the aortic arch isthmus, defined as the aortic arch isthmus's central diameter, in the transverse section of the aortic arch in steady-state free precession sequence imaging and the diameter of ductus arteriosus near the descending aorta. The average values were calculated after repeating each measurement three times. The 5th, 50th and 95th percentiles and their 95% CI of the aortic arch isthmus diameter and the ductus arteriosus diameter corresponding to different gestational age and the mean value and its 95% CI of the ratio of the aortic arch isthmus diameter to the ductus arteriosus diameter were calculated. Pearson correlation analysis and regression analysis were used to evaluate the relationship of the aortic arch isthmus diameter and the ductus arteriosus diameter with gestational age. Results:The regression equation between the aortic arch isthmus diameter and gestational age was as follows: the aortic arch isthmus diameter (mm) =-2.85+0.22×gestational age (weeks), and there was a positive linear correlation between them ( R2=0.737, P<0.001). The 50th percentile of the aortic arch isthmus diameter was 1.8-3.5 mm at 20-28 weeks and 3.5-5.0 mm at 28-36 weeks. The regression equation between the diameter of ductus arteriosus and gestational age was as follows: the diameter of ductus arteriosus (mm) =-2.17+0.19×gestational age (weeks), and a positive linear correlation between them was revealed ( R2=0.606, P<0.001). The 50th percentile of the diameter of ductus arteriosus was 2.0-3.5 mm at 20-28 weeks and 3.2-4.8 mm at 28-36 weeks. The 95% CI for the ratios of the aortic arch isthmus diameter to the ductus arteriosus diameter at 20, 22, 24, 26, 28, 30, 32, 34 and 36 weeks of gestation were 0.8-1.1, 0.8-1.0, 0.8-1.0, 0.8-1.3, 0.8-1.5, 0.9-1.5, 0.9-1.7, 0.9-1.1 and 1.0-1.3, respectively, and were all close to 1. Conclusions:It is feasible to measure fetal aortic arch isthmus diameter and ductus arteriosus diameter at 20-36 weeks of gestation in MRI, and both measurements have a linear correlation with gestational age.

Objective To facilitate a better understanding of the progress in the research, diagnosis and treatment of Peutz Jeghers syndrome (PJS).Methods Almost all the papers related to PJS from various magazines published in English and Chinese in recent years were reviewed. Current progresses in PJS research and related diagnosis and treatment were discussed in this review.Results PJS is a rare inherited disease with autosomal dominant trait, which is characterized by the presence of hamartomatous gastrointestinal polyps and mucocutaneous pigmentation of the lips, buccal mucosa, and digits. This syndrome is commonly complicated with intestinal obstruction, bleeding, or intussusception,and patients with this disease are at high risk for the development of both GI and extraintestinal malignancies. STK11 on chromosome 19p13.3 are responsible for most cases of PJS. The polyps of PJS tend to have a high incidence of malignant change, and the recurrence of malignancy after treatment is also high. Conclusion The STK11 has been identified as one of the main genes responsible for PJS and has close correlation with formation and development of tumors. Patients with PJS are at high risk for the development of both GI and extraintestinal malignancies.

Objective To analyze and compare the long-term therapeutic effect and image changes of conservative therapy versus lumbar discectomy for lumbar disc herniation to provide valid reference for its clinical treatment. Methods The clinical data from 182 patients with single-level lumbar disc herniation, who were treated from January 1983 to June 2008 and followed-up for more than 10 years, were analyzed retrospectively. These patients were divided into conservative treatment (CT) group (n=73) with a mean follow-up time of 17.61±3.87 years, and surgery group (n=109) with a mean follow up time of 17.17±3.47 years. In the CT group, 49 patients were male, 24 female; there were 44 patients with L4-L5 disc herniation, and 29 L5-S1 disc herniation. In 109 patients in the surgery group, 71 were male, 38 female; 68 had L4-L5 disc herniation, 41 had L5-S1 disc herniation, and all of them received lumbar discectomy. The long-term therapeutic effects were reviewed and compared retrospectively in the two groups, including clinical manifestations, image changes, neurofunctional evaluation, height of morbid intervertebral space, adjacent segment intervertebral space and the incidence of cephalad adjacent segment degeneration. Results Eight of 73 patients received lumbar spinal canal decompression because of intermittent claudication in the CT group, and 13 in surgery group underwent resurgery for recurrent lumbar disc herniation. At final follow up, the height of morbid intervertebral space (0.62±0.15cm)in surgery group was significantly lower than that in CT group (0.69±0.13cm, P<0.05), the Oswestry score (23.9%±6.3% in surgery group, 23.3%±6.5% in CT group) and height of adjacent segment intervertebral space (0.83±0.11cm in surgery group, and 0.82±0.11cm in CT group) were statistically compared, and no significant difference was found between the two groups. Five patients in CT group and 9 in surgery group were found to have degenerative instability by imaging, however, none of them presented obvious clinical symptoms. According to UCLA criteria, cephalad adjacent segment degeneration occurred in 8 patients (12%) of CT group, and in 23 (22%) of surgery group, and the incidence of cephalad adjacent segment degeneration was significantly higher in surgery group than in CT group (P<0.05). Conclusions The height of morbid intervertebral space is remarkably lower, and less of them trigger clinical symptom from adjacent segment degeneration in patients treated with lumbar discectomy. Both conservative therapy and lumbar discectomy can obtain better long-term results for lumbar disc herniation.

Objective To investigate the effects of duration of active phase on delivery mode and pregnancy outcome.Methods Data of 417 women with abnormal active phase identified from 1744 term-birth,singleton,cephalic presentation primiparas who had tried vaginal delivery in Peking University First Hospital from January 1,2009 to December 31,2009 were retrospectively studied.Effects of different durations of protracted active phase on pregnancy outcomes were compared between women with vaginal delivery or cesarean section by Chi square test.Results The incidence of protracted active phase was 23.9％ (417/1744); and the incidence of prolonged active phase was 2.9％ (50/1744).There were 205 cases of cesarean section and 212 cases of vaginal deliveries.The incidence of neonates hospitalization in Department of Pediatrics in vaginal delivery group with active phase ≥6 h was higher than that of those with active phase ＜6 h [20.6％ (26/126) vs 8.1％ (7/86),x2 =6.07,P＜0.05].The incidence of intrauterine infection in cesarean section group with active phase ＜6 h were higher than that of those with active phase ≥6 h [22.7％ (30/132) vs 6.8％(5/73),x2 =8.37,P＜0.01].In vaginal group with protracted active phase before 6 cm of cervical dilation,the incidences of postpartum hemorrhage (4.8％,9/186),maternal complications (3.8％,7/186) and neonates hospitalization (15.6％,29/186) were similar with those after 6 cm of cervical dilation [6.2％ (1/16),x2=0.12; 0.0％ (0/16),x2=0.01 and 12.5％ (2/16),x2=0.00; all P＞0.05] respectively.In cesarean delivery group with cervical dilation ≥6 cm,the incidence of neonates hospitalization was higher than that of those with cervical dilation ＜6 cm [60.0％ (6/10) vs 19.9％ (34/171),x2 =8.83,P＜0.05].There were no difference in maternal age,gestational age,body mass index at delivery,volume of postpartum hemorrhage and neonatal birth weight between women with cesarean section whose protracted active phase ≥4 h or ＜4 h when cervical dilation at 3 cm (P＞ 0.05 respectively).The incidence of neonates hospitalization was low in women whose indication of cesarean section was protracted active phase (11.2％,9/80),while it was high when protracted active phase complicated with intrauterine infection (42.1％,16/38).Conclusions Protracted active phase with cervical dilation less than 6 cm might not need active management if neither the mother nor the fetus is compromised.The infants born vaginally should be closely monitored if the active phase is over 6 h.

Objective To evaluate the safety, feasibility and curative effect of mini-incision ex-ploration of common bile duct. Methods In this study, 290 patients underwent min-incision explora-tion of common bile duct and 120 patients underwent open-incision exploration of common bile duct for bile duct stones and/or gallstones from 2005 to 2007. The iatrogenic bile duct injury, postoperative complication, residual stone, stone recurrence,therapeutic effect and clinical data were evaluated by randomized contrast analysis. Results Time of operation, bleeding, volume of drain pipe, time of re-covery of intestinal peristalsis and average duration in hospital were significantly lower in the group of min-incision exploration(MCE) than in the group of open-incision exploration(OCE). The iatrogentic bile duct injury occurred in 5 cases(1.72%), residual stone in 10 cases(3.45%), stone recurrence in 15 cases(5.18%) in the group of MCE, and in 2 cases(1.67%), 4 cases(3. 33%) and 6 cases respec-tively in the group of OCE. There was no marked difference between the two groups. Howevert post-operative complications occurred in 17 cases(6.8%) and 16(13.3%) in the group of MCE and OCE,respectively. There was remarkable difference between the 2 groups(P<0. 05). Conclusion Mini-in-cision exploration of common bile duct is a feasible and safe method resulting in fewer complications of iatrogentic bile duct injury, stone recurrence and residual stone.

Objective To explore the application and effect of scene imitation method in the education of patients before fiberoptic bronchoscopy.Methods 264 elective bronchoscopy patients between March 2007 and Decembet 2007 were randomly divided into control group(120 patients)and the experiment group(144 patients)Traditional health education was applied in the control group before bronehoscopy.Scene imitation method in health education was applied in the experiment group before bronchoscopy.Results The examination succes rate in the experiment group was significantly improved(P＜0.05).The medical order obeying behavior(MOOB)of the patients was significantly different between the two group(P＜0.01).Conclusion Before the use of fiberoptic bronchoscopy,the new scene simulation method Can help patients on the list obtain more cognitive ability about the testing.Comparing the traditional education,it establishes a sound relationship between doctors and patients,reduces complication and leads to more accurency of testing,thus helping patients to recover soon.

Carcinosarcoma ; Female ; Humans ; Maxillary Sinus Neoplasms ; Middle Aged

Carcinoembryonic Antigen ; analysis ; Humans ; Luminescence

[Objective]To discuss the failure and countermeasure of Ni-Ti shape memory alloy fixer for treatment of limb fracture.[Method]A retrospective survey was performed in 259 cases with fracture treated by Ni-Ti shape memory alloy fixer.Eight cases of the fixer had been ruptured,risen,loosen after operation.[Result]The failure case of Ni-Ti shape memory alloy fixer for treatment of limb fracture were 8 case in 259 case.There were one case of ulna and two cases of femur fracture had be ruptured after the first operation,healing up after the second operation.The fixer has been risen of shoulder bone and femur fracture in each one and two cases of clavicle,the fracture has be malformation concrescence.One case of patella fracture was loosn after concrescence.[Conclusion]The requisite for Ni-Ti shape memory alloy fixer is needed for treatment of limb fracture,the right operation's condition,the best type and length are selected for different part,the convalescent exercise is regnired after operation to avoid failure of treatment.

[Objective]To compare the reliability and value of clinical signs,MRI imaging and arthroscopy in management of meniscal tears in order to increase the diagnostic rate.[Method]A retrospective study was done on 176 cases undergoing MRI examination and arthroscopic treatment,and being diagnosed as meniscal injuries in knee joint by any one of the three clinical,MRI or arthroscopic examinations.Using arthroscopic diagnosis as the standard,the sensitivity,specificity.and overall accuracy of clinical diagnosis and MRI were then calculated respectively.Significant differences between arthroscopic diagnosis and clinical diagnosis or MRI diagnosis were analyzed using statistical method of Chi-square test.[Result]The sensitivity,specificity and accuracy of clinical diagnosis were 79.3%,26.3% and 73.8% respectively.There was statistically significant difference between arthroscopic diagnosis and clinical diagnosis.The sensitivity,specificity and accuracy of MRI diagnosis were 94.1%,92.9% and 93.4% respectively.The difference between arthroscopic diagnosis and MRI diagnosis had no statistically significance and can be used as an important examination before knee arthroscopy.[Conclusion]MRI is a reliable,noninvasive diagnostic tool for meniscal tears and can be used as an important examination before knee arthros copy with MRI examination combining with the clinical signs,diagnotic rate of meniscal tears can be increased.Unnecessary arthroscopic therapy could be avoided.