Objective: To describe 3D-TOF MRA features of anomalous vertebral artery(VA) and evaluate its clinical significance in healthy adults who were accepted physical examination. Methods: A total of 442 cases in which 3D-TOF MRA was performed were retrospectively reviewed to discuss the incidence and relationship between VA origin and course variation. Results: Among this 442 cases, the incidence of origin variation was 4.75%(21/442) in which all cases were unilateral(19 cases in the left and 2 cases in the right). In these cases, the anomalous VA originated from the aortic arch or the right common carotid artery. All of the 21 cases with origin variation had the aberrant entrance position into the transverse foramen (4th or 5th). The incidence of abnormal entrance position into the transverse foramen was 9.50%(42/442),of which most cases(95.24%, 40/42)were unilateral. Of 40 cases, the incidence of both sides was the same(50.00%(20/40)). Conclusion: The VA origin variation always happened in the left side, and often combined with the course variation. 3D-TOF MRA plays an important part in the detection of the anomalous vertebral artery in healthy adults. It can provide useful information for the surgery and the therapy of related diseases.

Objective:To investigate morphologic variations of circle of Willis in healthy adults using 3D-TOF MR angiography in medical examination and its clinical significance. Methods:To analyze the characteristics of the vascular morphology in 442 healthy adults of head 3D-TOF MRA in the post processing workstation retrospectively. Results: All the 442 cases, the variations of circle of Willis were found in 152,the variations of A1, A2, ACoA, PCoA, P1 were found in 76(50.00%), 23(15.13%), 7(4.61%), 101(66.45%), 68(44.74%). The variation of A1 was positively correlated with PCoA, the variation of PCoA in female was more than in male. Conclusion:Medical examination-3D-TOF MRA has important value to display morphologic variations of circle of Willis in healthy adults, which can provide important guide value in the clinical.

OBJECTIVE To study the disinfectant resistance of multi-drug resistant Escherichia coli strains isolated clinically,and to find out the efficacy of disinfectants commonly used in killing multi-drug resistant E.coli strains.METHODS Minimal inhibitory concentration(MIC) and suspension quantitative germicidal test were used.Compared with standard strains,strains of multi-drug resistant E.coli isolated clinically were determined the resistance to four kinds of disinfectants including benzalkonium bromide etc.RESULTS A higher MIC of benzalkonium bromide compared with standard strains was observed in 61.9% of all 21 multi-drug resistant E.coli strains,and as for povidone iodine and NaClO,the ratio was 71.4% and 14.3%,respectively.All multi-drug resistant E.coli strains had the same MICs of peroxyacetic acid with standard strains.The above-mentioned 4 disinfectants commonly used at the routine concentrations killed 100% of the resistant strains of E.coli within 5 minutes.CONCLUSIONS The resistance to benzalkonium bromide and povidone iodine of multi-drug resistant E.coli isolated clinically is higher than standard strains;and 4 kinds of disinfectants commonly used are effective for multi-drug resistant E.coli strains isolated clinically.

Objective:To explore the nursing work items and the technical difficulty in post anesthesia care unit, so as to provide the basis for accurate calculation of anesthesia nursing workload and reasonable matching of human resources.Methods:The primary and secondary indicators of the nursing working system in post anesthesia care unit were determined through the literature review and group discussion. Delphi method was used to revise the indicators and evaluate the importance and difficulty degree of the indicators. Finally, analytic hierarchy process and linear weighted sum method were used to calculate the weight value and difficulty coefficient of each index.Results:The positive coefficients of the experts in the two rounds were 100.00%, the authority coefficients of the experts were 0.90 and 0.96, the variation coefficients ranged from 0.000 to 0.342 and 0.042 to 0.307, and the Kendall coefficients were 0.239 and 0.273 (both P<0.01). The evaluation index system of the difficulty of nursing work in post anesthesia care unit was finally composed of 10 primary indicators and 85 secondary indicators. The weight of the primary index ranged from 0.016 4 to 0.186 4, and the weight of the secondary index ranged from 0.000 8 to 0.064 3. The standardized difficulty coefficient of the secondary index ranged from 1.02 to 1.59. Conclusions:The evaluation index system of the difficulty of nursing work items in post anesthesia care unit was comprehensive and the difficulty coefficient was in line with the actual clinical work in this study, which provides reference for the follow-up scientific calculation of nursing workload and human resources matching in post anesthesia care unit.

Objective:To explore the effect of adult growth hormone deficiency on cognitive function in adults.Methods:A total of 19 hypophyseal or craniopharyngioma patients who underwent surgical treatment and were diagnosed with adult growth hormone deficiency in Department of Endocrinolog, the Second Affiliated Hospital, School of Medicine, Zhejiang University from June 2017 to June 2018 were selected as the case group, and 19 normal people were included as the control group. All the members were assessed with the cognitive function scale and brain functional magnetic resonance examination, data between the groups were analyzed.Results:The body weight within a year of case group was significantly increased than that of the control group( P=0.017). Compared with the control group, the case group was relatively inattentive and had decreased memory(Time of stroop color words test-a, test-c, and trail-making test-A, P values were 0.009, 0.018, 0.020 respectively; Auditory word learning test N6, P=0.008). The executive function and language ability of the case group were weakened compared with the control group(Raven′s matrices score E1-E12, P=0.022; Time cost and the number of arrivals in 1 min of connection test B, P values were 0.023, 0.004; Symbol digit modalities test, P=0.037; The number of words spoken in 46-60 s and total number in 0-60 s of the case group was less than the control, P values were 0.030, 0.006). The general mental state of the case group was worse than the control group( P=0.018). The accuracy of the 2-back task of the case group was significantly lower and the activation signal of the left frontal lobe in the case group was significantly weaker( P<0.005). Conclusions:Adult growth hormone deficiency may increase obesity risk and have a detrimental influence on patients′ overall mental health, resulting in varying degrees of cognitive impairment. Working memory impairments associated with adult growth hormone deficiency may be a result of decreased frontal lobe brain activity.