The mechanism of coronary artery thrombosis(CAT)caused by Kawasaki disease is not clear yet.Endothelial injury,hypercoagulability and hemodynamic change of coronary arteries are now considered as the main causes in recent studies.As The clinical symptom of acute thrombus caused by Kawasaki disease is un-conspicuous,cardiac ultrasound should be use actively and thrombolytic therapy should be performed within 12 hours after thrombus formation or the onset of acute myocardial infarction.Intervention or intravenous thrombol-ysis are both proved to be effective.Treatment with oral antitplatelet drugs,such as aspirin,combine with warfa-rin is suggested to relieve acute myocardial infarction in the chronic phase.The adverse reactions of antithrom-botic and anticoagulant drugs should be monitored though they are minor.

Objective To evaluate the value of dual Doppler ultrasonography in the diagnosis of fetal atrial extrasystoles.Methods Seven thousands and thirteen fetuses were examined by fetal echocardiography.If fetal arrhythmias were found,information of pulsed wave Doppler signals in hepatic vein (HV) and descending aorta (DAo) using dual Doppler were colleted simultaneously.The detected times were compared between using general Doppler and dual Doppler in 20 cases.Results On dual Doppler examination,28 of the fetuses showed signals of atrial extrasystoles,14 fetuses atrial extrasystoles conducted to ventricle,8 fetuses atrial extrasystoles non-conducted to ventricle,6 fetuses with part of the extrasystoles conducted to ventricle and part of the extrasystoles non-conducted to ventricle.No case had congenital heart disease.Twenty-six fetuses with atrial extrasystole were converted to normal rhythm within the third trimester of pregnancy,and the others' were converted to normal rhythm during the first 3 days postnatally.The detected time of dual Doppler was shorter than that of general Doppler(P ＜0.05).Conclusions Dual Doppler ultrasonography of simultaneous recordings in HV and DAo is an easy,rapid method of assessing fetal atrial extrasystoles,which should allow precise diagnosis of atrial extrasystole.

Objective To compare the value of ultrasound International Ovarian of Tumor Analysis (IOTA) simple rules and gynecologic imaging reporting and data system (GI-RADS) ultrasonographie stratification in the diagnosis of adnexal masses.Methods A total of 463 patients with adnexal masses were classified according to IOTA simple rules by senior doctor.The benign and malignant masses were enrolled in the study.Then the masses were judged according to GI-RADS classification and IOTA simple rules by senior and junior doctors.And junior doctorn in diagnosis of adnexal masses with IOTA was group A1,senior doctor in diagnosis of adnexal masses with IOTA was group B1,junior doctor in diagnosis of adnexal masses with GI-RADS was A2,senior doctor in diagnosis of adnexal masses with GI-RADS was B2.The efficacy of the two methods were compared.Results Among the 463 cases,there were 411 cases (411/463,88.77％) of benign mass and malignant mass by IOTA and 52 cases (52/463,11.23 ％) of uncertain mass.The specificity,positive predictive value,diagnostic accuracy had statistical differences between groups A2 and B2,A1 and A2 (all P＜0.05),and sensitivity and negative predictive value had no statistical differences (all P＞0.05).Diagnostic efficacy index had no statistial signifi cance between group A1 and B1,B1 and B2 (all P＞0.05).Conclusion The diagnostic efficacy of IOTA simple rules and GI-RADS is high and similar in diagnosis of benign and malignant adnexal masse.IOTA simple rules do not depend on experience,but they are not suitable for the diagnosis of all adnexal masses.

Objective To evaluate the effect of magnetic stimulation on sleep disorder of patients with sequela of brain damage.Methods 60 patients with sequela of stroke or brain injury were divided into the control group and treatment group with 30 cases in each group.All patients in two groups were treated with regular rehabilitation training,and treatment group was added with magnetic stimulation,7±2 MT,20～30 min every time,once or twice a day.The period of treatment was 12 weeks.Results After treatment,the sleep disorder of patients of the treatment group improved significantly(P<0.05).Conclusion Magnetic stimulation could improve sleep disorder of patients with sequela of brain damage.

Objectives To analyze and compare the clinical features of autonomic nervous mediated syncope (NMS) and pseudo psychogenic syncope (PPS) in children.Methods Clinical features were retrospectively analyzed in children with syncope complaint not caused by cardiac syncope, situation of syncope, drug-induced syncope, and neurogenic and metabolic diseases that caused brief loss of consciousness, and the clinical features of similarities and differences between NMS and PPS were compared. Results In 106 children with syncope were included, there were 85 cases (80.2%) of NMS, 13 cases (12.3%) of PPS, and 8 cases (7.5%) of unexplained syncope. PPS was induced by recent mental stimulation; the syncope was more frequent; the score of orthostatic intolerance was higher; the omen was rare; the duration of attack was longer. NMS was induced by long time standing, movement and body position change; the omen was mainly dizziness, blurred vision and gastrointestinal symptoms; the duration of attack was short (<5 min).Conclusions NMS is the most common cause of syncope in children, while PPS is an important cause of transient consciousness of non-syncope. There are similarities in clinical features between NMA and PPA and differential diagnosis is needed.

Objective To evaluate the value of fetal dual Doppler ultrasonography in the diagnosis of fetal arrhythmias.Methods 77 53 1 fetuses were examined by echocardiography.If fetal arrhythmias were found,information of pulsed wave Doppler signals in hepatic vein(HV) and descending aorta(DAo) using dual Doppler were collected simultaneously.Results On dual Doppler examination,13 1 of the fetuses showed signals of cardiac dysrhythmias,including 60 fetuses with irregular fetal heart rhythm but having normal heart rate,45 with tachyarrhythmias and 26 with bradyarrhythmias.Sixteen and 2 with tachy- or bradyarrhythmias fetuses complicated fetal malformation or severely maternal systemic diseases.Eighteen and 3 with tachy- or bradyarrhythmias fetuses revealed intrauterine death or intermediate pregnancy induction.The three main kinds of fetal arrhythmias had statistical differences in complicating with fetal malformation,maternal diseases,intrauterine fetal demise or intermediate pregnancy induction(all P <0.05).There was a significant difference in the accuracy of diagnosing rhythm abnormalities in the fetus between conventional ultrasonography and dual Doppler ultrasonography(k = 0.562,P < 0.05).Sixty cases of irregular fetal heart rhythm,42 cases of fetal tachyarrhythmias,and 8 cases of fetal bradyarrhythmias were changed to normal rhythm at the third-pregnancy or prenatal period through appropriate treatment.All surviving fetuses were examined by echocardiography within 3 days,without any combination of congenital heart disease,and 1 months after the delivery,the ECG were shown as sinus rhythm.Conclusions Dual Doppler ultrasonography is a precise and rapid method of assessing various types of fetal arrhythmias.Different types of fetal arrhythmias have different fetal prognosis.

Objective To study the literatures distribution and research status of the elderly tuberculosis published in the Chinese Medical Association Journals (CMAJ) from 2004-2013 in order to provide literature methodological data for the tuberculosis research.Methods The literatures on the elderly tuberculosis published in 82 kinds of CMAJs from 2004-2013 were classified and analyzed.The publication year,distribution,content,author,institution and region of these literatures were analyzed.Results There were 66 articles about the elderly tuberculosis published in 20 kinds of the Chinese Medical Association Journals.These literatures were published mostly in 2011 (16 articles,24.2％),secondly in 2012 (13 articles,19.6％) and 2010 (7 articles,10.6％),which were published mostly in Chinese Journal of Geriatrics (15 articles,22.7％).The main contents included clinical diagnosis and treatment,epidemiological investigation and drug research.The most published form was treatise (55 articles,83.3 ％).Most of the articles involved in pulmonary tuberculosis (34 articles,51.6 ％).The provinces or cities in which the most articles were published were Beijing (28 articles,42.4％) and Shandong (6 articles,9.1％).There was significantly difference in the article number between 2004-2008 and 2009-2013 (P＜ 0.05).The epidemiology,drug resistance mechanism,influencing factors,clinical characteristics,diagnosis and treatment strategy of the elderly tuberculosis,especially diagnosis and treatment development were well discussed in these literatures.Conclusions The literatures of the elderly tuberculosis published in Chinese Medical Association Journals are insufficient in quantity,with number increases of articles significantly over the past 5 years.Projects supported by the foundation is less and discipline construction should be strengthened.The distributions of authors and the primary population of tuberculosis are different,and early diagnosis and treatment of pulmonary tuberculosis in the elderly are concerned especially.

Purpose To investigate the clinicopathological features,diagnosis and differential diagnosis of myxoid synovial sarcoma (MSS).Methods Clinicopathological changes and immunophenotype were retrospectively evaluated in two MSS cases collected from Fujian Provincial Hospital,conbined with genetic mutation analysis.The relevant literatures were reviewed to explore its clinical and pathological features of this tumor.Restilts The two cases,one man and one woman,aged 71 and 15years,respectively.Tumor was located in the left down abdomen in case 1,and left frontal temporal lobe in case 2.Histopathologically,at low magnification in case 1,the tumor was nodular,which was made up of areas of hypercellularity and hypocellularity.In some areas of hypocellularity,the tumor cells were arranged in fascicular,story-form,sheet arrangements with mucoid degeneration.In hypercellularity area,the tumor cells were arranged in fascicular,fish bone-liked arrangenents.At low magnification in case 2,the tumor was nodular,which was made up of areas of hypercellularity and hypocellularity.In hypocellularity area,the tumor cells were arranged in net-like,sheet arrangements,and fascicular,sheet arrangements in case 2.In some area,the tumor cells were epithelioid with cluster distribution,without infringing brain tissue.Immunohistochemically,the tumor cells were diffusely positive for BCL-2,vimentin,and α-SMA and EMA were partially positive,while CD34,CD57,S-100,CD117,PLAP were negative.However,in case 2,only BCL-2 was positive,and MyoD1,GFAP,Olig-2,EMA,Syn,CD99,CgA,S-100,Myogenin,STAT6,CD34,desmin and α-SMA were negative.Molecular detection SYT-SSX fusion gene was detected in both cases.Conclusion MSS is a rare malignancy of soft tissue.The diagnosis of MSS depends on molecular pathology.The clinical and pathological findings are different from mucinous fibrosarcoma and solitary fibrous tumor.The treatment is surgical resection,combined with radiotherapy,with poor prognosis.