Objective To describe the echocardiographic and clinical findings of patients with accessory mitral valve(AMV).Methods Four adult patients were diagnosed to have AMV by Doppler echocardiography.Results All the four patients had cardiac murmur but 2 were asymptomatic.Echocardiogram showed that two cases had isolated AMV with significant left ventricular outflow tract (LVOT)obstruction.Another patient was complicated by idiopathic hypertrophic subaortic stenosis and his systolic pressure gradient across the LVOT reduced to normal after taking negative inotropic drugs.The fourth patient was associated with complex congenital cardiac anomalies but without LVOT obstruction.Conclusions AMV may not be very rare as previously reported.An echocardiographic examination Can detect AMV and difierentiate it from other causes of LVOT obstruction.

Objective To evaluate the role of transeso phageal echocardiography(TEE) before chemical or electric cardioversion for non-vulvular atrial fibrillation. Methods Forty-three patients, confirmed non-vulvular atrial fibrillation, undertook anticoagulation or anti-platelet therapy and transthoracic echocardiography and TEE less than 24-48 hours prior to cardioversion. Results Two thrombi in the left atrial appendage and three spontaneous echo contrasts in the left atrium were evidenced. After anticoagulation or anti-platelet therapy, 39 patients undertook cardioversion therapy. Among them,31 patients received drug cardioversion,success in 19,and failure in 12;8 patients received electric cardioversion,success in 6,and failure in 2. There were no thromboembolic events during the hospitalization. Conclusions TEE performed before cardioversion for atrial fibrillation is necessary to reduce the risks of thromboembolic events and to guide for anticoagulation therapy.

Objective To evaluate the efficacy of a new micro-bubble contrast agent of C_3F_8 in the opacification of the left ventricle. Methods Seven pigs received a bolus injection of C_3F_8 (0.002) and (0.02) (ml/kg) intravenously. Left ventricular opacification grades and number of endocardial border delineation segments were observed and left ventricular ejection fraction(LVEF) were measured using modified Simpson method after each intravenous contrast injection. Heart rate and respiration rate were recorded before and after each injection. Results There was a significant improvement for every measurement of contrast enhancement in each intravenous injection. In addition, part of myocardial tissue could be enhanced after contrast injection. There was no difference in heart rate and respiration rate between pre- and post-injection. Conclusions This new contrast agent is safe and helpful in delineating endocardial border of the left ventricle.

Objective To determine the accuracy and usefulness of dobutamine stress echocardiography(DSE) in detecting restenosis after percutaneous coronary intervention (PCI). Methods DSE was conducted in 47 patients before coronary angiography, 6 months to 18 months after PCI. The standard protocol of DSE was 5,10,20,30 ?g?kg~(-1)?min~(-1) with subsequent incremental increases every 3 minutes to a maximum dose of 40 ?g?kg~(-1)?min~(-1). Consistency of the results was compared between DSE and coronary angiography.Results Compared with coronary angiographic results, DSE had a low sensitivity(64%) but high specificity(86%) for detection of restenosis after PCI. The total accuracy was 72%. Conclusions DSE can assess restenosis after PCI with lower cost and safety.

Objective To assess the radial systolic function of left ventricle(LV) in patients with dilated cardiomyopathy(DCM) by velocity vector imaging(VVI).Methods Sixteen patients with DCM and twenty control subjects were detected by VVI.VVI data were collected from the six basal segments and six mid segments in parastenal LV short axis views.The radial systolic velocity(V) ,strain(ε) ,strain rate(SR),the time to peak systolic velocity(PTV) and the time to maximum strain(PTε) were measured with special software.The differene of the earliest and the latest time to peak velocity(T-max) and the standard deviation of time to peak velocity(T-SD) of 12 segments were calculated.Results Compared to the controlled group,patients with DCM had significantly lower radial V,ε and SR (P ＜0.01) in all the 12 segments,significantly longer PTV and PTε (P ＜ 0.05) in most segments, and significantly larger T-max and T-SD (P ＜0.05).Conclusions VVI is useful to assess the abnormalities in LV radial movement in patients with DCM and could provide more information about regional cardiac function.

BJ-DRGs grouping process was cited as an example, to describe the factors affecting the grouping process, grouping results and assessment results, and the solutions in transferring homepages into WJT form 4-1 for inpatient medical record homepages (WJT form 4-1 for short).Authors analyzed how to better information acquisition quality of such homepages by unifying the data interface standard of WJT form 4-1, for the purposes of enhancing BJ-DRGs grouping efficiency, and expanding its functions as a tool for medical quality management and that for medical insurance payment management.

Objective To assecess the role of CT in the diagnosis and the reasons of misdiagnosis of biliary duct carcinoma.Methods 23 cases with biliary duct carcinoma pathologically comfirmed were reviewed.Results 2 cases were peripheral type,10 cases were major intrahepatic biliary duct type,7 cases were extrahepatic type and 4 cases ampullar type.The masses within biliary duct were showed by CT in 16 cases.The obstruction of biliary duct was cut off abruptly in 18 cases and narrowing sharply in 5 cases.The intrahepatic biliary duct indicated mild or marked expansion,of them,17 cases were showed as vine and 6 as segmental.The extrahepatic biliary duct were dilated in 11 and gallbladder dilatation in 7.4 cases were misdiagnosed and leaked diagnosis was in one cases by CT preoperation.Conclusion CT is valuable in diagnosis of biliary duct carcinoma,but it still has some limitations.

Objective To investigate the anti- inflammatory and analgesic a ctions of Huangqi Guizhi Wuwu Decoction (HGWD) and its compositions and to study its rule of compatibility.Methods Analgesic action of HGWD and its compositio ns were observed by hot- plate method and acetic- acid- induced body twist me thod. Anti- inflammatory action of HGWD and its compositions were observed on t he models of xylene- induced auricular swelling in mice, celiac capillary perme ability in mice, cotton- induced granuloma in rats, albumem- induced arthritis and adjuvant arthritis in rats.Results HGWD and its drug pairs could inhibit the acute inflammation induced by albumen and xylene and rat adjuvant arthriti, decrease the celiac capillary permeability, inhibit the proliferation of granu loma, increase the pain threshold in mice and reduce the frequencies of body tw ist induced by acetic acid.Conclusion HGWD has significant anti- inflammatory and analgesic actions, so does single drug; Radix Astragali alone, but when Ra dix Astragali is used with the other drugs in HGWD, its effect can be enhanced.

Objective To analyze the imaging characteristics of hepatic involvement in Langerhans cell histiocytosis(LCH) in children on MRCP, MRI and CT. Methods Twenty-nine children from three children hospitals in China, who were diagnosed as hepatic involvement by disseminated LCH during Aug 2008 and Jan 2015 were included in this study. Their MRCP (n=16), MRI (n=22), contrast?enhanced CT (n=15) data were retrospectively analyzed. The stenoses and dilatation of the intrahepatic bile ducts, the common hepatic bile duct and its first order branches and the common bile duct were evaluated on the MRCP image. The size and shape of the liver, the imaging characteristics of the periportal lesions in the Glisson sheath and hepatic parenchymal lesions were also evaluated on the cross?sectional images. Results MRCP indicated alternative stenoses/dilatation of the bile duct tree (n=16), stenoses of the common hepatic duct and its first?order branches (n=15), partialindistinctness of the common bile duct (n=2) and multiple cystic lesions along the biliary tree (n=5). On the cross?sectional images, the periportal lesions in the Glisson sheath were observed in 28 children. On MRI, the periportal lesions were shown in all the 22 children with MRI, presented as hypo-signal intensity on T1WI, hyper?signal intensity on T2WI (n=11) or mixed?signal intensity on T1WI and T2WI (n=11); On CT, the periportal lesions were found in 14 of the 15 children with CT, presenting as low density (n=13) and mixed density (n=1). Multiple nodular or cyst?like parenchymal lesions were observed in 21 patients including 18 patients on MRI and 5 patients on enhanced CT. Sixteen patients presented as hypo?intensity on T1WI, hyper?intensity on T2WI and low density on plain CT, and 5 patients with iso? or hypo?intensity on T1WI, hypo?intensity on T2WI,and milder enhancement relative to the adjacent parenchyma on contrast?enhanced CT. Conclusions The imaging characteristics of hepatic involvement by LCH include alternative stenoses and dilatation of the intrahepatic ducts, stenoses of the common hepatic bile duct and its first?order branches on MRCP, the periportal lesions in the Glisson sheath and hepatic parenchymal nodular or cyst?like lesions on cross?sectional images.

Neurofibroma is an autosomal dominant genetic disease which is originated from the abnormal differentiation of neural crest cells and would cause system damage.NF can occur at most organs in the body,while it is rarely seen in the common bile duct.In February 2007,1 old patients with NF was admitted to the Lishui Central Hospital of Zhejiang Province.The results of preoperative magnetic resonance cholangiopancreatography (MRCP) revealed that the common bile duct was slightly dilated,and the diameter of the common bile duct was 1.2 cm.A nodular short T2 signal lesion was detected at the middle part of the common bile duct with the size of 1.4 cm × 1.6 cm.The results of intraoperative rapid frozen section pathological examination showed that the lesion was cholangiocarcinoma,then cholangiocarcinoma resection + biliojejunal Roux-en-Y anastomosis was applied to the patient.Postoperative pathological examination confirmed that the lesion was neurofibroma.The patient was followed up for 7 years and died of pulmonary infection in June 2014.The clinical presentation of neurofibroma of the common bile duct is untypical.Space-occupying lesions detected in the patients with history of bile duct injury or operation should be considered to be diagnosed as neurofibroma.Special attention should be paid to the accuracy of the results of rapid frozen section pathological examination in order to avoid missdiagnosis.