Objective To explore the value of clinical features combined with 3-D reconstruction of multi-slice spiral CT in diagnosis of foreign body in trachea or bronchus in children. Methods The data of 52 children diagnosed of foreign body in trachea or bronchus were retrospectively reviewed. Both clinical features and 3-D reconstruction of multi-slice spiral CT were analyzed and summarized. Results In 52 children included ( 35 males and 17 females), 82 . 7%were under 3 years old. 30 children has repeated coughing and wheezing as the principal manifestation while 22 children presented with burst irritating and cough as primary manifestation. The main clinical signs were the asymmetry of pulmonary respiration ( 43 cases), wheeze ( 32 cases) and moist rale ( 29 cases). The positive rate of 3-D reconstruction of multi-slice spiral CT was 100%and consistent with the results of surgery. Among them, 5 cases were embedded in the trachea, 27 cases in the right bronchus, and 20 cases in the left bronchus. The main complications were emphysema ( 38 cases), bronchitis and pneumonia (32 cases), and pulmonary atelectasis (5 cases). Conclusion The combination of clinical features and 3-D reconstruction of multi-slice spiral CT can provide a reliable basis for the diagnosis of foreign body in trachea or bronchus in children.

The correlation between lipids and stroke is complex. The levels of serum total cholesterol can increase the risk of stroke no matter it is too high or too low. Low-density lipoprotein is the risk factor of atherosclerotic stroke, while high-density lipoprotein is its protective factor. Triglyceride is closely associated with ischemic stroke. This article reviews the relationship between lipids and stroke, as well as the role of lipid-modulating therapy in the prevention and treatment of stroke.

Aortic Valve ; Aortic Valve Insufficiency ; congenital ; Heart Defects, Congenital ; Heart Valve Diseases ; Humans

Objective:To analyze ultrasonic and clinical manifestation of noncompaction of the ventricular myocardi‐um (NVM) in order to guide clinical early diagnosis and treatment .Methods :Echocardiographic manifestations of 36 NVM patients were observed .Combined with electrocardiogram (ECG) ,cardiac MRI and coronary angiography (CAG) etc .,clinical manifestations of NVM were comprehensively analyzed .Results:Multiple coarse trabecular muscles and deep crypts among them were founded in heart chamber in all cases .Color Doppler showed that blood flow inside the crypts communicated with blood flow in heart chamber ,there were 33 cases (91.6% ) of left ventri‐cle type and three cases (8.4% ) of right ventricle type .Different types of abnormal ECG existed in all cases and at‐rial fibrillation occupied the largest proportion (50% ,18/36) .Some MRI results were accorded with those of ultra‐sound .In most cases ,CAG didn′t show coronary stenosis .Conclusion : Echocardiography is most convenient and effective examination ,which can provide important basis for diagnosis and treatment of noncompaction of ventricular myocardium .

Objective To assess the relative value of individual positions in the functional departments of a general hospital in Beijing,for reference of improving the salary allocation system and fine management of human resources.Methods The expert consultation method and International Position Evaluation system were used to quantitatively assess the tasks,work difficulty,size of responsibility and the qualifications required for every.Results A total of 38 experts contributed to this research which studied 140 positions including all functional departments of this hospital.The department having the most positions is the finance department(17)and the least is the Youth League committee(1).The position scoring the highest(805)was the director of medical affairs department;that scoring the lowest(263)was the food and beverage service positions of the diet and nutrition department.There was an evident turning point at score 547.Conclusions Functional departments′ position setting of this hospital proves reasonable,and the assessment scoring can reflect the value of the position in related dimensions.The result can be used as reference indexes for the hospital to perfect its human resource management system and improve the remuneration precision.

Objective To evaluate the effect of self-treatment and observe the change of heart morphology and function in patients with Keshan disease by echocardiography.Methods The left atrium diameter(LAd),left ventricular end-diastolic diameter(LVEDd),the thickness of interventricular septum in end diastolic(IVSTd),the thickness of left ventricular posterior wall in end-diastolic(LVPWTd),the left ventricular mass(LVM),the left ventricular mass index(LVMI),the relative wall thickness(RWT),the left ventricular ejection fraction(LVEF)and the mitral valve flow E/A ratio(E/A)were measured before the self treatment by echocardiography,and also measured on the 3rd month and 6th month after self-treatment with the same method,and observed the change of the parameters above.Results The LAd,LVEDd,IVSTd,LVPWTd,LVM,LVMI and RWT decreased on the 3rd month after self-treatment compared with prior self-treatment,and decreased on the 6th month further.There was significant difference between the prior self-treatment and post self-treatment(P＜0.05).The mitral valve flow E/A ratio and LVEF increased on the post self-treatment compared with the prior self-treatment slightly,but there was no statistical difference(P＞0.05).Conclusions Left ventricular hypertrophy and remodeling in patients with Keshan disease were prevented and reversed,and the cardiac function were improved after the self-treatment.Echocardiography can be used to evaluate the effect of self-treatment on patients with Keshan disease and can provide direction for clinical treatment.

Objective To investigate the safety, efficacy and key points of technology of endovascular embolization for ruptured wide-necked aneurysms of anterior communicating arteries. Methods The clinical, DSA imaging, interventional treatment and follow-up data of 35 patients with ruptured wide-neck aneurysms of anterior communicating arteries were analyzed retrospectively. Results Immediate postoperative angiography of the 35 patients found 100% occlusion were achieved in 29 (82.9%), 90% occlusion were achieved in 5 (14.3%), and 80%occlusion was achieved in 1 (2.8%). One patient had occlusion in ipsilateral anterior cerebral artery , whose blood vessel was patent after thrombosis. One patient had intraoperative aneurysm rupture. One patient had cerebral infaraction of anterior cerebral artery after the operation. Clinical follow-up was made from 6 to 60 months , and no aneurysms ruptured was found. 21 patients were followed up for 6 to 60 months with DSA. Two of them experienced recurrence, and they were not treated with supplementary packing. Conclusion Endovascular embolization for ruptured wide-necked aneurysms of anterior communicating arteries is more difficult , but it is safe and effective. Flexible choosing of various kinds of embolism technique and designing the most optimal embolism treatment plan are the keys to the improvement of embolization effect.

Objective To investigate the feasibility,efficacy and key points of individually designed endovascular embolization for ruptured tiny aneurysms of anterior communicating arteries. Methods The clinical,DSA imaging,interventional treatment and follow-up data of 21 patients with ruptured tiny aneurysms (21 aneurysms)of anterior communicating arteries from March 2009 to March 2014 were analyzed retrospectively. Thirteen of them were treated with coil embolization only,6 were embolized with microcatheter-assisted technique,and 2 were embolized with balloon-assisted technique. Results (1)One patient was failed to embolize because of technical reason. Immediate postoperative angiography found that in the other 20 patients:14 were packed densely,6 had residual aneurysm necks. (2)Intraoperative complications:One patient had acute occlusion of ipsilateral anterior cerebral artery,the blood vessel was patent after thrombolytic method;2 patients had intraoperative ruptured aneurysm. (3)The modified Rankin scale (mRS)scores of 20 patients with successful embolization at discharge:0-1 in 14 cases,2 in 4 cases, and 3-4 in 2 cases. (4)Follow-up study:20 patients were followed up for 12 months after discharge. The mRS scores:0-1 in 18 cases,2 in 1 case,and 3-4 in 1 case. Clinical follow-up for 6 to 60 months,no aneurysm ruptured. Fifteen patients were followed up for 6 to 60 months with DSA,one of them recurred,and he was treated with supplementary dense packing. Conclusion Endovascular embolization for ruptured tiny aneurysms of anterior communicating arteries is difficult,but it is feasible and effective. The proficient surgical skill,individualized surgical design and appropriate embolism are the keys to improve the embolization effect.

Objective:To investigate the intra- and inter-observer agreements of different experiencers using the Ovaria-adnexal Reporting and Data System (O-RADS) in the evaluation of adnexal masses.Methods:Totally 48 patients with adnexal masses (48 masses, mean size 9.5±4.7 cm, range 2.3-18.6 cm) found by ultrasound examination in the Third Affiliated Hospital of Sun Yat-sen University, from May 2019 to March 2020 were retrospectively analyzed. All the masses were confirmed by pathology or surgery. Four observers were divided into 2 senior doctors (Doctor 1 and Doctor 2) and 2 junior doctors (Doctor 3 and Doctor 4). Each observer independently evaluated adnexal masses twice using ultrasound O-RADS before and after systematic training, with an interval of 60 days. The intra-observer and inter-observer agreements were analyzed before and after training.Results:The inter-observer agreement between senior doctors were both excellent before and after systematic training (weight Kappa: 0.833 vs 0.802, percentage of agreement: 83.3% vs 81.3%). Whereas there was difference in the inter-observer agreement between non-experienced observers before and after training (weight Kappa: 0.399 vs 0.824, percentage of agreement: 50.0% vs 77.1%). After training, inter-observer agreement between junior doctors was significantly improved and comparable to senior (weight Kappa: 0.824 vs 0.802, percentage of agreement: 77.1% vs 81.3%). Before and after systematic training, the intra-observer agreements of the same doctor, the senior physicians were better than the junior (weight Kappa: 0.882 and 0.843 vs 0.440 and 0.605; percentage of agreement: 87.5% and 83.3% vs 58.3% and 54.2%).Conclusions:O-RADS risk classification system is a highly reproducible method in the subjective assessment of an adnexal mass among observers with varying levels of expertise. However, systematic training before clinical application is necessary and effective for non-experienced observers.

Objective:To build a three-dimensional evaluation model of single bed efficiency in an obstetrics and gynecology hospital and provide reference for bed management in hospital.Methods:The sample ward and key indicators were determined through interviews. A two-level database was built according to patients′ data from hospital information system. K-means cluster analysis was used to get the beds classified by annual average vacancy(x), annual average turnover(y) and annual average case-mix index per capita(z). The authors built the three-dimensional bed efficiency model with x, y, z as boundaries and analyzed the bed efficiency by comparing the within group average point A k( x k, y k, z k) with the overall average point A0( x, y, z). Whereafter the bed efficiency of each medical work team was analyzed. Results:Thirty-six beds were classified into 4 categories according to utilization efficiency. 50% of the beds(18 beds) were well used, 28%(10 beds) had room for improvement, and 19%(7 beds) may have resource waste. Significant differences existed in bed efficiency among medical work teams.Conclusions:The model in our study can realize in-depth exploration by evaluating bed efficiency from two aspects of the whole ward and each medical work team. This model, which is mainly applicable to the situation where beds are under the charge of fixed medical work groups or doctors, can be adjusted and extended to meet different strategic needs of hospitals.