This study aims to innovate a homogeneous outpatient service management system across multiple hospital campuses to enhance service quality.Based on the practical experience of a tertiary general hospital in Guangdong Province and in accordance with the"Interim Regulations on Outpatient Quality Management in Healthcare Institutions,"we constructed a"6+1"homogeneous outpatient service management system.This system includes:① a multi-stakeholder co-governance outpa-tient management system,②a vertical and cross-hierarchical management network,③ a democratic-centralized clinical coordina-tion strategy,④ a guidance-encouragement performance evaluation standard,⑤a collaborative dynamic supervision mechanism,⑥a spiral retrospective evaluation and improvement method,and ⑦ an integrated outpatient diagnosis and treatment system.Af-ter over two years of implementation,the hospital's outpatient volume has grown by an average of over 15％annually,patient waiting time after appointment has been reduced to 20 minutes,and patient satisfaction in the tertiary public hospital performance evaluation achieved full marks.The electronic medical record system functionality reached Level 6,significantly improving healthcare service efficiency and quality while enhancing homogeneous management across campuses.

This study aims to innovate a homogeneous outpatient service management system across multiple hospital campuses to enhance service quality.Based on the practical experience of a tertiary general hospital in Guangdong Province and in accordance with the"Interim Regulations on Outpatient Quality Management in Healthcare Institutions,"we constructed a"6+1"homogeneous outpatient service management system.This system includes:① a multi-stakeholder co-governance outpa-tient management system,②a vertical and cross-hierarchical management network,③ a democratic-centralized clinical coordina-tion strategy,④ a guidance-encouragement performance evaluation standard,⑤a collaborative dynamic supervision mechanism,⑥a spiral retrospective evaluation and improvement method,and ⑦ an integrated outpatient diagnosis and treatment system.Af-ter over two years of implementation,the hospital's outpatient volume has grown by an average of over 15％annually,patient waiting time after appointment has been reduced to 20 minutes,and patient satisfaction in the tertiary public hospital performance evaluation achieved full marks.The electronic medical record system functionality reached Level 6,significantly improving healthcare service efficiency and quality while enhancing homogeneous management across campuses.

OBJECTIVES: Hypertrophic cardiomyopathy (HCM) frequently leads to myocardial ischemia and cardiac dysfunction. Even genotype-positive/phenotype-negative (G⁺/P^-) individuals, carriers of pathogenic sarcomere gene mutations without left ventricular hypertrophy, remain at risk of progression to clinical HCM. This study aims to evaluate myocardial perfusion and contractile function in familial HCM patients and their first-degree relatives using myocardial contrast echocardiography (MCE) and velocity vector imaging (VVI), in order to identify early myocardial dysfunction and at-risk individuals within families. METHODS: Thirty-five genetically confirmed HCM patients with left ventricular hypertrophy were assigned to a G⁺/P⁺ group. A total of 30 first-degree relatives carrying sarcomere mutations but without echocardiographic evidence of left ventricular hypertrophy were assigned to a G⁺/P^- group. A total of 38 age- and sex-matched gene-negative healthy family members served as controls. All participants underwent MCE and VVI assessments. Myocardial perfusion parameters, including peak intensity (PI), time to peak concentration (TP), and the ratio of declining intensity and declining time (dI/dT), as well as strain parameters including global longitudinal strain (GLS), global radial strain (GRS), and global circumferential strain (GCS) were recorded and analyzed for differences and correlations. RESULTS: Compared to both the G⁺/P^- and normal control groups, the G⁺/P⁺ group had significantly lower PI, dI/dT, GLS, and GRS, along with significantly increased TP (all P<0.05). GLS and GRS were positively correlated with PI (r=0.629 and r=0.613, respectively; both P<0.01) and negatively correlated with TP (r=-0.597 and r=-0.571, respectively; both P<0.01). Compared to the normal control group, the G⁺/P^- group showed a significant reduction in GLS (P<0.05), but no significant differences in GRS, GCS, PI, TP, or dI/dT (all P>0.05). CONCLUSIONS Myocardial contractile dysfunction in HCM patients is closely related to impaired perfusion. Even in the absence of wall hypertrophy, sarcomere mutation carriers show early signs of subclinical left ventricular dysfunction. MCE and VVI can quantitatively assess myocardial perfusion and function, offering valuable tools for early detection and risk stratification in HCM patients and their relatives.
Humans ; Male ; Female ; Myocardial Contraction/physiology* ; Echocardiography/methods* ; Adult ; Cardiomyopathy, Hypertrophic/genetics* ; Middle Aged ; Cardiomyopathy, Hypertrophic, Familial/genetics* ; Family ; Mutation

Objective:To develop Z-scores for the aortic arch in normal fetuses as a reference for fetuses with suspected coarctation of aorta(CoA).Methods:The aortic arch inner diameters of 610 normal fetuses and 59 CoA fetuses from May 2010 to March 2015 in the Second Xiangya Hospital of Central South University were measured at the long axis of the aortic arch view. Gestational age(GA), femur length(FL) as the independent variable, the aortic arch inner diameters as the dependent variable, Z-scores were created relating the aortic arch inner diameters to the GA and FL. Z-score=[ln(measured diameter)-ln(predicted diameter)]/root MSE. Z-scores of the CoA fetuses were calculated with the above regression, and compared with the Z-scores of the control group.Results:A simple linear regression model was the best description of the data in each case and correlations between FL and the aortic arch inner diameters were excellent ( P<0.001). There was no significant difference in Z-scores calculated with FL or GA as independent variables ( P>0.05). Z-scores of the control group was between -2 and + 2, Z-scores of the CoA group was significantly lower and below -2( P<0.001). Conclusions:Z-scores of fetal aortic arch are sensitive indicators of fetal coarctation, and are of clinical importance for the diagnosis and follow-up study of CoA.

Objective:To explore the variation of renal volume with gestational age(GA), biparietal diameter(BPD), abdominal circumference(AC), femur length (FL) and the Z value calculation formula.Methods:Five hundred and eighty singleton pregnancy women from 20th to 38th gestational weeks in Second Xiangya Hospital of Central South University were enrolled. Two dimensional ultrasound was performed to record fetal growth parameters and renal longitudinal, transverse, anteroposterior diameters. Renal volume was calculated using ellipsoid volume equation: Volume =6/π×length×width×thickness. Using GA, BPD, AC, FL as independent variables and renal volume as dependent variables, the regression analyses of the mean and the standard deviation(SD) for each parameter were calculated separately. The Z-scores were calculated by the formula: Z-scores=(actual measurements of renal volume-predictive value of renal volume)/SD of predictive value.Results:Five hundred and forty-three cases of normal singleton fetuses were involved.The left and right renal volume were increased along with GA, BPD, AC, FL. Quadratic polynomial regression equations were each fitted to the models( r=0.775, 0.771, 0.811, 0.738, P<0.001; r=0.747, 0.735, 0.754, 0.745, P<0.001, respectively). The SD increased with the increases of independent variables and could be modeled with a simple linear regression( r=0.146, 0.225, 0.071, 0.155, P<0.001; r=0.091, 0.157, 0.091, 0.123, P<0.001, respectively). Z-scores were calculated and proved normally distributed after Shapiro-Wilk test( P>0.05). Conclusions:The normal Z-score reference range of fetal renal volume is established to help assess the normal renal growth and identify fetal renal abnormalities.

Objective To investigate the clinical value of prenatal diagnosis of fetal double outlet ventricle . Methods T he data of double outlet ventricle from fetal echocardiography in Second Xiangya Hospital of Central South University and Changde Women and Children Health Hospital of Hunan Province from January 2000 to August 2018 were collected . T he statistical method was used to analyze characteristics of echocardiography ,related‐intracardiac and extracardiac abnormalities ,postnatal echocardiography ,surgery and autopsy findings . Results Ninety‐four fetuses were diagnosed with double outlet ventricle ,including 84 cases of double outlet right ventricle ( DORV ) and 10 cases of double outlet left ventricle ( DOLV ) . T he pregnancy was terminated in 45 cases . Autopsy was offered to all patients after termination of pregnancy ,42 cases were consistent with prenatal diagnosis ,1 case was tetralogy of fallot ,2 cases were transposition of great artery . Forty‐nine cases were decided to continue the pregnancy ,32 cases of them were confirmed by postpartum surgery ,17 cases were confirmed by postnatal echocardiography . Echocardiographic findings of fetal double outlet ventricle was characterized by the origin of the both great arteries arising predominantly or completely( ＞50% ) from the same ventricle . Conclusions Prenatal ultrasound diagnosis of double outlet ventricular has important clinical value ,facilitate appropriate prenatal counseling and postnatal management and it should be differentiated with transposition of the great arteries ,tetralogy of fallot and ventricular septal defect .

To explore the way of prenatal echocardiography in the diagnosis of fetal double aortic arch . Methods T he data of fetuses diagnosed as double aortic arch in 6 prenatal centers in Hunan in echocardiograms performed at 20－36 weeks of gestation from 2013 to 2018 were reviewed . T he characteristics of echocardiographic with double aortic arch , and the associated malformations were observed ,the clinical outcome were analyzed . Results T he main echocardiographic features of the double aortic arch were three‐vessel‐tracheal view s ,which showed a bifurcation of the ascending aorta and a ring consisted of aortic right and left arch . From this retrospective analysis , 29 double aortic arches were identified ,which 8 cases ( 28% ) combined with cardiac defect and extracardiac abnormalities , 1 case with 22q11 deletion . Among them ,5 cases were confirmed by autopsy ,24 cases were diagnosed by computed tomography angiography ( 8 cases were confirmed by operation ) . Conclusions Systematic prenatal echocardiography in the diagnosis of fetal double aortic arch has significant clinical value in the cliagnose of double aortic arch ,w hether it is associated with other malformations and is important for assessing fetal prognosis .

Objective To explore the clinical values of the modified thoracic drainage devices that were applied in treatment of primary spontaneous pneumothorax patients who underwent single-port video-assisted thoracoscopic surgery. Methods Clinical data of 82 primary spontaneous pneumothorax patients who underwent single-port video-assisted thoracoscopic lung wedge resection and pleurodesis from January 1st, 2015 to August 31st, 2016 was analyzed retrospectively. These patients, according to the thoracic drainage devices, were divided into traditional group (Group A, n = 42) or modified group (Group B, n = 40). These statistical data, including duration of thoracic drainage, lengths of hospital stay, duration of using antibiotic, amounts of pleural drainage, scales of pain, and complications of the two groups of patients in postoperative stage, were compared. Results There was no significant differences (P > 0.05) in volumes of thoracic drainage while there were significant differences (P < 0.05) in duration of thoracic drainage, lengths of hospital stay, duration of using antibiotic, scales of pain, and complications in postoperative stage between the two groups. And patients in group B had shorter time of thoracic drainage, hospital stay, and using antibiotic, lower scales of pain and rates of complications when compared with group A. Conclusion There are some clinical values of application of modified thoracic drainage devices in treatment of primary spontaneous pneumothorax underwent single-port video-assisted thoracoscopic surgery, because of it could give the patients fast recovery and made the operations simpler.

Objective To investigate the clinical application valve of prenatal ultrasound in diagnosis of fetal isolated levocardia ( IL ) . Methods Thirty-eight IL fetuses diagnosed in three prenatal diagnosis centers from 2000 to 2016 were reviewed with their prenatal ultrasound features and cardiac and extracardiac malformations . Results Thirty-eight IL cases included 19 cases of left isomerism ( LI) ,14 cases of right isomerism( RI) and 5 non-classified cases . The overall incidence of malformations in IL patients was 97 .4％with 94 .7％ in LI patients and 100％ in RI patients . The incidence of cardiac malformations was 92 .1％with 84 .2％ in LI patients and 100％ in RI patients . The most common congenital heart diseases were:right ventricle outlet obstruction , univentricular physiology and atrioventricular septal defect . Anomalous pulmonary venous connection was more commonly seen in LI patients than in RI patients . The most common extracardiac malformation was duodenal obstruction( 86 .9％ ) . Inferior vena cava interruption and polysplenia were more commonly seen in LI patients .Juxtaposition of aorta and inferior vena cava and asplenia were more commonly seen in RI patients . Conclusions IL is very rarely seen in population with high incidence of congenital heart diseases and extracardiac malformations .