This article outlines the systematic radiological approach preoperative evaluation of perihilar cholangiocarcinoma (pCCA) using CT and MRI to provide key information regarding the suitability for curative surgical resection. It discusses older classification systems (BismuthCorlette, Memorial Sloan Kettering Cancer Center T staging) and follows the Korean Society of Abdomi­nal Radiology 2019 consensus recommendations for step-by-step assessment.The correlation between radiological, surgical, and pathological findings is illustrated through a pictorial review of pathologically proven cases. Benign and malignant mimics of pCCA are included to provide a comprehensive overview.

This article outlines the systematic radiological approach preoperative evaluation of perihilar cholangiocarcinoma (pCCA) using CT and MRI to provide key information regarding the suitability for curative surgical resection. It discusses older classification systems (BismuthCorlette, Memorial Sloan Kettering Cancer Center T staging) and follows the Korean Society of Abdomi­nal Radiology 2019 consensus recommendations for step-by-step assessment.The correlation between radiological, surgical, and pathological findings is illustrated through a pictorial review of pathologically proven cases. Benign and malignant mimics of pCCA are included to provide a comprehensive overview.

This article outlines the systematic radiological approach preoperative evaluation of perihilar cholangiocarcinoma (pCCA) using CT and MRI to provide key information regarding the suitability for curative surgical resection. It discusses older classification systems (BismuthCorlette, Memorial Sloan Kettering Cancer Center T staging) and follows the Korean Society of Abdomi­nal Radiology 2019 consensus recommendations for step-by-step assessment.The correlation between radiological, surgical, and pathological findings is illustrated through a pictorial review of pathologically proven cases. Benign and malignant mimics of pCCA are included to provide a comprehensive overview.

Objective:To build a data-driven operation and maintenance management model for large-scale medical imaging equipment,and to analyze its application value in medical equipment management.Methods:The data-driven operation and maintenance management mode of large-scale medical imaging equipment was composed of operation and maintenance management mode architecture,equipment health status monitoring management platform architecture,historical data fault diagnosis model architecture and operation and maintenance management.16 medical imaging equipment in clinical use in Chengdu Public Health Clinical Medical Center from January 2020 to February 2022 were selected,and the traditional medical imaging equipment operation and maintenance management mode(referred to as traditional mode)and data-driven large-scale medical imaging equipment operation and maintenance management mode(referred to as data-driven mode)were adopted respectively for management according to different management modes.The imaging effect of equipment image,the frequency of equipment failure,the cost effectiveness of equipment and the satisfaction score of equipment management personnel were compared between the two management modes.Results:The scores of accuracy of diagnosis results,accuracy of patient information,image position qualification rate,image clarity,image pass rate,image quality rate and total image imaging score of the data-driven model were(9.78±1.25)points,(9.88±1.11)points,(9.54±1.08)points,(9.66±1.27)points and(9.83±1.43)points,(9.86±1.63)points and(58.55±1.44)points,respectively,which were higher than those in the traditional mode,the difference was statistically significant(t=4.958,5.268,6.522,4.327,9.765,3.923,21.474,P<0.05).The self-repair and human-made failures occurred 22 times and 10 times respectively in the data-driven model,which were lower than those of the traditional model,and 24 times of long-term use faults,which was higher than that of the traditional model,the difference was statistically significant(x2=4.363,4.294,18.692,P<0.05).The satisfaction scores of radiologists,equipment maintenance personnel,imaging technicians and patients with the data-driven mode were(94.52±6.15)points,(91.19±5.35)points,(89.27±4.93)points and(92.24±5.51)points,respectively,which were higher than those of the traditional mode,the difference was statistically significant(t=6.504,5.534,6.821,9.556,P<0.05).Conclusion:The operation and maintenance management mode based on data driven of large medical imaging equipment can improve the imaging quality of imaging equipment,reduce the incidence of failure,reduce equipment maintenance and maintenance costs,and improve user satisfaction.

ObjectiveTo describe the epidemic characteristics of COVID-19 after policy adjustment from “Category B notifiable disease with category A management” to “Category B notifiable disease with category B management”， and to explore the protective effect of previous infection with SARS-CoV-2 on common symptoms of reinfection. MethodsHealthcare workers infected with SARS-CoV-2 in a grade A tertiary hospital in Shanghai were included in the study from December 4， 2022 to January 11， 2023. Data on demographic characteristics， clinical symptoms， medical history， and COVID-19 vaccination history were collected. We determined the epidemiological curve and characteristics， and then compared the difference in the severity of clinical symptoms between primary and reinfection subjects. ResultsA total of 2 704 cases were included in the study， of which 45 had reinfection， 605 （22.4%）were males， 608 （22.5%）were doctors， 1 275 （47.2%） were nurses， and 2 351 （86.9%） received ≥3 doses of COVID-19 vaccination. The average age of these healthcare workers was （34.9±9.1） years old. The number of cases with mild/moderate illness， asymptomatic infection， fever， headache， dry cough， expectoration， and chest tightness were 2 704 （100.0%）， 92 （3.4%）， 2 385 （88.2%）， 2 066 （76.4%）， 1 642 （60.7%）， 1 807 （66.8%）， and 439 （16.2%）， respectively. Reinfection was a protective factor for fever （OR=0.161， P<0.001）， headache （OR=0.320， P<0.001）， and peak body temperature （β=-0.446， P<0.001）. ConclusionFollowing the COVID-19 policy adjustment as a category B notifiable disease， healthcare workers at a grade A tertiary hospital in Shanghai predominantly experiences mild to moderate COVID-19 symptoms. Reinfection results in milder clinical manifestations， with a lower proportion of being asymptomatic.

Objective To explore the effect of applying comprehensive interventions on promoting pathogen detec-tion before antimicrobial therapy in hospitalized patients.Methods Hospitalized patients who received therapeutic use of antimicrobial agents in a tertiary first-class hospital from January 2020 to December 2021 were selected as the research subjects.Comprehensive intervention measures were implemented from January 2021.The pathogen detec-tion rates,detection classification,and detection rates of key monitored departments before antimicrobial therapy were compared between the pre-intervention group(January-December 2020)and the post-intervention group(Janu-ary-December 2021).Results A total of 10 239 hospitalized patients who received therapeutic use of antimicrobial agents were included in analysis,4 526 cases were in the pre-intervention group and 5 713 cases in the post-interven-tion group.The pathogen detection rates before antimicrobial therapy,before restricted grade antimicrobial therapy,and before special grade antimicrobial therapy after intervention were 94.56％,94.72％,and 96.03％,respective-ly,which were higher than 83.74％,84.47％,and 84.95％before intervention,with statistical significance(all P＜0.05).The detection rate of targeted pathogens after intervention was 64.87％,higher than that before interven-tion(28.04％),with statistically significant difference(P＜0.05).The pathogen detection rates before therapeutic use of antimicrobial agents in departments of critical care medicine,pulmonary and critical care medicine,pediatrics,neurosurgery,and general surgery after intervention were 93.20％,91.17％,92.20％,94.12％,and 91.15％,re-spectively,higher than the rates before intervention,namely 85.00％,82.19％,83.20％,83.33％,and 83.03％,respectively,with statistical significance(all P＜0.05).Conclusion The application of comprehensive intervention measures can improve the pathogen detection rate before antimicrobial therapy of hospitalized patients.Close atten-tion should be paid to the pathogen detection indicators related to healthcare-associated infection diagnosis and for the detection of sterile body fluid.

Objective:To construct a comprehensive evaluation model of equipment operation efficiency,and to explore its application value in process management of large medical equipment.Methods:Based on the driving-pressure-state-impact-response(DPSIR)model,22 evaluation indicators of the operation efficiency of large medical equipment were selected,and the importance of the indicators was evaluated by the composite weight evaluation method.According to the comprehensive evaluation results of the operation efficiency,the management countermeasures for optimal allocation of large medical equipment,the improvement of management processes,the technical support and the improvement of efficiency were formulated.The 61 large medical equipment in clinical use in Public Health Clinical Medical Center of Chengdu from 2019 to 2022 was selected,and the traditional demonstration mode was adopted for process management for 57 devices from 2019 to 2020,the 60 devices(including 56 in the traditional demonstration mode and 4 new ones)from 2021 to 2022 adopted comprehensive evaluation mode for process management.The comprehensive evaluation index,the increase in operating benefit and the recognition of equipment use were compared between the two management modes of large medical equipment.Results:The operation benefit closeness and comprehensive coordination index of large medical equipment managed by comprehensive evaluation mode were(0.91±0.03)and(0.89±0.05),respectively,which were higher than those of the traditional demonstration mode,and the obstacle factor was(0.30±0.09),which was lower than that of the traditional demonstration mode,the difference was statistically significant(t=3.387,3.539,2.912,P<0.05).The increases of the cost-effectiveness,service benefit and development benefit of large medical equipment managed by comprehensive evaluation mode were(2.72±0.97)%,(3.16±0.97)%and(3.90±1.26)%,which were higher than those of traditional demonstration mode,the difference was statistically significant(t=3.428,4.130,4.135,P<0.05).The average scores of the recognition of users for the basic allocation,operation quality,service effect and management level of large medical equipment managed by comprehensive evaluation mode were(90.93±4.26)points,(92.14±4.32)points,(89.75±3.93)points and(92.67±2.94)points,respectively,which were higher than those of the traditional demonstration mode,the difference was statistically significant(t=4.042,5.294,4.438,6.142,P<0.05).Conclusion:The comprehensive evaluation model can improve the process management quality of large medical equipment,improve the operation efficiency of large medical equipment,and improve the recognition of the use of the use of large medical equipment.

Myasthenia gravis (MG) is mainly acetylcholine receptor antibody-mediated acquired autoimmune disease that affects the postsynaptic membrane at the neuromuscular junction. The predominant manifestation is muscle weakness. Extraocular muscles are frequently affected in the early stage of disease with typical symptoms of intermittent drooping of the upper eyelid (ptosis) and double vision (diplopia), which is easy to be misdiagnosed as an ophthalmic disease. When the weakness of the face, bulbar, neck and limb muscles occur, it needs to be differentiated from a variety of diseases. Other clinical disorders can present in a similar fashion and may be mistakenly labeled as MG. This paper summarizes the epidemiology, etiology, pathogenesis, clinical manifestations, classification, auxiliary examination, diagnosis, differential diagnosis, and treatment progress of MG, which can be used as a reference for clinicians and neurologists.

Myasthenia gravis is mainly acetylcholine receptor antibody-mediated, T cells-dependent and complement participated acquired autoimmune disease characterized by impairment of the neuromuscular transmission. The main clinical feature of the disease is the presence of fatigability or muscle weakness. Most patients can be successfully managed with nonspecific immunotherapies such as corticosteroid and non-steroidal immunosuppressants. However, the side effects caused by long-term corticosteroid therapy are still a hurdle in the treatment of myasthenia gravis (MG). Oral non-steroidal immunosuppressants, as add-on therapy, can greatly reduce the relapse of the disease, but some drugs have a slow onset of action and the potential for significant toxicity, and even increase the risk of infection and neoplasms with long-term treatment. Despite these therapies, a minority of patients can be refractory because of incompletely responding or not well tolerated to available therapies. Thus, the need to avoid the use of corticosteroids, or at least reduce their use as much as possible should concern all patients with MG. Targeted immunotherapy is a therapeutic monoclonal antibody or antibody fragment targeting immune cells, complement, neonatal Fc receptor and cytokines. Recently, targeted immunotherapy has completed phase Ⅱ and Ⅲ clinical trials in patients with MG, and some of them have been approved by Food and Drug Administration. These promising biologics showed efficacy in symptoms persistent improvement, steroids reduction and were well tolerated, now evolving into powerful tools changing the algorithm of MG. This paper summarizes the results of clinical trials of new biologics in MG and looks forward to the prospect of MG treatment.

The Singapore Health Services cluster (SingHealth) radiology film archives are a valuable repository of local radiological cases dating back to the 1950s. Some of the cases in the archives are of historical medical interest, i.e. cerebral angiography in the workup of patients with hemiplegia. Other cases are of historical social interest, being conditions seen during earlier stages of Singapore's development, i.e. bound feet. The archives form a unique portal into the development of local radiology as well as the national development of Singapore. A selection from the archives is published in commemoration of the International Day of Radiology in 2020, as well as the 200th anniversary of the Singapore General Hospital in 2021. This pictorial essay comprises gastroenterology, musculoskeletal and obstetrics and gynaecology cases from the archives.