Objective:To analyze the current employment status and the reasons for not engaging in general practice among general practice residents who completed training during 2018-2020.Methods:This study was a cross-sectional study. A questionnaire survey on the current employment was conducted among general practice residents who completed redidency training from 2018 to 2020, participants were selected by stratified random sampling in 57 training centers from each 5 provinces(municipalities) of the eastern, middle and western regions in China. The reasons for not engaging in general practice were investigated through telephone contact.Results:Of the 1 037 general practice residents who responded to the questionnaire, 677 residents(65.3%, 677/1 037) were engaged in general practice after training, while 360 residents(34.7%, 360/1 037) left general practice career or were awaiting employment. The three provinces with the highest proportion of residents leaving general practice career were Hubei(76.5%, 26/360), Sichuan(74.4%, 29/360) and Shandong provinces(59.6%, 28/360). There were significant differences in proportion of residents leaving general practice career after completing the training among eastern, middle and western regions(χ 2=42.911, P<0.001). A total of 261 participants(25.2%, 261/1 037) were engaged in non-general practice clinical career like internal medicine, surgery, gynecology, pediatrics or medical imaging; and the proportion in the eastern(27.3%, 67/245) and middle(33.3%, 106/318) regions was significantly higher thant that in the western region(18.6%, 88/474)(χ 2=6.855, P<0.05; χ 2=21.651, P<0.05). Among 259(71.9%, 259/360) participants who left general practice career, the main reasons were personal choice(63.3%, 164/259) or employers′ arrangement(22.4%, 58/259); the three provinces with the highest percentage of personal choice were Hubei(92.0%, 23/25), Sichuan(85.2%, 23/27) and Henan provinces(80.0%, 20/25). The proportion of personal choice in the middle region(82.4%, 84/102) was significantly higher than that in the eastern(52.1%, 37/71) and western(50.0%, 43/86) regions(χ 2=16.799, P<0.05; χ 2=20.830, P<0.05). The three provinces with the highest proportion of employers′ arrangement were Xinjiang Uygur Autonomous Region(66.7%, 22/33), Zhejiang province(9/13), and Inner Mongolia Autonomous Region(38.5%, 10/26). The proportion of employers′ arrangement in the western region(41.9%,36/86) was significantly higher than that in the eastern(18.3%, 13/71) and middle(8.8%, 9/102) regions(χ 2=8.980, P<0.05; χ 2=26.186, P<0.05). Conclusions:The majority of general practice residents are engaged in general practice after training. The proportion of residents who left the general practice career and the related reasons in different regions are not the same.

Objective:To analyze the current employment status and the reasons for not engaging in general practice among general practice residents who completed training during 2018-2020.Methods:This study was a cross-sectional study. A questionnaire survey on the current employment was conducted among general practice residents who completed redidency training from 2018 to 2020, participants were selected by stratified random sampling in 57 training centers from each 5 provinces(municipalities) of the eastern, middle and western regions in China. The reasons for not engaging in general practice were investigated through telephone contact.Results:Of the 1 037 general practice residents who responded to the questionnaire, 677 residents(65.3%, 677/1 037) were engaged in general practice after training, while 360 residents(34.7%, 360/1 037) left general practice career or were awaiting employment. The three provinces with the highest proportion of residents leaving general practice career were Hubei(76.5%, 26/360), Sichuan(74.4%, 29/360) and Shandong provinces(59.6%, 28/360). There were significant differences in proportion of residents leaving general practice career after completing the training among eastern, middle and western regions(χ 2=42.911, P<0.001). A total of 261 participants(25.2%, 261/1 037) were engaged in non-general practice clinical career like internal medicine, surgery, gynecology, pediatrics or medical imaging; and the proportion in the eastern(27.3%, 67/245) and middle(33.3%, 106/318) regions was significantly higher thant that in the western region(18.6%, 88/474)(χ 2=6.855, P<0.05; χ 2=21.651, P<0.05). Among 259(71.9%, 259/360) participants who left general practice career, the main reasons were personal choice(63.3%, 164/259) or employers′ arrangement(22.4%, 58/259); the three provinces with the highest percentage of personal choice were Hubei(92.0%, 23/25), Sichuan(85.2%, 23/27) and Henan provinces(80.0%, 20/25). The proportion of personal choice in the middle region(82.4%, 84/102) was significantly higher than that in the eastern(52.1%, 37/71) and western(50.0%, 43/86) regions(χ 2=16.799, P<0.05; χ 2=20.830, P<0.05). The three provinces with the highest proportion of employers′ arrangement were Xinjiang Uygur Autonomous Region(66.7%, 22/33), Zhejiang province(9/13), and Inner Mongolia Autonomous Region(38.5%, 10/26). The proportion of employers′ arrangement in the western region(41.9%,36/86) was significantly higher than that in the eastern(18.3%, 13/71) and middle(8.8%, 9/102) regions(χ 2=8.980, P<0.05; χ 2=26.186, P<0.05). Conclusions:The majority of general practice residents are engaged in general practice after training. The proportion of residents who left the general practice career and the related reasons in different regions are not the same.

Objective:To survey the post competency of general practitioners who had completed residency training in China.Methods:This study was a cross-sectional survey. An online questionnaire survey was conducted among general practitioners, institution leaders and patients from January to February 2021. The participants were selected from 45 general practice residential training bases in the eastern, central and western regions of China by a combination of stratified sampling and proportional random sampling methods. The post competency self-assessment questionnaire was used for the general practitioners, and the competency evaluation questionnaire was used for institution leaders and the patients.Results:A total of 677 valid self-assessment questionnaires were returned from general practitioners, 600 from institution leaders, and 2 579 from patients. The professionalism and humanistic literacy of the self-assessment questionnaire had the highest score (4.41±0.60),and the teaching, learning and research abilities had the lowest score(3.57±0.84). There was no significant difference in the post competency score of general practitioners among different regions ( P>0.05). The highest score of general practitioners′ post competency evaluated by leaders was the professionalism and humanistic literacy (4.64±0.57), and the lowest one was the basic public health service ability (4.31±0.95). The score of professionalism and humanistic ability in the eastern region was significantly higher than that in the central and western regions ( P<0.05). The highest score of general practitioners′ post competency evaluated by patients was the professionalism and humanistic literacy (4.73±0.55), and the lowest score was the basic medical service ability (4.11±1.35). There were significant differences in scores of the ability for basic medical service, ability for basic public health service, ability for interpersonal communication and ability for professionalism and humanistic literacy among different regions ( P<0.05). For institution leaders, 68.2% (409/600) believed that the general practitioners were fully competent for their current jobs, 28.7% (172/600) believed that the general practitioners were basically competent for their current jobs. For patients, 70.5% (1 817/2 579) were very satisfied with the general practitioners′ service, and 27.1% (700/2 579) were basically satisfied with the general practitioners′ service. Conclusions:The competency of general practitioners who had received training in some provinces is basically up to standard, but the basic public health service ability and teaching, learning and research ability need to be improved.

Objective:To survey the post competency of general practitioners who had completed residency training in China.Methods:This study was a cross-sectional survey. An online questionnaire survey was conducted among general practitioners, institution leaders and patients from January to February 2021. The participants were selected from 45 general practice residential training bases in the eastern, central and western regions of China by a combination of stratified sampling and proportional random sampling methods. The post competency self-assessment questionnaire was used for the general practitioners, and the competency evaluation questionnaire was used for institution leaders and the patients.Results:A total of 677 valid self-assessment questionnaires were returned from general practitioners, 600 from institution leaders, and 2 579 from patients. The professionalism and humanistic literacy of the self-assessment questionnaire had the highest score (4.41±0.60),and the teaching, learning and research abilities had the lowest score(3.57±0.84). There was no significant difference in the post competency score of general practitioners among different regions ( P>0.05). The highest score of general practitioners′ post competency evaluated by leaders was the professionalism and humanistic literacy (4.64±0.57), and the lowest one was the basic public health service ability (4.31±0.95). The score of professionalism and humanistic ability in the eastern region was significantly higher than that in the central and western regions ( P<0.05). The highest score of general practitioners′ post competency evaluated by patients was the professionalism and humanistic literacy (4.73±0.55), and the lowest score was the basic medical service ability (4.11±1.35). There were significant differences in scores of the ability for basic medical service, ability for basic public health service, ability for interpersonal communication and ability for professionalism and humanistic literacy among different regions ( P<0.05). For institution leaders, 68.2% (409/600) believed that the general practitioners were fully competent for their current jobs, 28.7% (172/600) believed that the general practitioners were basically competent for their current jobs. For patients, 70.5% (1 817/2 579) were very satisfied with the general practitioners′ service, and 27.1% (700/2 579) were basically satisfied with the general practitioners′ service. Conclusions:The competency of general practitioners who had received training in some provinces is basically up to standard, but the basic public health service ability and teaching, learning and research ability need to be improved.

Objective To investigate the development of the temporomandibular joint in patients with developmental malformations of the external middle ear.Methods Retrospective analysis of high-resolution computed tomography(HRCT)images of 183 patients with external middle ear malformation,a total of 248 affected ears were examined,and 53 patients with 67 temporomandibular joint abnormalities(abnormal group)were detected visually,accounting for approximately 27％.Further quantification and measurement of the internal and external diameters and anterior and posterior diameters of the mandibular condyle,the depth of the temporomandibular joint fossa,and the angle of the transverse axis of the condyles bilaterally,and the corresponding data of 30 healthy controls(control group)were also measured,and the differences between the two groups were statistically analyzed.Results The internal and external diameters of the condyle was(12.22±3.30)mm in the abnormal group,compared with(17.67±2.90)mm in the control group(t=-9.814,P＜0.001);the anterior and posterior diameters of the condyle was(7.58±1.82)mm in the abnormal group,compared with(8.62±1.09)mm in the control group(t=-3.850,P＜0.001);the joint fossa depth was(4.16±2.83)mm in the abnormal group,compared with(6.12±1.65)mm in the control group(t=-4.700,P＜0.001);the angle of the transverse axis of the condyles bilaterally was(122.17±21.12)° in the abnormal group,compared with(136.49±11.04)° in the control group(t=-3.437,P＜0.001),all differences were statistically significant(P＜0.05).Conclusion Visually visible temporomandibular joint abnormalities are present in 27％of patients with external middle ear malformation,as evidenced by shortening internal and external diameters and anterior and posterior diameters of the condyle,shallowing joint fossa,and reducing angle of the transverse axis extension line of the condyles bilaterally.

OBJECTIVE: To investigate imaging and audiology features of temporal bone and analyze the classification and prevalence of inner ear abnormalities in children with sensorineural hearing loss. METHOD: Children who were diagnosed with sensorineural hearing loss were examined by high resolution CT and the inner ear fluid of MRI. And each chart was retrospectively reviewed to determine the imaging and audiology features. RESULT: There were 125 patients(232 ears) found with inner ear malformation in 590 children with SNHL. About 21.71% of the inner ear malformation occurred in severe and profound hearing loss ears, and 12.85% occurred in r moderate hearing loss ears. The inner ear malformation rate in normal hearing ears were 13.59%. CONCLUSION CT and MRI examinations of temporal bone are important diagnostic tools to indentify inner ear malformations. Inner ear malformations are almost bilateral and hearing loss are profoud. Cochleo-vestibular malformations and large vestibular aqueduct are the 2 most frequent deformities. Among the children with SNHL, deformity rate in the severe and profound hearing loss ears is higher than that in moderate hearing loss ear. Inner ear malformations can exist in people with normal hearing.
Audiology ; Child ; Ear, Inner ; abnormalities ; Hearing Loss, Sensorineural ; congenital ; pathology ; Humans ; Magnetic Resonance Imaging ; Prevalence ; Retrospective Studies ; Temporal Bone ; Tomography, X-Ray Computed ; Vestibular Aqueduct ; abnormalities

Objective To investigate the clinical features, diagnosis and prognosis of sudden sensorineural hearing loss accompanied with inner ear hemorrhage.Methods Eleven cases of sudden sensorineural hearing loss accompanied with inner ear hemorrhage were retrospectively analyzed, including clinical manifestation, hematological and audiological examinations, as well as characteristics of inner ear three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging (3D-FLAIR MRI).Results Eleven cases of sudden hearing loss with inner ear hemorrhage were accompanied by varying degrees of vertigo, lasting from several minutes to several hours, nine of whom had persistent tinnitus.The audiometry curves of the 11 cases included total deafness or flat descending type.The inner ear 3D-FLAIR MRI studies revealed abnormal high signals at different positions of the inner ear, one case with endolymphatic hydrops.After the treatment, seven cases were invalid, two cases had notable effect, and two cases were effective.Conclusions Abnormal high signals in the inner ear were sensitively detected by 3D-FLAIR MRI sequence, which was applied for the diagnosis of the sudden hearing loss accompanied with inner ear hemorrhage.The effect of conventional treatment was not good and the appropriate treatments for this type of sudden hearing loss need further investigation.

Objective To explore the contrast perilymphatic MRI characteristics of inner ears with sudden hearing loss with vertigo.Methods Forty three patients with sudden hearing loss with vertigo and 35 patients with unilateral tinnitus diagnosed by the department of Otolaryngology-Head and Neck Surgery were retrospectively included.Forty eight ears (38 ears with unilateral sudden hearing loss and 10 ears in 5 cases with bilateral sudden hearing loss) were regarded as sudden hearing loss group,35 asymptomatic ears (the opposite ears of the unilateral tinnitus ears) as control group.Thirty eight opposite ears of the 38 unilateral sudden hearing loss ears and 35 ears of the control group showed normal in the pure tone audiometry exam.One hundred and twenty one ears (48 hearing loss ears,38 opposite ears of the 38 unilateral sudden hearing loss ears and the 35 control group's ears) underwent contrast perilymphatic MR exams,0.4 to 0.5 ml gadolinium hydrate diluted with saline was injected through the tympanic membrane,twenty four hours later,three-dimensional fluid attenuated inversion recovery (3D-FLAIR) sequence was performed using a 3.0 T MRI scanner.After the contrast perilymphatic MR exam,success in the exam was judged through the raw image.The signal intensity ratio (SIR) of cochlea basal turn and homolateral brain stem was quantitatively calculated.The SIR difference of 48 ears with sudden hearing loss and 35 asymptomatic ears in control group was analyzed by t test.The SIR difference of the 38 unilateral sudden hearing loss ears and the contralateral asymptomatic ears was also analyzed.The presence of endolymphatic hydrops was judged.Results The contrast perilymphatic MRI of 121 inner ears with intratympanic gadolinium injection were all successful.Endolymphatic hydrops were observed in 12 sudden hearing loss ears with the occurrence rate of 25％(12/48).The SIR of basal turn and homolateral brain stem of the sudden hearing loss ears (2.062±0.907) were lower than the SIR of the control groups' asymptomatic ears (2.703± 0.640) with significant difference between them (t=3.619,P=0.001),the SIR of basal turn and homolateral brain stem of the unilateral sudden hearing loss ears (1.941 ±0.860) were also lower than the SIR of the contralateral asymptomatic ears (2.411±0.670) with statistical difference between them (t =3.270,P=0.002).Conclusions Endolymphatic hydrops were observed in sudden hearing loss with vertigo.The SIR of the cochlea in sudden hearing loss ears were lower than that of the asymptomatic ears,indicating the abnormal permeability of the round window membrane.

OBJECTIVE: To introduce the efficacy of three surgical options for juvenile nasopharyngeal angiofibroma (JNA) resection, and causes of operative bleeding. METHOD: Retrospective analysis of 36 JNAs,three surgical options were used to resect the tumor. There were 15 cases of Class I tumors , using endoscopic nasal cavity approach. Eighteen cases of class II tumors, via extended Caldwell-Luk incision, using the transantral-infratemporal fosse-nasal cavity combined approach for tumor resection. Three cases of class III tumors, the combined intracranial and extra-cranial approach was used to resect the tumor. Meanwhile, report six typical cases for reference. RESULT: Fifteen (15/36) cases of class I tumors, 14 cases were completely resected for the first time without recurrence, 1 recurrence case was re-resected using the same approach. Eighteen (18/36) cases of class II tumors, 13 cases were completely resected for the first time without recurrence, 5 recurrence cases were re-resected totally. Three (3/36) cases of class III were not completely removed, and underwent about 40 Gy radiotherapy with good effects. CONCLUSION Using these three surgical options can effectively remove different types of JNA. When necessary, the intracranial residue can use radiotherapy. Under direct vision to separate the tumor, and effective hemostasis play crucial roles for complete removal of the tumor.
Adolescent ; Angiofibroma ; surgery ; Blood Loss, Surgical ; Child ; Female ; Humans ; Male ; Nasopharyngeal Neoplasms ; surgery ; Retrospective Studies ; Treatment Outcome ; Young Adult

Objective To propose a MR scoring methods for spatium perilymphaticum gadolinium opacification and explore the value of their diagnosis of Meniere' s disease. Methods Fifty-one asymptomatic and 65 symptomatic patients with Meniere's disease were enrolled in this study.MR imaging ofspatium perilymphaticum after intratypanic gadolinium injection were analyzed with following scoring method.　( 1 ) Semicircular canal not visualized equal to score 0 ; some visualized equal score 1 ; full visualized equal　score 2.(2)There were high-signal and low-signal in the vestibule,low-signal areas above the lateral　semicircular canal plane equal score 6 ; low signal areas down to lateral semicircular canal plane equal score　3 ; no higher signal in the vestibule area equal score 0.( 3 ) Basal turn of cochlea:full visualized equal score　3; part visualized equal score 2; scala vestibule of basal turn smaller than scala tympani equal score　1 regardless of full or visualized in basal turn; no visualized equal score 0. Medial turn of cochlea:full　visualized equal score 2 ; part visualized equal score 1 ; no visualized equal score 0.Apical turn of cochlea:　visualized equal score 1 ; no visualized equal score 0. One radiologist scored all cases with double blind.　SPSS 17.0 software was used to conduct multiple independent-samples nonparametric tests,multivariate　Logistic regression, and ROC curve analysis. Evaluate the sensitivity and specificity for diagnosis of　Meniere's disease with the scoring system. Results ( 1 ) Meniere's disease summation score 0 to 12,median 9 (quarter spacing 4.5 ) ; no symptoms group summation score 15 to 18,median 17 (quarter spacing 3),two group differences has statistics significance (Wilcoxon rank and inspection U =-9.118,P =0.00).(2)Based on summation score for the diagnosis of Meniere's disease,tangent point was 14.5,Youden index 0.969,specificity 100.0％,sensitivity 96.9％.( 3 ) Let cochlear,vestibular,semicircular canal scoring for association variable,Logistic regression model:LogitP =61.216 - 7.381 × vestibular -3.056 × canal,based on the P value of ROC curves,diagnostic cut-off point 0.651 (vestibular ≤ 3 or semicircular canals ≤ 4 points ),Youden index 96.9％,specifisity 100.0％, sensitivity 96.9％.Conclusions Perilymphatic space of gadolinium contrast MR score in distinguishing Meniere's disease have practical value,any case meet one of following point could be diagnostic:( 1 ) Perilymphatic space of gadolinium contrast MRI total less than 14.5 ; (2) Vestibular low signal areas down more than lateral semicircular canal plane,namely vestibular score value ≤3;( 3 )Semicircular Canal scoring value ≤4.