Objective:To explore the diagnostic value of fetal echocardiography (ECHO) for ventricular septal defect (VSD) and the causes of missed diagnosis and misdiagnosis by analyzing the standard of ECHO sections and image quality.Methods:A retrospective analysis was conducted on 94 VSD fetuses diagnosed by ECHO at Xiangtan Maternal and Child Health Care Hospital from January 2022 to June 2024. Clinical data including the anatomic subtypes, associated anomalies, chromosomal karyotype results, pregnancy outcomes, and neonatal ECHO results were collected and analyzed. Besides, by reviewing the ultrasound images from the institution's ultrasound workstation, a descriptive analysis was conducted on the ECHO section criteria and image quality in the missed and misdiagnosed cases.Results:Among 10 984 fetuses undergoing ECHO, a total of 94 cases of fetal VSD were detected (0.7%), including 45 (48%) isolated VSD and 49 (52%) non-isolated VSD cases. Anatomic distribution revealed perimembranous type predominance (67, 71%), followed by muscular (24, 26%), subarterial types (2, 2%), and perimembranous+muscular type (1, 1%). Among 29 missed diagnosis cases (fetal ECHO-negative but neonatal ECHO-confirmed VSDs), all were isolated VSD, muscular types accounted for 19 (66%), perimembranous types for 8 (27%), and subarterial types for 2 (7%). The causes of missed diagnosis include: technical limitation in 14 cases (48%), restricted cardiac acoustic window in 11 cases (38%), and operator-dependent factors in four cases (14%). All 18 misdiagnosed cases occurred in isolated VSD, with 15 cases of perimembranous and three cases of muscular types. The causes of misdiagnosis include: nine cases due to non-perpendicular beam alignment to perimembranous septum, six cases due to excessively high color flow gain,and three cases due to the misinterpretation of the right ventricular outflow tract flow above the aortic valve as VSD septal perforation blood flow. The sensitivity and specificity of fetal ECHO for diagnosing VSD were 76.42% and 99.83%. Among the 94 cases of fetal VSD, 38 cases (40%) underwent chromosomal karyotype analysis and chromosomal microarray analysis, which identified chromosomal karyotype abnormalities or pathogenic gene variants in 4/16 non-isolated VSDs (all perimembranous), while no anomalies were detected in 22 isolated VSDs. Pregnancy outcomes showed 31 terminations due to associated structural or chromosomal abnormalities versus 63 live births. In the live births, who underwent echocardiography in the neonatal period, 19 cases (30%) showed no VSD and were considered to have undergone spontaneous in utero closure, and persistent defects were found in 44 (70%).Conclusions:Fetal ECHO demonstrates high sensitivity and specificity in the diagnosis of fetal VSD. Critical quality control measures include individualized parameter adjustment and systematic multiplanar continuous scanning to minimize diagnostic errors. Isolated small and medium-sized muscular and perimembranous VSD usually have a good prognosis.

Objective:To explore the diagnostic value of fetal echocardiography (ECHO) for ventricular septal defect (VSD) and the causes of missed diagnosis and misdiagnosis by analyzing the standard of ECHO sections and image quality.Methods:A retrospective analysis was conducted on 94 VSD fetuses diagnosed by ECHO at Xiangtan Maternal and Child Health Care Hospital from January 2022 to June 2024. Clinical data including the anatomic subtypes, associated anomalies, chromosomal karyotype results, pregnancy outcomes, and neonatal ECHO results were collected and analyzed. Besides, by reviewing the ultrasound images from the institution's ultrasound workstation, a descriptive analysis was conducted on the ECHO section criteria and image quality in the missed and misdiagnosed cases.Results:Among 10 984 fetuses undergoing ECHO, a total of 94 cases of fetal VSD were detected (0.7%), including 45 (48%) isolated VSD and 49 (52%) non-isolated VSD cases. Anatomic distribution revealed perimembranous type predominance (67, 71%), followed by muscular (24, 26%), subarterial types (2, 2%), and perimembranous+muscular type (1, 1%). Among 29 missed diagnosis cases (fetal ECHO-negative but neonatal ECHO-confirmed VSDs), all were isolated VSD, muscular types accounted for 19 (66%), perimembranous types for 8 (27%), and subarterial types for 2 (7%). The causes of missed diagnosis include: technical limitation in 14 cases (48%), restricted cardiac acoustic window in 11 cases (38%), and operator-dependent factors in four cases (14%). All 18 misdiagnosed cases occurred in isolated VSD, with 15 cases of perimembranous and three cases of muscular types. The causes of misdiagnosis include: nine cases due to non-perpendicular beam alignment to perimembranous septum, six cases due to excessively high color flow gain,and three cases due to the misinterpretation of the right ventricular outflow tract flow above the aortic valve as VSD septal perforation blood flow. The sensitivity and specificity of fetal ECHO for diagnosing VSD were 76.42% and 99.83%. Among the 94 cases of fetal VSD, 38 cases (40%) underwent chromosomal karyotype analysis and chromosomal microarray analysis, which identified chromosomal karyotype abnormalities or pathogenic gene variants in 4/16 non-isolated VSDs (all perimembranous), while no anomalies were detected in 22 isolated VSDs. Pregnancy outcomes showed 31 terminations due to associated structural or chromosomal abnormalities versus 63 live births. In the live births, who underwent echocardiography in the neonatal period, 19 cases (30%) showed no VSD and were considered to have undergone spontaneous in utero closure, and persistent defects were found in 44 (70%).Conclusions:Fetal ECHO demonstrates high sensitivity and specificity in the diagnosis of fetal VSD. Critical quality control measures include individualized parameter adjustment and systematic multiplanar continuous scanning to minimize diagnostic errors. Isolated small and medium-sized muscular and perimembranous VSD usually have a good prognosis.

OBJECTIVE:To provide reference for reducing the clinical return of finished infusions. METHODS:Interventions for clinical return of PIVAS finished infusions in our hospital were introduced,the return situation of finished infusions before(dur-ing 2013-2014)and after(during 2015-2016)intervention was compared,and intervention effects were evaluated. RESULTS:Our hospital intervened it by rationally selecting and using syringes,strengthening visible particle check of finished infusion before dis-tribution;optimizing the order of drug configuration,reasonably arranging the drug infusion sequence;strengthening the clean-up in work area before drug infusion,correctly using disinfectant;strictly implementing intravenous infusion associative operation, playing the role of pharmacists;cultivating good work habits,and strengthening teamwork,etc. Compared with before interven-tion,the return numbers of finished infusion were decreased by 41.2%,and reported loss amount reduced by 45.7%. The return caused by visibility particles,finished infusion oxidation discoloration after too long storage time,finished infusion leakage,contin-uous infusion of drugs compatibility,heterodyne error,improper drug configuration method in packaging to the ward,improper use of disinfectant before infusion decreased by 25.3%,46.9%,39.4%,77.8%,73.9%,75.0%,100%,respectively. CONCLU-SIONS:Intervening the return of finished infusion can reduce the return numbers and drug waste.

The lacquer figure with meridian-points marked of the western Han dynasty, unearthed in Tianhui town, Jinniu district, Chengdu in 2012, has been the earliest and the most complete human figure of meridian-acupoints in China so far. There were over ten courses of meridians, and over 100 visible acupoints as well as multiple intaglio inscriptions. All of them are valuable in academic study. The writers introduced the lacquer figure un- earthed in Laoguanshan in terms of the briefs and characteristics of meridian and acupoint distributions, which give the references to the future studies.
Acupuncture ; history ; instrumentation ; Acupuncture Points ; China ; History, Ancient ; Human Body ; Humans ; Meridians

Objective To compare the efficacy and safety of 3 rivaroxaban regimen in patients with venous thromboembolism (VTE).Methods This is a retrospective study.Thirty three inpatients with VTE received rivaroxaban were divided into 3 groups,in which 16 patients were treated with 15 mg rivaroxaban twice daily for 21 days then followed by 20 mg once per day till 3 months (group 1),9 patients were treated with 20 mg rivaroxaban once daily for 3 months (group 2),8 patients were treated with 10 mg rivaroxaban once daily for 3 months.The reduction rate of D-Dimer on the third therapy day,the duration of D-Dimer normalization and hospital stay as well as symptom remission,the imaging assessment results after three months treatment,rate of recurrent VTE,bleeding,liver and kidney function were compared among the 3 groups.Results The reduction rates of D-Dimer on the third therapy day were significantly higher ((46.12±15.42)％ vs.(26.59±8.11)％ and(25.55 ± 14.00)％,P =0.02,P=0.01),and the duration of D-Dimer normalization was significantly shorter ((17.9 ±7.7) days vs.(24.1 ±5.1) days and (26.3 ± 6.2) d,P =0.03,P ＜ 0.01) in group 1 than in group 2 and 3.There was one recurrent deep-vein thrombosis in group 3,one non-major bleeding in group 1 and group 3.Major bleeding or liver and kidney dysfunction were not observed in these patients.Conclusions Venous thromboembolism can be safely and effectively treated by rivaroxaban,and does of 15 mg twice daily for 21 days followed by 20 mg once daily for 3 months are superior to the other 2 tested therapy regimen in this patient cohort.