Objective:To investigate the feasibility of the ultrasound "triangular method" in evaluating the morphology of the aortic arch in normal mid-to-late trimester fetuses，establish the gestational age-specific reference ranges for its morphological parameters，and to analyze their correlations with gestational age（GA）and cardiac valve annulus diameters.Methods:A prospective study was conducted on 317 normal singleton fetuses at 20-38 +6 weeks of gestation from the Second Xiangya Hospital of Central South University. Morphological parameters including arch length（a+b），arch width（w），arch height（h）and arch angle（θ）were measured using the "triangular method" in the aortic arch long-axis view. Arch tortuosity（a+b/w）and height-to-width ratio（h/w）were calculated. Linear regression was used to analyze correlations between arch length，width，height and GA，the reference intervals were established. Pearson correlation was applied to assess relationships between angle，tortuosity，height-to-width ratio and GA，cardiac valve annulus diameters（aortic，pulmonary，mitral，tricuspid）. Results:Aortic arch length，width and height showed strong positive correlations with GA（ r = 0.88，0.88，0.85；all P < 0.001）. The arch angle，tortuosity，and height-to-width ratio were independent of GA（all P > 0.05），with reference values of（69.2 ± 6.1）°，1.7 ± 0.1，and 0.7 ± 0.1，respectively. These parameters also showed no significant correlations with cardiac valve annulus diameters（all P > 0.05）. Conclusions:The ultrasound "triangular method" systematically quantifies fetal aortic arch morphology. The stability of arch angle，tortuosity and height-to-width ratio during mid-to-late gestation may provide a morphological benchmark for prenatal screening of aortic arch anomalies.

Hyoid-related carotid artery diseases represent rare clinical entities,encompassing conditions such as carotid atherosclerotic plaque formation,mural thrombosis,carotid artery dissec-tion,carotid stenosis or occlusion,and carotid pseudoaneurysm.Unstable plaques and thrombi may dislodge under external force,leading to middle cerebral artery stenosis or embolism,triggering ische-mic cerebrovascular events.This study reported a related case and explored its clinical characteris-tics,pathogenic mechanisms,and potential risk factors through a review of relevant literature.

Objective To investigate the value of MRI of the sternal end of clavicle in bone age assessment in Chinese population,especially its applicability in the determination of criminal responsible age.Methods A total of 431 patients aged from 10.00 to 29.99 years with neck or chest MRI were retrospectively collected.According to the Schmeling grading method,the epiphyseal development of the clavicle MRI was divided into five grades.The consistency of methods was evaluated.The correlation and general descriptive analysis between MRI grades and age was analyzed.The sex difference was analyzed.Curve fitting was used to establish a nonlinear model between age and grades.Results The grades of clavicle MRI showed a significant age-related trend(Figure 2),and the correlation was 0.861(0.887 in males and 0.840 in females).Except for grade 1,there was no significant difference between males and females in other grades.The minimum age of male grade 3 was greater than 14 years old,and the minimum age of female grade 3 was greater than 16 years old.The minimum age in grade 4 and grade 5 was over 18 years old in both sexes.The best curve fitting model was cubic model for both sexes(R2=0.805 for men and 0.722 for women).Conclusion Clavicle MRI can be used for the assessment of bone age in Chinese population.Complete epiphyseal plate closure can be used as a reliable indicator for the determination of age at 18 years old,and it is expected to achieve radiation-free forensic bone age assessment.

Objective To investigate the value of MRI of the sternal end of clavicle in bone age assessment in Chinese population,especially its applicability in the determination of criminal responsible age.Methods A total of 431 patients aged from 10.00 to 29.99 years with neck or chest MRI were retrospectively collected.According to the Schmeling grading method,the epiphyseal development of the clavicle MRI was divided into five grades.The consistency of methods was evaluated.The correlation and general descriptive analysis between MRI grades and age was analyzed.The sex difference was analyzed.Curve fitting was used to establish a nonlinear model between age and grades.Results The grades of clavicle MRI showed a significant age-related trend(Figure 2),and the correlation was 0.861(0.887 in males and 0.840 in females).Except for grade 1,there was no significant difference between males and females in other grades.The minimum age of male grade 3 was greater than 14 years old,and the minimum age of female grade 3 was greater than 16 years old.The minimum age in grade 4 and grade 5 was over 18 years old in both sexes.The best curve fitting model was cubic model for both sexes(R2=0.805 for men and 0.722 for women).Conclusion Clavicle MRI can be used for the assessment of bone age in Chinese population.Complete epiphyseal plate closure can be used as a reliable indicator for the determination of age at 18 years old,and it is expected to achieve radiation-free forensic bone age assessment.

Objective:To investigate the feasibility of the ultrasound "triangular method" in evaluating the morphology of the aortic arch in normal mid-to-late trimester fetuses，establish the gestational age-specific reference ranges for its morphological parameters，and to analyze their correlations with gestational age（GA）and cardiac valve annulus diameters.Methods:A prospective study was conducted on 317 normal singleton fetuses at 20-38 +6 weeks of gestation from the Second Xiangya Hospital of Central South University. Morphological parameters including arch length（a+b），arch width（w），arch height（h）and arch angle（θ）were measured using the "triangular method" in the aortic arch long-axis view. Arch tortuosity（a+b/w）and height-to-width ratio（h/w）were calculated. Linear regression was used to analyze correlations between arch length，width，height and GA，the reference intervals were established. Pearson correlation was applied to assess relationships between angle，tortuosity，height-to-width ratio and GA，cardiac valve annulus diameters（aortic，pulmonary，mitral，tricuspid）. Results:Aortic arch length，width and height showed strong positive correlations with GA（ r = 0.88，0.88，0.85；all P < 0.001）. The arch angle，tortuosity，and height-to-width ratio were independent of GA（all P > 0.05），with reference values of（69.2 ± 6.1）°，1.7 ± 0.1，and 0.7 ± 0.1，respectively. These parameters also showed no significant correlations with cardiac valve annulus diameters（all P > 0.05）. Conclusions:The ultrasound "triangular method" systematically quantifies fetal aortic arch morphology. The stability of arch angle，tortuosity and height-to-width ratio during mid-to-late gestation may provide a morphological benchmark for prenatal screening of aortic arch anomalies.

Objective To investigate peripheral blood cell count and characteristics of dyshaematopoiesis of peripheral blood and bone marrow cells in patients with myelodysplastic syndrome(MDS).Methods A total of 40 patients with MDS newly diagnosed in the hospital from January 2015 to December 2022 were selected as the experimental group,while 17 patients with megaloblastic anemia(MA group),11 patients with aplastic a-nemia(AA group),and 24 patients with autoimmune disease(AID group)were selected as the non-MDS group.Blood routine of patients in each group was detected by whole blood cell analyzer Sysmex XN20,and the white blood cell count(WBC),red blood cell count(RBC),hemoglobin(Hb),platelet count(PLT),mean red blood cell volume(MCV)and coefficient of variation of red blood cell distribution width(RDW-CV)of patients in 4 groups were compared and analyzed.Bone marrow and peripheral blood cell morphology in 4 groups were observed and recorded by artificial microscopy.The positive rate of common dyshaematopoiesis of peripheral in 4 groups was compared and analyzed.Results Compared with MA group,RBC and Hb in MDS group were significantly increased(P＜0.05),while MCV was significantly decreased(P＜0.05).Compared with AA group,WBC,MCV,RDW-CV and PLT in MDS group were significantly increased(P＜0.05).Com-pared with AID group,WBC,RBC,Hb and PLT in MDS group were significantly decreased(P＜0.05),while MCV and RDW-CV were significantly increased(P＜0.05).The positive rate of peripheral blood primitive cells in MDS group was significantly higher than that in non-MDS group(P＜0.05).Large red blood cells and polylobulated granulocyte were the main dysplasia types in the peripheral blood of MA group,and the positive rate of dyshematopoietic was significantly higher than that in MDS group(P＜0.05).Compared with the non-MDS group,the positive rates of five types of dyshaematopoiesis in the MDS group were significantly higher than those in the control group(P＜0.05),including increased blasts,decreased or absent cytoplasmic gran-ules,pseudo Pelger neutrophils,binucleated granulocytes and micromegakaryocytes.The positive rates of polylobulation and giant change in granulocytes,giant change,large red cells,basophilic stippling erythrocyte and H-J corpuscle in erythrocytes in MA group were significantly higher than those in MDS group(P＜0.05).Dyshematopoiesis was absent or rare in the bone marrow smears of AA group and AID group.Conclu-sion Specific dyshaematopoiesis combined with peripheral blood cell count is helpful for the diagnosis and differential diagnosis of MDS,and reduces the possibility of misdiagnosis and missed diagnosis.

Objective:To explore the acupoint selection law in acupuncture and moxibustion in treating postpartum incontinence by using data mining technology.Methods:The clinical research literature on acupuncture and moxibustion treatment for postpartum incontinence was retrieved from CNKI, Wanfang Data, VIP, CBM, China Medical Journal Full-text Database, PubMed, Embase, Web of Science from the establishment of the databases to February 1, 2023. The acupoint prescription database was established using Excel 2016 and conducting frequency statistics of acupoints, meridians and specific acupoints. Clustering analysis was performed using SPSS Statistics 25.0, and association rule analysis was performed using SPSS Modeler 18.0.Results:A total of 70 articles were included, involving 70 acupuncture prescriptions and including 31 acupoints with a total frequency of 384 times. The top five acupoints were Sanyinjiao (SP6, 46 times), Guanyuan (CV4, 45 times), Zusanli (ST36, 43 times), Zhongji (RN3, 41 times), and Qihai (CV6, 38 times). The commonly used meridians were Conception Vessel, bladder meridian and spleen meridian. The involved acupoints were mostly located in the lower limbs and belly, and most of them were Jiaohui, Mu and Wushu acupoints. Five effective clustering groups were obtained by clustering analysis of high frequency acupoints. The core acupoint combination of association rules was Sanyinjiao (SP6)-Zusanli (ST36)-Guanyuan (CV4)-Qihai (CV6)-Zhongji (RN3).Conclusions:The pathogenesis of postpartum urinary incontinence is mainly characterized by qi deficiency. Acupuncture and moxibustion treatment of postpartum urinary incontinence follows the principles of invigorating qi and tonifying spleen, nourishing lung and tonifying kidney, paying attention to the use of acupoints in abdomen and lower limbs, and using the methods of upper and lower acupoints, anterior and posterior acupoints.

Objective To observe the clinical effect of remazolam combined with remifentanil on elderly patients undergoing painless fiberscopy,and to analyze its effect on the depth of sedation and hemodynamics.Methods Eighty-six elderly patients who underwent painless fiberscopy in Jiangxi Provincial Chest Hospital from January 2022 to June 2023 were selected as study subjects and divided into group A and group B according to the randomized lottery method.After enrollment,both groups of patients were opened to intravenous nasal catheter for oxygen administration,and 2% lidocaine was given to the patients,so that the patients held their breath for choking in order to fully diffuse into the trachea to achieve local anesthesia effect,and at the same time,remifentanil was given to the patients in both groups as the basic analgesia.On this basis,group A was injected with remazolam and group B was injected with propofol.The hemodynamic indexes[mean arterial pressure(MAP),pulse oximetry(SpO2)and heart rate(HR)]and Ramsay sedation scores of the two groups were recorded before anesthesia induction(T1),after anesthesia induction(T2),at the time of the passage of the fiberscope through the vocal folds(T3),at the time of the complete insertion of the fiberscope(T4),at the time of completing the examination(T5).And the onset time of sedation was compared between the two groups,awakening time,number of respiratory depression,adverse reactions and incidence,and satisfaction with the sedation effect in the two groups.Results The MAP and HR of group A were significantly lower than those of group B at T3,T4 and T5(P＜0.05).While the SPO2 and Ramsay sedation score were significantly higher than those of group B(P＜0.05).The repeated measures ANOVA and different awakening time measurements were statistically different between groups(P＜0.05).Compared with group B,group A had a significantly shorter sedation onset time and awakening time and fewer respiratory depression,which was statistically significant(P＜0.05).Group A had a statistically significant lower incidence rate of adverse reactions than group B(P＜0.05).Conclusion Remazolam combined with remifentanil in compound surface local anesthesia for painless ciliopathy has more efficient sedation effect,more stable hemodynamics,and lower incidence of adverse reactions for elderly patients,and it is a potential drug that can be a safer and more efficient.

Objective To evaluate the effect of extracorporeal membrane oxygenation combined with intra-aortic balloon pump mechanical circulatory support for patients with cardiogenic shock complicating acute myocar-dial infarction during PCI process.Methods Patients with cardiogenic shock complicating myocardial infarction who underwent PCI in the hospital from January 2015 to December 2019 were selected.Those who were under support of extracorporeal membrane oxygenation combined with intra-aortic balloon pump were enrolled in the observation group,the patients under support of only intra-aortic balloon pump were selectedin the control group.The differ-ences of clinical features and prognosis were compared.Results A total of 40 patients were enrolled,11 were in the observation group and 29 in the control group.Compared with control group,more patients were complicated with old myocardial infarction(5/11 vs.2/29,P=0.016),more patients were diagnosed as non-ST elevated myocardial infarction(8/11 vs.11/29,P=0.049)and left ventricular ejecting fraction was lower[(38.5±10.10)vs.(48.55±8.86),P=0.01]in observation group.Moreover,the proportion of patients with EF＜35％was higher in the observation group(5/11 vs.3/29,P=0.01).The observation group has significantly higher rates of multi-vessel disease and Syntax scores compared to the control group(multi-vessel disease:10/11 vs.11/29,P=0.02;Syntax score:[(33.36±13.37)vs.(25.74±5.75),P=0.015];the observation group exhibited a higher proportion of patients achieving complete revascularization(9/11 vs.8/29,P=0.002).Mechanical complications were higher in observation group(6/11 vs.5/29,P=0.02),The survive rate in observation group is higher than that in control group(91.00％vs.55.17％,P=0.03)at one-year follow-up.Conclusion Compared with only IABP,ECMO com-bined with IABP hemodynamic support during PCI process for patients with cardiogenic shock complicating acute myocardial infarction enjoys more complete revascularization and better mortality outcome,although it has rela-tively higher mechanical complications.

Objective To evaluate the effect of extracorporeal membrane oxygenation combined with intra-aortic balloon pump mechanical circulatory support for patients with cardiogenic shock complicating acute myocar-dial infarction during PCI process.Methods Patients with cardiogenic shock complicating myocardial infarction who underwent PCI in the hospital from January 2015 to December 2019 were selected.Those who were under support of extracorporeal membrane oxygenation combined with intra-aortic balloon pump were enrolled in the observation group,the patients under support of only intra-aortic balloon pump were selectedin the control group.The differ-ences of clinical features and prognosis were compared.Results A total of 40 patients were enrolled,11 were in the observation group and 29 in the control group.Compared with control group,more patients were complicated with old myocardial infarction(5/11 vs.2/29,P=0.016),more patients were diagnosed as non-ST elevated myocardial infarction(8/11 vs.11/29,P=0.049)and left ventricular ejecting fraction was lower[(38.5±10.10)vs.(48.55±8.86),P=0.01]in observation group.Moreover,the proportion of patients with EF＜35％was higher in the observation group(5/11 vs.3/29,P=0.01).The observation group has significantly higher rates of multi-vessel disease and Syntax scores compared to the control group(multi-vessel disease:10/11 vs.11/29,P=0.02;Syntax score:[(33.36±13.37)vs.(25.74±5.75),P=0.015];the observation group exhibited a higher proportion of patients achieving complete revascularization(9/11 vs.8/29,P=0.002).Mechanical complications were higher in observation group(6/11 vs.5/29,P=0.02),The survive rate in observation group is higher than that in control group(91.00％vs.55.17％,P=0.03)at one-year follow-up.Conclusion Compared with only IABP,ECMO com-bined with IABP hemodynamic support during PCI process for patients with cardiogenic shock complicating acute myocardial infarction enjoys more complete revascularization and better mortality outcome,although it has rela-tively higher mechanical complications.