Objective:To investigate the predictive value of the combination of real-time three dimensional echocardiography of esophagus(RT-3D-TEE),computed tomography angiography(CTA)and congestive heart failure hypertension age diabetes mellitus prior stroke or transient ischemic attack vascular disease sex category(CHA2DS2-VASc)for left atrial appendage thrombosis in patients with non-valvular atrial fibrillation.Methods:A total of 88 patients with non-valvular atrial fibrillation admitted to the department of cardiovascular medicine of Cangzhou People's Hospital from January 2022 to June 2023 were selected as the study subjects.They were divided into thrombus group(n=36)and non-thrombus group(n=52)based on whether occurred left atrial appendage thrombosis.All patients underwent RT-3D-TEE and CTA examinations,and underwent CHA2DS2-VASc scoring.Logistic regression was used to analyze the related factors of forming left atrial appendage in patients with non-valvular atrial fibrillation.Receiver operating characteristic(ROC)curve was used to analyze the predictive values of RT-3D-TEE,CTA and CHA2DS2-VASc on left atrial appendage thrombosis in patients with non-valvular atrial fibrillation.And then,area under curve(AUC)value,sensitivity and specificity were calculated.Results:The maximum left atrial appendage emptying velocity(LAAeV)(51.48±5.87),the maximum left atrial appendage filling velocity(LAAfV)(48.36±5.49)and three-dimensional volume ejection fraction(3D-EF)(39.26±3.24)in the thrombus group were all significantly lower than those in the non-thrombus group,and the differences were statistically significant(t=5.933,6.767,4.605,P＜0.05),respectively.The opening diameter,short diameter and circumference,volume and area of left atrial appendage of the thrombus group were all larger than those of the non-thrombus group,while the ejection fraction was smaller than that of the non-thrombus group(t=6.581,3.410,9.220,3.178,4.453,4.162,P＜0.05),respectively.The ratios of cauliflower and cactus types of thrombus group were larger than those of non-thrombus group,and the ratios of wind vane type and chicken wing type were smaller than those of non-thrombus group,and the differences were significant(x2=3.771,7.132,1.003,5.455,P＜0.05),respectively.The CHA2DS2-VASc score of the thrombus group was significantly higher than that of the non-thrombus group,and the difference was statistically significant(t=12.269,P＜0.05).LAAeV,LAAfV,3D-EF,the long diameter of opening,the short diameter of opening,circumference of opening,volume,ejection fraction,spatial morphology and CHA2DS2 VASc score significantly correlated to the left atrial appendage thrombosis of patients with non-valvular atrial fibrillation(OR=4.323-19.562,P＜0.05).The sensitivity,specificity and AUC value of the combination of RT-3D-TEE,CTA and CHA2DS2-VASc were respectively 93.48%,90.83%and 0.895(0.654-0.963)in predicting left atrial appendage thrombosis of patients with non-valvular atrial fibrillation.Conclusion:The predictive values of RT-3D-TEE,CTA and CHA2DS2-VASc are higher for left atrial appendage thrombosis of patients with non-valvular atrial fibrillation.Among of them,the combinations of two or three indicators can effectively improve the predictive efficiency of individual test.The clinical practice should make choice on the basis of actual conditions.

Objective:A multi-center and large sample volume study was conducted on the verification and improvement of the early established criteria for intelligent routine urinalysis validation (including the microscopic review rules and manual validation rules, referred to as intelligent criteria for short), in order to improve the clinical application of this intelligent criteria.Methods:A total of 31 456 urine specimens were collected from the inpatients and outpatients in six hospitals in China, from March to September 2019. Firstly, 3105 specimens were analyzed for preliminary verification and improvement of the intelligent criteria based on the results of the microscopic examination and manual validation. Secondly, 28 351 specimens were used to verify the clinical application of the improved intelligent criteria. All samples were manually validated as reference.Results:The approval inconsistency rate of the manual validation rules in the original intelligent criteria was 8.59% (202/2 352), and the interception inconsistency rate was 8.84% (208/2 352). The false negative rate and the microscopic review rate of the microscopic review rules were similar to the previous results. Based on an in-depth analysis of big data and the discussions by senior technicians from eight hospitals, one microscopic review rules and four manual validation rules were added, meanwhile two manual validation rule was deleted. The manual validation standards were unified. Finally, the intelligent criteria was improved. Based on the improved intelligent criteria, for microscopic review rules, the false positive rate, false negative rate (misdiagnosis rate), and microscopic review rate did not change significantly, which were 14.72% (457/3 105), 4.06% (126/3 105), and 24.73% (768/3 105), respectively. The approval inconsistency rate and the interception inconsistency rate of manual validation rules were both reduced to 0; the total manual validation rate of the intelligent criteria was 50.89% (1 580/3 105), and the auto-validation rate was 49.11% (1 525/3 105). The large sample volume verification results were consistent with the preliminary verification results of the improved intelligent criteria.Conclusion:This multi-center and large sample volume study had shown that the improved intelligent criteria had better clinical performance.

Objective Toinvestigatethecharacteristicsofclinicalpathologyand MRIofintracranialsolitaryfibroustumor/hemangiopericytoma (SFT/HPC).Methods ThisstudyanalyzedtheMRIimages,pathologicalandclinicaldataof14SFT/HPCpatientsretrospectively. AllthecasesweresubjectedtoMRIplainscanandenhancementexamination.CharacteristicsofMRIofallcaseswerereviewedtogetherwith clinicopathologicchanges.Results AllSFT/HPClesionswerelocatedintheintracranialbutextra-cerebralspace.6werelocatedabovethe tentoriumofcerebellum,and2werelocatedbelowit.Lesionsof6patientswereacrossthetentoriumofcerebellumandspreadfrom supratentorialtosubtenorialspace.Amongalllesions,4wereroundinshape,10werelobulated,and3weresmallnodulesaroundthe edge.9ofthemexhibitednecrosisandcysticstructures.11lesionsshowedhypointensityand3casesshowedisointensityonT1WI.All thelesionswereheterogeneoushyperintensetyonT2WI,and5ofthemdisplayed"yin-yang"patternonT2WI.11casesexhibitededema.Signalof vascularvoidflow wasobservedin6cases.Thesolidpartsofthetumorsshowedsignificanthomogeneousenhancementon MRI. StrongpositiveSTAT6stainingwasobservedforthenuclearoftumorcells.Conclusion ItisdifficulttodifferentiateSFT/HPCfrom meningeoma.The"yin-yang"patternonT2WIisthecharacteristicofSFT/HPC.Inaddition,nuclearpositivestainingofSTAT6isalsospecific featureofSFT/HPCcell.

Objective To access the prevalence of type 2 diabetes mellitus ( T2DM) and its associated risk factors among adults with obesity in Zhejiang province. Methods The enrolled subjects were selected among local residents aged≥18 years with body mass index≥28 kg/m2 from 15 counties by multi stage stratified cluster random sampling from July to November, 2010. Each participant was required to attend complete questionnaire, physical examination, and testing overnight fasting blood specimen. Results A total of 1 351 residents were enrolled, including 613 males and 738 females. The prevalence of T2DM in adult population with obesity was 15. 03%, being 14. 03% in male, and 15. 85% in female;and that in urban area was 16. 64%, and in rural area was 13. 93%. Data from multivariable logistic regression showed that factors such as ageing (OR=1. 473, 95% CI 1. 243-1. 747), a family history of T2DM(OR=8. 945, 95% CI 5. 481-14. 598), staple food intake (OR=1. 185, 95% CI 1. 017-1. 380), triglyceride(≥1. 7 mmol/L, OR=1. 542, 95%CI 1. 066-2. 232) were risk factors of T2DM;while annual income(OR=0. 695, 95%CI 0. 544-0. 888), and milk intake(OR=0. 750, 95%CI 0. 567-0. 993) were shown as protective factors. Conclusion The prevalence of T2DM in adults with obesity was raised, ageing, a family history of T2DM, staple food intake, and dyslipidemia appeared to be major risk factors for T2DM.

ObjectiveTo study the epidemiological characteristics of diabetes mellitus and awareness rate in Zhejiang adults.MethodA total of 17 437 adults from 15 counties were randomly selected with stratified multi-stage cluster sampling method from July to November,2010.Each participant was required to complete a set of standardized questionnaire,physical examination,and blood specimen collection.ResultsThe overall standardized rate of diabetes mellitus was 5.94％ ( crude prevalence 8.80％ ).It was increased by 96.67％ during past 8 years,as compared with the prevalence 3.02％ in 2002.The standardized rate of diabetes mellitus of the urban and rural area were 7.52％ and 5.19％ ( crude prevalence 11.33％ and 7.09％ ),respectively.The standardized rate of diabetes mellitus in the urban was higher than rural ( u =6.58,P＜0.05 ).The standardized rate of diabetes mellitus of the male and the female were 5.74％ and 6.15％ ( crude prevalence 8.36％ and 9.13％ ),respectively,without significant difference ( u =1.39,P＞0.05 ).The awareness rate of diabetes mellitus was 59.19％ ( 56.66％ in male and 61.23 ％ in female,x2 =3.26,P＞0.05 ).The awareness rate of the urban was higher than the rural (63.47％ vs 54.69％,x2=12.20,P＜0.01 ).ConclusionThe prevalence of diabetes mellitus showed a rapidly rising trend in Zhejiang province.The effective intervention should be taken at its early stage.

Objective To reduce the misdiagnosis of the inpatients admitted to digest department with abdominal pain through analyzing the consultation undertaken by surgeon.Method The causes and the constituent ratio according to the case records of those inpatients admitted to digest department because of abdominal pain were analyzed.Results The obstruction of hollow viscus was the first cauge(51.07%),and the tumor of digestive tract(17.78%)was the second cause for invitation for consultation to surgeon of the inpatients with abdominal pain in digest department wards.The ultrasound 32.78%,CT 26.67% and gastroenterological endoscope 13.89% were definite diagnosis,and should shorten the time of consultation.Conclusion Whether inpatient or outpatient with abdominal pain should be planned to be examined by ultrasound,CT or gastroenterological endoscope,obgerve the changes of the symptom and sign so that the misdiagnosis can be avoided.