Objective To investigate the mid- to long-term follow-up results of ascending aorta (AAO)-descending thoracic aorta (DTA) bypass grafting via median sternotomy incision for the treatment of complex aortic arch coarctation. Methods A retrospective analysis was conducted on the clinical data of patients with complex aortic arch coarctation who underwent AAO-DTA bypass grafting via median sternotomy incision at the First Hospital of Tsinghua University from August 2004 to May 2017. Results A total of 7 patients were enrolled, including 4 males and 3 females, aged (13.3±4.6) years, and weighted (40.2±12.2) kg. Six (85.7%) patients had concomitant upper limb hypertension. Four patients were aortic arch coarctation combined with intracardiac malformations, two were post-operative restenosis, and 1 was post-operative restenosis combined with intracardiac malformation. All patients underwent surgery under cardiopulmonary bypass. There were no perioperative deaths or major complications. The pre-operative upper-lower limb pressure difference was (39.3±19.2) mm Hg, which decreased to (2.9±2.7) mm Hg post-operatively (P<0.01). The follow-up period was (14.9±5.9) years. There were no long-term deaths or artificial graft-related complications. Except for one patient who still had mild hypertension, the blood pressure of the remaining patients returned to normal. Conclusion AAO-DTA bypass grafting via median sternotomy incision for the treatment of complex aortic arch coarctation can effectively reduce upper limb blood pressure and the upper-lower limb arterial pressure difference, has fewer complications, and demonstrates satisfactory mid- to long-term efficacy.

Objective To explore the role of an artificial intelligence(AI)model based on real-time object detection network in fetal facial ultrasound examination.Methods With the normal fetal facial ultrasound standard plane(FFUSP)at 20-24 weeks of gestation as the research object,a FFUSP recognition model based on real-time object detection network was constructed.The recognition accuracy of the model for FFUSP and the anatomical structures were analyzed,and the clinical value was evaluated by analyzing its performance in identifying FFUSP in 119 cases of fetal ultrasound images.Results The overall precision,recall rate,mAP@.5 and mAP@.5:.95 of the AI model were 97.8%,98.5%,98.1%and 61.0%,respectively.The clinical validation showed that the AI model had a sensitivity,specificity,positive predictive value,negative predictive value and accuracy of 100.0%,98.5%,87.4%,100.0%and 98.7%for facial anatomy recognition,and the results were highly consistent with the classification of fetal ultrasound experts(k=0.925,P<0.001).The recognition accuracy of the model for 3 types of standard planes reached 100%;and the average speed of dynamic video detection was 33.93 frames per second.Conclusion The FFUSP recognition model based on real-time object detection network exhibits excellent performance,and it can be applied to real-time ultrasound diagnosis,teaching and intelligent quality evaluation.

[Objective] To evaluate the efficacy and safety of zero-pressure percutaneous nephrolithotomy (PCNL) combined with hands-free pneumatic lithotripsy in the one-stage treatment of calculous pyonephrosis in the non-acute infection phase. [Methods] Clinical data of 15 patients' treated during Feb.2022 and Dec.2023 were retrospectively analyzed.Double-sheath negative pressure PCNL was adopted, with zero-pressure gravity perfusion where the perfusion height was at the level of the patients' kidney, not exceeding 20 cm above the kidney.Pneumatic lithotripsy was performed without the need to hold the device with hand. [Results] The median stone diameter was 28 (range 22—40) mm, with a median stone density of 1028 (range 765—1305) Hu.All operations were successful.The median operation time was 55 (range 35—90) min.Postoperative low fever (Clavien grade Ⅰ) occurred in 1 case, and high fever (Clavien grade Ⅱ) occurred in 1 case, with no complications of Clavien grade Ⅲ or above.The initial stone-free rate was 73.3%, and the stone-free rate after one month was 93.3%. [Conclusion] For patients with calculous pyonephrosis in the non-acute infection phase, one-stage treatment using zero-pressure PCNL combined with hands-free pneumatic lithotripsy demonstrates good efficacy and safety.

[Objective] To summarize the clinical manifestations, pathological characteristics, treatment options and prognosis of the world's first case of prostate ductal adenocarcinoma (PDA) complicated with prostate mucinous adenocarcinoma (PMA). [Methods] The clinical and follow-up data of a patient with PDA and PMA treated in Zhongnan Hospital of Wuhan University were retrospectively analyzed, and relevant literature in PubMed and CNKI databases was retrieved. [Results] The patient sought medical attention due to dysuria, frequent urination, urinary urgency and urinary pain for more than half a year, and was admitted to hospital 3 times in total.The initial diagnosis upon the first admission was benign prostatic hyperplasia complicated with prostatic abscess.After 2 months, the patient was readmitted due to worsening symptoms, received transurethral bladder neck incision+ cystoscopy+ transurethral plasma resection of the prostate, and postoperative diagnosis confirmed PDA with local PMA.Three months after surgery, the patient had bleeding.After auxiliary examinations revealed extensive metastasis, he received hormonal therapy.After 9 months, the patient died due to multiple lung metastases. [Conclusion] Early diagnosis has a significant impact on the treatment and prognosis, but there have been no previous reports of PDA combined with PMA, so the lack of specific biomarkers in the early stage has led to missed diagnosis or misdiagnoses.There is no specific treatment for PDA with PMA. Radical prostatectomy was not satisfactory in the treatment of this case.

Objective:To study the longitudinal trends and spatial clustering characteristics of healthcare service efficiency in China and in North,Northeast,East,Central,South,Southwest,and Northwest China.Methods:The Malmquist index model is used to measure China's healthcare service efficiency from 2012 to 2021,the Dagum Gini coefficient as well as the decomposition method are used to measure the magnitude and source of regional gaps in healthcare service efficiency,and the Kernel density estimation is used to study the longitudinal trend of change and spatial agglomeration characteristics of China's healthcare service efficiency.Results:China's overall healthcare service efficiency is growing,and the inter-regional gap is gradually narrowing,characterized by a concentration trend;the gap in the level of healthcare service efficiency between regions did not widen during the period under examination,but it was found that the gap within some regions was still significant.Conclusion:The national health service efficiency is growing slightly,and the regional gap is generally decreasing,but the Gini coefficient shows that the inter-regional contribution is still the main source of the gap.National health service efficiency is generally concentrated,but some regions are less efficient,with significant internal disparities.

Objective:To study the longitudinal trends and spatial clustering characteristics of healthcare service efficiency in China and in North,Northeast,East,Central,South,Southwest,and Northwest China.Methods:The Malmquist index model is used to measure China's healthcare service efficiency from 2012 to 2021,the Dagum Gini coefficient as well as the decomposition method are used to measure the magnitude and source of regional gaps in healthcare service efficiency,and the Kernel density estimation is used to study the longitudinal trend of change and spatial agglomeration characteristics of China's healthcare service efficiency.Results:China's overall healthcare service efficiency is growing,and the inter-regional gap is gradually narrowing,characterized by a concentration trend;the gap in the level of healthcare service efficiency between regions did not widen during the period under examination,but it was found that the gap within some regions was still significant.Conclusion:The national health service efficiency is growing slightly,and the regional gap is generally decreasing,but the Gini coefficient shows that the inter-regional contribution is still the main source of the gap.National health service efficiency is generally concentrated,but some regions are less efficient,with significant internal disparities.

Objective:To study the longitudinal trends and spatial clustering characteristics of healthcare service efficiency in China and in North,Northeast,East,Central,South,Southwest,and Northwest China.Methods:The Malmquist index model is used to measure China's healthcare service efficiency from 2012 to 2021,the Dagum Gini coefficient as well as the decomposition method are used to measure the magnitude and source of regional gaps in healthcare service efficiency,and the Kernel density estimation is used to study the longitudinal trend of change and spatial agglomeration characteristics of China's healthcare service efficiency.Results:China's overall healthcare service efficiency is growing,and the inter-regional gap is gradually narrowing,characterized by a concentration trend;the gap in the level of healthcare service efficiency between regions did not widen during the period under examination,but it was found that the gap within some regions was still significant.Conclusion:The national health service efficiency is growing slightly,and the regional gap is generally decreasing,but the Gini coefficient shows that the inter-regional contribution is still the main source of the gap.National health service efficiency is generally concentrated,but some regions are less efficient,with significant internal disparities.

Objective:To study the longitudinal trends and spatial clustering characteristics of healthcare service efficiency in China and in North,Northeast,East,Central,South,Southwest,and Northwest China.Methods:The Malmquist index model is used to measure China's healthcare service efficiency from 2012 to 2021,the Dagum Gini coefficient as well as the decomposition method are used to measure the magnitude and source of regional gaps in healthcare service efficiency,and the Kernel density estimation is used to study the longitudinal trend of change and spatial agglomeration characteristics of China's healthcare service efficiency.Results:China's overall healthcare service efficiency is growing,and the inter-regional gap is gradually narrowing,characterized by a concentration trend;the gap in the level of healthcare service efficiency between regions did not widen during the period under examination,but it was found that the gap within some regions was still significant.Conclusion:The national health service efficiency is growing slightly,and the regional gap is generally decreasing,but the Gini coefficient shows that the inter-regional contribution is still the main source of the gap.National health service efficiency is generally concentrated,but some regions are less efficient,with significant internal disparities.

Objective:To study the longitudinal trends and spatial clustering characteristics of healthcare service efficiency in China and in North,Northeast,East,Central,South,Southwest,and Northwest China.Methods:The Malmquist index model is used to measure China's healthcare service efficiency from 2012 to 2021,the Dagum Gini coefficient as well as the decomposition method are used to measure the magnitude and source of regional gaps in healthcare service efficiency,and the Kernel density estimation is used to study the longitudinal trend of change and spatial agglomeration characteristics of China's healthcare service efficiency.Results:China's overall healthcare service efficiency is growing,and the inter-regional gap is gradually narrowing,characterized by a concentration trend;the gap in the level of healthcare service efficiency between regions did not widen during the period under examination,but it was found that the gap within some regions was still significant.Conclusion:The national health service efficiency is growing slightly,and the regional gap is generally decreasing,but the Gini coefficient shows that the inter-regional contribution is still the main source of the gap.National health service efficiency is generally concentrated,but some regions are less efficient,with significant internal disparities.

Objective:To study the longitudinal trends and spatial clustering characteristics of healthcare service efficiency in China and in North,Northeast,East,Central,South,Southwest,and Northwest China.Methods:The Malmquist index model is used to measure China's healthcare service efficiency from 2012 to 2021,the Dagum Gini coefficient as well as the decomposition method are used to measure the magnitude and source of regional gaps in healthcare service efficiency,and the Kernel density estimation is used to study the longitudinal trend of change and spatial agglomeration characteristics of China's healthcare service efficiency.Results:China's overall healthcare service efficiency is growing,and the inter-regional gap is gradually narrowing,characterized by a concentration trend;the gap in the level of healthcare service efficiency between regions did not widen during the period under examination,but it was found that the gap within some regions was still significant.Conclusion:The national health service efficiency is growing slightly,and the regional gap is generally decreasing,but the Gini coefficient shows that the inter-regional contribution is still the main source of the gap.National health service efficiency is generally concentrated,but some regions are less efficient,with significant internal disparities.