Objective To investigate the efficacy and safety of interventional therapy for bronchopleural fistula(BPF).Methods A total of 172 patients with confirmed BPF were treated with continuous negative pressure drainage(CNPD)and/or airway stent occlusion therapy.The clinical data were collected,and its effectiveness and safety were analyzed.Results In 5-7 days after interventional treatment,the pneumonia severity index(PSI)decreased significantly,and successful drainage was achieved in 166 patients(96.5％).One month after interventional therapy,the lung volume was remarkably increased.The median clinical healing time of interventional therapy was 9.0 months(95％CI=6.18-1 1.83).Multivariate analysis of the Cox proportional hazards model showed that the diagnosis time(HR=0.53,95％CI=0.38-0.74,P＜0.01)and fistula size(HR=0.74,95％CI=0.55-0.99,P=0.04)were significantly correlated with the clinical healing time.Conclusion For the treatment of BPF,CNPD and/or airway stent occlusion has several advantages such as accurate operation,minimally invasive,safe and effective.It can quickly improve the symptoms and quality of life,and prolong survival,therefore,it is worthy of clinical promotion and application.(J Intervent Radiol,2024,33:641-645)

Objective:To improve the understanding of special type of atrioventricular septal defect (AVSD) and reduce clinical missed diagnosis and misdiagnosis by investigating its echocardiographic features.Methods:Echocardiographic images of patients with special type of AVSD diagnosed by echocardiography and confirmed by surgery in Pediatric Cardiovascular Center, Beijing Anzhen Hospital, Capital Medical University from November 2011 to November 2021 were retrospectively analyzed. Depending on the presence of ventricular septal defect(VSD), special type of AVSD were divided into two types, namely AVSD with intact ostium primum and AVSD with intact ostium primum and ventricular septum. The echocardiographic features of special type of AVSD were summarized.Results:Twenty-five cases of special type of AVSD were diagnosed by echocardiography and 13 cases were confirmed by surgery, including 12 cases with intact ostium primum and 1 case with intact ostium primum and ventricular septum. There were 5 cases without surgical indications, and 1 case was kept under observation due to small VSD. One patient with complex malformation only underwent pulmonary artery banding operation without treating intracardiac malformation. The other 4 cases of perimembrane VSD and 1 case of partial AVSD were misdiagnosed as special type of AVSD by echocardiography. All patients had mild to severe left atrioventricular regurgitation before surgery, and most patients remained left atrioventricular regurgitation of varying degrees after left atrioventricular valve formation. Characteristic sonographical findings included: ①The ostium primum was continuous and there was no ostium primum defect. ②The attachment points of the left and right atrioventricular valves were at the same level. ③The left atvioventricular valve was a trileaflet left atrioventricular valve and attached to the crest of the ventricular septum, forming the so-called "anterior mitral valve leaflet cleft". ④The two groups of papillary muscles of the left ventricle changed the normal anterolateral and posterolateral alignment, but showed a anteriorly and posteriorly relationship (counterclockwise transposition). ⑤In the presence of VSD, an inlet ventricular septal defect would be present. ⑥Color Doppler showed varying degrees of regurgitation signals from the left atrioventricular valve during systolic period. ⑦Other complex deformities may be combined with special type of AVSD.Conclusions:Echocardiography can make a definite diagnosis for special types of AVSD. The prognosis of this malformation is closely related to the left atrioventricular valve, and the shaping effect depends on the development of left atrioventricular valve and regurgitation.

In this paper, the uncertainties of correction factors of fluconazole impurities determined by HPLC standard curve method were evaluated, and the main common factors affecting the accuracy of standard curve method were found, so as to improve the accuracy of the method.In this study, the corresponding fitting lines of fluconazole and its impurities A, B, C, D, F and I were established respectively, and the ratio of the slope of fitting lines of each impurity and its corresponding principal component was calculated as the correction factor of the impurity.Then on the basis of GUM method, the uncertainty of each impurity correction factor determined by standard curve method was evaluated according to the established uncertainty evaluation scheme of correction factor determination process.The correction factor and uncertainty of fluconazole impurities A, B, C, D, F and I were 1.068 ± 0.046, 0.102 ± 0.005, 0.0582 ± 0.0031, 1.382 ± 0.121, 0.802 ± 0.067 and 1.383 ± 0.119, respectively, and the coverage factor k was 2.Finally, the contribution rate of each uncertainty component was calculated.In the relative combined standard uncertainties urel(f) of fluconazole impurities A, B, C, D, F and I correction factors, the sum of contribution rate of slope uncertainty urel(K) of the linear equation of principal component and its impurity is more than 85%; in the slope uncertainties urel(K) of linear equation, the contribution rates of uncertainties of solution concentration in 8 of 12 data groups are more than 80%, and the contribution rates of uncertainties introduced by reference substance content in solution concentration are about 80%.It can be seen that the preparation of linear solution concentration is the most influential factor in the determination of impurity correction factor by standard curve method, followed by the linear fitting process.In the preparation process of linear solution concentration, the purity of reference substance is the most influential factor, followed by weighing and pipetting times.The conclusion can help the experimenters to better formulate experimental plans and ensure the accuracy of the results when doing similar work.

ObjectiveTo explore the characteristics of oral sensory-motor function in children with functional articulation disorders (FAD). MethodsFrom June, 2021 to January, 2022, 61 children with FAD in the Department of Children's Health of the Affiliated Hospital of Qingdao University were as case group, 90 normal healthy children were as control group. They were assessed with Oral Sensory-Motor Assessment, and were compared among different genders and different ages. Hyperactivity problems were assessed using Conners Parent Symptoms Questionnaire, and their oral sensory-motor function were compared between patients with hyperactivity problem (n = 13) and without hyperactivity problem (n = 48). ResultsThe total score and the scores of oral sensation, mandibular motion, lip motion and tongue motion were significantly lower in the case group than in the control group (t > 4.471, P < 0.001). There were significant differences in the total score and motor function scores among different ages in the control group (H > 17.015, P < 0.001), and they increased with age. There were significant differences in the total score, oral sensory and motor function scores among different ages in the case group (H > 10.567, P < 0.01), and they increased with age. The total scores, and the scores of mandibular, lip and tongue movements were lower in the boys and girls of the case group than in the same gender of the control group (t > 2.49, P < 0.05). The total score and the scores of the lip and tongue movements were lower in boys than in girls in the case group (|Z| > 2.409, P < 0.05). There was no significant difference in the total score and other scores between the patients with hyperactivity problem and without hyperactivity problem (P > 0.05). ConclusionThe oral sensory-motor function is poor for children with FAD, and can develop with age in both normal and FAD children.

To improve the standard of quality control of tazobactam and its preparations in China, national reference standard of tazobactam impurity A was developed. After tazobactam impurity A was synthesized, its structure was validated by infrared (IR), mass spectrometry (MS) and nuclear magnetic resonance (NMR), and its content uniformity and short-term stability were measured and investigated. Then, water content and residue on ignition of impurity A were determined, and its purity was determined using high performance liquid chromatography (HPLC) with 10 mmol/L ammonium acetate solution-acetonitrile (98∶2) as the mobile phase. Mass balance method was used to determine the content of the first batch of tazobactam impurity A national standard substance. Meanwhile, nuclear magnetic quantitative method was used to calculate the content, which was mutually verified with the mass balance method. The developed reference material of tazobactam impurity A is consistent with the maximum degradation impurity in tazobactam system applicability solution and the reference material of tazobactam related substance A contained in USP41. Within the 95% confidence range, the ratio of inter- and intra-bottle variance of impurity A after separation was 0.61 (< F0.05(11,12)), proving that the uniformity was satisfying. The contents of organic impurity, water content and inorganic impurity in impurity A were 0.90%, 1.24% and 0.25%, respectively. The content of impurity A was determined to be 97.6% by mass balance method, which was basically consistent with the result of nuclear magnetic quantitative method (97.1%). Under the condition of 25 °C, the area normalized purity of impurity A was 99.1% at 0, 3, 5 and 10 days, proving that the sample was stable at room temperature for 10 days. Finally the first batch of national standard substance of tazobactam impurity A was established successfully.

Objective:The research was aimed to investigate the association between serum total homocysteine (tHcy) and subacute combined degeneration of the spinal cord (SCD).Methods:A retrospective survey of 106 newly diagnosed patients with SCD were enrolled in this research who were treated in the department of neurology of Xijing Hospital from January 2008 to February 2019, meanwhile, 121 patients with spinal cord lesion (not SCD) and 104 neurology mild outpatients were selected as controls. Serum tHcy level was determined by using the chemiluminescent immunoassay assay. A multivariate logistic regression model was used to analyze the risk factors for SCD. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve, sensitivity, specificity and Youden index were used to evaluate the diagnostic efficacy of tHcy. Spearman correlation analysis was used to observe the correlation between tHcy and SCD severity. The SCD patients were categorized into normal or mild tHcy group, moderate tHcy group, and severe tHcy group based on tHcy levels. Clinical symptoms, nerve conduction velocity, magnetic resonance imaging (MRI) findings from the patients were studied.Results:The serum tHcy levels in SCD patients were 64.3(26.5, 98.8) μmol/L, while in patients with spinal cord lesion (not SCD) group were 13.7(10.8, 19.2) μmol/L, neurology mild outpatients were 10.6(8.2, 13.0) μmol/L, which was higher in SCD group ( H=112.020, P<0.001), ( H=165.525, P<0.001).The multivariate logistic regression model showed tHcy is the impact factor of SCD ( OR=1.107, 95% CI:1.077-1.139, P<0.001). At ROC analysis, tHcy showed diagnostic value with an optimal cut-off value of 24.9 μmol/L (AUC 0.913, 95% CI: 0.875-0.951, sensitivity 79.2%, specificity 91.6%). Spearman correlation analysis showed that tHcy was positively correlated with functional disability rating scale ( r=0.254, P=0.009). Conclusions:Serum tHcy is the risk factor for SCD and related to its disability. Focus on the increased level of tHcy plays a positive role in the diagnosis of SCD.

Objective:The research was aimed to investigate the association between serum total homocysteine (tHcy) and subacute combined degeneration of the spinal cord (SCD).Methods:A retrospective survey of 106 newly diagnosed patients with SCD were enrolled in this research who were treated in the department of neurology of Xijing Hospital from January 2008 to February 2019, meanwhile, 121 patients with spinal cord lesion (not SCD) and 104 neurology mild outpatients were selected as controls. Serum tHcy level was determined by using the chemiluminescent immunoassay assay. A multivariate logistic regression model was used to analyze the risk factors for SCD. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve, sensitivity, specificity and Youden index were used to evaluate the diagnostic efficacy of tHcy. Spearman correlation analysis was used to observe the correlation between tHcy and SCD severity. The SCD patients were categorized into normal or mild tHcy group, moderate tHcy group, and severe tHcy group based on tHcy levels. Clinical symptoms, nerve conduction velocity, magnetic resonance imaging (MRI) findings from the patients were studied.Results:The serum tHcy levels in SCD patients were 64.3(26.5, 98.8) μmol/L, while in patients with spinal cord lesion (not SCD) group were 13.7(10.8, 19.2) μmol/L, neurology mild outpatients were 10.6(8.2, 13.0) μmol/L, which was higher in SCD group ( H=112.020, P<0.001), ( H=165.525, P<0.001).The multivariate logistic regression model showed tHcy is the impact factor of SCD ( OR=1.107, 95% CI:1.077-1.139, P<0.001). At ROC analysis, tHcy showed diagnostic value with an optimal cut-off value of 24.9 μmol/L (AUC 0.913, 95% CI: 0.875-0.951, sensitivity 79.2%, specificity 91.6%). Spearman correlation analysis showed that tHcy was positively correlated with functional disability rating scale ( r=0.254, P=0.009). Conclusions:Serum tHcy is the risk factor for SCD and related to its disability. Focus on the increased level of tHcy plays a positive role in the diagnosis of SCD.

OBJECTIVE: To analyze the clinical features and genetic variants in a 13-month-old child with Bloom syndrome. METHODS: Clinical data of the child was collected. Genetic variants were detected by high-throughput sequencing and Sanger sequencing. RESULTS: The child was born at full term but was small for gestational age. His clinical features included loss of appetite, severe growth retardation, microcephaly, and small mandible. Genetic testing found that he had carried compound heterozygous c.1068+3A>C and c.1069-1G>C variants of the BLM gene, both of which were unreported previously. CONCLUSION Bloom syndrome is mainly characterized by severe growth retardation in infancy. The novel variants have expanded the variant spectrum of the BLM gene.

Objective:To explore the application effects of the Doctor-nurse-therapist integrated Model on the patients with brain injury in the rehabilitation period.Methods:A total of 60 patients with brain injury from January 2016 to October 2017 were selected as the control group underwent interventions based on traditional treatment model involving medical treatment, nursing and rehabilitation, and then 56 patients with brain injury from January 2018 to October 2019 were aselected as the experimental group followed Doctor-Nurse-Therapist integrated model for rehabilitation treatment. All subjects were recruited from inpatients hospitalized in the Forth Department of Neurological Rehabilitation, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center). The differences of motor function, activities of daily life (ADLs), anxiety and depression scores between the two groups were compared.Results:After 6 weeks of interventions, the scores of motor function were 80.27±18.20 and 67.32±19.71, and ADLs scores were 73.14±19.18 and 64.59±20.33 for the experimental group and the control group, respectively. The differences of the motor function and ADLs scores showed statistical significance between the experimental group and the control group ( t values were 3.491, 2.105, P<0.05). The anxiety and depression scores were 44.68±12.29 and 42.61±17.95 in the experimental group, while 52.25±12.95 and 50.84±18.14 in the control group, respectively. Statistical significance was found according to differences of anxiety and depression scores between the experimental group and the control group ( t values were 2.965,-2.236, P<0.05). Conclusions:Under the integrated model, doctors, nurses and therapists can evaluate, discuss, formulate and implement the flow scheme of the model, which can significantly improve the motor function and daily life ability of patients with brain injury in the rehabilitation period as well as anxiety, depression and the quality of medical services, and reduce the burden of family and society.

Objective:To explore the clinical application effect of the integrated health education model of medical care and treatment in the rehabilitation of hospitalized patients with brain injury.Methods:A total of 90 patients with brain injury who were admitted to Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center) from May 2018 to October 2019 were selected as the research objects by the convenient sampling method. The patients were divided into the observation group ( n=46) and the control group ( n=44) by random number table method. The control group adopted traditional methods for health education, while the observation group adopted integrated health education model of medical care and treatment. Standardized assessments were performed before the intervention and the first, third and sixth weeks of the intervention. The responsible nurses used Fugl-Meyer Assessment Scale (FMA) , Self-care Ability Assessment Scale (Barthel index) and Exercise of Self-Care Agency scale (ESCA) to evaluate the motor function, daily life self-care ability and self-care ability of the observation group and the control group. And self-made questionnaire was used to assist patients to complete the nursing quality satisfaction score. Results:After 6 weeks, the score of limb motor function score of the observation group was (89.57±11.28) and score of the daily self-care ability was (89.46±11.75) . Those of the control group were respectively (69.82±10.04) and (56.70±10.67) . The differences were all statistically significant ( P<0.05) . After intervention, the scores of self-care ability of patients in the observation group were (23.26±2.87) , (34.17±4.23) , (17.57±2.52) and (48.40±6.03) , and the satisfaction rate of nursing quality was 87.0% (40/46) . The scores of self-care ability of patients in the control group were (16.50±1.86) , (24.21±3.01) , (12.66±1.78) and (34.18±3.96) and 63.6% (28/44) . The differences were all statistically significant ( P<0.01) . Conclusions:The integrated health education model of medical care and treatment can improve the limb motor function of patients with brain injury and the self-care ability of daily life, improve the self-care ability of patients in rehabilitation treatment, improve the satisfaction of nursing quality and improve the quality of medical service.