Evaluation study on the appropriateness of hospitalization days at a tertiary hospital / 中华医院管理杂志

Objective To evaluate the appropriateness of hospitalization days at a tertiary hospital in 2014 by means of the Appropriateness Evaluation Protocol ( AEP ) , and to analyze the causes of inappropriate stays. Methods Medical records of inpatients admitted at a tertiary hospital in 2014 were randomly selected. AEP( US version) was used to evaluate the appropriateness of every hospitalization day, while the causes of inappropriate hospitalization day were also analyzed. Results A total of 1 641 days of stay from 148 medical records were reviewed, and 129 days of stay (7. 9%) were seen as inappropriate. Two major factors for inappropriate stays were waiting for surgery and waiting for test, roughly 89. 1% of the inappropriate hospitalization days. The proportion of inappropriate hospital stays reduced to 4. 8% after adjustment of two-day weekend. Inappropriate hospital stays mostly appeared during the second day to the eighth day after admission(93. 8%). Logistic analysis results showed that with concomitant symptoms, preoperative waiting days > 5 days, high level surgery, non-emergency admission were significantly associated with appropriateness of hospital stays (P<0. 05). Conclusions The rate of inappropriate stays will be reduced and the quality of medical services will be improved if comprehensive measures could be carried out according to the causes of inappropriate stays.

Study of demonstrating main operative section of facial recess approach using double oblique multiplanar reconstruction on multislice CT / 中华放射学杂志

Objective To explore the method of demonstrating main operative section of facial recess approach with multi-slice CT by using double oblique muttiplanar reconstruction.MethodsSimilarly as surgical procedure of facial recess approach,30 (60 eras) normal temporal bones in cadavers were reconstructed to observe main operative sections and anatomical marks.Main images of operative section of facial recess approach were reconstructed using double oblique multiplanar reconstruction on multislice CT.With the reference of operative anatomical marks,the ratios of visibility of anatomical marks on the transverse plane,coronal plane,sagittal plane and double oblique were calculated and compared.The degree,of which major anatomical landmarks were displayed on the same plane ( axial,coronal,sagittal,or doubleoblique sagittal plane),was classified using the following criteria: level 4: 100％ of anatomical landmarks were presented in the same plane; level 3: 90％ to 99％ of anatomical landmarks were presented in the same plane; level 2: 80％ to 89％ of anatomical landmarks were presented in the same plane; level 1: 70％ to 79％ of anatomical landmarks were presented in the same plane ; level 0: ＜ 70％ of anatomical landmarks were presented in the same plane.Classification data were tested by chi-square test.Results Four key operative section were involved in facial recess approach,which were of oblique sagittal orientation.The central mark of the first key operative section was semicircular canal by using double oblique multi-planar reformation.On reconstructed images of the first key operative section,horizontal reference line was short process of incus,and the angle adjusting the reference line on the transverse plane was 22.15° ±5.22°.On the reconstructed images of the first key operative section,coronal reference line was tympanic segment of facial canal,and the angle adjusting the reference line on the coronal plane was 14.35° ± 4.02°.On the reconstructed images of the second key operative section,the central mark was fossa incudis,the horizontal reference line was short process of incus and the angle was 20.15° ± 5.52°,while the coronal reference line was tympanic segment of facial cana,and the angle was 13.15° ± 3.33°.On the reconstructed operative images of the third key section,the central mark was pyramidal eminence,the horizontal reference line was the horizontal portion of the facial nerve and the angle was 32.53° ±5.22°,while the coronal reference line was the tympanic segment of facial nerve,and the angle was 15.05° ± 4.43°.On the fourth reconstructed images of the key operative section,the central mark was the posterior border of round window,the horizontal reference line was the superior border of oval window,and the angle was 50.15° ± 8.02°,while the coronal reference line was the tympanic segment of facial nerve,and the angle was 15.25° ± 4.12°.For the four planes (double-oblique sagittal,axial,coronal,or sagittal plane),the results of the degree to which they could include the major anatomical landmarks in the same layer of the first section were: level 4 in 60 sides,level 2 in 12 sides and level 3 in 48 sides,level 2 in 15 sides and level 3 in 45 sides,level 3 in 10 sides and level 4 in 50 sides,respectively.The results of the second section were: level 4 in 60 sides,level 2 in 11 sides and level 3 in 49 sides,level 2 in 13 sides and level 3 in 47 sides,level 3 in 11 sides and level 4 in 49 sides,respectively.The results of the third section were: level 4 in 60 sides,level 2 in 10 sides and level 3 in 50 sides,level 2 in 11 sides and level 3 in 49 sides,level 3 in 9 sides and level 4 in 51 sides,respectively.The results of the fourth section were: level 4 in 60 sides,level 2 in 9 sides and level 3 in 51 sides,level 2 in 8 sides and level 3 in 52 sides,level 3 in 5 sides and level 4 in 55 sides,respectively.The four planes differed significantly in the degree to which they could include the major anatomical landmarks in the same layer ( x2 =123.3200,121.4231,122.4011,125.4213,all,P ＜ 0.05 ).The visibility ratio of every section is 100％ (60/60).Conclusion Double oblique multi-planar reformation is a new method to demonstrate landmarks of operative section of facial recess approach in one slice.The reconstructive images of operative section with double oblique multi-planer reconstruction may provide valuable information for operation.

Study of demonstrating main operative mark of transmastoid-epitympanum approach of the facial nerve using double oblique multi-planar reconstruction in multi-slice CT / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore a method of demonstrating the facial nerve anatomical landmarks under transmastoid and epitympanum approach with multi-slice CT using double oblique multi-planar reconstruction (MPR).@*METHOD@#Two temporal bone of a corpse were dissected, under transmastoid and epitympanum approach, to observe the anatomical landmarks of facial nerve. Based on that, the anatomical landmarks of facial nerve under transmastoid and epitympanum approach in 30 (60 ears) normal temporal bones of adult corpses were reconstructed using double oblique MPR in multi-slice CT. The achievement ratio was calculated and the differences among transverse plane, coronal plane, sagittal plane and double oblique were compared.@*RESULT@#The different part of facial nerve, such as mastoid segment, tympanum segment, pyramid segment, geniculate ganglion and the outer labyrinthine segment could be exposed clearly with the main anatomical landmarks, such as horizontal semicircular canal, epitympanic recess and cochleariform process through transmastoid and epitympanum approach. The image of anatomical landmarks could be showed in the same sections by double oblique multi-planar reconstruction. The double oblique multi-planar reconstruction to show the landmarks of facial nerve displaying on the same imaging is better than transverse plane, coronal plane and sagittal plane. The achievement ratio of every section is 100%.@*CONCLUSION@#Double oblique MPR is a new method to demonstrate anatomical landmarks through transmastoid and epitympanum approach in one slice. Combined with the operative approach and purpose, the reconstructive images with double oblique MPR can provide valuable information for operation.

The diagnostic value of apparent diffusion coefficient in monitoring the development of cerebral infarction / 中国医师杂志

Objective To study the values of apparent diffusion coefficient (ADC) changing with time and space in cerebral infarction,and to provide the evidence in defining the infarction stages.Methods 117 work-ups in 98 patients with cerebral infarction (12 hyperacute,43 acute,29 subacute,10 steady,and 23 chronic infarctions) were imaged with both conventional MRI and diffusion weighted imaging.The average ADC values,the relative ADC (rADC) values,and the ADC values or rADC values from the center to the periphery of the lesion were calculated.Results The average ADC values and the rADC values of hyperacute and acute infarction lesion depressed obviously.rADC values in hyperacute and acute stage was minimized,and progressively increased as time passed and appeared as "pseudonormal" values in approximately 8 to 14 days.Thereafter,rADC values became greater than normal in chronic stage.There was positive correlation between rADC values and time[ (174 ±3.47)% vs (58±6.75)%,t =2.03,P ＜0.05 ].The ADC values and the rADC values in hyperacute and acute lesions had gradient signs that these lesions increased from the center to the periphery.The ADC values and the rADC values in subacute lesions had adverse gradient signs that these lesions decreased from the center to the periphery.Conclusion The ADC values of infarction lesions have evolution rules with time and space.The evolution rules with time and those in space can be helpful to provide the evidence in guiding the treatment or judging the prognosis in infarction.

Struma Ovarii: Correlation of CT Appearances and Pathological Findings / 实用放射学杂志

Objective To analyzed the CT features of struma ovarii(SO).Methods The clinical data and CT features of eleven patients with pathologically proved SO were retrospectively analyzed.CT features were compared with pathological results.Results(1)All tumors were unilateral.On non-enhanced CT,the lesions presented as well-defined irregular masses,which were cystic-solid(n=6,54.5%)or cystic(n=5,45,5%).(2)The cystic portions presented as well-defined,multiple,various size,and there were entire cystic walls with smooth inner wall.The tumors(63.6%)showed a high at attenuation lesions in the cyst portion of the mass on precontrast scans and the attenuation ranged from 72.3 to 113.5 Hounsfield units(HU)in 7 cases.The solid portions showed irregular tissue density,and were often distributed in the cysts.After contrast administration,the cystic portions showed no enhancement,the solid portions marked enhancement,and the cystic walls demonstrated no moderate,or marked enhancement.(3)The tumors(72.7%)showed stippled calcification in solid portions and(or)cystic wall in 8 cases.(4)The tumors(27.3%)accompanied with mature cystic teratomas,and showed fat density in 3 cases.(5)The tumors(27.3%)accompanied a great of ascites and pleural liquid.Conclusion CT characteristics of SO might be of great value for the diagnosis.

Calculation of cardiac function values at different heart rates with computer simulation / 中国组织工程研究

Computer simulation cardiac function values were calculated at different heart rate level, including left ventricular ejection fractions (LVEF), stroke volume (SV), cardiac output (CO) and so on, which was aimed to observe the effects of heart rate on cardiac function. It showed that the simulation results of LVEF, SV and CO were reliable at a low heart rate with linear regression model, but unreliable at a high heart rate. CO reached its maximum value when heart rate was 100 times per minute. Heart function values varied with heart rate. The effect of heart rate should be paid much attention to when heart function report was read.

MRI Features of Foot Fatigue Fracture Without X-ray Film Abnormality / 实用放射学杂志

Objective To study the MRI features of the fatigue fracture of ankle.Methods 15 patients including 11 man and 4 women were studied.The age of the patients ranged from 15～45 years,with average of 22 years.All cases had no traumatic history of ankle joint and a negative result of plain radiographs,and its clinical symptoms was pain in the local site of feet.Siemens 1.5T MRI with SE and FSE were used to investigate the ankle,T 1WI(TR/TE=700/20)and T 2WI(TR/TE=4700/100) and T 2WI fat surpassion.Results All cases demonstrated abnormal MRI signals in both T 1 and T 2 weighted image:6 involving the talus,7 involving calcaneus,1 case located the navicular bone and 1 case involving both talus and calcaneus.15 cases with 16 were abnormalities of bone marrow,which 10 demonstrated hypointensity on T 1WI and hyperintensity on T 2WI,6 cases with hypointensity on T 1WI and complex signal intensity on T 2WI.Conclusion MR features of fatigue fracture of ankle joint without abnormality in X-ray films include trabecular fracture under cortical bone and edema in the trabecular bone which demonstrate irregular abnormal signal in MRI.