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Objective:To explore the clinical and ultrasound image characteristics and differential diagnosis of female urethral diverticulum(UD) and vaginal wall cysts.Methods:A retrospective analysis of the clinical and ultrasound image features of 12 female patients with UD were collected as UD group and 30 patients with vaginal wall cysts confirmed by surgical pathology and clinical follow-up were collected as vaginal wall cysts group in Peking Union Medical College Hospital from January 2017 to May 2021. Ultrasound image characteristics, and the main points of the differential diagnosis of the two were analyzed and summarized.Results:There were no significant differences in the age of the patients and the maximum diameter of the lesions between UD group and vaginal wall cysts group(all P>0.05). Eight cases (66.7%) of female patients with UD had urinary system symptoms, 5 cases (16.7%) of vaginal wall cysts had urinary system symptoms, the difference was statistically significant ( P<0.05); In 10 cases (83.3%) the UD lesions were located in the upper middle and upper pelvic floor, and vaginal wall cyst lesions in 23 cases (76.7%) were located in the lower middle and lower pelvic floor, the difference was statistically significant ( P<0.05). In terms of ultrasound image characteristics, UD lesions were often irregular in shape, surrounding the urethra, with unclear borders, cyst wall thickness >0.1 cm, internal wall not smooth along with calcification, internal visible separation, partly visible to the urethra, and peripheral blood flow signals were abundant. Vaginal wall cysts were mostly round-shaped, not surrounding the urethra, clear borders, thin and smooth walls, less internal partitions, not communication with the urethra, and the peripheral blood flow signals were not abundant. The differences between the two group were statistically significant (all P<0.05). Whether the sound transmission inside the lesion was not statistically significant ( P>0.05). Conclusions:Combined with urinary system symptoms, lesion location, ultrasound characteristics (morphology, whether surrounding the urethra, boundary, cyst wall thickness, inner wall calcification, internal separation, whether it is connected to the urethra, blood flow distribution) can be used to distinguish between UD and vaginal wall cysts, whether the sound transmission inside the lesion cannot be used as the basis for the differential diagnosis of the two.
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Objective:To discuss the value of ultrasound in the diagnosis of pelvic lipomatosis and analyze the causes of misdiagnosis.Methods:A retrospective analysis of 68 cases of pelvic lipomatosis confirmed by operation or imaging in Peking Union Medical College Hospital from January 2000 to December 2018 was made to summarize the characteristics of ultrasonic manifestations.Results:Ultrasonographic findings were as follows: 6 cases (8.8%) had increased fat-like hyperecho in pelvic cavity; 60 cases (88.2%) had abnormal bladder; 42 cases (61.7%) had pyelectasis and 24 cases (35.3%) had ureterectasis. Of the 68 cases, 6 cases (8.8%) were correctly diagnosed; 54 cases (79.4%) were missed; 8 cases (11.8%) were misdiagnosed, including 7 cases (10.3%) of bladder tumor and 1 case (1.5%) of retroperitoneal giant mass.Conclusions:Pelvic lipomatosis has characteristic sonographic features.When urinary tract obstruction and bladder wall thickening are observed, pelvic lipomatosis should be considered. Bladder shape and existence of increasing fat-like hyperecho in the pelvis should be further scanned to reduce the misdiagnosis rate of pelvic lipomatosis.
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Objective@#To investigate the promotional effect of the new teaching method of goal orientation combined with plan-do-check-act (PDCA) cyclic improvement on specialized medical knowledge and operation skills among physicians in critical care medicine.@*Methods@#A total of 84 physicians who received critical care medicine training in Department of Critical Care Medicine in Foshan Hospital of Traditional Chinese Medicine from January 2013 to December 2015 were selected, and according to the time of admission, they were divided into control group with 41 physicians and experimental group with 43 physicians. The physicians in the experimental group received the new teaching method of goal orientation combined with PDCA cyclic improvement, i.e., the physicians started systematic learning according to the learning goals sent out by the teaching secretary, summarized problems during learning and looked for optimal solutions every week, and then continued learning in the next week through PDCA cyclic improvement. The physicians in the control group received traditional teaching combined with bedside teaching, but no learning goals were set for them. The two groups were compared in terms of theoretical examination scores, clinical operation skills, and results of the questionnaire survey. The t-test and Wilcoxon ranksum test were used for comparison of scores between the two groups by SPSS 18.0.@*Results@#Compared with the control group, the experimental group had significant increases in the scores of theoretical examination (91.50±4.18 vs. 87.80±3.63) and operation skills (88.80±3.34 vs. 85.40±2.88). The questionnaire survey showed that compared with the control group, the experimental group had a significantly higher degree of satisfaction, significantly greater learning interests, and significantly greater improvements in operation skills, clinical thinking ability, and self-confidence.@*Conclusion@#The new teaching method of goal orientation combined with PDCA cyclic improvement can stimulate learning interests, clarify learning goals, help physicians to master important and difficult issues, and thus improve their learning outcomes and scores in Department of Critical Care Medicine.
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Objective To investigate the promotional effect of the new teaching method of goal orientation combined with plan-do-check-act (PDCA) cyclic improvement on specialized medical knowledge and operation skills among physicians in critical care medicine.Methods A total of 84 physicians who received critical care medicine training in Department of Critical Care Medicine in Foshan Hospital of Traditional Chinese Medicine from January 2013 to December 2015 were selected,and according to the time of admission,they were divided into control group with 41 physicians and experimental group with 43 physicians.The physicians in the experimental group received the new teaching method of goal orientation combined with PDCA cyclic improvement,i.e.,the physicians started systematic learning according to the learning goals sent out by the teaching secretary,summarized problems during learning and looked for optimal solutions every week,and then continued learning in the next week through PDCA cyclic improvement.The physicians in the control group received traditional teaching combined with bedside teaching,but no learning goals were set for them.The two groups were compared in terms of theoretical examination scores,clinical operation skills,and results of the questionnaire survey.The t-test and Wilcoxon ranksum test were used for comparison of scores between the two groups by SPSS 18.0.Results Compared with the control group,the experimental group had significant increases in the scores of theoretical examination (91.50 ± 4.18 vs.87.80 ± 3.63) and operation skills (88.80± 3.34 vs.85.40 ± 2.88).The questionnaire survey showed that compared with the control group,the experimental group had a significantly higher degree of satisfaction,significantly greater learning interests,and significantly greater improvements in operation skills,clinical thinking ability,and self-confidence.Conclusion The new teaching method of goal orientation combined with PDCA cyclic improvement can stimulate learning interests,clarify learning goals,help physicians to master important and difficult issues,and thus improve their learning outcomes and scores in Department of Critical Care Medicine.
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Objective To study the effect of Xuebijing injection on transfusion and systemic inflammation in traumatic coagulopathy patients. Methods Seventy-nine patients were randomly divided into Xuebijing Group (36 cases) and Control Group (43 cases). Xuebijing group received Xuebijing injection in addition to the regular treatment received by control group. Levels of TNF-α, IL-6, IL-8 and transfusion amount between two groups were compared. Results Coagulation abnormality was almost corrected in all patients after treatment. In Xuebijing Group, transfusion of RBC, FFP and cryoprecipitate were significantly less than that in control group (P<0.05). At 72 h after admission, TNFα, IL-6 and IL-8 were significantly lower in Xuebijing Group (P < 0.05). Conclusion Xuebijing injection could reduce transfusion in traumatic coagulopathy patients , possibly resulting from its antagonism against systemic inflammation.
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Objective To summarize the sonographic features and differential diagnosis points of mass-type cornual pregnancy. Methods The sonographic ifndings of 23 pathological proven mass-type cornual pregnancy cases enrolled in PUMCH from 2011 January to 2013 January were retrospectively analyzed. Results All pathological proven mass-type cornual pregnancy were located at one corner of the uterus presenting as a heterogenous outward mass. Well-deifned margins were found in 20 cases, and interstitial-line signs were found in 15 cases. The surrounding muscle thickness is 0.1-0.3 cm. Typical hyperechoic villi were found on sonography in cases with bloodβ-hCG>20 000 IU/L. On Doppler, the lesion showed abundant peripheral vascularity with low resistance in 22 cases, 9 lesions also showed abundant internal vascularity. Among 23 mass-type cornual pregnancy cases, 7 cases were misdiagnosed as gestational trophoblastic neoplasia (GTN) due to the similar sonographic characteristics including mixed-echo and abundant vascularity with low resistance. Sixteen cases were diagnosed by ultrasound preoperatively, with featured sonographic signs including mass located in the endometrial extension line;clear margin;peripheral vascularity;or detection of interstitial-line sign and typical villus. Conclusions Mass-type cornual pregnancy may be correctly diagnosed according to the location, boundary of the mass and the distribution of blood flow combining with clinical manifestation and bloodβ-hCG level. Transvaginal sonography could play an important role in diagnosis of cornual pregnancy.
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Objective To evaluate the differences among five representative and useful Doppler parameters in the diagnosis of the three common types of renal artery stenosis (RAS). Methods Five Doppler parameters including renal peak systolic velocity (RPSV), renal-aortic ratio (RAR), renal-interlobar ratio (RIR),acceleration time (AT),and resistant index (RI) were measured in 221 patients before renal arteriography. Differences between the groups of patients with various clinical causes of RAS were analyzed by Chi-Squared test. One-way ANOVA or t test were used to compare the means between different groups.The optimal cutoff value was determined with the maximum sum of sensitivity and specificity. Results Of the 442 renal arteries (main and accessory renal arteries) demonstrated at arteriography,214 were normal or stenosed less than 50 %, 204 stenoses 50% - 99 %, and 24 occlusions. RIR, RAR and RI were significantly different between the atherosclerotic and non-atherosclerotic RAS groups (P ＜0.05), while RPSV and AT were not. The optimal cutoff values of RAR,RIR and RI for detecting RAS between the atherosclerotic and non-atherosclerotic groups were much different (2.5 versus 1.9, 5. 1 versus 6.5, 0.57 versus 0.50,respectively) ,but those of RPSV and AT were similar or the same (170 cm/s versus 200 cm/s,51 ms versus 51 ms,respectively). Conclusions In the case of RAS (diameter reduction≥50%),it is advised to establish separate cutoff values of RAR, RIR and RI according to atherosclerotic and non-atherosclerotic RAS, but the same cutoff value of RPSV and AT can be applied. RIR is a good Doppler parameter in the diagnosis of RAS,especially atherosclerotic and fibromuscular dysplasia RAS.
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Objective To investigate the relation between intrauterine growth and the development of carotid atherosclerosis in later life. Methods The intima-media thickness of carotid was measured with ultrasonography in 2036 people aged above fifty who had complete birth records, and divided into normal and abnormal group. They were asked to fill in the cardio-cerebrovascular questionnaire, and venous blood samples were taken and analysed for various biochemical parameters. The relation between carotid atherosclerosis and various parameters at birth and in adult life was assessed. Results The birthweight and head circumference in abnormal group were less than those in normal. The prevalence of carotid atherosclerosis was greatest in those weighed 2500g or less, whose risk of carotid atherosclerosis was greater than those weighed between 3000g and 3500g, after adjustment for cardiovascular risk factors. Conclusions Increased atherogenesis may be one independent mechanism mediating the epidemiological link between impaired fetal growth and vascular disease.