A 46-year-old woman was admitted to the cardiovascular department because of a 3-month history of palpitations and exertional dyspnea. She had a history of a successful pregnancy at a very young age. The chest radiograph presented a \"calabash\" configuration. Echocardiogram discovered a large atrial septal defect with a suspected pulmonary vein abnormality. Cardiac CT revealed supracardiac total anomalous pulmonary venous return, whereby, all the pulmonary veins drain into a vertical vein and, finally, to the superior vena cava. Cardiac catheterization was consistent with anomalous pulmonary venous drainage without pulmonary hypertension. Finally, she underwent a successful surgical repair and appeared asymptomatic before her discharge.

In clinical practice, many patients complained that their knees became larger after total knee arthroplasty (TKA), yet no studies have described this phenomenon. We named this as \"patient-perceived enlargement of knee\" (PPEK). This study aimed to investigate the prevalence of PPEK after TKA; assess the association between PPEK and demographics, surgical options, or component size; assess the influence of PPEK on patient satisfaction and functional outcomes; and determine whether there was radiological difference between patients with or without PPEK.
We reviewed patients that underwent unilateral primary TKA between May 2018 and April 2019. We investigated the prevalence of PPEK and acquired functional scores and satisfaction. Patients were divided into two groups according to whether they complained of PPEK. In radiological evaluation, we measured anterior and posterior condyle offset (ACO and PCO) of the femur, tibial coverage lines, tibial overhanging lines, and femoral overhanging lines.
A total of 389 patients were enrolled and 101 patients felt their knee became \"larger\" after TKA. Patients with PPEK had significantly shorter height and lower weight, yet component size distribution showed no statistical difference. Patients with PPEK had significantly lower functional scores and satisfaction. Patients with PPEK had significantly larger ACO, shorter postoperative PCO, more ACO increase, and less anterior underhang of the tibia.
PPEK is common in TKA patients, especially in individuals with smaller height and weight. PPEK is associated with poor satisfaction and lower functional scores. In radiology, post-operative ACO, PCO, and anterior underhang of the tibial component were correlated with PPEK.

OBJECTIVE: To explore the value of radiomics features on non-contrast computed tomography (NCCT) in predicting early enlargement of spontaneous intracerebral hemorrhage (SICH).
METHODS: 167 patients with SICH were divided into enlarged hematoma and non-enlarged hematoma groups based on the volume of hematoma on 24-h follow-up CT images > 30% and/or 6 ml of the baseline NCCT. The baseline NCCT images of all cases were imported into radiomics software to extract the radiomics features of the initial hematoma. For each case, the features with good predictability were retained after the feature-selected process; the remaining features were used to construct model with 23 algorithms one-by-one. A 5-fold method was used to cross-validate the model and repeated 5 times. The algorithm model with the highest accuracy was selected as predictive model for hematoma enlargement (HE) in SICH, its average parameters including AUC, accuracy, sensitivity, specificity, F1 score, positive predictive value (PPV), negative predictive value (NPV), false positive rate (FPR), false negative rate (FNR),and false discovery rate (FDR) were taken as evaluating indicators.
RESULTS: A total of 1227 texture features of each cerebral hematoma were obtained. After the feature-selected process, 4 features (wavelet-LHL mean, wavelet-LLL _ Idm, wavelet-LLL _run length non-uniformity normalized, and wavelet-LLL _contrast) remained to construct the predictive models. Among 23 model algorithms, Linear Support Vector Classifier showed the highest accuracy (72.6%), and eventually was selected as the predictive model, its AUC, accuracy, sensitivity, specificity, F1 score, PPV, NPV, FPR, FNR, and FDR were 0.729, 0.726,0.717,0.736,0.714, 0.736, 0.741, 0.264, 0.283 and 0.264, respectively.
CONCLUSIONS: Radiomics features of cerebral hematoma on baseline NCCT images showed good performance in predicting HE of SICH.

Bilateral cavernous carotid aneurysms (CCAs) are often not amenable to neurosurgical clipping or endovascular coiling. Here, we report the case of a 50-year-old female who presented with a 1-year history of gradual severe headache. Preoperative angiograms revealed bilateral CCAs. Among these findings, the right giant CCA had been trapped after the external carotid artery-saphenous vein-middle cerebral artery (ECA-SV-MCA) bypass 8 years prior. Additionally, the left CCA was again trapped after the internal maxillary artery-radial artery-middle cerebral artery (IMA-RA-MCA) bypass, followed by parent artery occlusion (PAO), because of the enlargement of a 0.4-cm aneurysm to a 1.3-cm aneurysm during the 5th to 8th years following surgery. Postoperative radiologic findings proved that the aneurysms disappeared with good graft patency of the bilateral anastomoses and excellent filling of the bilateral MCA territories. This is the first case of bilateral CCAs treated with two stages of bilateral high-flow extracranial-intracranial (EC-IC) bypass, including an IMA-RA-MCA bypass.

In this paper, a phononic crystal (PC) plate with tubular pillars is presented and investigated. The band structures and mode displacement profiles are calculated by using finite element method. The result shows that a complete band gap opens when the ratio of the pillar height to the plate thickness is about 1.6. However, for classic cylinder pillar structures, a band gap opens when the ratio is equal or greater than 3. A tubular pillar design with a void room in it enhances acoustic multiple scattering and gives rise to the opening of the band gap. In order to verify it, a PC structure with double tubular pillars different in size (one within the other) is introduced and a more than 2times band gap enlargement is observed. Furthermore, the coupling between the resonant mode and the plate mode around the band gap is characterized, as well as the effect of the geometrical parameters on the band gap. The behavior of such structure could be utilized to design a pillar PC with stronger structural stability and to enlarge band gaps.

BACKGROUND: Emergency department (ED) enlargement became a trend with its development. However, there came some problems such as ED overcrowding and increasing medical disputes. Here we did a survey about the development tendency of EDs in 3A grade hospitals in China, analysed the problems we facing and rendered some solutions combining some special characteristics in China.
METHODS: We randomly selected 17 3A grade general hospitals from 12 provinces from the 50 members of Chinese College of Emergency Physician. A questionnaire survey was conducted. The basic information and problems of EDs were collected and analysed.
RESULTS: The gross area, the number of beds and the attention paid by the hospitals of EDs increased during the development, so did the patients admitted to EDs, also more doctors and nurses devoted into emergency medicine. But it had become more difficult for doctors to admit ED patients to inpatient wards. Besides the problem of increasing crowding degree, EDs faced more medical disputes and complains during the development.
CONCLUSIONS: ED expanding was the result of emergency medicine development, but the enlargement of ED should be more rational. We should improve our doctors\' medical skills, optimize the health system, pay more attention to preventive medicine and push hard for health-care reform instead of forcing ED enlargement to satisfy the need for ED.