Objective To compare the clinical effects of different doses of methylprednisolone therapy for children with severe hand,foot and mouth disease (HFMD).Methods According to different dosage methods, 240 children with severe HFMD were divided into large dose group,medium dose group and small dose group,80 cases in each group.The three groups were given different doses of methylprednisolone infusion on the basis of conventional treatment:large dose group(5 ~10mg·kg· -1 d -1 ),medium dose group(3 ~5 mg·kg· -1 d -1 ),small dose group (1 ~2mg · kg · -1 d -1 ).Results The time of fever sustaining,panic ease,mechanical ventilation,duration of hypertension and heart rate recovery of the medium -dose group were (47.93 ±4.72)h,(45.54 ±2.42)h,(51.43 ± 6.85)h,(53.66 ±7.62)h,(52.45 ±7.84)h,which were significantly shorter than those of the small -dose and large -dose group(all P <0.05).The incidence of turning to critically ill and the rate of ventilator use of the medium-dose group were significantly lower than those of the small -dose and large -dose group (all P <0.05 ).The incidence of pulmonary edema and pulmonary hemorrhage of the medium -dose group were significantly lower than those of the small -dose and large -dose group(all P <0.05).The differences among three groups were not statistically significant in the complications such as hypokalemia,hypocalcemia and gastrointestinal bleeding (all P >0.05 ). Conclusion Medium dose of methylprednisolone in the treatment of children with severe HFMD has significant effect and less adverse reactions,which is worthy of promotion.

Objective To summary and analysis the clinical experiences on the three hole method of VATS surgery in treatment of primary spontaneous pneumothorax.Methods The clinical data of 276 cases of primary spontaneous pneumothorax undergoing VATS surgery from July 2005 to July 2011 were analyzed retrospectively.Results The operating times were 25 to 76 minutes,averaging (41.7 ± 2.1) minutes ; all with traces of bleeding; transiting assisted small incision operation in 5 cases;postoperative thoracic closed drainage extubation time of 4-13 days,average (6.7 ± 0.2) days,mild postoperative air leakage in 27 cases,moderate in 9 cases without severe leakage,leakage,postoperative pulmonary atelectasis in 7 cases,pulmonary infection in 2 cases,reexpansion pulmonary edema in 1 cases,postoperative follow-up for 6-17 months,averaging(10.2 ± 1.7) months,recurrence occurred in 7 cases,1 case of operation again.Conclusion Three hole method of VATS technique has short operating time,less trauma,fewer complications,faster recovery,shorter hospitalization time and other advantages,and the recurrence rate is low,which is the ideal mode of operation for the treatment of primary spontaneous pneumothorax.

Objective To explore the diagnostic value of four tumor markers analyzed with Logistic regression and receiver operator characteristic (ROC) curve in patients with lung cancer.Methods The serum levels of carcinoembryonic antigen (CEA) 、carbohydrate antigen 125 (CA125),cytokeratin 19 fragment (CYFRA21-1) and neuron specific enolase (NSE) were determined by radioimmunoassay in 112 patients with lung cancer and 74 patients with benign pulmonary disease.Four tumor markers were analyzed by Logistic regression and ROC curve.Results The serum levels of CEA,CA125,CYFRA21-1 and NSE in lung cancer patients were [4.53(2.22-11.53)ng/ml,28.97 (11.39-62.10) U/ml,4.05(2.29-8.18)ng/ml,14.11 (11.35-24.12) ng/ml],respectively,which were significantly higher than those in health adults[2.08 (1.45-2.52) ng/ml,12.90 (9.80-19.44) U/ml,1.53 (1.21-2.17) ng/ml,11.38 (9.07-12.80) ng/ml] (all P ＜ 0.01).According to regression equation Y =1/[1 + EXP (4.902-0.394X1-0.627X2-0.165X3)],the area under the ROC curve (AUC),sensitivity,specificity,and accuracy of new variable Y were 0.915 ± 0.020,79.46％,93.24％,and 84.95％,respectively.Conclusions Application of logistic regression and ROC curve increases diagnostic accuracy in lung cancer.

Objective To investigate the efficacy of proton pump inhibitors (PPI) combined with flupethixol melitracen in the treatment of non-erosive gastroesophageal reflux disease (NERD) with anxiety and depression.Methods Fifty six NERD patients with anxiety and depression were evenly divided into the positive treatment group and positive control group.Thirty NERD patients without anxiety and depression were set as negative control group.Both flupethixol melitracen (20 mg per day after breakfast) and PPI esomeprazole magnesium (20 mg per day,20 minutes before breakfast) were administrated in positive treatment group.Only esomeprazole magnesium was given in positive control group and negative control group and the dosage was same as that of positive treatment group.The treatment course of three groups was eight weeks.Before and after the treatment,the symptoms of patients were scored according to gastroesophageal reflux disease questionnaire (GERDQ),Hamilton anxiety scale (HAMA),Hamilton depression scale (HAMD) and Pittsburgh sleep quality index (PSQI).Adverse effects were also observed.Variance analysis was performed for the comparison among three groups.Variance analysis or Post-hoc analysis were used for comparison between two groups.Results The differences of different score value before and after treatment of three groups were statistically significant in total score of GERD Q,score of type A,score of type C,score of HAMA,score of HAMD and PSQI (F=6.32,3.93,5.63,49.61,78.69 and 7.07,all P＜ 0.05).The differences of the score value before and after treatment of positive treatment group in total score of GERD Q,score of type A,score of type C,score of HAMA,score of HAMD and PSQI (4.24±2.05,3.16±1.46,1(0,3),9.32±3.21 and 8.88±2.92) were all higher than those of positive control group (2.38±2.22,1.68±1.33,0(0,2),3.72±2.95 and 3.84±1.97) and negative control group (2.32±2.18,2.48±1.34,0(0,1),2.36±1.25 and 2.36±0.79).And the differences were statistically significant (positive treatment group vs positive control group:Post-hoc analysis,P=0.002,0.022,0.003,0.002 and 0.002; positive treatment group vs negative control group:Post-hoc analysis,P=0.001,0.021,0.004,0.001 and 0.001).The difference of the score value before and after treatment of positive treatment group in PSQI (4 (2,6)) was higher than that of negative control group (2 (1,3),Post-hoc analysis,P=0.001).Two cases of positive treatment group had mild dizziness and the symptom relieved after three to four days.Conclusions For NERD patients with anxiety and depression,anti-depression drug flupenthixol melitracen can be used and the effect is superior to using PPI alone.

Objective To investigate the effect of thyroxine replacement therapy with residual subclinical hypothyroidism on the success rate of catheter ablation in elderly patients with atrial fibrillation(AF).Methods Among the consecutive patients with AF who underwent a first AF ablation in our center between 2009 and 2012,we identified 56 patients(41 paroxysmal AF,15 persistent AF)with subclinical clinical hypothyroidism after receiving thyroid hormone replacement therapy as study group.The control group consisted of 56 patients with euthyroidism and no history of thyroid dysfunction.All patients underwent catheter ablation.Results At the end of follow up,37.5%(21/56)patients were AF free after the first procedure in the study group,in comparison to 64.3%(36/56)in control group(χ2=8.655,P=0.003).Last procedure was performed in 27 patients of study group and in 15 patients of control group.After the last performed ablation,62.5%(35/56)study group patients and 80.4%(45/56)controls group patients had no recurrence(χ2=4.653,P=0.031).The major complications rate did not differ between two groups(P=0.642).Conclusions Thyroid hormone replacement therapy with residual subclinical hypothyroidism reduces catheter ablation success rate in elderly patients with atrial fibrillation.

Objective To investigate ablation characteristics of PVC/VT originating from left ventricle anterior papillary muscles.Methods This study included 10 patients of PVC/VT originating from left ventricle anterior papillary muscles from January 2015 to June 2016 in Beijing Anzhen Hospital.Electrophysiological mapping and radiofrequency ablation were completed using three-dimensional anatomical mapping system combined with three-dimensional intracardiac ultrasound technology.ECG and abaltion target diagram characteristics as well as the special anatomy were explored.Results All the 10 patients were successfully ablated and followed up for 12 months.One patient had recurrence within 12 months and no complications were recorded.The target sites localized at the tip (n =1),middle portion(n =4)or the base (n =5) of the LV-APM.Among 7 patients,the target sites were located at the anterior septal papillary muscle and in 3 patients were located in the free papillary muscle.9 patients were successfully ablated via anterograde trans-septal catheterization after the failure of retrograde approach.Premature QRS wave time were 152.80 ± 11.72 ms and 6 patients presented sharp potential at the targets during PVC/VT.Conclusions PVC/VT originating from left ventricle anterior papillary muscles have similar ECG and diagram characteristics that is different from which originating from left anterior fascicle.It is recommended to get the target via transseptalpuncure approach.Ablation target could be clearly positioned by three-dimensional intracardiac ultrasound technology.

Objective The recurrence of perimitral atrial tachycardia is common after initial ablation of persistent atrial fibrillation (AF). The aim of the study is to explore a preferable ablation approach for perimitral atrial tachycardia in the redo ablation of persistent AF. Methods Seventy-four patients with perimitral atrial tachycardia after initial ablation for persistent AF were included in our study. Patients were distinguished into either the group of having ablation during tachycardia (Group A) or the group having ablation after cardioversion to sinus rhythm (Group B) according to the different ablation strategies. The procedural endpoints were pulmonary vein isolation and bidirectional conduction block of all the ablated lines. The primary endpoint of the study was freedom from atrial tachyarrhythmia recurrence during the follow-up period. Results There were statistical differences in baseline clinical data between the 2 groups. During the redo procedure, conduction recovery rate across the mitral isthmus (MI),cavotricuspid isthmus and left atial roofline were 100％, 40.5％ and 48.6％ respectively. The procedural time, fluoroscopy time, mapping time were longer in the patients of group A. During a mean follow-up of (16.9±6.3) months, 31 (72.1％) patients in group A and 21(67.7％) patients in group B maintained in sinus rhythm in the absence of antiarrhythmic durgs (P =0.771) . Conclusion In patients with perimitral atrial tachycardia after initial ablation for persistent AF,ablation in sinus rhythm is a more simplified method and as effective as ablation during tachycardia.

Objective To observe the management and outcome of the cardiac tamponade patients during the ablation procedure using two different anticoagulation strategies. Methods All the patients developed tamponade during the ablation procedure were enrolled from January 2007 to December 2013 in our center. In group 1, warfarin was discontinued 3 to 5 days before the procedure and low molecular weight heparin (LMWH) was administered subcutaneously until ablation procedure day. In group 2, warfarin was not discontinued and the international normalized ratio INR was to maintained between 2 and 3. Results There were 27 patients (0.6%) developed cardiac tamponade out of a total 4487 patients received ablation in our center. The baseline clinical characteristics including age, left atrium, the heparin dose and ACT during the procedure had no signiifcant difference between the groups, except that the INR was higher in the group 2 (0.9±0.1 vs. 2.3±0.5, P<0.001). There was no signiifcant difference in the amount of pericardiac drainage between the two groups (365±222 ml vs. 506±300 ml, P=0.137). Two patients in group 1 patient (11.1%) and 1 in group 2 (11.1%) needed emergency surgical repair (P>0.999). The median hospital day was similar in the 2 groups [(9.6±3.3) d vs. (12.1±4.5) d, P=0.167]. There were no other serious complications and no hospital death. Conclusions Non-discontinuation of warfarin during peri-procedural catheter ablation of AF is not signiifcantly different to bridging with LMWH in the management and outcome of acute cardiac tamponade.

Objective Identify the mechanism of induced atrial arrhythmias after pulmonary vein isolation (PVI) in patients with paroxysmal atrial ifbrillation(PAF), and investigate its long-term prognosis. Methods All patients with PAF undergoing PVI and induction test afterwards between Feburary 2010 and October 2010 were included. The induction protocol was rapid pacing initiated at cycle length of 250 ms with progressive shortening in a decrement of 10 ms down to 180 ms or refractoriness. Isoproterenol of 2-4μg/min was administrated as well. Inducibility was deifned as induction of atrial arrhythmia lasting >1 min. The mechanism of induced tachycardia was identiifed by activation mapping and entrainment mapping under the guidance of CARTO system. All patients were followed up by 36 months. Results Forty-nine atrial tachycardia were induced in 39 (19.7%) patients, including 35 organized atrial tachycardia (OAT) and 14 atrial ifbrillation (AF). The LA diameter was signiifcantly larger in inducible group than non-inducible group (39.5±6.6 mm vs. 36.7±5.2 mm, P=0.004). Macroreentry was the most common mechanism in induced OATs (28, 80.0%), and mitral isthmus was the most common critical site (20, 40.8%), followed by cavo-tricuspid isthmus (12, 24.5%), PV (6, 12.2%), LA septum (4, 8.2%), superior vena cava (3, 6.1%) and LA roof (1, 2.0%). Conclusions The most common mechanism of induced tachycardia by IV isoproterenol and rapid pacing is MI and CTI dependent after PVI in PAF patients, which can be succssefully eliminated by liner ablation, not increasing long-term recurrence rate.

Objective To identify the electrophysiological charateristics and cause of ridge gap related reentry after MI ablation in atrial ifbrillation patients. Methods Activation and entrainment mapping was performed in 82 redo cases for OAT recurrence in whom MI was ablated during the index produre. Once ridge gap related reentry was conifrmed, detailed mapping was performed in MI and ridge region. In addition, in 36 cases undergoing MI ablation and fulfilling criterion for bidirectional block, differential pacing was repeated at the ridge to identify a ridge gap. Results Out of 82 redo cases for OAT recurrence in whom MI was ablated during the index produre, 7 (8.5%) was found to be ridge gap related reentry. TCL was (247.9±19.2) ms, and the left atrial endocardial activation time was (145.4±17.7) ms, accounting for (58.5±3.2)%of TCL. However, wide double potential was recorded along the previous ablated MI line where PPI was (34.3±6.6) ms longer than TCL, while PPI was signiifcantly shorter at the ridge[PPI-TCL (11.4±3.9) ms, P<0.001]. Tachycardia was terminated at the ridge in 6 cases and at the corresponding site in coronary sinus in 1 case. No recurrence was found during follow-up for (11.1±4.5) months. In addition, in 36 patients undergoing MI ablation in whom criterion of bi-directional block was fuliflled, conduction gap located at the ridge was found in 5 (13.9%) cases. Conclusions MI ridge gap related reentry is a distinctive OAT, in which the ridge was used as the critical isthmus, whereas the previous ablated MI line is not part of the reentry. MI pseudo-block due to the ridge gap may lead to this type of recurrent tachycardia.