OBJECTIVE An understanding of the complex anatomy of the anterior skull base is crucial for the surgeon doing endoscopic surgery. The anatomic data of the olfactory sulcus and adjacent structures in Chinese patients were defined using 3-dimensional reconstruction images. The surgeon is encouraged to develop a detailed pre-operative surgical plan by utilizing these dynamic anatomical observations to avoid intracranial injury. METHODS The paranasal sinus CT scanning images of 100 adults were reconstructed for observation using EBW2.0 software and multiplanar reformation. All data obtained were in the coronal plane from the anterior point of the olfactory sulcus. The cribriform plate depth as compared to the ethmoid roof and adjacent structures, was measured bilaterally. Data obtained on adjacent structures include the vertical height of the lateral lamella of olfactory sulcus, the horizontal distance between the cribriform plate and the orbital lamella, the length of the middle turbinate, the height of the orbit, and the vertical distance between the cribriform plate and the nasal floor. RESULTS The olfactory sulcus was classified into three types: platform type (60 %), sloping type (17 %) and mixed type(23 %), as distinguished from Keros classification. In this study the vertical height of the lateral lamella of olfactory sulcus was (5.03 ± 0.17) mm (R) and (5.39 ± 0.19) mm (L) in platform type, and (2.79 ± 0.49) mm (R) and (4.72 ± 0.49) mm (L) in the mixed type. There were statistically significant differences between the right side and the left side in these two types (P＜0.01). The horizontal distance between the cribriform plate and the orbital lamella on the same side was significantly different between the platform type and the mixed type of olfactory sulcus. A similar result was observed for the vertical distance between the cribriform plate and the nasal floor. Gender differences exist in the horizontal distance between the cribriform plate and orbital lamella on the same side and the vertical distance between the cribriform plate and the nasal floor. CONCLUSION Different types of olfactory sulcus have distinct characteristics, hence care which must be taken into account when doing endoscopic surgery.

Objective To examine the relationship between hematocrit and risk of long term mortality among patients with acute myocardial infarction. Methods A total of 274 patients with acute myocardial infarction were recruited and divided into two groups by death after long term follow-up, the relationship between hematocrit and mortality was evaluated through the methods of independent t-test,chi-square test and multivariate regression analysis. Results The mean age was 69. 79 ± 7.45 years, with 73. 0% of male. The average of followup was 44. 4± 10. 7 months, with mortality of 38.7% . Comparison of baseline data showed that NYHA classification, smoking history, hemoglobin, hematocrit, mean red cell volume, glomerular filtration rate, ejection fraction,left ventricular diastolic diameter and right ventricular diameter was significantly different between the two groups( Ps ＜ 0. 05), Multivariable logistic analysis showed that hematocrit ,glomerular filtration rate, ejection fraction and smoking history were independently predicted factors, with OR of 0. 904 (95% CI: 0. 832 - 0. 982,P =0. 016) ,0. 983 (95% CI: 0. 969 -0. 996,P =0. 014) ,0. 932 (95% CI: 0. 887 -0. 979,P =0. 005) and 3. 230 (95% CI: 1.468 - 7. 106, P = 0. 004), respectively. The power of hematocrit to predict mortality was examined by ROC curves, the area under the curve was 0. 669(P ＜ 0. 001,95% CI: 0. 603 - 0. 736) Conclusion Hematocrit is a significant independent predictor for long term death among patients with acute myocardial infarction.

Objective To investigate the prevalence and prognostic value of anemia in male and female patients with chronic systolic heart failure (CSHF).Methods Data of in-hospital patients with CSHF were investigated between 2000 and 2010 from 12 hospitals in Hubei Province.Patients were divided into normal hemoglobin (Hb) group,mild anemia group,moderate anemia group,severe and extreme anemia group.According to age,body mass index (BMI) and correction of glomerular filtration rate (GFRc),patients were divided into several subgroups,respectively.Multivariate logistic regression was performed to determinate the associated factors with anemia.Kaplan-Meier curve was performed to evaluate the difference in all-cause mortality in male and female patients with anemia.Univariate and multivariate Cox proportion hazard analysis was performed to determinate the risk of all-cause mortality among different anemia group in male and female patients.Results A total of 16681 patients were enrolled.Anemia accounted for 23.79％ and 27.29％,separately,in male and female patients with CSHF.BMI and GFRc were related to anemia in both male and female patients with CSHF,while only age was related to anemia for female patients with CSHF.The hazard ratio of all-cause mortality was 1.08 (P ＜ 0.01),1.13 (P ＜ 0.O1) and 1.02 (P =0.74),respectively,for all,male and female anemia patients with CSHF,compared to normal Hb group.Compared to normal Hb group,the hazard ratio of mild anemia group,moderate anemia group,severe and extreme anemia group was 1.05 (P =0.14),1.20 (P ＜0.01) and 1.36 (P ＜0.01),respectively,for all CSHF patients;1.11 (P ＜ 0.01),1.35 (P ＜ 0.01) and 1.37 (P ＜ 0.01),respectively,for male;0.96 (P=0.48),1.08 (P=0.40) and3.47 (P＜0.01),respectively,for female.Conclusions Compared to male,female patients suffer higher prevalence of anemia in patients with CSHF.There is a significant difference in risk factors and prognosis of anemia between male and female patients with CSHF.

Objective To determine the prognostic value of fight ventricular end-diastollc diameter (RVDD)in patients with chronic heart failure(CHF).Methods The clinical data of the in-hospital patients diagnosed as CHF were analyzed retrospectively.Telephone follow-up was carried out for all participants.The patients were divided into the survival group and death groups according to their clinical outcomes.The relationship between RVDD and death was evaluated by independent t-test and multivariate Logistic regression analysis.Results 1552 in-hospital patients were enrolled into the study.The mean age was 64.62 ± 10.45 years old,with 879(56.64％)male.After 3 years' follow-up,439(28.29％)patients died.Comparison of baseline data showed that gender,age,SBP,NYHA classification,the serum level of creatinine,LVEF,LVDD and RVDD were significantly different between the two groups(P ＜ 0.01);Multivariable logistic analysis showed that RVDD(OR=1.11,95％ CI:1.07-1.14,P ＜0.01),age(OR =1.03,95％ CI:1.02-1.05,P ＜0.01),creatinine(OR =1.02,95 ％ CI:1.01-1.04,P ＜ 0.01),LVEF(OR =0.93,95 ％ CI:0.92-0.97,P ＜ 0.01),LVDD(OR =1.13,95％ CI:1.09-1.17,P ＜0.01)and NYHA classification(OR =1.17,95％ CI:1.12-1.24,P ＜ 0.01)were independent predicting factors for the death of CHF patients.The power of RVDD to predict mortality was examined by ROC curves.The area under the curve was 0.805(95％ CI:0.798-0.812,P ＜ 0.01).Conclusion RVDD increases the risk of death in patients with CHF.RVDD is a significant independent predictor for death among patients with CHF.

Objective To investigate whether transcatheter renal sympathetic denervation (RSD) by radiofrequency ablation interfere with the development of left ventricular (LV) mechanical dyssynchrony during the progression of heart failure (HF).Methods Nineteen beagles were randomly divided into sham-operated group (six dogs),control group (seven dogs),and RSD group (six dogs).Sham-operated group were implanted with pacemakers without pacing;Control group were implanted with pacemakers and underwent 3 weeks of rapid right ventricular pacing;and RSD group underwent catheter-based RSD bilaterally and were simultaneously implanted with pacemakers.LV dyssynchrony was analyzed via 2D speckle-tracking strain echocardiography to evaluate LV function.Longitudinal dyssynchrony was determined as the standard deviation for time-to-peak speckle-tracking strain on apical 4-and 2-chamber views.Radial and circumferential dyssynchrony was determined as the standard deviation for time-to-peak speckle-tracking strain in mid-and base-LV short-axis views.LV systolic pressure (LVSP) and LV end-diastolic pressure (LVEDP) were measured.The LV interstitial fibrosis was determined by histological analysis.Results After 3 weeks,all of the dogs in both the control and RSD groups showed greater LV end-diastolic volume compared with the sham-operated group;however,the dogs in the RSD group had a higher LV ejection fraction (LVEF) than the dogs in the control group (P ＜0.001).The LV systolic strains were higher in the RSD group than in the control group (P ＜0.001 for longitudinal,circumferential and radial strain,respectively).The levels of LV dyssynchrony were lower in the RSD group than in the control group (P ＜ 0.001 for longitudinal,circumferential and radial dyssynchrony,respectively).Compared with control group,RSD group had lower LV end-diastolic pressures and less fibrous tissue.Conclusions RSD inhibites the development of left ventricular mechanical dyssynchrony during the progression of heart failure in dogs.

Objective To evaluate the effects of transcatheter renal sympathetic denervation (RSD) on the cardiac systolic function of dogs with pulmonary arterial hypertension(PAH)using two-dimensional speckle tracking imaging (2D-STI).Methods Twenty two dogs were divided in to three groups:control group (n=7),PAH group (n =8),PAH+RSD group(n =7).Pulmonary artery hypertension models were made by monocrotaline injection in PAH group and PAH+RSD group,while bilateral renal artery sympathetic nerve were also ablated in PAH+RSD group.Meanwhile,sham operation treatment were made in the control group and PAH group.The changes of blood pressure and cardiac indicies of ultrasound were observed before and after 8 weeks respectively.Then the left ventricular(LV)lateral strain,septal strain (IVS LS)and right ventricular(RV)strain were calculated.In the apical 4-chamber view,time from QRS onset to peak systolic strain in each the six segments of the LV and RV were measured and standard deviation of the time to peak longitudinal strain of six segments (LVTsl-6SD and RVTsl-6SD)were calculated.LV twist degree were obtained from LV rotation curve in basal and apical short-axis planes. Results After 8 weeks,there was no difference in the mean strain of LV lateral wall among the three groups,while the mean strain of RV lateral wall and septal were higher in PAH+RSD group than the PAH group [(18.91±0.86)% % vs 16.34±1.36)%,P <0.001;(18.39±1.03)% vs (17.02±1.00)%,P <0.001,respectively].Compared with PAH group,LVTsl-6SD and RVTsl-6SD of PAH + RSD group decreased significantly [(25.45±3.59)ms vs (40.40±2.83)ms,P <0.001;(34.16±2.81)ms vs (51.98± 3.64)ms,P <0.001,respectively].The LV twist degree of PAH+RSD group increased significantly[(10.47± 0.73)°vs (8.46±1.06)°,P <0.001].Conclusions RSD can reduce the influence of pulmonary artery hypertension on cardiac systolic function.

Objective To investigate the prognostic value of right ventricular end-diastolic diameter (RVDD) in patients with chronic systolic heart failure (CHF).Methods A retrospective study was conducted with clinical data of inpatients from 12 third-grade class-A hospitals of Hubei Province between 2000 to 2010,followed up by phone calls.Based on RVDD,patients diagnosed with chronic systolic CHF were divided into four groups:＞38 mm,31-38 mm,25-30 mm and ＜25 mm groups;based on prognosis,patients were divided into the death group and the survival group.Of the death group,patients were further divided into the heart failure death subgroup and the sudden cardiac death subgroup.Single-factor and multi-factor Cox survival analyses were conducted to analyze the relationships between RVDD and mortality,including all-cause mortality,CHF mortality and sudden cardiac death (SCD).Results A total of 16681 patients were enrolled in this study.They were followed up for 1-4 years,during which 6453 died.Multivariate Cox survival analysis showed that the mortality risk for patients with RVDD between 25-30 mm,between 31-38 mm,and ＞38 mm groups was 1.87,2.41,3.95 times that for patients with RVDD＜25 mm,respectively (95％CI:1.64-2.13,2.06-2.80,3.61-4.32,all P＜0.01).The risk of sudden cardiac death for patients with RVDD＞38mm was 3.82 times that for patients with RVDD＜25 mm (95％CI:2.27-5.94,P＜0.01).The areas under the ROC curve for death by the best prediction model alone and RVDD combined with the best respectively.RVDD increased the areas under the ROC curve for all cause mortality,CHF mortality and sudden cardiac death.The best prediction model combined with RVDD could discriminate between total mortality,heart failure mortality and sudden cardiac death for patients with different causes of death in multivariate analysis.Conclusions RVDD has a predictive value in the prognosis of patients with chronic systolic heart failure.RVDD increases the sensitivity and specificity of the best prediction model for total mortality prediction in patients with chronic systolic heart failure.RVDD increases the sensitivity and specificity of the best prediction model to discriminate between all-cause mortality,heart failure mortality and sudden cardiac death in patients with different causes of death.RVDD＞38 mm can serve as an indicator for the assessment of sudden cardiac death in CHF patients.

ObjectiveTo evaluate the treatment efifcacy of the treatment promotion of standardized management for chil-dren with asthma.MethodsMedical records of 150 children with asthma were reviewed and divided into management group or control group according to whether standardized management was accepted. Comprehensive asthma education for asthma pa-tients and their parents including asthma associated basic knowledge education, health education as well as follow-ups at deifned intervals was conducted in 78 cases. In the meantime, standardized asthma therapies were performed. Control group involved 72 cases who did not receive asthma education managements and only accepted regular clinical therapies. After 1-year observational follow-up, , clinical efifcacy of children with asthma, changes of knowledge-attitude-practice of parents, and compliance of med-ication were compared between the two groups.ResultsAfter promotion of standardized managements treatment, asthma con-trol rates in the management group were signiifcantly higher than that of the control group(χ2=54.68,P<0.01); In addition, the rate of asthma attacks, emergency visits as well as hospitalizations were obviously reduced in the management group than control group (both withP<0.01). Knowledge associated with asthma, therapy and management executions as well as knowledge-atti-tude-practice of parents also demonstrated apparent elevations in the management group (P<0.01); At the same time, management group has illustrated superior medication compliance over the control group (χ2=66.27,P<0.01).ConclusionPromotion of standardized treatment management among children with asthma can help to achieve effective control by raising levels of knowl-edge-attitude-practice of the parents as well as the patient’s compliance to the treatment.

Objective To evaluate the synchrony of heart after catheter-based renal denervation by two dimensional speckle tracking imaging.Methods Each renal sympathetic nerve of 20 dogs were ablated,and the index of heart and blood pressure were detected 6 weeks later.Standard 2D images were acquired in the 2-,3-and 4-apical views.The times from QRS onset to peak-systolic strain rate and to peak-diastolic strain rate were measured for the longitudinal 16-segments in Qlab software,and the standard deviation were calculated.The time to peak longitudinal strain rate and time to peak contraction strain rate of left atrium were measured for each segment contained septal,latera,anterior and posterior in the level of the basal segments,middle sections and apical in Qlab software,and the standard deviation were calculated.Parameters were compared among the before and after of the ablation.Results The systolic pressure and diastolic pressure had no changes after the ablation of renal sympathetic nerve (P ＞ 0.05).The R-R showed a increasing trend,but no significant differences(P ＞0.05).The peak time of LV systolic and diastolic strain rate had a extended trendency too,but no differences(P ＞0.05),and standard deviations of the peak times had no significant differences(P ＞0.05).The peak time of LA longitudinal strain rate and contraction strain rate had a extended trendency,but no obvious change (P ＞0.05),and the standard deviations of the peak times had no significant differences (P ＞0.05).The size of the heart cavity had no differences(P ＞0.05).Conclusions The systolic pressure and diastolic pressure have no changes after the ablation of renal sympathetic nerve,and the synchrony parameters of LV and LA have no significant differences,demonstrate that the synchrony of heart is not affected by the renal sympathetic denervation.

Objective To evaluate the security of catheter-based renal denervation by two dimensional speckle tracking imaging.Methods 20 dogs was ablated,whose indicies of heart and blood pressure were detected 6 weeks later.Standard 2D images were acquired in the 2-,3-and 4-apical views as well as the parasternal short-axis views at the level of the mitral valve and papillary muscles.The time to peak-systolic strain of each segment in the level of the mitral valve and papillary muscles,the standard deviation of the time to peak-systolic strain,the peak strain of the longitudinal 12-segment were recorded.Parameters were compared among the before and after ablation.Results Compared with before ablation of renal sympathetic nerve,the systolic pressure and diastolic pressure didn't reduced significantly after the ablation of renal sympathetic nerve (P ＞ 0.05),while there were no significant difference in the peak strain of the longitudinal 12-segment,the dyssychrony parameters and the size of the heart cavity before and after ablation(P ＞0.05).Conclusions The pressure had no change after the ablation of renal sympathetic nerve while without harmful effect on the the size of the heart cavity,the function of the myocardial contraction and the dyssychrony parameters.The ablation of renal sympathetic nerve can' t lower the normal blood pressure and be safe for heart at the same time.