Objective To observe the clinical effectiveness of manipulation combined psychological counse-ling in treating early perimenopausal depression.Methods 62 patients with early perimenopausal depression were selected,and randomized into the two groups according visiting sequence.The treatment group received manipulation combined psychological counseling therapy, and control group received fluoxetine therapy.The clinical effectiveness between two groups was compared.Results The total effective rate of the treatment and control group was 90.30%and 83.90%,respectively,there was significant difference between the two groups (P=0.707);the score of HAMD depression scale was (8.90 ±0.87)points vs (9.29 ±2.98)points post 6 weeks of therapy,and the score reduction rate was (53.74 ±2.86)points vs (51.95 ±15.03)points (t=-0.69,0.65;P=0.492,0.520,respectively).No obvious side adverse effect was seen in the treatment group,and nausea (5 cases),dizziness (4) and anorexia (7) was seen in the control group.Conclusion Manipulation combined psychological counseling therapy was similarly effective in treating early perimenopausal depression compared with fluoxetine,but associated with less adverse effect.

Objective To study the clinical use of the ulnar-basilic arteriovenous fistula as a long-term vascular access in patients with hemodialysis.Methods The clinical data of 36 patients with 1-year follow-up who had a wrist ulnar-basilic arteriovenous fistula formed in China-Japan Friendship Hospital from January 2013 and December 2014 were retrospectively analyzed.The outcomes for this study including the surgical results,complication rate of ulnar-basilic arteriovenous fistula,immediate patency rate,average maturation time,1-year primary patency rate and true patency rate were analyzed.Results Thirty-four cases patients got successful ulnar-basilic arteriovenous fistula formed with palpable vascular thrill.There were no death cases and no severe cardio-cerebrovascular complications.No infection,heart failure,distal swelling and ischemia occurred.The immediate patency of ulnar-basilic arteriovenous fistula was 94.4%(34/36),the average maturation time was (67±4) d,1-year primary patency rate was 63.9%(23/36),and true patency rate was 67.6%(24/36).Conclusion Ulnar-basilic arteriovenous fistula with adequate 1-year primary patency and low risk of infection and complications can be a viable alternative as the hemodialysis vascular access.

The clinical data of 21 patients with carotid body tumor (CBT) were analyzed retrospectively.The lesions were unilateral (n =20) and bilateral (n =1).Among 20 surgical cases, the procedures included tumor resection alone (n =11) , tumor resection along with external carotid artery (n =6) and vascular reconstruction of carotid artery after resection of tumor body (n =3).No mortality occurred during perioperative period.CBT was confirmed by pathologic examination in all cases and 1 case was malignant.Follow-up period ranged from 3 months to 7 years and the follow-up rate was 85％.Five cases of cranial nerve impairment recovered completely over 3 months.One case of bilateral CBT underwent contralateral tumor resection at another hospital 1 year later and 1 case with malignant tumor died from metastases 3 years later.The remainder survived recurrence-free.CBT tends to be misdiagnosed.Therefore ultrasonography, digital subtraction angiography (DSA), CT angiography (CTA) or magnetic resonance angiography (MRA) are important for preoperative diagnosis and evaluation.Surgical resection is a first choice for CBT.

Objective To evaluate carotid endarterectomy (CEA) for bilateral moderate to severe carotid stenosis.Methods The clinical data of 59 patients with bilateral moderate to severe carotid stenosis who were treated with CEA in our hospital from October 2010 to August 2014 were retrospectively analyzed.There were 50 males and 9 females age ranging 42-80 years (mean:65 ± 9 years).48 patientsunderwent ipsilateral CEA and 11 underwent staged bilateral CEA.In patients who were confirmed to have coronary artery disease or peripheral vascular disease by preoperative angiography,6 received coronary artery bypass graft (CABG)simultaneously,1 received iliac artery balloon angioplasty and stent implantation simultaneously,and 1 received renal artery stenting simultaneously.Results A total of 70 endarterectomies were performed,shunt and patching were used in all patients,the surgical success rate was 100％.2 patients suffered from vagus nerve injury,4 patients suffered from hypoglossal nerve injury,and 3 patients presented with hyperperfusion syndrome.Follow-up period was 2-36 months (mean:19 ± 10 months).1 patient died of heart attack during the follow-up,the other patients were relatively stable with no restenosis.Conclusion CEA should be performed in patients with bilateral moderate to severe carotid stenosis,and the prognosis is good.

Objective To compare the outcome of combined and staged approach on concomitant carotid and coronary severe stenosis.Methods From March 2013 to May 2015,27 patients with concomitant carotid and coronary severe stenosis were treated by carotid endarterectomy and coronary artery bypass grafting,15 cases received one-stage operation and 12 staged.The basic characteristics,details during surgery,complications,quality of life score,hospital stay and cost were compared.Results 27 patients received carotid endarterectomy and off-pump coronary artery bypass grafting under general anesthesia.Revascularization were performed on 27 carotid and 82 coronary artery.The characteristics of patients were similar between two groups,reflected with WIC,combined approach subgroup was (5.27 ± 0.88) and staged subgroup was (4.92 ± 1.24).The operation time was significantly decreased in the synchronous group [(295.33 ± 49.73)min vs (390.83 ± 73.45) min,P ＜ 0.001].Hospital stay days was also reduced [(30.20 ± 12.91) days vs(44.67 ± 6.34) days,P =0.002],the medical cost was lower in combined approach group,but no significant statistical difference.The complications including 1 case TIA,1 recurrent nerve injury in one-stage group and 1 case myocardial infarction,1 mediastinal bleeding post-operation and 1 pulmonary infection in stage group.No cerebral infarction and death.Quality of life scores(SF-36) of the two groups was 5.53 ± 1.30 and 5.75 ± 1.36 respectively,no significant difference.Conclusion The efficacy and safety of treatment for concomitant carotid and coronary severe stenosis patients with combined or staged approach was similar.But the combined approach program can reduce the hospital stay time and cost in some degree.