Objective: To explore the efifcacy and safety of sildenaifl for treating the patients of congenital heart disease (CHD) with severe pulmonary hypertension in plateau area.
Methods: A total of 50 CHD patients combining severe pulmonary hypertension treated in our hospital from 2010-01 to 2013-10 were studied. The patients were randomly divided into 2 groups, n=25 in each group. Control group, the patients received conventional treatment and Sildenaifl group, based on conventional treatment, the patients received additional sildenaifl medication. The hemodynamic, blood gas, routine and biochemistry were recorded and compared between 2 groups.
Results: Compared with Control group, Sildenaifl group had more reduction of pulmonary artery pressure, increased arterial pressure of oxygen, left ventricular output, cardiac index and oxygenation index, all P<0.05. The patients’ arterial pressure, blood routine and biochemistry were similar between 2 groups, P>0.05. There was no obvious adverse reaction observed in Sildenaifl group.
Conclusion: Based on conventional treatment, Sildenafil may effectively reduce the pulmonary artery pressure in CHD patients combining pulmonary hypertension in plateau area, it improving the cardiac function without adverse reaction.

Three cases of Good's syndrome with pulmonary lesions in our hospital from June 1,2010 to June 1,2013 were retrospective analyzed and relevant literatures were reviewed.Clinical manifestation,characteristics of pulmonary lesions,diagnosis and treatment were summarized.Abnormality of lymphocyte subpopulation to varying degrees in peripheral blood was detected in all 3 cases.However none showed hypogammaglobulinemia.If thymoma patients developed recurrent respiratory infections,Good's syndrome should be considered.Pulmonary manifestations of Good's syndrome have lesions similar to those of diffuse panbronchiolitis or interstitial lung disease.Early screening of immune competency and treatment for immunodeficiency may improve prognosis.

Objective To investigate the diagnosis and treatment of serous cystadenoma of the pancreas. Methods The clinical data of 18 patients with serous cystadenoma of the pancreas which were admitted into the First Affiliated Hospital of China Medical University from October 1999 to October 2010 were retrospectively analyzed. Results There were 15 females(83.3%) and 3 males (16.7%).Tumors were present in the pancreatic body and tail in 12 cases ( 66. 7% ), in the pancreatic head in 3 cases ( 16. 7% ) and in the pancreatic neck in 3 cases( 16. 7% ). The mean maximum diameter of the tumor was 6. 5 cm. No specific clinical features were indentified. The size of the tumor was significantly correlated with clinical symptoms. CT was main examination with correct diagnosing rate of 61.1%. All 18 patients received surgical resection. Pancreaticoduodenectomy was performed in 3 patients, distal pancreatectomy in 5 cases,spleen-preserving distal pancreatectomy in 5 cases, middle pancreatectomy in 3 cases, and tumor enucleation in 2 cases. Postoperative pancreatic fistula developed in 10 cases (55.6%);Fistula was healed by conservative therapy in all these 10 cases. Postoperative followed up from 6 to 125 months (mean,48. 3months) found no recurrence or metastasis. Conclusions CT was main imaging examination for serous cystadenoma of the pancreas. Surgical resection should be adopted for serous cystadenoma of the pancreas with clinical symptoms but uncertain malignancy.

Objective To study the human lymphangiogenesis in the early stage of embryo and the expression of forkhead box C2(FOXC2) in human lymphangiogenesis.Methods Lymphatic vessel endothelial haluronic acid receptor-1(LYVE-1) was used as the special marker of lymphatic vessels.Immunohistochemical and double immunofluorescence staining were used to detect the expressions of FOXC2 and LYVE-1 in lymphatic vessels of 85 human embryos of 5 to 11 weeks pregnancy and analyze the features of lymphatic vessel genesis and development.Results LYVE-1 was initially detected in lymphatic vessels in 7-week human embryos.The lymphatic vessel endothelial cells presented brown staining for LYVE-1 in jugular and thoracic region.LYVE-1 was also found to express in human embryonic mesentery lymphatic vessels on the 70th day of pregnancy.The expression of FOXC2 in human embryo was detected prior to that of LYVE-1.At the beginning of the 6th week of pregnancy,FOXC2 was obviously seen in human embryonic mesoderm mesenchyme.FOXC2 expressed not only in human embryonic lymphatic vessels,but also in the vertebral body,cardiovascular wall and other tissues.The expressions of FOXC2 and LYVE-1 were still seen in human embryonic lymphatic vessel endothelial cells after 80 days of pregnancy.Conclusion Lymphangiogenesis of human embryo begins between the 7th and 8th weeks of pregnancy.FOXC2 and LYVE-1 could have some relation with the human embryonic lymphatic vessel genesis and development.

Objective To compare the anesthetic effects of interscalene brachial plexus combined with ulnar nerve and axillary brachial plexus block guided by nerve stimulator. Methods Eighty patients belonging to ASA ⅠorⅡ and undergoing replantation of severed palm or wrist were divided randomly into 2 groups, Each group had 40 patients. Nerve stimulator guided nerve block. Patients in groupⅠreceived interscalene brachial plexus combined with ulnar nerve block, and those in groupⅡreceived axillary brachial plexus block. The onset time, hold time, tourniquet tolerance of radial nerve, median nerve and ulnar nerve of two groups was recorded. The phrenic nerve block, Horner′s syndrome and recurrent laryngeal nerve block was compared between two groups. Results The onset time of radial nerve, median nerve and ulnar nerve in group Ⅰwas (5.13 ± 0.76), (7.13 ± 1.04), (3.23 ± 0.62) min , in group Ⅱ was (9.23 ± 1.61), (12.35 ± 1.76), (8.83 ± 1.13) min, and there were significant differences (P<0.05). The excellent rates of sensory block of radial nerve, median nerve and ulnar nerve in group Ⅰ were 90.0%(36/40), 85.0%(34/40), 97.5%(39/40), in group Ⅱ were 72.5%(29/40), 65.0%(26/40), 70.0%(28/40), and there were significant differences (P<0.05). The full rates of motor block of radial nerve, median nerve and ulnar nerve in groupⅠwere 75.0%(30/40), 37.5%(27/40), 80.0%(32/40), in groupⅡ were 47.5%(19/40), 40.0%(16/40), 45.0%(18/40), and there were significant differences (P < 0.05). The tourniquet tolerance rate in group Ⅰwas significantly higher than that in groupⅡ:90.0%(36/40) vs. 62.5%(25/40) , P<0.05. In groupⅠ, phrenic nerve block occurred in 2 patients, and Horner syndrome occurred in 1 patient. None had laryngeal recurrent nerve block in both group. Conclusions The interscalene brachial plexus combined with ulnar nerve block guided by nerve stimulator is more suitable for a long time microsurgery of the palm or wrist, because it takes action faster, has better sensory and motor block effects, improves the rate of tourniquet tolerance without increasing untoward reaction.

Eosinophil extracellular traps (EETs), an important pathway of eosinophil to exert its effects, are composed of DNA fibers, histone and eosinophil granule proteins. Recently, many researches have shown that EETs play an important role in the genesis and development of respiratory diseases including asthma, allergic bronchopulmonary aspergillosis and chronic obstructive pulmonary disease. EETs can directly damage airway epithelial cells, promote airway inflammation and airway hypersecretion, increase the stickiness of secretions and induce the generation of autoantibody, helping eosinophils and their products participate in a cascade of events leading to inflammation and disease. Researches on EETs can also be helpful in investigating new targets for the treatment of chronic airway diseases.

The data of a case of congenital subglottic stenosis (C-SGS) who underwent slide laryngotracheoplasty in the Center for Respiratory Intervention, Children′s Hospital Affiliated to Shandong University in December 2021 was analyzed retrospectively.The patient was a girl aged 2 months and 15 days.She visited the hospital 23 days after tracheotomy due to dyspnea for more than 2 months.The bronchoscopy and annular cartilage B ultrasound results suggested subglottic stenosis and no scar hyperplasia.Based on the medical history, the child was diagnosed with C-SGS.Slide laryngotracheoplasty was performed 2 weeks after admission, and the tracheotomy tube was removed after surgery.The child was followed up 2 months after surgery, and she recovered well with no dyspnea.The study results suggest that early and safe slide laryngotracheoplasty after definite diagnosis can provide immediate and sufficient airway space for C-SGS patients, and protect their voice and swallowing function.

Hematologic Neoplasms ; Hepatitis E virus ; Humans

OBJECTIVE To provide a reference for the standardized treatment of chronic obstructive pulmonary disease （COPD） and the adjustment of therapeutic drugs for COPD in the national essential medicine list. METHODS Relevant clinical experts， pharmaceutical experts and medical insurance experts were invited to sort out the COPD treatment drugs involved in the domestic and foreign COPD clinical guidelines， the national essential medicine list， the WHO standard list of essential medicine， the national medical insurance catalogue， and comparatively analyzed the COPD treatment drugs. RESULTS & CONCLUSIONS Compared with domestic clinical guidelines， foreign clinical guidelines included an additional COPD triple preparation， while involving fewer types of expectorants and antioxidants； there were only 12 kinds of COPD treatment drugs included in the WHO standard list of essential medicine， while there were 18 kinds in the national essential medicine list in China， and more theophylline drugs， expectorants and antioxidants were included. In addition， 15 kinds of COPD treatment drugs were found in both the national clinical guidelines and the national medical insurance catalogue， but not in the national essential medicine list， including terbutaline， levalbuterol hydrochloride， salmeterol， formoterol， indacaterol， beclometasone， mometasone furoate， salbutamol ipratropium， glycopyrronium formoterol， umeclidinium vilanterol， indacaterol glycopyrronium， beclometasone formoterol， budesonide/glycopyrrolate/formoterol fumarate， fluticasone furoate/vilanterol/umeclidinium， and fudosteine， which were mainly long-acting beta 2-agonists and COPD triple preparations. These drugs had certain evidence-based medicine evidence， their efficacy and economy had certain advantages， and their impact on the budget of the medical insurance fund was controllable. Therefore， it is suggested that the aforementioned drugs should be included in the essential medicines list in the subsequent update.