Objective To explore the value of asthma journal and corresponding monitoring of pulmonary ventilation function in treating bronchial asthma with the existing classification of asthma severity as control.Methods After 137 patients with bronchial asthma were evaluated according to the existing grades,they kept asthma diaries and received corresponding monitoring of pulmonary ventilation function at least 5 times per day,and all of the above clinical data were analyzed by relevant statistical methods.Results Among the 126 patients who completed monitoring,only 61(48.41%) patients could be graded by the Guide for Prevention and Treatment of Bronchial Asthma;27(21.43%) patients felt sensitive while 33(26.19%) ones felt insensitive.Conclusion The corresponding monitoring can not only accurately evaluate the severity of patients' bronchial asthma condition,but also detect those patients with deviated symptom perception.

Objective To summarize the technique of stent placement in treatment of fusiform aneurysms and dissecting aneurysms of vertebral artery. Methods we report a retrospective analysis of 16 aneurysms which underwent stent placement ,9 fusiform aneurysms which performed by using stent and GDC;7 dissecting aneurysms which performed by using stent first, Stent placement was followed by coil placement in the 5 aneurysms. Results all patients were cured,2 of 11 aneurysm showed up transient ischemia of cerebral.Follow-up angiographic studies performed in 13 patients from 3 months to 24 months revealed no aneurysm regrowth and no incident of in-stent stenosis.Conclusions the treatment of fusiform aneurysms and dissecting aneurysm of vertebral artery is distinguishing, Using stent combined with GDC to treat fusiform and dissecting aneurysm may restore the patency of parent artery and become safe and effective treatment for fusiform and dissecting aneurysm of vertebral artery.

Objective To evaluate the short-term effect and safety of endoscopic pyloromyotomy for congenital hypertrophic pyioric stenosis(CHPS).Methods Twelve infants,including 8 boys and 4 girls,mean age(57.5±14.4)days,who were diagnosed as CHPS,underwent endoscopic pyloromyotomy by using an ultra-thin gastroscope.Incisions were made from the duodenal to the antral side of the pylorus by an endoscopic electrosurgical sphincterome or a needle knife.Results These 12 patients underwent 13 endoscopic operations.Vomiting ceased in 1-10 days in 11 cases,of which one patient's vomiting was recurrent 35 days after the first procedure,which was improved 10 days later after another endoscopic operations.Another one did not stop vomiting because of cytomegalovirus hepatitis,whose symptoms were relieved after secondary treatment.No complications were observed except for minor melena in one case after the therapy.Conclusion Endoscopicall pyloromyotomy in CHPS is effective and safe in short-term follow-up.

Objective To explore the clinical and imaging characteristics of traumatic carotid cavernous fistula(TCCF) with hemorrhage.Methods There were thirteen cases of TCCF underwent car accidents combined with epistaxis or intracranial hemorrhage between 1990 and 2000.Their clinical symptoms,CT,MR,and digital substract angiogram(DSA) were retrospectively analysed.Results There were special clinical and imaging characteristics in TCCF.Small amount of epistaxis and isolateral loss of sight might be found in cases with epistaxis at early stage,but delayed fatal and massive epistaxis occured at various time after trauma.Cranial base fracture and pseudoaneurysm were special imaging signs.In the TCCF cases with intracranial hemorrhage,prominent and tortuose cortical drainage veins might be found.And pseudoaneurysm at posterio-lateral wall of cavernous sinus might be another special imaging sign.Conclusion Small amount of epistaxis at early stage,cranial base fracture,pseudoaneurysm,prominence and tortuosity of cortical veins are characteristic diagnostic references for TCCF with hemorrhage.Emergent DSA examination at early stage should be regarded as a key step for diagnosis and treatment.

Objective To investigate the genotypic frequency of glucose-6-phosphate dehydrogenase (G6PD) (1376G ＞ T),G6PD 1311C ＞ T and G6PD IVS11-93T ＞ C in 50 newborns with G6PD deficiency in Guangdong region.Methods To identify G6PD deficiency in the patients of neonatal ward in Guangzhou First People's Hospital during 2010,detected by methemoglobin reduction test and measurement of G6PD/6-phosphate dehydrogenase (6PGD) ratio.Fifty G6PD deficiency subjects were classified into the experimental group,20 neonatal jaundice subjects were classified into the control group.Genomic DNA was extracted by standard method from the peripheral blood of each subject.PCR-direct DNA sequence analysis was used to identify G6PD 1376G ＞ T,1311C ＞ T and 11 intron 93T ＞ C mutations.Results The overall results of mutation analysis in the 50 G6PD deficiency subjects showed the existence of 3 different alleles:G6PD 1376G ＞T,1311C ＞T,11 intron 93T ＞ C(including 1311C ＞ T/IVS11-93T ＞ C and 1376G ＞T/1311C ＞T/IVS11-93T ＞ C complex mutations).The different genotypic frequency in the experimental group was G6PD 1376G ＞T 26.0％ (13/50 cases),1311C ＞ T 4.0％ (2/50 cases),11 intron 93T ＞ C 4.0％ (2/50 cases),1311C ＞ T/IVS11-93T ＞ C 2.0％ (1/50 cases),1376G ＞ T/1311C ＞ T/IVS11-93T ＞ C 2.0％ (1/50 cases).The G6PD enzyme activity of the subjects with 1311C ＞ T/IVS11-93T ＞ C and 1376G ＞ T/1311C ＞ T/IVS11-93T ＞ C complex mutation were reduced.These G6PD mutations were not found in the controls.Conclusions G6PD 1376G ＞ T is one of the commonest mutation in G6PD deficiency newborn in Guangdong region.A novel complex mutation 1376G ＞ T/1311C ＞ T/IVS11-93T ＞ C in this study was found.

Objective To study the safety and efficacy of endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilation (EPBD) in the treatment for extrahepatic bile duct stones.Methods A total of 164 patients underwent endoscopic treatment for extrahepatic bile duct stones.Seventy eight underwent EST and EPBD (the EST + EPBD group),86 others underwent EST only (the EST group).The complication rate,complete stone clearance rate and gravel incidence rate were compared between the two groups.Results Hyperamylasemia occurred in 3 cases,mild acute pancreatitis in 2 cases of the EST and EPBD group,while hyperamylasemia occurred in 5 cases,mild acute pancreatitis in 3 and hemorrhage in 2 of the EST group.There were no severe complications like severe acute pancreatitis or intestinal perforation.The complication rate of the EST + EPBD group ( 6.4％,5/78 ) was slightly lower than that of the EST group ( 11.6％,10/86),(x2 =1.340,P =0.288),so was gravel incidence (33.3％ vs.60.5％,x2 =12.073,P =0.001 ).While complete stone clearance rate of this group was obviously higher than that of the EST group (100.0％ vs.93.0％ ),(x2 =5.649,P=0.030).Conclusion EST combined with EPBD is safe and effective for extrahepatic bile duct stone removal,especially for large stones or poor duodenal papilla.

Fifty cases with chronic rheumatic valvular disease were examined with two dimensional echocardiography to evaluate the valvular pathology preoperatively. The echocardiographic findings were correlated and compared with the operative findings.It was found that 89% of the thickening pattern cases and 75% of the funnel-shaped cases showed thickening of the leaf-lets- All the 28 membranous cases showed diastolic doming and restricted tip motion of the anterior leaflet in different degrees. In the 4 funnel-shaped cases, 3 showed restricted tip and body motion of the leaflets and the 4th case showed stiffness of the leaflet base. 63% of the mitral regurgitation cases were confirmed at operation.It is concluded that preoperative evaluation of the valvular pathology with two dimensional echocardiography is helpful in selection of suitable operative candidates.

Objective To evaluate the safety of endoscopic retrograde cholangiopancreatography (ERCP) for elder patients (age more than or equal to 80 years).Methods Data of 464 patients (age ≥ 80 years) who underwent ERCP procedures from June 2008 to June 2014 in the First Affiliated Hospital of Nanchang University were compared with those of patients less than or equal to 60 years old,randomly chosen at 1∶4,for comorbidity,feature of disease distribution,intraoperative situation and postoperative complications of ERCP.Results The comorbidity rates of coronary heart disease,hypertension,chronic pulmonary disease and type 2 diabetes in observation group were significantly higher than those in the control group(P＜0.05),but there was no significant difference between two groups regarding to the comorbidity rate of arrhythmia(P =0.111).The main feature of disease distribution in two groups was choledocholithiasis,but the rate of malignant tumor in observation group was higher than that in the control group(P＜0.05).The success rate of ERCP showed no significant difference in two groups (98.92％ VS 99.35％,P=0.358).There was no significant difference between the two groups in the complication rates of acute pancreatitis (4.96％ VS 3.18％,P =0.064),infection (0.43％ VS 0.54％,P =1.000) and hemorrhage (1.08％ VS 0.59％,P=0.259).However the rate of perforation in observation group was lower than that in the control group (0.43％ VS 0.05％,P =0.043).Conclusion ERCP is safe and effective for elder patients.

Objective To compare the difference of the effects and safety of endoscopic submucosal dissection (ESD) and surgery for early gastric cancer. Methods We searched the Pubmed, CBM, Embase, Cochrane Library, CNKI, CQVIP and WanFang data from January 1990 to June 2016 studies comparing endoscopic resection with gastrectomy for treatment of early gastric cancer. We selected the eligible studies according the including and excluding criteria. The quality of the included studies was assess using the Newcastle-Ottawa Scale (NOS), then using Revman 5.3 to make the Meta analysis. Result The meta-analysis enrolled 12 studies with 4331 patients, all of the studies were retrospectively analyzed. The result of the meta-analysis showed that there were no significant difference regarding the recurrence rate [(22/2586, 0.85%) vs (6/1134, 0.53%), P = 0.370] and five-year survival rate [(852/909, 93.72%) vs (707/746, 94.77%), P = 0.340] between endoscopic resection and gastrectomy. Gastrectomy was associated with higher en bloc resection rate, which were 100.00% and 92.23% respectively. However, gastrectomy was also related to longer operative time (SMD = -3.04, 95%CI: -3.64 ~ -2.45, P = 0.000) and hospital stay (SMD = -2.53, 95%CI: -3.73 ~ -1.32, P = 0.000). The postoperative complication was also higher than endoscopic, which were (45/816, 5.50%) vs (101/686, 14.72%) respectively. Conclusion There were no significant difference regarding recurrence rate and five-year survival rate between endoscopic and gastrectomy. While the en bloc resection rate was lower than gastrectomy, endoscopic offers a shorter hospital stay, shorter operative time with minimal invasive and fewer operating and postoperative complications than gastrectomy. Endoscopic should be recommended as a standard treatment for early gastric cancer with indications.

Objective To evaluate the safety of anesthesia endoscopic retrograde cholangio pancreatography (ERCP) under general anesthesia.Methods From January 1st,2008 to June 30th,2016,patients underwent ERCP under general anesthesia were enrolled as anesthesia group and from January 1st,2005 to December 31st,2007,patients accepted ERCP without anesthesia were enrolled as control group.Chi-square test was performed to analyze disease composition,conditions during operation,success rate of operation and complications in these two groups.Results A total of 14 724 patients with ERCP under general anesthesia and 2 102 patients received ERCP without anesthesia were enrolled.In 14 724 patients with ERCP under general anesthesia,1 799 cases had malignant biliary and pancreatic diseases and 12 925 cases with biliary and pancreatic diseases.During the operation,transient hypoxemia occurred in 441 cases (3.00％) and relieved by increasing oxygen flow,lower anesthetic dose or lifting lower jaw.The success rate of ERCP in the anesthesia group (98.41 ％,14 490/14 724) was higher than that in the control group (97.34％,2 046/2 102),and the difference was statistically significant (x2 =11.500,P=0.001).The incidence rate of post-ERCP pancreatitis in the anesthesia group was 2.35％ (346/14 724),which was lower than that in the control group (3.85％,81/2 102),and the difference was statistically significant (x2 =16.813,P＜0.01).Conclusion ERCP under general anesthesia is safe,which could increase the success rate of operation and reduce the incidence rate of post-ERCP pancreatitis.