Objective To investigate the correlation between plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) and haemodynamics evaluated by right-heart catheterization in patients with chronic thromboembolic pulmonary hypertension (CTEPH).Methods Fifty-three patients with CTEPH were retrospectively reviewed.All patients underwent right-heart catheterization to detect haemodynamics.The level of plasma NT-proBNP was measured by electrochemical luminescence.The indexes were analyzed.Results Pulmonary artery systolic pressure was (84.9 ± 21.6) mmHg (1 mmHg =0.133 kPa).Pulmonary artery diastolic pressure was (31.1 ± 9.7) mmHg.Pulmonary artery pressure was (49.3 ± 13.4) mmHg.Pulmonary vascular resistance was (1 047.4 ± 86.1) dyn ·s/cm5.Pulmonary capillary wedge pressure was (8.16 ± 3.02) mmHg.Right cardiac output was (3.36 ± 1.42) ml.Right cardiac work was (1.97 ± 0.95) kg·m.The level of plasma NT-proBNP in CTEPH was (2 301.5 ± 1 787.3) ng/L.The level of plasma NT-proBNP in CTEPH had positive correlation with pulmonary vascular resistance (r =0.429,P =0.02),and had negative correlation with right cardiac output (r =-0.583,P＜ 0.01) and right cardiac work (r =-0.521,P ＜ 0.01).The level of plasma NT-proBNP in CTEPH had no correlation with pulmonary artery systolic pressure,pulmonary artery diastolic pressure,pulmonary artery pressure,pulmonary capillary wedge pressure (P ＞ 0.05).Conclusion The level of plasma NT-proBNP can be used as a better predictor for evaluating pulmonary vascular resistance and right cardiac function in CTEPH.

Objective:To revise the Psychological Security-insecurity Questionnaire(S-I) developed by Maslow and examine its reliability and validity.Methods:Data were collected from 1893 junior middle school students with the original S-I.Results:The revised S-I consisted of 44 items,including 10 first-order factors and 3 second-order factors.It had good test-retest reliability,homogeneity reliability and criterion validity.Conclusion:The revised S-I has satisfying reliabilities and validities,and is suitable to asses the psychological security and insecurity for Chinese junior school students.

Objective To evaluate the efficacy and safety of long-term anticoagulation therapy with warfarin in elderly patients with pulmonary thromboembolism (PTE) and the maintenance dosage of warfarin,and provide evidence for anticoagulation therapy. Methods Twenty elderly patients ( ≥65 years old) with PTE whose anticoagulation therapy duration exceeded 12 months were included into this study. The hemorrhage event, recurrence event and the maintenance dosage of warfarin in each patient were determined by the follow-up record. Results Six male patients and 14 female patients [(73.55 ± 5.76) years old] were diagnosed as PTE by CT pulmonary arteriography(CTPA). The average duration of follow-up was (22.60 ± 11.45 ) months. No fatal hemorrhage event such as cerebral hemorrhage was found during the course of long term anticoagulation therapy, and mild hemorrhage was found in 5 patients, including 1 patient with gingiva hemorrhage, 1 patient with epistaxis, 1 patient with hemoptysis, 1 patient with ecchymosis in the left leg and 1 patient with conjunctiva hemorrhage. PTE recurrence emerged in 1 patient and the recurrence rate was 5%.No change was found in the maintenance dosage of warfarin during the course of long-term anticoagulation therapy and the average dosage of warfarin was about 3.5 mg with sufficient anticoagulation therapy.Conclusions Long-term anticoagulation therapy with warfarin in elderly patients with PTE is safe and efficacious. The maintenance dosage of warfarin is about 3.5 mg, and detecting the international normalized ratio regularly is necessary.

Objective To investigate the injury posterior vertebral pedicle nail fixed treatment of thoracolumbar fractures of the clinical efficacy and safety .Methods Forty-eight cases of thoracolumbar fractures were treated by the posterior vertebral pedicle screw fixation ,according to cases decompressive laminectomy ,underwent intertransverse fusion treatment .Postoperative follow-up of 1 year ,preoperative ,postoperative 3 months ,after 1 years of vertebral compression rate ,Cobb Angle were compared .Results Forty-eight patients with postoperative 3 months and 1 year after injury postoperative spinal vertebral body compression rate were significantly decreased compared with preoperative (P<0 .05);After 3 months and 1 year after the Cobb Angle were markedly sig-nificant reduction than preoperative(P<0 .05) .X-ray showed all fractures were obtained good reduction ,internal fixation with no looseness or breakage ,no protruding after spinal deformity ,neural function were all in 1 -3 level recovery .Conclusion Posterior vertebral pedicle injury by nail fixed treatment of thoracolumbar fractures with fixed reliable ,reset effect is good .

Purpose　To investigate the pathomorphological and immunohistochemical features of gastrointestinal stromal tumors (GIST). Methods　Light microscopy was used to study the morphologic characteristics of 77 cases of GIST. The expression of c-kit(CD117), CD34, vimentin, SMA and S-100 protein were detected in all cases with S-P immunohistochemical method. Results　GIST tended to have a higher degree of cellularity and lesser degree of cytoplasmic eosinophilia than observed in classic leiomyomas. The neoplastic cells of GIST were spindle, epithelioid or both in different proportion. Focal to prominent cytoplasmic vacuolization was often seen. The histological spectrum included interlacing fascicles, diffuse sheets, storiform and palisading pattern. The formation of cell clusters was rather special. Stromal and vascular hyalinization was common. GIST primary in the mesentery tended to have a higher potentiality of malignancy. The positivity of CD117 and CD34 were 90%, 92%, respectively. Conclusion　The characteristic histological features exist in GIST. The detection of CD117 and CD34 is helpful to differential diagnosis.

Objective To explore the influence of different positive end-expiratory pressure (PEEP) levels on cerebral blood flow (CBF) and cerebrovascular autoregulation in patients with acute respiratory distress syndrome (ARDS).Methods A prospective study was conducted.Moderate or severe ARDS patients admitted to Department of Critical Care Medicine of Jiangxi Provincial People's Hospital from January 1st,2013 to October 1st,2013 were enrolled.The changes in hemodynamics,respiratory mechanics and gas exchange under different levels of PEEP were observed.CBF velocity of middle cerebral artery (MCA) was measured using transcranial Doppler (TCD),and breath-holding index (BHI) was also calculated.Results 35 patients with ARDS were included.The oxygenation index (OI),peak inspiratory pressure (PIP),plat pressure (Pplat) and central venous pressure (CVP) were markedly elevated [OI (mmHg,1 mmHg=0.133 kPa):324.7± 117.2 vs.173.4± 95.8,t=5.913,P=0.000; PIP (cmH2O):34.7 ± 9.1 vs.26.1 ± 7.9,t=4.222,P=0.000; Pplat (cmH2O):30.5 ± 8.4 vs.22.2 ± 7.1,t=4.465,P=0.000; CVP (mmHg):12.1 ± 3.5 vs.8.8 ± 2.2,t=4.723,P=0.000] when PEEP was increased from (6.4 ± 1.0) cmH2O to (14.5-± 2.0) cmH2O (1 cmH2O=0.098 kPa).But no significant difference in the heart rate (beats/min:85.5 ± 19.1 vs.82.7 ± 17.3,t=0.643,P=0.523),mean arterial pressure (mmHg:73.5 ± 12.4 vs.76.4 ± 15.1,t=0.878,P=0.383) and CBF velocity of MCA [peak systohc flow velocity (Vmax,cm/s):91.26 ± 17.57 vs.96.64 ± 18.71,t=1.240,P=0.219; diastolic flow velocity (Vmin,cm/s) 31.54 ±7.71 vs.33.87 ±8.53,t=1.199,P=0.235; mean velocity (Vmean,cm/s) 51.19 ± 12.05 vs.54.27 ± 13.36,t=1.013,P=0.315] was found.18 patients with BHI＜0.1 at baseline demonstrated that cerebral vasomotor reactivity was poor.BHI was slightly decreased with increase in PEEP (0.78 ± 0.16 vs.0.86 ± 0.19,t=1.905,P=0.061).Conclusions Some of moderate or severe ARDS patients without central nervous system disease have independent of preexisting cerebral autoregulation impairment.However,independent of preexisting cerebral autoregulation may not further be impaired when a high PEEP was chosen.

Objective To explore the effect of exposure of the recurrent laryngcal nerve(RLN) in prevention of RLN injury during thyorid surgery.Methods The clinical data of 810 cases of thyroid operation in which the RLN was exposed in 252 cases(group A) and was unexposed in 558 cases(group B) were analyzed.Results Although the extent of thyroid resection was greater in group A than in group B,the rate of RLN injury in group A(1.19 %) was significantly lower than that of group B(3.05 %,P

Objective To approach the effect of different vasopressor on hemodynamics, volume responsiveness, fluid volume balance, renal function and prognosis in patients with acute respiratory distress syndrome (ARDS) complicated with septic shock.Methods A prospective single-blind randomized controlled trial was conducted. ARDS patients with septic shock admitted to the Department of Critical Care Medicine of Jiangxi Provincial People's Hospital from January 1st, 2015 to May 1st, 2016 were enrolled. The patients satisfied ARDS Berlin diagnostic criteria, over 15 years old, needing vasopressor after fluid resuscitation were enrolled. The patients were divided into norepinephrine group (NE group) and terlipressin group (TP group) by randomise number table derived by computer. Patients in TP group were given terlipressin (0.01-0.04 U/min) with an intravenous pump, while those of NE group were given norepinephrine (> 1μg/min) with an intravenous pump, and the target mean arterial pressure (MAP) was maintained at 65-75 mmHg (1 mmHg = 0.133 kPa). Hemodynamics and extravascular lung water index (EVLWI) were monitored by pulse indicator continuous cardiac output (PiCCO). The volume responsiveness of patient was evaluated by passive leg raising (PLR) test, and cardiac index (CI) change (ΔCI ≥ 10%) served as positive volume responsiveness. The differences in hemodynamics, EVLWI, oxygenation index (OI), lactate clearance rate (LCR), rate of positive volume responsiveness, urinary output, fluid volume balance, renal function, and prognostic indicators were compared between the two groups.Results Fifty-seven patients with ARDS complicated with septic shock were enrolled, with 26 patients in NE group, and 31 patients in TP group, thebaseline data in both groups was balanced with comparability. Compare with NE group, 48-hour and 72-hour heart rate (HR) in TP group was significantly slowed (bpm: 82.1±6.8 vs. 87.6±7.4, 81.3±6.1 vs. 85.6±8.3, bothP < 0.05), 72-hour central venous pressure (CVP) was significantly decreased (mmHg: 9.4±2.6 vs. 10.9±3.0,P < 0.05), but no significant difference was found in HR, MAP, CVP, CI, EVLWI, OI and LCR at other time points between the two groups. 48-hour and 72-hour positive volume responsiveness rate in TP group were significantly increased as compared with those of NE group (74.2% vs. 46.2%, 64.5% vs. 38.5%, both P < 0.05), urinary output on the 2nd day (mL/24 h: 2342.8±704.1 vs. 1944.6±684.3) and fluid volume balance (mL: -319.7±54.8 vs. -169.6±27.2) were significantly decreased (bothP < 0.05). There was no significant difference in positive volume responsiveness rate, urine output, fluid volume balance, and the level of serum creatinine at other time points between the two groups. There was no statistically significant difference in the following features between TP group and NE group: duration of mechanical ventilation (days: 8.41±2.97 vs. 9.67±3.56), length of intensive care unit (ICU) stay (days: 12.84±4.47 vs. 14.77±5.01), total length of hospital stay (days: 19.34±7.37 vs. 21.07±8.41), and 28-day mortality (29.0% vs. 30.8%, allP > 0.05).Conclusions Compared with norepinephrine, terlipressin for ARDS patients with septic shock is more conducive to restrict fluid load, improve the renal perfusion and increase urine output. However, in both groups therewas no significant difference in the efficiency of stabilizing hemodynamics, shortening the duration of mechanical ventilation, reducing ICU or hospital days and decreasing 28-day mortality.

Objective To discuss possible mechanism of chronic obstructive pulmonary disease(COPD)coagulation and fibrinolysis dysfunction.Methods Totally 47 healthy controls(Group A)and 38 cases of AECOPD(Group B)were chosen respectively.The plasma levels of vWF,Factor Ⅹ,TF,TFPI,TM,PC,tPA,PAI-1 and D-dimer were measured by ELISA method,and the blood AT-Ⅲ activity was measured by chromogenic assay.The cases of Group B were measured for RBC,WBC,PLT,PH,PaO2,PaCO2,HCO-3,PT,APTT,FBG,and so on.Results The plasma levels of vWF,TF,Factor Ⅹ,t-PA and D-dimer in Group B were significantly higher than those in Group A while TM and PC were significantly lower in Group B(P

Objective To evaluate the diagnostic value of deep venous thrombosis(DVT)on lowerlimb venous ultrasonography combined with right ventricular dysfunction (RVD) on transthoracic echocardiography(TTE) in patients with acute pulmonary thrombo embolism(PTE). Methods This prospective multicenter control trial included 520 patients with confirmed acute PTE from 41 hospitals between June 2002 and February 2005.Results The incidence of RVD and DVT was associated with the severity of PTE.There were 57.0%(207/363)patients with RVD,49.6%(1 80/363)patients with DVT,265(73.0%)patients with RVD and/or DVT,and 121(33.3%)patients with combined sign of DVT plus RVD in the whole population.As to major PTE population,206(99.5%)patients had RVD and 121 (58.5%)patients had DVT.In addition,the rate of RVD was much greater in proximal PTE than in lobar PTE and segmental PTE(78.7%,51.4%and 21.7%,respectively,P＜0.001).DVT occurred more frequently in proximal PTE than in lobar PTE and segmental PTE(61.7%,46.8%and 37.0%,respectively,P＜O.001).The incidence of the combined sign was 51.1%,24.3%and 8.7%,respenctively (P＜0.001).Conclusions The incidence of the combined sign of RVD plus DVT was associated with the severity of PTE and the localization of emboli.The combined sign of RVD plus DVT help diagnose major PTE especially in emergency department.