This paper compares invasive positive pressure ventilation technology with noninvasive one. Sequential mechanical ventilation technology comes into being recently, which is analyzed according to its clinical application.

ObjectiveTo assess the value of transvalvular pressure gradient (TPG) by use of realtime color Doppler echocardiography in percutaneous balloon pulmonary valvuloplasty (PBPV).Methods Patients with pulmonic stenosis (80 cases) were performed by PBPV,in which the pilmonic annular diameter and TPG were measured by using of 2-D and color Doppler echocardiography in the different periods of this operation.Results The pilmonic annular diameter was not significantly difference by intraoperative echocardiography and radiography measurement (t =2.013,P ＞ 0.05).And pressure measurement by catheterization pre- and post-dilatation was not markedly significant ( t =1.258,P ＞0.05).However,TPG in patients with the different degree of pulmonic stenosis were decreased significantly ( P ＜0.01).PBPV treatments in the mild pulmonic stenosis for twice got an excellent effect according to operation criteria,but PBPV treatment in patients with the moderate and severe pulmonic stenosis need to be done for three times.ConclusionsReal-time color Doppler echocardiography is an effective way and plays a guiding role in PBPV.

Objective To investigate the therapeutic effects,adverse effects,and patterns of failure of elective irradiation of lymphatic drainage area (extended-field) and involved-field irradiation in three-dimensional radiotherapy (3DRT) in patients with esophageal cancer via a Meta-analysis.Methods The databases Wanfang Data,CNKI,VIP,CBM,PubMed,Embase,and Cochrane Library were searched to collect the controlled clinical trials on extended-field irradiation and involved-field irradiation in 3DRT in patients with esophageal cancer.Stata 11.0 was used for data analysis.The odds ratio (OR) with 95％ confidence interval was used to describe the differences between two groups.Results According to the inclusion and exclusion criteria,a total of 12 controlled clinical trials involving 1 095 patients with esophageal cancer were included in this meta-analysis.The results of the meta-analysis showed that compared with the involved-field irradiation group,the extended-field irradiation group had a significantly reduced rate of out-field failure in patients with esophageal cancer who received 3DRT (OR=3.727,P=0.007),but showed significantly higher rates of grade ≥ 3 acute radiation pneumonitis and radiation esophagitis (acute radiation pneumonitis:OR =0.348,P =0.001;radiation esophagitis:OR =0.385,P =0.000).The two groups had similar 1-,2-,and 3-year local control rate and overall survival rate (local control rate:OR=0.966/0.946/0.732,P=0.837/0.781/0.098;overall survival rate:OR=0.952/1.149/0.768,P=0.756/0.422/0.120),as well as a similar distant metastasis rate (OR=0.986,P=0.937).Conclusions Compared with involved-field irradiation,extended-field irradiation can reduce the rate of out-field failure in patients with esophageal cancer who receive 3DRT.However,it does not have significant advantages in local control rate and overall survival rate and has an increased incidence rate of adverse effects.

BackgroundThe relationship between lipids and coronary artery disease has been well established. However, this is not the case between lipids and heart failure. Ironically, high lipid levels are associated with better outcomes in heart failure, but the mechan-isms underlying the phenomenon are not fully understood. This study was performed to test the hypothesis that reduced intestinal lipid absorption due to venous congestion may lead to low lipid levels.MethodsWe collected data of clinical characteristics, echocardio-graph, and lipid profile in 442 unselected patients with congestive heart failure. Correlations between lipid levels[including total cho-lesterol(TCL), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C), and triglycerides(TG)]and right ventricle end diastolic diameter (RVEDD), left ventricle end diastolic diameter (LVEDD), right atrium diameter (RA), left atrium diameter (LA), or left ventricle ejection fraction (LVEF) were analyzed using Pearson correlation and partial correlation. RVEDD, LVEDD, RA, and LA were indexed to the body surface area.ResultsThere was a significantly inverse correlation between TCL le-vels and RVEDD (r=-0.34,P<0.001) and RA (r=-0.36,P<0.001). Other lipids such as LDL-C, HDL-C, and TG had asimilar inverse correlation with RVEDD and RA. All these correlations remained unchanged after adjusting for age, gender, smoking status, physical activity levels, comorbidities, and medication use.ConclusionsLipid levels were inversely correlated to RVEDD in patients with congestive heart failure; however, because this was an observational study, further investigation is needed to verify our results as wellas identify a causal relationship, if any.

Background Hyperuricemia is frequently present in patients with heart failure. Many pathological conditions, such as tissue ischemia, renal function impairment, cardiac function impairment, metabolic syndrome, and inflammatory status, may impact uric acid (UA) metabolism. This study was to assess their potential relations to UA metabolism in heart failure. Methods We retrospectively assessed clinical characteristics, echocardiological, renal, metabolic and inflammatory variables selected on the basis of previous evidence of their involvement in cardiovascular diseases and UA metabolism in a large cohort of randomly selected adults with congestive heart failure (n = 553). By clustering of indices, those variables were explored using factor analysis. Results In factor analysis, serum uric acid (SUA) formed part of a principal cluster of renal functional variables which included serum creatinine (SCr) and blood urea nitrogen (BUN). Univariate correlation coefficients between variables of patients with congestive heart failure showed that the strongest correlations for SUA were with BUN (r = 0.48, P < 0.001) and SCr (r = 0.47, P < 0.001). Conclusions There was an inverse relationship between SUA levels and measures of renal function in patients with congestive heart failure. The strong correlation between SUA and SCr and BUN levels suggests that elevated SUA concentrations reflect an impairment of renal function in heart failure.

Objective To evaluate the clinical efficacy and analyze relevant prognostic factors of simultaneous integrated boost intensity-modulated radiation therapy ( SIB-IMRT ) for esophageal squamous cell carcinoma. Methods A total of 101 patients diagnosed with esophageal squamous cell carcinoma received SIB-IMRT from 2009 to 2015. The prescribed dose of PTV was 5040 cGy/28 times ( 180 cGy/time) and the dose for planning gross tumor volume (PGTV) was 6020 cGy/28 times (215 cGy/time) or 6160 cGy/28 times ( 220 cGy/time) simultaneously. The total treatment time was 5. 5 weeks ( once a day, 5 times a week).The adverse events, mode of treatment failure,l-,3-and 5-year local control (LC) and overall survival ( OS) rates were observed. Results The quantity of patients who completed the 1-,3-and 5-year follow-up was 101, 84 and 45, respectively. The 1-,3-and 5-year LC rates were 81. 6％,70. 4％ and 68. 4％, respectively. The 1-, 3-and 5-year OS rates were 72. 3％, 49. 4％ and 45. 2％, respectively. The median survival time was 36 months. Univariate and multivariate analyses showed that clinical staging ( stageⅠ/Ⅱ/Ⅲ) and tumor response ( complete remission/ partial remission/no remission ) were the prognostic factors of OS (P=0. 016,0. 000,0. 005,0. 000).There were no significant differences in the LC and OS between the two groups of 215 cGy and 220 cGy (P=0. 283,0. 951).The incidence rates of grade 1,2,3 acute pneumonitis were 10. 9％(11/101),2. 0％(2/101) and 2. 0％(2/101), respectively. The incidence rates of grade 1, 2, 3 acute esophagitis were 63. 4％( 64/101 ) , 10. 9％( 11/101 ) and 4. 0％( 4/101 ) , respectively. No acute esophageal perforation or hemorrhage occurred. Five patients experienced late pneumonitis ( two died) . One case developed late lemostenosis, two cases developed esophageal perforation and hemorrhage, and two patients experienced esophageal hemorrhage. The patients treated with a fractionated dose of 220 cGy had a higher incidence rate of acute pneumonitis and upper gastrointestinal adverse reactions than those receiving 215 cGy ( P= 0. 062, 0. 024 ) . The local failure and recurrence accounted for 62. 5％ of all treatment-related failures. Conclusions SIB-IMRT yields high long-term clinical efficacy and tolerable adverse events in the treatment of esophageal squamous cell carcinoma. Compared with the dose of 215 cGy, the fractionated dose of 220 cGy fails to improve LC and OS rates, whereas enhances the risk of adverse events. The clinical staging and short-term clinical efficacy are the prognostic factors of survival rate.

Prostate cancer has become the most common malignant disease in male. Due to development of therapy methods, the overall survive rate of advanced prostate cancer has been improved significantly. The demands for higher quality of life are impending in advanced prostate cancer patient. With the progression of prostate cancer, about 1/3 to 2/3 of patients will suffer from moderate to severe lower urinary tract symptoms. Severe lower urinary tract symptoms can lead to negative effects on treatment and quality of life. However, there is no standard treatment for lower urinary tract symptoms in advanced prostate cancer patients. This article reviews the clinical application of palliative transurethral resection of prostate in patients with advanced prostate cancer.