4 cases of simple blunt trauma to the heart,with laceration of cardiac valve in 2 cases,perforation of valve in 1 and rupture of chordae tendineae in 1,were reported.The immediate symptoms were chest pain and sensation of oppression,palpitation,dizziness or syncope.The most threatening episode,however,was acute heart failure,which occurred 3-6 months after the injury.3 cases in this series required emergent operation due to acute heart failure.2 patients made an uneventful recovery following valve replacement,and 1 patient died of ventricular fibrillation during operation.Autopsy confirmed the diagnosis of Marfan's syndrome.A brief discussion on blunt trauma of the heart was made with analysis of the mechanism involved,and the literature was reviewed.Preliminary experience in diagnosis and management of this series of patients was presented.

Objective To improve the ingestion protocol of esophageal capsule endoscopy in right lateral supine (RLS) position. Methods A total of 53 patients were randomized into RLS group and improvement group. The time of passing the esophagus, visual range and clarity of esophagus and z-line, and comfort of the procedure were compared between the two groups. Results The time of capsule passing the esophagus in improvement group was significantly longer than that in RLS group [ 202 (20-480) s vs.63 (8-210) s, P ＜ 0. 001 ) ]. The range of visualization in esophagus (2. 69 ± 0. 21 ) and Z-line (2. 54 ±0. 22) in improvement group was significantly larger than that in RLS group (2. 55 ± 0. 23 and 2. 40 ± 0. 24,respectively, P =0. 019 and P =0. 037, respectively). No significant difference was detected in clarity of esophagus or Z-line between 2 groups (P ＞0. 05). Two patients (7.7%) in RLS group had transient cough due to frequent water drinking, while no cough was observed in improvement group. Conclusion Compared with the ingestion protocol of esophageal capsule endoscopy in right lateral supine position, the improved ingestion protocol shows larger range of visualization, better safety and the same definition.

Objective To investigate the clinical characteristics of the patients with portal hypertension secondary to primary myelofibrosis (PH-PMF). Methods The clinical data of patients with PH-PMF retrieved from Peking University Third Hospital were collected and analyzed. Results A total of 6 from illness onset to definite diagnosis was 24 months. The symptoms related to portal hypertension included bloating, abdominal mass, hematemesis and melena. The signs related to portal hypertension included splenomegaly ( moderate or severe in all patients), hepatomegaly ( mild or moderate in most of patients),shifting dullness positive and varices in abdominal wall. Only a small portion of patients had jaundice, liver palms and spider angioma. The indexes related to liver functions were normal or only mild abnormal in most cases. The average diameters of portal vein and splenic vein were ( 16. 0 ±3.2) mm and ( 11.0 ±3.4) mm,respectively. Thrombosis of portal vein or splenic vein was found in 2 cases. Liver biopsy revealed extramedullary hemopoiesis in one patient. In addition to medicine therapy related to portal hypertension in 5 patients with PH-PMF, 1 patient received splenectomy and another received endoscopic variceal ligation.Conclusions The patients with PH-PMF were clinically rare and easy to be misdiagnosed. The main keys to differentiate PH-PMF from cirrhosis included marked splenomegaly, mild or moderate hepatomegaly, good liver functions, lack of liver palms or spider angioma and extramedullary hemopoiesis showed in liver biopsy samples.

Objective To explore the value on application of combined C-reactive protein(CRP), serum albumin(PA)with blood routine inspection in diagnosis of bacterial infectious diseases in children.Methods 98 cases of patients confirmed infectious diseases in our hospital were selected as the study objects, and 68 cases with bacterial infectious diseases were as the bacterial infection group, while 30 cases with non-bacterial infection were as the non-bacterial infection group.Another 50 cases of healthy children were as the control group.All the children and children in the control group were given CRP, PA and blood routine detection, The diagnostic coincidence rates were evakuated according to the examination Results .ResultsCRP and WBC levels in the bacterial infection group were significantly higher than those in the non-bacterial infection group and the control group (P<0.05), PA level in the bacterial infection group were significantly higher than that in the non-bacterial infection group and the control group (P<0.05), The children's urine and cerebrospinal fluid or sputum bacterial culture results as the gold standard, 68 cases were true positive, and 30 were negative.CRP diagnosis showed 40 cases were positive, 58 cases negative, 13 cases false positive, and 41 cases false negative, the detection sensitivity was 39.71%, specificity was 56.67%, and coincidence rate was 44.90%.PA diagnosis showed 43 cases were positive, 55 cases negative, 12 cases false positive, and 37 cases false negative, the detection sensitivity was 45.59%, specificity was 60.00%, and coincidence rate was 50.00%.WBC diagnosis showed 47 cases were positive, 51 cases negative, 14 cases false positive, and 35 cases false negative, the detection sensitivity was 48.53%, specificity was 53.33%, and coincidence rate was 52.04%.CRP, PA, WBC combined diagnosis showed 62 cases were positive, 36 cases negative, 3 cases false positive, and 9 cases false negative, the detection sensitivity was 86.76%, specificity was 90.00%, and coincidence rate was 87.76%.The sensitivity, specificity and coincidence rate of CRP, PA and WBC combined diagnosis were significantly higher than those of CRP, PA and WBC diagnosis results.There were no significant differences in sensitivity, specificity and coincidence rate among single diagnosis of CRP, PA and WBC.Conclusion Implementation of combined CRP, PA with WBC in diagnosis of bacterial infection in children can effectively improve diagnostic coincidence rate.and provide theoretical basis for clinical treatment.

Objective To evaluate the efficacy and safety of common therapy and individualized treatment in newly diagnosed patients with Helicobacter pylori (H.pylori) infection.Methods From March 2008 to February 2010,September 2013 to April 2014,January to October 2015,a total of 1 440 patients with H.pylori infection who received eradication therapy and with complete clinical data were retrospectively enrolled.Each was 350 cases in individualized treatment group,clarithromycin and bismuth containing quadruple therapy group and concomitant therapy group.A total of 100 cases were in standard triple therapy group,90 cases in sequential therapy group,and 200 cases in levofloxacin and bismuth-containing quadruple therapy group.The eradication rate of H.pylori,incidence of adverse events and compliance rate were compared in the six groups.Chi square test was performed for statistical analysis.Results The results of intention-to-treat analysis indicated that there was no statistically significant difference in H.pylori eradication rates among six groups (x2 =0.985,P=0.323).However,the results of modified intention-to-treat analysis showed that H.pylori eradication rate of individualized treatment group was the highest (92.5％ (282/305) and 93.3％ (278/298)),second was levofloxacin and bismuth-containing quadruple therapy group (90.3％ (167/185) and 91.6％ (164/179)),and the differences were statistically significant (x2 =11.285 and 13.981,both P＜0.01).There was statistically significant difference in indcidence of adverse events among the six groups (x2 =5.692,P=0.018),the incidence of adverse events in levofloxacin and bimuth-containing quadruple therapy group was lowest (16.2 ％ (30/185)),and second was individualized treatment group (21.0％ (64/305)).There was statistically significant difference in compliance rates among the six groups (x2 =4.712,P=0.023),the compliance rates of standard triple therapy group and sequential therapy group were highest (100％ (100/100) and 100％ (90/90)),and second was individualized treatment group (97.7％ (298/305)).Conclusions Both the levofloxacin and bimuth-containing quadruple therapy group and individualized treatment group can effectively eradicate H.pylori infection.The former may be safe and effective to patients unable to receive individualized therapy.

The portable high frequency (HF) X-ray machine for field use is introduced in this paper, which applies HF technology and the microcomputer. Compared with the traditional one, it has many new functions such as the self-motion exposal, real-time inspection and display, the alarm of the failure and the automatic disposal. With the advanced technology, it has overcome the deficiencies of the traditional one, including the overweight, bulkiness and unportability. Equipped with the portable mobile shelf, this machine is fit for field operations.

Clinical phenotypes and endophenotypes of atopic dermatitis are diverse, and it is of great significance to identify characteristics of different clinical phenotypes and endophenotypes for auxiliary diagnosis and targeted treatments. This review elaborates clinical phenotypic differences of atopic dermatitis in terms of age of onset, ethnic background, disease severity, etc., and summarizes clinical significance of endophenotypes and related biomarkers.

Objective To study the protective effects of low frequency electric stimulation at bilateral mastoid processes on the focal cerebral lesion induced by ischemia-reperfusion in rats. Methods Focal cerebral ischemia in rats was produced by 2 hours of the middle cerebral artery occlusion (MCAO) and 24 hours reperfusion. The neurological deficits scale was used to evaluate and screen the rats for tests. The cerebral water content was determined by wet/dry weighing method. The infarct volume was measured by 2,3,5-triphenyltetrazolium chloride (TTC) staining technique and image analysis instrument. The activity of superoxide dismutase (SOD) and the content of malondialdehyde (MDA) in ischemic tissue of brain were analyzed. Results Compared with the control group, the severity of cerebral edema in the treatment group, apart from the emergency group,was lessened(P

Objective:To evaluate the efficacy and safety of amisulpride and risperidone in the treatment of schizophrenia. Meth-ods:The RCTs literatures on amisulpride and risperidone in the treatment of schizophrenia were retrieved and screened, and the quali-fied ones were analyzed by meta-analysis. Results:A total of 10 literatures were included involving 802 patients. Meta-analysis results showed that the difference between the two groups after the treatment was not statistically significant by comparing the clinical efficien-cy, PANSS score and TESS score. About the incidence of adverse reactions, amisulpride was better than risperidone in the endocrine function, extrapyramidal symptoms, weight gain and cardiovascular system. The incidence of nausea and vomiting of amisulpride was more than that of risperidone. There was no statistical significance in insomnia, headache, dizziness and the others. Conclusion:Ex-isting literature analysis shows that amisulpride is safe and effective in the treatment of schizophrenia.