Pulmonary embolism(PE)is a relatively common cardiovascular emergency.Haemodynamic instability is the characteristics of massive pulmonary embolism,with a mortality as high as 20%.The goals of PE treatment are to remove the thromboembolic obstruction rapidly,exert beneficial effects on haemodynamic parameters and save the lives of patients.Haemodynamic and respiratory support is of vital importance in some critically ill patients with PE.The basic treatment is anticoagulation,the methods of which are different for PE during pregnancy,among cancer patients,with right heart thrombi and with heparin-induced thrombocytopenia.

Nuclear reconstitution around Lambda DNA in a cell-free system from Xenopus eggs involves distinct steps at ultrastructural level. First, Lambda DNA polymers were induced to form chromatin-like structures with the proteins in egg extracts. Then, along with membrane vesicles and nuclear pore components attached to them to assemble double nuclear membranes, these chromatin-like structures underwent variations from condensation to decondensation, simultaneously. It is different from the nuclear reconstitution induced by chromatin in that, while membrane vesicles were attaching to the chromatin-like structures to fuse each other, the assembly of nuclear pore complexes occurred practically.

Objective To emphasize the importance of the early diagnosis and treatment of Lemierre syndrome caused by Arcanobacterium haemolyticum.Method A case of Lemierre syndrome caused by Arcanobacterium haemolyticum and three similar reported cases were reviewed.Results A man complained of fever with a sore throat,and examination found an enlarged left tonsil with prominent exudate,normal blood routine test and chest radiograph.Although the patient received the treatment of penicillin G and azithromycin,his condition worsened.Blood test showed white blood cell count 13.59 × 109/L (neutrophils 0.933),platelet count 7.4 × 109/L,TBil 54.3 mmol/L,DBil 28.3 mmol/L,AST 127 IU/L,ALT 82 IU/L,serum albumin 19.3 g/L with the development of the conditions.Blood cultures grew Arcanobacterium haemolyticum and the piperacillin-tazobactam was administered until fever was controlled.In addition,anticoagulation was administered when the thrombus was confirmed in the left internal jugular vein.Two follow-up clinic visits over the following 4 months were unremarkable.Besides three similar cases reported,four patients were male,and the ages ranged from 19 to 54 years.The chief complaints were sore throat and fever (4/4),with neck pain (4/4).Physical examinations found pharyngitis (2/4),exudate or abscess in the tonsillar crypt (2/4),maculopapular rashes (2/4).Laboratory results showed leukocytosis and thrombocytopaenia (4/4),acute cholestatic liver dysfunction (3/4),acute renal failure (2/4),acute respiratory failure (1/4).The first chest radiographs were normal at the onset,but chest radiography features included peripheral nodules and cavitation (3/4),focal or wedge-shaped lesions (1/4),pleural effusion (1/4) with the development of the conditions.Blood culture proved that there was only growth of Arcanobacterium haemolyticum (2/4),both Fusobacterium necrophorum and Arcanobacterium haemolyticum were found (2/4).Amoxicillin/clavulanic acid or piperacillin/tazobactam was administered (4/4).Neck CT proved internal jugular vein thrombosis (3/4) and anticoagulation was administered (3/4).All patients recovered and no one died.Conclusions The characters of Lemierre syndrome include primary oropharynx infection,septicaemia,septic or embolic phlebitis of jugular vein,and metastatic abscess.Early recognition and aggressive intravenous broad-spectrum antibiotics are critical to reduce mortality.

Purpose: To measure the distribution of radiation dose on neighboring tissue of the mandible metallic. Materials and Methods: The stainless steel and tantalum prothesis of mandible were inserted in the phantoms. The percent radiation dose distributions of 60 Co ?-ray were measured by Lithium fluoride thermo-luminsence method. Results: Using unidirectional beam, the radiation dose was increased in the front of metallic and decreased at the back of it in 3mm thickness. Stainless steel gave higher changes than tantalum. Using opposite beams irradiation, these changes were compensated each other. Conclusion: Tantalum prothesis is advised to mandible when 60 Co is used.

Objective To investigate the classification and its application in one-stage repair of massive posttraumatic bone defects which are infection-induced and refractory in lower extremities. Methods From March 2002 to December 2008, we treated 42 patients with massive posttraumatic refractory infection-induced bone defects in lower extremities. We classified the defects into 3 types: simple massive infection-induced bone defects (type Ⅰ), massive infection-induced bone and soft-tissue defects (type Ⅱ) and massive infection-induced bone defects plus limb shortening (type Ⅲ). After thorough debridement, various types of vascularized fibular grafts were used to repair the 3 kinds of defects accordingly. Simple fibular grafts were used in 6 cases, transplantation with fibular and skin flaps was used in 31 cases, fibular grafts combined with anterior lateral thigh flap in 4 cases, and one-stage limb lengthening and fibular graft in one. Results The follow-ups of 6 to 41 (average, 26. 3) months revealed that the refractory bone defects were repaired successfully in 38 cases, amputation due to necrosis of fibular grafts in 2 cases and uncontrolled infection in 2 cases. In the 38 cases, infections were controlled effectively, circulation of the traumatic limbs was good,contour and function were restored satisfactorily, and no obvious complication was found in donor limbs. By Johner-Wruhs evaluation, 17 cases were excellent, 18 cases good, 3 cases fair and 4 cases poor, with a total excellent and good rate of 83.33%. Conclusions Refractory and massive posttraumatic infection-induced bone defects in lower extremities can be classified into 3 types. They can be repaired using various types of vascularized fibular grafts according to the defect types at one-stage.

Objective To evaluate the effectiveness of pulmonary embolectomy by cathether for the treatment of acute pulmonary embolism. Methods 38 cases were diagnosed pulmonary embolism by pulmonary angiography, treated by thrombus fragmentation and suction by cathethers, and local fibrinolysis. The symptoms, PaO 2, PAPM and pulmonary arteries were observed after the procedure. Results 36 patients survived and showed clinical improvement with significant decrease in PaPm and increase in PaO 2( P

OBJECTIVE To demonstrate a rare case of hepatic abscess caused by amebiasis and to discuss the reason of misdiagnosis.METHODS A fifty years old male patient with amebic liver abscess,misdiagnosed as hepatic(carcinoma),was studied.RESULTS The patient with a huge hepatic mass lesion was misdiagnosed as hepatic(carcinoma) and received interventional therapy four times within 13 months.Amebae were found in the(aspiration) of the lesion and in patient′s sputum.The temperature of the patient returned to normal range after(antibiotics) and anti-amebic therapy.CONCLUSIONS Amebic abscess is a clinically rare encountered pathology now.When to make the diagnosis,hepatic carcinoma should be carefully considered and differentiated.

Objective:To evaluate the efficacy and safety of combined cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) with lobaplatin and docetaxel for treatment of synchronous peritoneal carcinomatosis (PC) from gastric cancer. Methods:Fifty patients with synchronous PC from gastric cancer were treated by 52 CRS+HIPEC procedures with 100 mg of lobaplatin and 120 mg of docetaxel in 12000 mL of normal saline at (43 ± 0.5)℃for 60 min. The primary and secondary endpoints were overall survival (OS) and perioperative safety profiles, respectively. Results:At a median follow-up of 22.5 months, the median OS rate was 14.3 (95%CI:7.6-21.0) months, and the 1-, 2-, and 3-year survival rates were 58%, 40%, and 32%, respectively. No perioperative deaths or serious adverse events occurred in 12 cases (23.1%). Multivariate analysis indicated that completeness of cytoreduction, nor-mality of perioperative tumor markers, and adjuvant chemotherapy of more than six cycles were independent predictors for improved survival. Conclusions:CRS+HIPEC with lobaplatin and docetaxel could improve the OS and ensure perioperative safety of patients with synchronous PC from gastric cancer.

Objective To investigate the prevention and treatment effects of Compound Kushen Injection on acute radiation esophagitis. Methods Eighty-two eligible patients with esophageal cancer were randomly divided into the treatment group (41 cases) and the control group (41 cases). All the patients received radiotherapy. Throughout the course of radiotherapy, patients in the treatment group received Compound Kushen Injection, and patients in the control group received Kangfuxin Liquid. Occurrence time and level of radiation esophagitis, and dosage of painkillers were observed. Results Different degrees of acute esophageal toxicity were observed in the two groups. The occurrence rate of high level (degree III and degree IV) acute radiation esophagitis was 7.3%(3/41) in the treatment group, and 31.7%(13/41) in the control group. There was significant difference between the two groups (P<0.05). The dosage of the analgesic drug (Fentanyl Transdermal System) in the treatment group was far less than the controlled group (P<0.001). Conclusion Compound Kushen Injection could decrease the incidence rate of acute radiation esophagitis, and reduce the high-level esophagitis and the dosage of the analgesic drug, which can help the completion of radiation.

Objective:To introduce a novel clinical classification that can be applied to osteoradionecrosis treatment in an easy and considerably acceptable manner through a retrospective analysis of patients with osteoradionecrosis of the mandible (ORNM). Methods:The clinical data of 99 ORNM patients admitted to shanghai Ninth People's Hospital between 2000 and 2013 were summa-rized. A novel classification was established based on bone necrosis and soft tissue lesions. The new staging system was developed based onBandSclassifications. Corresponding strategies and methods of ORNM treatment at different stages were also proposed. Results:A new staging system with four different stages (i.e., stage 0:8 cases;stageⅠ:14 cases;stageⅡ:65 cases;and stageⅢ:12 cases) was proposed. Conservative treatment was applied to stage 0 patients, whereas sequestrectomy was performed in stageⅠcases. Marginal or segmental resection of the mandible was selected for stageⅡpatients;osteocutaneous flap or just soft tissue flap was also reconstructed. Conclusion:This new classification and staging system is easier to use and more acceptable for clinical evaluation than other systems.