Objective To investigate and analyze the usage of expensive outpatient prescriptions in different hospitals in Longgang area,Shenzhen,and to discuss and provide reference for the rational usage of expensive pre-scriptions.Methods Two primary hospitals,two secondary hospitals and one tertiary hospital in the Longgang area, Shenzhen,were chosen as the research targets.The expensive outpatient prescriptions,defined as the amount of pre-scription was over 150,200 and 300 yuan for primary,secondary and tertiary hospital respectively,were randomly selected and evaluated using international standards for the rational use of drugs.Results The average prescription items for primary,secondary and tertiary hospitals were 2.96,2.61 and 2.61.The largest proportions of prescription costs were 150 to 200 yuan,200 to 250 yuan and 300 to 350 yuan,which were respectively accounted for 49.6%, 56.6% and 37.7%.The frequency of using proprietary Chinese medicine,was 60.08%,68.18% and 41.62%respectively,which was not reasonable.The clinical diagnosis for the prescriptions of primary and secondary hospitals was mainly composed of trauma,bronchitis and vaginitis.The usage of drugs was not reasonable about the use of anti-biotics and infusion.In addition,the clinical diagnosis for the prescription of tertiary hospital was mainly diabetes, hypertension and cerebral infarction,where the abuse of using large dose of adjuvant drug was observed.Conclusion The frequency of using proprietary Chinese medicine is higher at all levels of hospital.In order to reduce the propor-tion of expensive prescription,the medicine institution should establish a sound system for drug use management and strengthen supervision and verification for western medicine physicians using proprietary Chinese medicine in their prescription.Furthermore,we should intervene and restrict the abuse usage of the adjuvant medicine.

Objective To characterize the feasibility of low-dose CT angingraphy on 16-slice multislice computed tomography (16-MSCT), and its relationship to the noise in the pre-contrast image and enhancement value.Methods Forty-three consecutive patients (male 21, female 22, mean age 59 years, median age 56 years) underwent abdominal 16-MSCT (Toshiba Aquilion 16) with constant scanning parameters including 120 kVp, a 0.5-second gantry rotation time, a pitch of 0.938: 1, and 16×1-mm detector collimation.The mA was set at 200 in the pre-contrast scan and 160 in the contrast-enhanced scan.The arterial phase images were retrospectively reconstructed with 1-mm slice thickness, 0.8 mm interval.The pre-contrast noise was defined as the standard deviation (SD) of the aorta at the level of right posterior crura of diaphragm.The enhancement of aorta was also measured at level of celiac artery.The volume rendering of CT angiography was made and classified into three grades (excellent, good, bad).Receiver operating characteristic curve (ROC) was used to evaluate the relationship between the image quality of CT angiography and noise in the pre-contrast image and enhancement value.Results Twenty-five cases had the aorta enhancement between 300.0--400.0 HU.The sensitivity and specificity of excellent CTA image was 75% and 62%, respectively when the SD was 12.00.Eighteen cases had the aorta enhancement more than 400.0 HU.The sensitivity and specificity of excellent CTA image was all 100% when the SD was 12.25, and 100% and 75%, respectively when the SD was 13.35.The area under curve of CTA image quality and enhancement in receiver-operated characteristic analysis was O.907.The enhancement was more than 356.7 HU when the sensitivity and specificity of excellent CTA image was 100% and 60%, respectively, and 389.8 HU when 78% and 80%.When the enhancement was more than 442.4 HU, the specificity of excellent CTA image was 100%.Conclusions MSCT angiography with low radiation dose is feasible.Good CT angiography demands great enhancement, and then, the needed mAs is lower when the SD is smaller.

Objective:To explore the effect of sarpogrelate on platelet function in patients at the bridging stage before coronary artery bypass grafting (CABG).
Methods: A total of 40 consecutive patients with peripheral artery stent and scheduled for CABG in our hospital from 2011-05 to 2013-04 were enrolled in this study. The patients were randomly divided into 2 groups, Low molecular weight heparin (LMWH) alone group, n=19 and Sarpogrelate+LMWH group, n=21. The medications started at 5-7 days before CABG and stopped at 24 h before CABG. The platelet inhibition rates (platelet aggregation induced by collagen+ serotonin) were examined and compared between 2 groups at the baseline (before randomization), 24h and 1h before CABG respectively.
Results: The platelet inhibition rates were similar between 2 groups at the baseline (87.33 ± 6.82) % vs (86.11 ± 6.87) %, P=0.577 and 1h before CABG (62.60 ± 12.39) % vs (56.19 ± 14.99) %, P=0.148. At 24h before CABG, the platelet inhibition rate in Sarpogrelate+LMWH group was higher than that in LMWH alone group (83.87 ± 8.99)%vs (63.13 ± 10.88)%, P<0.001. Compared with the baseline, the falling range of platelet inhibition was lower in Sarpogrelate+ LMWH group at 24h before CABG, (3.46 ± 6.18) % vs (22.98 ± 9.43) %, P<0.001 and the falling range was similar between 2 groups at 1h before CABG (24.73 ± 14.19)%vs (29.92 ± 14.28)%, P=0.257.
Conclusion: Sarpogrelate + LMWH may result better platelet inhibition rate with quicker recovery of platelet function upon the medication stopping, which might be a feasible management in patients at the bridging stage before CABG.

Objective: To explore the effect of the aortic arch type on technical indicators in patients with carotid artery stent implantation.
Methods: We retrospectively analyzed 224 consecutive patients treated in Fu Wai hospital for unilateral carotid artery stent implantation from 2011-01 to 2012-12. We summarized the catheter category, type and the operating techniques including ① retracement, turn and insertion of the catheter, ② retracement, turn of catheter+the guidance of guide wire,③ retracement, turn of catheter+the guidance of guide wire+the supporting of another catheter, ④ using special graphic catheter+the guidance of guide wire+the supporting of another catheter. The procedural X-ray exposure time, dosage of contrast agent and operation related complications were recorded. According to Myla classiifcation, the aortic arches were divided into Myla I, Myla II and Myla III types.
Results: There were 7/224 (3.1%) patients with Myla I aortic arch, 113 (50.4%) with Myla II aortic arch and 104 (46.4%) with Myla III aortic arch. A total of 48/104 (46.2%) Myla III patients used special techniques (tech③, tech④), it was more than the patients with Myla I, (1/7,14.3%) and Myla II (17/113, 15.0%), P<0.01. The patients with Myla III aortic arch had the longer X-ray exposure time and used the higher dose of contrast agent, all P<0.01. The procedural success rate in patients with
Myla III was 96.2%, it was lower than those with Myla I (100%) and Myla II (100%), P=0.045. The procedural complication rate in patients with Myla III was 22.1%, it was higher than those with Myla I (0%) and Myla II (8.9%), P=0.007.
Conclusion: The aortic arch type is the important inlfuential factor for the techniques used in carotid stent implantation. There were more dififculties and complications for stent implantation in patients with Myla III aortic arch.

Objective: To evaluatethe efficacy of renal artery stenting combining optimal drug therapy in patients with atherosclerotic renal artery stenosis.
Methods:This is a prospective cohort study for patients who received percutaneous renal artery stenting in our hospital from 2011-09 to 2013-03. All patients had conifrmed diagnosis of atherosclerotic renal artery stenosis combing hypertension and/or renal functional damage. Thepatients received optimal drug therapy for anti-platelet and blood pressure, lipids, glucose controlling, and they were followed-up for at least 12 months to observe the improvement of blood pressure and renal function.
Results:There were 149 patients at the mean age of (61.54 ± 9.63) years and 185 renal artery stenosis with stent implantation;the average stenosis rate was (83.11±7.30)%and the success rate of operation was 99.32%(148/149). During follow-up period, the patients had increased estimated glomerular ifltration rate (GFR) compared to base line from (76.49 ± 22.50) ml/(min·1.73 m2) to (84.09 ± 28.79) ml/(min·1.73 m2), P<0.05 and decreased 24 h urinary protein from 0.1(IQR 0.02, 0.5) g to 0.04 (IQR0.01, 0.11)g, P<0.001;less type of drug therapy for hypertension from 2.22 to 1.56, P<0.05, decreased clinical and 24h dynamic systemic/diastolic blood pressure from (153.4 ± 15.6)/(83.77 ± 12.60) mmHg to (134.6 ± 14.4)/(73.57 ± 9.12) mmHg and from (143.32 ± 19.87)/(80.51 ± 11.33) mmHg to (124.44 ± 14.90)/(69.09 ± 9.49) mmHg, all P<0.05.
Conclusion:Renal artery stenting combining optimal drug therapy may improve blood pressure controlling and renal function in strictly selected patients with atherosclerotic renal artery stenosis.

Objective: To explore a single center large cohort of patients with Takayasu’s arteritis for their clinical manifestation and long-term outcome in China. Methods: We retrospectively analyzed 566 patients with Takayasu’s arteritis admitted in our hospital from 2002-01 to 2013-11 for their clinical characteristics, laboratory ifndings, angiographic features, treatment and long-term outcomes. Results: The patient’s ratio for female to male gender was 1 to 3.8 and the average onset age was (28.9 ± 12.0) years. The most common non-speciifc symptom, initial symptom and complication were fever (52/566 patients, 9.2%), dizziness (214 patients, 37.8%) and hypertension (392 patients, 69.3%) respectively. The patients with pulmonary artery and coronary artery involvement were 83 (14.7%) and 66 (11.7%) respectively, and 131 (23.1%) patients had faster erythrocyte sedimentation rate. The major vascular damage was steno-occlusive lesion and the most common involvement was left sub-clavian artery, which was observed in 278 (49.1%) patients. The treatments were mainly included in medication, interventional therapy, autologous blood vessel transplantation, artiifcial blood vessel transplantation and aortic valve replacement. There were 32 patients died during the mean follow-up period of (5.0 ± 0.2) years. Hypertension, complication and the progressive stage of disease were the major factors affecting prognosis in relevant patients (regression coefifcients: 4.664, 1.959 and 1.870 respectively, allP<0.05). Conclusion: Hypertension was the leading reason for patients’ hospital visit. Takayasu’s arteritis was closely related to cardiovascular disease, the early diagnosis and treatment were really important in clinical practice.

Objective: To explore the clinical features and prognosis in patients with Takayasu arteritis (TA) combining neurological symptoms. Methods: We retrospectively studied 274 TA patients combining neurological symptoms who admitted to our hospital from 2002-01 to 2013-10 for their clinical and imaging features with prognosis. Results: The ratio of male to female was 1:4.3 and the mean age of disease onset was at (28.2±11.2) years. The most common neurological symptom was dizziness (214/274 cases, 78.1%), most frequent type was type III TA (112 cases, 40.9%), most common affected artery was left subclavian artery (147 cases, 53.6%), and there were 77 cases (28.1%) with (3-4) branches of the aortic arch involvement. For stroke conditions, ischemic stroke was more frequently observed in patients with steno-occlusive lesions in subclavian artery and common carotid artery, while hemorrhagic stroke was more frequently found in patients with steno-occlusive lesions in descending aorta, abdominal aorta and/or renal artery. Heart failure was the most common cause of death, it was also the most common cardiovascular event in surviving cohorts. Conclusion: TA patients could have many neurological symptoms, which were related to the number and site of artery involvement.

Objective:To analyze the clinical characteristics and causes of death of 80 dead cases with confirmed coronavirus disease 2019 (COVID-19).Methods:The clinical data of 80 dead patients with COVID-19 who were admitted to Renmin Hospital of Wuhan University from January 11 to February 11, 2020 were retrospectively analyzed.The laboratory examination indexes (including white blood cells, lymphocytes, procalcitonin (PCT), lactic acid, D-dimmer, fibrinogen degradation products, N-terminal pro-brain natriuretic peptide (N-proBNP), ultra sensitive-troponin I, lactate dehydrogenase (LDH) and CD4 + T lymphocyte) of the patients at the time of admission were compared with the indexes at the last time before death. Statistical analysis was conducted by using paired t test or Wilcoxon′s signed rank test. Results:The median age was 72 years old of the 80 patients, and 78.75%(63/80) of them were older than 60 years. Thirty-six cases (45.00%) were severe and 44(55.00%) were critical at admission. Fifty-eight cases (72.50%) had underlying diseases. The common underlying diseases were hypertension, diabetes mellitus, coronary atherosclerotic heart disease, and chronic obstructive pulmonary disease. Comparing the patients′ first laboratory tests at admission with those before death, white blood cells increased (8.01(4.86, 12.29)×10 9/L vs 12.55(8.25, 17.66)×10 9/L), lymphocytes decreased (0.70(0.46, 0.88)×10 9/L vs 0.54(0.39, 0.75)×10 9/L), PCT increased (0.20(0.11, 0.74) μg/L vs 1.00(0.20, 1.99) μg/L), lactic acid increased (2.10(1.40, 3.10) mmol/L vs 3.10(2.60, 4.10) mmol/L), D-dimmer increased (4.33(0.97, 18.98) mg/L vs 15.29(5.17, 53.44) mg/L), fibrinogen degradation products increased (15.90(3.58, 76.60) mg/L vs 63.14(21.23, 110.67) mg/L), N-proBNP increased (1 078.00(347.35, 2 996.50) ng/L vs 3 439.50(1 576.00, 9 281.50) ng/L), ultra-sensitive troponin I increased (0.08(0.03, 0.17) μg/L vs 0.33(0.14, 2.47) μg/L), LDH increased (397.00(327.00, 523.50) U/L vs 624.00(481.00, 854.00) U/L) and CD4 + T lymphocyte decreased (137.00(104.00, 168.00)/μL vs 97.00(67.00, 128.00)/μL). The differences between the two groups were all statistically significant ( W=238.00, 1 053.50, 150.00, 152.00, 192.00, 190.00, 108.00, 57.00, 53.00 and 40.00, respectively, all P<0.05). All patients received antiviral and respiratory-support therapy and the main cause of death was respiratory failure caused by intractable hypoxemia and multiple organ failure. Among them, seven cases died in one day hospitalization, and 66 cases died in seven days hospitalization. Conclusions:Elderly patients with a variety of chronic underlying diseases have poor prognosis. It′s essential to pay more attention and deal with the above clinical characteristics at an early stage to improve the outcome of the COVID-19 patients.

OBJECTIVE: To provide transsphenoidal endoscopic surgery with the anatomic reference through anatomic study on the lateral wall of sphenoid sinus under transnasal endoscope. METHOD: The dissection of the lateral wall of sphenoid sinus were performed on 10(20 sides) damp cadaveric heads of Chinese adults via transsphenoidal approach. The anatomic relationship of the lateral wall of sphenoid sinus and its adjacent structures were observed. The distance and angle from the bony prominence of optic canal and internal carotid artery to the columella nasi and midline of sellar floor were measured by ruler and protractor respectively. RESULT: From the study of endoscopic anatomy, the specific structure of optic canal and internal carotid artery were found, and the lateral wall of the cavernous sinus could be exposed by tracing the internal carotid artery. The mean distance from the midpoint of the medial wall of optic canal orbital aperture and the anterior bony prominence of internal carotid artery to the columella nasi were (75. 33 +/- 5. 59)mm and (81. 02 +/- 5. 29) mm respectively, to the midline of sellar floor were (5. 81+/- 1. 52)mm and (5. 53 +/- l. 47)mm respectively. The angle from the midpoint of the medial wall of optic canal orbital aperture to columella nasi was (53.4 +/- 4. 1) degrees. CONCLUSION Taken the columella nasi and midline of sellar floor as the reference points, the anatomic observation and measurement under endoscope via transsphenoidal approach can provide a guide for surgeons.
Adult ; Anatomy, Regional ; Endoscopy ; Humans ; Sphenoid Sinus ; anatomy & histology ; surgery

Objective:To verify the clinical applicability of " eCura system" , a scoring system for assessing the risk of lymph node metastasis after non-curative endoscopic submucosal dissection (ESD) for early gastric cancer (EGC).Methods:A retrospective analysis was performed on clinicopathological data of 155 patients with EGC, who underwent non-curative ESD confirmed by postoperative pathology in Drum Tower Hospital Affiliated to Medical School of Nanjing University from January 2012 to March 2018. According to the eCura scoring system, the 155 patients were divided to three groups: 100 cases in the low-risk group (0 to 1 point), 46 cases in the intermediate-risk group (2 to 4 points), and 9 cases in the high-risk group (5 to 7 points). Lymph node metastasis rates and prognosis of the three groups were observed and compared.Results:The follow-up time of the 155 patients was 25±15.0 months, of which median follow-up time was 25 months in the low-risk group, 23 months in the intermediate-risk group, and 34 months in the high-risk group. A total of 57 patients underwent additional surgery in the low-risk group, including 3 cases [5.26% (3/57)] of lymph node metastases; 29 patients underwent additional surgery in the intermediate-risk group, including 2 cases [6.90% (2/29)] of lymph node metastases; all 9 patients in the high-risk group underwent additional surgery and 4 cases had lymph node metastasis. Multivariate Logistic regression analysis showed that the risk of lymph node metastasis in the high-risk group was significantly higher than that in the low-risk group ( P=0.003, OR=14.499, 95% CI: 2.513-97.214), while the risk of lymph node metastasis in the intermediate-risk group was slightly higher than that in the low-risk group ( P=0.767, OR=1.326, 95% CI: 0.165-8.594). During follow-up, there was no metastasis or cancer-specific mortality in the low-risk group, and recurrence was found in 3 cases [6.98% (3/43)] of the 43 patients without additional surgery. Among the 17 patients in the intermediate-risk group, who did not undergo additional surgery, 1 case [5.88% (1/17)] had recurrence and 2 cases [11.76% (2/17)] had metastasis including 1 case [5.88% (1/17)] died of brain metastasis. There was no recurrence, metastasis or cancer-specific mortality in 29 patients in the intermediate-risk group, who underwent additional surgery during follow-up. And there was no recurrence, metastasis or cancer-specific mortality in the all 9 patients in the high-risk group received additional surgery after ESD during follow-up. Conclusion:The eCura scoring system could contribute to predict the lymph node metastasis risk in patients after non-curative ESD for EGC. The benefits of additional surgery are limited for low-risk patients, while for intermediate-risk and high-risk patients, additional surgery can effectively improve prognosis.