Objective: To summarize the characteristics of arrhythmia with the relevant factors affecting its prognosis in patients of apical hypertrophic cardiomyopathy (AHCM). Methods: A total 283 AHCM patients with echocardiography or cardiac magnetic resonance (CMR) conifrmed diagnosis in our hospital from 2005-01 to 2012-08 were summarized. The patients were divided into 2 groups: With arrhythmia group, n=103 and Without arrhythmia group,n=180. The endpoint event was followed-up by clinical and telephone visits in both groups and the relevant risk factors affecting AHCM prognosis were investigated by Cox regression analysis. Results: There were 269 patients ifnished the follow-up investigation, 98 in With arrhythmia group, 171 in Without arrhythmia group, and the death rate was 4.08% vs 1.17%, the occurrence of endpoint event was 18.37% vs 5.58%respectively. Cox regression analysis indicated that age (HR=23.051, 95% CI 1.08-1.068,P<0.005), left atrial diameter (HR=4.113, 95%CI 1.002-1.119,P=0.043) and NT-proBNP (HR= 18.653, 95% CI 3.433-26.650,P<0.005) were the independent risk factors affecting prognosis in AHCM patients. Conclusion: Arrhythmia is one of the common presentations of AHCM, it does not have much impact on survival, while it may cause ventricular ifbrillation and increase the occurrence of cardiovascular events.

Objective To investigate the clinical value of platelet parameters in patients with acute myocardial infarction(AMI) in plateau.Methods A total of 72 patients diagnosed as acute myocardial infarction in our department from January 2016 to June 2017 were enrolled into this study.Clinical data and outcomes were analyzed.Platelet parameters were measured within 24 h after AMI occurrence.The relationship between platelet distribution width (PDW),mean platelet volume (MPV),and the severity of disease,infarct size as well as short-term prognosis were further investigated.Results Compared with control group,PDW and MPV were positively correlated with the severity of disease (PPDW=0.039,PMPV=0.038) and infarct size (rPDW=0.305,P=0.009;rMPV=0.263,P=0.025).The AUC of PDW was 0.827,optimal operating point (OOP) was 16.3％,the AUC of MPV was 0.813,OOP was 13.1 fl,the AUC of GRACE was 0.865,OOP was 145.Conclusions PDW and MPV could be regarded as laboratory index to evaluate the severity of disease,infarct size,pathological changes of coronary artery and short-term prognosis of acute myocardial infarction in plateau.

Objective To observe the influence of edaravin combined with cerebroside-kinin on the level of glial fiber acidic protein (GFAP) and ubiquitin carboxyl terminal-L1 (UCH-L1) in the treatment of severe craniocerebral injury.Methods From January 2016 to December 2017,a total of 123 patients with severe craniocerebral injury were selected in our hospital,and randomly(random number) assigned to the observation group (61 cases) and control group (62 cases).Patients in the control group were given cerebroside-kinin,and patients in the observation group were given cerebroside-kinin and edaravone.The acute physiology and chronic health evaluation score (APACHE Ⅱ),activities of daily living (ADL) score,serum malonaldehyde (MDA),superoxide dismutase (SOD),myeloperoxidase (MPO),matrix metalloprotein 9 (MMP-9),GFAP and UCH-L1 before and after treatment were observed.The side effects were also recorded.Results The APACHE Ⅱ score was significantly reduced in both groups after treatment (P=0.008;P=0.003),and was lower in the observation group than that in the control group (P=0.013).The ADL score of both groups increased after treatment (P=0.025;P=0.008),and was higher in the observation group than that in the control group (P=0.012).After treatment the levels of MDA,SOD and MPO in the observation group were significantly higher than those in the control group (P＜0.05);the level of MMP-9 in the observation group was significantly lower than that in the control group (P=0.012);the levels of GFAP and UCH-L 1 in the observation group were significantly higher than those in the control group (P=0.014;P=0.035).There was no significant difference of the total side effect incidence between the observation group and the control group (8.06％ vs 9.83％,x 2=0.088,P=0.719).Conclusions The treatment by edaravone combined with cerebroside-kinin on severe craniocerebral injury may effectively protect the nerve cells,improve nerve function,clinical efficacy and the body's antioxidant capacity,reduce the serum levels of GFAP,UCH-L1,and have better safety.

Objective:To investigate the effects of propofol and sevoflurane on post-traumatic stress disorder (PTSD) after emergency surgery in trauma patients.Methods:A total of 160 trauma patients undergoing emergency surgery under general anesthesia were randomly divided into the propofol group and the sevoflurane group. The perioperative clinical data of the two groups were collected. The incidence of PTSD was evaluated by PCL-5 score one month after the operation in the two groups. The relevance of the injury time and PCL-5 score was assessed by Spearman correlation analysis. Logistic regression analysis was used to analyze the risk factors of PTSD.Results:The incidence of PTSD in the propofol group was significantly higher than that in the sevoflurane group at postoperative 1 month (24.0% vs 10.8%, P=0.034). The injury time was negatively correlated with PCL-5 score in the propofol group ( r=0.229, P<0.01). There was no correlation between the injury time and the PCL-5 score in the sevoflurane group ( r=0.001, P=0.804). Logistic regression analysis showed that the use of propofol was an independent risk factor for PTSD ( P=0.004). Conclusions:Sevoflurane anesthesia is more effective than propofol anesthesia in reducing the occurrence of PTSD in emergency surgery for trauma patients.

Objective To summarize the magnetic resonance imaging (MRI) features of the persistcnt perineal sinus (PPS).Methods The retrospective and descriptive study was conducted.The clinical data of 7 patients with PPS who were admitted to the Nanjing University of Traditional Chinese Medicine between July 2010 and January 2017 were collected.Patients received horizontal,anteroposterior axes and coronal scanning of MRI after abdominoperineal resection (APR) of rectal cancer.Two physicians read collectively films and then achieved consistent results if there was a disputed result.Observation indicators:(1) MRI features;(2) treatment and follow-up situations.Patients underwent resection of PPS according to results of MRI examination,and then regular pathological examination.Follow-up using telephone interview was performed to detect sinus recurrence and reoperation up to April 2017.Results (1) MRI features:① Lesion location:lesions of PPS in 7 patients were located at the presacral areas,top side was up to the third sacral plane,and lower side extended down to the pubic area.② Morphology and signal:sinus tract of 7 patients showed irregular flaky and tubular abnormal signals;fibrotic sinus tract wall showed low signals in T1 weighted imaging (T1WI) and T2WI;contents of sinus tract in 7 patients showed low signal in T1WI and high signals in T2WI and T2WI-fat suppression (T2WI-FS).Of 7 patients,uniform signal and mixed signal were respectively detected in 2 and 5 patients.③ Branches and cystic spaces:1 patient had a branch at the tip of the coccyx,extending to the rear of the sacral vertebra.The top of sinus tract in 4 patients enlarged to form a cavity.④ Signs of infection:signs of infection in 3 patients included blurred and exuded fat gaps around the sinus tract,unclear and partially adhesion with pelvic organ;the pelvic floor muscles in 1 patient were thickened and swollen,with a high signal in T2WI-FS;flaky fluid shadows in 2 patients were seen in the posterior sinus,with a high signal in T2WI-FS,showing a tissue edema of anterior sacrum.⑤ Enhancement features:result of MRI examination of 1 patient showed mild and heterogeneous enhancement of sinus.(2) Treatment and follow-up situations:among 7 patients undergoing sinus resection,2 received curettage of superior sinus due to high location,and 5 received successfully operation.All patients underwent postoperatively regular antibiotic therapy.The healing time was 14-78 days,with an average time of 42 days.The postoperative pathological examination showed different degrees of inflammatory cell infiltration.Seven patients were followed up for 2-74 months,with an average time of 40 months.Of 7 patients,sinus in 6 patients was healed,1 had recurrence of sinus and didn't receive therapy.Seven patients didn't undergo debridement or transposition of skin flap again.Conclusion The MRI imaging features of PPS includes flaky and tubular abnormal signal in the the anterior sacrum,low signal in T1WI,high signals in T2WI and T2WI-FS,and the enhanced scanning of sinus duet shows mild and heterogeneous enhancement.

Objective To investigate the application value of magnetic resonance imaging (MRI) examination in the efficacy evaluation of infliximab combined with seton placement for perianal fistulizing Crohn's disease (PFCD) and influencing factors of deep remission.Methods The retrospective case-control study was conducted.The clinicopathological data of 57 patients with PFCD who were admitted to the Affiliated Hospital of Nanjing University of Chinese Medicine from August 2010 to October 2017 were collected.There were 39 males and 18 females,aged (24±9)years,with a range of 14-58 years.Patients underwent MRI examination preoperatively and postoperatively.Observation indicators:(1) follow-up situations;(2) influencing factors analysis of deep remission of PFCD.Follow-up using outpatient and inpatient reexamination was performed to detect clinical recovery of patients up to October 2017.Measurement data with normal distribution were represented as Mean±SD.Measurement data with skewed distribution were described as M (range).Count data were represented as absolute number or percentage.The univariate analysis was performed using the chi-square test.The multivariate analysis was done using the logistic regression model,using P＜0.15 as an inclusion criteria in the univariate analysis.Results (1) Follow-up situations:57 patients with PFCD undergoing inflixmab combined with seton placement were followed up for (40±24)months.During the follow-up,24 of 57 patients had clinical response,33 had long-term clinical healing.The fistulas of 24 patients with clinical response presented as high signal on T2 weighted image (T2WI) of postoperative MRI.Of 33 patients with long-term clinical healing,the fistulas of 16 patients with deep remission presented loss of high signal and replacement of fibrosis tissue on T2WI of postoperative MRI,the fistulas of 17 patients without deep remission presented as high signal on T2WI of postoperative MRI.(2) Influencing factors analysis of deep remission of PFCD:results of univariate analysis showed that extent of fistula was related factors affecting deep remission of PFCD (x2 =4.312,P＜0.05).Results of multivariate analysis showed that a single fistula complicated with branches and times of infliximab maintenance treatment ≤3 were independent risk factors affecting deep remission of PFCD (odds ratio=4.377,4.296,95％ confidence interval:1.124-17.043,1.158-15.940,P＜0.05) and fistula under levator ani muscle was an independent protective factor affecting deep remission of PFCD (odds ratio =0.182,95％ confidence interval:0.041-0.815,P＜ 0.05).Conclusions Partial patients with long-term clinical healing can achieve deep remission after Infliximab combined with seton placement for perianal fistulizing Crohn's disease,requiring MRI examination to further evaluate recovery situations.A single fistula complicated with branches and times of infliximab maintenance treatment ≤ 3 are independent risk factors affecting deep remission of PFCD and fistula under levator ani muscle is an independent protective factor affecting deep remission of PFCD.

Objective To investigate the value of early trophic feeding on maintenance of the integrity of intestinal mucosa barrier in severe traumatic patients.Methods The seriously traumatic patients were eligible for enrollment to this study from January 1st,2014 to March 31st,2015 in the intensive care unit of Xiangcheng People's Hospital.All patients were randomly divided into early enteral nutrition (EEN)group and the control group.Within 12 to 24 hours after ICU admission,all patients were fed on enteral nutrition.In the EEN group,the nutrient was reached to 25％ of target nutrient amount [104.6 kJ/ (kg · d)],and in the control group,the nutrition was reached to 60％ of the target nutrient amount.Comparisons of feeding intolerance,incidence of newly developed lung infection,the total length of hospital stay,ICU medical costs,and the markers of mucosa barrier function including lactulose/mannitol ratios (L/M),serum lactic acid level,and diamine oxidase (the first day,the third day and the seventh day) between two groups were carried out.Results Of them,56 patients were treated with early enteral nutrition.Early enteral feeding intolerance and ICU associated infection complications were significantly lower in EEN group than those in control group (P =0.012,P =0.046).There were no significant differences in ICU associated infection complications,the length of ICU stay,the length of hospital stay,ICU medical costs,L/M ratios,D-lactic acid level and diamine oxidase concentration between the two groups (P=0.135,P=0.126,P =0.223,P =0.235).Conclusions Under the seriously traumatic stress,the significantly increased intestinal mucosal permeability will be occurred early.In patients with early trophic feeding,the intestinal mucous membrane barrier function can be improved,thus decreasing ICU associated infection complications and incidence of feeding intolerance.