The microvasculature of the lung of three humans was studied with the replicascanning electron microscopic method. The pulmonary arteriole belongs to microvasculature at the level of the respiratory bronchiole and gives out some side branches to the alveoli. The diameter of the arteriole is about 30-50 ?m. The arteriole divided into terminal arterioles, which accompanied with primary alveolar ducts. The diameter of the terminal arteriole is about 10-20 ?m, 17.35?1.62 ?m in average (n=30). There are obvious imprints of smooth muscles and endothelial nuclei on the surface of the casts of arteriole and terminal arteriole. The diameter of the alveolar capillary is 5.87?0.90 ?m in average (n=500). The proportion of the capillary area arround the alveole is 66?1.4%. There are two patterns of capillary network, i. e. long mesh and round mesh in type. The diameter of the mesh is (9.24?2.02)?(5.65?1.40) and 5.75?0.84 ?m, respectively. The distance of the mesh center is 17.13?1.74 ?m (long) and 11.52?1.12 ?m (short) in long mesh, and 11.63?0.88 ?m in round mesh. The capillary network of the long mesh located at the entrance and the base of the alveoli; and the round mesh in the area between them. The metaarteriole supplying the alveoli enters the alveoli at their entrance and thev venule draining the alveoli at their base. The distance between them is about 330 ?m.According to the microvascular architecture, the pulmonary microvasculature may be divided into three ordered units: i. e. the alveolar, the alveolar duct, and the respiratory bronchiolar units.

Objective To analyze the medium and long-term results of tricuspid valve replacement (TVR)and summarize the operative experience for tricuspid valve disease.Methods Clinical data of 27 patients with severe tricuspid valve disease from September 2005 to May 2010 were retrospectively reviewed.Biological valve prosthesis was replaced in 23 patients,while mechanical valve prosthesis was replaced in 4 patients.Accompanying procedures included mitral valve replacement in 8 cases,mitral valve replacement and aortic valve replacement in 4 cases,and repair of atrial septal defect in 4 cases.Results The operative mortality was 11.1％(3/27),among these patients,2 cases died of serious low cardiac output syndrome,1case died of muhiorgan failure on the 7th day after operation,1 case who underwent reoperation for hemorrhage postoperative was improved after treatment.During follow-up,1 patient died of biological valve prosthesis dysfuncion 3 years after operation,1 patient died of cerebral embolism 19 months after operation.Six cases were in New York Heart Association(NYHA)class Ⅰ,and 14 cases in NYHA class Ⅱ during the period of follow-up.Conclusions Because operative and follow-up mortality is high,TVR is the last selection for the treatment of tricuspid valve disease.Appropriate operative technique and perioperative therapy are the key for clinical success.For those older than 50 years,follow-up inconvenience and reproductive-age female patients,biological valve prosthesis should be recommended as a preferential choice.

ObjectiveTo explore the surgical treatment of congenital heart disease combined with severe pulmonary hypertension.MethodsThirty-two patients of congenital heart disease combined with severe pulmonary hypertension were included in the study.The saturation of arterial oxygen ranged from 0.84 to 0.94 and echocardiography showed left to right slow velocity shunt in 20 eases,double direction shunt in 10 cases and no shunt in 2 cases.The pulmonary arterial pressure was 65-120 (82 ± 14) mm Hg ( 1 mm Hg =0.133 kPa).All patients received surgical repairs under cardiopulmonary bypass and were treated preoperatively with oxygen inhalation therapy,oral intake of beraprost sodium or silaenafil respectively according to the degree of pulmonary hypertension.During cardiopulmonary bypass,pulmonary artery perfusion was performed with protective solution containing ulinastatin for lung protection.Vasoactive drugs were routinely administrated postoperatively.Results Thirty-two cases underwent the surgical treatment successfully with their postoperative pulmonary arterial pressure decreased 20 -40 mm Hg and 2 cases died of severe low cardiac output syndrome and fatal arrhythmia.The mortality was 6.25％(2/32).ConclusionComprehensive perioperative management followed by radical operation can achieve a good clinical result on congenital heart disease combined with pulmonary hypertension.

Objective To summarize the results of valve re-operative cases after cardiac valve replacement, to find the better re-operative time, and to estimate the re-operative methods and influencing factors of the operation. Methods Thirteen valve re-operative cases after cardiac valve replacement from October 2008 to February 2010 were retrospectively studied. According to NYHA classification, 9 cases belonged to class Ⅳ, and only 4 cases belonged to class Ⅲ preoperatively. Mitral valve replacement (MVR)was performed in 7 cases, aortic valve replacement (AVR) in 3 cases, MVR + AVR in 3 cases. Results The early-stage postoperative mortality was 7.7%( 1/13),and the reason was low cardiac output syndrome. Two cases who underwent re-operation and re-intubation respectively after operation for hemorrhage were improved after treatment. Twelve cases were discharged in 3-6 weeks after heart valve surgery and all were followed up for 6-15 months. The cardiac function of all the discharged patients recovered well and no death occurred during follow-up. Conclusion The key factors to reduce the death of re-operation are improving preoperative heart function,setting up extracorporeal circulation as soon as possible,consummating myocardial preservation,perfecting operating skills,correcting low cardiac output syndrome in time and preventing complications.

Objective To observe the clinical effects of intensive insulin therapy on postoperative infection, inflammatory response and prognosis in the non-diabetic patients of different ages undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). Methods 60 cases of non-diabetic patients (>60) undergoing coronary artery bypass grafting with cardiopulmonary bypass between June 2005～June 2010 were selected and analyzed retrospectively. 60 patients were divided into 2 groups, the previous 24 cases were included in a routine treatment group and later 36 cases were included in the intensive therapy group. The blood sugar of intensive therapy group was strictly controlled starting from the anesthesia. The routine treatment group was controlled starting from backing to ICU according to blood glucose results. Patients were assigned to the routine therapy group with the blood glucose maintained at 10.0～11.1 mmol/L and the intensive therapy group received tight glycemic control with the target blood glucose maintained at 4.4～6.1 mmol/L. Postoperative infection, mechanical ventilation time, hospital stay and mortality indicators were compared between the 2 groups. Results There were no significant difference (P＞0.05) in gender, body weight, disease diagnosis and combined surgical methods and surgical materials such as cardiopulmonary bypass time between the 2 groups. Neutrophil count［(12.6±2.8)×109/L vs (18.8±3.1)×109/L］, blood infections, respiratory tract infection(6/36 vs 10/24) and wound infectionrates(2/36 vs 6/24) and other indicators of intensive of insulin therapy group were lower than the regular therapy group (P＜0.05). The postoperative hospital stay of intensive therapy group［(12.2±3.7)d vs (15.6±5.4)d)］ was statistically significant shorter compared with the conventional treatment group (P＜0.05). There was no significant difference in postoperative mortality between the 2 groups (P＞0.05). Conclusions Intensive insulin therapy may significantly reduce postoperative infection rate in the old age patients, thus leading to an improved prognosis in the non-diabetic patients undergoing coronary artery bypass grafting with cardiopulmonary bypass.

Objective To investigate the safety,effectiveness and prognosis of percutaneous microwave ablation (MWA) combined with synchronous transarterial chemoembolization (TACE) to treat of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) with liver metastases (LMs).Methods This retrospective study included 19 cases of GEP-NENs with LMs patients who received percutaneous MWA combined with synchronous TACE treatment from 2013 to 2016.The mRECIST standard was selected to assess the curative effect.SPSS 21.0 software was applied in the statistical analysis of overall survival (OS),progression-free survival (PFS) and factors related to prognosis.Results All patients were capable of curative effect evaluation,including 1 case of complete remission (CR),3 cases of partial remission (PR),7 cases of progressive disease (PD) and 8 cases of stable disease (SD) respectively accounting for 5 ％,16 ％,37 ％,42 ％,which exhibited 21％ of response rate (RR) and 63％ disease control rate (DCR).In the present study,the median OS and median PFS was respectively 25 months and 34 months,and the one-year survival and three-year survival was respectively 95％ and 84％.Serum CA199,the WHO classification of LMs and the tumor burden of LMs were the major risk factors of prognosis through single factor analysis of survival,which showed that G3 of the WHO classification of LMs predicted a poor OS (P＜0.05) and tumor burden of LMs was negatively related to PFS (P＜0.05).It was obviously observed that serum CgA was decreased by the therapy of percutaneous MWA with synchronous TACEfor GEP-NENs (P＜0.05).Conclusions Percutaneous MWA combined with synchronous TACE is a safe and effective method to treat GEP-NENs with LMs.

Objective:To improve the quality and efficiency of pharmaceutical care of clinical pharmacists by standardizing phar-maceutical care process using tracking table design for clinical drug therapy. Methods: The experience and skills of pharmaceutical care performed by clinical pharmacists in endocrinology department were summarized and the tracking table for clinical drug therapy was designed, which could provide information for patients clearly and concisely, and make the process of pharmaceutical care more system-atical. Results:After using the tracking table, clinical pharmacists improved work efficiency significantly. In addition, the average hospitalization, average hospitalization expenses and drug proportion significantly reduced resulting in higher satisfaction of patients. Conclusion:The standardized pharmaceutical care process performed by clinical pharmacists in endocrinology department makes phar-maceutical care more specific, comprehensive and convenient.

Objective To summarize the effect of supra-arch branches bypass combined with endovascular aortic repair for aortic diseases.Methods From January 2012 to August 2015,120 cases of thoracic aortic diseases (aortic dissection 103,aortic aneurysm 16,penetrating aortic ulcer 1) received hybrid operation in Guangdong Cardiovascular Institute.Vascular bypass was established among the brachiocephalic arteries,followed by endovascular repair through femoral artery either one-stage or two-stage.Patients were followed up for 3-24 months.Results Technical success was achieved among all the patients.Five patients died after the operation(one patient had retrograde aortic dissection,2 patients had pericardial tamponade,one patient had apnea,and one patient had respiratory and cardiac arrest.The death rate is 4.1％),4 patients had stroke,among them,symptoms were relieved in three patients,one patient was not cured.Total 92 patients were followed-up and had no symptoms of up-limb ischemia or dizziness.CT scan showed bypass graft and endovascular stent patency.6 patients had endoleak (type Ⅰ b 2 cases,type Ⅱ 3 cases,and type Ⅲ 1 case),distal aortic dissection occurred in one patient,three patients had mild contrast agent leakage around the distal endovascular stent,type A aortic dissection occurred in one patient,there were no late stage death.Conclusion Supraarch branches bypass combined with endovascular aortic repair for treating aortic disease is minimally invasive,safe,and can reduce the incidence of postoperative complications.

ObjectiveTo investigate the myocardial protection on cardiac valve replacement surgery with creatine phosphate of myocardial GIK (GIK) in order to reduce the surgical risk and improving the efficacy.Methods126 cases were unergone surgical treatment of heart valve disease,whose cardiac function on admission wereⅢor Ⅳ. 126 patients were randomly divided into two groups. Cardiopulmonary bypass time, aortic cross clamp time, postoperative myocardial injury markers ( CK-MB, cTNI) changes, arrhythmias, heart function recovery, length of stay and mortality rate and other indicators were compared between the two groups. ResultsThe age, gender, body mass,heart disease and surgery combined data were not statistically significant between the two groups( all P ＞0. 05). The cardiopulmonary bypass time, aortic cross clamp time and mortality had no significant differences between the two groups( all P ＞ 0.05 ). The CK-MB( 21.36± 9.21 ) U/L and cTNI(0.83 ± 0. 35 ) ng/ml of creatine phosphate group were significantly lower than those of the control group. The incidence of arrhythmia in phosphocreatine group (37. 1％ ) was significantly lower than ordinary group (57.8 ％ ) ( X2 ＝ 5. 418, P ＜ 0. 05 ). ConclusionThe application of creatine phosphate GIK before valve replacement surgery could effectively reduce reperfusion injury after myocardial ischemia,myocardial protection,and significantly reduce the incidence of arrhythmia and improve heart function in patients.

Objective To investigate the clinical features, diagnosis, treatment and outcome of patients with Takayasu arteritis associated pulmonary hypertension (TA-PH). Methods Patients diagnosed as TA-PH in Shanghai Pulmonary hospital from 2008 to 2017 were retrospectively reviewed and followed up. Baseline characteristics including hemodynamics were collected. Data were summarized as mean ± standard deviation or frequency (％). Survival analyses were performed using the Kaplan-Meier method. Results Thirteen TA-PH patients (10 female, aged 39±11 years old) were included. The duration from symptoms onset to diagnosis was 2 months to 50 years, and ten patients were diagnosed TA and PH at the same time. Shortness of breath was the most common clinical manifestation (12 cases), followed by chest pain and tightness (8 cases) and palpitation (6 cases). All patients had a moderated WHO functional class and 8 patients were in active phase. Vessel wall thickening, lumen narrowing, occlusion and/or dilation were found in CT pulmonary angiography and angiography. Mean pulmonary arterial pressure (48.0±14.0) mmHg and pulmonary vascular resistant (7.59±4.21) Wood U were increased. All patients received PH-specific therapies, and patients at active status took glucocorticoid. Stentimplantation in pulmonary artery was performed in 4 patients. Three patients died during the follow-up. Conclusions Patients with TA are at risk of PH, and PH can be the first manifestation of TA, which suggest that PH should be screened regularly in patients with TA and shortness of breath. The prognosis of TA-PH is poor. PH-specific therapies and vascular reconstruction therapy may be effective, but need further investigation.