Objective To evaluate whether Loewenstein occupational therapy cognitive assessment (LOTCA) can be used in the diagnosis of postoperative cognitive dysfunction (POCD) by comparing it with mini-mental state examination (MMSE).Methods Thirty patients performed cardiac valve replacement surgery in our hospital from October 2010 to March 2011 were chosen; the cognitive function of these patients were neuropsychologically evaluated by MMSE and LOTCA 1 d before and 7 d after the surgery; the differences of accurately diagnostic rate on POCD,the scores and the time-consuming when MMSE and LOTCA were chosen were compared.Results Thirteen patients (43.33％) were diagnosed as having POCD by MMSE and 17 patients (56.67％) by LOTCA; the difference of accurately diagnostic rate on POCD was not statistically significant (x2=1.067,P=0.302).MMSE scores,LOTCA scores and scores of 4 subtests (motor praxis,visuomotor organization,operation of thinking,and attention and concentration) 7 d after the surgery was significantly decreased as compared with those 1 d before the surgery (P＜0.05).MMSE scores were highly correlated with LOTCA scores (γ=0.711,P=0.005).Conclusion LOTCA can be used in the diagnosis and research of POCD.It can do a more comprehensive assessment than MMSE in cognitive function with longer times.

Objective To investigate the relationship between the patient-based questionnaires and the computed tomography (CT) staging in patients with chronic rhinosinusitis (CRS). Methods Quantitative data of 121 preoperative recruits with CRS were collected by using the Lund-Mackay CT staging system, a visual analogue scale ( VAS), sino-nasal outcome test-20 ( SNOT-20), and the medical outcome study short-form 36 items (SF-36). The patients were classified into several subgroups according to whether CRS was associated with nasal polyps (NP) or not, sex, duration of disease, and educational background.Correlation between the patient-based questionnaires and the CT staging were analyzed in the total cohort patients and subgroups. Results In the total cohort patients, there were significant correlations between SNOT-20 and SF-36 ( r = -0. 561, P ＜ 0. 01 ), SNOT-20 and VAS ( r = 0. 743, P ＜ 0. 0l ), and SF-36 and VAS ( r = - 0. 504, P ＜ 0. 01 ), however, the CT staging did not correlate with the patient-based questionnaires (P ＞ 0. 05 ). Significant but weak correlations were found between the CT staging and the patient-based questionnaires in the C RS with NP subgroup (CT vs SNOT-20, r = 0. 318, P = 0. 005; CT vs SF-36, r = - 0. 358, P = 0. 002; CT vs VAS, r = 0. 358, P = 0. 002). Compared between CRS with NP and without NP subgroup, there were statistic differences on the Lund-Mackay CT stage and the SNOT-20 and VAS scores (t value was 3.249, -2.409, -2.957, respectively, all P＜0.05). Conclusions The patient-based questionnaires correlate well with each other, but CT staging correlated significantly but weakly with the patient-based questionnaires only in the CRS with NP subgroup. Nasal polyps do not appear to be responsible for the adverse effects of CRS on quality of life.

Background Vascular anomalies are common and multidisciplinary involved diseases. The greatest impediment to their treatment in the past was their confusing terminology and clinical heterogeneities. This hospital-based retrospective study assessed some clinical characteristics, diagnosis, therapies and outcomes of patients with vascular anomalies in southeast China.Methods A total of 592 vascular anomalies patients (patients with intracranial tissues or viscera involved were excluded), admitted to the First Affiliated Hospital of Sun Yat-sen University from January 2006 to September 2009, were enrolled in the study. Data for clinical characteristics, diagnosis, therapies and outcomes were collected and analyzed.Results Of the 592 patients, the male:female ratios in the vascular tumor group (n=187) and the vascular malformation group (n=405) were 1∶1.49 and 1∶1.06 respectively, with no significant difference between them. The mean onset age of the vascular tumor group was significantly younger than that of the vascular malformation group (P ＜0.001). The head and neck were the most commonly (31.4％) involved areas in vascular anomalies. A total of 23.8％ of the patients with vascular anomalies had definite symptoms caused by the vascular lesions. In the vascular tumor group, 94.1％ of them were infantile hemangiomas. Venous malformation was the most common (41.0％) subtype of vascular malformations.Surgical therapy was undertaken in 94.2％ of the patients with vascular anomalies. Of the 519 patients available for the 16-58 month follow-up, 322 patients (62.0％) were cured, 108 patients (20.8％) were markedly improved, 57 patients (11.0％) were partially improved, and 32 patients (6.2％) were uncured.Conclusions Vascular anomalies are clinically heterogeneous. While the outcome is generally favorable, further effort should be made to determine the appropriate terminology and management.

Objective To observe the correlation of plasma amino-terminal pro-A-,B-and C-type natriuretic peptide(NT-proANP,NT-proBNP and NT-proCNP)levels with New York Heart Association (NYHA)functional class and echocardiographic derived parameters of cardiac function in heart failure patients.Methods Data of NYHA grade,echocardiographic derived parameters of cardiac function,plasma levels of NT-proANP,NT-proBNP and NT-proCNP(measured by enzyme immunoassay method)were obtained in 112 heart failure patients and 44 normal control Subiects.The correlation analysis was made between NT-proANP,NT-proBNP,NT-proCNP and NYHA functional class,left atrium diameter(LAD),left ventricular end-diastolic diameter(LVEDD) and left ventricular ejection fraction(LVEF),respectively.Results The plasma concentrations of NT-proANP,NT-proBNP and NT-proCNP in heart failure patients were significantly higher than in control group(all P＜0.05).Correiation analysis revealed a strong correlation between NT-proANP and NT-proBNP(r=0.790,P=0.000)and a weak correlation between NT-proCNP and NT-proBNP(r=0.278,P=0.003)as well as between NT-proCNP and NT proANP(r=0.236,P=0.012)in heart failure patients.Univariant analysis showed that NT-proANP and NT-proBNP were positively correlated to LAD,LVEDD and negatively correlated to LVEF(all P＜0.05)while there was no significant correlation between NT-proCNP and echocardiographic derived parameters of cardiac function in heart failure patients.Multivariate stepwise regression analysis including age,gender,NYHA classification,LAD,LVEDD and LVEF revealed that NYHA classification,LVEF,LAD and age were independent predictors of NT-proANP;while NYHA classification,LVEF and age were independent predictors of NT-proBNP while there Was no association among these factors and NT-proCNP.Conclusion In heart failure patients,the plasma concentration of NT-proANP,NT-proBNP and NT-proCNP were significantly increased and NT-proANP,NT-proBNP but not NT-proCNP were significantly correlated to NYHA classification and echocardiographic derived parameters of cardiac function.

Objective To determine the prevalence and to identify risk factors of peri-procedure electrical storm (ES) in patients with acute myocardial infarction (AMI) underwent emergency percutaneous coronary intervention (PCI).Methods The clinical data of 228 AMI patients underwent emergency PCI were retrospectively analyzed and patients were divided into ES group (n = 39) and non-ES (n = 189) group.ES was referred to spontaneous ventricular tachycardia or ventricular fibrillation occurring twice or more within 24 h and requiring emergency treatment including anti-arrhythm medicine and/or cardioversion or defibrillation.Results ES was diagnosed in 39 out of 228 patients (17.1%) during peri-procedure stage.The incidence of ES in patients with various infarct related arteries (IRA) was as follows:55.6% with left main artery (LM),23.7% with right coronary artery (RCA),12.4% with anterior descending branch (LAD) and 0 with left circumflex artery (LCX).Older age,lager diameter of IRA,higher concentration of CK-MB and cTnT,higher incidence of reporfusion arrhythmia (RA),lower grade of TIMI after PCI and higher mortality were associated with increased risks of ES (The P value was 0.043,0.012,0.036,0.018,0.001,0.049,respectively).Gender,systolic pressure,diastolic pressure,random blood glucose level,white blood count and concentration of hs-CRP were similar between ES and non-ES patients.Logistic analysis showed that the diameter of IRA (OR 2.381,95% CI 1.127-5.028,P = 0.023),TIMI grade of IRA after PCI (OR 4.744,95% CI 1.773-12.691,P = 0.002) and RA (OR 12.680,95% CI 4.360-36.879,P =0.000)were the independent risk factors of per-procedure ES in AMI patients underwent emergency PCI.Conclusions The AMI patients with LM as IRA had the highest incidence of ES during emergency PCI and the diameter of IRA,TIMI grade of IRA after PCI and RA were independent risk factors for the development of ES during peri-PCI stage.

Objective To evaluate the predictive value of admission plasma amino-terminal pro-B type natriuretic peptide(NT-proBNP)on in-hospital mortality in patients with decompensated heart failure.Methods Plasma NT-proBNP levels were measured in patients with decompensated heart failure within 24 hours after admission with ELISA method.The NT-proBNP levels were compared between survivals and dying patients in hospital.ROC analyses were performed to evaluate the predictive value of admission plasma NT-proBNP on in-hospital mortality and to identify the optimal NT-proBNP cut-point for predicting in hospital mortality.A binary logistic regress analyses was used to evaluate if NT-proBNP was an independent predictor for in-hospital mortality.Results A total of 804 patients with decompensated heart failure were enrolled in his study(293 valvular heart diseases,219 ischemic cardiomyopathy,141 dilated cardiomyopathy,14 hypertrophic cardiomyopathy,21 restrictive cardiomyopathy,39 hypertensive heart disease,41 chronic pulmonary heart disease and 36 adult congenital heart disease)and 96 patients were in class Ⅱ,450 in classⅢand 258 in cases Ⅳ according to NYHA Classification.During hospitalization,64 deaths were recorded and the on admission plasma NT-proBNP levels of patients died during hospitalization were significantly higher than those of survivals[4321.1(3063.8,6606.5)pmol/L VS.1921.6(873.9,3739.2)pmol/L,P＜0.01].Area under receiver operating characteristic curve(AUC)of NT-proBNP to predict in-hospital death was 0.772(95%CI:0.718-0.825,P＜0.01),the optimal plasma NT-proBNP cut-point for predicting in-hospital mortality Was 3500 pmol/L,with a sensitivity of 70.3%,a specificity of 72.0%,an accuracy of 71.9%.a positive predictive value of 17.8%and a negative predictive value of 96.6%.Patients whose NT-proBNP levels were equal or more than 3500 pmol/L had a much higher in hospital mortality(17.8%)compared with those with NT-proBNP levels of less than 3500 pmol/L (3.4%),P＜0.01.Binary logistic regress analyses demonstrated that admission plasma NT-proBNP,pneumonia,heart rate and NYHA class were independent predictors for in-hospital mortality in patients with decompensated heart failure(P＜0.05 or 0.01)and admission plasma NT-proBNP Was the strongest predictor for in-hospital mortality.Conclusions Admission plasma NT-proBNP level was an independent predictor for in-hospital mortality in patients with decompensated heart failure.The optimal NT-proBNP cut point for predicting in-hospital mortality was 3500 pmol/L in this patient cohort.

Objective To analyze the status of quality indicators(QI) on specimen acceptability and establish preliminary qual ity specification.Methods Web based External Quality Assessment system was used to collect data of laboratories partici pated in "Medical quality control indicators in clinical laboratory" from 2015 to 2017,including once in 2015 and 2017 and twice in 2016.Rate and sigma scales were used to evaluate incorrect sample type,incorrect sample container,incorrect fill level and anticoagulant sample clotted.The 25th percentile (P25) and 75th percentile (P75) of the distribution of each QI were employed to establish the high,medium and low specification.Results 5 346,7 593,5 950 and 6 874 laboratories sub mitted the survey results respectively.The P50 of biochemistry (except incorrect fill level),immunology and microbiology reach to 6σ.The P50 of clinical laboratory is 4 to 6σ except for incorrect sample container.There is no significant change of the continuous survey results.Based on results in 2017 to establish the quality specification,the P25 and P75 of the four QIs is 0 and 0.084 4 ％,0 and 0.047 6 ％,0 and 0.114 2 ％,0 and 0.078 4 ％,respectively.Conclusion According to the results of the survey,most laboratories had a faire performance in biochemistry,immunology and microbiology,and clinical laboratory needs to be strengthened.Laboratories should strengthen the laboratory information system construction to ensure the actual and reliable data collection,and make a long time monitoring to achieve a better quality.