Objective To evaluate the common causes of chronic cough and the diagnostic value of clinical symptoms,and provide evidences for empirical treatment.Methods The causes of patients with chronic cough were evaluated by a validated systematic diagnostic protocol.The characteristics of the cough timing,characters,incentives and associated manifestations of chronic cough with different causes were compared.Results A total of 160 patients with at least 8 weeks of chronic cough and normal chest radiographswere recruited from the Department of respiratory diseases of Yichang Central Hospital between Jan.to Dec.2009.The most common causes of chronic cough were cough variant asthma (CVA,n =72,45％ ),upper airway cough syndrome ( UACS,n =54,33.75％ ),eosinophilic bronchitis ( EB,n =14,8.75％ ),gastroesophageal reflux-related chronic cough ( GERC,n =9,5.63％ ),other etiologies ( n =11,6.87％ ).Significant differences were observed in different etiological subtypes.The incidence of nocturnal cough in CVA was 52.8％ ( 38/72 ),significantly higher than others types ; URCS patients manifested more day coughs,with 70.2％ postnasal drip syndrome and significantly more cases had the history of nasal diseases compared with other types.The specificity of cough associated with meals in GERC were 66.7％,and the regurgitation associated symptom in GERC were77.8％,significantly higher than other types.However no special syndromes were observed in EB patients.Conclusion All kinds of chronic coughs have specific symptoms.The spectrum of causes and clinical features of chronic cough are important in the diagnostic procedure of chronic cough.

Objective To survey small dense low-density lipoprotein cholesterol(sdLDL-C)distribution among different popula-tions,and analyze its relationship with lipid component.Methods 986 cases of people who underwent medical examination in the hospital were recruited in the study.There were 654 people with normal concentrations of serum blood lipids(normal blood lipids group),according to sex and age they were divided into groups.The people whose serum lipids concentrations increased above the normal range were divided into TG increasing group,LDL-C increasing group and joint increasing group according to the type of lip-ids componet increased.Serum sdLDL-C,LDL-C,TG,TC,HDL-C,ApoAⅠ and ApoB were determind in the people mentioned a-bove,and the correlation between sdLDL-C and TG,TC,HDL-C,ApoAⅠ,ApoB concentrations were analyzed.Results SdLDL-C began to decline after the age of 70,the difference was statistically significant(P <0.05 );the ensemble average of the males was higher than that of females,the difference was statistically significant(P <0.05).The serum sdLDL-C cocentrations of all the serum lipis increasing groups were significantly higher than those of normal blood lipids group,the difference was statistically significant (P <0.05 ).SdLDL-C concentrations were positively correlated with TC,TG,ApoB(r =0.254,0.589,0.302),and was negative correlated with HDL-C and ApoA Ⅰ (r = - 0.421,- 0.275,- 0.311 ).Conclusion There was a positive correlation between sdLDL-C and TC,TG,ApoB,and sdLDL-C was negatively correlated with HDL-C,ApoAⅠ,which can accurately reflect the overall status of lipid metabolism.

Objective To observe the clinical efficacy of dye laser combined with Xin'an repair solution in the treating superficial infantile hemangioma(IH). Methods 100 patients with superficial IH were randomly divided into observation group and control group.The observation group received dye laser combined with Xin'an re-pair solution,while the control group was treated only with dye laser.The clinical efficacy and the rate of complica-tions after treatment were compared between the two groups,and the different efficacy between the head neck group and the non head neck group in the observation group was further analyzed. Results The total effective rate of the observation group(90%)was significantly higher than the control group(70%),and the difference was sta-tistically significant(P<0.05).The rate of complications in the observation group was significantly lower than that in the control group(6%vs.32%,P<0.05).In the observation group,the total effective rate of head neck group was better than that the non head neck group(P<0.05). Conclusion Dye laser combined with Xin'an repair so-lution is effective in the treatment of superficial IH,and it can significantly reduce complications.It is evidently ef-fective for head and neck superficial IH.

Since the 2019 novel coronavirus (2019-nCoV or officially named by the World Health Organization as COVID-19) outbreak in Wuhan, Hubei Province, China in 2019, there have been a few reports of its imaging findings. Here, we report two confirmed cases of 2019-nCoV pneumonia with chest computed tomography findings of multiple regions of patchy consolidation and ground-glass opacities in both lungs. These findings were characteristically located along the bronchial bundle or subpleural lungs.
China ; Coronavirus ; Lung ; Pneumonia ; Thorax ; World Health Organization

OBJECTIVETo retrospectively evaluate the results of deep sternal wound infection (DSWI) after cardiac surgery.

METHODSBetween January 2010 and September 2013, 139 patients suffering from DSWI after median sternotomy. The incidence of DSWI was 0.47% (139/29 574). There were 111 (79.9%) male and 28 (20.1%) female patients. The mean age was (61 ± 11) years, the mean body weight was (74 ± 14) kg. The incidence of postoperative DSWI was 0.88% (91/10 341) after isolated coronary artery bypass grafting (CABG), 0.70% (15/2 143) after valve surgery or other cardiac surgery plus CABG, 0.21% (24/11 429) after valve surgery, 0.15% (3/2 002) after thoracic aortic surgery, and 0.19% (6/3 158) after congenital heart disease. The sternotomy was re-opened and extensive debridement of the wound was performed in all patients. When the wound was clean and there was a bed of fresh granulation tissue, the sternum was rewired. The surgical procedure performed included debridement, drainage, sternal wire reclosure and pectoralis major muscular transpositions depended on the clinical condition of the patient.

RESULTSThe in-hospital mortality was 9.3%. Failure of secondary sternal refixation appeared in 15 (10.8%) patients, the reoperation procedure of these 15 patients was pectoralis major muscular transpositions. Other complications included sepsis in 13 patients, perivalvular leakage in 3 patients, and cardiac rupture during the surgical procedure in 3 patients. The mean hospitalization was (39 ± 30) days.

CONCLUSIONDeep sternal wound infection is a life-threatening complication after cardiac surgery associated with high morbidity and mortality.

Adult ; Aged ; Aged, 80 and over ; Cardiac Surgical Procedures ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Sternum ; surgery ; Surgical Wound Infection ; surgery ; Young Adult

Objective: To report the medium-long term survival rates of ventricular septal myectomy for treating the patients with hypertrophic obstructive cardiomyopathy and to analyze the predictive factors affecting the outcomes. Methods: A total of 655 consecutive patients who received ventricular septal myectomy in our hospital from 1984-10 to 2014-12 were retrospectively summarized. The cohort study was conducted with questionnaires by cardiovascular nurses. Result: The operative mortality was 1.4% (9/655). The mean follow-up time was (30.8 ± 30.9, from 3 to 213) months, there were 52/646 (7.9%) patients lost contact and 583 patients having NYHA classification at I or II during that period. The overall survival rates for 1 year, 5-year and 8-year were 98.3%, 90.5% and 88.3% respectively. There were 80 patients suffered from end point events including HCM-related death, heart transplantation, repeated myectomy, permanent pacemaker implantation and re-admission for ischemic stroke, tachyarrhythmia, myocardial ischemia or infarction, congestive heart failure. The end point events free survival rates for 1 year, 5-year and 8-year were 94.2%, 76.7% and 65.9% respectively. Multivariable Cox regression analysis presented that age>50 years (HR=2.16, 95% CI 1.36-3.46,P=0.001) and pre-operative atrial ifbrillation (FA) (HR=2.31, 95% CI 1.35-3.94,P=0.002) were the independent predictors for end point events occurrence. Conclusion: Ventricular septal myectomy may achieve good medium-long term survival rate with less adverse event in patients with hypertrophic obstructive cardiomyopathy. Elder than 50 years of age and with pre-operative FA were the independent predictors for adverse events occurrence.

Objective To investigate the impact of eotaxin-3 gene polymorphisms on the clinical effect of inhaled corticosteroids (ICS) to provide clinical basis for eotaxin-3 as the target spot for treating bronchial asthma.Methods One hundred and ninety-six cases of asthma and 196 cases as controls were selected from the outpatients and inpatients in our hospital.Peripheral blood samples were collected from the asthma patients and normal controls.PCR-RFLP was adopted to detect the genotypes of eotaxin-3 +2497T＞G and-+-77C＞T.The response of ICS treatment and the change situation of ACT scores were compared among asthmatic patients with various genotypes.Results Peripheral blood eosinophil(EOS) counts,EOS proportion and total IgE in the patients with TG genotype at+2497 locus were significantly decreased compared with those in the patients with TT genotype,the difference was statistically significant(P＜0.05).The level of PD20 in asthmatic patients with TG genotype was significantly higher than that in the patients with TT genotype,the difference was statistically significant[(0.07-±-0.03)mg vs.(0.03 ± 0.01)mg,t=2.45,P=0.048];whereas the above indicators had no statistical difference among 3 kinds of +-77 genotypes.During ICS treatment process in the patients with TT genotype at +-2497 locus,the FEV1％,PD20 value and ACT scores were significantly improved compared with those in the patients with TG genotype,the difference was statistically significant(P＜0.01).Conclusion The asthmatic patients with TT genotype at +-2497 locus were more sensitive to ICS treatment,regular ICS treatment can significantly improve the lung function and clinical symptom score in these patients.

Objective:To explore the accuracy of mpMRI combined with Partin table, MSKCC nomogram and CAPRA score in predicting extracapsular extension and seminal vesicle invasion of prostate cancer.Methods:From January 2016 to June 2021, a total of 178 patients who underwent laparoscopic radical prostatectomy were selected. The average age of patients was (68.3±3.5) years, the average preoperative PSA level was (24.5±7.1)ng/ml, and the average percentage of positive cores in biopsy was 44.3%. The clinical T 1c stage was determined in 67 cases (37.6%), T 2a in 69 cases (38.8%) and T 2b-2c in 42 cases(23.6%). Biopsy Gleason score of 3+ 3=6 was found in 45 cases(25.3%), 3+ 4=7 in 41 cases(23.0%), 4+ 3=7 in 26 cases(14.6%), 8 with different combinations in 36 cases(20.2%), and 9 or 10 in 30 cases(16.9%). According to preoperative PSA level, biopsy Gleason score, clinical stage, age, total biopsy cores and positive cores, the posibility of extracapsular extension and seminal vesicle invasion were predicted using 2012-version Partin table and MSKCC nomogram. CAPRA score of each patient was calculated. The prediction schemes were built as follows: ①mpMRI alone, ②mpMRI combined with Partin scale, ③mpMRI combined with MSKCC nomogram, ④mpMRI combined with CAPRA score. The results of each prediction scheme were compared with postoperative pathological reports. Logistic regression analysis was used to evaluate the relationship between predictive results and postoperative pathological outcomes. The receiver operating characteristic curve of each prediction scheme was drawn. The area under curve was used to compare the predictive accuracy of each combination scheme for the pathological results of prostate cancer. The decision analysis curve of each prediction scheme was drawn. The clinical benefits of each scheme were analyzed by comparing the net return under different risk thresholds. Results:mpMRI predicted extracapsular extension in 21 cases(11.8%) and seminal vesicle invasion in 16 cases(9.0%). The postoperative pathological results reported extracapsular extension in 27 cases(15.2%) and seminal vesicle invasion in 39 cases(21.9%). Logistic regression analysis showed that mpMRI and clinical scales were predictors related to the pathological results of prostate cancer( P<0.05). The receiver operating characteristic curve of each scheme showed that the area under curve for predicting extracapsular extension by using mpMRI, mpMRI combined with Partin table, mpMRI combined with MSKCC nomogram and mpMRI combined with CAPRA score were 0.599, 0.652, 0.763 and 0.780, respectively, and the area under curve for predicting seminal vesicle invasion were 0.607, 0.817, 0.826 and 0.820, respectively. Compared with simple application of mpMRI, except that the scheme of mpMRI combined with Partin table had no obvious advantage in predicting extracapsular extension( P=0.117), any other combined scheme had higher prediction accuracy( P<0.01). mpMRI combined with MSKCC nomogram or CAPRA score was better than mpMRI combined with Partin table in predicting extracapsular invasion ( P<0.01). There was no significant difference in predicting seminal vesicle invasion among these three combination schemes ( P>0.05). The net income of the combined prediction scheme was higher than that of using mpMRI alone under any risk threshold. The scheme of using mpMRI combined with MSKCC nomogram had the highest net income. Conclusions:mpMRI combined with clinical scales has good accuracy in predicting pathological characteristics of prostate cancer in Chinese population. Compared with other schemes in this study, the combination scheme of mpMRI combined with MSKCC nomogram has the highest prediction accuracy.