Objective To explore the surgical strategy and effects for treating complex malignant tumors of the inferior vena cava (IVC) or/and the tumors extending into right atrium/ventricle.Methods Between Dec 2004 and Jul 2008, eight patients underwent surgical resections, among those seven patients with tumors of IVC or the tumors extending into right atrium/ventricle were operated on under deep hypothermia with cardiopulmonary bypass( CPB), and one patient with recurrence of leiomyosarcoma of the IVC successfully underwent en bloc resection and caval reconstruction. The prosthetic graft was used for IVC reconstruction in two patients and vascular patch in the other two patients. Preoperative chest roentgenography, computed tomography, ultrasonography, or magnetic resonance imaging was used to exclude the presence of metastatic disease, to assess local resectability of the tumour and the extent of involvement and obstruction of the IVC. Results One patient died of liver failure postoperatively. The postoperative course was uneventful in other 7 patients. On follow-up two patients died 2 and 5 months later due to functional disorder of the liver. Three patients have been followed up for 14 - 24 months and were

Objective:To analyze KCNJ5 mutation of adenomas in patients with aldosterone-producing adenoma (APA) companying with hypokalemia, and to compare the clinical characteristics of patients with and without KCNJ 5 mutations.Methods:Clinical data of 144 APA patients were retrospectively analyzed. DNA were extracted from adenoma tissues, and amplified and sequenced for KCNJ5 gene. The serum potassium level and cardiac complications in patients with and without KCNJ5 gene mutation were compared.Results:Among 144 tumors, 131 tumors (91%) had KCNJ5 mutation, including 68 tumors with G151R, 56 tumors with L168R, 5 tumors with E145Q, and two tumors with novel mutations, V156_K160delITE and G151delinsVR. Compared with patients without KCNJ5 mutation, patients with KCNJ5 mutation had lower preoperative serum potassium levels, more cardiac complications, lower postoperative systolic blood pressure, and better postoperative hypertension relief. There were no statistical differences in age, gender, blood pressure, serum potassium level, plasma renin activity or plasma aldosterone concertration.Conclusion:91% adenomas in patients with APA and hypokalemia had KCNJ5 mutation, suggesting that KCNJ5 mutation is the main cause in these patients.

Objective: To develop an indicator system for assessing public hospital performance. Methods:Based on literature research and expert consultation, we formed an indicator system framework and indicators for as-sessing public hospital performance. Using Delphi expert consultation, focus group interviews, focus group discussion and individual in-depth interview qualitative research methods, we constructed a public hospital performance evalua-tion indicators. Results:There are four dimensions, 11 secondary indicators, 30 tertiary indicators in the indicator system, depending on the level of hospital, the indicators and weights are adjusted. Conclusion:The indicator system is suitable for public-interest-oriented performance assessment of public hospitals, and provides basis for the perform-ance assessment system.

Objective To explore the clinical efficacy of early micro-porous surgery in the treatment of patients with encephaledema after small-and moderate-volume basal ganglia hemorrhage and its influence on serum inflammatory factors.Methods A total of 104 patients with small-and moderate-volume basal ganglia hemorrhage were randomly divided into control group and observation group,52 cases in each group.Control group was treated with conventional treatment,while observation group was treated with early micro-porous surgery.The volume of encephaledema and clearance time of hematoma 3 d and 14 d after treatment were observed in both groups.The levels of serum interleukin-6 (IL-6),IL-13 and tumor necrosis factors-α (TNF-o) were detected before treatment and 3 d after treatment in both groups.National Institutes of Health Stroke Scale (NIHSS) and Activities of Daily Life Function Assessment Scale Barthel index (BI) were used before and 3 weeks after treatment to evaluate patients' neurological function.Results The 3 d and 14 d after treatment,observation group was significantly smaller in volume of encephaledema (P ＜ 0.05) and shorter in clearance time of hematoma (P ＜0.01) when compared with control group.Three days after treatment,levels of serum IL-6,IL-1 β and TNF-α decreased significantly in both groups,which decreased more significantly in observation group than in control group (P ＜0.05 or P ＜0.01).Three weeks after treatment,NIHSS score decreased significantly while BI increased significantly in both groups,which improved more significantly in observation group than in control group (P ＜ 0.05).Conclusion Early micro-porous surgery can significantly relieve the severity of encephaledema after intracerebral hemorrhage,and has greater advantages in recovering patients' neurological function.

Objective To explore the clinical efficacy of early micro-porous surgery in the treatment of patients with encephaledema after small-and moderate-volume basal ganglia hemorrhage and its influence on serum inflammatory factors.Methods A total of 104 patients with small-and moderate-volume basal ganglia hemorrhage were randomly divided into control group and observation group,52 cases in each group.Control group was treated with conventional treatment,while observation group was treated with early micro-porous surgery.The volume of encephaledema and clearance time of hematoma 3 d and 14 d after treatment were observed in both groups.The levels of serum interleukin-6 (IL-6),IL-13 and tumor necrosis factors-α (TNF-o) were detected before treatment and 3 d after treatment in both groups.National Institutes of Health Stroke Scale (NIHSS) and Activities of Daily Life Function Assessment Scale Barthel index (BI) were used before and 3 weeks after treatment to evaluate patients' neurological function.Results The 3 d and 14 d after treatment,observation group was significantly smaller in volume of encephaledema (P ＜ 0.05) and shorter in clearance time of hematoma (P ＜0.01) when compared with control group.Three days after treatment,levels of serum IL-6,IL-1 β and TNF-α decreased significantly in both groups,which decreased more significantly in observation group than in control group (P ＜0.05 or P ＜0.01).Three weeks after treatment,NIHSS score decreased significantly while BI increased significantly in both groups,which improved more significantly in observation group than in control group (P ＜ 0.05).Conclusion Early micro-porous surgery can significantly relieve the severity of encephaledema after intracerebral hemorrhage,and has greater advantages in recovering patients' neurological function.

Pulmonary sarcomatoid carcinoma(PSC)is a rare and highly malignant tumor,which includes the follow-ing five pathologic types:pleomorphic carcinoma,spindle cell carcinoma,giant cell carcinoma,carcinosarcoma and pulmonary blastoma.The onset of PSC is occult with non-specific clinical symptoms and signs.The clinical manifestations include irritat-ing cough,bloody sputum,dyspnea,chest pain and so on,which are closely related to the growth and invasion site of the tumor.PSC tends to metastasize early,so most patients are already in local advanced stage or advanced stage with a median survival of 9 months at the time of hospital visit.A patient with primary PSC which led to 90%stenosis in central airway was treated by com-bined method of vascular and tracheoscopic intervention in our respiratory center.This treatment prolonged the patient's survival time and got a satisfactory effect at 19-month follow-up after surgery.Herein we report the case for clinical reference.

Background and objective As a new technique developed in recent years,bronchoscopic interven-tion therapy has the advantages of minimal invasion,high safety and repeatability.The aim of this study is to investigate the clinical characteristics of bronchopleural fistula(BPF)induced by surgeries for lung malignancies or benign diseases and the effect of bronchoscopic intervention therapy for BPF,so as to provide support for prevention and treatment of BPF.Methods Data 64 patients with BPF who were treated by bronchoscopic intervention in Respiratory Disease Cen-ter of Dongzhimen Hospital,Beijing University of Chinese Medicine from June 2020 to September 2023 were collected.Patients with fistula diameter ≤5 mm were underwent submucous injection of macrogol,combined with blocking therapy with N-butyl cyanoacrylate,medical bioprotein glue or silicone prosthesis.Patients with fistula diameter＞5 mm were im-planted with different stents and cardiac occluders.Locations and characteristics of fistulas were summarized,meanwhile,data including Karnofsky performance status(KPS),shortbreath scale(SS),body temperature,pleural drainage volume and white blood cell count before and after operation were observed.Results For all 64 patients,96 anatomic lung resections in-cluding pneumonectomy,lobectomy and segmentectomy were executed and 74 fistulas occurred in 65 fistula locations.The proportion of fistula in the right lung(63.5％)was significantly higher than that in the left(36.5％).Besides,the right inferior lobar bronchial fistula was the most common(40.5％).After operation,KPS was significantly increased,while SS,body tem-perature,pleural drainage volume and white blood cell count were significantly decreased compared to the preoperative values(P＜0.05).By telephone follow-up or readmission during 1 month to 38 months after treament,median survival time was 21 months.33 patients(51.6％)showed complete response,7 patients(10.9％)showed complete clinical response,18 patients(28.1％)showed partial response,and 6 patients(9.4％)showed no response.As a whole,the total effective rate of broncho-scopic intervention for BPF was 90.6％.Conclusion BPF induced by pulmonary surgery can lead to severe symptoms and it is usually life-threating.Bronchoscopic intervention therapy is one of the fast and effective therapeutic methods for BPF.

Pulmonary mixed squamous cell and glandular papilloma(MSCGP)is a subtype of pulmonary papil-loma,which can be classified as central type and peripheral type based on its site of development.The central type is the most common.The clinical manifestations of pulmonary MSCGP are mainly related to the location of the tumor.Surgery is the main treatment for this disease.Bronchoscopic interventional treatment for the MSCGP in the central trachea could receive satis-factory effect.We reported a patient suffered from diffuse tracheal MSCGP who was treated by bronchoscopic interventional treatment in Respiratory Disease Center,Dongzhimen Hospital of Beijing University of Chinese Medicine,aiming to enhance the recognition of the clinical features and provide clinical references for the diagnosis and treatment of such disease.

Objective To study the efficiency changes of private hospitals in Shenzhen and explore influencing factors for the utilization efficiency of health resources. Methods DEA-Tobit two-stage model was used to analyze the operating efficiency and influencing factors of Shenzhen′s private hospitals. Results The range of technical efficiency varied between 0.690 to 0.742 in six years, and the index of total factor production was consistent with the technical change index. The input and output indicators showed non-linear growth. The internal and external factors of sample hospitals jointly influence the efficiency of operation. Conclusions The two-stage method effectively reveals the dynamic efficiency change and the influencing factors of these hospitals in Shenzhen. The technical efficiency of sample hospitals fluctuates in waves in six years,with investment redundancy and insufficient output found. Sample hospitals need to strengthen their innovative application of diagnostic and therapeutic technology,and to strengthen their internal management and improve operating efficiency.