Objective Investigate the clinical features of the neurological disorders in patients after pulmonary thromboendarterectomy (PTE) for chronic pulmonary thromboembolism , analyze the factorial. Methods A retrospective study was made of 26 patients who underwent PTE between 2002 and 2010 in Beijing Chao-Yang hospital. The symptom of neurological system disorders occurred in the survivors were been investigate. The preoperative conditions and the perioperative conditions of all survivors were investigated. Compared the differences between the groups with neurological system disorders and the groups without. Results There were 22 patients of 26 survived after the surgery. Cardiac function of the survivors improved, and the quality of life improved significantly. 5 cases of the 22 survivors had symptoms of neurological system disorders. 3 patients showed lethargy, delirium, memory disorders, brain CT found no abnormal, symptoms recovered within 2 weeks. The fourth patient showed ataxia, unsteady gait, dance-like movements symmetry, in addition to the above symptoms, brain CT no abnormal showed,brain MRI showed bilateral abnormal signal in the midbrain, basal ganglia, symptoms improved and discharged after 8 weeks, the symptoms completely disappeared 6 months, and the abnormal signals in brain in MRI disappeared. The fifth patient with similar symptoms to the fourth, brain CT no abnormal found, be discharged 10 weeks after the operation, recovery is poor, living part of themselves. The postoperative neurological disorders occurred in the patients of Jamieson surgery type Ⅲ type, Ⅳ type of larger proportion, (P = 0.024), longer circulatory arrest surgery (P = 0.034). Conclusion The neurological disorders postoperative PTE often showed diffuse symmetric cerebral cortex and basal ganglia nerve dysfunction, brain MRI showed abnormal signal corresponding region, the majority of symptoms disappeared in 2 - 8 weeks, abnormal signal in brain MRI could disappeared after 6 months. Neurological dysfunction occurs in patients with more difficult surgical procedure, longer circulatory arrest, suggesting that with the surgery cerebral ischemia and hypoxia related.

Objective Background Pulmonary endarterectomy (PEA) is a safe and effective surgical treatment for chronic thromboembolic pulmonary hypertension. University of California at San Diego Medical Center is widely recognized as the world's leading referral center for PEA surgery with extensive surgical experience, which has surgically treated about 2400 patients till 2009, which account for more than 50% of the total cases in the world. Methods During visiting in UCSD, 32 pulmonary endarterectomy operations were performed by Prof. Stuart W Jamieson and Mechel M Madani. In these patients, 17 were males (53%), the average age was (47.56 ± 16.04 ) years, 47% with prior history of pulmonary embolism and/or deep vein thrombosis. Obvious pulmonary hypertension and hypoxemia were observed in all patients. Bilateral pulmonary endarterectomy was performed under cardiopulmonary bypass with profound hypothermic circulatory arrest. Results According to the classification of surgical specimens, 21.8% are type Ⅰ , 28.1% are type Ⅱ and 37.5% are type Ⅲ. The average time of cardiopulmonary bypass (CPB) was (236.32 ± 37.27) mins. The aortic cross clamp time was ( 111.69 ± 28.14) mins. The circulatory arrest time was (38.00±13.58 ) mins [ right side (21.39 ± 9.57 ) mins and left side ( 16.61 ± 6.83) mins]. Postoperatively the average mechanical ventilation time was ( 66.23 ± 99.24) hours, and the ICU stay was (4.62 ± 4.50 ) days.There was no postoperative moorality. All cases had significant decrease in systolic pulmonary artery pressure [(81.03 ± 16.92)mm Hg vs. (51.20±12.16) mm Hg] and pulmonary vascular resistance [(88.91 ±42.32) kPa · s · L-1 vs. (34.38 ±15.68 ) kPa · s · L-1 ], great improvement in cardiac output [(3.65 ±1.08 ) L/min vs. ( 5.85 ± 1.21 ) L/min ] and central venous pressure [(13.07 ± 2.11) cmH2O vs. ( 9.86 ± 3.02 ) cmH2O] postoperatively compared to preoperative data. Shortterm follow-up showed that the cardiac function of all cases returned to NYHA class Ⅰ or Ⅱ, with great improvement in CTPA.Conclusion PEA is definitive treatment of chronic thromboembolic pulmonary hypertension. According the successful experience of UCSD PEA team, first and foremost pulmonary endarterectomy is a bilateral procedure, because chronic thromboembolic pulmonary hypertension is mostly a bilateral disease. Second, cardiopulmonary bypass with the aid of deep hypothermia and circulatory arrest are essential to operator in recognizing the true endarterectomy plane of the media and in following the specimen to its feathered tail end in each branch, using these approaches can effectively reduce pulmonary hypertension and provide good hemodynamic and symptomatic results. Third, PEA remains an uncommon procedure in China. Only a few centers can perform high qualified PEA surgery. In most of inexperienced centers, type Ⅰ and type Ⅱ disease should be choose to operation.Patients with sPAP ≥100 mm Hg, PVR ≥ 100 kPa · s · L-1 or type Ⅲ disease will face more dangers peri-operation.

Objective To investigate the value of prognosis of NT-proBNP in severe sepsis and septic shock patients .Methods 70 patients with sepsis admitted to our hospital were divided into general sepsis group (n=23) ,severe sepsis group(n=28) and sep-tic shock group(n=19) according to the severity of the disease ,the plasma NT-proBNP ,lactic acid ,C-reactive protein were meas-ured within 1 h after admission ,and calculated the 24 h acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) .Results (1) Plasma NT-proBNP concentration ,lactic acid ,CRP and APACHE Ⅱ score in severe sepsis group ,septic shock group was sig-nificantly higher than that of general sepsis group(P< 0 .05);Plasma NT-proBNP concentration ,CRP and APACHE Ⅱ score in septic shock group was significantly higher than severe sepsis group (P<0 .05) .(2)70 cases of patients with sepsis with 15 cases died and 55 cases survived .Plasma NT-proBNP concentration ,lactate ,CRP and APACHEⅡscore of death patients was significantly higher than the survival patients(P<0 .01) .(3) Plasma NT-proBNP concentration at the time of sepsis patients admitted to hospi-tal with positively correlated to APACHE Ⅱscores(r=0 .528 ,P<0 .01) .Conclusion The plasma NT-proBNP is closely related to the prognosis of patients with sepsis ,early detection of plasma concentration of NT-proBNP helps to evaluate the prognosis of pa-tients w ith sepsis .

Objective To evaluate the right ventricular function of chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary thromboendarterectomy (PTE) by Doppler echocardiography. Methods In 16 patients with CTEPH,end-diastolic left ventricular diameter(LVDd), end-diastolic right ventricular areas (RVEDA), end-systolic right ventricular areas (RVESA), right ventricular fractional area change (RVFAC), pulmonary accelerative time (Pact), pressure gradient of tricuspid valve regurgitation (PGT1), area of tricuspid valve regurgitation (AT1) were measured by echocardiography. Results Fifteen and thirty days after surgery,the LVDd and Pact had increased,RVEDA, RVESA,PGT1 and AT1 had decreased while RVFAC had increased in all cases. Conclusions PTE may effectively improve the right ventricular function of patients with CTEPH.

OBJECTIVE:To observe clinical efficacy and safety of Kangfuxin liquid in the treatment of radioactive dermatitis of nasopharyngeal carcinoma patients. METHODS:A total of 73 nasopharyngeal carcinoma patients with radioactive dermatitis in the Third Affiliated Hospital of Kunming Medical University during Feb. 2016 to Feb. 2017 were divided into control group (36 cases) and observation group (37 cases) according to random number table. Both groups received routine treatment as Methylrosanilinium chloride solution,Compound cod liver oil and zinc oxide ointment for external use. Observation group was additionally given gauze soaked with Kangfuxin liquid on affected area,3 times a day on the basis of routine treatment. Both groups were treated for 4 weeks. Clinical efficacies of 2 groups were compared,and RTOG classification and dermatitis area were compared before and after treatment. The occurrence of ADR was recorded. RESULTS:There was statistical significance in the total response rate between observation group (94.6％) and control group (97.2％)(P<0.05). Before and after treatment,there were no RTOG Ⅳ patients in 2 groups. Before treatment,there was no statistical significance in the proportion of RTOG 0-Ⅲpatients or dermatitis area between 2 groups (P>0.05). After treatment,RTOG classification of observation group was improved significantly, the proportion of grade 0 patients was significantly higher than control group, that of gradeⅠpatients was significantly lower than control group,with statistical significance(P<0.05). There was no statistical significance in the proportion of RTOG 0-Ⅲpatients of control group before and after treatment(P>0.05). Two,four weeks after treatment,dermatitis areas of 2 groups were decreased significantly;dermatitis area 4 weeks after treatment was significantly smaller than 2 weeks after treatment;observation group was significantly smaller than control group,with statistical significance(P<0.05). No obvious ADR was found in 2 groups during treatment. CONCLUSIONS:Additional use of Kangfuxin liquid in the treatment of radioactive dermatitis of nasopharyngeal carcinoma patients can effectively relieve symptoms and reduce dermatitis area with good safety.

Objective To study the relationship between bronchial asthma and smoking status in Chinese people.Methods Asthma epidemiological survey and stratified-cluster-random method survey were performed in residents over 14 years in 8 provinces (cities) of China from February 2010 to August 2012.Asthma was diagnosed based upon case history,clinical signs and lung function test.Smoking status was investigated by questionnaire.Results Sampling population was 180 099 and 164 215 were valid.A total of 2 034 subjects were diagnosed as asthma including 79 692 men and 84 523 women.The overall prevalence rate of asthma was 1.24％ (2 034/164 215).Smokers were 23.8％ (39 137/164 215) in the whole population.Smokers were 34.5％ (702/2 034) in asthmatic patients,compared with 23.7％ (38 435/ 162 181) in no-asthmatic population.The incidence of asthma was 1.79％ and 1.06％ in smokers and nonsmokers respectively (P ＜0.001),suggesting that OR of smoking was 1.70 (95％ CI 1.55-1.86,P ＜ 0.001).According to asthma control test (ACT) score,the level of asthma control in non smoking group was higher than that in smoking group(43.2％ vs 35.3％).The times of hospitalization due to acute exacerbations (0.51 vs 0.41 events/person/year),total hospitalization rate (27.35 ％ vs 20.12％),annual emergency room visits (0.80 vs 0.60 events/person/year) and emergency room visit rate (31.77％ vs 24.47％) were all much higher in smoking asthmatic patients than those in non smoking asthmatic patients,indicating that the level of asthma control in smoking patients was significantly worse than in non smoking patients.Conclusions The smoking rate in Chinese people over 14 years is still high.The prevalence rate of asthma in smokers is significantly higher than that of non-smokers.The level of asthma control in smokers is significantly worse than that in non smokers.

Objective: The purpose of this study was to a new operative approach for sagittal condylar fractures via a preauricular small incision-based technique and to examine the effectiveness of this approach. Methods: Fifteen patients (19 sides) with sagittal condylar fractures were included in the study. The incision length was approximately 4 cm through the tragus, exposing the superficial temporal vessels, which was then pulled forward. Next, the deep temporal superficial fascia was cut, and the surface of the zygomatic arch and the articular capsule of the temporomandibular joint were exposed. Joint capsule incision was performed, with mandibular condylar fracture fixation under direct vision. We followed up with the patients postoperatively for 6 months with clinical and radiographic examinations. Results : All patients had 1 week postoperation before being discharged, during which 2 cases of mild facial paralysis (with lateral temporal level Ⅱ facial paralysis, with lateral temporal branch level Ⅲ facial paralysis and level Ⅱ zygomatic branch of facial nerve paralysis after treatment) were observed, after given nerve nutrition agents, 2 cases returned to normal within 3 months. No patient exhibited a postoperative delayed fistula infection or other serious complications. Intraoperative occlusion relationships recovered well, and postoperative CTs suggested that the fracture ends and condyles were in good condition. The occlusion relationship was normal for 3 months after surgery, with a degree of opening greater than 30 mm, no play in the joints and no oblique openings being observed, and reexamination 6 months after the surgery revealed no obvious scars. Conclusion This surgical method involves a small incision and clear anatomic structures and avoids damage to the facial nerve. This method provides better surgical vision for treatment of sagittal condylar fractures, is safe and convenient, and deserves clinical recommendation.