ObjectiveTo study the changes and clinical significance of vascular endothelial growth factor (VEGF) in sputum of patients with pulmonary arterial hypertension associated with chronic obstructive pulmonary disease (COPD).MethodsThe sputum VEGF levels of 52 cases with pulmonary arterial hypertension associated with COPD during stable period (group A),60 cases with COPD during stable period (group B) and 50 normal persons (group C) were detected by enzyme linked immunosorbent assay (ELISA)method.The pulmonary function,arterial blood gas analysis and pulmonary artery systolic pressure (PASP)were detected.ResultsThe sputum VEGF levels of group A,B and C were (4.30±0.93),(2.64±0.57)and ( 1.48±0.32 ) μ g/L respectively,which had significant difference ( F =31.612,P ＜ 0.01 ).The percentage of forced expiratory volume in the first second (FEV1) in predicted value (FEV1％) of group A,B and C were (48.68±10.53 )％,(67.56±14.61 )％,( 101.60±21.97 )％ respectively,which had significant difference (F =28.983,P ＜ 0.01 ),as well as PASP had [ (55.02±11.90),(23.50±5.08 ),(16.16±3.49) mm Hg (1 mm Hg =0.133 kPa),F=34.887,P＜ 0.01 ].The arterial partial pressure of oxygen (PaO2) and carbon dioxide(PaCO2) of three groups had no significant difference (F=2.159,3.167,P ＞ 0.05).The sputum VEGF level had significantly negative correlation with FEV1％ (r =-0.562,P ＜ 0.05),and positive correlation with PASP(r =0.783,P＜0.05),while had no correlation with PaO2,PaCO2(r =-0.318,0.275,P＞0.05).ConclusionsThe sputum VEGF level of patients with pulmonary arterial hypertension associated with COPD expresses high level,which has significant correlation with pulmonary function and PASP.Therefore,VEGF plays an important role in the pathogenesis of pulmonary arterial hypertension associated with COPD.

Objective To explore the effect of exposure of the recurrent laryngcal nerve(RLN) in prevention of RLN injury during thyorid surgery.Methods The clinical data of 810 cases of thyroid operation in which the RLN was exposed in 252 cases(group A) and was unexposed in 558 cases(group B) were analyzed.Results Although the extent of thyroid resection was greater in group A than in group B,the rate of RLN injury in group A(1.19 %) was significantly lower than that of group B(3.05 %,P

Objective To analyze the treatment effect of deep venous thrombosis (DVT) in acute pulmonary thromboembolism (PTE) with thrombolytic and anticoagulant therapy. Methods Post hoc analysis of data from a prospective multicenter randomized control thrombolytic and anticoagulant trial of 516 patients with acute symptomatic PTE from June 2002 to December 2004. Thrombolytic therapy was performed in patients with massive and sub-massive PTE and anticoagulant therapy was given in patients with non-massive PTE. A total of 362 patients that accepted compression uhrasonography (CUS) before and 14 days after treatment constituted this study. Results The ratio of detected DVT by CUS 14 days after treatment was reduction than that before treatment ( x2 = 22. 667, P < 0. 001 ), but 11.6% patients had new or recurrent DVT. The rates of recanalization in thrombolysis group and anticoagulant group were 56. 5% and 47. 8% respectively (x2 = 1. 435 ,P =0. 231 ). The results after three months follow up showed not recovery in 30. 4% DVT patients and new or recurrent DVT in 10. 4% patients. Conclusions The normalization rate of DVT is low during 14 days treatment, and recurrence rate is high. Thrombolysis has no better rate of recanalization than anticoagulant. The prognosis of DVT hasn't improved significantly during short term treatment.

Objective To investigate the differences in clinical symptoms and risk factors between non-elderly and elderly patients with acute pulmonary thromboembolism(PTE).Methods Totally141 patients with acute PTE and 100 sex and age-matched healthy controls were enrolled in the study.The final diagnosis was confirmed by CT pulmonary angiography (CTPA) and/or pulmonary angiography and/or pulmonary perfusion imaging as well as medical history.The patients with acute PTE were divided into two groups according age:elderly group (n=78,age≥60 years),young group (n =63,age ＜ 60 years).Multivariate Logistic regression analysis was performed to identify independent risk factors of PTE and to confirm the risk of each factor.Results The morbidity rate of dyspnea,cough,chest distress and chest pain were 88.5％ (69 cases),76.9％ (60 cases),56.4％ (44 cases),15.4％ (12 cases) in elderly group,which was similar to 84.1％ (53 cases),69.8％ (44 cases),63.5％ (40 cases),25.4％ (16 cases) in young group (all P＞0.05)； while the morbidity rate of hemoptysis in elderly group [9.0％ (7 cases)] was lower than in young group [23.8％(15 cases)](P＜0.05).9％ (7 cases) in elderly patients without any symptoms were more than 1.6％ (1 cases) in young patients,but no significant differene (P＞0.05).There were more risk factors in the elderly group accompanying with diabetes (x2 =7.41,P ＜ 0.01),hypertension (x2 =14.51,P＜ 0.01),chronic obstructive pulmonary diseases (COPD) (x2 =7.42,P＜0.01) and previous stroke (x2 =4.91,P＜0.05)compared with young group.Independent risk factors for elderly acute PTE included COPD (OR:3.29,95％CI:1.04-10.46),previous deep veneus thrombosis(DVT) (OR:4.72,95％CI:1.68-13.27),cancers (OR:4.35,95％CI:1.00-18.13) and previous stroke (OR:5.13,95％CI:1.15-24.52).Independent risk factors for non-elderly PTE included previous DVT (OR:11.94,95％ CI:3.35-42.60)and cancers (OR:11.44,95％CI:1.44-89.92).Conclusions Much attention should be paid to the identification of diagnosis of acute PTE depending on the non-specific clinical features,although dyspnea may be the most frequency symptoms,but unexplained cough and chest distress should be alert for PTE.COPD,cancer,DVT and previous stroke are independent and important risk factors for elderly acute PTE.

Objective To explore the clinical value of interferon gamma release assays in early childhood diagnosis of latent tuberculosis infection.Methods 33 patients with suspected latent tuberculosis infection and 35 patients with active tuberculosis infection in our hospital from January 2012 to March 2013 were selected.During the same period selected 30 healthy children as a control group.Respectively were given sputum smear analysis,tuberculin skin test (TST)and vinterferon release assay (IGRA).Compare the positive rate of different methods. Results In suspected latent tuberculosis group,IGRA test results were significantly higher than TST and sputum smear method(P<0.05);in active tuberculosis infection group, IGRA test results were significantly higher than TST and sputum smear(P<0.05 );in healthy control group,TST test results were higher than the IGRA,it is because of patients had been vaccinated with BCG.Conclusion IGRA can be used as one way to diagnosis the latent tuberculosis infection.

AIM:To investigate the therapeutical effect of Geranium sibirium extract on the patients with low rectal carcinoma,reserving anus reducing complication and increasing survival rate. METHODS:The treatments included extrasomatic radiotherapy near to tumor,intracavity and extracavity microwave diathermy as well as oral administration of Geranium sibirium extract.All the 30 patients were treated. RESULTS:The four-year follow -up showed that except 4 cases had local recurrence and 5 cases had distant metastasis,four-year survival rate and tumor -free survival rate were 86.7%(26/30) and 83%(25/30),respectively. CONCLUSION:With general treatment and low dose radiotherapy ,the therapeutics of reserving anus in low rectal carcinoma may increase survival quality ,reduce complication and recurrence rate.

Objective To discuss possible mechanism of chronic obstructive pulmonary disease(COPD)coagulation and fibrinolysis dysfunction.Methods Totally 47 healthy controls(Group A)and 38 cases of AECOPD(Group B)were chosen respectively.The plasma levels of vWF,Factor Ⅹ,TF,TFPI,TM,PC,tPA,PAI-1 and D-dimer were measured by ELISA method,and the blood AT-Ⅲ activity was measured by chromogenic assay.The cases of Group B were measured for RBC,WBC,PLT,PH,PaO2,PaCO2,HCO-3,PT,APTT,FBG,and so on.Results The plasma levels of vWF,TF,Factor Ⅹ,t-PA and D-dimer in Group B were significantly higher than those in Group A while TM and PC were significantly lower in Group B(P

Objective To observe the changes in fibrinolytic factors in rats with pulmonary thromboembolism (PTE) after recombinant prourokinase ( rPro-UK) treatment and its significance .Methods PTE was induced in male Sprague-Dawley (SD) rats by injecting heated 125iodine-labeled fibrinogen(Fib) autologous thromboemboli into external jugular veins.Twenty-eight rats were randomly assigned into following groups (7 rats each):①healthy control group;②PTE 5 d group,the rats in which were sacrificed at 5 d after the PTE model was made; ③ PTE3d receiving rPro-UK thrombolytic treament groups including multibolus treatment sub group ( rPro-UK was given in 1 mg/kg on the post-PTE third day followed by 2 consecutive days of a lower dose 0.25 mg/kg and rats were sacrificed 2 h after the last injection at the same time as PTE5d group) and single bolus treatment sub group ( rPro-UK was given in 1 mg/kg on the post-PTE third day followed by 2 consecutive days of 0.5 ml saline and rats were sacrificad at the same time as the former group ).The rats were quickly sacrificad at the fixed time through carotid bleeding and plasma samples were reserved for analysis of uroki -nase-type plasminogen activator (u-PA), urokinase-type plasminogen activator receptor (u-PAR), fibrinogen (Fib) andα2-antiplasmin (α2-AP) .Results ①Plasma concentrations of u-PA and u-PAR were increased were significantly in rPro-UK multibolus treatment sub group than in PTE 5 d group(Pu-PA <0.05,Pu-PAR <0.01)and rPro-UK single bolus treatment sub group(Pu-PA <0.01,Pu-PAR <0.05),correlated with the thrombolysis rate in rPro-UK multibolus treatment sub group (ru-PA =0.766,P<0.05;ru-PAR=0.785,P<0.05).② No difference of plasma Fib and α2-AP was seen between Pro-UK treatment groups and PTE 5 d group(P >0.05).Conclusion ① Plasma levels of endogenous u-PA and u-PAR are increased at different time points after PTE and are further enhanced after Pro-UK treatment, which promotes endogenous fibrinolysis and thrombus lysis .This is probably related to increased synthesis and secretion of endothelial cells which may be a key thrombolytic mechanism of Pro-UK.②Absence of systemic activation of the fibrinolytic system in Pro-UK multibo-lus treatment sub group means that the regimen is feasible and Pro-UK is fibrin specific .

Objective To evaluate the diagnostic value of deep venous thrombosis(DVT)on lowerlimb venous ultrasonography combined with right ventricular dysfunction (RVD) on transthoracic echocardiography(TTE) in patients with acute pulmonary thrombo embolism(PTE). Methods This prospective multicenter control trial included 520 patients with confirmed acute PTE from 41 hospitals between June 2002 and February 2005.Results The incidence of RVD and DVT was associated with the severity of PTE.There were 57.0%(207/363)patients with RVD,49.6%(1 80/363)patients with DVT,265(73.0%)patients with RVD and/or DVT,and 121(33.3%)patients with combined sign of DVT plus RVD in the whole population.As to major PTE population,206(99.5%)patients had RVD and 121 (58.5%)patients had DVT.In addition,the rate of RVD was much greater in proximal PTE than in lobar PTE and segmental PTE(78.7%,51.4%and 21.7%,respectively,P＜0.001).DVT occurred more frequently in proximal PTE than in lobar PTE and segmental PTE(61.7%,46.8%and 37.0%,respectively,P＜O.001).The incidence of the combined sign was 51.1%,24.3%and 8.7%,respenctively (P＜0.001).Conclusions The incidence of the combined sign of RVD plus DVT was associated with the severity of PTE and the localization of emboli.The combined sign of RVD plus DVT help diagnose major PTE especially in emergency department.

Objective To evaluate the valRe of Geneva score,plasma D-dimer lUmitel,lower extremity compressive ultrasonography and transthoracic echocardiography,as well a8 their combination,in diagnosis for suspected pulmonary thmmboernbolism(PTE)and its exclusion.Methods In total,139 confirmed FrrE patients were enrolled in the study,with 50 patients with suspected PTE at admission but excluding PTE after testing as controls,Geneva scores and plasma level of D-dimer were determined,and deep vein uhrasonography in the lower extremity and transthoracic echocardiography were performed for all the confirmed cases of PTE and controls.Diagnostic values were evaluated with each teat index alone or in combination,to confirm or exclude PTE.Results FrrE could be diagnosed by hish Geneva score,with a positive likelihoed ratio more than 10 and it could not be excluded by a negative likelihood ratio more than 0.1 with Latex semi.quantitative method and quantitative methed Latex method P,rE could be excluded by a multi-tests in parallel with negative likelihoed ratio less than 0.1.High Geneva scores,in combination with ultrasonography of the lower extremity and transthoracic echoeardiography in combination with Youden index greater than 0.6 could indicate PTE.Sensitivity and specificity of P1'E diagnosis could be improved by multi-tests in parallel or in series.Conclusions Geneva SCOre is more objective indicator and hish score has diagnostic value for PTE.PTE could be excluded reliably by negative result of multi-diagnostic tests in paralleL Misdiagnosis and under-diagnosis for PTE can be reduced by Geneva score,blood D-dimer level,lower extremity compressive ultrasonogaphy and transthoracic echocardiography,as well as their combination,in parallel in hospitals without ECT or spiral CT.