Objective To evaluate the efficacy and safety of long-term anticoagulation therapy with warfarin in elderly patients with pulmonary thromboembolism (PTE) and the maintenance dosage of warfarin,and provide evidence for anticoagulation therapy. Methods Twenty elderly patients ( ≥65 years old) with PTE whose anticoagulation therapy duration exceeded 12 months were included into this study. The hemorrhage event, recurrence event and the maintenance dosage of warfarin in each patient were determined by the follow-up record. Results Six male patients and 14 female patients [(73.55 ± 5.76) years old] were diagnosed as PTE by CT pulmonary arteriography(CTPA). The average duration of follow-up was (22.60 ± 11.45 ) months. No fatal hemorrhage event such as cerebral hemorrhage was found during the course of long term anticoagulation therapy, and mild hemorrhage was found in 5 patients, including 1 patient with gingiva hemorrhage, 1 patient with epistaxis, 1 patient with hemoptysis, 1 patient with ecchymosis in the left leg and 1 patient with conjunctiva hemorrhage. PTE recurrence emerged in 1 patient and the recurrence rate was 5%.No change was found in the maintenance dosage of warfarin during the course of long-term anticoagulation therapy and the average dosage of warfarin was about 3.5 mg with sufficient anticoagulation therapy.Conclusions Long-term anticoagulation therapy with warfarin in elderly patients with PTE is safe and efficacious. The maintenance dosage of warfarin is about 3.5 mg, and detecting the international normalized ratio regularly is necessary.

Objective To investigate the correlation between plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) and haemodynamics evaluated by right-heart catheterization in patients with chronic thromboembolic pulmonary hypertension (CTEPH).Methods Fifty-three patients with CTEPH were retrospectively reviewed.All patients underwent right-heart catheterization to detect haemodynamics.The level of plasma NT-proBNP was measured by electrochemical luminescence.The indexes were analyzed.Results Pulmonary artery systolic pressure was (84.9 ± 21.6) mmHg (1 mmHg =0.133 kPa).Pulmonary artery diastolic pressure was (31.1 ± 9.7) mmHg.Pulmonary artery pressure was (49.3 ± 13.4) mmHg.Pulmonary vascular resistance was (1 047.4 ± 86.1) dyn ·s/cm5.Pulmonary capillary wedge pressure was (8.16 ± 3.02) mmHg.Right cardiac output was (3.36 ± 1.42) ml.Right cardiac work was (1.97 ± 0.95) kg·m.The level of plasma NT-proBNP in CTEPH was (2 301.5 ± 1 787.3) ng/L.The level of plasma NT-proBNP in CTEPH had positive correlation with pulmonary vascular resistance (r =0.429,P =0.02),and had negative correlation with right cardiac output (r =-0.583,P＜ 0.01) and right cardiac work (r =-0.521,P ＜ 0.01).The level of plasma NT-proBNP in CTEPH had no correlation with pulmonary artery systolic pressure,pulmonary artery diastolic pressure,pulmonary artery pressure,pulmonary capillary wedge pressure (P ＞ 0.05).Conclusion The level of plasma NT-proBNP can be used as a better predictor for evaluating pulmonary vascular resistance and right cardiac function in CTEPH.

Objective To investigate the injury posterior vertebral pedicle nail fixed treatment of thoracolumbar fractures of the clinical efficacy and safety .Methods Forty-eight cases of thoracolumbar fractures were treated by the posterior vertebral pedicle screw fixation ,according to cases decompressive laminectomy ,underwent intertransverse fusion treatment .Postoperative follow-up of 1 year ,preoperative ,postoperative 3 months ,after 1 years of vertebral compression rate ,Cobb Angle were compared .Results Forty-eight patients with postoperative 3 months and 1 year after injury postoperative spinal vertebral body compression rate were significantly decreased compared with preoperative (P<0 .05);After 3 months and 1 year after the Cobb Angle were markedly sig-nificant reduction than preoperative(P<0 .05) .X-ray showed all fractures were obtained good reduction ,internal fixation with no looseness or breakage ,no protruding after spinal deformity ,neural function were all in 1 -3 level recovery .Conclusion Posterior vertebral pedicle injury by nail fixed treatment of thoracolumbar fractures with fixed reliable ,reset effect is good .

Purpose　To investigate the pathomorphological and immunohistochemical features of gastrointestinal stromal tumors (GIST). Methods　Light microscopy was used to study the morphologic characteristics of 77 cases of GIST. The expression of c-kit(CD117), CD34, vimentin, SMA and S-100 protein were detected in all cases with S-P immunohistochemical method. Results　GIST tended to have a higher degree of cellularity and lesser degree of cytoplasmic eosinophilia than observed in classic leiomyomas. The neoplastic cells of GIST were spindle, epithelioid or both in different proportion. Focal to prominent cytoplasmic vacuolization was often seen. The histological spectrum included interlacing fascicles, diffuse sheets, storiform and palisading pattern. The formation of cell clusters was rather special. Stromal and vascular hyalinization was common. GIST primary in the mesentery tended to have a higher potentiality of malignancy. The positivity of CD117 and CD34 were 90%, 92%, respectively. Conclusion　The characteristic histological features exist in GIST. The detection of CD117 and CD34 is helpful to differential diagnosis.

Objective:To revise the Psychological Security-insecurity Questionnaire(S-I) developed by Maslow and examine its reliability and validity.Methods:Data were collected from 1893 junior middle school students with the original S-I.Results:The revised S-I consisted of 44 items,including 10 first-order factors and 3 second-order factors.It had good test-retest reliability,homogeneity reliability and criterion validity.Conclusion:The revised S-I has satisfying reliabilities and validities,and is suitable to asses the psychological security and insecurity for Chinese junior school students.

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.

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 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 explore the changes of the serurn cardiac enzymes in patients with acute massive pulmonary thromboembolosm(PIE),sub-massive PTE and non-massive FIE between pre-therapy and past-therapy and its relationship.Method The prospective multi-centres trial included 519 patients with confirmed PTE from 24 joint hospitals in Beijing,consisting of 54 massive FIE,195 sub-massive PTE and 270 non-massive PIE.Thrombolytic treatment was used in massive and sub-massive PTE patients with employment of urokinase and recombinant tissue plasminogen activator(rt-PA),and anti-coagulative therapy with unfractionated heparin and low molecular heparin was used in non-massive PTE.Results(1)The values of serum CPK and LDH in massive PTE patients before therapeutical intervention were obfiously higher than those in sub-massive and non-massive PTE patients(P<0.01);(2)Of 45 patients with high pulmonary pressure,24(54.4%)patients had high serum LDH(P<0.01).Of 169 patients with right ventrieular dysfunction,68(40.2%)ones has high serum LDH(P=0.049).Of 48 patients suffered from poor prognosis,15(30.8%)ones had high serum.LDH(P=0.039).Conclusions ①The vMues of serum CPK and LDH in acute PTE patients increase without elevation of CK-MB.②Serum LDH associates with pulmonary presure,right ventrieular function and prognosis.

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.