Objective: To compare patent foramen ovale (PFO) detected by transesophageal echocardiography (TEE) between patients with PFO complicated paradoxical cerebral embolism (PCE) and those PFO without symptom.Methods: A total of 132 PFO+PCE patients from our hospital were regarded as PFO+PCE group, another 80 patients with asymptomatic PFO identified by physical examination were collected as asymptomatic PFO group.Both groups received esophageal multi-faceted echocardiography at rest and during Valsalva manoeuvre and right ventricular acoustics angiography.PFO size, shunt degree, presence of atrial septal aneurysm.Eustachian valve and PFO tunnel length were recorded.Results: Compared with asymptomatic PFO group, there were significant rise in PFO size [(1.2±1.2)mm vs.(3.8±1.3)mm], PFO tunnel length [(11.2±5.6) mm vs.(13.0±5.8) mm], proportions of large shunt (2.5% vs.41.7%), atrial septal aneurysm (16.3% vs.47.7%) and Eustachian valve (13.8% vs.46.2%) in PFO+ PCE group, P<0.05 or <0.01.Conclusion: The foramen ovale of PFO+PCE patients is usually bigger, typically complicated with large shunt, atrial septal aneurysm and Eustachian valve, and foramen ovale tunnel is longer.These morphological characteristics may be meaningful for paradoxical cerebral embolism.

Objective: To study the correlation between serum N terminal pro brain natriuretic peptide (NT-proBNP) concentration and mean pulmonary arterial pressure (mPAP) in patients with congenital heart disease (CHD). Methods: According to mPAP level, a total of 62 CHD patients undergoing transcatheter closure were divided into non- pulmonary artery hypertension （PAH）CHD group (n=26), CHD + mild PAH group (n=17), CHD + moderate PAH group (n=12) and CHD + severe PAH group (n=7). Another 20 healthy subjects in the same period were selected as healthy control group. The changes of serum NT-proBNP concentration was compared among all groups before, 24h and three months after operation. Correlation between NT-proBNP concentration and mPAP was analyzed before transcatheter closure. Results: Compared with healthy control group, there was significant rise in serum NT-proBNP level in all CHD groups before operation, and it significantly elevated along with mPAP increased [healthy control group (34.0±16.8) pg/ml vs. CHD non-PAH group (68.0±20.2) pg/ml vs. mild PAH group (116.7±43.5) pg/ml vs. moderate PAH group (273.1±64.2) pg/ml vs. severe PAH group (326.5±50.2) pg/ml, P<0.01? all]; linear correlation analysis indicated that serum NT-proBNP concentration before operation was positively correlated with mPAP in 62 CHD patients (r=0.604, P=0.002). On 24h after transcatheter closure, NT-proBNP concentration was significantly higher than before operation in all groups, but it possessed significant difference only in non-PAH CHD group [(98.9±22.1) pg/ml vs. (68.0±20.2) pg/ml, P<0.05]. NT-proBNP concentration was significantly lower than before operation in all CHD groups after three months (P<0.01? all). Conclusion: Serum NT-proBNP level rises along with pulmonary arterial pressure increased in patients with congenital heart disease, which could be used as an index judging severity of pulmonary artery hypertension and prognosis in these patients.

Objective To compare the effect of pancreatic duct stent internal versus external drainage in the prevention of postoperative complications after pancreaticoduodenectomy through the method of Meta analysis.Methods PubMed,Embase and the Cochrane Library,were searched for randomized controlled trials (RCTs) concerning pancreatic duct stent in the prevention of postoperative complications after pancreaticoduodenectomy.All these databases were searched from their establishment to March 31,2015.The data was reviewed and extracted by two investigators independently.Then,the Cochrane network RevMan 5.3 software was used for statistic analysis.Results As a result,this meta analysis has got 3 RCTs,including 362 participants.The outcomes in our study design were classified as major and minor one.The former was the outcomes of the major postoperative complications,like postoperative pancreatic fistula and delayed gastric emptying.The minor outcome were postoperative morbidity,mortality and intestinal obstruction.The results of meta analysis were:(1) Postoperative total pancreatic fistula rate (A/B/C):three studies showed a statistic difference between the internal and external drainage groups (OR =0.59,95％CI:0.36-0.97,P =0.04).(2) Postoperative pancreatic fistula rate (B/C):three studies showed a statistic difference between the internal and external drainage groups (OR =0.44,95％ CI:0.20-0.97,P =0.04).(3) Postoperative incidence rate of delayed gastric emptying:three studies showed a certain statistic difference between the internal and external drainage groups (OR =0.42,95 ％ CI:0.23-0.79,P =0.007).(4) Post-operative incidence rate of total mortality:three studies showed no certain statistic difference between the internal and external drainage groups (OR =0.81,95 ％ CI:0.23-2.86,P =0.74).(5) As for the postoperative incidence rate of total complications and intestinal obstruction,the heterogeneity was bigger than 50％.So we made an analysis of the cause of heterogeneity.We deduced that it may be caused by the different and complicated perioperative management.Then,we used the random effect model rather than the fixed effect model to make a quantitative analysis.No statistical difference was found eventually in both this two marks.Conclusions By comparing the outcomes in both internal and external drainage groups,we found pancreatic duct stent external drainage could effectively decrease the incidence rate of postoperative pancreatic fistula rate and delayed gastric emptying.But when the limit studies and sample size considered,this conclusion still need to be certificated with more high-quality clinical research.

[Abstract ] Objective Chronic renal disease,a common and frequent disease,is the most cause inducing chronic renal failure. There is an important guiding significance for renal biopsy in the diagnosis,treatment and prognosis of renal disease.The aim of this study was to analyze the characteristics of renal biopsy and the relation between pathological types and clinical presentation in Tibet. Methods Between June 2011 and December 2013 in General Hospital of Tibetan Military Command, Lhasa, percutaneous renal biopsy were per-formed in 107 renal patients.In this study, the gender, age, pathologic entities, and clinical manifestation were analyzed retrospectively. The final diagnosis was made by the clinical manifestation, laboratory examination,and pathologic results. Results The mean age at renal biopsy was 29.8 ±12.2(10~66)years in 47 male cases (43.9%) and 69 female cases (56.1%).This includes 75 Tibetan cases (70.1%), 31 Han cases (28.9%), and Bai cases (1.0%).The primary glomerular disease was 95.3%and the secondary glomerular disease was 4.7%in the total 107 cases.Fourty-four point three percent of the primary glomerular disease were male cases and 100%of secondary glomerular disease were female cases.The main pathological type of the primary glomerular disease was podocyte nephropathy (43.9%), followed by membranous nephropathy (18.7%), IgA nephropathy (11.2%), focal segmental glomerulosclerosis (9.3%) and mesangiocapillary glomerulonephritis (5.6%).The clinical manifestations of 107 cases were classified as syndrome of nephrotic syn-dromn(69.1%),urinary abnormalities(14.9%),isolated macrographic haematuria (3.7%),chronic renal failure(2.8%).Among the nephrotic syndrome,podocyte disease was 63.5%,membranous glomerulopathy was 18.9%,focal segmental glomeruolsclerosis was 8.1%,and membranoproliferative glomerulonephritis was 5.4%. Conclusion The primary glomerulonephritis was the most common glomerular diseases at high altitude area in Tibet.The most frequent type of pri-mary glomerular nephritis was podocyte disease, and the most frequent type of secondary glomerular nephritis was Henoch-Schonlein purpura glomerulonephritis.