The normal value of cardiac output and relative indices of cardiac function were determined using Doppler ultrasound technique,by means of measurinp the blood flow velocity in the ascending aorta on a level with the suprasternal notch,in 358 healthy adults aged 20 to 81 years(mean 46?16)in the Kunming area.The diff- erences of the indices of the cardiac function among persons prouped on the basis of age were analysed.The effects of sex,body size and particularly aging and the changes of the aortic dimension,ejection time and heart rate associated with aging on the cardiac function were studied using the method of multivariate aoalysis.

In order to explore the influence of age and some related factors on cardiac dimensions,more than 300 healthy adults 20-81(average 46?16)years old were studied by echocardiography. By stepwise regression analysis and multiple covariance analysis,it was shown that the left ventricular wall thickness increased with age gradually,but no significant change was found in the diastolic left ventricular internal diameter.The ratio of the interventricular septum(IVS)/left ventricular posterior wall(LVPW)thicknesses increased with age,sug- gesting that the increment of thickness of IVS appeared more than that of LVPW,so that the left ventricular outlet decreased slightly with aging.The left atrium,aortic root and right ventricular chamber were found to be dilated slightly with advance in age.The diastolic mitral valve EF slope reduced with aging,probably reflcting the decrease of left ventricular compli- ance and of elasticity of the valve. In addition,it was also found that there was a sexual difference in some cardiac measurements,and many cardiac dimensions correlated with body size and blood pressure. The sources of differences in cardiac dimensions among various age groups and the rela- tionship among cardiac dimensions were analysed and discussed. In conclusion,the effects of age,sex,body size and blood pressure should be considered in clinical evaluation of cardiac dimensions by echocardiography.

The infrapopliteal arteriosclerosis occlusive disease mainly involves the anterior tibial artery,posterior tibial artery and fibular artery.For the arteriosclerosis occlusive disease of larger arteries of lower extremity,such as iliac artery,femoral artery,etc.,the interventional therapy pattern has been already very mature.However,as the infrapopliteal artery is fine in diameter and the lesion is usually wide with extensive calcification,it is hard to effectively treat the infrapopliteal arteriosclerosis occlusive disease with routine interventional therapy.The therapeutic methods of infrapopliteal arteriosclerosis occlusive disease mainly include surgical treatment,endovascular treatment,drug therapy,and the autologous stem cell transplantation therapy that is still in the research stage at present.This paper aims to introduce the latest progress in interventional therapy for the treatment of infrapopliteal arteriosclerosis occlusive disease in recent years,and to make a prospect for clinical practice in future.

Objective To study the preventive effects of selective bile ductal cannulation using an aqua-coat tipped Metro tracer guidewire on pancreatitis and hyperamylasemia after ERCP. Methods A total of 291 patients with biliary disease were enrolled in the study. The patients were randomized into the guidewire group (n= 149) and the control group (n= 142). In the guidewire group, the bile duct was first accessed by insertion of an aqua-coat tipped Metro tracer (diameter 0. 029 inch) guidewire through a 5.5Fdouble channel ERCP-tube to judge the bile duct by the direction of guidewire. As soon as cannulation was accomplished, the guidewire was removed to allow injection of contrast medium and other therapeutic manipulation. In the control group, the bile duct was opacified by the traditional method of cannulation of the biliary tree followed by single ERCP-tube cannulation, judgment of the bile duct by injection of contrast medium and performance of other therapeutic procedures. The incidences of post-ERCP pancreatitis and hyperamylasemia were compared between the 2 groups. Results The selective bile ductal cannulation was successfully conducted in 145 patients in the guidewire group and 138 in the control group. The incidences of post-ERCP pancreatitis and hyperamylasemia were significantly lower in the guidewire group than in the control group. Pancreatitis tended to be less severe for patients in the guidewire group. Conclusion Using the Double-Crossing method in selective bile ductal cannulation with an aqua-coat tipped Metro tracer guidewire reduced not only the frequencies of post-ERCP pancreatitis and hyperamylasemia but also the severity of post-ERCP pancreatitis.

Objective To explore the superiority and clinical efficacy of endoscopic thyroidectomy via breast approach in treatment of thyroid diseases .At the same time evaluation of endoscopic application value in the treatment of the disease .Methods Retrospective analysis of menstrual breast approach endoscopic 20 patients with benign thy-roid tumor patient clinical data ,and with the same period in 20 cases of thyroid cancer patients underwent convention-al operation of undergraduate clinical comparativeanalysis .Results Cavity mirrors the operative time , intraoperative blood loss,postoperative flow,length of hospital stay,postoperative complications and beauty satisfaction respectively (97.2 ±15.6)min,(17.8 ±8.6)mL,(30.2 ±11.8)mL,(4.7 ±0.9)d,15%,90%;the traditional group respec-tively(70.3 ±19.0)min,(24.6 ±15.2)mL,(35.6 ±19.6)mL,(5.2 ±0.6)d,10%,30%.Two groups of postoper-ative hospital stay,led traffic,beauty satisfaction difference had statistical significance (t=-2.203,-2.427,χ2 =54.432,all P<0.05).Conclusion Laparoscopic operation for treatment of thyroid disease has the advantages of small operation wound ,fewer complications ,and without scar on the neck ,which is an ideal minimally invasive opera-tion treatment .

Objective To analyze the related factors and the independent risk factors of death in patients with multiple injuries. Methods Data of 651 patients with multiple injuries treated in our hospital from June 2012 to June 2015 were retrospectively analyzed. According to the outcomes, patients were divided into effective group (n=608) and death group (n=43). Data of gender, age, cause of injury, the primary diseases related with the trauma, ISS score, number of trauma, time from injury to the treatment and the body parts of injury were compared between two groups. Logistic regression analysis was used to analyze the risk factors of death in multiple trauma patients. Results The proportion of patients≥60 years old, ISS score≥16 points, the number of trauma≥4, a major brain injury and time of trauma to the treatment ≥3 h were higher in death group than those of effective group (P<0.05). The independent risk factors for emergency death in multiple injuries included patients≥60 years old, major brain injury, ISS score ≥16 points and time of trauma to the treatment ≥ 3 h. The cause of death in patients with craniocerebral trauma (cerebral laceration) accounted for up to 27.91%(n=12), intracranial hematoma accounted for 20.93% (n=9), and traumatic hemothorax accounted for 11.63% (n=5). Conclusion The related factors and independent risk factors should be paid attention to doctors in emergency department, and the emergency plan should be made to reduce the death rate of emergency patients with multiple injuries.

Objective To observe CT characteristics of primary retroperitoneal malignant fibrous histiocytoma (MFH). Methods CT images and clinical data of 25 patients with primary retroperitoneal MFH proved pathologically were reviewed and analyzed retrospectively. Results A total of 37 lesions were identified in 25 patients, in which 17 had single lesion and 8 had multiple lesions, with mean diameter of the tumor of 12.85 cm, including 32 light lobulated and 5 round-shaped lesions. Among all 37 lesions, 28 were well-defined and the others had unclear border, while 7 masses were homogenous in density and the other 30 were inhomogenous with necrosis, cysts, bleeding or calcification. All lesions enhanced in various degrees with slight enhancement in arterial phase and moderate enhancement in venous phase. All the patients underwent immunohistochemistry examination, and the positive rate of Vimentin, CD68, AACT, S-100, CKpan and EMA were 94.74%, 90.48%, 88.24%, 0, 0 and 15.00%, respectively. Conclusion Primary retroperitoneal MFH have some specific CT manifestations that being helpful to the diagnosis, but final diagnosis depends on the cytopathology and immunohistochemistry.

Objective to evaluate the validation of atypical depression among Chinese outpatients with depressive episodes and explore the role of atypical depressive symptoms in distinguishing bipolar depression from unipolar depression.Methods Structural clinical interviews with self-compiled questionnaires were performed on 276 outpatients with current depressive episode,then comparison of clinical characteristics including age of onset,gender proportion,seasonality,comorbidity of anxiety disorder,bipolar property,psychotic features,number of depressive episodes,and maximum duration of depressive episode were conducted between atypical (defined by DSM-Ⅳ-TR) and nonatypical depression.then the rate of atypical depressive symptoms were compared between unipolar depression and bipolar depression.Results The proportion of atypical depression among all the participants was 23.9％.Compared to nonatypical depression,psychotic features were more likely seen in atypical depression (20.0％ vs 9.1％,P＜0.05),but no difference was found in other clinical features between atypical and nonatypical depression.Except mood reactivity,atypical symptoms including oversleeping(45.5％ vs 26.0％),overeating (22.7％ vs 15.4％),weight gain(24.1％ vs 14.6％),leaden paralysis (56.6％ vs 47.2％),interpersonal rejection sensitivity(66.7％ vs 34.2％) were more likely to occur in bipolar depression than in unipolar depression,the difference was statistically significant for oversleeping and interpersonal rejection sensitivity (P ＜ 0.05).Patients with mood reactivity differed little from those without mood reactivity in other clinical features.No association was found between mood reactivity,leaden paralysis and other criteria symptoms of atypical depression.Conclusion-Atypical depression might be a useful concept,but its diagnostic criteria needs further validation among Chinese population.

Objective To test the efficacy of cognitive behavioral self help therapy for chronic insomnia (CBTI-SH) patients with hypnotic long-term use.Methods A total of 60 adults with chronic insomnia and common comorbidities were recruited.Participants were randomly assigned to either intervention group (IG,n =30) if they had used hypnotics more than 6 months,or control group(CG,n =30) if they had never used hypnotics in the past 6 months.All the patients were given CBTI-SH for 4 weeks.The primary outcome was self-report symptom,based on sleep diaries (including Sleep Latency(SL),Wake after Sleep Onset(WASO),Total Sleep Time(TST),Time In Bed(TIB),Sleep Efficiency(SE) which were evaluated on baseline and at the end of the 2nd,4th week treatment.Continuous variables were evaluated by repeated-measures multivariate analyses of variance (MANOVA).At the conclusion of treatment,each participant was asked how many days per week they enacted each of 6 core elements of the CBT regimen.Linear regression models were examined to determine net predictors of CBTI-SH adherence.Results The MANOVA showed a significant treatment group × time interaction,as well as time main effects for SE,TIB and WASO(P＜0.05).The patients in CG made better improvements than those in IG on SE,TIB and WASO((0.19 ±0.08) vs(0.09 ±0.09),(92.48 ± 32.64) vs (78.06 ±60.05),(103.08 ±64.82) vs (64.92 ±56.36),respectively) (P ＜ 0.05).Effect size were 1.14,0.85 and 0.62 respectively.Self-ratings of treatment adherence showed patients in the IG reported less adherence to standard rise time and TIB prescription than those in CG.(P ＜ 0.05).According to the linear regression models,both age and the comorbidity of chronic somatic diseases explained net associations with CBTI-SH adherence (P ＜ 0.05).Conclusion Chronic insomnia patients with hypnotic long-term use show less sleep improvement and less adherence to CBTI-SH compared with those who don' t use these medicines.Both age and the comorbidity of chronic somatic diseases explain net associations with CBTI-SH adherence.

Objective To analyze the clinical efficacy of balloon occlusion of distal abdominal aorta for patients with pernicious placenta previa and placenta accreta.Methods Data of 72 patients with pernicious placenta previa and placenta accreta were retrospectively analyzed.There were 53 cases (occlusion group) reserved balloon occlusion in abdominal aorta before cesarean section,which can temporarily blocked abdominal aortic blood flow during operation.The other 19 cases (non-occlusion group) underwent cesarean section without balloon occlusion of abdominal aorta.The intraoperative,post operative situations and the birth state of newborn of the two groups were compared.Results The bleeding,blood transfusion and hysterectomy rate during the operation in occlusion group were less than those in non-occlusion group (all P＜ 0.05).Differences of the rate of postoperative transferring to intensive care unit (ICU) and the time in ICU were statistically significant between two groups (both P ＜0.05).No statistical difference of operation time,postoperative total hospital stay time and the rate of postoperative infection was found between two groups (both P＞0.05).There was no statistical difference of newborns weight and Apgar scores (5 min and 10 min after birth) between two groups (all P＞0.05).Conclusion The balloon occlusion of distal abdominal aorta in cesarean section for patients with pernicious placenta previa and placenta accreta is safe and feasible,which can effectively reduce the intraoperative bleeding,the blood transfusion and the risk of hysterectomy.