Objective To observe the effect of neuromuscular electric stimulation (NMES) on post-stroke dysphagia (PSD). Methods Two hundred patients with swallowing dysfunction after stroke were randomly divided into a control group with 67 cases and a study group with 133 cases. All patients received pharmacotherapy and swal-lowing training. The study group also received NMES. The study group was sub-divided into unilateral and bilateral cortical stroke sub-groups, an ischemic stroke sub-group and a hemorrhagic stroke sub-group. The swallowing levels of the groups were compared after 2 courses of treatment with NMES. Results After an average of 20 days of NMES treatment, the level of dysphagia and its severity improved significantly. The patients with dysphagia due to unilateral stroke improved, on average, more than those with bilateral stroke. Patients with dysphagia due to ischemic stroke improved more than those with hemorrhagic stroke. Conclusions NMES therapy combined with rehabilitation train-ing can significantly improve swallowing in patients with PSD.

Objective To investigate the clinical characteristics, risk factors and prevention measures of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection. Methods Thirty-nine cases whose CRKP isolation and culture were positive and who were confirmed with nosocomial infection in 2nd affiliated hospital medical school of Zhcjiang University between July 2006 and July 2008 were retrospectively investigated. Results There were 22 (56.4%) sputum specimens among CRKP samples. The average age of the patients was 64.0 years old and the average length of staying in hospital was 80.8 days. There wcre 36 patients who had been in intensive care unit (ICU) within 2 weeks and 26 were conscious disturbance,38 received urethral catheterization, 34 inserted with central venous catheter, 32 received tracheal intubation and 30 assisted with mechanical ventilation. There were 27 (69. 2 % ) patients who were co-infected with other bacteria and 8 were co-infccted with fungi. The mortality was 46. 2% in patients with CRKP infection. Before CRKP-positive culture, 27 (69.2%)experienced ＞4 kinds of antibiotics with the majority of β-lactams/β-lactamase inhibitors and carbapenems.Conclusions CRKP infection frequently occurrs in elder and patients who prolonged stay in hospital,especially patients in ICU. Invasive procedures could increase the infection opportunities.

OBJECTIVE:To investigate the market demand for residence drug allocation and dispatch in Kunming. METHODS:A questionnaire was carried out about the residence drug allocation and dispatch market in plan.RESULTS & CONCLUSION:The target market of residence drug allocation and dispatch is initially established,and the market holds the promising future in Kunming.

Objective] To sum up director doctor He Ruoping’s by stages treatment experience in treating bladder cancer. [Method]By learning from director doctor He Ruoping for many years and combining my own clinical experience, from the etiology and pathogenesis, therapeutic principle of TCM syndrome differentiation treatment characteristics, etc, it sums up the teacher He ’s unique feature of by stages treatment of bladder cancer, and with 1 case for detailed explanation. [Result]Teacher He advocating the combination of traditional Chinese medicine and western medicine, puts forward the principle of by stages treatment to bladder cancer:treatment of postoperative perfusion stage, treatment of following up stage without perfusion and treatment of palliative transfer stage, and makes prescriptions in line with the characteristics of each stage. [Conclusion] Teacher He ’s by stages treatment to bladder cancer obtains the good curative effect, having enlightenment meaning to clinical practice, with promotion value.

Objective To analyze the efficacy and the safety of ultrasound guided multiple-spot sector stereotaxis in unipolar cooling cycle radiofrequency ablation treatment of adrenal malignant tumors.Methods 36 adrenocortical carcinoma primary or metastatic tumors were treated with ultrasound guided percutaneous radiofrequency ablation by the multiple spot sector stereotaxis in unipolar cooling cycle.All patients were performed contrast enchanced ultrasound (CEUS) 15 minutes after treatment to determine whether the tumors were completely inactivated,if did not completely inactivated based on the imaging,the same therapy can be repeated.To evaluate response,contrast-enhanced CT scans (CECT) or CEUS were obtained 1 month after the procedure,if did not completely inactivated,the same therapy can be repeated.Before and after the procedure,the blood cortisol,adrenocorticotropic hormone (ACTH) and sugar level were detected and compared respectively.Results The efficacy:in the 36 lesions,31 lesions were inactivated and 5 lesions were residual by realtime CEUS.32 lesions were inactivated and 4 lesions were residual by CECT one month after the RFA therapy.There were no significant differences between the two groups(x2 =0.127,P =0.722).The hormone level:the blood cortisol,ACTH and sugar level were recovered normal after the therapy.The complication and adverse reaction:①Pain:all the patients felt slight pain and thermal expasion of the ablation region,among them,19 patients felt obvious pain were relieved after using analgesic.② Fluctuation of heart rate:14 patients' heart rate were slowed down,it was reached to 25-55 beats per minute,0.5mg atropine was given by intravenous injection to make the heart rate return to normal.③ Fluctuation of bloodpressure:9 patients' bloodpressure were elevated in the procedure,systolic pressure was 21-28 kPa,diastolic pressure was 13-19 kPa,5 mg nicardipine was given then relieved.There was no serious complication and dead cases in all the patients.Conclusions RFA is a safe and effective procedure for the treatment of adrenal malignant tumors and has great value in clinic applications.

Objective To determine the effect of apoptosis in different host cells induced by L. in- terrogans and the associated intracellular signaling pathway. Methods L. interrogans serogroup Icterohaem- orrhagiae serovar icterohaemorrhagiae strain Lai infected cell models in mouse mono-macrophage like cell J774A. 1, human EVC304 cells and A549 cells were established, respectively. Flow cytometry with fluores- cein labeling of FITC-Annexin V/PI was performed to examine the apoptosis or necrosis of the infected cells. Fluorometry as well as Western blot assay was applied to measure the activity of caspase-3, -8, -9 and the expression levels of apoptotic associated protein FADD in the infected cells , respectively . Results 36.70%-63.70% of the L. interrogans strain Lai infected J774A. 1 cells displayed obvious early apoptosis during the infection for 1-6 h, and then altered to later apoptosis / necrosis (53.68%) as the major injury pattern when infected for 12 h. 78.52% of the L. interrogans strain Lai infected A549 cells only showed later apoptosis / necrosis. However, no obvious apoptosis and / or necrosis could be found in the L. interrogans strain Lai infected EVC304 cells. The maximal activities of caspase-3 and -8 in the infected J774A. 1 cells were (1453.41±36.07) and (1402.15± 59.09) FU, respectively, which were the 16.38-fold and 29.99- fold of those the non-infected cells. The caspase-9 activity of the infected J774A. 1 cells slightly increased [(89.42±5.08) FU ], which significantly lower than those of caspase-3 and -8 (P <0.001). The FADD expression level of the infected J774A. 1 cells was gradually increased in an infection time-dependent man- ner. Conclusion There is a distinct diversity of apoptosis in different cells induced by L. interrogans, and FADD→caspase-8→caspase-3 is the major signaling pathway to mediate L. interrogans infection associated cell apoptosis.

Objective To compare the effect of Buzhong Yiqi Decoction (BYD) containing different doses of Radix Astragali on fibulin-3 expression in the hemorrhoid tissues of stage Ⅲ internal hemorrhoids patients with spleen deficiency and sinking of qi, and to evaluate its therapeutic efficacy and possible mechanism. Methods Fifty-five qualified patients were randomly divided into control group(N = 15), Chinese medicine group 1(N =20), and Chinese medicine group 2(N=20). All of the 3 groups were treated with operation, and additionally, Chinese medicine group 1 was given BYD containing Radix Astragali 20 g, and Chinese medicine group 2 was given BYD containing Radix Astragali 50 g orally after operation. The scores of anal pendant expansion and anal prolapse were evaluated, and the expression level of fibulin-3 in the hemorrhoid tissues was detected by Western blot method. Results After treatment, the symptoms of anal pendant expansion and anal prolapse were improved in the 2 Chinese medicine groups (P < 0.05) , and the improvement of anal pendant expansion symptom in Chinese medicine group 2 was superior to that of Chinese medicine group 1(P<0.05). Compared with the control group, the expression level of fibulin-3 in the hemorrhoid tissues of the two Chinese medicine groups was increased (P < 0.05); the expression level of Chinese medicine group 2 showed an increasing trend as compared with that of Chinese medicine group 1, but the difference was statistically insignificant (P > 0.05). Conclusion BYD with large dose of Radix Astragali exerts stronger therapeutic efficacy for the treatment of prolapsed hemorrhoids than BYD with small dose of Radix Astragali, and its therapeutic mechanism has no obvious relation with promoting the increase of fibulin-3 expression.

BACKGROUND: It has been reported that nanosilver-containing biomaterials produce bad biological effects after they directly contact with or are implanted into human body.OBJECTIVE: To investigate whether nanosilver yields potential adverse biological effects on human body and to evaluate its bioiogical safety.DESIGN, TIME AND SETTING: An animal experiment observation was performed at the Medical Device Center of National Institute for the Control of Pharmaceutical and Biological Products from June 2005 to August 2006.MATERIALS: Nanosilver particles and microsilver particles were purchased from Sigma Company, USA.METHODS: Thirty rats were randomly divided into 3 groups, with 5 male and 5 female rats per group: nanosilver, microsilver, and blank control. Nanosilver and microsilver particles were respectively and subcutaneously implanted for subchronic toxicity test.The nanosilver and microsilver groups were given 0.33 g/kg nanosilver and microsilver, respectively. Rats from the blank control group received identical procedure, with the exception of drug application. Four rats were selected from each group for determination of silver content in serum and some organs by plasma mass spectrometry.MAIN OUTCOME MEASURES: serum biochemical indices, organ coefficient, and silver content.RESULTS: There was significant difference in individual organ coefficient between each drug application group and blank control group. But no significant difference in absolute mass was found between each drug application and the blank control group.These findings suggested no clinical significance of organ coefficient. Other organ coefficients were in the normal range, and there was no significant difference between each drug application group and the blank control group. Patho-histological changes related to toxicity were not found. Rats from the nanosilver group did not show toxic reaction.CONCLUSION: Nanosilver produces potential adverse biological effects after implanted into human body.

Objective:To evaluate the effects of neuregulin-1 (NRG-1) pretreatment on diaphragmatic function in septic rats.Methods:Twenty-six clean-grade healthy adult male Sprague-Dawley rats, weighing 220-260 g, were divided into 3 groups using a random number table method: sham operation group (group S, n=6), sepsis group (group Sep, n=10) and NRG-1 group (group N, n=10). Sepsis was induced by cecal ligation and puncture in anesthetized rats.Group S underwent simple laparotomy.At 30 min before operation, recombinant human NRG-1β 10 μg/kg was injected through tail vein in group N, while the equal volume of normal saline was given in S and Sep groups.At 24 h after operation, the survived rats were sacrificed, and the diaphragm was removed for determination of the contractile function and contents of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) (by enzyme-linked immunosorbent assay) and for examination of the pathological changes (by hematoxylin and eosin staining). Results:Compared with group S, the force-frequency curve was shifted downward, and the levels of TNF-α and IL-6 were increased ( P<0.01), inflammatory cell infiltration was observed in Sep and N groups.Compared with group Sep, the force-frequency curve was shifted upward , and the levels of TNF-α and IL-6 were decreased ( P<0.01), inflammatory cell infiltration was alleviated in group N. Conclusion:NRG-1 pretreatment can improve diaphragmatic contractile function in septic rats, and the mechanism is related to reducing diaphragmatic inflammatory responses.

Objective : To evaluate the excess mortality risk related to heat wave in Ningbo, Zhejiang from 2013 to 2018, so as to provide a basis for formulating coping strategies for heat wave. Methods : The data of daily mortality, meteorological and air quality from May to October in Ningbo from 2013 to 2018 were obtained from Ningbo Center for Disease Control and Prevention, Ningbo Meteorological Bureau and Environmental Monitoring Center of Ningbo, respectively. The generalized linear model ( GLM ) and distributed lag non-linear model ( DLNM ) were used to estimate the associations between heat wave and cause-specific mortality. Results : Among 1 104 days of the study period, 18 heat waves occured and lasted for 132 days, accounting for 11.96%. A total of 102 954 deaths were reported in the same period. The risks of mortality in circulatory system diseases ( RR=1.09, 95%CI: 1.03-1.16 ), respiratory system diseases ( RR=1.14, 95%CI: 1.04-1.25 ), digestive system diseases ( RR=1.38, 95%CI: 1.15-1.65 ), nervous system diseases ( RR=1.32, 95%CI: 1.08-1.61 ), mental disorders ( RR=1.51, 95%CI: 1.12-2.03 ) and accidental injury ( RR=1.18, 95%CI: 1.06-1.32 ) and all causes ( RR=1.10, 95%CI: 1.06-1.14 ) increased at lag 0-1 day of heat wave. The total excess death related to heat wave was 1 218 ( 95%CI: 731-1 705 ) . The excess deaths of circulatory system diseases, respiratory system diseases, accidental injury, digestive system diseases, nervous system diseases, mental disorders, urinary system diseases and endocrine system diseases were 313 ( 95%CI: 104-556 ), 206 ( 95%CI: 59-368 ), 164 ( 95%CI: 55-292 ), 122 ( 95%CI: 48-208 ), 69 ( 95%CI: 17-131 ), 56 ( 95%CI: 13-113 ), 18 ( 95%CI: -15-64 ) and 3 ( 95%CI: -51-72 ). The excess deaths of urinary system and endocrine system diseases was not statistically significant ( P>0.05 ). Conclusion Heat wave can increase the mortality risk on the day and after a day in Ningbo from 2013 to 2018. Circulatory system diseases, respiratory system diseases and accidental injury rank top three in excess deaths.