Objective To study the clinical feature of 26 cases which were diagnosed pathologically as cerebral amyloid angiopathy ( CAA ) and to improve the level of diagnosis.Methods The clinical characteristics of the 26 cases with CAA in our hospital from 1983 to 1999 were retrospectively reviewed and analyzed,including previous history,clinical manifestation,and laboratory examination.Results Of the 26 CAA patients,there were 17 men and 9 women with age ranging from 45 to 78 years.Eight patients (30.7％ ) had the history of hypertension; 6 cases (23.1％ ) suffered from diabetes; 2 patients(7.6％ ) were taking anticoagulant or antiplatelet agents in whom serious CAA and multiple hemorrhages were histopathologically confirmed by autopsy.There were 20 cases diagnosed as cerebral hemorrhage,including 2 patients with single lobe hemorrhage,8 patients with multiple lobe hemorrhage,5 patients with putamen hemorrhage,2 patients with cerebral ganglion hemorrhage,2 patients with cerebellar hemorrhage,and 1 patient with brain stem hemorrhage.Of the 26 CAA patients,there were 2 patients with subaracchnoid hemorrhage,1 patient with hemorrhagic cerebral infarction,1 patient with basal ganglia infarction,1 patient with basilar artery occlusion,1 patient with subdural hematoma.The clinical manifestation of the 20 cases diagnosed as cerebral hemorrhage included headache,limb palsy,coma,and hyperspasmia.Conclusions CAA always begin as cerebrovascular disease symptoms with or without hypertension.The most common manifestation of CAA is lobe hemorrhage,while the CAA-related hemorrhage seldom occurs in basal ganglia,cerebellum and brainstem.CAA can also manifest cerebral infarction and subarachnoid hemorrhage.Anticoagulant (warfarin) or antiplatelet agents (aspirin) maybe a contributing factor for CAA-related hemorrhage.

ObjectiveTo research a way to verify whether the stomach duct is misplaced into the trachea.MethodsThe air pressure of the stomach duct placed in the stomach or in the trachea were measured using a water bottle.ResultsThe air pressure of the stomach duct was (1±0.45)cmH2O When it was put in the stomach, and was (7±2.03)cmH2O when it was put in the trachea(P<0.01).ConclusionsWhen it is impossible to draw out acerbic substances from the stomach to verify whether the stomach duct is placed in the stomach or misplaced in the trachea, measure the air pressure stomach duct by a water bottle can be used as substitute, which is reliable and convenient.

目的观察水封瓶排除偏瘫患者鼻饲前胃管误入气管的效果。方法将胃管与水封瓶连接,检测胃管前端的压力,通过观察水封瓶内的水柱波动范围来判断胃管的位置,以确定胃管是否误入气管。结果此法经过28例,78次测量,无一次判断失误,及时发现4例患者胃管部分脱出。结论用水封瓶检测判断胃管是否误入气管,是一种客观、可靠、简便的方法。

目的探讨住院偏瘫患者的“偷行”行为与跌倒的关系,以防止患者跌伤。方法自制“偏瘫患者偷行动机与行动问卷”调查表,发给404例住院偏瘫患者填写或由他人协助填写。结果56.93%的被调查患者有偷行动机,5.44%有偷行行为,占有偷行动机人数的9.48%,发生跌倒的占有偷行行为的86.36%,跌倒患者中出现跌伤者占10.52%。结论偏瘫患者中普遍有偷行动机,相当一部分患者有偷行行为,偷行者跌倒率高,容易跌伤,故偷行行为是引起住院偏瘫患者跌伤的主要原因之一 ,应引起医护人员重视,并列为评估患者跌倒因素的内容之一。

目的帮助截瘫患者解决便秘的痛苦及促进排便功能的恢复。方法卫生棉条刺激排便和定时排便训练。结果治疗组的有效率为90.49% ,明显高于对照组的33.33%(P<0.01)。结论棉条刺激和定时排便训练能使患者短时间内大量排便并对排便功能的恢复有促进作用。

Objective To know the indication for patients with spinal cord injury during the course of intermittent urethral catheterization.Methods Divided 33 patients with spinal cord injury into the experimental group(18 cases)and control group(15 cases)randomly.The indication of beginning in the experiment group was less than 500 ml transfusion per day,without press ulcer,more than 150 ml bladder capacity.The indication in the control group was＞28 cm H2O pressure of bladder.Compared the effects between the two groups.Results The incidence rate of infection in the experiment group was lower than control group,all the indexes of uretharal catheterization were better in the experiment group than those of in the control group.Conclusions The indication of less than 500ml transfusion per day,without press ulcer,more than 150 ml bladder capacity are proper.

Objective To investigate the effects of a chitosan product on scarring and adhesion after never injury in laminectomy in rats. Methods 48 male Sprague-Dawley rats were divided into group A and group B, and carried laminectomy of L4-5, and injured the right spinal nerve roots. The normal saline was smeared on the operation field in the group A, while the chitosan product was smeared in the group B. The adhesion was assessed with Rydell score 1 (groups A1/B1), 2 (groups A2/B2) and 4 (groups A3/B3) weeks after operation, while the spinal nerves were observed with HE staining and Masson staining, and the adhesion was assessed with Nussbaum score. The complete blood count and the series of blood chemistries and enzymes for liver and kidney functioning were measured. Results The Rydell scores of adhesion was I grade in group A1, II grade in A2 and III grade in A3, while was 0 grade in B1, 0 grade in B2 and II grade in B3. The scar and adhesion contact more loosely in the group B than in the group A, and the Nussbaum score was less in the group B than in the group A at the same time (P<0.05). The complete blood count and the series of blood chemistries and enzymes for liver and kidney functioning were in normal. Conclusion This chitosan product can prevent the formation of epidural scar and adhesion around the spinal and the nerve roots after laminectomy, with little toxicity and side effects.

Objective:To evaluate the relationship between intraoperative concentration of C-X-C motif chemokine 13 (CXCL13) in peripheral blood and postoperative delirium (POD) in elderly patients under general anesthesia.Methods:Ninety-three patients of both sexes, aged 65-85 yr, of American Society of Anesthesiologists physical statusⅠor Ⅱ, scheduled for elective hip replacement under general anesthesia, were selected.Peripheral venous blood samples were collected to determine the concentrations of CXCL13 and interleukin-6 (IL-6) before anesthesia and during surgery (30 min after skin incision). The Confusion Assessment Method Scale in Chinese was used to detect the development of POD every day within 7 days after surgery in 2 groups.The patients were divided into POD group and non-POD group.Logistic regression analysis was used to identify the risk factors for POD.Results:Seventeen patients developed POD (19%). There was significant difference in ages, preoperative mini-mental state examination (MMSE) scores before surgery, hospital stay time and intraoperative concentrations of CXCL13 and IL-6 in peripheral blood between group non-POD and group POD ( P<0.05). The results of logistic regression analysis showed that preoperative MMSE scores, intraoperative concentrations of CXCL13 and IL-6 in peripheral blood and advanced ages were independent risk factors for the development of POD ( P<0.05). Conclusion:Preoperative MMES scores, intraoperative concentrations of CXCL13 and IL-6 in peripheral blood and advanced ages are independent risk factors for the development of POD.

Objective:To evaluate the effect of edaravone on long-term cognitive function in elderly patients undergoing hip replacement.Methods:A total of 160 patients, aged≥65 yr, undergoing elective hip replacement, were divided into 2 groups ( n=80 each) using the random sequence generated by the McLeod-modified Wichmann-Hill pseudo-random number generator: edaravone group (group E) and control group (group C). Spinal-epidural anesthesia was applied in two groups.Edaravone 60 mg (in 100 ml of normal saline, infusion rate 200 ml/h) was intravenously infused from the time point immediately after achieving the anesthesia plane until the following 30 min.Serum chemokine ligand 13 (CXCL13) and interleukin-6 (IL-6) concentrations were detected by enzyme-linked immunosorbent assay before anesthesia, during surgery (30 min after skin incision), and at postoperative days 1, 3 and 7.The Confusion Assessment Method Scale in Chinese was used to detect the postoperative delirium at postoperative days 1, 2, 3 and 7, and the Telephone Interview for Cognitive Status-Modified and ADL score were adopted to assess the cognitive function and quality of daily living, respectively, and the occurrence of cognitive impairment was recorded at 1 and 12 months after surgery. Results:Compared with group C, the total Telephone Interview for Cognitive Status-Modified score and ADL score were significantly increased, the incidence of postoperative delirium and cognitive impairment was decreased, and the serum CXCL13 and IL-6 concentrations were decreased during surgery and at each time point after surgery in group E ( P<0.05). Conclusion:Edaravone can reduce inflammatory responses and improve long-term cognitive function in elderly patients undergoing hip replacement.

Chronic inflammation induced by Helicobacter pylori is considered to be one of the main causes of gastric cancer,and CagA is a main virulence factor of H.pylori.The study aimed to investigate the role and mechanism of CagA in host inflammatory response.Mass spectrometry was used to identify the interacting proteins of CagA in AGS cells.By immunoprecipitation and immunofluorescence,the interaction was validated.Pathway expression was detected by immunoblotting after knockdown by using siRNA,and mRNA levels of inflammatory cytokines were detected by quantitative PCR.CagA-induced inflammatory responses were detected in clinical samples using hemoglobin-eosin staining(H&E).Data showed that CagA interacted with SHARPIN.And CagA activated the NF-κB signaling pathway and upregulated the mRNA and protein levels of the inflammatory cytokines IL-6,IL-8,and TNF-α,as compared with the CagA knockout strain(all P<0.05).Knockdown of SHARPIN by siRNA reduced inflammation levels and partially inhibit NF-κB signaling.In clinical samples,CagA-positive samples exhibited stronger inflammatory responses.To sum up,CagA promoted the host inflammatory response,and CagA-induced inflammatory response was reduced when SHARPIN was partially inhibited,suggesting that CagA activates the NF-κB signaling pathway through binding to SHARPIN.