Objective To investigate the risk factors of pneumonia associated to elderly patients with cerebral stroke.Methods Totally 248 elderly patients with stroke were retrospectively analyzed on medical history,treatment and prognosis.Results In 248 cases of senile stroke patients,78 cases had an associated pneumonia,accounting for 31.5％.The onset with admission period ≥48 h was in majority (48 cases),less than 48 h in 30 cases (38.5％).12 patients (15.4％)were involved blood culture,38 cases sputum culture,accounting for 48.7％.In the univariate correlation analysis,older age,consciousness,basic diseases,stroke location,NIHSS score of nasal feeding therapy were associated with associated pneumonia (all P＜0.05).As compared to patients without no associated pneumonia,the patients with associated pneumonia had more aged and higher proportions of bulbar paralysis and impaired consciousness,more underlying diseases.At the time of admission,increased occurrences of National Institute of Health Stroke Scale (NIHSS) score,brainstem stroke and multiple feeding treatment appeared in most of patients.Multivariate Logtistic regression analysis showed that age≥ 65 years,history of pulmonary disease,bulbar paralysis,disturbance of consciousness,nasal treatment among older stroke were the associated pneumonia risk factors.The hospitalized time was prolonged [(31.3±20.4)d and(17.6±8.1)d,t＝7.57,P＝0.001] and fatality rate increased (41.0％ vs.4.1％) in patients with pneumonia than without pneumonia(x2＝ 54.96,P＝ 0.000).The independent factors of death were aged ≥ 75 years(OR＝1.6,95％CI:1.0-2.6),NIHSS＞13 (OR＝5.0,95％CI:1.7-24.6) and pulmonary infection(OR＝5.2,95％ CI:1.8-17.3).Conclusions The occurrence of associated pneumonia in elderly patients with cerebral stroke is related with age,underlying disease,state of consciousness and NIHSS scores.The prevention and treatment of relevant factors can improve prognosis.

BACKGROUND:Articular capsule ligaments can lead articular surface to move normally and limit the excessive movement, especially to prevent any non-physiological movement. They are the important structures for stabilizing hip joints. It was previously thought that articular capsule should be routinely resected in the total hip arthroplasty (THA). OBJECTIVE: This study was designed to investigate the effect of retaining articular capsule in THA through posterior approach on maintaining hip stability. DESIGN, TIME AND SETTING: This study, a retrospective case analysis, was performed on 61 patients with femoral neck fracture, who received treatment in the Department of Orthopedics, Xiangya Second Hospital of Central South between January 2005 and December 2006. PARTICIPANTS: Twenty-nine patients who underwent THA with retaining articular capsule from January to December 2006 were included as retaining group, and thirty-two patients who underwent THA with routine resection of partial articular capsule were included as routine group. The two groups were kept identical in case selection, prosthesis selection, post-surgery processing and operators. METHODS: Four holes were drilled on greater trochanter on the proximal femoral bone. The superior part of articular capsule valve was sutured to the superior part of original articular capsule using No.1-0 absorbing thread, then sutured to base of femoral neck in mattress manner, and the suture was not ligated. The inferior part of articular capsule valve was sutured to the inferior part of original articular capsule using another suture. And the suture passed through two bone holes on base of femoral neck. The lower limbs were externally rotated and the suture was ligated. Subsequently, the excised extortor was repaired. Prior to and subsequent to suture, hip was slowly bent for 90° and femur was internally rotated for45°to investigate the suture of articular capsule on strengthening articular stability. MAI OUTCOME MEASURES: Operation time, bleeding volume and hip dislocation after THA. RESULTS: The operation time and bleeding volume were lower in the retaining group than in the routine group (P < 0.05). After THA, hip dislocation did not occur in any patients in the retaining group but occur in 2 patients (6.2%) in the routine group. Statistical tests could not be performed due to less data, resulting in no statistical significance.CONCLUSION: There has been no precise conclusion about the effects of retaining articular capsule or not on hip stability.But retaining articular capsule shortens operation time, reduces intrao-perative bleeding, unable raise operation risk, and re-establishes hip soft tissue balance.

Objective:To compare amony ceftriazone, penicillin, and ciprofluxacin in the treatment of lower respiratory tract infection. 　Methods:Cost-effectiveness was comparitively analysed by using the principle of pharmacoeconomics with ceftriazone, penicillin, and ciprofluxacin in the treatment of lower respiratory tract infection. 　Results:Three drugs in the treatment of lower respiratory trace infection, while cost of penicillin was the lowest.　Conclusion:Penicillin is a first selective drugs for lower respiratory tract infection.

Objective To study the influencing factors on the time of acute cerebral apoplexy patients visiting the hospital.Methods 64 patients with acute ischemic stroke were researched.The clinical data of all patients were collected.The influencing factors on treatment time were analyzed by univariate and multivariate Logistic regression analysis.Results In the 64 patients, 26 cases of the visiting time≤6 h(40.63%), 38 cases of visiting time>6 h(59.37%).The results of single factor analysis showed that the relationship between the time of treatment,pre-hospital transfer mode (x2=6.650,5.081,all P<0.05),educational level,living location,MRS score,whether or not know the stroke(x2=4.561,6.557,8.788,4.146,all P<0.05);the disturbance of consciousness and symptoms ≥3 symptoms compared with the visiting time had significant difference(x2=5.133,5.926,all P<0.05);in the multiple factors Logitic regression analysis,the degree of education(OR=2.332,95%CI:1.402~3.904),severity of illness(OR=3.956,95%CI:1.934~7.446),understanding of stroke(OR=3.621,95%CI:1.563~8.125),disturbance of consciousness(OR=4.336,95%CI:2.394~11.374),pre-hospital transport mode(OR=5.658,95%CI:2.546~12.554) were the risk factors of treatment time.Conclusion There is a close relationship with extension and various factors of acute ischemic stroke patients,in the future,not only need to improve the pre-hospital emergency care system,but also need to strengthen the public understanding of the disease.

The right chest electric admittance plethsmography (RCEAP) is a simple no invasive and reliable method in detecting the blood flow volume in the pulmomary artery and vein, an indirection of the left heart function. In this clinical study, the RCEAP, left heart catheterization for measurement of LVEDP and coronary angiogram and echocardiography for investigating the LVEF were performed on 34 patients with coronary heart disease. Of these 34 patients,24 had single or no left vessel lesion (Group A), 10 had left main coronary artery or its double branches lesions (Group B) ;8 underwent percutaneous trans-lumin coronary angioplasty (PTCA)and 10 had coronary artery bypass graft (CABG).The data obtained were analysed and compared to evaluate their respective diagnostic values. Correlation analysis demonstrated the values of hc/hz ratio, ha/hz ratio were moderated with LVEDP(r = 0. 68 or 0. 73,P

ObjectiveIn order to study the effect of three-month rehabilitation on motor function in hemiplegics after stroke. Methods125 patients were randomly divided into two groups, rehabilitation group (72 cases)and control group(53 cases).Patients in the rehabilitation group were given clinical treatment,electric stimulation therapy(EST) and regularly physical therapy, while those in control group were given clinical treatment and unguided self-training, and the evaluation was done in pre-treatment and post-three-month respectively. Motor function was assessed in Fugl-Meyer Assessment(FMA).ResultsMotor scores in each group had a more significant difference(P<0.001)before and after treatment, the process of scores in the rehabilitation group was obviously superior to that in the control group(P<0.001). Conclusions Rehabilitation training on hemiplegics after stroke may obviously improve motor function, depressing the disability and increasing the living quality.

With the concepts of minimal invasive surgery and precision medicine embedding deeply in modern medicine, traditional clinical treatment strategies are constantly updated due to the rapid progression of medical research. Systematic dissection of the regional lymph nodes is a key component in the surgical therapy of gynecologic malignancies, however it may result in a series of complications, such as lower extremity lymphedema, deep venous thrombosis, immune disorders and so on, which seriously impact the patients' quality of life. The necessity of systematic lymphadenectomy and the extent of lymph nodes resection have always been one of the most controversial issues in gynecologic oncology. In recent years, the extensive application of sentinel lymph node (SLN) technology has been increasingly used in the treatment of gynecologic malignancies, which may provide important guidance on this issue. This article reviews the clinical application status, detection methods, detection efficiency, and current controversies regarding SLN mapping and biopsy in cervical cancer, endometrial cancer, ovarian cancer and vulvar cancer, discussing the application value of SLN technology in gynecologic oncology.

Objective To explore clinical effect of reconstruction for chronic Achilles tendon rupture of Kuwada IV type with flexor hallucis longus (FHL) harvested using a minimally invasive technique.Methods The data of 35 patients with chronic Achilles tendon rupture of Kuwada IV type was retrospectively analyzed who were treated by FHL which was harvested using a minimally invasive technique from July 2006 to June 2011.There were 21 males and 14 females,with the age from 23 to 71 years (average,42.1 years).All patients were unilateral injury.MRI showed Achilles tendon rupture fissures 6.0-9.2 cm.The local appearance and function recovery on postoperation was observed,and all patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Leppilahti Achilles tendon repair score.Results Thirty-two patients were followed up for 18 to 72 months,with an average of 33.2 months.Except for 1 patient whose wound healed after six weeks through resuture immediately for the wound dehiscence occurred in the ten days,other patients' wound healed smoothly.The average of AOFAS ankle-hindfoot score had increased from 51.92±7.08 preoperatively to 92.56±6.71 postoperatively.Leppilahti Achilles tendon repair score had increased from 72.56±7.43 preoperatively to 92.58±5.1 postoperatively.Twenty-seven cases were excellent,good in 3,and fair in 2,with the total excellent and good rate 93.8％ (30/32).No case of the sural nerve and tibial nerve injury,plantar painful scar,plantar outside nerve injury.MRI of Achilles tendon showed even signal without signal of tear and cystic degeneration.Conclusion Reconstruction for chronic Achilles tendon rupture of Kuwada IV type with FHL harvested using a minimally invasive technique offers a desirable outcome in rapid postoperative recovery,high strength in tenodesis,fewer complications.

Objective To explore the application value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG PET/CT) and 99Tcm-methylene diphosphonate (99 Tcm-MDP) bone scintigraphy for detecting bone destruction in multiple myeloma (MM).Methods 18 F-FDG PET/CT and 99Tcm-MDP bone scintigraphy results of 27 MM patients were analyzed retrospectively.Inspection areas checked by magnetic resonance imaging (MRI) and X-ray were the limited scopes.The location and number of bone destruction were recorded,and the maximal standardized uptake value (SUVmax) was measured simultaneously.The results were comparatively analyzed.Diagnostic certainty regarding the presence or absence of bone destruction was evaluated according to the reference standard consisting of MRI and X-ray.Results A total of 235 lesions were found according to the reference standard.Of these,227 lesions (97％) were identified by 18F-FDG PET/CT,whereas 187 lesions (80％) were identified by bone scintigraphy,with a significant statistical difference (x2 =32.43,P ＜ 0.05).SUVmax was 8.3 ± 1.7 (4.3 to 18.9).The discovery rates of bone fracture of 18F-FDG PET/CT and bone scintigraphy were 100％ (97/97) and 90％ (87/97),and there was a significant statistical difference between them (x2 =78.09,P ＜ 0.05).Conclusion 18 F-FDG PET/CT is a possible method to detect bone lesions in patients with MM,and is better than 99Tcm-MDP bone scintigraphy.

Objective To investigate the MRI features of pilomyxoid astrocytoma ( PMA ) in children.Methods MRI features of seven children with pathologically proven PMA in 2011-2013 were retrospectively analyzed.The ages of the patients ranged from 10 months to 32 months at initial diagnosis.Results All tumors were well-circumscribed masses.Six tumors were located in the hypothalamic-chiasmatic-third ventricular region , two tumor involved the bilateral temporal lobe , and one tumor was associated with NF-I.One occurred in the basal ganglia region.Four tumors were solid masses , whereas the other three showed cystic components.Six tumors were hypointense and one was isointense on T 1-weighted image.Five tumors were hyperintense and three were isointense on T 2-weighted image.Four tumors were hypointense , one was iso-hypointense and one was isointense on DWI.After contrast administration , four tumors enhanced homogenously and three tumors enhanced heterogeneously , with intratumoral irregular hypointense region in two tumors and rim enhancement in one tumor.Cerebrospinal fluid ( CSF ) dissemination, hydrocephalus and peritumor edema were observed in 2, 4 and 1 of cases, respectively.Proton magnetic resonance spectrum of two PMA showed elevated Cho /Cr ratios and decreased NAA/Cr ratios.Conclusions The imaging features of pilomyxoid astrocytoma include common origination from the midline of the neuroaxis in younger children about 2-3 years old.The CSF dissemination is common.The presence of hemorrhage and peritumor edema is not common.