Objective To observe the effect of metoclopramide combined with early enteral nutritional on patients with mechanical ventilation after craniocerebral operation.Methods A prospective randomized control study was conducted.56 patients with mechanical ventilation after craniocerebral operation were randomly divided into metoclopramide combined with early enteral nutritional group (observation group) and parenteral nutrition group (control group),28 in each group.The patients in the observation group received early enteral nutrition (24-48 h after operation),and intramuscular injection of metoclopramide (10mg Q8H) for 7 days.The patients in the control group received parenteral nutrition.The nutritional parameters,mechanical ventilation (MV) time,success rate of the ventilator weaning and the occurrence rate of pneumonia associated with ventilation (VAP) in one week,the incidence of adverse reaction were compared between the two groups.Results After 1 week therapy,the nutritioual parameters of the two groups showed no statistical significance(P ＞ 0.05);the observation group compared with the control group,3 、7days of blood glucose(P1 、P2) decreased significantly[(8.9 ± 1.6) mmol/L vs (11.4 ± 3.2) mmol/L,(8.2 ± 1.3) mmol/L vs (10.6 ± 2.1) mmol/L] (P1 =0.002,P2 =0.011),Mechanical ventilation (MV) time (P3) and the occurrence rate of VAP(P4) in one week also declined[(6.5 ±2.3)d vs (8.9 ±3.1)d,21.4％ vs 46.4％] (P3 =0.022,P4 =0.048),but within a week of success rate of the ventilator weaning improved (67.9％ vs 39.3％,P5 =0.032).Return rate (P6),gastrointestinal bleeding (P7) was significantly lower than those of the control group (17.9％ vs 42.9％,14.3％ vs 42.9％,P6 =0.042,P7 =0.038),but abdominal distention,diarrhea were no significant contrast (P ＞ 0.05).Conclusion Metoclopramide combined with early enteral nutritional may obviously improve the nutrition parameters,shorten the MV time,decrease the occurrence rate of VAP,not increase in side effects.

Objective To study the incidence of PTEN, p53 and Ki-67 expression in astrocytoma and show the relationship between PTEN, p53 expression and the proliferation activity. Methods The surgical specimens from 68 brain astrocytoma patients were analysed to detect PTEN, p53 and Ki-67 expression with immunohistochemical method. Results The incidence of PTEN, p53 and Ki-67 expression was 54.4 %,45.6 % and 48.5 % respectively in astrocytoma. With the grade of astrocytoma increasing the levels of PTEN protein decreased, on the other hand the levels of p53, Ki-67 increased. There was a negative correlation between PTEN expression and grade of astrocytoma while there was a positive correlation between p53, Ki-67 expression and grade of astrocytoma by using the Spearman Correlation test to analyse the data. The incidence of Ki-67 positive expression was 24.3 % in 37 cases exhibiting PTEN positive staining, whereas the incidence of Ki-67 positive expression was 77.4 % in 31 cases exhibiting PTEN negative staining. In statistics, there was an inverse correlation between PTEN and Ki-67 expression. Conclusion There is an inverse correlation between histopathological grades of astrocytoma and PTEN expression. A positive correlation is found between p53, Ki-67 expression and histopathological grades of astrocytoma. PTEN can inhibit tumor cell proliferation in astrocytoma.

Objective To investigate the effects of health education on diet and behaviors in stegmonth. Methods Three hundred and forty three primiparas were divided into the experiment and control group.The 163 primiparas in the experiment group took the courses in the pregnant women’s school and 180 primiparas in the control group did not.The differences of diet and daily behaviors in stegmonth were compared between the two groups.Results There were statistically significant differences in the rate of diet,health behaviors,breast feeding between the two groups(P<0.01).Conclusion The health education for the pregnant woman can enhance their sense of self care,change their wrong behaviors,and improve the rate of breast feeding.

Objective To investigate the correlation of rCBV with vascular endothelial growth factor (VEGF) protein expression and microvessel density (MVD) in gliomas Methods MR examinations were performed preoperatively in 46 patients with suspected supratentorial gliomas All the 46 cases were proved by operation and pathology Immunohistochemical stain methods were used to demonstrate the situation of VEGF protein expression and quantitatively measure the MVD in gliomas The procedures of MR examinations included plain MR scan, PWI and routine contrast enhanced MR scan The pulse sequence of PWI was single shot GRE EPI T  2WI The CBV maps were calculated from the original data of perfusion images and the maximum rCBV of gliomas was acquired from CBV maps through measurement on the region of interest (ROI) According to the situation of VEGF protein expression, all the 46 cases were divided into two groupsincluding positive VEGF protein expression group and negative VEGF protein expression group Mann Whitney U test was used for comparing the difference between the two groups Spearman′s rho correlation analysis was used for observing the correlation between maximum rCBV and MVD in gliomas Results Of the 46 cases; 12 cases were astrocytomas, 3 were oligodendrogliomas, 1 was mixed glioma, 14 were anaplastic astrocytomas, and 16 were glioblastomas multiforme The maximum rCBV value in VEGF(-) group ( n =14) and VEGF(+) group ( n =32) ranged from 0 33～6 63 and 1 03～10 68, with median of 3 08 and 5 95, respectively The difference in maximum rCBV between the two groups was statistically significant ( Mann Whitney U test | z| =2 638, P

Objective To observe the levels of serum 25‐hydroxy(25OH) vitamin D and bone mineral density(BMD) in appar‐ently healthy middle‐aged and elderly people in Zhongshan area and investigate the correlation between each other .Methods The BMD of 200 participants was measured by ultrasound BMD detector ,the participants were divided into 3 groups according BMD re‐sults .Simultaneously ,their serum 25OH vitamin D levels were measured by ECLIA .Results Among 200 participants ,the preva‐lence of vitamin D severe deficiency ,deficiency ,insufficiency and sufficiency w ere 7 cases (3 .5% ) ,35 cases (17 .5% ) ,102 cases (51 .0% )and 56 cases(28 .0% ) ,respectively .There was no significant difference in the BMD values among subgroups of different vitamin D levels(P>0 .05) .The prevalence of low BMD and osteoporosis were 60 cases(30% ) and 10 cases(5% ) ,the levels of ser‐um 25OH vitamin D in normal BMD ,low BMD and osteoporosis group were (67 .31 ± 18 .28) ,(65 .62 ± 15 .41) and (64 .95 ± 19 .86)nmol/L ,respectively .There was no significant difference in the levels of serum 25OH vitamin D among BMD subgroups (P>0 .05) .Serum 25OH vitamin D levels were not directly correlated with BMD(P>0 .05) .Conclusion Vitamin D deficiency and insufficiency are quite serious problems in apparently healthy adults in Zhongshan area .There is no evidence that the status of ser‐um 25OH vitamin D is correlate with BMD ,for laboratory diagnosis of osteoporosis ,more sensitive laboratory markers are needed .

Objective To investigate the application value of procalcitonin (PCT ) ,C-reactive protein (CRP) ,prealbumi (PA ) and white blood cell count (WBC))in children with hand-foot-and-mouth disease (HFMD) .Methods A total of 209 children with HFMD were classified into ordinary group (171 patients) and severe group (38 patients) according to the condition of disease ,an-other 30 healthy children were selected as the control group .The levels of PCT ,CRP ,PA and WBC in the three groups were meas-ured and compared .Results The levels of PCT ,CRP ,PA and WBC of ordinary group were 0 .16(0 .08 - 0 .34)μg/L ,11 .7(5 .0 -19 .0)mg/L ,(142 .6 ± 38 .4)mg /L and (11 .3 ± 4 .6) × 129 /L respectively ,and those of severe group were 0 .26(0 .14 - 0 .92)μg /L , 18 .4(5 .3 - 41 .4) mg /L ,(125 .5 ± 32 .9)mg/L and (13 .0 ± 5 .6) × 129 /L respectively .The PCT ,CRP ,PA and WBC in ordinary group and severe group were significantly different with those in the control group (P < 0 .05) .The PCT ,CRP and PA in severe group had statistical differences compared with those in the ordinary group (P< 0 .05) .Conclusion PCT ,CRP ,PA and WBC could be used as reference indexes of inflammation in HFMD ,and could be used in the diagnosis of HFMD in children ,PCT and PA could be used to evaluate the severity of disease .

OBJECTIVE:To study the percutaneous permeability of Hydrocortisone cream with different substrates in diabetic model rats. METHODS:The Hydrocortisone O/W(oil/water)cream,water-soluble cream and oil-soluble cream were respectively prepared. Wistar rats were randomly divided into normal control group and model group. Model group was given streptozotocin(40 mg/kg)to reproduce diabetic model. Franz diffusion cell percutaneous test and HPLC were used to detect the percutaneous permea-bility rates of Hydrocortisone O/W cream,water-soluble cream and oil-soluble cream in rats of 2 groups. RESULTS:Compared with normal control group,the percutaneous permeability rates of Hydrocortisone O/W cream and water-soluble cream were obvi-ously increased,with significant difference(P<0.05);there was no significant difference in the percutaneous permeability rate of oil-soluble cream (P>0.05). CONCLUSIONS:Hydrocortisone O/W cream and water-soluble cream are easier to go through the skin of diabetic model rats,and Hydrocortisone oil-soluble cream is hard.

Objective:To discuss the influence and curative effect of intensive lipid-lowering with atorvastatin on blood fat and ser-um inflammatory factors levels in the patients with acute cerebral infarction. Methods:Totally 94 cases of patients with acute cerebral infarction were divided into the intensive group(n=47) and the ordinary group (n=47). The patients in the two groups were given the basic medical treatment, such as reducing intracranial pressure and dehydration, controlling blood pressure and blood sugar, anti-platelet aggregation, neural protection and etc. The patients in the ordinary group were orally given 20mg atorvastatin calcium tablets, once a day, while the patients in the intensive group were additionally given 40mg atorvastatin calcium tablets, once a day, and the treatment course was 8 weeks. The changes of blood fat index and serum inflammatory factors of hs-CRP, TNF-αand IL-10 in the two groups before and after the medical treatment were detected, and the clinical curative effect was compared as well. Results:After the 8-week medical treatment, TC, TG and LDL-C levels in the two groups were declined at different degree, while HDL-C levels were in-creased at different degree (P<0. 05 or P<0. 01), and the changes in the intensive group was more notable than those in the ordinary group (P<0. 05). After the treatment, the serum hs-CRP and TNF-αlevels in the two groups were declined at different degree, while serum IL-10 levels were increased at different degree (P<0. 05 or P<0. 01), and the changes in the intensive group was more signifi-cant than those in the ordinary group (P<0. 05). Meanwhile, the total clinical efficiency in the intensive group (95. 74%) was much higher than that in the ordinary group (80. 85%, P<0. 05). Respectively 2 and 4 cases of untoward effect were appeared in the ordi-nary group and the intensive group without statistical difference between the two groups(P>0. 05). Conclusion:Intensive lipid-lower-ing with atorvastatin has significant curative effect with favorable security on acute cerebral infarction, which can obviously improve the degree of neural function defect, and the mechanism may related with reducing blood fat, serum hs-CRP and TNF-αlevels, increasing serum IL-10 levels and inhibiting topical inflammatory reactions.

Objective To investigate the cryoprecipitate fracture hemorrhage clinical application value in the skull fracture hemorrhage,and provide reference for clinical treatment.Methods 80 patients with standard skull frac-ture hemorrhage were selected as the research subjects.The patients were randomly divided into observation group (40 cases)and the control group (40 cases).The control group was given hemostasis,dehydration,protecting stom-ach,antibacterial,nerve nutrition,reducing intracranial pressure,head up in bed and other symptomatic treatment.The observation group received the treatment besides in the control group and added the cryoprecipitate hemostasis,every time given 10U,every 6 -8h 1 time.According to the condition,they were given the cold sediment of 1 -3 times. Then,the cases that fit to give surgery we must cured them by the operation.After treatment 24h,the coagulation inde-xes were examined [prothrombin time (PT),activated partial thromboplastin time (APTT),thrombin time (TT),two D -dimer],plasma fibrinogen (Fbg),International Glasgow (GOS).Finally,we observed clinical prognosis in two groups.Results PT,APTT,TT were significantly shorter than before treatment in the observation group and the con-trol group(t =6.654,5.746,6.193 and 3.342,3.552,3.646,P <0.01 or P <0.05).The PT,APTT and TT of the observation group were significantly shorter than those in the control group (t =3.322,3.406,3.315,all P <0.05). Plasma Fbg was significantly higher than before treatment in two groups(t =5.762,3.592,P <0.01 or P <0.05). Fbg in the observation group was significantly higher than the control group(t =3.407,P <0.05).The clinical prog-nosis in the observation group was significantly better than the control group(χ2 =8.747,P <0.05).Conclusion Cryoprecipitate is a safe and efficient drug.It can effectively improve the blood coagulation dysfunction of patients with fracture of skull base,active endogenous coagulation system,improve hemostatic effect,and reduce the occurrence of progressive cerebral hemorrhage.Therefore,it can improve the prognosis of patients.

Objective To find out a reference range of epidermal nerve fiber density in normal humans and compare the concordance between clinical features, electrophysiology and the results of skin biopsy. Methods Fifty-one patients with peripheral neuropathy and 10 normal controls were studied. Skin biopsies were obtained from distal leg and/or proximal leg and nerves identified using immunohistochemistry with antibody against protein gene product (PGP) 9. 5. Forty-one in 51 performed routine nerve conduction vdocity and electromyography, 21 in 51 performed sympathetic skin response(SSR). The concordance of the consequences was compared. Results Intraepidermal nerve fiber density (IENFD) was (21.4 + 2. 7) /mm in thigh and (15.4±2. 2) /mm in the distal part of the leg in normal controls. IENFD was (15.0± 6. 3)/mm and (8. 1±5.9) /mm in patients. The intraepidermal nerve fiber density was significantly lower in the patients than in the normal controls both in proximal (t = 2. 976, P = 0.004) and distal legs (t= 3.191, P=0.002). Forty-eight out of 51 patients showed abnormalities in skin biopsy, among which 33 patients had length-dependent neuropathy. In the group of abnormal skin biopsy, 41 received routine electrophysiology, among which 21 (51.2%) were abnormal and they were performed SSR, turning out that 17 (81.0%) were abnormal. In 29 patients who had only small fiber neuropathy, 27(93. 1%) showed abnormalities in skin biopsy, out of whom 20 were performed routine electromyography, and it identified that 6 (30. 0%) were abnormaL In 14 receiving SSR, 11 were abnormal. Conclusion Skin biopsy is safe and tolerable, which has a higher sensitivity especially in small fiber neuropathy.