ObjectiveTo study the effect of electromygraphic biofeedback on upper extremity function in patients with hemiplegia after stroke.Methods79 patients were randomly divided into experimental group(40 cases) and control group(39 cases).Patients in each group were given clinical treatment and regularly physical therapy, while those in experimental group were given electromygraphic biofeedback training. All patients were evaluated with electromyography amplitude and active range of motion(AROM) of wrist dorsiflexion and upper extremity Fugl-Meyer assessment pre-treatment and 3 months after stroke.ResultsAll the patients gained improvement after treating(P<0.05).Compared with the controls, patients in experimental group significantly improved their function in all measured item(P<0.01).ConclusionThe electromygraphic biofeedback can improve the arm function of hemiplegic patients.

Attention Deficit Disorder with Hyperactivity ; therapy ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Phytotherapy ; methods

Objective To evaluate the prognostic significance of metastastic lymph node ratio in patients with gastric cancer. Methods Clinical data of 319 patients with gastric cancer who underwent radical gastrectomy with at least 15 lymph nodes dissected per patient were analyzed retrospectively. Patients were divided into 4 groups according to the TNM staging system (1997,5th edition): pN0 (no positive lymph node), pN1(with 1～6 metastatic lymph nodes), pN2 group (with 7～15 metastatic lymph nodes), and pN3 group (with more than 15 metastatic lymph nodes), or into 4 groups according to the lymph node metastatic ratio: rN0 group (without metastasis of lymph node), rN1 group (with a lymph node metastatic ratio of <30%), rN2 group (with a lymph node metastatic ratio of 30%～60%), and rN3 group ( with a lymph node metastatic ratio of >60%). Survival was determined by the Kaplan-Meier method and differences were assessed by the Log-rank test. Multivariate analysis was performed using the COX proportional hazard regression model in forward stepwise regression with SPSS 13.0. Results Kaplan-Meier survival analysis demonstrated that the metastatic lymph node ratio significantly influenced the postoperative survival time. According to the lymph node metastasis system 77 patients were in group 1, 109in group 2, 60 in group 3, and 73 in group 4. The 2-year survival rate was 84.4%,66.1%, 35.0%,and 15.1% respectively, 3-year survival rate was 80.5%,45.0%,15.0% and 5.5% respectively, and 4-year survival rate was 71.4%,33.0%,5.0% and 1.4% respectively. If cases with the same positive number of lymph node (pN) group were stratified futher by lymph node metastatic ratio, there were no significant differences in the 3-year survival rate among the new rN groups (P>0.05), but there was a great difference in the distribution of prognosis among different groups. COX proportional hazard regression model analysis showed that the metastatic lymph node ratio was an independent factor for poor prognosis. Lymph node metastatic ratio was closely related with the location, modality of the operation and infiltration depth. Conclusions The staging system based on metastatic lymph node ratio is more reliable than the system based on the number of metastatic lymph nodes in the prediction of the prognosis of gastric cancer.

Objective To investigate the value of cluster cate forpatients with ventilator-associated pneumo-nia (VAP) in the intensive care unit. Method Three hundred fifty-four consecutive patients with mechanical ven-tilation support in the Emergency Intensive Care Unit of Nanjing First Hospital from January 2006 to September 2007 were included in this study. The cluster care included elevating patient's head and chest to at least 30 de-grecs to the horizontal level, intensiving frequency of oral-pharyngeal nursing with thorough suction, washing hands, changing ventialtor tube at shorter regular interval, closely observing temperature, sputmn, WBC count, pu-turn, white blood cell count, chest X-ray examination and respiratory tract bacterial culture etc. Another 398 me-chanical ventilated patients with conventional care in the Hospital from January 2004 to November 2005 were taken as control. The t -test and X2 -test were used for analysis. Results The morbidity of VAP was significantly de-creased after cluster care(16.6 % vs. 24.6% P<0.01), the length of intensive care unit stay (LOS) was shorter in patients with cluster care than those in patients of control [(10.75±5.86) d vs. (14.26±9.40) d, P <0.05]. Conclusions Pneumonia associated with mechanical ventilation can be effectively reduced by the cluster care.

Objective To investigate the role of clinical pharmacist in medical therapy for a patient with cerebrovascular disease and epilepsy.Methods One patient was hospitalized due to headache and twitch.Clinical diagnosis was cerebral venous sinus thrombosis and epilepsy.During the treatment,the clinical pharmacist gave suggestion on drug selection of anti-infection and anti-epileptic therapy,assessed drug interaction between omeprazole-escitalopram and mannitoldexamethasone,monitored the adverse drug reaction of valproate,and provided medication education to the patient.Results Physician adopted clinical pharmacist's suggestion.The patient discharged with stable condition.Conclusion The participation of clinical pharmacists in the medication therapy of patients with cerebrovascular disease can reduce the risk of drug use and promote the efficacy and safety of medication.

Objective To investigate the relationship between the expression changes of p-Akt (Ser473),p-Bad (Ser136) and the cell apoptosis in peri-infarction tissue of permanent middle cerebral artery occlusion (MCAO) in rats.Methods Sixty male Sprague-Dawley rats were randomly allocated into sham operation,MCAO 3 h,MCAO 12 h,LY294002 intervention MCAO 3 h,and LY294002 intervention MCAO 12 h groups (n =12 in each group).A permanent MCAO model was induced by the modified suture method.At 15 minutes before modeling,the rats in the LY294002 intervention MCAO groups were administered via lateral ventricle.The neurological function score was scored by using Zea Longa method.2,3,5-triphenyltetrazolium chloride (TTC) staining was used to detect infarct volume.Immunohistochemical staining was use to detect pAkt (Ser473) and p-Bad (Ser136) expressions in peri-infaretion tissue.TUNEL assay was used to detect apoptotic cells in peri-infarction tissue.Results Three hours after modeling all the experimental rats awoke from anesthesia.The neurological deficit score in the sham operation group was 0,and the scores of the MCAO 3 h,MCAO 12 h,LY294002 intervention MCAO 3 h and LY294002 intervention MCAO 12 h groups were 2.25 ± 0.45,2.92 ± 0.99,3.00 ± 0.95,and 3.02 ± 0.36,respectively.There were significant differences among all groups (F =26.520,P =0.000).The score of the LY294002 intervention MCAO 3 h group was significantly higher than that of the MCAO 3 h group (P =0.009).There was no significant difference between the LY294002 intervention MCAO 12 h group and the MCAO 12 h group (P =0.354).TTC staining showed that no infarct was observed in the sham operation group.The infarct volumes of the MCAO 3 h,MCAO 12 h,LY294002 intervention MCAO 3 h and LY294002 intervention MCAO 12 h groups were 23.4 ± 1.4,40.3 ± 1.1,31.9 ±6.0 and 44.4 ±3.8 mm3,respectively.There were significant differences among the groups (F =30.440,P =0.000).The score of the LY294002 intervention MCAO 3 h group was significantly greater than that of the MCAO 3 h group (P =0.002).There was no significant difference between the LY294002 intervention MCAO 12 h group and the MCAO 12 h group (P=0.113).Compared with the sham operation group,the p-Akt (Ser473) expression in peri-infarction tissue in the MCAO 3 h group was significantly high,and it was significantly decreased in the MCAO 12 h group; the expression level of p-Bad (Ser136) showed a progressive decline with the passage of MCAO time,at the same time,the number of apoptotic cells increased progressively.After the LY294002 intervention,the expression levels of p-Akt (Ser473) and p-Bad (Ser136) in peri-infarction tissue decreased significantly at 3 h after MCAO,and the number of apoptotic cells increased significantly (P ＜0.05),but there was no significant effect on each index at 12 h after MCAO.Conclusions The activation of the PI3K/Akt signal transduction pathway in early cerebral infarction and the stress elevation of the key protein p-Akt (Ser473) of this pathway have brain protection,while the failure of this pathway activity and the drastical decrease of its key protein in the late cerebral infarction are associated with brain injury.

Pharmacology, pharmacokinetics, clinical study and safety of dapagliflozin in the treatment of type 2 diabetes mellitus were reviewed in the paper. As a sodium-glucose cotransporter 2 (SGLT2) inhibitor, dapagliflozin can reduce HbA1c, FPG and body weight of patients with type 2 diabetes mellitus. The main adverse reaction is genital infection. The antihypertensive effect of dapagliflo-zin is still under study at present.

Objective To investigate the species and drug resistance of pathogens causing bloodstream infections in hospitalized patients,and provide scientific evidence for antimicrobial use and control of healthcare-associated blood-stream infection.Methods From January 1 to December 31,2012,16 428 blood specimens were performed blood culture,pathogens were isolated and performed antimicrobial susceptibility testing.Results Of 16 428 blood speci-mens from 5 546 patients,384 (6.92%)were positive for blood culture,398 pathogenic isolates were detected,of which gram-positive bacteria,gram-negative bacteria,and fungi accounted for 23.62% (n=94),68.34% (n=272),and 8.04% (n=32)respectively,positive rate of blood culture were highest in 61-80 age group(8.26%), the top five departments of positive rate of blood culture were departments of burn,traditional Chinese medicine, cardiac intensive care unit,transplantation and traumatology;gram-positive cocci were highly susceptible to vanco-mycin,teicoplanin and linezolid,one Enterococcus faecium strain was found to be resistant to vancomycin;Among gram-negative bacilli,Enterobacteriaceae were highly susceptible to amikacin and carbapenems;drug resistance rates of Acinetobacterbaumannii and Pseudomonasaeruginosa to carbapenems was 70.97% and 35.90% respective-ly.Conclusion Gram-negative bacteria are the major pathogens causing bloodstream infection,positive rate of blood culture of elderly people is high.It is necessary to conduct regular surveillance on distribution and drug resistance of pathogens.

Objective:To explore therapeutic effect of atorvastatin on aged patients with mild to moderate hyperten-sion.Methods:A total of 427 aged patients with mild to moderate hypertension treated in our hospital from Jul 2011 to Jul 2013 were randomly divided into routine treatment group (n=210)and atorvastatin group (n=217,received atorvastatin additionally based on routine treatment)according to number table.All patients were treated with a continuous 24 months.Therapeutic effect of controlling blood pressure,changes of blood pressure level and high sensitive C reactive protein (hsCRP)level and occurrence of adverse reactions during treatment were compared be-tween two groups.Results:Compared with routine treatment group,there was significant rise in total effective rate of long-term (24 months)controlling blood pressure (76.8% vs.85.9%),and significant reductions in blood pres-sure [(145.3±10.1/88.6±6.7)mmHg vs.(136.9±6.8/83.0±5.2)mmHg]and hsCRP [(2.02±0.29)mg/L vs. (1.60±0.18)mg/L]level in atorvastatin group,P<0.05 or <0.01. There was no significant difference in inci-dence rate of adverse reactions during treatment between two groups (P>0.05).Conclusion:Atorvastatin combined antihypertensive drugs can well control blood pressure and reduce inflammatory reactions,which is suitable for long term use in aged patients with hypertension.

Objective To summarize the risk factors, the diagnostic and therapeutic approaches, and the outcomes of the ruptured primary hepatocellular carcinoma (PHC) occurred after transcatheter arterial chemoembolization (TACE) in order to make a further understanding of this complication. Methods The clinical data of 8 patients with ruptured PHC after TACE, who were encountered at the First Affiliated Hospital of Suzhou University during the period from Sep. 2007 to Sep. 2013, were retrospectively analyzed. Results A total of 1379 times of TACE were performed in 678 patients with PHC. Among the 678 patients, 8 developed rupture of PHC with bleeding after TACE. The overall incidence was 1.2%. The mean diameter of the tumors in the 8 patients was (11.5 ± 2.6) cm, ranging from 7.6 cm to 15.9 cm. All the lesions were located at the peripheral region close to the liver capsule, and most of them protruded outward. Five cases had coexisting portal hypertension. The average dosage of Lipiodol used in TACE was (14.9 ± 4.5) ml with a range of (8 - 20) ml. Of the 8 patients, emergency transcatheter embolization was carried out in 4 and medical management was employed in other 4. Seven patients died as all active emergency treatments failed. Only one patient, who had received emergency transcatheter embolization, survived the ruptured PHC. Conclusion Rupture of primary hepatocellular carcinoma after TACE is a rare, but very serious complication. Its occurrence may be related to lesion’s characteristics, such as large tumor size, superficial location and protrusion from the liver surface, etc. Besides, interventional management, e.g. without use of solid embolic material to enhance the embolization effect, may also be responsible for the rupture.