Objective To explore the role of architecture of the human muscle in treatment of spasticity after stroke with BTX.Methods40 patients with spasticity hemiplegia after stroke were involved,whose scores of Modified Ashworth Scale beyond 3.They were divided in 2 groups:control group and observed group,in which BTX dose and injection points designed without or with architecture of the human muscle.All muscles injected were located with electrical stimulator.They were evaluated with Modified Ashworth Scale and the incidence of brace wearing were observed 2 weeks after treatment.ResultsThe Ashworth scores for wrist flexors were(1.3±0.9234)in observed group,(1.9±0.8522)in control group(P<0.05);for the triceps surae,they were(1.6±0.8826)and(2.25±0.7864)respectively(P<0.05).10 cases wore brace for upper limbs in observed group and 14 cases in control group;for the brace for lower limbs,there were 12 in observed group and 16 in control group(P>0.05).ConclusionBTX dose and injection points designed by Architecture of the Human Muscle in Treatment of spasticity after stroke is better than routine way,but the brace wearing for patients showed no significant improvement.

AIM:To observe the expression of Toll like receptor 4 (TLR4) in the left ventricle of Goldblatt rats and to explore the role and mechanism of TLR4 in left ventricular remodeling of hypertension.METHODS:Goldblatt model of Two-kidney,one-clip (2K1 C) renovascular hypertension was induced in twenty-five rats(H group),and twenty rats served the sham-operated group(sham group).The tail cuff blood pressure was detected every week and echocardiogram was observed every other week.After eight weeks of operation,the rats were killed and the samples of the left ventricle were collected.The concentration of Ang Ⅱ in left ventricle was assessed by tadioimmunoassay.Western blotting and RT-PCR were used to exam the mRNA and protein expression of TLR4 in the left ventricle.Immunohistochemistry was adopted to exam the location of TLR4 in the myocardium.RESULTS:TLR4 mRNA and protein expression were consistently upregulated in the left ventricle of H group compared with sham group.In H group, predominantly sarcolemmal staining was observed,especially focal areas of intense TLR4 staining were found in juxtaposed regions of two or more adjacent myocytes;However,in sham group,TLR4 expression was diffuse and presumably cytoplasmic.Considerable correlation was found between blood pressure,MESS,LVMI,RWT,the concentration of Ang Ⅱ in left ventricle and the protein expression of TLR4 in myoeytes.CONCLUSION:During the development of left ventricular remodeling of Goldblatt rats,expression of TLR4 increases significantly.Enhanced expression of TLR4 locates in the sarcolemma,especially in juxtaposed regions of two or more adjacent myocytes.These indicate that TLR4 transmembrane receptor which is closely relative with inflammation and immunity probably contributes to the development of ventricular remodeling.[KEY WORDS]Hypertension;Ventricular remodeling;Receptors,Toll-like;Goldblatt rats

Objective To investigate the effect of integrated swallowing function rehabilitation training on nasal feeding patients with pseudobulbar palsy or bulbar palsy after acute ischemic stroke. Methods A total of 54 patients met the diagnosis criteria were enrolled prospectively. They were divided into either an integrated group (n=31)or a control group (n=23)using a random number table method. The patients of the control group received routine treatment of stroke,including brain protection therapy,improvement of cerebral circulation,dehydration,regulating blood pressure,and symptomatic treatment,etc;in addition to conventional treatment,those of the integrated group also received integrated swallowing function rehabilitation training,including neuromuscular electrical stimulation plus swallowing reflex facilitation technique,and oral facial glossopharyngeal function training,etc. The oral intake function in patients of the integration and pseudobulbar palsy or bulbar palsy (according to MRI and signs)was compared between the two groups. The evaluation index was the Functional Oral Intake Scale (FOIS)score. Results (1)The FOIS score (median 4)of the integrated group was higher than that of the control group (median 2). There was significant difference between the two groups (P<0. 01). There was also significant difference before and after comparison between the two groups. (2)The FOIS score of pseudobulbar palsy in the integrated group was higher than that of the control group (median scores 4 and 2 ). There was significant difference (P<0.01);There was no significant difference in the FOIS scores of bulbar palsy between the two groups,but the FOIS score of the integrated group was higher than that of the control group (median scores 4 and 3). (3)The median differences between the integrated group and the control group were 2 and 1 respectively. The increased amplitude of FOIS of the integrated group was higher than that of the control group. There was significant difference (P<0. 01). Conclusion The integrated swallowing function rehabilitation training can improve the oral intake function,significantly reduce irritating cough,increase the capacity of oral intake,and increase the types of food. The effect of the improvement of pseudobulbar palsy is more significant in the integrated group.

Background Greater variability in blood pressure and the disappearance of circadian rhythm are frequently found in the very elderly with hypertension.Blood pressure variability may be closely related to the target organ damages.Objective To assess the relationship between nocturnal blood pressure fall(NBPF)and 24 h blood pressure variability(BPV)by using BP weighted standard deviation as a new index for computing 24 h BPV,and to verify the clinical value of this new marker in the very elderly with hypertension.Methods We analysed retrospectively 1441 ambulatory blood pressure(BP)recordings,and computed:①the standard deviation(SD)of 24 h BP directly from all individual readings;②weighted mean value of daytime and night-time SD(wSD);③the magnitude of nocturnal BP fall(NBPF).Left ventricular mass(n=345)and carotid intima-media thickness(n=216)were determined by echocardiography.Results The 24 h SD of BP was significantly greater than the 24 h wSD(P

OBJECTIVE:To compare the in vitro antibacterial activity of azlocillin given alone with azlocillin plus tazobactam against168strains of clinically isolated pathogenic bacteria.METHODS:The antibacterial activities of two antibac_ terials against168strains of clinically isolated pathogenic bacteria in vitro were detected by two-fold dilution method.RE-SULTS:The MIC 50 and the MIC 90 of the combined therapy of azlocillin/tazobactam(4∶1)were1/32and1/64,respectively that of azlocillin given alone.CONCLUSION:The concomitant therapy of azlocillin with tazobactam improves the antibacterial activity.

Objective To explore small size toe tissue flap for aesthetic reconstruction of the thumb and / or finger. Methods Six kinds of small size toe tissue transplants had been applied in repairing skin-bone-joint composite tissue defects of the thumb or finger in 74 cases. Results Among 83reconstructed flaps of the 74 patients, 81 flaps survived completely. Follow-up examination made three to forty-eight months postoperatively showed that the outward appearance were excellent in most cases. The function of the thumbs or fingers were good. The donor feet can walk normally with no pain. Conclusion A variable combinations of toe tissues including skin, soft tissue, bone and joint can be harvested to form a lot of small size transplants for refined aesthetic reconstruction of thumb and finger. The functional and aesthetic results are good and the treatment course is shortened.

Objective To investigate the clonal relatedness of A.baumannii isolates from senile patients by conducting cross-sectional and longitudinal studies on antimicrobial susceptibility profiling and genomic diversity.Methods Cross-sectional study was done among the 170 non-repetitive A.baumannii isolates which were collected from senile patients during two years.Longitudinal study was conducted among 77 A.baumannii collected from 8 senile patients within longtime hospitalization.Results 75.3 ％ of the 170 isolates were non-susceptible to carbapenems,and the phenotype were XDR or MDR which spread evenly all over the senile wards.The isolates belonged to 36 pulsotypes determined by PFGE.Groups Ⅰ (contain119 isolates) were major epidemic strains,which were CRAB with XDR phenotype.In longitudinal study,comparison of pulsotypes was performed for each patient and all isolates were clustered into group Ⅰ except one isolate.All the 77 isolates were XDR.Conclusion Extensive drug-resistance of A.baumannii was a serious problem in the gerontal wards.Clone dissemina tion was the most important style of XDR strains spread.Horizontal infection control measures to interrupt person-to-person transmission should be reinforced to reduce the further spread of XDR A.baumannii.

OBJECTIVE To implement the automatic management of medical equipment.METHODS Based on the platform of net,three layers of C/S were applied with database technology to realize one-time importation of the basic information and current information,it made the information function of quantity evaluation,quantity determination,schedule formation,automatic alarm,apparatus distribution list,statistical inquiry,collection analysis,and information feedback coming to true.RESULTS By using one year,the application of management information system of medical equipment could meet the requirement in scientific and standardized supply,and standard,application and management of medical equipment.CONCLUSIONS It can be able to improve the system efficiency,reduce the labor and mistakes,and also achieve the aim that cannot be done by manual labor.

Objective To summarize and investigate the therapeutic effects of reconstruction of contracture of the first web space with snuff-box flap. Methods Eighteen patients with contracture of the first web space were treated by snuff-box flap. The width and the angle of the first web space was 19 mm and 20°on average. According to the first web space skin defects, the flap designed to nasopharyngeal fossa centers as rotation point, the radial line when the forearm in the neutral position as the axis. Results The followedup for 5-26 months revealed that 17 flaps had a success, but 1 case was partly necrosis. The width of the first web space was augmented by an aveage of 45 mm, the angle of the first web space was augmented by an average of 50°. Conclusion It is ralatively simple and reliable to repair the contracture of the first web space using the snuff-box flap.

Objective To explore the concept,denomination and technique of miniature tissue transplantation in hand clinic. Methods In 537 cases,local skin or composite tissue defect in 756 thumbs or fingers were repaired with 4 kinds of miniature island flap and 10 kinds of miniature vascularized composite tissue.Some of them were created in clinic practice.The precess,main points and indication of the operation were expounded and compared. Results In 639 fingers covered with miniature island flap,the transferred flaps were surviverd completely in 621 fingers(97.2%),survivered partly in 11 fingers(1.7%)and necrosised in 7 fingers(1%).In 117 fingers repaired with miniature vascularized composite tissue,all the transplanted tissues were survivered.In all the injuried fingers,beautiful outlook were recovered and no fat and clumsy were found,two-point difference was 6-8 mm,effctive sensibility and good function were restored,and all the patients were satisfied. Conclusion Miniature tissue transplantation were good methods to cover the local defect in fingers or thumbs,worth of generalization and aplication in hand clinic,and have an important significance for improve the trauma repair quality and treatment level in hand surgery.