Objective To investigate the efficacy and safety of tirofiban for emergency interventional therapy in patients with acute ST segment elevation myocardial infarction.Methods The 96 acute ST segment elevation myocardial infarction patients having accepted emergency percutaneous coronary intervention (PCI) were divided into treatment group and control group according to the treatment method with 48 cases each.The treatment group was given conventional standard treatment combined with tirofiban treatment [tirofiban intracoronary injection 10 μ g/kg and then intravenous 0.15 μ g/(kg· min) for 24-48 h].The control group was given conventional standard treatment only.The postoperative 60 min electrocardiogram ST segment recovery,the coronary blood flow TIMI grade,the major adverse cardiac events (angina,myocardial infarction,heart failure,death) and postoperative bleeding in 4 weeks were compared between the two groups.Results The patients having postoperative 60 min electrocardiogram ST segment recovery in treatment group was 45 cases (93.8％,45/48),in control group was 35 cases (72.9％,35/48),and there was statistical difference (P ＜ 0.05).The incidence rate of infarction vascular TIMI grade ≥ 3 grade flow in treatment group was 95.8％ (46/48),in control group was 75.0％ (36/48),and there was statistical difference (P ＜ 0.05).The incidence rate of the major adverse cardiac events 4 weeks in treatment group was significantly lower than that in control group,and there was statistical difference (P ＜ 0.05).There was no statistical difference in the incidence rate of bleeding between the two groups (P ＞ 0.05).Conclusion In patients with acute ST segment elevation myocardial infarction,the emergency interventional therapy with tirofiban is efficacy and safety.

目的观察肌电图导引下应用A型肉毒毒素治疗脑卒中偏瘫患者肢体痉挛的临床疗效。方法65例脑卒中痉挛性偏瘫患者按FMA量表评定分为3组,应用肌电图纪录痉挛肢体在功能位时的运动单元电位数,确定治疗肌肉,每一部位注射5U,0.2ml国产A型肉毒毒素,治疗3天后由康复训练师亲自或指导家属进行肢体功能训练。采用改良AshWorth分度评分评定痉挛状态,FMA量表评定日常生活能力(上下肢分别统计)。结果治疗后,中、轻度运动障碍者恢复至基本正常;严重运动障碍者恢复至明显运动障碍;严重运动障碍合并挛缩者可改善其生存质量;所有患者增高的肌张力均有明显改善。结论在肌电图导引下,A型肉毒毒素作为缓解痉挛药物使用安全、有效,对肢体功能的恢复有显著的辅助作用。

Effects of traditional Chinese medicine salvianolate combined with alprostadil and reduced glutathione on delay of progression in patients with acute kidney injury has been confirmed, but the role of this combination therapy on the progression of chronic renal failure is uncertain.

OBJECTIVE: To evaluate the effect of integrated traditional Chinese and Western medicine therapy on the progression of acute renal failure in patients with chronic renal insufficiency. METHODS: Thirty-two patients with chronic renal insufficiency developed acute renal failure recently were treated with Chinese herbs and western drugs intravenously and clysterizing of Chinese herbs liquid for 30 minutes, and the treatment course was 14 days. Assessment of liver and renal function, blood routine, electrolytes and endogenous creatinine clearance rate (Ccr) was performed before and 2 weeks after the treatment. RESULTS: The levels of hemoglobin (HB), white blood cell count (WBC) and serum electrolytes showed no significant changes after the treatment. The levels of blood urea nitrogen (BUN) and serum creatinine (SCr) decreased, while the level of Ccr increased significantly (P<0.05) after the treatment. The total effective rate was 65.6%. CONCLUSION: The integrated traditional Chinese and Western medicine therapy can effectively delay the deterioration of renal function in patients with chronic renal insufficiency accompanied by acute renal failure.

Seven emotions generation relates to the interaction between individual and external objective matters,which is accompanied with interaction between internal desire and external matters.The activity of seven emotions bases on essence of zang-fu organs,being regulated by five zang viscera.Heart is the upstream controller,liver is the key organ to maintain normal emotionds,spleen and stomach is the hub of emotional activities,lung is the auxiliary organ, kidney is origin of emotional generation.Five zang viscera's cooperation and interaction generate the seven emotions.

Objective To evaluate the significance of computed tomographic angiography guided emergent microneurosurgical management of intracranial hemorrhage on account of arteriovenous malformations. Methods 21 cases of intracranial hemorrhage on account of the rupture of the arteriovenous malformations received computed tomographie angiography guided emergent microneurosurgical management were analyzed. Diagnosis of AVM could be identified by 3-D reformatted images obtaining from multidetector CT angiography (CTA) .Then the resections of AVM and hematoma were performed with the help of CTA. We got the results of treatment by CTA examination postoperative. Results 15 AVM nests of 21 cases after operations were cut off, 5 got partial resection, except 1 in bulbus medullae, and the clinical symptoms eliminated in 6 patients (5 cases's hematoma in subcortex indomain, 1 in cerebellum), improved in 14 patients (7 cases in subcortex domain, 4 in cerebellum, 3 in basal ganglia), 1 patient died (AVM in bulbus medullae). Conclusion CTA could be used to get the emergency diagnosis of brain AVM hemorrhage and guid the emergent microneurosurgical management.

OBJECTIVETo investigate the medium-term curative effects of locking proximal humerus plate for the treatment of comminuted fractures of proximal humerus, and provide evidences for the clinical practice.

METHODSFrom August 2005 and April 2008, 23 patients with comminuted fractures of proximal humerus were treated with locking plates, including 12 males and 11 females, aged 27 to 76 years old (averaged 51.5 years old). There were 18 cases of traffic accident injuries, 4 cases of falls injuries, and 1 case injured after heavy pressure. According to Neer classification, 11 cases were three-part fractures, and 12 cases were four-part fractures. Outcomes were assessed with radiography and the Constant-Murley (C-M) shoulder evaluation.

RESULTSAll the patients got primary healing of incisions. Twenty-three patients were followed up, and the duration ranged from 17 to 49 months, with an average of 35.25 months. Twenty patients had fracture healing during 4 to 7 months after operation. There was no significant differences among 3, 6 and 12 months after operation in C-M scoring. The average C-M score was (79.85 +/- 17.23) points (38 to 100 points) at the 12th month after operation, 8 cases got an excellent result, 8 good, 5 fair, and 2 poor. In the LPHP plus bone graft group 6 cases got an excellent result, 4 good, 3 fair, and 1 poor; in LPHP fixation group 2 excellent, 4 good, 2 fair,and 1 poor.

CONCLUSIONThe medium-term curative effect of the locking proximal humerus plate in the treatment of proximal humeral fractures is significant. For the comminuted fractures of proximal humerus combined with osteoporosis and bone defects, bone graft should be performed routinely.

Adult ; Aged ; Bone Plates ; Bone Transplantation ; Female ; Fracture Fixation, Internal ; Fractures, Comminuted ; surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Shoulder Fractures ; surgery

OBJECTIVETo ensure and enhance the quality of multi-central large sample clinical trials of acupunc ture and moxibustion.

METHODSTake the multi-central clinical trials supported by National Key Technology R &- D Program of "the 11th Five-year Plan" as an example to introduce the duty of monitors and simply describe the formulation of the monitoring plan, the monitoring procedure and contents of the monitoring plan and treatment of the commonly-seen problems.

CONCLUSIONQuality monitoring work in multi-central large sample clinical trials of acupuncture and moxibustion is equally serious and scientific with clinical medical trials and it is an important way to guarantee the credible results.

Acupuncture Therapy ; Clinical Trials Data Monitoring Committees ; Clinical Trials as Topic ; Humans ; Quality Assurance, Health Care

OBJECTIVETo investigate the administration of far lateral craniocervical approach in the jugular foramen (JF) tumors.

METHODSA retrospective analysis was performed in 14 cases of JF tumors (9 neurilemmomas, 3 meningiomas, 1 glomus jugulare tumor, and 1 adenoid cystic carcinoma) surgically treated between January 2009 and January 2012, with focus on the surgical approach. Six patients (6/14) showed hydrocephalus. The tumor type was composed of 5 intracranial and intraforamen tumors with patent or occluded jugular bulb, 1 intracranial tumor with extension into the upper cervical canal, 4 extracranial and intra foramen tumors, 4 intra- and extracranial dumbbell-shaped communicating tumors involving the parapharyngeal space above C2 or extending caudally below C3. Far lateral postcondylar approach (FLPC) was carried out in 2 cases, far lateral tansjugular process approach (FLTJP) in 3 cases, combined FLPC + C1-2 semi-laminectomy approach in 1 case, combined FLTJP + trans-C1 transverse process approach in 7 cases, and combined FLTJP + neck approach with dissection of carotid sheath to the skull base in 1 case. Endovascular embolotherapy prior to surgical resection was performed in 1 glomus jugulare tumor.

RESULTSTotal tumor removal was achieved in 12 patients and subtotal removal in 2 patients, with no cerebrospinal fluid leakage or operative mortality. New cranial nerve paresis occurred after surgery in 1 case of facial nerve and 1 case of lower cranial nerve. Transient worsening of preoperative lower cranial nerve deficits was noted in 3 patients. Long-term follow-up study ranging from 5 to 32 months (average 13.7 months) showed 7 patients with lower cranial nerve deficits (6 preexisting and 1 new), with exception of one preoperative lower cranial nerve dysfunction due to the infiltration of an adenoid cystic carcinoma, experienced favorable improvement with recovery of adequate swallowing function, but voice disturbance remained in 4 cases. One patient with new facial nerve deficit presented with partial improvement and the hydrocephalus in 6 patients all spontaneously regressed. There was no tumor recurrence in patients receiving total removal and no tumor progression in patients undergoing subtotal removal.

CONCLUSIONSFLTJP is a basic approach for JF tumors. The combined cranial and cervical approach should be considered in those tumors extending into the upper cervical canal and parapharyngeal space. The associated hydrocephalus seldom requires additional surgical management.

Adult ; Aged ; Brain Neoplasms ; surgery ; Female ; Follow-Up Studies ; Glomus Jugulare Tumor ; surgery ; Humans ; Male ; Microsurgery ; Middle Aged ; Retrospective Studies ; Skull Base ; surgery