Objective To characterize the foot pressure distribution during walking of the male college students with a normal left foot and toes-out right foot gait.Methods Forty-two male college students age 20 to 25 with a toes-out gait on the right side and a normal gait on the left side were recruited.The FOOTSCAN system was used to measure their foot pressure distribution while walking.Results There were significant differences between the normal and the toes-out foot with regard to the peak pressure on the third metatarsal bone [(45.05 ±13.91)N/cm2 vs (26.83 ± 10.82) N/cm2] and pressure under the arch [(4.48 ± 1.94) N/cm2 vs (2.90 ±1.57) N/cm2],as well as the time for the appearance of peak pressure under the 1st and 4th metatarsal bones.The foot regional impulse was significantly lower on the normal side than on the toes-out side for toes 2 to 5 and for metatarsal bone 2.Conclusion In contrast to the normal foot,the pressure center of the toe-out foot deflects to the inner side.This results in slanted power application instead of straight ahead,so the strength in the direction of travel is small.And it will produce torsion between the tibia and fibula,which makes the tibia appear introverted and causes excessive friction in the knee joint.This will lead to injury of the knee joint.

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.

Hoarseness ; diagnosis ; etiology ; Humans ; Thyroglossal Cyst ; complications ; diagnosis

Objective To summarize the research results at home and abroad of raltitrexed on the patients with advanced gastric cancer,and to evaluate the clinical efficacy and adverse reactions of raltitrexed. Methods Clinical controlled trials of evaluating effects of raltitrexed on the advanced gastric cancer were searched in PubMed,EMBase,Ovid,Springer,Wanfang database,VIP database and China Biology Medicine disc. Besides,references and conference abstracts were searched manually. Literature screening and data extraction were performed according to inclusion and exclusion criteria. Then Meta-analysis was performed using RevMan 4. 2. Results Forty-four studies were found and 5 clinical controlled trails including 338 patients were included in this analysis. The results of Meta-analysis showed that there was a significant beneficial effect of raltitrexed on objective effective rate for the patients with advanced gastric cancer(RR = 1. 55,95% CI:1. 21-1. 99,Z = 3. 44,P = 0. 00)compared with other treatments. The incidences of Ⅲ-Ⅳadverse reactions in raltit-rexed group such as neutropenia(RR = 1. 97,95% CI:0. 85-4. 56,Z = 1. 59,P = 0. 11),thrombocytopenia (RR = 1. 56,95% CI:0. 60-4. 07,Z = 0. 92,P = 0. 36),anemia(RR = 2. 43,95% CI:0. 61-9. 78,Z =1. 25,P = 0. 21),arthralgia(RR = 3. 20,95% CI:0. 73-13. 98,Z = 1. 55,P = 0. 12),elevated transaminase (RR = 1. 37,95% CI:0. 29-6. 48,Z = 0. 39,P = 0. 69)were higher than those in other group,with no statis-tical significance. However,the adverse reactions in raltitrexed group such as diarrhea(RR = 0. 18,95% CI:0. 03-1. 07,Z = 1. 88,P = 0. 06),nausea and vomiting(Z = 1. 79,RR = 0. 45,95% CI:0. 19-1. 08,P =0. 07),neurotoxicity(RR = 0. 07,95% CI:0. 01-0. 52,Z = 2. 59,P = 0. 01),hand-foot syndrome(RR =0. 26,95% CI:0. 04-1. 59,Z = 1. 46,P = 0. 14),alopecia(RR = 0. 57,95% CI:0. 13-2. 55,Z = 0. 73, P = 0. 46)were lower than those in other group. There were no statistical significances except neurotoxicity. Conclusion Compared with other treatments,raltitrexed-based chemotherapy has a beneficial effect on objec-tive effective rate and less adverse reactions for the patients with advanced gastric cancer,which is worthy of clinical use.

ObjectiveTo evaluate the predictive value of the sperm quality to fertilization outcomes after short-time insemination.MethodsA total of 558 cycles of short-time insemination in the Reproductive Medical Center of Henan Provincial People's Hospital during January 2009 to June 2010 excluding patients aged ＞ 38 years and M Ⅱ oocyte number ＜ 3 were analyzed retrospectively.According to whether undergo rescue intracytoplasmic sperm injection( Re-ICSI),all cycles were divided into in vitro fertilization (IVF)group (472 cycles) and rescue intracytoplasmic sperm injection (Re-ICSI) group (86 cycles).Both IVFgroup and Re-ICSI group were subdivided into primary infertility and secondary infertility according to previous history of pregnancy.269 primary infertility cycles and 203 secondary infertility cycles were characterized in IVF group; and 64 primary infertility cycles and 22 secondary infertility cycles were characterized in Re-ICSI group.x2 test was applied for comparison of embryo plant rate,clinical pregnancy rate,early miscarriage rate between IVF and Re-ICSI groups,while Fisher test was used for comparison of live birth rate.and Mann-Whitney U test was utilized for comparison of duration of infertility,forward moving sperm counts,abnormal sperm rate,sperm acrosin activity between IVF and Re-ICSI groups.ResultsThe embryo plant rate,clinical pregnancy rate,early miscarriage rate,live birth rate of IVF group were:29.4％,44.9％,13.4％,37.0％ respectively; the above indicators in Re-ICSI group were:25.7％,34.6％,10.7％,29.6％ respectively,the differences of the indicators between the two groups had no statisticalsigmficance (x2 =0.869,2.963,0.010,P =0.351,0.085,0.922,0.098).Median of duration of infertility,forward moving sperm counts,abnormal sperm rate,sperm acrosin activity of primary infertility cycles in IVF group were:4.00(3.00 -6.00) years,58.37(33.64 - 102.27) × 106,81.09％ (79.41％ -88.69％ ),76.30 (48.50 - 92.46 ) μIU/106 sperm respectively ; in Re-ICSI group were:5.00 ( 3.25 -8.00) years,36.33 (20.59 -64.43 ) × 106,85.5％ (81.28％ - 89.02％ ),47.14( 31.61 -90.24) μIU/106 sperm respectively,the differences of them between the two groups had statistical significance (Z =-2.617, -3.505, -3.553, -3.530,P =0.009,0.000,0.000,0.000).Median of duration of infertility,forward moving sperm counts,abnormal sperm rate,sperm acrosin activity of secondary infertility cycles in IVF group were:5.00 (3.00 -7.00) years,63.00 (34.20 - 107.73 ) × 106,81.29％ (79.90 -86.09) ％,78.34 ( 53.87 - 98.00) μIU/106 sperm respectively,in Re-ICSI group were:5.00 ( 3.75 -7.00) years,28.80 ( 18.57 - 48.56 ) × 106,88.79％ ( 84.04 - 95.64 ) ％,54.70 ( 39.73 - 76.77 ) μIU/106 sperm respectively,the differences of them between the two groups showed statistical significance except duration of infertility (Z =- 0.338,- 3.505,- 3.553,- 3.530,P =0.735,0.000,0.000,0.006).ConclusionThe duration of infertility,forward moving sperm counts,abnormal sperm rate,sperm acrosin activity have predictive value of fertilization outcomes after short-time insemination.

Objective To observe the lumbosacral plexus nerves by diffusion tensor tractography (DTT) and quantitatively evaluate them by using diffusion tensor imaging (DTI) in healthy volunteers.Methods A total of 60 healthy volunteers (30 males and 30 females) underwent DTI scanning.Mean FA values of the lumbosacral plexus nerves (both sides of lumbar roots L3 to S1,proximal and distal to the lumbar foraminal zone) were quantified.Differences among various segments of lumbar nerve roots were compared with ANOVA test and SNK test.Differences between two sides of the lumbar nerve roots at the same lumbar segment were compared with paired-samples t test.Differences between the proximal and the distal nerve to the the lumbar foraminal zone at the same lumbar segment were compared with paired-samples t test.The lumbosacral plexus nerve was visualized with tractography.Results (1) The lumbosacral plexus nerve was clearly visualized with tractography.(2) Mean FA values of the lumbar nerve roots L3 to S1 were as followings:proximal to the left lumbar foraminal zone 0.202 ± 0.021,0.201 ± 0.026,0.201 ± 0.027,0.191 ±0.016,distal to the left lumbar foraminal zone 0.222 ± 0.034,0.250 ± 0.028,0.203 ± 0.026,0.183 ± 0.020,proximal to the right lumbar foraminal zone 0.200 ± 0.023,0.202 ± 0.023,0.205 ± 0.027,0.191 ±0.017,distal to the right lumbar foraminal zone 0.225 ±0.032,0.247 ±0.027,0.205 ± 0.033,0.183 ±0.021.Mean FA values were significantly different between the proximal nerve to the distal nerve in lumbar nerve roots L3,L4,S1 (t =-9.114-2.366,P ＜ 0.05),but not significantly different in L5 (P ＞ 0.05).Differences were not found between the right and left side nerves at the same lumbar segment (P ＞ 0.05).(3) The whole length of the lumbar roots nerve L3 to S1 can be visualized clearly by using DTT.Conclusions Diffusion tensor imaging and tractography can show and provide quantitative information of human lumbosacral plexus nerves.DTI is a potential tool for the diagnosis of lumbosacral plexus nerve disease.

Objective To study the mechanism and characteristic of traffic injury of front crash. Methods Thirty rabbits were divided randomly into 3 groups according to crash velocity. The initial velocity of GroupⅠ was 30 km/h, group Ⅱ 40 km/h, and group Ⅲ 50 km/h. The rabbits were fixed on the seats in a sitting position and the injury process were started by driving power system with the velocity and acceleration set primarily. The crashing velocity and deceleration were recorded by laser velocity measuring system and high speed camera system. The injury characteristics of rabbits were observed and then the AIS-ISS score was compared. Results During 1 hour after injury, all rabbits survived except one in group Ⅱ and three in group Ⅲ. No organ injury was found in group Ⅰ, but organ injuries in thorax and abdomen were found in group Ⅱ and Ⅲ. The score of AIS (MAIS) and ISS were (2.30?0.65), (14.50?2.10) in group Ⅱand (4.20?0.70), (36.40?4.58) in group Ⅲ respectively. Conclusion The velocity and deceleration of crash have impact on the injury character of animal, and the main injury organs are the thorax and abdomen in traffic injury of front crash in rabbits.

Objective To investigate the role of clinical pharmacists in the treatment of a Parkinson′s disease patient with mental disorders.Methods Clinical pharmacists provided appropriate pharmaceutical care and optimized the treatment program based on patient′s symptom, medication history, drug interactions,and adverse drug reactions etc.Results Clinical pharmacists improved rational drug use by participating in the development of patient′s treatment program, giving patient with proper medication instruction and discharge education.Conclusion With their professional knowledge, clinical pharmacists play an important role in rational drug use and helping physicians to optimize the medication regimen.

With the rapid development of medical imaging technology, there are many corresponding kinds of medical images. The traditional teaching and examination mode based on typical images cannot meet the needs of medical imaging teaching. Therefore, we took the post competence of medical imaging students as the guidance, integrated multidisciplinary medical image resources, and established the human-computer dialogue teaching and examination system for medical images. The system was applied to medical imaging teaching and examination, achieving the standardization and clinical simulation of teaching and examination, and effectively improving the post competence of students.

Objective:To assess the value of cerebral small vessel disease (CSVD) burden in predicting prognosis in acute ischemic stroke (AIS) patients with anterior circulation large vessel occlusion (LVO) after endovascular therapy (EVT).Methods:The study was a cross-sectional study. A total of 242 patients with AIS due to anterior circulation LVO received EVT in the First Affiliated Hospital of Nanjing Medical University from February 2018 to September 2022. The clinical and imaging data of all patients were analyzed retrospectively. On follow-up MRI within 7 days after EVT, CSVD features [white matter hyperintensity (WMH), lacune, perivascular space, cerebral microbleed, cerebral atrophy] and CSVD burden score (0-5) was evaluated. Modified Rankin scale (mRS) score at 90 days after EVT was assessed. Patients were categorized into a mild burden group (0-1 points) and a moderate-severe burden group (2-5 points) based on CSVD burden score. Meanwhile, patients were categorized into a good prognosis group (0-2 points) and a bad prognosis group (3-6 points) based on mRS score at 90 days after EVT. Mann-Whitney U test and χ2 test were used to compare the difference of clinical and imaging indexes between the 2 groups, and variables with P<0.1 in the univariate analysis were included in the multifactorial logistic regression to screen for independent factors to predict the prognosis. Results:There were 169 patients in the good prognosis group and 73 patients in the bad prognosis group out of 242 patients. Compared with the good prognosis group, age, incidence of hyperlipidemia, baseline National Institutes of Health Stroke Scale (NIHSS) scores, incidence of hemorrhagic conversion, CSVD burden scores, incidence of periventricular WMH scores of 3 and/or deep WMH scores≥2, and incidence of moderate-severe cerebral atrophy of patients in the bad prognosis group were higher, and the incidence of complete recanalization was lower (all P<0.05). Multivariate analysis showed hyperlipemia ( OR=8.438, 95% CI 1.691-42.119, P=0.009), baseline NIHSS score ( OR=1.103, 95% CI 1.047-1.162, P<0.001), complete recanalization ( OR=0.131, 95% CI 0.038-0.454, P=0.001) and hemorrhage transformation ( OR=1.952, 95% CI 1.031-3.697, P=0.040) were independent factors for the prognosis of EVT in patients with LVO AIS. There were 157 cases in the mild burden group and 85 cases in the moderate-severe burden group. The 90-day mRS score was higher in the moderate-severe burden group compared with the mild burden group ( Z=-2.24, P=0.025). Conclusion:CSVD burden has some clinical implications in predicting the prognosis of EVT in patients with anterior circulation LVO AIS.