Objective To study the effects of mosapride and domperidone on the pulmonary infection of acute stroke patients lying in bed and with nasal feeding. Methods Eighty-nine acute stroke patients lying in bed and with nasal feeding were divided randomly into the treatment group (47 cases) and the control group (42 cases). The control group was treated routinely,and the treatment group was treated with mosapride 5 mg and domporidone 20 mg thrice a day for 4 weeks, besides routine therapy. The incidence rate of pulmonary infection, gastric residual volume (GRV) and the number of cases with gastric contents remaining after 3 hours of nasal feeding were studied. All data were analyzed statistically. Results In the treatment group, 13 cases had pulmonary infection,and the incidence rate was 27.66%(13/47). In the control group,25 cases had pulmonary infection,and the incidence rate was 59.52% (25/42). There was significant difference between the two groups (P < 0.01 ). Three hours after nasal feeding,24 cases with gastric contents remaining were discovered in the treatment group,and GRV was (50.80±15.38) ml. Two hundred and thirty-seven cases with gastric contents remaining were discovered in the control group, and GRV was (112.17±32.54) ml. Significance differences were also detected between the two groups (P<0.01). Conclusion As for the acute stroke patients lying in bed and with nasal feeding,mosapride and domperidone can remarkably cut down the pulmonary infection upon common treatment.

Objective To investigate the effects of electro-acupuncture on muscular tension and motor function in the flaccid,paralytic limbs of stroke survivors.Methods Seventy-two stroke survivors with flaccid,paralytic limbs were divided randomly into a control group and an electro-acupuncture group.Both grourps received routine therapy and rehabilitation training,but the electro-acupuncture group was also treated with electro-acupuncture.Muscular tension and motor function in the flaccid,paralytic limbs in both groups were evaluated by modified Ashworth scale (MAS)and Fugl-Meyer scores before treatment and at the end of 4 weeks.Results After treatment,in 24 patients of the electro-acupuncture group and 10 patients of the control group muscular tension had increased 1-2 grades.The effectiveness rate(68.57%)in the electro-acupuncture group wag higher significantly than that(27.03%)in the control group(P＜0.01).Fugl-Meyer scores in the electro-acupuncture group were significantlv higher than those in the control group(P＜0.01).Conclusion Electro-acupuncture supplementing traditional rehabilitation improves muscle tension in flaccid,paralytic limbs and promotes the recovery of motor flunction after stroke.

Objective To explore the predictive value of brain lobe location of stroke lesion to development of long-term post-stroke depression(PSD)in the first-episode ischemic stroke patients for providing evidence for early intervention.Methods In the prospective study,158 patients aged 60 and over with first-episode ischemic stroke were continuously admitted into Department of Neurology of Shangqiu First People's Hospital from January 2013 to July 2013.The 2 to 3 years follow-up after stroke episode was performed in 126 cases for inquiring into correlation between brain lobe location of stroke lesion and development of PSD.The diagnosis of depression was in accordance with Mental Disorders Diagnostic and Statistical Manual 4(DSM-Ⅳ)standard,and divided into groups of stroke with depression(n=52)and stroke without depression(n=74).The degree of depression was evaluated by 17-item Hamilton Rating Scale for Depression(HAMD17).The location,number and volume of stroke lesions were determined by head MRI.The relationship between PSD and pathogenetic loci was analyzed by unconditional Logistic regression analysis.A difference in hemisphere commensalism.Results The morbidity of PSD was 41.3%(52/126),with 21.4%(27/126),12.7%(16/126),7.1%(9/126)in mild,moderate and severe PSD respectively.The frontal lobe(OR=2.824,95%CI=1.189-6.706)and the temporal lobe(OR=3.579,95%CI=1.233-10.393)cerebral infarction were correlated with the occurrence of PSD.The long-term PSD severity was more in frontal lobe than in temporal lobe(χ2=6.399,P<0.05).The average volume of cerebral infarction was larger in PSD group than in non-PSD group(t=3.271,P<0.05),and the average number of cerebral infarction loci was more in PSD group than in non-PSD group(t=3.176,P<0.05).The more severe the degree of depression according to HAMD17,the larger the average volume of cerebral infarction(F=6.280,P<0.05)and the more the average number of lesions(F=6.132,P<0.05).Conclusions The development of long-term PSD in the first-episode elderly patients is affected by the invasion site.The frontal lobe and temporal lobe infarction are independent risk factors for long-term PSD in patients with ischemic stroke,and the PSD was more severe in frontal lobe infarction than in temporal lobe infarction.

Objective:To explore the effects of acute sleep fragmentation (SF) on cognitive function and the relationship between hippocampal Homer1a and synaptic plasticity in aged rats.Methods:One hundred and eight SPF grade male SD rats aged 22 to 24 months were divided into three groups according to random number table: control group (Control group), non-sleep fragmentation group (NSF group) and sleep fragmentation group (SF group), with 36 rats in each group.A sleep fragmentation model was established by sleep deprivation rod method.Morris water maze and novel object recognition tests were used to evaluate the learning and memory function of rats.Homer1a expression in hippocampus was detected by Western blot, and its distribution in CA1 area of hippocampus was observed by immunohistochemical staining.Golgi staining was used to observe the density of dendritic spines in CA1 area of hippocampus, and in vitro electrophysiological patch clamp test was used to detect the slope of field excitatory postsynaptic potential(fEPSP) from CA3 to CA1 in hippocampus.SPSS 22.0 and GraphPad Prism 9.3 softwares were used for data statistical analysis and mapping.One-way ANOVA was used for comparison among groups, and Tukey-Kramer test was used for further pairwise comparison. Results:(1)In the behavioral tests, there were statistical differences in the times of crossing the original platform, the target quadrant residence time and the new object recognition index at 1 h and 24 h among the three groups( F=13.63, 11.34, 21.26, 16.22, all P<0.01). The times of crossing the original platform in SF group((2.00±1.27) times) was lower than that of Control group ((5.67±2.16) times) and NSF group ((6.50±2.35) times) (both P<0.05). The target quadrant residence time in SF group ((9.02±4.84) s) was shorter than that in Control group ((24.73±7.37) s) and NSF group ((27.81±8.37)s) (both P<0.05). The new object recognition index at 1 h and 24 h in SF group were lower than those in Control group and NSF group (all P<0.05). (2) In Western blot assay, the expression of Homer1a protein in hippocampus of SF group(0.91±0.13) was higher than that of Control group(0.70±0.05) and NSF group(0.74±0.04)(both P<0.05). (3) In immunohistochemical staining, the optical density value of the Homer1a protein in CA1 area of hippocampus in the SF group was higher than that in the Control group and NSF group(both P<0.05). (4) In Golgi staining, the density of dendritic spines in CA1 area of hippocampus in SF group was lower than that in Control group and NSF group (both P<0.05). (5) In vitro electrophysiological test showed that the slope of fEPSP in CA3-CA1 area of hippocampus in SF group were lower than that in Control group and NSF group (both P<0.05). Conclusion:Acute SF intervention in aged rats can cause cognitive impairment, which may be associated with the inhibition of hippocampal synaptic plasticity induced by hippocampal Homer1a overexpression.

Objective To explore the effect of comprehensive nursing intervention on ICGR15, psychological ability and self-care ability of patients with hepatocellular carcinoma treated by transcatheter hepatic arterial chemoembolization.Methods A total of 140 patients received transcatheter hepatic arterial chemoembolization in our hospital were divided into control group (n=70) and experimental group (n=70) according to the different nursing methods.The control group received routine nursing care and the experimental group received comprehensive nursing intervention.The ICGR15 level, psychological ability and self-care ability of two groups were observed and compared.The postoperative complications were recorded.Results After nursing, the ICGR15 level in the experimental group was significantly lower than that in the control group(P<0.01).The psychological ability and self-care ability of the experimental group were better than that of the control group(P<0.01).The total complication rate of the experimental group was 12.86% (9/70), which was significantly lower than 34.29%(24/70) of the control group, and the differences were statistically significant (P<0.01).Conclusion Comprehensive nursing intervention can effectively reduce the damage of liver reserve function and the incidence of complications, and improve the patient''s psychological and self-care ability.So it is worthy of clinical promotion.

Objective To explore the effect of comprehensive nursing intervention on ICGR15, psychological ability and self-care ability of patients with hepatocellular carcinoma treated by transcatheter hepatic arterial chemoembolization.Methods A total of 140 patients received transcatheter hepatic arterial chemoembolization in our hospital were divided into control group (n=70) and experimental group (n=70) according to the different nursing methods.The control group received routine nursing care and the experimental group received comprehensive nursing intervention.The ICGR15 level, psychological ability and self-care ability of two groups were observed and compared.The postoperative complications were recorded.Results After nursing, the ICGR15 level in the experimental group was significantly lower than that in the control group(P<0.01).The psychological ability and self-care ability of the experimental group were better than that of the control group(P<0.01).The total complication rate of the experimental group was 12.86% (9/70), which was significantly lower than 34.29%(24/70) of the control group, and the differences were statistically significant (P<0.01).Conclusion Comprehensive nursing intervention can effectively reduce the damage of liver reserve function and the incidence of complications, and improve the patient''s psychological and self-care ability.So it is worthy of clinical promotion.

Objective: To compare the efficacy and safety of mycophenolate mofetil versus cyclosporine A in treating children with primary refractory nephrotic syndrome. Methods: Conducted a prospective randomized controlled clinical trial in 62 pediatric patients (including 44 boys and 18 girls), age ranged from 2.1 to 17.0 years; 32 cases presented with frequently relapsing nephrotic syndrome (FRNS) and 30 cases presented with steroid-resistant nephrotic syndrome (SRNS), who were admitted to department of Nephrology, Children's Hospital Affiliated to Capital Institute of Pediatrics from October 2013 to October 2015. The patients received either mycophenolate mofetil (20-30)mg/(kg·d) or cyclosporine A (3-5)mg/(kg·d) randomly, on the basis of prednisone treatment. Follow-up interview was conducted regularly for at least one year. Efficacy rate, relapse rate, time required for induction of remission, relapse-free period and prednisone dosage were compared between the two groups. Results: (1) Renal histologic examination, which was available for 17 patients, revealed minimal change disease in 8 patients, mesangial proliferative glomerulonephritis (MsPGN) in five, membranous nephropathy in two, and focal segmental glomerulosclerosis (FSGS) in two. (2) Comparison of mycophenolate mofetil versus cyclosporine A in children with FRNS: There were 14 patients with FRNS in mycophenolate mofetil group and 18 patients with FRNS in cyclosporine A group respectively. The relapse rate (episodes/year) in cyclosporine A group was lower than that of mycophenolate mofetil group (1.0 (0.0, 1.0) vs. 1.0 (1.0, 3.0), Z=-2.405, P=0.016). The relapse-free period (months) in cyclosporine A group was longer than that of mycophenolate mofetil group (10.0 (5.7, 12.1) vs. 5.0 (1.0, 11.0), Z=-1.984, P=0.047). No significant difference in dosage of prednisone was found between cyclosporine A and mycophenolate mofetil groups when followed up for 1 year. (3) Comparison of mycophenolate mofetil versus cyclosporine A in children with SRNS: The efficacy rate was 6/14 in mycophenolate mofetil group and 13/16 in cyclosporine A group. The complete remission rate was 4/14 in mycophenolate mofetil group and 12/16 in cyclosporine A group (P<0.05). The time (months) required for induction of remission in cyclosporine A group was significantly shorter than that of mycophenolate mofetil group (1.0 (1.0, 2.0) vs. 3.0 (2.5, 4.0), Z=-2.529, P=0.011). No significant differences were found between the two groups with respect to relapse-free period and relapse rate. (4) Except that one patient developed hypertensive encephalopathy in cyclosporine A group, no other serious adverse events were recorded. There were no significant differences between two groups with respect to adverse events. Conclusion Our results indicated that both mycophenolate mofetil and cyclosporine A were effective in the treatment of children with refractory nephrotic syndrome. Cyclosporine A was superior to mycophenolate mofetil in preventing relapses in patients with FRNS and inducing complete remission in patients with SRNS. Although most patients were able to tolerate mycophenolate mofetil and cyclosporine A, but the toxicity and safety of cyclosporine A should be monitored closely.

Objective To evaluate the effect of dexmedetomidine on pulmonary function in elderly patients with mild obstructive ventilatory dysfunction under protective ventilation during laparoseopic gallbladder surgery. Methods Sixty patients were included who underwent laparoseopic gallbladder surgery with general anesthesia. For the all subjects, the age ranged from 65 to 75 years old, the body mass index range was 18.5～23.9 kg/m2, and the ASA grade wasⅡorⅢ. In the subject selection, the gender was not limited, and the included subjects were diagnosed with mild obstructive ventilation dysfunction by preoperative pulmonary function tests. All the subjects were randomly divided into 2 groups (n=30), including dexmedetomidine group (group D) and control group (group C). In the group D, dexmedetomidine was intravenously infused at a dose of 1 μg/kg 10 min before and after the general anesthesia induction, and at a rate of 0.4μg/(kg·h) after tracheal intubation until the end of operation. Group C was given an equal volume of normal saline. Airway peak pressure (Ppeak), mean airway pressure (Pmean), airway plateau pressure (Pplat), and positive end-expiratory pressure (PEEP) were measured at 5 min after intubation (before pneumoperitoneum) (T1), end of pneumoperjtoneum (T2), and 10 min after the end of pneumoperitoneum (T3). The driving pressure (DP) was calculated. The blood samples of the radial artery were collected for blood gas analysis, and PaO2 and PaCO2 were recorded. The oxygenation index (PaO2/FiO2), respiratory index (RI), dead space ventilation rate (VD/VT), and alveolar-arterial oxygen partial pressure difference (A-aDO2) were calculated. The time of removal of the tracheal tube and the occurrences of complications such as hypercapnia and hypoxemia within 48 hours after extubation were recorded. Results Compared with group C, Ppeak, Pmean, DP, RI, VD/VT and A-aDO2 at T1, T2, T3 were decreased in group D, PaO2/FiO2 was increased, postoperative extubation time was shortened, and the incidence of hypoxemia was reduced within 48 h after operation (P<0.05). Compared with T1, Ppeak, Pmean, DP, RI, VD/VT and A-aDO2 at T2 were increased, and PaO2/FiO2 was decreased(P<0.05). Conclusions Dexmedetomidine can improve the pulmonary function in elderly patients with mild obstructive ventilatory dysfunction under protective ventilation during laparoseopic gallbladder surgery.

Objective:To explore the surgical techniques and outcomes of closed reduction for geriatric subtrochanteric femoral fractures with certain radiological characteristics.Methods:A retrospective analysis was conducted in the 38 aged patients with subtrochanteric femoral fracture who had been treated at Department of Geriatric Orthopedics, Guangdong Provincial Hospital of Chinese Medicine from January 2015 to December 2019. There were 24 females and 14 males, aged from 62 to 95 years (average, 80.9 years). According to the Seinsheimer classification, there were one case of type ⅡB, 7 cases of type ⅡC, 18 cases of type ⅢA, 9 cases of type Ⅳ, and 3 cases of type Ⅴ. The time from injury to operation averaged 2.3 days (from 0.5 to 8.0 days). The fractures of this cohort were characterized by: ①The starting point of the medial fracture line was at the proximal end and the lesser trochanter separated. ②The fracture end was shortened and overlapped on the medial side and angled outward, showing a varus deformity. ③The alignment returned to normal after traction, with only partial lateral displacement left. Before fixation with proximal femoral nail antirotation (PFNA), all these patients were treated by closed reduction in a supine traction bed. In those whose reduction was unsatisfactory, a main nail was inserted or after the main nail was inserted reduction by leverage was performed through the screw blade incision. Intraoperatively, the quality of fracture reduction was evaluated according to the modified Baumgaertner assessment. Recorded were the patients’ operation time, intraoperative blood loss, fracture healing time, hip function and complications.Results:All the fractures achieved 100% of good to excellent reduction (38/38). The operation time ranged from 25 to 120 min (average, 55.6 min) and the intraoperative blood loss from 10 to 150 mL (average, 42.9 mL). This cohort of 38 patients was followed for 10 to 20 months (average, 15.3 months). All the fractures united after 3 to 8 months (average, 4.8 months). The Harris hip scores at the last follow-up ranged from 70 to 94 (average, 81.5). The follow-ups revealed no such complications as internal fixation failure, fracture re-displacement, malunion or nonunion.Conclusion:Closed reduction and PFNA fixation in a supine traction bed can lead to satisfactory clinical effects for the subtrochanteric femoral fractures with certain radiological characteristics in the aged patients.

Objective:To investigate the risk factors for prolonged procedure time of endoscopic submucosal dissection (ESD) for colorectal laterally spreading tumors (LSTs).Methods:Consecutive patients who underwent ESD for colorectal LSTs at Beijing Digestive Disease Center from June 2013 to March 2019 were retrospectively analyzed. Univariate analysis was used to identify factors associated with prolonged procedure time (≥60 min). Factors with significant difference in univariate analysis were included in multivariate logistic regression to determine the independent risk factors.Results:A total of 201 patients (age 65.05±10.44 years old, 53.73% were males) with 213 LSTs (diameter 2.52±1.67 cm) were included. En bloc resection rate, complete resection rate and curative resection rate were 93.90%, 84.04% and 79.81%, respectively. Intraoperative perforation rate, delayed perforation rate and delayed bleeding rate were 1.88%, 0.94% and 1.41%, respectively. Diameter ≥3 cm ( OR=13.48, P<0.001), granular nodular mixed (G-NM) subtype ( OR=25.28, P=0.002), granular homogenous subtype ( OR=9.00, P=0.045), location of rectosigmoid ( OR=3.08, P=0.002) and positive non-lifting sign ( OR=3.40, P=0.012) were associated with longer procedure time in univariate analysis. In multivariate logistic regression, diameter ≥3 cm ( OR=9.29, P<0.001), G-NM subtype ( OR=8.80, P=0.043) and positive non-lifting sign ( OR=3.43, P=0.043) were independent risk factors for prolonged procedure time. Longer procedure time was associated with lower rates of complete resection (69.56% VS 88.55%, P=0.003) and curative resection (63.64% VS 85.50%, P=0.002), and increased rate of carcinoma (86.96% VS 51.91%, P<0.001). Conclusion:LSTs of size over 3 cm, G-NM subtype or positive non-lifting sign predict prolonged procedure time, which is associated with reduced efficacy of ESD and higher risk of carcinoma.