Objective To investigate clinical value of serum procalcition(PCT) in early diagnosis of nosocomial infection in severe cerebral injury.Methods 58 patients with severe cerebral injury needing ICU monitoring were enrolled.Levels of serum PCT and C-reactive protein(CRP) and white blood cell(WBC) and nosocomial infection when entering ICU or on days 3 were observed.Results There were not difference in level Serum PCT when entering ICU in infection group compared with non-infection group(P ＞ 0.05).Serum PCT increeassd remarkably when entering ICU on days 3 in infection group as compared with non-infection group,the difference was significant (t =5.44,P ＜ 0.01).There were not difference in CRP and WBC level when entering ICU or on days 3 (all P ＞ 0.05).Conclusion Detection of serum PCT helps diagnosis early nosocomial infection in patients with severe cerebral injury.It is suggested that antibiotics should be chosen early in patients with obviously increased PCT,control abuse of antibiotics contributes to reduce incidence of drug resistance and mortality.

Objective To study the clinical value of percutaneous dilational tracheostomy(PDT) in the critical patients. Methods 56 critical patients who needed mechanical ventilation hospitalized in ICU were enrolled and divided into two groups: PDT group ,25 cases and 0T groups ,31 cases. The length of incision wound, duration of operation, amount of haemorrhage, complications were observed. Results The operation time was significantly shortened [(9.9±3.4)minutes vs (27.2 ±5.1)minutes],blood loss was significantly decreased[(5.2±2.2)ml vs (18.2±3. 5)ml] ,size of operation incision was significantly shorter[(15.0 ± 1. 6)mm vs (41.2 ±3.9)mm],lacking oxygen time was significantly shorter [(10.2±2.1) seconds vs (31.1 ±6.2) seconds] in PDT group compared with OT group (all P＜0. 01). PDT had less subcutaneous emphysema and incision bleeding in PDT group than those in OT group (all P＜0.05). Conclusion PDT was easier in performance with less complication,and was deserved to apply in critical patients.

Objective To compare and investigate the efficacy of small bone window via lateral fissure and cranial awl hole puncture aspiration via temporal lobe in treatment of hypertensive intracerebral hemorrhage (HIH) in basal ganglia. Methods Eighty-two patients with HIH in basal ganglia were divided into group A (34 cases) and group B (48 cases) by random digits table method. The patients in group A underwent small bone window via lateral fissure, and the patients in group B underwent cranial awl hole puncture aspiration via temporal lobe. The hematoma clearance rate, short-term effects, Barthel index, Scandinavian stroke scale (SSS) score and complications were compared between 2 groups. Results The Hematoma clearance rate and excellent rate in group A were significantly higher than those in group B:(91.12 ± 6.55)%vs. (55.83 ± 4.32)%and 52.94%(18/34) vs. 33.33%(16/48), the incidence of complications was significantly lower than that in group B:5.88%(2/34) vs. 22.92%(11/48), and there were statistical differences (P<0.05). The SSS score 14 d after operation and Barthel index 60 d after operation in group A were better than those in group B:(29.72 ± 6.39) scores vs. (26.43 ± 6.11) scores and (83.91 ± 17.82) scores vs. (72.34 ± 15.62) scores, there were statistical differences (P<0.05 or<0.01). Conclusions The efficacy of small bone window via lateral fissure in treatment of HIH in basal ganglia is better than cranial awl hole puncture aspiration via temporal lobe, however, surgical trauma is relatively large, and operation should be a reasonable choice according to the specific circumstances of patients.

The concentration of serum adiponectin [(2.51±1.42)mg/L] was lower in the group of patients with type 2 diabetes mellitus as compared with that in normal controlgroup [(5.26±0.78)mg/L ,P＜0.01]. The concentration of serum adiponectin was lower in the diabetics with macrovascular complications (MVC) [(1.38±0.77)mg/L] as compared with those without macrovascular complication [(3.66±0.91)mg/L]. The concentration of serum resistin was higher in the diabetic group as compared with that in control group[(7.07±1.11 vs 6.09±0.47)μg/L, P＜0.01]. It was also higher in patients with MVC [(7.96±0.65)μg/L] compared with those without MVC [(6.10±0.43)μgL, P＜0.01].

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Catalpol is a kind of iridoid,which has wide pharma-cological activities,including anti-cerebral ischemia,improving senile dementia,anti-inflammation,inhibiting capillary permea-bility,relieving pain,anti-tumor,antidiarrheal,reducing blood sugar level,protecting liver,and anti-aging.The mechanisms of Catalpol effects have been well studied.Signaling pathways in-clude NF-κB signaling pathway,PI3K/AKT signaling pathway, BDNF /TrkB signaling pathway,JAK2 /STAT3 /angiogenesis sig-naling pathway,MAPK signaling pathway,TGF-β/Smad signa-ling pathway,and ACh signaling pathway.We reviewed related signaling pathways of Catalpol effects,in order to broaden the understanding of molecular mechanism and signaling pathways of Catalpol,to know the status of catalpol,and to provide new di-rection to study Catalpol.

[Summary] The characteristics ot clinical data and relevant inspection (quantitative sensory and electrophysiological studies) in 5 patients hospitalized with acute painful neuropathy following rapid glycaemic control with insulin from 2010 to 2012 in our hospital were analyzed.The results showed that 5 patients were all males,aged 31-49 years,with lower body mass index,and diagnosed as latent autoimmune diabetes of adults (LADA) or type 2 diabetes.Glycaemic control was poor before application of insulin.When insulin was used,the hyperglycemia was rapidly corrected in a short time,with recurrent episodes of hypoglycemia during insulin treatment.The painful neuropathic symptoms appeared within 2-4 weeks after application of insulin,and were relieved partially or completely after 2-6 months.Neuropathic symptoms manifested as tingling and tenderness,with worsening during night and after insulin injection.The neuropathic symptoms were not significantly alleviated after application of neurotrophic drugs such as methycobal,protogen,and prostaglandin.These patients often suffered from severe anxiety.Nerve electromyogram examination showed slowed or normal motor conduction velocity of tibial and fibular nerves,and normal feeling threshold.

Objective To evaluate the effects of serum procalcitonin (PCT)-guided antibiotic therapy in elderly patients with early-onset stroke-associated pneumonia (EOP).Methods Totally 179 eligible elderly patients with EOP were randomly devided into 2 groups:standard therapy group (standard group,n=88) and PCT-guided group (PCT group,n=91).Patients in standard group received antibiotics according to antibiotics guidelines in China by the treating physicians.Patients in PCT group were treated with antibiotics for 5 days,then the antibiotic treatment was based on serum PCT levels as follows:discouraged if PCT＜0.25 μg/L and encouraged if PCT≥0.25 μg/L.Length of hospitalization,duration of antibiotics,costs of hospitalization and antibiotics,clinical efficacy,andmortality,National Institutes of Health Stroke Scale (NIHSS) score and Barthel index (BI) on the 28th day were observed.Results There were no significant differences in clinical efficacy,mortality,NIHSS score and BI between the two groups on the 28th day [(85.7％ vs.86.3％),(8.8％ vs.7.9％),10.1 (7.8,16.2) vs.9.8 (6.0,15.5),60.1(42.5,82.3) vs.57.9 (39.2,84.8),respectively,all P＞ 0.05].The length of hospitalization,antibiotic duration,costs of hospitalization and antibiotics were lower in PCT group than in standard group [19 (10,38) d vs.26(17,42) d,10 (7,14) dvs.15 (6,21) d,3350 (2052,6163) yuanvs.10355 (6877,15421) yuan,7532 (4810,12116) yuan vs.5358 (3089,8144) yuan,respectively,all P＜0.05].Conclusions PCT guidance of antibiotic therapy is effective and safe for the treatment of early-onset stroke associated pneumonia in elderly patients.It can reduce the antibiotic duration and costs of hospitalization.

Objective To explore the relationship between visfatin and mild cognitive impairment(MCI)in patients with type 2 diabetes mellitus(T2DM).Methods A perspective study involving 75 hospitalized T2DM patients were divided into groups with(MCI,n=35)and without (NMCI,n =40)mild cognitive impairment.Another 30 non-diabetic patients were chosen as normal control(NC).Fasting plasma levels of glucose (FPG),insulin (FINS),lipid,glycosylated hemoglobin (HbAlc),HOMA-IR and visfatin were measured and calculated.Results The serum visfatin level was higher in MCI(28.81±3.32)μg/L than in NMCI(20.69±3.40)μg/L and NC(19.06±2.35)μg/L (F=96.491,P＜ 0.01).Visfatin was negatively correlated with Montreal Cognitive Assessment (MoCA) total score (MoCA-TS) (r =-0.646,P ＜ 0.01),but positively correlated with course of disease,waist hip ratio,FPG,HbAlc,FINS,HOMA-IR and triglyceride (r=0.282,0.276,0.318,0.496,0.339,0.433,0.309,P＜0.05 or P＜0.01).MoCA-TS was negatively correlated with course of disease,HbAlc,HOMA-IR,triglyceride,total cholesterol,low density lipoprotein cholesterol (r =-0.582,-0.365,-0.234,-0.330,0.277,-0.238,P＜0.05 or P＜0.01),but positively correlated with high density lipoprotein cholesterol(r=0.290,P＜0.05).Higher values of visfatin(OR =3.246,P＜0.01),HbAlc(OR=2.308,P＜0.01)and course of disease(OR=1.634,P＜0.05)were the risk factors for MCI.Conclusions The elevated visfatin level might be a risk factor for MCI in T2DM patients.