Objective To observe effect of scalp acupuncture combined with cognitive rehabilitation training in ameliorating cognitive dysfunction in stroke patients. Methods Eighty-four stroke patients with cognitive dysfunction were randomly divided into a treatment group ( n = 42) and a control group (n = 42 ) . All of the patients in both groups received routine therapy including cognitive rehabilitation training by professional therapists aimed at improving their orientation, perception, attention and thinking. The patients in the treatment group also received prolonged scalp acupuncture, in which the acupuncture needle remained in the scalp for 6 hours. All cases were evaluated using Loewenstein's occupational therapy cognition assessment (LOTCA) before and 10 weeks after treatment. Results The LOTCA scores were significantly different before and after treatment in both groups. The effect in the treatment group was significantly better than in the control group. Conclusions Prolonged scalp acupuncture combined with cognitive rehabilitation training can significantly improve the cognitive ability of stroke patients.

Objective To assess the value of peripheral blood thyroid stimulating hormone receptor(TSHR) mRNA determination in differential diagnosis of benign and malignant thyroid nodules.Methods Fine needle aspiration cytology (FNAC) and (or) postoperative histopathology as the gold standard were carried out,the expression of circulating TSHR mRNA was determined by RT-PCR in 33 patients with benign thyroid nodules,39 patients with thyroid cancer,and 20 normal controls.Results TSHR mRNA signals were not detected in normal controls,the positive rate of TSHR mRNA was higher in the group with malignant nodules than the group of benign nodules (91.2％ vs 48.5％,P＜0.01).TSHR mRNA level in the preoperative malignant group was significantly higher than that in the normal,benign,and postoperative cancer groups (all P ＜ 0.01).Using peripheral blood TSHR mRNA for differentiating benign or malignant of thyroid nodule had a sensitivity,specificity,and accuracy of 91.2％,51.5％ and 71.6％,respectively.The sensitivities of TSHR mRNA,FNAC,and these two methods combined in detecting malignant nodules were 91.3％,86.9％,and 100.0％ respectively,while diagnostic accuracies were respectively 84.0％,80.0％,and 92.0％.TSHR mRNA expression showed no significant relationship with sex,age,size,and number of nodule in these patients (all P ＞ 0.05),but it did exhibit significant difference between benign and malignant nodules(P＜0.01).Conclusion The peripheral blood TSHR mRNA could be used as a molecular marker for thyroid cancer,and it would help enhance the preoperative differentiation of benign and malignant thyroid nodules.

ObjectiveTo detect the Alu expression in the stool of patients with pancreatic cancer and investigate its value in the diagnosis of pancreatic cancer.MethodsStool samples were obtained from patients with pancreatic cancer (PC) ( n =41 ),chronic pancreatitis (CP) ( n =27 ) and healthy subjects ( n =23 ),the DNA was extracted from the stool and the expression of Alu repetitive sequences was subjected to quantitative analysis by the real-time PCR.ResultsThe expressions of Alu repetitive sequences in PC,CP,and healthy subjects were (5.17 ± 0.99 ),( 3.79 ± 0.94),(0.28 ± 0.35 ) rig/g,and the difference among the three groups was statistically significant (P ＜0.05).The AUC of PC was 74.8％ with the 95％ CI 0.661 ～0.835,and the sensitivity,specificity was 75.6％ and 67.1％,respectively.ConclusionsAlu repetitive sequences are highly expressed in the stool of patients with pancreatic cancer,and it is of value in the diagnosis of pancreatic cancer.

Objective To report 11 cases with the tissue defects of their upper or lower limbs repaired with the anastomsed medial sural artery perforator flaps.Methods The free medial sural artery perforator flaps,with length of 8 cm to 15 cm and width of 6 cm to 14 cm were used for tissue defect reconstruction of the distal upper or lower limbs in 11 cases,including 6 females and 5 males.The flap was harvested from the ho- mo-lateral calf,confined between the posterior-medial edge of the tibia and the middle line of the calf and a- bove the distal half part of the medial sural muscle,with a same axis of this muscle.Results Ten cases survived very well,which was relatively thin,and the donor site can be acceptable.One case resulted in a complete flap necrotized and covered with a split skin graft.No obvious motor function defect was observed of the donor leg.Conclusion The anastomsed medial sural artery perforator flap is alternative donor flap for the upper or lower limb tissue defect repair,especially for the defect in the hand or foot.

Althoughtheevidenceoftheevidence-basedmedicinehasshowedthatrecombinant tissue-type plasminogen activator can effectively open the occluded vessels, because of its short therapeutic time w indow and the risk of bleeding, the thrombolytic rate is general y low er currently. Clinical studies have show ed that telestroke can effectively shorten the treatment time of the patients, increase the thrombolytic rate, reduce the risk of bleeding, and improve the outcomes of patients. Although the application of telestroke is restricted in many w ays, such as technology, policy, and funding, w ith the grow ing maturity of the related technologies, telestroke w il play an increasingly important role in the treatment of stroke.

BACKGROUND:The safety and efficacy of paclitaxel-eluting stents (Taxus DES) has been proved by international researchers in clinic investigations.Based on further inclusion criteria,the incidence of in-stent restenosis is still lower than that of bare-metal stent.OBJECTIVE:TO observe restenosis of Taxus DES and the effect on local vessels through applying the follow up of coronary angiography and to investigate the biocompatibility of stent and host.DESIGN:Following-up observation.SETTING:Department of Cardiology,General Hospital of Chinese PLA.PARTICIPANTS:A total of 297 patients who had undergone coronary Taxus DES implantation for coronary artery disease were selected from Cardiovascular Department of General Hospital of Chinese PLA from May 2003 to May 2005.There were 265 males and 32 females and their ages ranged from 36 to 76 years.All patients provided informed consent,and the experiment had got confirmed consent from local ethic committee.METHODS:All patients were implanted Taxus DES and received the follow up within 6 and 12 months.In addition,at 6 months after operation,coronary angiography was used to measure the reference vessel diameter (RVD) and the minimal lumen diameter(MLD),calculate diameter restenosis rate and observe late loss.MAIN OUTCOME MEASURES:Coronary angiography at 6 months after Taxus DES implantation and biocompatibility of stent and host.RESULTS:①Quantitative angiographic analysis(QCA):Angiographic follow-up showed that the late loss of in-stent was significantly higher than that of pro-in-lesion and dis-in-lesion(P＜0.05).②Coronary angiography in-stent restenosis:In 134 angiographic follow-up patients,a total of 14 patients experienced restenosis,and the incidence was 10.4%(14/134).The patterns of restenosis were diffuse in-stent in 7 patients and the rate of revascularization was 6.7%.③Stent aneurysm:Angiographic evidence of aneurysm was observed in one patient among follow-up cases,and the rate of which was 0.75% (1/134).④Clinic follow-up major adverse cardiac events(MACE):Among 297 patients,one patient was attracted sudden death 5 months after intervention (0.34%; 1/297),and one patient was suffered subacute thrombosis 5 days after stent implant (0.34%;1/297),and late thrombosis occurred in 2 patients.The general rate of MACE was 1.35%.CONCLUSION:①The late loss of Taxus DES mainly takes place in in-stent.The patterns of restenosis of Taxus DES are in majority of diffuse in-stent,and the incidence of MACE is low.②Taxus DES possibly results aneurysm in local vessels.The follow up indicates that Taxus DES has a good biocompatibility to patients.

Objective To detect the microRNAs in fecal with patients of pancreatic cancer, and evaluate its diagnostic value. Methods Stool samples were collected from three group persons including 29 pancreatic cancer, 22 chronic pancreatitis and 13 normal controls. The total fecal microRNAs were extracted.The quantity of miR-16, miR-21, miR-155, miR-181a, miR-181b, miR-196a, and miR-210 were detected by using real-time PCR, and miR-16 was used as reference gene. ROC AUC was used to evaluate the diagnostic value for pancreatic cancer. Results MicroRNAs were efficiently obtained from stools, and independent experiments showed high reproducibility for microRNAs extraction and detection. The expression of miR-181b,miR-196a, miR-210 in fecal was 2.22 ±0.64,2.78 ±0.14, 5.55 ±0.38 in pancreatic cancer; 1.42 ±0.39,3.88 ± 0.85,5.39 ± 0.69 in chronic pancreatitis; 0.32 ± 0.40, 1.14 ± 0.98,4.23 ± 0. 99 in normal controls;the three microRNA expressions in pancreatic cancer were group and CP group significantly higher than those in normal controls ( P ＜ 0.05 ). But there was no significant difference between pancreatic cancer group and chronic pancreatitis group. AUC of pancreatic cancer / normal controls miR 18lb was 0.745(95% CI 0. 597-0.894), the sentivity, specificity for pancreatic cancer was 84.6% and 51.7%. AUC of miR-210 was 0. 772(95% CI0.629-0.914), the sentivity, specificity for pancreatic cancer was 84.6% and 65.5%, and the difference was statistically significant (P ＜0.05). miR-196a was no significant for the diagnosis of pancreatic cancer, but the expression of miR-196a was correlated with the tumor size (r = 0.516, P = 0.041 ).Conclusions The extraction and detection of the fecal microRNAs were non-invasive and reproducible. The expression of miR-181b and miR-210 was increased in stool of patients with pancreatic cancer, and may be potential biomarker for pancreatic cancer.

Objective To investigate the diagnostic value of the K-ras mutations in FNA samples for early detection of pancreatic cancer. Methods FNA samples of 27 patients with pancreatic cancers, 9 patients with other malignant tumors and 14 patients with non malignant pancreatic mass (NMPM) were collected. DNA was extracted, and K-ras gene was amplified through PNA-mediated PGR clamping, the products were sequenced to determine the mutation type. Results The positive rate of K-ras mutations in pancreatic cancers,other malignant tumors and NMPM were 88.9%, 44.4%, 35.7%. There was significant difference in K-ras gene mutations in FNA samples between pancreatic cancer and other malignant tumors ( P = 0. 013 ) and NMPM ( P = 0. 001 ). The sensitivity, specificity, positive predictive value, negative predictive value,accuracy of K-ras mutations in FNA samples of pancreatic cancers were 88.9%, 55.6%, 85.7%, 62.5%,80.6% when compared with other malignant tumors, and the difference between the two groups was significant (P =0. 013) ;Those were 88.9%, 64.3%, 82.8%, 75.0%, 80. 5% when compared with NMPM, and the difference between the two groups was significant ( P = 0. 001 ). When cytology of FNA samples and K-ras mutations was combined, the positive rate of pancreatic cancer was up to 96.3%. Conclusions The detection of K-ras mutations in EUS-FNA samples helped improve the positive diagnostic rate of pancreatic cancer.

OBJECTIVETo provide the basic knowledge of wrist joint for diagnosing of these morphological change in pathological condition by measuring the posteroanterior X-ray films of different types of distal radius fracture by AO classification.

METHODSEleven radiographic indexes were measured including following 7 new parameters of 83 cases of distal radius fracture: ulnar styloid length (USL), ulnar head length (UHL), ulnar head diameter (UHD), maximal distal radius width (MDRW), proximal distal radius width (PDRW), sigmoid notch length (SNL) and sigmoid notch width (SNW) by Pacs system in standard X-ray films. The indexes were defined by the ratio of these parameters to the length of the third metacarpal. Statistical significance of indexes and correlations of parameters were analyzed by SPSS 16.0.

RESULTSIt was found that indexes of 11 parameters and 27 pairs of indexes had significantly different. Compared the indexes of 14 groups with normal group existed statistical significance, 62 pairs value of 11 parameters had correlations.

CONCLUSIONThe study provides additional radiographic index that will be helpful to more careful diagnosis and treatment of the distal radius fractures and their associated injuries such as ulnar wrist injuries or carpal instability.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Radiography ; Radius ; diagnostic imaging ; Radius Fractures ; diagnostic imaging ; Wrist Joint ; diagnostic imaging ; Young Adult

OBJECTIVETo evaluate the CT imaging characteristics of incomplete and complete myocardial bridges-mural coronary artery (MB-MCA).

METHODSFifty subjects with dual source coronary CT angiography (DSCTA) evidenced MB were included. The subjects were divided into incomplete MB-MCA and complete MB-MCA groups. The diameter of MCA in best systole phase and diastole phase, the MCA stenosis rate, the presence of atheromatous change proximal to the MB were evaluated.

RESULTSThere were 58 MB, the average length was (2.02 ± 1.02) cm, 23 were incomplete MB and 35 were complete MB. Thirty-two MB were in the middle segments of left anterior descending artery (55.2%); 17 MB were in the distal segment of the left anterior descending artery (29.3%); 1 MB was in the proximal segment of left anterior descending artery; 3 MB in diagonal branch; 4 MB in obtuse marginal branch, 1 MB in distal right coronary artery. It was statistically significant difference between the incomplete MB-MCA and the complete MB-MCA of the diameter change in diastole and systole phase [(1.93 ± 0.49) mm, (1.71 ± 0.45) mm vs. (2.21 ± 0.41) mm, (1.63 ± 0.52) mm, P = 0.008] and stenosis rate (10.38% ± 20.2% vs. 25.12% ± 21.02%, P = 0.01). Atherosclerotic finding was evidenced in 8 incomplete MB (34.78%) and 15 complete MB (42.86%) at the proximal vessel of mural coronary artery (P > 0.05).

CONCLUSIONDSCTA can vividly display the incomplete and complete myocardial MB, accurately evaluate the shape change of MB-MCA in diastole and systole phase and detect the atherosclerotic change in the proximal vessel of MB.

Adult ; Aged ; Aged, 80 and over ; Atherosclerosis ; diagnostic imaging ; Coronary Angiography ; Coronary Vessels ; Female ; Humans ; Male ; Middle Aged ; Myocardial Bridging ; diagnostic imaging ; Retrospective Studies ; Tomography, X-Ray Computed