Objective To evaluate the nutritional risk screening for younger patients with stroke and to explore risk factors of malnutrition. Methods Younger patients with stroke were enrolled in a prospective way. The patients were evaluated by nutritional risk screening 2002 (NRS 2002) at their admission for nutritional risk screening, and were divided into nutritional risk group and no nutritional risk group according to the evaluation results. Prealbumin less than 200 mg/L was defined as malnutrition. Demographic and baseline clinical characteristics of the patients were analyzed with multivariate logistic regression analysis to determine independent risk factors for malnutrition at the admission and the 14th day. Results (1) A total of 152 young stroke patients were enrolled, including 51 in nutritional risk group, 101 in no nutritional risk group, the rate of nutritional risk was 33.6%(51/152). (2) The rate of malnutrition at admission was 13.8%(21/152), the rate of malnutrition in nutritional risk group was 25.5%(13/51), and 7.9%(8/101)in no nutritional risk group on admission. While the rate of malnutrition was 32.2%(49/152), including the rate of malnutrition in nutritional risk group was 60.78%(31/51)and 17.8%(18/101)in no nutritional risk group was at the 14th day of admission. (3) Multivariate Logistic regression analysis showed that advanced age (from 36 to 45 years), sex, diabetes, hyperthyroidism were independent risk factors for malnutrition in younger patients with stroke. Recent history of surgery and smoking, stroke-associated pneumonia, post-stroke depression, swallowing disorder, sleep disorder, moderate and severe neurologic deficits were also risk factors for malnutrition. Conclusion The incidence of malnutrition in youngerpatients with stroke were higher, and earlier nutritional risk screening and nutritional support in these patients were urgent.

Purpose: To analyze the effect of the intraarticufar contact of the temporomandibular joint ( TMJ ) on three dimensional nonlinear simulation of human TMJ forces in order to simulate the distribution and transfer of TMJ forces more realistically and logically. Materials and Methods: Combining helical CT scanning technology with three dimensional finite element method, together with Auto CAD software, three dimensional nonlinear finite element models were developed in vivo for comparison with the changes in the stress within the TMJ in different contact conditions. Results: The stresses on the surfaces of articular disc and condyle in the finite element models with contact elements between the disc and condyle were mainly distributed on their anterior and medial regions, and the stresses on other regions were relatively smaller. But, the stresses of those models without contact element were mainly distributed on their midposterior and medial aspacts. Moreover, the stress values were higher. When the friction coefficient was in the range of 0 0.15, the distribution extent and magnitude of the contact stress between the disc and the condyle in the TMJ were completely same. Meanwhile, the surface stresses on the disc and the condyle were nearly coincident in three ways of disc condyle contact, which were no friction contact, rigid contact and elastic contact. Conclusion: In the issue of disc condyle contact of simulating TMJ forces with three dimensional nonlinear method, the stress distribution in the joint with complete contact relationship between the disc and the condyle conforms more to the physiological condition. The lower friction coefficient ( 0 0.15 ) in the TMJ and various contact patterns between the disc and condyle had no evident influence on the stress distribution in the TMJ. Three dimensional nonlinear analysis for the forces in the TMJ might be more realistic and reasonable because of contact simulation among various structures within the TMJ.

Tetrodotoxin(TTX) was coupled to Tachypleus tridentatus hemocyanin (TTH) chemically to form an artificial antigen.Balb/c mice were immunized with TTX TTH. The immunologic effect of different immunization schedules [14～20d for longer interval (group L) and 7～10d for shorter interval (group S)] of experimental anti TTX vaccine was compared. The quality of antisera and effect of vaccine on TTX poisoning were detected. The antibody quality of serum was increased more quickly in group S than that in group L after immunization. The average survival rates were 99 3% and 92 9%, respectively ( P

Objective To evaluate the effect of Sengstaken-Blakemore tube in assisting cyanoacrylate injection combined with sclerotherapy and variceal ligation under emergency endoscopy in treating escophageal and gastric variceal bleeding. Methods 60 patients were randomly selected, and were evenly divided into 2 groups single blindly. Endoscopic cyanoacrylate injection, sclerotherapy and variceal ligation were performed in control group, and additional Sengstaken-Blakemore tube were used in experimental group. Results All the 30 patients in study group got effective hemostasis (30 of 30, 100.00 %), whereas only 23 patients in control groups stopped bleeding (23 of 30, 76.67 %) (P < 0.05). escophageal and gastric variceal were cured 19 patients in the experimental group (19 of 30, 63.33 %) , and only 4 were cured in the control group (4 of 28, 14.28 %) (P < 0.05). Meanwhile, occurence of fever, chest pain, hospital days and hospitalization costs of experimental group was significantly lower than that in control group (P < 0.05). Conclusions Treating the escophageal and gastric variceal bleeding, using endoscopic cyanoacrylate injection, sclerotherapy; and variceal ligation under emergency endoscopy combined with Sengstaken-Blakemore tube could significantly increase the therapeutic efficiency as well as reduce complications and therapy cost.

Objective To explore the teaching feasibility and practicability on team-based learning (TBL) and lecture-based learning (LBL) combined with PDCA circle teaching in clinical teaching of neurol-ogy, and evaluate its teaching effect. Method 100 cases clinical medical professional training students were chosen, divided into experiment group and control group, with 50 cases in each group. Control group used TBL and LBL teaching while experiment group used combined with PDCA circle teaching on the basis of control group. After the teaching, the teaching effects difference between two groups was evaluated and compared. Result The theoretical examination scores in experiment group (85.95 ±7.63) was higher than that in control group (77.31±5.38), and the difference was statistically significant (t=2.126, P=0.034). The practical operation scores in experiment group (82.37±5.15) was higher than that in control group (76.62± 4.35), and the difference was statistically significant (t=2.173, P=0.029). In anonymous satisfaction survey, the average coutent degree with teaching in experiment group is higher than control ( 92% vs . 82%) . Conclusion TBL and LBL combined with PDCA circle teaching improves the students' basic theory, prac-tical operation and doctor-patient communication ability, whose satisfaction has also significantly increased, which is worth popularizing in the clinical practice teaching of neurology.

BACKGROUND:Pelvic fractures are mostly caused by high energy trauma. With the development of imaging techniques and in-depth study of the anatomical structure of the pelvis and biomechanics, internal fixation and external fixation materials are gradual y being used in the repair of pelvic fracture. OBJECTIVE:To summarize features and applications of external fixation stent material, percutaneous screw fixation, percutaneous sacral iliac screw material for internal fixation and intramedul ary tensile screw material for internal fixation after pelvic fracture. METHODS:We retrieved Wanfang Database and PubMed for studies on the application of internal fixation material and external fixation material in pelvic fracture from 1994 to 2015. Al data were analyzed and summarized. RESULTS AND CONCLUSION:Application of pelvic external fixation materials contributed to the stability of early pelvic fractures, showed smal injury, could increase the reliability of fixation. However, the biomechanical stability of external fixation materials was lower than other internal fixation, could only be used for the early temporary fixation of unstable pelvic fractures in particular cases. Internal fixation materials can achieve anatomical reduction, accorded with the requirements of the physical mechanics of the pelvis, improve the stability of the pelvis, and have become the first choice for repair of unstable pelvic fractures. Currently used methods are percutaneous hol ow screw fixation, percutaneous fixation of the sacral iliac screw, and intramedul ary lag screw fixation. The combination of external fixation and internal fixation can effectively restore the stability of the pelvic cavity. Therefore, we should consider the location, type and stability of the fracture to select the appropriate internal fixation and external fixation materials.

Objective To observe the efficacy and safety of rosuvastatin in the treatment of hyperlipidemia and carotid atherosclerotic plaque in young ischemic stroke patients.Methods In prospective study,264 young ischemic stroke patients with hyperlipidemia and carotid atherosclerotic plaque were randomly divided into low dose group,middle dose group,high dose group,88 cases in each group.All patients were given rosuvastatin immediately after dinner,in doses of 5mg,10mg,20mg,respectively,for eight months.Then,the changes of hyperlipidemia and carotid atherosclerotic plaque in the three groups were surveyed,and its safety by the observation of clinical symptoms and monitoring of adverse reactions after eight months were assessed.Results Before treatment,the blood fat and carotid atherosclerosis plaque index in the three groups had no statistically significant differences (all P >0.05). After treatment,the total cholesterol,triglycerides,low -density lipoprotein cholesterol of the high dose group were (1.67 ±0.68)mmol/L,(3.23 ±0.53)mmol/L,(1.83 ±0.62)mmol/L,which of the middle dose group were (1.93 ±0.74)mmol/L,(3.73 ±0.23)mmol/L,(2.24 ±0.73)mmol/L,which of the low dose group were (2.16 ± 0.77)mmol/L,(4.06 ±0.93)mmol/L,(2.93 ±0.35)mmol/L.These indicators were decreased than before treat-ment [(2.79 ±0.72)mmol/L,(5.40 ±0.67)mmol/L,(3.64 ±1.03)mmol/L,(2.75 ±0.81)mmol/L,(5.59 ± 0.95)mmol/L,(3.43 ±0.92)mmol/L and (2.83 ±0.53)mmol/L,(5.84 ±0.79)mmol/L,(3.83 ±0.88)mmol/L].The decrease of the high dose group was higher than the middle and low dose group,the difference was statistically significant(F =6.61,P <0.05).The effective rate of the high dose group was 85.23%.which of the middle dose group was 76.14%.The effective rate of the low dose group was 62.50%.The efficacy of the high dose group was better than the middle dose group and low dose group,the difference was statistically significant(χ2 =5.79,P <0.05).After treatment,the intima -media thickness,plaque area and Crouse score of the high dose group were (0.92 ±0.41)mm,(0.52 ±0.56 )mm,(3.07 ±0.58 )mm,which of the middle dose group were (1.11 ± 0.52)mm,(0.60 ±0.36)mm,(3.39 ±0.83)mm,which of the low dose group were (1.42 ±0.87)mm,(0.81 ± 0.91)mm,(4.09 ±0.77)mm,which were decreased than before treatment[(1.71 ±0.89)mm,(0.86 ±0.55)mm, (4.39 ±0.19)mm,(1.74 ±1.03)mm,(0.89 ±0.48)mm,(4.42 ±0.53)mm and (1.68 ±0.96)mm,(0.87 ± 0.61)mm,(4.38 ±0.22)mm].The decrease of the high dose group was higher than the middle and low dose group, the difference was statistically significant (F =5.83,P <0.05 ).The effective rate of the high dose group was 78.41%.The effective rate of the middle dose group was 52.27%.The effective rate of the low dose group was 30.68%.The efficacy of the high dose group was better than the middle dose group and low dose group,the difference was statistically significant(χ2 =5.37,P <0.05).There were 10 cases (11.36%)had adverse reaction in the low dose group,12 cases (13.64%)in the middle dose group,14 cases (15.91%)in the high dose group.There was no statistically significant difference in incidence of adverse reactions among the three groups (P >0.05),and no serious adverse reaction was found.Conclusion The high dose rosuvastatin treatment can reverse the nature of plaque, decrease the thickness of the plaques and lower blood lipid of young ischemic stroke with hyperlipidemia and carotid atherosclerotic plaque,which is better than middle and low dose,and has better security.There is no serious adverse reaction.It is worth for clinical promotion.

1-Alkyl-2-acetylglycerophosphocholine Esterase ; blood ; genetics ; Adolescent ; Asthma ; blood ; enzymology ; genetics ; Child ; Child, Preschool ; Female ; Gene Expression Regulation, Enzymologic ; Genotype ; Humans ; Infant ; Male ; Mutation ; Polymerase Chain Reaction

Objective To evaluate the clinical results of surgical treatment of isolated fractures of the sustentaculum tali of calcaneus via medial approach.Methods The data of 23 patients with isolated fractures of the sustentaculum tali of calcaneus was retrospectively analyzed who were treated with open reduction and internal fixation with cannulated screw or Kirschner wire via medial approach from September 2006 to March 2011.There were 19 males and 4 females,with an average age of 26.3 years (range,17-41 years).Associated injuries included 4 cases of talus fracture,4 of metatarsal fracture,and 3 of cuboid fracture.The functions of hiudfoot were assessed by American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores pre-operation and post-operation respectively.Results Fifteen patients got followed up with an average 20.5 months (10-56 months).Thirteen patients were rated as good,2 as excellent,and the excellent and good rate was 100％(15/15).All the fractures were stabilized reliably,and got clinical union with no obvious complications occurred.Time of fracture union was 8-10 weeks,with an average of 8.5 weeks.Three patients felt mild transient pain during the recovery of walking,but their pain disappeared quickly after physical therapy.No patients developed wound infection,nonunion and other complications.Conclusion For isolated fractures of the sustentaculum tali of caleaneus with articular surface displaced greater than 1 mm or involving the articular surface of middle subtalar joint,open reduction and internal fixation operation via medial approach under direct visualization is recommendable.

Objective To investigate the neuralprotective effect of Rho kinase inhibitor fasudil hydrochloride in cerebral ischemia/reperfusion injury in rats.Methods The SD rats were randomly divided into four groups:the sham group,the ischemia/reperfusion group,the fasudil hydrochloride group and the physiological saline group.Fasudil hydrochloride were injected intraperitoneally 30 minutes before ischemia.And the physiological saline group were treated with the intraperitoneal injection of the same volume of saline.The phosphorylation and protein expression of GluR6 at 6 hours during reperfusion were detected using immunoprecipitation and immunoblotting analysis to examine the effect of Fasudil hydrochloride.Furthermore,TUNEL staining was used to examine the apoptosis of neurons in rat hippocampal CA1 regions after 3 days reperfusion.Results 1.Immunoprecipitation and immunoblotting analysis were used to analyze the phosphorylation of GluR6 in serine site.The results showed that the GluR6 serine phosphorylation level increased significantly at 6h of reperfusion compared with the sham group (P＜0.05).Fasudil hydrochloride group could inhibit the increased phosphorylation of GluR6 at 6h of reperfusion compared with the ischemia/reperfusion group and saline group,respectively (P ＜ 0.05).2.TUNEL staining was used to examine the apoptosis of neurons in 3 days after reperfusion in CA1 regions of hippocampus.The results indicated that significant numbers of TUNEL positive cells (40.20 ± 2.77) were observed 3 days after ischemia/reperfusion.The numbers of viable neurons per 1 mm length of CA1 pyramidal cells were quantitatively analyzed.Fasudil hydrochloride markedly decreased the neuronal loss compared with the ischemia/reperfusion group (19.80 ± 2.86) (P＜0.05).Conclusion Fasudil hydrochloride can inhibit induced phosphorylation of GluR6 by the ischemia/reperfusion.Fasudil hydrochloride can reduce the neurons apoptosis in hippocampal CA1 regions,and perform a neuralprotective effect on ischemia/reperfusion injury in rats.