Objective To analyzethe expression level of peripheral blood mononuclear cell Toll like receptor 4(TLR4)in patients with acute coronary syndrome(ACS)undergoing elective percutaneous coronary intervention(PCI),and intensive atorvastatin on Toll like receptor 4 in clinical treatment.Methods 100 cases of patients with ACS were selected in our hospital from May 2014 to May 2016 were randomly divided into control group and experimental group,control group were given atorvastatin treatment after admission,20mg/d PCI postoperative continuous,after one month still maintain dose of 20mg/d.The experimental group were given atorvastatin treatment after admission,40mg/d,PCI postoperative continuous,after one month reduced to 20mg/d.After admission and a course of treatment,the expression level of peripheral blood mononuclear cells TLR4 was detected by flow cytometry and the Gensini scoring system on coronary lesion degree.At the same time,50 healthy subjects were selected as normal group.Results Compared with healthy subjects,the peripheral blood mononuclear cells TLR4 level in ACS patients has been significantly increased,and the level in patients with unstable angina pectoris is far lower than the level increased in patients with acute myocardial infarction,triple branch lesions groups were significantly higher than them in single and double branch lesion groups,the difference between the three obviously,with statistical significance(P<0.01); According to stepwise multiple linear regression and othercorrelation analysis showed that ACS category and the severity of coronary artery stenosis,coronary artery stenosis score were positively associated with the levels of TLR4(P<0.05); After treatment for one month,the levels of TLR4,the expression of low density lipoprotein cholesterol and total cholesterol levels were significantly lower,high density lipoprotein Cholesterol levels were significantly increased,the differences were statistically significant(P<0.01); compared with the normal group,the experimental group peripheral blood mononuclear cells of patients with Toll like receptor 4 expression level,total cholesterol,low density lipoprotein cholesterol level in the experimental group is higher than the normal group,high density lipoprotein cholesterol increased significantly,comparison between groups the differences were statistically significant(P<0.01).Conclusion The degree of lesions and the occurrence of acute coronary syndrome in patients with peripheral blood mononuclear cells of Toll like receptor 4 expression level increase has certain effect,increase the dosage of atorvastatin can significantly reduce the ACS after PCI in patients with peripheral blood mononuclear cells of patients with Toll4 like receptor expression.

Objective To explore the clinical effect of rosuvastatin in treatment of unstable angina and the influence of levels on blood lipids,hypersensitive C-reactive protein(hs-CRP),homocysteine(Hcy)and cardiac troponin(cTnl).Methods 200 patients with unstable angina pectoris(UAP)in our hospital from March 2014 to March 2016 were selected as the subjects of the study,they were randomly divided into control group and experimental group,each group had 100 cases.The control group was given conventional treatment,the experimental group was given rosuvastatin on the basis of conventional treatment,the clinical efficacy between two groups was observed and compared,and the levels of blood lipid and C reactive protein(hs-CRP),homocysteine(Hcy)troponin I(cTnl)pre-and post-treatment were detected.Results The total effective rate of the experimental group was 92％and the control group was 80％,the difference was statistically significant(P<0.05).Before treatment,the blood lipid,hs-CRP,Hcy and cTnl between two groups showed no significant difference; after treatment,the blood lipid,hs-CRP,Hcy and cTnl in both two groups were decreased,high density lipoprotein cholesterol(HDL-C)levels than before treatment significantly increased,and the experimental group decreased or increased significantly compared with the control group,the difference was statistically significant(P<0.05).Conclusion Rosuvastatin has remarkable curative effect in clinical treatment for UAP,not only can significantly reduce the blood lipid,and reduce inflammation in patients,the clinical treatment of unstable angina patients have help,it is worthy of clinical application.

ObjectiveTo probe into the clinical efficiency of reconstruction to person who had composite tissue defect of the floor of mouth and the lower part of face with the free forearm flap and free iliac bone in the same term.MethodsBefore the surgery, the surgeon should carefully evaluate the scope and shape of defects in 11 cases who had the composite tissue defects of the floor of mouth and the lower part of face, to design the individual forearm flap, so that it matches with the defect region. During surgery, the first resumption of defects using titanium plates forming the basic shape of mandible and the occlusal relationship,then used to re-sawing to take modeling of the iliac bone,transplanted free iliac bone and fixed after the inside of the titanium plate, thereby restoring the continuity of mandible missing.ResultsFree forearm flap and free iliac bone all survived in 11 cases, the success rate of 100％. The patients were followed up for 6 to 12 months, although the shape of restoration areas were different levels of fat, but eating, swallowing and other oral function had been well improved, 7/11 could enter normal diet, 4/11 to enter liquid diet, At the same time, the patients in social activities can communicate in a language daily, sensory function of skin flap and facial appearance has been satisfactory recovery.ConclusionConformal free forearm flap and free iliac bone is an ideal way to reconstruct the composite tissue defects of the floor of mouth and the lower part of face in the same period, not only safe, practical prognostic effect, and also can significantly improve the patients quality of life, which is worthy of reference and use.

Objective To characterize the vascular cognitive impairment of stroke patients with different injury sites (right or left cerebral hemisphere) and pathological type (hemorrhage or infarct). Methods A total of 119 stroke patients were assessed with regard to their cognitive functions using the LOTCA within one week of admis-sion, and comparison was made among patients in terms of VCI characteristics, injury site, and pathological type. Results In patients with left hemisphere injury, there found no significant difference between those with cerebral in-farct and hemorrhage with regard to the total score of LOTCA, but the score of perception of those with hemorrhage was lower than those with infarct(P<0.05). in patients with right hemisphere injury, both total score of LOTCA and the subscore were not significantly different between those with infarct and hemorrhage(P>0.05). In patients with infarct in left hemisphere, the total score of LOTCA was lower than those with infarct in right hemisphere(P<0.05), but the scores of orientation and thinking operation were lower than those with infarct in right hemisphere(P<0.001 or <0.01). In patients with hemorrhage in the left hemisphere, the total score of LOTCA was not significantly different from those with hemorrhage in right hemisphere, but the scores of orientation and perception were lower than thosewith hemorrhage in right hemisphere(P<0.001 or <0.01). Conclusions More attention with regard to perception training should be paid to those with cerebral hemmorhage than those with cerebral infarct. In patients with cerebral infarct, more attention with regard to orientation and thinking operation training should be paid to those with infarct in left side, while for those with cerebral hemorrhage, more attention with regard to orientation and perception training should be paid to the left hemisphere insult.

Objective To analyze the effect of clinical pharmacists involving in JCI clinical care program certification-AMI(CCPC-AMI) on the compliance rates of clinical drug treatment guideline and the awareness rates of patient medication health education in cardiovascular.Methods Selected cases of acute myocardial infarction(AMI) from March to August in 2015 was as the former group,from September 2015 to March 2016 as the latter group in their hospital,then comparative analysis of two groups was done by statistical method.Results After clinical pharmacists involved in CCPC-AMI,the compliance rates of AMI clinical drug treatment guidelines (after the AMI diagnosis, the 10min was given aspirin, intensified statin therapy and dose selection, the use of ACEI/ARB before discharge and the use of beta blocker before discharge) were increased from 92.7% 67.9%,60.7%,51.8% to 98.1%,85.2%,94.4%,90.7%.The awareness rates of patient medication health education (awareness of safe medication, awareness of self-management, awareness of follow-up knowledge) were all increased to 100% from 75.0%,57.1%,82.1% before participation.Conclusion Clinical pharmacists who carried out pharmaceutical care,has played a critical role in quality control of AMI single disease through the preparing of CCPC-AMI evaluation.

0.05).Compared with the CSS,GMFM and WV before treatment,there were statistically difference after 6 and 12 weeks treatment in two groups(Pa

After half a century of self-innovation, the integrated traditional Chinese and Western medicine has witnessed the great progress in both clinical and basic research. However, the theoretical system of the integrative medicine does not break through the limitations of traditional Chinese medicine and Western medicine, which hinders its implication in experimental study and clinical work. In view of the current situation, to develop the integration of traditional Chinese and Western medicine further, efforts should be made in such aspects as educational system construction, talent personnel training, improving the level of clinical practice and corresponding basic research as well as the establishing the basic theoretical system.
Clinical Medicine ; History, 20th Century ; Humans ; Integrative Medicine ; history ; methods ; Medicine, Chinese Traditional ; history ; methods ; Research

Objective To discuss the influencing factors of intracranial cerebral hemorrhage complicationin patients with acute ischemic stroke (AIS) after receiving Solitaire AB stent mechanical thrombectomy.Methods The clinical data of 32 AIS patients,who were treated with Solitaire AB stent thrombectomy during the period from June 2015 to October 2016 at authors' hospital,were retrospectively analyzed.The basic materials of patients,who developed intracranial hemorrhagic transformation (HT) after Solitaire AB stent thrombectomy,were analyzed and compared with the results of related studies published at home and abroad.Results Solitaire AB stent thrombectomy was successfully accomplished in all the 32 AIS patients.The postoperative fatality rate was 9.4％ (3/32).Three patients developed symptomatic intracranial HT after Solitaire AB stent thrombectomy,including artery occlusion in anterior circulation (n=1) and artery occlusion in posterior circulation (n=2),with the HT incidence being 9.4％ (3/32).Of the 3 patients,conservative treatment was adopted in 2 and ventricular external drainage with implantation of liquid storage bag through ventricular drilling-hole was carried out in one.Finally,2 patients died of HT and one patient recovered by conservative treatment.The percentage of HT death patients in all deaths was 66.7％ (2/3).Conclusion Intracranial HT is a fatal complication of embolectomy in AIS patients.In clinical practice,the indications of thrombectomy should be strictly observed,besides,intraoperative fine manipulation and sandardized perioperative management are also very important to reduce the incidence of bleeding complications.

Objective To evaluate the accuracy and clinical application of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) in diagnosis of occupying lesions in upper digestive tract and its pe-ripheral areas. Methods The data of 64 patients who underwent EUS-FNA for occupying lesions in upper di-gestive tract, between July 2006 and December 2007, were retrospectively analyzed. Results EUS-FNA was successfully performed on 62 patients, with a success rate of 96.88%. The overall diagnostic accuracy, sensi-tivity, specificity, positive predictive value and negative predictive value of EUS-FNA for occupying lesions in upper digestive tract and its peripheral areas were 88.71%, 86.54%, 100.00%, 100.00%, and 58.82%, respectively. There was no significant difference between the foei larger and smaller than 3cm (P > 0.05), re-garding the diagnostic accuracy and average puncture numbers. Diagnostic accuracy of those with real-time cy-tolngical evaluation was significantly higher than those without (P=0.029), and the puncture numbers were less (P=0.001). Among the total 99 punctures, the positive diagnostic accuracy of those with 5ml negative pressure suction was significantly higher than those of 10 ml (P = 0.044). Conclusion EUS-FNA is a safe and applicable approach to diagnosis of occupying lesions in upper digestive tract and its peripheral areas with higher diagnostic accuracy, sensitivity, specificity and positive predictive value. Moreover, the real-time cyto-logical evaluation and adequate negative pressure might facilitate the diagnosis accuracy.

OBJECTIVETo investigate the effects of transcutaneous electrical nerve stimulation (TENS) on motor function in children with spastic cerebral palsy (CP).

METHODSAfter signing the informed consent, 78 children with CP, aged 45.6 +/- 8.5 months (36 to 58 months), were randomly divided into a TENS group (n = 40) and a control group (n = 38). All the subjects received standardized functional exercise program. In TENS group, 2 TENS devices were used and the surface electrodes were applied on the spastic musculotendinous and antagonist muscles in the affected lower extremity. TENS lasted for 20 min per session, 5 days weekly for 6 weeks. After 6 weeks, the functional exercise program was applied by the caregivers. Demographic data were recorded, including age, gender, number of the hemiplegic and diplegic CP, level of gross motor function classification system (GMFCS). Clinical assessments included the composite spasticity scale (CSS), D and E dimensions of the Gross Motor Function Measure (GMFM), and walking velocity was determined before treatment and at 6, 12 and 24 weeks after treatment.

RESULTSNo statistically significant differences were found in age, gender, number of the hemiplegic and diplegic CP, level of GMFCS, as well as clinical assessments (CSS, GMFM and walking velocity) before treatment between the 2 groups (P > 0.05). All the children showed a reduction of spasticity (CSS) after 6, 12 and 24 weeks of treatment (P < 0.05). When compared with the results obtained before treatment, the improvement of standing and walking (GMFM), walking velocity was statistically significant after 6, 12 and 24 weeks of treatment (P < 0.05). Furthermore, the differences of CSS, GMFM and walking velocity between the two groups at 6, 12 and 24 weeks examination were also statistically significant (after 24 weeks of treatment: t value was 8.96, 3.14 and 2.35, P < 0.05, respectively).

CONCLUSIONWhen compared with the control group, 6 weeks of TENS treatment on the affected lower extremity was more effective in terms of reducing spasticity and improving functional performance in standing, walking, and walking velocity in ambulant children with the spastic CP.

Cerebral Palsy ; therapy ; Child ; Electric Stimulation Therapy ; methods ; Female ; Gait Disorders, Neurologic ; therapy ; Hemiplegia ; therapy ; Humans ; Male ; Muscle Spasticity ; therapy ; Transcutaneous Electric Nerve Stimulation ; methods ; Treatment Outcome