Objective To investigate the curative effects of selected proprioceptive neuromuscular facilitation (PNF) patterns and techniques on shoulder subluxation soon after strokd. Methods Forty-one stroke patients with shoulder subluxation were randomly divided into a treatment group(n=22) and a control group (n=19). The patients in the treatment group receiveed the selected PNF techniques daily for 4 weeks, while the patients in the control group were treated with their previous therapeutic protocol. The shortest distance from the lower border of the acromion to the nearest point of the humeral head(AHH) was measured. Brunnstron grading was used to evaluate motor function in the affected upper linb, and a visual analogue scale (VAS) to assess subLuxation. Shoulder pain before and after treatment was also assessd. Results There was no significant difference in general condition between the patients in the two groups before treatment. In the treatment group, a significant improvement in AHH distance of the affected shoulder was observed after 4 weeks. Shoulder subluxation waw cured in 13 patients, with AHH distance ＜0.75 cm after 4 weeks of treatment. Conclusion The PNF technique applied was effective for the early treatment of subluxation after stroke. Motor function in the affected upper limb could be improved significantly and pain alleviated.

Objective:To explore the urgent management strategy for quadriplegia following China Wenchuan earthquake under filed condition.Methods:The 57-year-old male patient was sent to the earthquake relief team of Changzheng Hospital,Second Military Medical University.He was hit by heavy object during the Sichuan earthquake 6 days ago.Physical examination revealed cervical spinal cord injury accompanied by incomplete paralysis.The patient underwent cervical 3-7 laminectomy under general anesthesia.Results: After surgery,the muscle strength of lower limbs recovered to grade four from grade one;the muscle strength of upper limbs recovered to grade five from grade three.Sensory loss was found below the nipple level and totally recovered after operation.Conclusion:Early surgery for quadriplegia following earthquake trauma can timely relieve compression to the spinal cord and therefore improve prognosis of patients.Under field condition where facilities are not readily available,decompression of spinal cord can be achieved by lamineetomy via posterior approach.The key to successful operation is correct diagnosis and skillful manipulation.

Background: Creatine transporter (CRTR) deficiency is the most common creatine deficiency syndrome, of which the final diagnosis relies on mutation in the X-linked CRTR gene. To date, more than 90 mutations in the SLC6A8 gene have been reported. This paper discusses a novel mutation detected via the thorough sequencing of all the X-chromosome-specific exons investigated in a four and a half year old boy with an intellectual disability, speech and language delay and motor disturbance. Methods: A brain magnetic resonance imaging (MRI) and a proton magnetic resonance spectroscopy (MRS) were carried out, the creatine and creatinine concentrations in the urine were checked and all exons were sequenced. Results: A detailed clinical investigation revealed a reduction in the cerebral creatine levels in the brain by the MRS, elevated creatine and creatinine concentrations in the urine and signal abnormalities in the left frontal cortex of the brain by the MRI. A novel change was identified in the heterozygosity of the exon 10: c.1395-c.1401 deletion. Conclusion: The use of a combination of powerful new technologies, such as thorough exome-nextgeneration sequencing and a brain MRS, should be considered, in order to determine any neurometabolic diseases, especially when the signal abnormalities in the brain MRI cannot be explained by any other factors. This mutation results most likely in a dysfunction of the creatine transport and synthesis, hence causing central nervous system symptoms.
Carrier Proteins

Objective To observe the effects of standardized three stage rehabilitation treatment on the neu- rological deficit scores (NDS) and ADL performance of ischemic stroke patients.Methods A total of 164 ischemic stroke patients were recruited and randomly divided into a rehabilitation group and a control group.The neurological function and ADL performance of the patients were assessed by using NDS and Modified Barthcl Index (MBI) at the admission,at the end of 1st,3rd and 6th months post stroke.Results No significant differences were found be- tween the rehabilitative and the control groups with regard to NDS and MBI at admission.The NDS demonstrated a decreasing tendency,while the MBI score an increasing tendency in both groups.In the control group,significant difference of NDS was found between admission and the end of 1st month as well as between the end of the 1 st and the 3rd months.In rehabilitation group,significant difference was revealed between all the time points with regard to NDS and MBI scores.At the end of the 1st,3rd and 6th months,the MBI scores of the rehabilitation group were signifi- cantly higher than those of the control group,indicating that the ADL performance of those treated with standardized three-stage rehabilitation protocol was improved quicker than those without the protocol.Conclusion Standardized three-stage rehabilitation treatment could improve the neurological function and ADL performance of the ischemic stroke patients.

[Summary] The aim of this study was to examine the association between obstructive sleep apnea-hypopnea syndrome ( OSAHS ) and microalbuminuria in type 2 diabetes mellitus patients. We found that severe OSAHS significantly increases the risk of early renal damage in type 2 diabetes mellitus patients with HbA1C<7% ( lowest oxygen saturation:OR=2. 41, 95% CI 1. 19-8. 08; apnea hyponea index: OR=2. 91, 95% CI 1. 50-9. 11), suggesting that OSAHS may increase the risk for early renal damage in type 2 diabetes mellitus, especially in those with successful control of glucose.

: Objective To evaluate the value of rehabilitation direction for the treatment of the children with spastic cerebral palsy. Methods 116 children with spastic cerebral palsy were investigated. 56 children who accepted rehabilitation direction and training in family participated in study group and 60 children who wouldn't accept rehabilitation direction participated in control group. All the children received comprehensive rehabilitation treatment in hospital, including physical therapy, acupuncture, low frequency electrotherapy and occupational therapy. All the children were assessed with Gross Motor Function Measure-88 (GMFM) before and 3 months after treatment. Results There was a significant difference before and after treatment in scores of GMFM in each dimension and total in both groups (P<0.01), and the treatment group improved more than control group(P<0.05). Conclusion Rehabilitation direction can facilitate the recovery of spastic cerebral palsy children.

Objective To explore the relationship between blood lipids level with creatinine clearance rate(Ccr)in patients with heart failure(HF). Methods A total of 955 patients who were diagnosed with heart failure(cardiac function NYHAⅡ~Ⅳclassification)upon discharge from the Department of Cardiology of the Second Hospital of Tianjin Medical University, between January 2010 to June 2013 were enrolled as HF group. Healthy adults (n=200) with normal cardiac function which approximately matched basic condition with HF group were selected as control group. The HF group was fur?ther divided intoⅡ,Ⅲ,Ⅳclassification according to their cardiac function(NYHA classification). HF group was also divid?ed into normal renal function group, mild renal injury group and moderate-severe renal injury group based on their Ccr. Ef?fect of gender and lipid parameters were also compared. Binary logistic regression was used to analyze factors influencing renal function in patients with HF. Results Compared with people in the control group, the levels of triacylglycerol(TG), total cholesterol(TC), low density lipoprotein cholesterol(LDL-c)and non high density lipoprotein cholesterol(non-HDL-c)in patients of HF group were increased while Ccr and high density lipoprotein cholesterol(HDL-c)were decreased. Ccr and lipids were obviously decreased in patients with HF of Ⅳclassification. TG and HDL-c were decreased in moderate-severe renal injury group. Females had a higher lipid levels than males in HF group(P<0.05 or P<0.01). Advanced age, coronary heart disease and hypertension were all risk factors for renal impairment in patients with HF by binary logistic re?gression. On the other hand, weight gain and HDL-c were the protection factors for renal function in HF patients. Conclu?sion Dyslipidemias may lead to renal insufficiency in patients with HF. It was important to control lipids and improve re?nal function in patients with HF.

Objective To discuss the clinical effects of hemiarthroplasty for the treatment of intertrochanteric comminuted fracture in aged patients.Methods From June 2006 to June 2010,91 cases with intertrochanteric comminuted fractures were treated by hemiarthroplasty using Zweymtüller long-stem cementless implant.There were 35 males and 56 females,with an average age of 81.2 years (range,75-94 years).There were fresh fractures in 75 cases and old fractures in 16 cases.According to classification of Evans-Jensen,there were 36 cases with type Ⅲ fracture and 55 with type Ⅳ.Osteoporosis was graded by Singh index,and there were 51 cases with level Ⅲ and 40 with level Ⅱ.The interval between injury and operation was 2-10 d (average,3.5 d).Results The surgery lasted 30-50 min (average,39 min).The blood loss was 320-610 ml (average,405 ml).The hospital stay was 14-21 d (average,16.5 d).Two cases who experienced with the infection of the respiratory system after operation,recovered through routine treatment.Thirty-seven cases were followed up for 15 to 38 months (average,24.5 months).According to the Harris score,the overall rate of excellent or good result was 83.8％ (31/37).Conclusion Hemiarthroplasty using Zweymüller long-stem cementless prosthesis is reliable option for intertrochanteric comminuted fracture in the aged patients.

OBJECTIVETo explore therapeutic effect and action mechanism of regulating spleen-stomach needling on diabetic nephropathy (DN).

METHODSUsing multi-centric, randomized, controlled and blind principles, 144 cases of DN were divided into an observation group and a control group according to random digital tab, 72 cases in each one. Based on regular treatment of diabetes, the regulating spleen-stomach needling was applied at Zhongwan (CV 12), Quchi (LI 11), Hegu (LI 4) and Xuehai (SP 10), etc. in the observation group while Shenshu (BL 23), Taixi (KI 3), Sanyinjiao (SP 6), Yanglingquan (GB 34), etc. were selected in the control group by reference of Acupuncture and moxibustion. The treatment was given twice a day, six days as a treatment session with interval of one day between sessions. Totally six weeks were required. Changes of clinical symptoms and signs, fast blood glucose (FBG), urinary albumin excretion rate (UAER), beta2-microglobulin (beta2-MG), monocyte chemotactic protein-1 (MCP-1), lymphocyte membrane cholesterol, propanediol (MDA), PCO, 8-hydroxydeoxy guanosine (8-OHdG), superoxide dismutase (SOD), CD3+, CD4+, CD8+, and CD4+/CD8+ were observed before and after treatment in two groups.

RESULTSAs for improving clinical symptoms and signs, total effective rate was 84.29% (59/70) in the observation group and 55.56% (40/72) in the control group, which had statistical difference between two groups (P<0.01). As for regulating glycometabolism [(6.25 +/- 0.32) mmol/L vs (8.09 +/- 0.63) mmol/L], reducing UAER [(154.43 +/- 55.14) mg/24h vs (268.91 +/- 77.65) mg/24h], restraining over-expression of MCP-1 [(137.59 +/- 36.15) pg/mL vs (166.89 +/- 42.82) pg/mL], regulating level of oxidative stress, prohibiting oxidation of protein and adjusting quantity and activity of T lymphocyte subgroup, the observation group was superior to the control group (P< 0.05, P<0.01).

CONCLUSIONThe regulating spleen-stomach needling is an effective method for treatment of DN, which cold improve glycometabolism disturbance-induced progressive kidney injury, recover glomerular filtration, reduce urinary albumin excretion rate, restrain overexpression of MCP-1, adjust level of oxidative stress, prohibit oxidation of protein, increase protectiveness of membrane, adjust quantity and activity abnormity of T lymphocyte subgroup, leading to repairing lymphocyte damage and improving immune expression to delay kidney damage.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Diabetic Nephropathies ; immunology ; physiopathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Spleen ; physiopathology ; Stomach ; physiopathology

OBJECTIVETo study the therapeutic effects of Qianggan Capsule (QC) combined Lamivudine on hepatic fibrosis in patients with chronic hepatitis B.

METHODSEighty-five patients were randomly divided into two groups, group A (40 cases) were treated with QC and Lamivudine and group B (45 cases) were treated with QC alone both for 6 months. Hepatic fibrosis related indexes and pathologic examination of liver biopsy were performed within 3 months before treatment and in 1 month after treatment.

RESULTSSerum levels of hyaluronic acid, collagen N and laminin decreased markedly after treatment in both groups (P < 0.05). Hepatic histopathological examination showed that the total effective rate of impovement in activity of inflammation-necrosis and fibrosis was 80.0% and 70.0% in group A, 57.8% and 75.6% in group B, respectively, the combined treatment showed a better effect in improving the activity of inflammation-necrosis than QC alone (P < 0.05), but with no significant difference to the latter in improving fibrosis.

CONCLUSIONQC combined Lamivudine could markedly reduce the activity of hepatic inflammation-necrosis, QC alone could also improve hepatic fibrosis.

Adult ; Capsules ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Hepatitis B, Chronic ; complications ; drug therapy ; Humans ; Lamivudine ; therapeutic use ; Liver ; drug effects ; pathology ; virology ; Liver Cirrhosis ; drug therapy ; etiology ; Male ; Middle Aged ; Phytotherapy ; Reverse Transcriptase Inhibitors ; therapeutic use ; Treatment Outcome