Objective To observe cerebral apoplexy patients complicated with carotid atherosclerosis plaque given aggressive lipid lowering treatment on the prognosis of stroke and reduce the recurrence rate through the large sample study on neurological department of internal medicine.Methods 300 cases of cerebral infarction complicated with different degree of neck lesions were selected and randomly divided into 3 groups,each group had 100 cases.Intensive lipid-lowering group received fluvastatin,80mg/d + 100mg aspirin,conventional dose group received fluvastatin,40mg/d + 100mg aspirin,aspirin group was given aspirin 100mg.After 4 weeks,8 weeks,12 weeks,16 weeks,20 weeks,24 weeks,blood lipid level,changes in internal carotid artery plaque (CIMT),plaque area,and the incidence rate of cerebral vascular events after 24 weeks were observed.Results The results of intensive lipid-lowering treatment group IMT (1.06 ± 0.36) mm,plaque area (8.09 ± 0.47) mm3,the incidence rate of cerebral vascular events after 24 weeks (12％),serum lipid levels and regular dose group after treatment with IMT (1.19 ±0.39) mm,plaque area (9.91 ± 0.78) mm3,the incidence rate of cerebral vascular events after 24 weeks (18 ％),serum lipid levels after aspirin group were significantly reduced(P ＜ 0.05).Aspirin group before and after treatment,IMF,plaque area and lipid levels had no significant differences(P ＞ 0.05).Intensive lipid-lowering treatment group compared with the conventional dose group,IMT,plaque area and lipid levels improved obviously(P ＜ 0.05),the recurrence rate of ischemic cerebral vascular disease had significant difference compared with the other two groups (P ＜ 0.05).Conclusion Intensive lipid-lowering treatment on blood lipid levels,delay and reverse the carotid atherosclerosis is superior to conventional dose using fluvastatin group and simply antiplatelet group,and can prevent the recurrence of ischemic cerebrovascular disease.

Objective To discuss magnetic resonance imaging(MRI)scanning technology for ankle joint and its clinical value.Methods 42 cases of ankle joint trauma were examined with MRI using GPFLX coil.It was performed through sagittal T2WI,T2WI F/S,T1WI;coronal T2WI;axial T2WI.FOV was big enough for the whole trauma ankle joint.To make image clear,some soft materials should be placed between the trauma ankle joint and the GPFLX coil.The injured ankle joint was not allowed to move.The technology of No Phase Wrap is also necessary.Results The high quality rate was up to 90% for the ankle joint.Among 42 cases,6 had traumatic arthritis,14 had ankle joint contusion,9 had Achilles tendon rupture,6 had other structural injuries,4 had late degenerative change,and 3 had normal images.Conclusion MRI is a sensitive technique for injured ankle joint.It can accurately show the degree and location of ankle joint trauma.It has an important clinical significance in finding bone contusion and other structural injuries,and it is very helpful for treatment.

Objective To find the nursing methods to train the neonatal sucking function and accelerate the gastrointestinal peristalsis and the secretion of digestive juice. Methods 80 premature infants with feeding difficulty within two days after they were born were chosen by random. Then according to the psychological characteristics of neonates, took the canonical and practical feeding methods by the appointed person in continuity. Results Compared with before, the incidence of difficult feeding decreased, sucking ability and gastrointestinal function greatly alleviated after using the modified method. Conclusions The improved method could accelerate the recovery of sucking and gastrointestinal function as soon as possible for premature infants without complications, which has practical clinical significance.

ObjectiveTo explore an appropriate way and its effect on neonatal resuscitation training in Uygur area of Xinjiang, China.MethodsFrom October 2014 to February 2015, obstetricians, neonatologists (pediatricians), midwives and anesthetists from Turpan Region Central Hospital, Turpan City People's Hospital,Aksu Region First People's Hospital and other five hospitals at county level were chosen to attend the training course of neonatal resuscitation. The textbook for the course was Guidelines for Resuscitation which had been translated to Uygur language from English and the class was lead by less than ten Uygur trainees with Mandarin and Uygur when necessary in addressing some difficult or important points. The duration of theoretic courses took 6 h and the operational course took 8 h. Theorectical exam was taken before, immediately after and three months after (before re-training) the training. The accuracy rate was applied to assess the effect of training through evaluation for each resuscitation techniques. Repeated measures analysis of variance andChi-square test were used for statistical analysis.ResultsA total of 220 health care staff were included in the study. The average score of theoretical examination after the training was higher than that before (85.68±8.52 vs 65.37±12.08,t=18.532,P=0.000), and that before re-training was lower than that after training (80.08±12.70 vs 85.68±8.52,t=-4.943,P=0.000). After the training, the proportions of Done in each item, including rapid assessment, preliminary resuscitation, correct positive pressure artificial ventilation, external cardiac massage together with artificial ventilation, proper endotracheal intubation and proper administration of resuscitation drugs, were all higher that those before [72.7%(160/220) vs 1.4%(3/220), 40.0%(88/220) vs 0%(0/220), 15.9%(35/220) vs 0%(0/220), 37.7%(83/220) vs 8.2%(18/220), 51.8%(114/220) vs 5.9%(13/220) and 48.2%(106/220) vs 10.5%(23/220), allP<0.01]. But at the time before re-training, only one proportion ofDone which was higher than those immediately after initial training was proper administration of resuscitation drugs [49.6%(109/220) vs 48.2%(106/220),χ2=9.129,P<0.05].ConclusionBilingual (Mandarin and Uygur) neonatal resuscitation training in Xinjiang minority areas might enhance the recovery skills for local medical personnel.

Objective To evaluate the feasibility and accuracy of virtual navigation contrast enhanced sonography in accurately location of small liver tumors which cannot be detected by conventional sonography during microwave ablation therapy. Methods Twenty-three patients with 28 small liver tumors,which could not be detected by conventional sonography but CT/MRI,underwent microwave ablation with virtual navigation contrast enhanced sonography from January 2015 to March 2017 at Nanfang Hospital. After fusion of images from both sonography and CT/MRI,small liver tumors were ablated under the real-time monitoring of navigated sonography. Virtual navigation contrast enhanced sonography was also utilized to evaluate the efficacy of ablation after the ablation.All patients underwent CT/MRI examination at one month post-ablation to evaluate the efficacy of ablation. Results Virtual navigation system successfully provided image fusion for all patients and all lesions(image fusion efficacy was 100%). All patients underwent virtual navigation contrast enhanced sonography monitored microwave ablation.Only one patient received extra ablation since a small proportion of residual tumor checked after the initial ablation. No severe complications occurred in the present study. One-month after ablation,all patients showed complete ablation by further CT/MRI examinations.Conclusion Virtual navigation sonography can precisely target small liver tumors which are undetected by conventional sonography.Evaluation of lesions and ablation efficacy can be performed with the help of virtual navigation contrast enhanced sonography during the ablation period,which have shown satisfactory clinical efficacy.

Objective:To investigate the association of serum protein kinase Cε(PKCε)activity with insulin resistance in elderly patients with concurrent type 2 diabetes mellitus(T2DM)and non-alcoholic fatty liver disease(NAFLD).Methods:Clinical data of 229 patients with T2DM admitted to the Department of Geriatric Endocrinology of the Second Affiliated Hospital of Xi'an Jiaotong University from October 2017 to October 2018 were retrospectively analyzed.Patients were divided into the T2DM group(T2DM patients without NAFLD, n=112)and the T2DM+ NAFLD group(T2DM patients with NAFLD, n=117). Healthy elderly subjects who underwent physical examination during the same period served as the control group(n=110). Clinical data and laboratory results were compared between the three groups.Serum PKCεactivity was measured by enzyme-linked immunosorbent assay, and the correlation between serum PKCεactivity and insulin resistance was analyzed statistically.Results:Serum PKCεactivity and HOMA-IR were higher in the T2DM+ NAFLD group than in the T2DM group and the control group[PKCε: (195.5±62.1) μg/L vs.(188.7±61.2 )μg/L and (89.1±20.2 )μg/L, F=9.76, P=0.010; HOMA-IR: 12.5±7.9 vs. 14.1±5.7 and 5.8±4.1, F=10.21, P=0.010]. Pearson correlation analysis revealed that serum PKCεactivity, HOMA-IR and TG were positively correlated with T2DM+ NAFLD( r=0.339, P=0.01; r=0.305, P=0.01; r=0.329, P=0.01)and that serum PKCεactivity was positively correlated with HOMA-IR and triglyceride( r=0.339, 0.305 and 0.329, P=0.01). Logistic regression analysis showed that serum PKCε activity, HOMA-IR and triglycerides were risk factors in the T2DM+ NAFLD group, and the regression coefficients were 0.849, 0.022 and 0.710, respectively.Increased serum PKCεactivity was an independent influencing factor for T2DM+ NAFLD. Conclusions:Elevated serum PKCεactivity is positively correlated with insulin resistance in elderly T2DM patients with NAFLD.Reducing serum PKCεactivity and improving insulin sensitivity will help to delay or reverse the development of T2DM and NAFLD.

Objective To investigate the independent association of serum Fetuin-B with metabolic syndrome in obese Chinese adults.Methods Cross-sectional data on socio-demographic,lifestyle,clinical characteristics, and serum Fetuin-B were collected for 1 318 Chinese adults with central obesity.Associations of serum Fetuin-B with metabolic syndrome and insulin resistance were analyzed using multivariable Logistic regression analysis.Results A total of 820(62.2%)individuals were identified as metabolic syndrome.Subjects with metabolic syndrome showed significantly increased levels of serum Fetuin-B than those with non-metabolic syndrome[(4.18 ±1.39 vs 4.02 ± 1.35)μg/ml,P=0.043].Increased serum Fetuin-B were significantly associated with increased fasting plasma glucose and insulin levels, as well as prevalences of non-alcoholic fatty liver disease(NAFLD)and insulin resistance.After adjustment for potential confounders, serum Fetuin-B was significantly associated with increased risks of metabolic syndrome and insulin resistance(OR=1.19,95%CI 1.06-1.34,P=0.004;OR=1.15,95%CI 1.01-1.30,P=0.031 respectively).Conclusion Serum Fetuin-B level was significantly associated with NAFLD;and elevated serum Fetuin-B was significantly associated with increased risk of metabolic syndrome.

Objective:To compare the efficacies of arthroscopic modified Brostr?m procedure combined with or without peroneal tendon debridement in the treatment of chronic lateral ankle instability (CLAI) concomitant with fibular tendinitis.Methods:A retrospective cohort analysis was conducted on the clinical data of 31 patients with CLAI concomitant with fibular tendinitis, who were treated in Beijing Tongren Hospital, Capital Medical University between March 2019 and December 2021. The patients included 17 males and 14 females, aged 16-57 years [(32.8±9.6)years]. The anterior drawer test and talar tilt test were positive in all patients preoperatively. Diagnosis was confirmed by physical examination and MRI, and calcaneofibular ligament rupture was excluded. Eleven patients received arthroscopic modified Brostr?m procedure combined with peroneal tendon debridement (modified Brostr?m procedure+tendon debridement group), and 20 underwent pure arthroscopic modified Brostr?m procedure (modified Brostr?m procedure group). The operation time, intraoperative blood loss and length of hospital stay were documented. The visual analogue score (VAS) in peroneal tendon area was assessed before operation and at postoperative 2, 6 and 12 weeks. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and foot and ankle outcome score (FAOS) were assessed before operation and at postoperative 6 and 12 weeks. The anterior drawer test was performed at the last follow-up. The foot and ankle ability measure (FAAM) score was assessed before operation and at the last follow-up. Postoperative wound healing and complications were also observed.Results:All the patients were followed up for 4-19 months [(11.3±3.5)months]. The operation time was (66.0±4.2)minutes in the modified Brostr?m procedure+tendon debridement group, which was significantly longer than (61.5±3.4)minutes in the modified Brostr?m procedure group ( P<0.05). There was no significant difference in intraoperative blood loss or length of hospital stay between the two groups (all P>0.05). Compared with the preoperation, the value of VAS was significantly lowered, and the values of AOFAS ankle-hindfoot score, FAOS and FAAM score were significantly increased at different postoperative timepoints (all P<0.01). No significant differences in the values of VAS, AOFAS ankle-hindfoot score, FAOS or FAAM score were seen between the two groups before operation (all P>0.05). The value of VAS was 3.0(3.0, 4.0) points in the modified Brostr?m procedure+tendon debridement group, being markedly different from 4.0(4.0, 4.0)points in the modified Brostr?m procedure group at 2 weeks postoperatively ( P<0.05). The value of VAS was 2.0(1.0, 3.0)points in the modified Brostr?m procedure+tendon debridement group, being markedly different from 3.0(2.3, 3.0)points in the modified Brostr?m procedure group at 6 weeks postoperatively ( P<0.05). At 12 weeks postoperatively, there was no significant difference in the value of VAS between the two groups ( P>0.05). There were no significant differences in the values of AOFAS ankle-hindfoot score and FAOS between the two groups at 6 or 12 weeks postoperatively (all P>0.05). The anterior drawer test was negative in all patients at the last follow-up. No significant difference was seen in the value of FAAM score between the two groups at the last follow-up ( P>0.05). All incisions were healed well in the first stage after operation, without the occurrence of joint infection, impaired joint motion, nerve injury or deep vein thrombosis. Conclusions:Arthroscopic modified Brostr?m procedure combined with or without peroneal tendon debridement can both improve the foot function in CLAI patients concomitant with fibular tendinitis. However, the combined treatment allows for early pain relief, without increasing the risk of complications, and can therefore contribute to a faster postoperative recovery.

Objective To investigate the predictive value of preoperative frailty for pulmonary com-plications(PPCs)after cardiac surgery in elderly patients.Methods A total of 162 elderly patients,109 males and 53 females,aged 65-83 years,BMI 18-36 kg/m2,ASA physical status Ⅱ-Ⅳ,underwent elec-tive open heart surgery from July 2022 to January 2023 were collected.The patients were divided into two groups according to the occurrence of PPCs:the PPCs group(n=57)and the non-PPCs group(n=105).General information,smoking history,alcohol consumption history,EuroSCORE Ⅱ,frailty,chronic comorbidities(hypertension,diabetes mellitus,myocardial infarction,pulmonary hypertension,chronic ob-structive pulmonary disease,sleep apnea syndrome,etc.),Hb,creatinine,albumin,pulmonary function indices,left ventricular ejection fraction,type of surgery,duration of surgery,aortic clamping time,and cardiopulmonary bypass time were collected.Factors with P＜0.2 and clinically significant in the univariate regression analysis were included in the multivariate logistic regression analysis,and the predictive efficacy of the Fried frailty scale and EuroSCORE Ⅱ for PPCs were compared by the area under the ROC curve(AUC).Results PPCs occurred in 57 patients(35.2％).Multifactorial Logistic regression analysis showed that frailty(OR=3.14,95％CI 1.05-9.37,P＜0.05)and EuroSCORE Ⅱ(OR=2.16,95％CI 1.01-4.60,P＜0.05)were risk factors for the development of PPCs.The predictive power of Fried frailty scale(AUC=0.76,95％CI 0.68-0.82)was significantly higher than that of EuroSCORE Ⅱ(AUC=0.65,95％CI 0.57-0.72)(P＜0.05).Conclusion Preoperative frailty is the independent risk factors for pulmonary complications after cardiac surgery in elderly patients,and the Fried frailty scale has a better predictive efficacy compared to EuroSCORE Ⅱ,a traditional risk predictor.

Wound repair is a fundamental task that the whole field of the Burn and Plastic surgery pays urgent attention to and longs for a breakthrough. In this column, wound repair balance laws theory is expounded and we are expecting people in the field gradually began to value the use of balance law. Guided by the law of balance principle, people are required to conduct scientific research, improve clinical technique and develop new materials. The theory is designed to improve the level of scientific research and clinical diagnosis, and will set up a new milestone in the field of wound repair.