Objective To investigate the best time to establish the enteral nutrition (EN) in elderly patients with se?vere craniocerebral diseases. Methods Eighty-one elderly patients were divided into groups A, B and C. The EN support were given 24 h, 25-48 h, and 49-72 h after surgery. Changes of serum biochemical indexes, complications and GCS score were detected and statistical analysed. Results The serum levels of albumin and hemoglobin were significantly increased in group B than those of group A and group C. The total number of lymphocytes was significantly higher in group A and group B than that of group C (P<0.05). The amount of diarrhea was significantly fewer 7-day after operation in group B than that of group A (3.6%vs 26.9%). The amount of stress ulcer was significantly fewer in group B than that of group C (0 vs 22.2%). The amounts of lung infections (10.7%vs 38.5%) and stress ulcer (3.6%vs 25.9%) were significantly fewer 14-day after oper?ation in group B than those of group A. The scores of GCS were significantly higher 14-day after operation in group B than those of group A and group C (10.2±1.3 vs 9.5±1.2 vs 9.4±1.2, P<0.05). Conclusion The establishment of EN support 25 to 48 hours after surgery may meet the need of nutritional and metabolic support, reduce complications, be conducive to the consciousness recovery in elderly patients with severe craniocerebral diseases.

Objective To investigate the level of urinary TGF-β1 and evaluate its clinical significance in patients with chronic nephritis.Methods 22 healthy people and 40 patients with chronic nephritis were selected,the levels of urinary TGF-β1 were measured by RT-PCR and ELISA.Results Urinary TGF-β1 were significantly increased in Mesangial Proliferative Glomerulonephritis (76.44± 24.29 ng/mmol.Cr vs 31.53 ± 11.59 ng/mmol.Cr,P<0.01);Focal Glomerular Sclerosis (65.07±20.59 ng/mmol.Cr vs 31.53±11.59 ng/mmol.Cr,P<0.01)and IgA Nephritis (67.01±21.95 ng/mmol.Cr vs 31.53±11.59 ng/mmol.Cr,P<0.01),comparing with normal group.Conclusion The levels of urinary TGF-β1 could be a predictor in reflecting the sate of renal diease,estimating pathological type,diagnosing the renal diease and observing the therapeutic effects.

Objective To compare the clinical efficacy and safety of esomeprazole in treatment of elderly and young patients with gastric ulcer.Methods 120 cases of elderly patients with gastric ulcer and 95 cases of young and middle-aged patients with gastric ulcer were selected this study.Two groups of patients were treated with amoxicillin and clavulanate potassium dispersible tablets 0.457 g,tinidazole tablets 0.5 g and esomeprazole magnesium enteric coated tablets 20mg orally,once daily treatment 1 week for a course of treatment,1 week after continue to every morn-ing fasting taking esomeprazole 20mg,1 times/D,treatment for 3weeks.The clinical curative effect,Hp clearance rate and incidence of adverse reactions between two groups of patients after treatment were compared.Results The total effective rate in the treatment of elderly group patients (87.50%)compared with young and middle -aged group (92.63%),there was no significant difference (χ2 =1.52,P>1.52).Elderly group of patients with helicobacter pylori clearance rate (71.67%)compared with young and middle-aged group (76.84%),there was no significant difference (χ2 =0.74,P>0.74).The incidence of adverse reactions (8.33%)of elderly group had obvious differ-ences by comparing with young and middle -aged group (2.1 1%),and the difference was statistically significant (χ2 =3.90,P<0.05).Conclusion Application of esomeprazole based triple therapy in the treatment of the elderly and young people in the gastric ulcer could heal ulcers and eradicate Hp,but young and middle -aged patients is superior to the elderly group in terms of adverse reactions.

Objective To analyze the safety and effectiveness of using lumbar drainage (LD) in patients with subarachnoid hemorrhage (SAH).Methods Data from 44 patients with SAH were collected.Of these patients,the LDs group consisting 19 patients in whom a lumbar drain had been placed for cerebro-spinal fluid (CSF) drainage,whereas the control group was composed of 25 patients who received no form of CSF drainage or treated solely with an external ventricular drainage (EVD).Incidence of new cerebral infarction of the two groups was measured on sequential CT and complications of LDs group.Results This retrospective review demonstrated a statistically significant beneficial effect in LDs group on CT,reducing the incidence from 32％ to 5％.A similar degree of benefit was observed in two group patients with hydrocephalus.Complications with lumbar drains were rare and yielded no permanent sequelae.Conclusion With rare complications and definite safety,LDs are effective to reduce vasospastic cerebral infarction of SAH patients when appropriate patient selection and good technique are employed.

Objective To investigate the correlation between serum C-reactive protein (CRP) level and carotid atherosclerotic plaque calcification in patients with ischemic stroke or transient ischemic attack (TIA).Methods The patients with non-cardiogenic ischemic stroke or TIA in anterior circulation performed head and neck vascular CTA at 1-6 months from the time of onset were enrolled prospectively.The demographic and clinical data were collected and serum CRP levels were detected.Univariate and multivariate logistic regression analyses were used to determine the correlation between the serum CRP level and the carotid atherosclerotic plaque calcification.Results A total of 165 patients were enrolled.Their age was 62.4± 10.6years,male patients accotnted for 66.7％;113 patients (68.5％)had carotid atherosclerotic plaque calcification (calcification group),52 (31.5％) did not have carotid atherosclerotic plaque calcification (non-calcification group).The age of the calcification group (median,interquartlle;66 [58-73] years vs.58 [51-66] years;Z=-3.738,P＜0.001) and CRP levels (1.9 [0.5-3.8] mg/L vs.0.0 [0.0-2.2] mg/L;Z =-4.126,P ＜ 0.001) were significantly higher than those of the non-calcification group.There were no significant differences in other baseline clinical data between the two groups.Multivariate logistic regression analysis showed that age (odds ratio 1.063,95％ confidence interval 1.024-1.104;P =0.001) and CRP levels (odds ratio 1.209,95％ confidence interval 1.030-1.419;P=0.020) were still significantly correlated with the plaque calcification after adjusting for other confounding factors.Conclucions Carotid plaque calcification was correlated with older age and increased serum CRP level in patients with ischemic stroke or TIA.

Objective:To validate the predictive function of Field Assessment Stroke Triage for Emergency Destination (FAST-ED) score on large vessel occlusion (LVO) in Chinese population.Methods:The information about the patients who had the disease onset within 24 hours, were treated in the Emergency Department of Jinling Hospital, and diagnosed as ‘acute ischemic stroke’ was collected. Via the emergent brain computed tomography angiography or digital subtraction angiography, the patients were divided into LVO group and non-LVO group. The scores of FAST-ED were calculated according to the National Institutes of Health Stroke Scale (NIHSS) scores and compared with Rapid Arterial oCclusion Evaluation (RACE), 3-item Stroke Scale (3I-SS), Cincinnati Stroke Triage Assessment Tool (C-STAT), and Prehospital Acute Stroke Scale (PASS) scores. Moreover, the patients were further divided into anterior and posterior circulation lesion groups to explore whether the FAST-ED scale can differ the anterior or posterior circulation effectively.Results:Three hundred and eighty-one patients were eventually included, among whom 284 were diagnosed as LVO, and 97 were diagnosed as non-LVO. Receiver operating characteristic curves showed that cut-off value of 4 optimized the scale (sensitivity: 0.76, specificity: 0.69, area under the curve: 0.78). The area under the curve of FAST-ED score(0.78) showed no statistically significant difference with NIHSS (0.79), RACE (0.77), 3I-SS (0.78) and C-STAT scores (0.75), and exhibited statistically significant difference with PASS score (0.74; 95% CI 0.69-0.78, P=0.01). FAST-ED score showed no statistically significant difference in predicting anterior and posterior circulation lesions. Conclusions:FAST-ED score can predict LVO in a rather accurate manner. It can predict anterior and posterior circulation lesions with similar effectiveness. So FAST-ED is able to be a prehospital screening tool and make assistance to the prehospital treatment.

Objective:To discuss the clinical characteristics,diagnosis and treatment experience of a case of lateral ectopic thyroid.Methods:The patient with lateral ectopic thyroid was diagnosed by thyroid color ultrasound and single-photon emission computed tomography(SPECT)-CT examination.The right thyroidectomy and the thyroid tissue in cervical section Ⅳ of the patient were removed by received the operation.The pathological examination after operation was performed.The daily usage of euthyrox after operation was 50 μg.Results:The patient recovered well,who accepted 10 months follow-up with normal life and stable condition,and had no recurrence and metastasis.Conclusion:The mechanism of lateral ectopic thyroidy is not clear yet,the surgical treatment can result in good effectiveness and better prognosis.

Objective To evaluate the effect of diabetic peripheral neuropathy on peripheral neurotoxicity induced by local anesthetics in rats.Methods Sixty healthy adult male SPF Sprague-Dawley rats,aged 6 weeks,weighing 150-180 g,were divided into either control group (n =18) or diabetic peripheral neuropathy group (n=42) using a random number table.The rats were fed a high-fat and high-sucrose diet for 8 weeks,and streptozotocin (STZ) 30 mg/kg was injected intraperitoneally to induce diabetes mellitus which was confirmed by blood glucose level≥ 16.7 mmol/L.The mechanical paw withdrawal threshold to yon Frey filament stimulation and thermal paw withdrawal threshold were measured.The decrease in reaction thresholds to thermal and mechanical stimuli (changing from sensitivity to insensitivity) was observed after STZ injection.At 4 weeks after STZ injection,the rats showing a marked hyperalgesia served as early diabetic group.At 8 weeks after STZ injection,the rats showing a marked insensitivity to pain served as late diabetic group.Experiments were carried out in early or late diabetic rats,and ordinary Sprague-Dawley rats of the same age were used as control group.Left sciatic nerve block was performed with 2％ lidocaine 0.2 ml.Before the sciatic nerve block and at 1 week after the sciatic nerve block,the nerve conduction velocity of the left sciatic nerve and F-wave minimal latency were measured,and the sciatic nerve block time was recorded.Results Compared with the baseline before block,the nerve conduction velocity was significantly decreased,and the F-wave minimal latency was prolonged in late diabetic rats (P＜0.05).Compared with control group,the sciatic nerve block time was significantly prolonged in late diabetic group (P＜0.05).Conclusion Diabetic peripheral neuropathy aggravates peripheral neurotoxicity induced by local anesthetics in rats.

Early treatment of acute ischemic stroke has been proven clinically effective.However,these early reperfusion strategies are highly time-dependent.It is important to reduce the onset-reperfusion time,especially the prehospital delay.Currently prehospital stroke scales have been widely used to screen stroke patients on field.It is urgent to introduce the Chinese versions of these scales to educate emergency personnel and the public.More qualified stroke centers and regional stroke networks are needed to facilitate the triage and transfer of stroke patients.

Objective To investigate the protective role of human serum albumin in treatment of monocyte-inducible C-type lectin (Mincle)-associated neuroinflammation in subarachnoid hemorrhage (SAH) rats and its underlying mechanisms.Methods Vascular perforation model was used to induce SAH.Ninety-two male SD rats were randomly assigned to sham (n =23),vehicle (n =23),low-dose albumin (0.63 g/kg,n =23) and high-dose albumin (1.25 g/kg,n =23) groups.Saline and albumin were intravenously injected into rats two hours after surgery.Modified Garcia scale was employed to assess neurological functions.Iba-1 and myeloperoxidase (MPO) staining was used to examine the activation of microglial cells and infiltration of neutrophils.Real-time PCR was applied to determine the changes of IL-1β,inducible nitric oxide synthase,CD11b,monocyte chemoattractant protein-1,cytokine-induced neutrophil chemoattractant-1 and CXC motif chemokine ligand-2 mRNA levels.Co-immunoprecipitation was conducted to assess the binding ability of albumin with Mincle.Immunoblotting was carried out to evaluate protein levels of Minlce,Syk and p-Syk.SAH severity measurement was performed before conductions of all the experiments.Results SAH severity scores were 11.4 ± 1.6,12.8 ±2.5 and 11.2 ±3.2 in the vehicle,low-dose albumin and high-dose albumin groups,respectively,without statistically significant difference among groups (F =0.694,P =0.516).Neurological score was 7.5 ± 2.9 in the vehicle group,while the low-dose albumin (14.6 ± 2.2) and high-dose albumin groups (13.6 ± 2.7) exhibited better neurological perfomance (P ＜ 0.01).Immunostaining showed that albumin significantly inhibited the activation of microglia,and reduced the percentage of MPO positive cells from 20.7％ ± 1.9％ in the vehicle group to 12.1％ ±2.1％ in the low-dose albumin group and 9.8％ ±0.9％ in the high-dose albunin group (F =32.216,P =0.001).mRNA levels of pro-inflammatory cytokines and chemotactic factors were also suppressed by albumin (P ＜ 0.05).The results of co-immunoprecipitation displayed that albumin could directly bind Mincle and disrupt the association between Mincle and SAP130.Immunoblotting demonstrated that albumin depressed the protein levels of Mincle,Syk and p-Syk.Conclusion Human serum albumin can inhibit Mincle/Syk-induced neuroinflammation via directly binding Mincle receptor in SAH rats.