BACKGROUND: Post-stroke depression(PSD) is the most common emotional change after stroke. It has high morbidity, which also seriously affects the near and long term functional prognosis of the patients and affects the quality of life (QOL) of the patients during convalescence.OBJECTIVE: To investigate the impacts of integrated rehabilitative therapy on post-stroke depression and ability of daily life(ADL) through interventional therapy in patients with post-stroke depression.DESIGN: A randomized controlled study with the patients as subjects basedon diagnosis.SETTING: Department of cadre in a university hospital.PARTICIPANTS: Sixty cases including 34 males and 26 females hospitalized in the Department of Cadre of the General Hospital Affiliated to Tianjing Medical University between October 2001 and March 2002 were randomly divided into rehabilitation group( n = 30) and control group( n = 30).INTERVENTIONS: Patients of rehabilitation group received both routine medication and integrated rehabilitative therapy (cinesiotherapy + psychotherapy) while the patients of control group only received routine medication(decompression, improving cerebral circulation and symptomatic therapy) . Barthel index(BI) and Hamilton rating scale for depression(HAMD)were used to assess the patients at admission, the 3rd month and the 6th month during the course of the disease.MAIN OUTCOME MEASURES: BI and HAMD score at the 3rd and 6thmonth in patients of rehabilitation group and control group.RESULTS: BI at 3rd month or 6th month was (68.0 ± 2.9) or (70.0 ± 3.5)in patients of rehabilitation group, which was significantly higher than (62.0±3.3) at 3rd month and (65.0±3.8) at 6th month in patients of control group( P ＜ 0. 001, 0. 01) . HAMD score at 3rd month or 6th month was(8.9 ±4.9) or(8.7 ±5.1) in patients of rehabilitation group, which was significantly lower than(15.2 ±5.6) at 3rd month or(14. 9 ±8. 1) at 6th month in patients of control group ( P ＜ 0.05).CONCLUSION: Integrated rehabilitative therapy can effectively improve the ADL of patients with post-stroke depression and relieve depression.

Objective To analyze the therapeutic effect of rehabilitation intervention for patients with post-stroke depression. Methods Sixty patients with post-stroke depression were divided randomly into a rehabilitation group(n=30) and a control group(n=30). Those in the former group were intervened with comprehensive rehabilitation programs (mainly the exercise and psychotherapy), while those in the later group only the ordinary medical drugs. 3～6 months later, therapeutic effect was assessed according to the recorded Barthel index and the HAMD scores, and a comparison was carried out between the two groups. Results In comparison with the control group, the therapeutic effect was significantly better in the rehabilitation group, as shown by significant increase of Barthel index scores at 3 months (P

OBJECTIVE:To observe therapeutic efficacy and safety of glutamine combined with low molecular weight heparin in the treatment of elderly severe pneumonia (SP).METHODS:In retrospective study,88 SP elderly patients were divided into control group (44 cases) and observation group (44 cases).Based on conventional treatment,control group was given Enteral nutritional suspension via nasal feeding.Observation group was additionally given Alanyl glutamine injection 20 g,dissolved in Amino acid solution with ratio of 1:5 at least and maximum concentration belowing 3.5％,i.v.,once a day+Low molecular weight heparin calcium injection 4 KU/kg subcutaneously,once a day,on the basis of control group.Both groups were treated for 7 d.Clinical efficacies and postoperative recovery (ventilator support time,pulmonary rale disappearance time and ICU hospitalization time) were observed in 2 groups.The levels of IgA,IgG,TNF-a,hs-CRP,APACHE Ⅱ score,coagulation function indexes (APTT,D-D,FIB,PT,PLT),blood gas analysis indexes [pa (CO2),SpO2,Oi,pa (O2)] and receptor for advanced glycation end products (RAGE),the occurrence of ADR before and after treatment were also observed in 2 groups.RESULTS:Total response rate of observation group (90.91％) was significantly higher than that of control group (72.73％),while ventilator support time,pulmonary rale disappearance time and ICU hospitalization time were significantly shorter than control group;the incidence of ADR was significantly lower than control group,with statistical significance (P＜ 0.05).After treatment,the levels of IgA,IgG,Oi,SpO2 and pa (O2) in 2 groups were significantly higher than before treatment,and the observation group was significantly higher than the control group.The levels of TNF-αt,hs-CRP,APACHE Ⅱ score,coagulation function indexes,pa(CO2) and RAGE in 2 groups were significantly lower than before,and the observation group was significantly lower than the control group,with statistical significance (P＜0.05).CONCLUSIONS:Based on conventional treatment,glutamine combined with low molecular weight heparin show significantly effect on elderly SP,effectively improve cellular immune function,coagulation function and blood gas analysis indexes and reduce RAGE level with good safety.

Objective To evaluate the color Doppler ultrasound in diagnosing venous diseases of lower extremity, and to compare it with DSA. Methods By using color Doppler ultrasound (CDUS)apparatus, two-dimensional spectrum, color Doppler flow image, pulse wave Doppler and Valsalva examination were performed in 48 patients with suspected venous diseases of lower extremity. The CDUS findings were compared with DSA findings. Results Of 48 cases with suspected lower extremity venous diseases, deep vein thrombosis formation was confirmed in 27, among them 15 were accompanied with lower extremity deep venous valvular incompetence, 8 were complicated by lower extremity varicosity and 2 were associated with both conditions. Another one had cyst in the left popliteal fossa and popliteal venous thrombosis. Decreased blood flow in iliac veins was found in some cases. Pure lower extremity venous valvular incompetence was seen in 5 cases and pure lower extremity superficial varicosity in 6 cases. Six cases suffered both valvular incompetence and superficial varicosity. CDUS showed normal findings in 4 cases, of them DSA demonstrated compressed iliac vein in 2. When taking DSA as golden standard, the accuracy of CDUS was 95.83%. By using the uniformity test, Kappa value was 0.65. Conclusion CDUS is of great clinical usefulness in diagnosing venous diseases of lower extremity as well as in evaluating the therapeutic effect.

Objective To discuss the application of spiral CT angiography in postoperative re-examination of lower limb artery stent implantation. Methods During the period from March 2012 to March 2014 at the Affiliated Nanjing Hospital of Nanjing Medical University, CT angiography was carried out in 67 patients who had received stent implantation for arteriosclerotic occlusion of lower limb. The diseases involved 78 lower limbs, and a total of 85 stents were employed. The volume rendering (VR), maximum intensity projection (MIP), multi-planar reformation (MPR) and curved surface reconstruction (CSR) were performed to stereoscopically display the lesion’s anatomy as well as the implanted stents, and the imaging manifestations were compared with the clinical symptoms and DSA findings. Results Successful examination was accomplished in 65 patients (81 stents in total), and clear images were obtained. Of the 81 stents, no stenosis was seen in 43, Ⅱ - Ⅳ grade stenosis in 32 and complete occlusion in 6. The results were closely correlated with the clinical symptoms. The CT angiography manifestations in 31 patients (34 stents in total) were compared with their DSA performed in two weeks, and the results showed that the stenotic degrees of three stents judged by CT angiography were not consistent with those judged by DSA. The consistent rate of CT angiography was 91.2% when taking DSA as the standard. Conclusion Lower limb arterial CT angiography examination is a safe and non-invasive technique, it can clearly display the stent inner canal. Therefore, this technique is of great value in postoperative re- examination of lower limb artery stent implantation.

The hybrid pencil beam model (HPBM) is an effective algorithm for calculating electron dose distribution in radiotherapy. The mean energy distribution of incident electron beam in phantom is one of the factors that affect the calculation accuracy of HPBM, especially in field edge areas near the end of the electron range. A new fitted formula based on Monte Carlo (MC) simulation data for electron beams with energy range of 6-20 MeV in the homogeneous water phantom is proposed in this paper. The precision of the fitted formula within the scope of the energy was evaluated by comparing the electron dose distribution of ECWG measured data with that obtained from HPBM which took the mean electron energy that calculated by the fitted formula and the existed empirical formula, respectively. The results showed that the accuracy of dose distribution that obtained by the mean electron energy calculated with the fitted formula increased about 1%.
Algorithms ; Electrons ; Humans ; Monte Carlo Method ; Phantoms, Imaging ; Radiotherapy Planning, Computer-Assisted ; Water

Objective To study the effects of health management on blood pressure and lifestyle of hypertensive outpatients.Methods A total of 319 hypertensive outpatients were randomly assigned to the control group (n =160) or the health management group (n =159).Pharmacologic therapy was given to the control group,while in the health management group,intensive health management combined with pharmacologic therapy was conducted.Blood pressure,height,body weight (BW),total cholesterol (TC),and fasting blood glucose (FBG) of the participants were measured and compared at baseline and 12 months.Results There were no significant differences of clinical characteristics between two groups at baseline.After 12 months' intervention,more significant decrease of systolic blood pressure and diastolic blood pressure was found in the health management group (t values were 2.701 and 2.306,respectively;both P ＜ 0.05).There were statistically significant differences of body mass index (BMI) and serum TC levels between the control and the health management group (t values were 2.111 and 2.227,respectively ;P ＜ 0.05).After the intervention,two groups showed no significant difference in current cigarette smoking (x2=2.787,P ＞ 0.05).The participants in the health management group showed improved physical exercises,diet,and adherence to treatment at the end of the observation (x2 values were 59.459,52.018,6.321 and 5.392,respectively; all P ＜ 0.05).Conclusion Compared with pharmacologic therapy,health management combined with pharmacologic therapy could significantly improve clinical parameters and life style of hypertensive patients.

Objective　To investigate the diagnosis and treatment of acute rejection of orthotopic liver transplantation (OLT). Methods　From July 1999 to April 2000, two piggyback liver transplantations were performed on two patients with Wilson's disease. Results　Cyclosporine A, azathioprine and methylprednisolone were the baseline immunosuppression management. Acute rejection occured 5 times in the 2 patients. The correct diagnosis was obtained through clinical inspection, liver function test and biopsy. The rejections were controlled by intensive steriod therapy plus OKT3 or FK506. Conclusions　Clinical inspection and liver function test can suggest the episode of acute rejection in time. Hepatic biopsy is the key point for diagnosis of acute rejecton, Reasonable use of immunosppression is critical for the treatment.

ObjectiveTo study the effects of health management on elderly patients with metabolic syndrome and lower extremity arterial disease.Methods A total of 118 metabolic syndrome( MS ) patients with ankle-brachial index (ABI) ＜ 0.9 and no intermittent claudication were randomly assigned to the control group( n =60,receiving pharmacologic therapy ) or health management group ( n =58,receiving intensive health management + pharmacologic therapy).Blood pressure,ABI,total cholesterol (TC),and fasting blood glucose(FBS) were tested before and 12 after the intervention.Results Clinical data were comparable between the two groups at baseline.After 12-months' intervention,systolic blood pressure(SBP) and FBS in both groups were significantly decreased,especially in the health management group[SBP:(141 ± 10)mm Hg(1 mm Hg=0.133 kPa) vs(146±11) mm Hg,t =2.581,P=0.011; FBS:(5.32 ±1.33) mmol/L vs ( 5.92 ± 1.61 ) mmol/L,t =2.231,P =0.028].TC ( 5.51 ± 0.51 ) mmol/L vs ( 5.11 ± 0.49 ) mmol/L,(t=4.307,P=0.000) and ABI(0.77 ±0.17 vs 0.84 ±0.19,t=2.091,P=0.039) of the health management group were significantly improved at 12 months.Patients in the health management group also showed higher SF-36 scores than those in the control group( physical functioning:72.2 ± 12.4 vs 65.2 ±20.1,t =2.268,P =0.025 ; emotion:73.9 ± 18.0 vs 65.6 ± 21.1,t =2.295,P =0.023 ; mental health:63.9 ± 13.3vs 58.3 ± 12.5,t =2.358,P =0.020 ).Conclusion Compared with medication,health management and pharmacologic therapy could significantly improve clinical parameters and quality of life of elderly MS patients combined with peripheral arterial disease.

Objective To assess the value of multi-slice spiral CTA in the diagnosis of iliac vein compression syndrome(IVCS)and secondary thrombosis.Methods The CTA data of 80 controls and 31 patients with IVCS conformed by DSA were retrospectively studied.The inner diameters of the compressed iliac vein in two groups were measured and compression ratios were calculated.The data were compared using t test and Wilcoxon test.The findings of CTA were compared with that of DSA and the accuracy of CTA was analyzed.Results For the control group,the inner diameters of left iliac vein in female group(7.0±2.5)mm were significantly less than that in male group(8.1±2.5)mm(t=2.42,P＜0.05).For the control group,the inner diameters of left iliac vein was(7.6±2.0)mm,and the compression ratios were 0 to 65.41%(median 27.65%).The compression ratios were no statistical differences between male group(0 to 61.36%,median 26.82%)and female group(0 to 65.41%,median 28.75%)(Z=-0.59,P＞0.05).For the patients group,the inner diameters of compression iliac vein was(2.7±1.1)mm.The compression ratios were 55.18% to 100%(median 76.12%).Both inner diameters and compression ratios were statistically different between the control and patients group(t=12.78,P＜0.05;Z=-8.18,P＜0.05).Fifteen of 31 cases with IVCS were accompanied with deep vein thrombosis.The left iliac veins were compress in 28 cases,while right iliac veins were compressed in 2 cases.The left and right iliac common veins were compressed by the left and right jliac common arteries in one case.The results of CTA were consistent with that of DSA in all cases.Conclusions CTA can not only measure the inner diameters of iliae vein compression and calculate compression ratios,but also demonstrate secondary thrombosis clearly.CTA is an effective examination in diagnosis of IVCS and secondary thrombosis.