Objective To analyze the value of serum calcitonin level to determine the illness severity of the elderly patients with severe pneumonia within six hours after admission and to dynamically observe the predictive value of serum PCT level change rate in different time points on the prognosis of the patients.Methods A total of one hundred and twenty olderly patients with severe pneumonia were enrolled.Within six hours after admission,the serum PCT level was detected by enzyme linked fluorescence analysis.Acute physiology and chronic health score (APACHEⅡ)were used to assess the severity of the disease.The correlation between serum PCT and APACHEⅡ score was analyzed by Pearson correlation coefficient.The receiver operating characteristic curve (ROC curve)showed the value of serum PCT level for the prognosis.Serum PCT levels were respectively monitored on the 1st,2nd,3rd and 5th day. Based on the prognosis outcome on twenty -first day after admission,the patients were divided into survival group and death group.The changes of serum PCT level in two groups were compared and the rate of change of serum PCT was also compared and the value of the clinical mortality of twenty -first day was assessed.Results Within six hours after admission,the level of serum PCT was positively correlated with APACHE Ⅱ score (r =0.768,P <0.05).The receiver operating characteristic curve (ROC curve)showed that the level of serum PCT was low for the predictive value on the prognosis of the patients,and the area under the curve was 0.502(t =0.915,P =0.153).All patients, there were ninty -four cases in the survival group and twenty -six cases of death group.Dynamic observation of serum PCT levels in the survival group showed a trend of gradual decline with time prolong,the level of PCT change rate was more than or equal to 50 percent within 72 hours.The level of serum PCT change rate in death group showed a gradual upward or downward trend and the change rate of PCT in seventy -two hours was less than 50%.The ROC curve showed that the rate of change of serum PCT level in seventy -two hours was better in predicting the mortality of patients on the twenty -first day,and the area under the ROC curve was 0.892(t =3.895,P =0.001).Conclusion Dynamic monitoring of serum PCT levels can be helped to assessment the prognosis of patients with sepsis and also predict the severity of the illness.The level of serum calcitonin can reflect the severity of severe pneumonia in elderly patients within six hours after admission,but can not accurately determine the prognosis of patients with severe pneu-monia.Dynamic monitoring of changes in serum calcitonin level is helpful to judge the prognosis of the elderly patients with severe pneumonia and the predictive value of serum calcitonin level change rate is higher in seventy -two hours after admission.

The present paper takes an intensive perspective in analyzing learner autonomy and factors influence autonomy.It reveals the actuality of English learning in China,and also gives some advice on how to promote learner autonomy.

FLT can't simply focus on the teaching of grammar,pronunciation and vocabulary,but on its application in practical life.After all,the objective of it is to improve the students' intercultural communication competence.This paper proposes the importance of cultural input in FLT,and analyzes the causes of pragmatic failure,also puts forward several strategies to cultivate students' intercultural communication competence.

Motor imagery can improve upper limb and hand function of stroke patients. This review focused on the research progress of motor imagery about the way of treatment, the clinical effect, and the mechanism.

ObjectiveTo observe the effect of the rehabilitation treatment on the motor function and activities of daily living(ADL) at different period after cerebral hemorrhage.Methods208 patients with cerebral hemorrhage were retrospectively analyzed. Patients were divided into five groups according to the disease course(≤1 month, 1-3 months, 3-6 months, 6-12 months and 12-24 months). Two months before and after rehabilitation treatment, the motor function of the involved limb, ADL and ambulation were assessed.ResultsAfter treatment the motor function of upper and lower limbs and hands, ambulation and ADL of ≤1 month group were improved(P<0.05); except for the hand motor function, 1-3months and 3-6 months group were also improved(P<0.05); the ambulation and ADL of 6-12 months group were improved(P<0.05),but the motor function had no change; in 12-24 months group only ADL improved.Conclusions Rehabilitation treatment do benefit for stroke patients in different periods. Treatment emphasis should vary with the start time of rehabilitation treatment.

ObjectiveTo explore the clinical features and rehabilitation effect of patients with ischemic-hypoxic encephalopathy at recovery stage. MethodsThe clinical features and ADL rehabilitation effect of 32 ischemic-hypoxic encephalopathy patients who were received rehabilitation therapy were retrospectively analyzed.ResultsThe extrapyramidal tract lesion was the most common clinical feature and most of the patients combined with cognitive function impairment. There was no significant improvement in ADL after rehabilitation (P>0.05).ConclusionsThe ADL rehabilitation effect of patients with ischemic-hypoxic encepha1opathy in the recovery stage is not effective. The key points of increasing ADL are to reduce hypertonic muscle and improve cognitive function.

Objective To study the influence of carbamazepine on the neuromuscular block induced by rocuronium. Methods Thirty-two ASA Ⅰ- Ⅱ patients scheduled for neurosurgical operations were studied: 16 cases suffered from epilepsy were treated with carbamazepine for 24 to 180 months (carbamazepine group); the others suffered from intracranial tumors without antiepileptic treatment (noncarbamazepine group). Anesthesia was induced and maintained with target controlled with propofol 5 μ g/ml was monitored using train-of-four (TOF) stimulation. The onset time and times of muscle relaxation recovery 25%,50%,75% was recorded. Results The onset time was no difference between two groups (P＞0.05),but the times of muscle relaxation recovery 25%, 50%, 75% in carbamazepine group [(23.9±3.8 ), ( 29.2 ±4.5 ), ( 36.0 ± 5.4 ) min] were shorter than those in non-carbamazepine group [( 34.0 ± 2.8 ), (40.5 ± 4.6),( 49.9 ± 5.3 ) min] ( P ＜ 0.01 ). The recovery index in carbamazepine group [( 12.1 ± 2.9 ) min] was shorter than that in non-carbamazepine group [(15.8 ± 3.1) min](P＜0.05 ). Conclusion The duration of the rocuronium-induced neuromuscular block is significantly shortened by preceding chronic carbamazepine therapy.

BACKGROUND: In clinic, primary progressive aphasia is a dementia syndrome with the only or prominent characteristic of progressive decline in language function. In advanced stage, deficit of cognitive capability and loss of daily living ability would turn up while memory ability would be relatively preserved. The risk factors of primary progressive aphasia might include poor language ability in childhood and speech center involved by brain trauma.OBJECTIVE: To report the intracerebral image features of 1 case of primary progressive aphasia so as to disclose the general lesion area of the disease , the changes of intracerebral blood volume and metabolism , and connecting fibers among the language domains.DESIGN: Case-report.SETTING: Department of Intervention, Hongqi Hospital, Mudanjiang Medical College, Hei Longjiang Province.PARTICIPANTS: 1 case of patient with primary progressive aphasia,male, 56 years old and with senior high school culture, was in business before the onset of disease. He had "progressive decline in language ability for 3 years" as the main complaint and was diagnosed in Department of Neurology of Beijing Tiantan Hospital on March 20th, 2004. 3 years before that time, the patient could not tell the name of daily living appliances while his comprehensive ability was generally normal. 2 years before, he could still be in business. 1 year before, his language disorder was aggravated, auditory and comprehensive abilities gradually decreased and the changes of character turned up while he could take care of himself and had no obvious degeneration in memory ability. Neural systemic examination: systolic pressure was 130 mmHg and diastolic pressure was 80 mmHg, with clear consciousness, poor language expression ability, and nomenclatural disability while no abnormity was inspected in other neural systematic examinations. He was assessed as sensory aphasia with normal memory and intelligence according to aphasia assessment measuring scale made by the First Hospital of Beijing Medical University.METHODS: First, general magnetic resonance examination was taken to fix the lesion area of the patient. Then, functional magnetic resonance was carried out, which mainly included using magnetic resonance spectroscopy analysis to determine the metabolic rates of N-acetyl-aspartic acid, choline and creatine in the lesion area and then compare them with those in the contralateral corresponding area; Magnetic resonance perfusion imaging was carried out to detect regional cerebral blood volume, regional cerebral blood flow, average pass time and peak time of the contrast medium; Fibertracking method was used to track corticospinal tract and the amount of connecting fibers between left Broca and Wernicke areas and then compare them with those in the contralateral corresponding area.MAIN OUTCOME MEASURES: Detection of the metabolic rates of Nacetyl-aspartic acid, choline and creatine in lesion area and the contralateral area; Detection of regional cerebral blood volume, regional cerebral blood flow, average pass time and peak time of the contrast medium in lesion area and the contralateral area; Comparison of the amount of connecting fibers between left cortioospinal tract and left Broca and Wernicke areas.RESULTS: ①The results of general magnetic resonance: there was atrophy in left temporal and frontal lobes, especially significant in temporal pole, which was manifested as widening of cerebral sulcuses and fissures,thinness of cortex, and enlargement of frontal and temporal angles. ② The results of functional magnetic resonance: N-acetyl-aspartic acid, choline and creatine in left temporal lobe and anterior part of frontal lobe decreased more obviously and regional cerebral blood volume and regional cerebral blood flow in these areas decreased,while average pass time and peak time of the contrast medium in these areas slightly increased as compared with those in the conitralateral areas; fraction of anisotropy values and the tracked fasciculus in left corticospinal tract decreased, and the connecting fibers between Broca and Wernicke areas also decreased as compared with those in the contralateral area.CONCLUSION: The lesion area of primary progressive aphasia is mainly located in left temporal and frontal lobes where low perfusion, low metabolic state and decrease of connecting fibers between Broca and Wernicke areas were shown as compared with those in the contralateral area, which might be the pathogenesis of this case of primary progressive aphasia.