Objective To explore the effect of patients with acute cerebral infarction and complication of acute gastric mucosal lesions (AGML) on their short-term prognoses.Methods Two hundred and sixteen patients with acute cerebral infarction admitted to the Department of Neurology in Tianjin Nankai Hospital from January to December 2014 were enrolled, and they were divided into the control group without AGML (167 cases) and observation group with AGML (49 cases) according to whether AGML occurred or not. The digestive tract was monitored in the two groups, and the relationships between the incidence of AGML and the location of infarction, stroke classification, as well as the anti-thrombosis treatments like thrombolysis, anti-coagulation and anti-platelet, etc. were analyzed; the changes in scores of the National Institutes of Health Stroke Scale (NIHSS) on admission, 7 days and 14 days after onset and 14-day mortality of two groups were compared.Results AGML occurred in 49 of 216 patients (22.69%); the 14-day mortality of the observation group was obviously higher than that of the control group [6.12% (3/48) vs. 1.80% (3/167),P < 0.05], the incidence of infarction located in cerebellum, brainstem, multiple cerebral lobes, etc. (low density shadow > 1/3 hemispheres) in the observation group was higher than that in the control group [cerebellum: 18.37% (9/49) vs. 4.19% (7/167); brainstem: 24.49% (12/49) vs. 8.98% (15/167), multiple lobes: 16.33% (8/49) vs. 2.99% (5/167), all P < 0.05]; the incidence of cardiac cerebral embolism (CE) was significantly higher than that in the control group [55.10% (27/49) vs. 12.57% (21/167),P < 0.05]. With the extension of disease course, the NIHSS score of the observation group was increased, while the score of the control group was gradually reduced, and the NIHSS scores of the observation group were obviously higher than those of control group on the 7th and 14th day after onset (7 days: 18.12±4.20 vs. 10.93±6.73, 14 days: 19.33±3.11 vs. 9.66±9.15, bothP < 0.05). The thrombolysis, argatroban anti-coagulation and anti-platelet incidence between the two groups after treatments was of no statistically significant difference (the incidence in control group was 4.79%, 47.31%, 47.90%, and it was 4.08%, 44.90%, and 48.98% in observation group, allP < 0.05). Conclusion The occurrence of AGML complication in patients with acute cerebral infarction is closely related to their short-term prognoses, and when the cerebral embolus is cardiac in origin or the infarction is located at multiple cerebral lobes, brain stem or cerebellum, the probability of the occurrence of AGML is relatively high, suggesting a poor outcome.

Objective To investigate the diagnostic significance of combined detection of neuron specific enolase (NSE ) , cytokeratin 19 fragment(CYFRA21-1) ,carcinoembryonic antigen(CEA) ,carbohydrate antigen 125(CA125) ,carbohydrate antigen 19-9(CA19-9) and serum ferritin(SF) in non-small-cell lung cancer(NSCLC) .Methods NSE ,CYFRA21-1 ,CEA ,CA125 ,CA19-9 and SF were detected by chemiluminescent immunoassay in 52 patients with NSCLC(NSCLC group) ,35 patients with benign lung diseases(benign lung diseases group) and 44 healthy controls(control group) .Results These serum tumor markers in NSCLC group were significantly higher than those in benign lung diseases group and control group(P<0 .01) .Serum level of CEA was ob-viously higher ,while CYFRA21-1 was lower in patients with adenocarcinoma than those in patients with squamous carcinoma(P<0 .05) .The sensitivity(96 .2% ) ,specificity(87 .3% ) and accuracy(90 .8% ) of combined detection of these tumor markers preceded any single ones .Conclusion The combined detection of NSE ,CYFRA21-1 ,CEA ,CA125 ,CA19-9 and SF can improve the diagnos-tic sensitivity and accuracy of NSCLC ,which could provide higher clinical value in the diagnosis of NSCLC .

BACKGROUND:Psychological factors could influence the degree of pain after total knee arthroplasty. However, the effects of perioperative psychological intervention on postoperative pain and joint function are rarely reported. OBJECTIVE:To study the efficacy and safety of alprazolam for patients with anxiety and depression before total knee arthroplasty. METHODS:Sixty-one patients with anxiety and depression before unilateral total knee arthroplasty were recruited. The patients were given the treatment of alprazolam (experimental group) or placebo (control group) at 2 weeks preoperatively. Baseline data were collected, preoperative anxiety and depression were assessed with Hamilton Anxiety Scale and Beck Depression Inventory, perioperative pain at rest and in activity at each time point was evaluated, postoperative NSAIDs drugs and intravenous self-control analgesia pump usage were recorded, the peripheral neurotransmitters were detected by ELISA, short-and mediate-term joint fuction was evaluated through Western Ontario and McMaster Universities Osteoarthritis Index and Knee Society Score after joint replacement, patient satisfaction and in-hospital relevant indexes and adverse reactions were detected. RESULTS AND CONCLUSION:(1) After the application of alprazolam, anxiety and depression were improved notablely, and the levels of 5-hydroxytryptamine andγ-aminobutyric acid in peripheral blood were increased at 2 weeks. (2) The visual analogue scale scores at rest in the experiemntal group were significnatly lower than those in the control group at 12 hours, 1, 2, 3, 5 and 7 days postoperatively (P<0.05);the visual analogue scale scores in activity in the experiemntal group were significnatly lower than those in the control group at 12 hours, 1, 2, 3, and 5 days postoperatively (P<0.05). (3) Analgesia pump and analgesic drug usage in the experiemntal group were significantly less than those in the control group, and the analgesic drug dosage and preoperative anxiety depression were correlated. (4) There were no significant differences in the Western Ontario and McMaster Universities Osteoarthritis Index and Knee Society Score between two groups. (5) The patient satisfaction, sleep index and hospitation time in the experimental group were superior to those in the control group. No obvious adverse reactions occurred during medication. (6) Our results suggest that for patients diagnosised with anxiety and depression before total knee replacement, the preoperative application of alprazolam can alleviate anxiety and depression, improve perioperative pain at rest and in activity, reduce postoperative analgesia drug useage, and increase patient satisfaction.

Objective To study the effects of Buyang Huangwu decoction(BHD) on serum matrix metalloproteinase-9(MMP-9),high sensitivity C-reactive protein(hs-CRP)levels and inflammatory reaction of patients with ischemic stroke accompanied by Qi deficiency and blood stasis syndrome. Methods Thirty-nine patients with acute ischemic stroke onset for 24-48 hours accompanied by Qi deficiency and blood stasis syndrome were admitted into Nankai Hospital of Tianjin City,and in accordance with the random number table,they were divided into BHD treatment group(21 cases)and conventional western treatment control group(18 cases). The patients in both groups were given conventional western medicine,such as anti-platelet,descent of blood lipid and protection of brain. In the BDH group,the patients were additionally given BHD oral administration. Before and after treatment for 72 hours and 7 days,the changes of serum levels of MMP-9 and hs-CRP were observed in both groups. In the mean time,20 subjects having taken physical healthy examinations in outpatient clinics were assigned in the healthy control group. Results Compared to the healthy control group,before treatment the levels of MMP-9 and hs-CRP in western treatment control and BHD groups were significantly higher than those in the healthy control group〔MMP-9 (μg/L):403.3±32.9,417.9±45.3 vs. 86.5±6.1;hs-CRP(mg/L):7.4±0.7,6.9±0.6 vs. 2.2±0.4,all P<0.05〕. After treatment for 72 hours,the levels of MMP-9 and hs-CRP achieved their peaks,after treatment for 7 days, the levels of MMP-9 and hs-CRP were significantly lower than those at 72 hours in both groups〔the control group:MMP-9(μg/L):190.4±58.0 vs. 528.9±65.1,hs-CRP(mg/L):5.8±0.7 vs. 11.1±0.8;the BDH group:MMP-9 (μg/L):89.5±11.4 vs. 437.6±55.2,hs-CRP(mg/L):3.1±0.9 vs. 7.3±0.6,all P<0.05〕. Conclusions In patients with acute cerebral infarction,the serum levels of MMP-9 and hs-CRP are significantly increased. After conventional treatment,the levels gradually decline,and the descent in the group with addition of BHD is more remarkable,suggesting that BHD have prominent effect for treatment of patients with acute cerebral infarction accompanied by Qi deficiency and blood stasis syndrome.

Objective:To investigate the correlation between the CTLA-4 expression in the peripheral blood CD4+ and CD8+T cells in the patients with glioma and glioma WHO classification and operation,and to clarify the clinical significances of CTLA-4.Methods:60 patients with glioma from our hospital were selected as glioma group, and 46 healthy volunteers were used as control group.Then the CTLA-4 expression levels in the peripheral blood CD4+ and CD8+T cells of the subj ects in glioma group and control group were detected by fluorescence-activated cell sorting (FACS)and the relationship between CTLA-4 and glioma WHO classification and surgery was analyzed. Results:The CTLA-4 expression levels in CD4+ and CD8+T cells in peripheral blood of the patients in glioma group were higher than those in control group (P<0.01).The CTLA-4 expression level in the patients with gradeⅣ glioma was the highest, the expression level of the patients with grade Ⅳ glioma was higher than that of the patients with grade Ⅲ glioma (P<0.01),and the expression level of grade Ⅲ the patients with was higher than that of the patients with grade Ⅱ (P<0.01).The expression level of CTLA 4 in CD4+ and CD8+T cells of the patients with glioma after operation was lower than before operation (P<0.01 ). Conclusion:The CTLA-4 expression levels in the peripheral blood CD4+ and CD8+T cells are increased with the increasing of malignancy degree of the patients with glioma,and it has a promotion role in the occurrence of development of glioma.

Dopa-responsive dystonia (DRD) is a complex genetic disorder with either autosomal dominant or autosomal recessive inheritance, with autosomal dominant being more frequent. Autosomal dominant DRD is known to be caused by mutations in the GCH1 gene, with incomplete penetrance frequently reported, particularly in males. Here, we report a male patient with DRD caused by exon 1 deletion in the GCH1 gene inherited from the asymptomatic mother. The patient had an atypical presentation, notably with no dystonia, and underwent extensive workup for a myriad of neuromuscular disorders before a low-dose L-dopa trial and confirmatory genetic testing were performed. Our experience with this family highlights an atypical presentation of DRD and prompts us to consider the genetic complexity of DRD.

OBJECTIVETo observe the effect of purgation and detoxification therapy on gastrointestinal dysfunction of critically ill patients undergoing abdominal surgery.

METHODSTotally 56 inpatients with severe gastrointestinal dysfunction after abdominal surgery at ICU of Guangdong Provincial Hospital of Traditional Chinese Medicine were assigned to the treatment group and the control group, 28 in each group. All patients received routine Western medical treatment. Patients in the treatment group additionally took Modified Huanglian Jiedu Decoction (MHJD) and received electroacupuncture (EA) for 7 days. The first exhaust time, defecation time, scores for gastrointestinal dysfunction, mechanical ventilation time, ICU hospitalization time, and 28-day fatality rate were observed. Furthermore, serum levels of diamine oxidase (DAO) and D-lactic acid were detected at day 1, 3, and 7 after treatment.

RESULTSThe first exhaust time and the first defecation time in the treatment group were ahead of schedule, when compared with those of the control group (P <0. 05). Scores for gastrointestinal dysfunction, mechanical ventilation time, serum levels of DAO obviously decreased in the treatment group (P <0. 05). There was no statistical difference in serum levels of D-lactic acid, ICU stay time, the incidence of pulmonary infection, and 28-day mortality between the two groups (P >0. 05). Results of Logistic analysis showed that scores for gastrointestinal dysfunction were related with the incidence of pulmonary infection (P <0. 05).

CONCLUSIONMHJD combined EA could promote the recovery of gastrointestinal function in critically ill patients after abdominal surgery via improving intestinal barrier function, which was benefit for shortening mechanical ventilation time.

Critical Illness ; Defecation ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Electroacupuncture ; Gastrointestinal Diseases ; drug therapy ; Humans ; Lactic Acid ; Medicine, Chinese Traditional

Objective To explore the treatment of acquired benign tracheoesophageal fistula.Methods Clinical data of 13 cases of acquired benign tracheoesophageal fistula were retrospectively studied and the related literature was reviewed.The physical conditions,locations of fistula and risk factors of the patients were assessed before surgery.A specific surgical protocol was determined for each individual patient using either radical surgery or palliative surgery to repair the fistula.Ten patients underwent radical surgery,including suture closure of the esophageal or tracheal defects only in 7 patients and segmental tracheal reseetion in 3 patients.The remaining 3 patients underwent palliative operation.Results No major complication was observed except pulmonary infectin in 2 patients.No patient died during the perioperative period.All but one patient who treated with mediastinal and neck radiation therapy 4 years ago were able to resume oral food three months after operation.All patients were followed up for 8 months to 73 months[mean (39.6 ± 19.7) months]and no fistulas were occurred in the patients who received a radical surgery.The tracheoesophageal fistula orifices became smaller or closed fairly well in the patients who underwent a palliative surgery.Conclusion Surgery is the treatment of choice for acquired benign tracheoesophageal fistula.Airway and esophagal stent placement is not recommended.Adequate drainage of gastric juice is a crucial step in the management of the condition.

Objective To evaluate the reliability and validity of informant questionnaire on cognitive decline in the elderly(IQCODE) in Chinese elderly patients and to estimate the efficacy of IQCODE in the screening of patients with cognitive impairment.Methods Ninety three patients with cognitive impairment and 128 community-dwelling healthy elderly over 60 years old were assessed.Informants were interviewed with the short version of the IQCODE.Results The internal consistency coefficient of IQCODE was 0.83.The correlation coefficient of test-retest reliability was 0.86.The validity coefficient of IQCODE with mini-mental state examination and activities of daily living were-0.78 and 0.71 respectively.The scores of IQCODE of the patients varied with the degree of cognitive deficits,and the differences had statistical significance.But there was no significant difference among different types of senile dementia.The scores of IQCODE of the patients with cognitive impairment were closely correlated with the degree of cognitive deficits.Conclusions IQCODE is a reliable and effective measurement for the patients with cognitive impairment.It could discriminate the cognitive impairment patients from the normal cognitive ones,and is practical in screening.But it can not distinguish different kinds of dementia.

Objective:To investigate the efficacy of single time intra-articular different concentration of allogeneic bone marrow mesenchymal stem cells ( BM-MSCs ) injection in the treatment of Sprague-Dawley ( SD) rat model of osteoarthritis ( OA) .Methods: In the study, 32 SD rats were equally ran-domized into 4 groups:control group, high concentration group (1 ×107/mL BM-MSCs), low concentra-tion group (5 ×106/mL BM-MSCs) and high vs.low concentration group.The two knees of each rat were set up to a pair.The induction of OA was performed surgically randomly at one side in model group, and bilaterally in the other groups, which were through anterior cruciate ligament transaction ( ACLT) and medial meniscus excising.After the operation, the SD rats were allowed free movement.Four weeks later, different concentrations of allogeneic BM-MSCs isolated from the SD rats, expanded in vitro and suspended in phosphate buffered solution( PBS) were delivered in the articular cavity of both knees;PBS was used as the control.After injection, we excised the femoral nerve and sciatic nerve to disuse the low limb.The cartilage histological sections of knees were scored by Mankin scoring system to assess the se-verity of the pathology.mRNA of collagen Ⅱwas detected by real time polymerase chain reaction ( RT-PCR) .eGFP was detected by fluorescence microscope.Assessments were carried out 4 weeks after the operation in model group, and 3 weeks after injection in the other groups.Results:Mankin scores of the BM-MSCs side and control side were 6.60 ±0.40 vs.10.00 ±0.32 in low concentration group ( P<0.05), and 5.40 ±0.51 vs.9.60 ±0.51 in high concentration group (P<0.05).Mankin scores of high sv.low concentration group were 6.40 ±0.51 vs.7.60 ±0.75 (P>0.05).mRNA expression of collagen Ⅱ of the BM-MSCs side in low concentration group was 106%±1%in contrast to the control side.As in high concentration group it was 108%±1%, and 102%±1%in high vs. low concentra-tion group.Labeled BM-MSCs were detected unexpectedly in the synovial membrane but not in cartilage tissue three weeks from injection.Conclusion:BM-MSCs could promote cartilage repair and inhibit OA progression through a trophic mechanism.There was no difference between the two concentrations.