BACKGROUND: Some researches suggest that improvement of motor function is closely related to cognitive function. The better the cognitive status is, the better the recovery of motor function is. Early evaluation of cognitive function can predict prognosis of motor function and improve generalized ability, social communication abilities and quality of life (QOL).OBJECTIVE: To observe the correlation of cognitive function in hemiplegia and aphasia and analyze the prognostic factor of early cognitive dysfunction in patients with acute stroke.DESIGN: Contrast study.SETTING: Department of Neurology, Taian Central Hospital; Department of Neurology, Affiliated Hospital of Medical College of Qingdao University.PARTICIPANTS: Fifty patients with acute stroke were enrolled from Neurological Department of Taian Central Hospital and Neurological Department of the Affiliated Hospital of Medical College of Qingdao University from January 2002 to May 2005. They were 32 males and 18 females aged 34-78 years. All patients were coincidence with the Diagnostic Criteria of Acute Stroke established by the Fourth National Cerebrovascular Diseases Meeting and diagnosed with CT or MRI. Patients were told about the evaluation in details. Among them, 44 patients had hemiplegia, including 30 males and 14 females aged 34-78 years; 30 had aphasia, including 17 males and 13 females aged 34-78 years; 20 had non-aphasia, including 14 males and 6 females aged 38-70 years.METHODS: ① Aphasia was tested with Western Aphasia Battery (WAB).Aphasic quotient of ＜ 93.8 was regarded as aphasia; otherwise, it was regarded as non-aphasia. ② Motor function was evaluated with Fugl-Meyer (FMA).Motor function of upper and lower limbs was scored as 100 in total. The higher the points were, the better the motor function was. ③ Cognitive function was evaluated with Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), which contained 4 items (orientation, perceptibility, visual-motor organization and thinking ability) and 22 subtests in total. The higher the points were, the better the cognitive function was. Functional evaluation started at half-month treatment onset. Intergroup comparison of their mean value was tested using Student's test and one-way analysis of variance.MAIN OUTCOME MEASURES: ① Correlation between cognitive function and hemiplegia; ② correlation between cognitive function and aphasia.RESULTS: Fifty patients with acute stroke were all involved in the final analysis. ① Correlation between cognitive function and hemiplegia: Scores of orientation, perception, visual-motor organization and cognitive function of 44 patients with hemiplegia were positive positively correlated with FMA scores of motor function (r=0.534, 0.598, 0.500, 0.548, P ＜ 0.01); however,scores of thinking ability was not correlated with FMA scores of motor function (r=0.310, P ＞ 0.05). ② Correlation between cognitive function and aphasia: Scores of orientation, perception, visual-motor organization, thinking operation and cognitive function of patients with aphasia were (4.60±2.37), (15.10±6.02), (14.00±6.93), (12.33±6.77), (1.83±1.09) points,which were lower than those of patients with non-aphasia (7.30±1.08),(23.20±1.11), (24.25±4.08), (24.20±5.43), (3.50±0.76) points (t=5.44 to7.197, P ＜ 0.05).CONCLUSION: The more severe the cognitive dysfunction is, the more severe the hemiplegia is. Cognitive function in stroke patients with aphasia is significantly reduced.

BACKGROUND:Percutaneous kyphoplasty for the treatment of vertebral compression fractures has gained good clinical results and it is characterized as smal trauma, less bleeding and very low rate of complications. The vast majority of elderly patients can tolerate it, but this method cannot prevent fracture replase in the elderly. OBJECTIVE:To evaluate clinical outcomes of percutaneous kyphoplasty combined with anti-osteoporosis drug for the treatment of acute osteoporotic vertebral compression fractures METHODS:According to strict inclusion and exclusion criteria, 137 patients, including 26 males and 111 females, mean age of (75.55±6.96) years, with a total of 198 acute osteoporotic vertebral compression fractures treated by kyphoplasty that involves injection of polymethyl methacrylate cement under radiologic control into a treated vertebral body were conducted in this study. Al patients were asked to take anti-osteoporosis drugs for 3 post-treatment months. The primary outcomes were visual analogue scale, ertebral restoring rate, Oswestry disability index, Cobb angle at different time (pre-operation, 1 week and 3 months after operation). In addition, the rate of complications and the replase rate of vertebral compression fractures after operation were recorded. RESULTS AND CONCLUSION:There were significant differences in the mean visual analog scale scores, vertebral restoring rate, Oswestry disability index, Cobb angle at pre-procedure and post-procedure (at 1 week and 3 months) (P<0.001). In addition, the rate of postoperative complications was 0.7%and there were no vertebral compression fractures during 3-month fol ow-up period. Our study suggests that percutaneous kyphoplasty combined with anti-osteoporosis drug for the treatment of acute osteoporotic vertebral compression fractures can gain good clinical results.

Objective To investigate the neuroprotection of delayed treatment of thoracic acute spinal cord injury with recombinant human erythropoietin (rhEPO) in rat model of compressive injury. Methods Sixteen adult male Sprague-Dawley rats were randomly divided into two groups: control group (compressive injury group) and experimental group (rhEPO group), In the compressive injury group,the animals recived 0.9% saline treatment at 2 h, day 1 and day 3 after the injury, while in the rhEPO group, rhEPO (3 000 U/kg) was given to rats at 2 h, day 1 and day 3 after the injury. All the rats were observed in 4 days after the injury. The primary outcomes were evaluated by BBB scale, apoptotic index, inflammatory index and electron microscopy. Results Delayed treatment of thoracic acute spinal cord injury with rhEPO could reduce apoptosis, regulate inflammation, improve motor function and promote regeneration of the spinal cord. Conclusion Our study suggests that delayed treatment of thoracic spinal cord compressive injury with rhEPO could exert neuroprotection.

0.05). Conclusion The lesions of left and right hemisphere can both cause cognitive impairment, which is significantly correlated with the severity of motor dysfunction in acute stroke patients with subcortical lesion.Great attention should be paid to the evaluation and treatment of cognitive dysfunction in patients with serious hemiplegia.

Objective To investigate clinical features and antifungal therapeutic effect of chronic severe hepatitis (CSH) patients with invasive fungal infection (IFI), and to improve the diagnosis and treatment.Methods Clinical manifestation, blood routine, imageology and mycetology characteristic, antifungal treatment perscription and therapeutic effect of 79 CSH patients with IFI were retrospectively analyzed. Antifungal therapeutic effect was compared between fluconazole and voriconazole. Results Thirteen (16.5%) patients received glucocorticoid or other immunodepressants for a relatively long time, 40 (50.6%) patients had invasive operation, and 61 (77.2 %) patients were administered 1-6 kinds of broad-spectrum antibiotics. Seventy-three patients had fever. Leucocytes and neutrophilic granulocyte increased in 96.2% of the patients. Lung (31.6%), intestinal tract (26.2%) and oral cavity (14%) infections were common. Fungus was found in 70.9% of the patients. Candida albicans (40.9%) and aspergillus (21.1%) were often seen. Halo signs and crescent signs on lung CT were relatively specific in 40% of the patients with fungal pneumonia. Voriconazole was more effective than fluconazole(71.4% vs. 39.0%, P<0.05). Twelve patients with lung aspergillus infection were administered voriconazole, 8 (66.7%) patients of whom was effective, and the other 4 (33.3%) patients died. Conclusion There are high risk factors in major CSH patients with IFI. The most common clinical manifestations of CSH patients with IFI are fever, leukocytosis, lung and intestinal tract infection. Candida albicans and aspergillus infection are common. Voriconazole is more effective than fluconazole, and can increase the survival rate of CSH patients with IFI.

Adult ; Alanine Transaminase ; metabolism ; Diagnosis, Differential ; Humans ; Liver ; pathology ; Male ; Niemann-Pick Diseases ; pathology

Objective To explore the application value of telepathological consultation in helping grassroots hospitals.Methods 578 cases of intraoperative telepathology consultation were reviewed,and the accuracy and the timely rate of diagnosis were calculated.The systematic distribution,benign and malignant distribution,and the distribution difference in different primary hospitals were analyzed,so as to evaluate the popularization value of the intraoperative telepathology consultation.Results The accuracy rate of 578 cases of intraoperative telepathology consultation was 99.83％.The timely rate of consultation in 30min was 96.02％,and most reports could be diagnosed in 2 to 5 mins.The source of tissues involved in consultation were thyroid,breast,ovary/fallopian tube and lung.In all cases,24.39％ of the malignant tumors were found.Among the diseases of different systems,the proportion of malignant tumors is the highest in breast diseases,followed by lung,thyroid and ovary.Among the four hospitals with most of the consultations,the rate of malignant tumor in Renmin Hospital of Jianli County was the highest,followed by Renmin Hospital of Yingshan County,Renmin Hospital of Xiaochang County,and Fifth Division Hospital of Xinjiang.Conclusion Intraoperative telepathology consultation can provide accurate and timely expert consultation for grassmots hospitals,avoid the "second operations" of the patients,improve the access of medical treatment for people living in relatively remote areas,solve the shortage of pathologists at the grassroots hospitals,and improve the level of doctors' diagnosis and treatment at the grassroots hospitals,which is worth popularizing and applying in Pathology Department of the grassroots hospitals.

Objective: To investigate the effect of oral nutritional supplements(ONS) on body weight loss and life quality in post-discharge patients with gastric and colorectal cancer. Methods: All the enrolled post-operative gastric or colorectal cancer patients were randomly divided into ONS group and control group. Body weight loss, middle arm circumference, triceps skinfold thickness and right-hand grip strength were measured and the Karnofsky score, ECOG score and QOL score were calculated 3 months after the discharge. Results: The body weight loss of gastric cancer patients was lower in ONS group than in control group since 2 months after discharge.(2 months after discharge: 1.65±2.11vs. 2.70±1.90 kg, t=-2.385 3, P=0.019 3; 3 months after discharge: 1.95±2.75vs. 3.67±2.29 kg, t=-3.134 7, P=0.002 4), There was no difference of body weight loss between two groups in colorectal cancer patients. The middle arm circumference, triceps skinfold thicknessand right-hand grip strength showed no statistic difference between two groups both in gastric and colorectal cancer patients. The Karnofsky score(56.82±13.65%vs. 51.71±9.72%, t=2.014 8, P=0.047 2) and QOL score(41.91±6.92 vs. 38.39±8.77, t=2.059 7, P=0.042 6) were higher in ONS group than in control group in gastric cancer patients. While all 3 types of scores had no difference between two groups in colorectal cancer patients. Conclusion ONS can efficiently reduce the body weight loss and improve the performance status and life qualityin post-discharge gastric cancer patients, but not in colorectal cancer patients.

Objective: To compare the clinical value of ultrasonic elastography (UE) and three common ultrasonic features in diagnosing papillary thyroid carcinoma (PTC). Methods: From January 2012 to December 2017, the clinical data of 105 cases with PTC which were confirmed by postoperative pathologic examination and 20 cases with benign thyroid nodules (BTN) in the Integration of Chinese and Western Medicine Hospital Affiliated to Nanjing University of Traditional Chinese Medicine were analyzed retrospectively.The UE and common ultrasonic features comprising a taller-than-wide shape, irregular margins and microcalcifications were analyzed.The sensitivity, specificity and area under curve (AUC) of PCT dingnosis with two different ultrasonic parameters are calculated. Results: Based on surgical pathology, the diagnostic sensitivity of irregular boundary is the highest amony the three paraneters of ordinary ultrasound.Although an irregular margin showed higher sensitivity than taller-than-wide shape and microcalcifications with 71.42% vs.59.04% vs.60.00%, but there was no statistically significant difference (χ²=4.3, P=0.116). There was also no statistically significant difference in specificity (χ²=0.134, P=0.935). The diagnostic efficiency of UE was higher than taller-than-wide shape (Z=3.046, P=0.002), irregular margin(Z=2.962, P=0.003) as well as microcalcifications(Z=3.942, P=0.000), the difference was statistically significant(P<0.05). The diagnostic efficiency of UE was higher than the combined three common ultrasonic features together (Z=3.125, P=0.001). Conclusion UE score shows a higher diagnostic efficiency, easy to perform, indicating the important application value in preoperative diagnosis of PTC, and is worthy of promoting in clinic.