目的探讨对急性脑卒中后吞咽障碍的康复。方法急性脑卒中后吞咽障碍的患者52例,对其中26例患者在给予药物治疗的同时,按不同程度制定不同的训练计划。对照组仅进行神经内科常规治疗和护理。结果对内囊以及以上部位病损引起的吞咽障碍,观察组康复效果好,多在10天内改善,优于对照组。结论急性脑卒中后吞咽障碍患者接受康复护理,能改善吞咽功能。

ObjectiveTo investigate the risk factors of upper gastrointestinal hemorrhage in elder patients with lung cancer after operation,providing the basis for clinical prophylaxis and treatment of complications.Methods360 elder patients with lung cancer in department of thoracic surgery of our hospital were enrolled from Jun 2005 to Dec 2010,the complications after operation were reviewed retrospectively.ResultsAfter investigation,we found that only 10 patients(2.8％ ) had upper gastrointestinal hemorrhage.6 cases of them were fluid and electrolyte imbalance,8 cases of them were hyoxemia,3 cases of them was hypotension after operation.8 cases of them were older than 70 years old.There was significant difference between older and smaller than 70 years old.ConclusionThe incidence of postoperative upper gastrointestinal bleeding in elderly patients with lung cancer was 2.8％,which was a relatively uncommon condition in clinic.Its major risk factors were age,fluid and electrolyte imbalance,hypotension and hyoxemia caused by operation.

To observe the therapeutic effect of acupuncture and moxibustion on the climacteric syndrome, patients with climacteric syndrome were treated by acupuncture and moxibustion and randomly compared with the patients in control group treated by Chinese herbs. There was a significant difference between two groups (P＜0.05). The results showed that the therapeutic effect in acupuncture and moxibustion group was obviously better than that in Chinese herbs group.

Objective To investigate the latest situation in the period 2006-2008 of drug resistance tuberculosis among migratory population in Chaoyang district of Beijing.Methods All sputum culture-positive specimens from migratory population were collected.Drug susceptibility of Mycobacterium tuberculosis to M,H,R and E were tested by proportion method.Results Drug susceptibility of 371 isolates from 2006-2008 were tested.Total drug resistance wag 22.4%(83/371),the primary drug resistance and the acquired drug resistance were 17.5%(58/331)and 62.5%(25/40)respectively.The multi-drug resistance was 5.9%(22/371);the primary multi-drug resistance was 4.2%(14/331)and acquired multi-drug resistance wag 20.0%(8/40).The drug resistance and multi-drug resistance were higher in treated cases than that in new cases.and the difference wag statistically significant(χ~2 was 39.020 and 13.210,P<0.01).The drug resistance to 4 anti-tuberculosis drugs from high to low was M(16.7%).H(12.1%),R(11.3%),E(1.9%).The primary drug resistance rate were 13.3%(S),8.8%(H),8.2%(R),1.8%(E).The acquired drug resistance rate were 45.5%(S),40.0%(H),37.5%(R),2.5%(E).The drug resistance to S,H and R were higher in treated cases than that in new cases,and the difference was statistically significant(χ~2 was 23.549,29.810 and 27.754,P<0.01).Conclusion The drug resistance to mycobacterium tuberculosis among migratory population was relatively high in chaoyang district of Beijing,suggesting the necessity to strength the tuberculosis control program for migratory population.

Objective To investigate the application of expanded p01ytetrafluoroethylene(ePTFE)grafts in upper arm to build arteriovenous aCCeSS for hemodialysis. Methods ePTFE graft vascular access was built in the upper arm in 20 uremia patients.Three operation strategies were applied according to the reference,including loop grafts connected axillary artery and axillary vein,straight graft connected axillary artery and elbow basilic vein,and bridge connected elbow brachial artery and axillary vein. Results Twenty operations were successful and after 6-8 weeks the fistula of all cases were used in hemodialysis.The blood flows were 220-300 ml/min without re-circulation found.Conclusion ePTFE graft arteriovenous vascular access in the upper arm could be an alternative for hemodialysis patients who are difficult to build native arteriovenous fistula.

Objective To Investigate the concentration of VILIP-1 and NR2 peptide in the serum of patients with ischemic stroke , and to explore their clinic value in early diagnostic of ischemic stroke patients.Methods The levels of VILIP-1 and NR2 peptide were examined by ELISA ( enzyme linked immunosorbent assay ,ELISA) with suspicious TIA ( defined as a neurological deficit that resolved within 24 hours) or acute ischemic stroke patients ( within 72 hours of onset of symptoms ) 340 cases,102 healthy controls,98 patients with vascular risk factors and 35 patients with hemorrhagic stroke.Among all the groups , VILIP-1 and NR2 peptide level were analyzed using the nonparametric Wilcoxon test.Diagnostic performance were analyzed among the groups with the two biomarkers independently and combinedly .Results Serum levels of VILIP-1 and NR2 peptide in patients with ischemic stroke (IS) were 9.80 (1.90-14.22) μg/L, 14.40 (5.60-27.91) μg/L respectively,which was higher than that of the healthy control group [VILIP-1:0.02 (0.01-0.09),NR2:0.33 (0.02-1.15),χ2 were 5.61 and 9.54,P<0.001],the group with vascular risk factors [VILIP-1:0.03 (0.02-0.16),NR2:0.27 (0.01-1.54),χ2 were 6.74 and 10.62,P<0.001], the group of patients non-stoke [VILIP-1:0.04 (0.03-0.19),NR2:0.53 (0.45-1.21),χ2 were 3.78 and 7.63, P <0.001 ].The levels of VILIP-1 and NR2 peptide was significantly increased in IS patients presenting within 3 h of symptom onset.When differentiating IS from patients with hemorrhagic stroke ,NR2 had a AUC of 0.934,showing a strong distinguishing effectiveness.Differentiating IS from healthy controls , patients with vascular risk factors and non-stroke patients,the AUC of combination of VILIP-1 and NR2 was 0.974,which was higher than the AUC of either VILIP-1(0.849) or NR2(0.862) alone(P <0.05). Conclusions VILIP-1 and NR2 peptide are very sensitive and specific biomarkers to the early diagnosis of IS.The combination of VILIP-1 and NR2 peptide has higher value of clinical applications than one of them independently.

Objective To investigate the effects of early Xuebijing injection on procalcitonin (PCT) with septic shock patients.Methods Sixty-five patients with septic shock were randomly divided into the control group and Xuebijing injection group.The patients in Xuebijing injection group were received Xuebijing injection therapy(50 ml Xuebijing + 100 ml 0.9％ NaCl injection,2 times/d,for 7 d) besides basic treatment,while in the control group were received basic treatment including antibiotic susceptibility + early fluid resuscitation + correct acidosis.At the entering the ICU day and 1,3,5 d after treatment,patients were collected 5 ml venous blood serum C reactive protein(CRP) and PCT,and before treatment and at the 5th,7th day after treatment conducted APACHE Ⅱ evaluation to observation of curative effect of two groups.Results Before treatment,there were no significant difference in terms of heart rate,blood pressure,PCT,CRP,APACHE Ⅱ scores between the two groups (P ＞ 0.05).There was no significant difference in terms of PCT and CRP between the two groups at the 1 d after treatment(P ＞0.05).While at the 3th day after treatment,PCT and CRP of Xuebijing group were lower than of control group and the differences were significant ((7.37 ± 2.58) μg/L vs.(12.25 ± 3.32) μg/L,(64.32 ± 11.12) mg/L vs.(72.37 ± 12.42) mg/L;P ＜0.05).The APACHEⅡ score in control group at before and 5th,7th day after treatment were (20.48 ± 4.41),(16.52 ± 3.45),(12.78 ± 2.91) respectively,in Xuebijing injection group were (20.74 ± 4.73),(12.48 ± 2.76),(9.24 ± 6.67) respectively.And all indices were significant different time points between groups (P ＜ 0.05).At 7th day after treatment,15 cases were improved,10 cases progressed and 8 cases died in the control group and the effect rate was 75.8％ (25/33).Meanwhile,22 cases were improved,5 cases progressed and 5 cases died in the Xuebijing group and effect rate was 84.8％ (27/32).There was significant difference between two group(x2 =7.27,P =0.03).Conclusion Early Xuebijing injection application can inhibit the PCT r~tion of septic shock patients and improve the prognosis.

ObjectiveTo evaluate and compare the outcomes of missed Monteggia fractures in children treated with ulnar angulation-distraction osteotomy and plate fixation or external fixation.Methods Nineteen patients,including 11 boys and 8 girls who presented with missed Monteggia fracture,were reviewed from July 2005 to June 2011.Twelve children (Group A) were treated with ulna angulation osteotomy and plate fixation,and 7 eases(Group B) with ulna angulation-distraction osteotomy and external fixator.Thirteen patients were classified as type Bado Ⅰ,and six as type Bado Ⅲ.The age,the delay from injury to surgery,complications,elbow and forearm function,and the healing time of the osteotomy were compared.ResultsAll 19 patients were followed up.The duration of missed dislocation was from 6 to 36 months (mean,10 months).Redislocation of the radiocapitellar joint occurred after surgery in one case in group A.Forearm compartment syndrome occurred in one case after surgery in group B.All patients,except one,regained full elbow flexion in group A and B,various forearm pronation limitation were noted in all patients (mean,15°).The average healing of osteotomy of group A and B was 8 weeks(6-15 weeks) and 22 weeks (10-44 weeks).ConclusionThe ulnar angulation-distraction osteotomy could correct the ulnar deformity in children of missed Monteggia fractures,which is the key issue to be corrected.Both of the fixation strategies can obtain the same treatment results.Preoperative assessment is most important,plate internal fixation was recommended for young age and short delay cases,on the contrary,we prefer to choose external fixator.

Objective To evaluate the clinical effect of therapy of the trisacryl gelatin microspheres combinee the gelatin sponge particle on embolize the bronchial artery in acute massive hemoptic patients. Methods One huneree cases with massive hemoptysis were selectee as our subjects ane eivieee into control ane research group(n = 50 for each group). Patients in control group were given only gelatin sponge particle,ane in research group were given the trisacryl gelatin microspheres combinee the gelatin sponge particle to embolize the bronchial artery. All cases were followee up for more than 12 months. Ane the effect of therapy was recoreee. Results In research group,42 cases(84. 0% ,42 / 50)were got the bleeeing stop immeeiately after embolization,7 cases in 72 h(14. 0% ,7 / 50),ane the effective rate of hemostasis was 98. 0%(49 / 50). In the control group,41 case(82. 0% ,41 / 50)were got the stop bleeeing immeeiately,8 cases in 72 h(16. 0% , 8 / 50),ane the effective rate of hemostasis was 98. 0%(49 / 50). There was no statistic eifference between two groups(P > 0. 05). After more than one year follow-up,3 cases(6. 12% )were reoccurree in the therapy group ane 15 cases(30. 61% )was in the control group. The eifference was significant between two groups after surgery for one year( χ2 = 9. 801,P < 0. 01 ). There was no serious complication in patients of two groups. Conclusion The operation of BAE is effective therapy for the massive hemoptoe,ane it is provee to be a safe,effective ane lower rate of recurrence approach of the trisacryl gelatin microspheres combinee the gelatin sponge particle for eouble embolzation the bronchial artery.

Clinical data of 899 patients,who received colposcopic examination,were retrospectively analyzed.Both Reid's colposcopic index(RCI)score and biopsy were performed.The study showed that the value of RCI score was positively related to the severity of cervical lesions(F=2.043,P=0.03).The specificity of RCI for cervicitis,cervical intraepithelial neoplasia(CIN)Ⅰ were 98.8%,95.7% respectively;while sensitivity and negative predictive value for CIN Ⅱ,CIN Ⅲ were 77.7%,70.0%and 96.8%.97.4%,respectively.So RCI scoring can increase the diagnostic value of colposcope.