ObjectiveTo evaluate the clinical efficacy of Zuogui Pill （左归丸，ZGP） decoction on neurological function， motor function， and activities of daily living in patients with ischemic stroke （IS） of liver-kidney yin deficiency syndrome， and to assess its potential mechanisms from the perspectives of cerebral perfusion and corticospinal tract （CST） remodeling. MethodsA total of 108 patients with IS of liver-kidney yin deficiency syndrome and onset time ≤14 days were enrolled and randomly divided into a control group and a treatment group， with 54 cases in each group. The control group received conventional western medicine， while the treatment group received ZGP decoction （one dose per day） in addition to the conventional treatment. Both groups were treated for 90 days. The National Institutes of Health Stroke Scale （NIHSS）， modified Rankin Scale （mRS）， modified Barthel Index （MBI）， Fugl-Meyer Assessment （FMA）， and Chinese medicine syndrome score （CMS） were evaluated before treatment and after （90±3） days of treatment. Three-dimensional arterial spin labeling （3D-ASL） and diffusion tensor imaging （DTI） were performed to obtain ipsilesional cerebral blood flow （CBF） in the unaffected and affected hemispheres， relative CBF （rCBF）， and fractional anisotropy （FA） of the CST. Nodal analysis of FA values along the CST was also conducted. Correlation analysis was used to assess the relationships between post-treatment cerebral perfusion parameters （CBF and rCBF）， and FA values with clinical neurological function scores. ResultsAfter treatment， both groups showed significantly decreased NIHSS， mRS and CMS scores， together with significantly increased FMA and MBI scores （P＜0.01）. Intergroup comparison showed that NIHSS， mRS， and CMS scores in the treatment group were significantly lower than those in the control group ， while MBI and FMA scores were significantly higher （P＜0.01）. The 3D-ASL results revealed that CBF and rCBF values in the affected hemisphere significantly increased in both groups after treatment， and the treatment group had significantly higher values （P＜0.01）. DTI showed that the FA value of the CST on the affected side in the treatment group was significantly higher than that in the control group after treatment （P＜0.05）. Nodal analysis along the CST further demonstrated that the continuity of FA values at lesion-related nodes 45~99 in the treatment group was significantly better than that in the control group （P＜0.01）， with significant increases at nodes 65~71 and 76~81 compared with baseline （P＜0.05 or P＜0.01）， whereas the control group showed a decreasing trend at nodes 80~93 （P＜0.05）. Correlation analysis indicated that CBF and rCBF values in the affected hemisphere were negatively correlated with NIHSS and mRS scores and positively correlated with MBI score （P＜0.05）. FA value of the CST on the affected side， both before and after treatment， were negatively correlated with NIHSS score and positively correlated with FMA score （P＜0.05 or P＜0.01）. ConclusionZGP decoction can effectively improve neurological function， motor function， and activities of daily living in IS patients with liver-kidney yin deficiency syndrome， and its mechanism may be related to enhanced cerebral perfusion in the affected hemisphere and corticospinal tract structural remodeling.

Purpose To explore the predictive value of myocardial perfusion in assessing myocardial systolic function recovery after primary percutaneous coronary intervention (PPCI),in order to improve poor prognosis by early detection of myocardial no-reflow.Materials and Methods Forty nine patients with acute myocardial infarction (AMI) who had received PPCI were chosen as subjects.All the patients underwent two-dimensional strain (2DS) images and resting real-time myocardial contrast echocardiography (MCE) within one week after surgery,and 2DS measurement was repeated after three months.2DS imaging was used to acquire longitudinal peak systolic strain (LPSS) at all myocardial segments.Based on the graphs of LPSS,left ventricular myocardium was divided into normal contractile function myocardium (red) and impaired contractile function myocardium (light red,blue).According to the myocardial perfusion scores (MPS) qualitatively assessed by MCE visual interpretation,the myocardia with impaired systolic function were categorized into three groups with different perfusion level.The changes of LPSS within one week and three months after surgery (△ LPSS) among the three groups were analyzed.The correlation between MPS and LPSS within one week and three months after PPCI was also analyzed respectively.Results The △ LPSS increased significantly among the three groups with the improvement of myocardial perfusion level [(-5.78±6.23)％ vs.(-4.37±6.60)％ vs.(-1.21 ±4.77)％,all P＜0.05].The MPS measured one week after PPCI was both positively correlated with the LPSS detected within one week after surgery and that after three months (r=0.47,0.58,P＜0.001).The consistence of myocardial perfusion scores given by two evaluators was good (Kappa=0.785,P＜0.05).Conclusion The level of myocardial perfusion after PPCI in patients with AMI is closely related to regional myocardial systolic function,and the improvement of myocardial perfusion can forecast the recovery of regional systolic function.

Objective To evaluated the value of myocardial perfusion before delayed percutaneous coronary intervention (PCI) for predicting the recovery of systolic function of patients with acute myocardial infarction (AMI).Methods A total of 64 patients with AMI receiving delayed PCI treatment in the First People's Hospital of Foshan from January 2014 to June 2015 were selected.One day prior to delayed PCI,all of the patients underwent two dimensional strain to measure the longitudinal peak systolic strain (LPSS) of each left ventricular segment and the global longitudinal strain (GLS) of the left ventricle.The myocardial perfusion score (MPS) and the perfusion score index (PSI) were measured by myocardial contrast echocardiography (MCE).Left ventricular myocardial perfusions were classified as good,reduced,or absent.The two dimensional strain measurements were again conducted at 6 months after the delayed PCI to assess LPSS and GLS.The change of GLS and LPSS between one day prior to delayed PCI and six months after delayed PCI was assessed by paired t-test.The differences of LPSS among good,reduced,or absent myocardial perfusion groups were analyzed by one-way ANOVA.LSD-t test was used to compare in pairs of groups that had different values.The correlations between PSI and GLS,MPS and LPSS were assessed by Spearman's rank-correlation test.Results The GLS of all patients were higher at six months after delayed PCI than at one day prior to delayed PCI [(-15.39±7.80)％ vs (-12.44±8.38)％,t=14.398,P ＜ 0.001].The LPSS of myocardial perfusion in good,reduced and absent groups at one day prior to delayed PCI were (-2.64±5.60)％,(-6.19±6.87)％ and (-12.07±5.86)％,respectively.The LPSS of myocardial perfusion in good,reduced and absent groups at six months after delayed PCI were (-2.97 ± 4.93)％,(-11.38± 7.26)％ and (-15.82 ± 5.97)％,respectively.The myocardial LPSS of left ventricular segment with good or reduced perfusion was significantly higher at six months after delayed PCI (t=13.013,10.821,both P ＜ 0.001),but the LPSS of left ventricular segment with absent perfusion was similar to that of pre-PCI.Whether at one day prior to delayed PCI or six months after delayed PCI,there were significant differences in LPSS parameters among the three groups (at one day prior to delayed PCI,myocardial perfusion absent vs reduced or good,t=4.201 and 11.771,both P ＜ 0.001;myocardial perfusion reduced vs good,t=12.561,P ＜ 0.001;at six months after delayed PCI,myocardial perfusion absent vs reduced or good,t=9.714 and 15.646,both P ＜ 0.001;myocardial perfusion reduced vs good,t=9.254,P ＜ 0.001).The LPSS both at one day prior to delayed PCI and six months after delayed PCI in myocardial perfusion good group ＞ those of myocardial perfusion reduced group ＞ those of myocardial perfusion absent group.PSI was positively correlated with GLS at both one day prior to delayed PCI and six months after delayed PCI (r=0.69,0.72,both P ＜ 0.001).MPS was positively correlated with LPSS at both one day prior to delayed PCI and six months after delayed PCI (r=0.49 and 0.45,both P ＜ 0.001).Conclusion Myocardial perfusion before delayed PCI,monitored by MCE,is correlated well with myocardial systolic function,and may be used to predict the recovery of myocardial systolic function after delayed PCI.

Objective To explore the clinical efficacy of nibble debridement combined with silver ions dressing in treatment of diabetic foot ulcer.Methods The data of 238 patients with diabetic foot ulcer in people's hospital of Meishan from January 2012 to December 2016 were retrospectively analyzed.Of which 125 patients were treated by nibble debridement combined with silver ions dressing(nibble debridement group),113 patients were treated with surgical debridement combined with silver ions dressing(surgical debridement group).The clinical efficacy,wound healing time and complication between two groups were compared.Results The wound healing time of nibble debridement group was (37.5 ± 10.8) days,which was shorter than (45.3 ± 11.7) days of surgical debridement group,the difference was significant (P ＜0.05).The total effective rate of nibble debridement group was 92.80％,which was higher than 73.45％ of surgical debridement group,the difference was significant(P ＜ 0.05).No complication occurred in two groups.Conclusion The method of nibble debridement combined with silver ions dressing treatment has a better satisfactory clinical result,shorter wound healing time and lower medical costs for patients with diabetic foot ulcer.

Objective To explore the distribution characteristics of ankle-brachial index ( ABI) examination for peripheral arterial dis-ease in diabetic patients, and to provide basis for clinical diagnosis. Methods Randomly selected 110 cases of patients who were admitted into our hospital from February 2014 to January 2015, and divided them into the observation group (34 cases with diabetic lower extremity peripheral vascular lesions) and the control group (76 cases without diabetic lower extremity peripheral vascular lesions). Measured the ABI of the two groups, and analyzed the value of ABI data range for the diagnosis of diabetic lower extremity peripheral vascular lesions. Mean-while, analyzed the risk factors of peripheral arterial disease in diabetic patients according to ABI. Results The sensitivity of ABI for diag-nosis of diabetic lower extremity peripheral vascular lesions was 91. 18%, and the coincidence rate was 95. 36%, the specificity was 98. 68%, the misdiagnosis rate was 8. 82%, and the omission diagnostic rate was 8. 82%. ABI of the observation group was obviously lower than that of the control group, and the difference was statistically significant (P<0. 05). Conclusion ABI examination could be basis of clinical diagnosis and important standard of disease assessment for peripheral arterial disease in diabetic patients. It is suggested to strengthen the control of blood glucose, blood pressure and weight of patients with diabetes in order to reduce the risk of morbidity.