Intracerebral hemorrhage: natural history and rationale of ultra-early hemostatic therapy

Stroke is a major health problem worldwide, causing high morbidity and mortality. Intracerebral hemorrhage (ICH) accounts for 15% of stroke cases in the US and Europe and up to 30% in Asian populations. It is less treatable than other forms of stroke and causes higher morbidity and disability. Data suggest that early hematomy growth is the principal cause of early neurological deterioration after ICH. Prospective and retrospective studies indicate that early hematoma growth occurs in 18–38% of patients scanned within 3 h of ICH onset, and that hematoma volume is an important predictor of 30-day mortality. As hematoma growth in acute ICH is a dynamic process, intervention with ultra-early hemostatic therapy could lead to minimization and even prevention of early hematomy growth. Recombinant activated factor VII (rFVIIa, ‘NovoSeven’), a powerful initiator of hemostasis, is approved for the treatment of bleeding in patients with hemophilia and inhibitors and may also promote hemostasis in patients with normal coagulation. rFVa acts locally at the bleeding site without activating systemic coagulation and may be a valuable therapy during the hyperacute stage of ICH. A randomized, double-blind, placebo-controlled, dose-ranging trial is currently in progress to investigate the potential of rFVIIa as an ultra-early hemostatic therapy to prevent or minimize hematoma growth in ICH patients without coagulopathy.     

结肠回肠反流与回肠黏膜结肠化相关性的实验研究

目的探讨结肠回肠反流后回肠末端黏膜结肠化的机制.方法取SD大鼠60只,均为雄性,体重25¨3∞g,随机分为实验组和对照组,分别进行末端回肠-盲肠侧侧吻合术或回肠末端手术缝线,2个月后处死动物并取组织进行观察.结果实验组术后一般状况良好.大体形态学观察:实验组回肠末端黏膜表现为绒毛萎缩、间距增宽、沟变浅、光滑性增强.病理组织学:实验组表现为黏膜绒毛萎缩、间距增宽、沟变浅、上皮细胞变短、杯状细胞增多.电镜观察:实验组可见绒毛变小、变短或脱落;微绒毛变短、分布不均匀;杯状细胞数目在非坏死区增多.结论结肠-回肠反流后可导致回肠末端黏膜结肠化的变化,它可能是慢性末端回肠炎的发病基础或前期表现.     

人源化抗体构建过程中假链的产生及应对策略

目的在人源化抗体构建过程中，采用方便、快捷的分子克隆手段。消除SP2／0内源性畸形轻链转录本以获得正确的轻链cDNA。方法在mRNA抽提时，不用常规的TRIZOL法抽提总RNA，而采用经腹腔培养。生长状态良好的杂交瘤细胞。用QIAGEN公司Oligotex Direct mRNA Purification Kit，将polyA^＋的mRNA富集。可有效减少畸变转录本的含量，提高功能型mRNA的丰度。利用polyA^＋RNA。采用RT-PCR，我们成功地克隆到了轻链可变区序列，序列分析证实读码框完全正确，属于轻链可变区基因。结果NCBI数据库BLAST显示。克隆的基因序列符合小鼠lg可变区特征，具有正确的CDR和FR功能区及VJ连接区。结论采用polyA^＋ mRNA富集技术，成功克隆获得阻断型抗人CD154 mAb（4F1）单克隆抗体的轻链、重链可变区基因，成功地消除了SP2／0内源性畸形转录本对免疫球蛋白功能性轻链基因的影响。     

麻痹性痴呆12例临床分析

目的探讨麻痹性痴呆(GPI)患者的临床表现,实验室检查、影像学、脑电图特征以及诊断、治疗及预后。方法回顾性分析经临床和实验室确诊的12例GPI患者的相关资料。结果GPI患者临床以智能障碍、精神异常、癫痫最常见。12例患者血清甲苯胺红凝集试验(TRUST)和梅毒螺旋体明胶凝集试验(TPPA)均( ),脑脊液TPPA均( ),而TRUST( )9例。头颅MRI检查结果示大脑皮质萎缩。3例以肢体抽搐为表现者脑电图可见广泛中高幅尖慢波,余脑电图为弥漫性慢波。经抗梅毒治疗,痊愈4例,显效5例,好转3例。结论GPI现已是我国神经梅毒分型中极常见类型,多见于中年男性,临床表现多变,早期误诊率高,早期发现、及时正规治疗预后好。     

吻合指固有神经背侧支的邻指皮瓣修复手指远端掌侧软组织缺损

目的探讨采用吻合指固有神经背侧支的邻指皮瓣修复手指远端掌侧软组织缺损的疗效. 方法 1996年10月～2004年6月,25例(32指)伴肌腱或骨组织外露的手指远端掌侧软组织缺损患者,其中男18例,女7例,年龄13～45岁.切割伤6例,冲压伤8例,机器绞伤11例.损伤部位:拇指2例,食指8例,中指5例,环指3例,小指2例,食、中指2例,中、环指2例,食、中、环、小指1例.缺损范围:1.5 cm×1.0 cm～4.0 cm×2.1 cm.损伤至就诊时间30 min～48 h.急诊行清创,采用带蒂邻指皮瓣修复,术中同时将指固有神经的背侧支与指神经残端吻合重建皮瓣感觉,术后3周断蒂.供区中厚皮片游离植皮. 结果术后皮瓣及供区均成活,创面Ⅰ期愈合.获随访6～26个月,手指指腹饱满,色泽正常,感觉恢复,两点辨别觉为5～8 mm,均无功能障碍. 结论采用吻合指固有神经背侧支邻指皮瓣修复手指远端掌侧软组织缺损不仅能修复缺损皮肤,且能重建皮瓣感觉,术式操作简便.     

Schlaf bei neurodegenerativen Erkrankungen

Zusammenfassung Die neurodegenerativen Erkrankungen bestehen aus einer Gruppe heterogener, progredient verlaufender Erkrankungen unterschiedlicher Ätiologie, die ein oder mehrere Systeme beeinträchtigen. Sie treten überwiegend im höheren Lebensalter auf, in dem sich zusätzlich sowohl die Art wie auch das Ausmaß des Schlafes ändern. Die neurodegenerativen Prozesse verursachen strukturelle Veränderungen der Schlaf-Wach-Generatoren im Hirnstamm, die Schlafstörungen wie Tagesschläfrigkeit, Insomnie, nächtliche bewegungs- und schlafbezogene Atmungsstörungen sowie Störungen des zirkadianen Schlaf-Wach-Rhythmus zur Folge haben können. Bei manchen neurodegenerativen Erkrankungen sind im Vorfeld der Krankheitsmanifestation auftretende Schlafstörungen bereits Krankheitsprädiktoren. Polysomnographisch finden sich Schlaffragmentierung, tonische oder phasische Beinbewegungen, Störungen der Atemmuskulatur, verminderter Tiefschlaf, Abwesenheit von REM-Schlaf oder REM-Schlaf ohne Muskelatonie, vermehrte Arousal- und Weckreaktionen, epileptiforme EEG-Aktivität oder schlafbezogene Atmungsstörungen. Sehr häufig sind REM-Schlaf-Verhaltensstörungen assoziiert mit neurodegenerativen Erkrankungen. In dieser Übersichtsarbeit werden Symptomatik, Pathophysiologie und polysomnographische Befunde von Schlafstörungen häufiger neurodegenerativer Erkrankungen vorgestellt.     

Is substance P a primary afferent neurotransmitter for nociceptive input? III. Valproic acid and chlordiazepoxide decrease behaviors elicited by intrathecal injection of substance P and excitatory compounds

Intrathecal (i.t.) injections of substance P (SP) and kainic acid in rats produced rostrally directed scratches with the hindlimbs and caudally directed bites or licks. These behaviors, together with myoclonic twitches and vocalization, were also produced by I.T. morphine and strychnine. Intrathecal valproic acid (VA) significantly reduced all behaviors when these occurred spontaneously, and VA and chlordiazepoxide both reduced these behaviors when they were evoked by a light cotton swab tap to the lumbosacral region, in rats treated with the excitatory compounds. Since neither anticonvulsant affected the thermal or mechanical pain threshold at these doses, these results suggest that (a) the behaviors elicited by i.t. injection of the excitatory compounds are not responses to perceived pain, but rather the expression of a spinal convulsive-like state, and (b), since scratching and biting were the only behaviors produced by SP, this peptide is neither necessary nor sufficient for the elicitation of pain at the spinal level. Although our experiments do not rule out other roles for SP in pain processes such as that of a neuromodulator, it is unlikely that this compound is a traditional primary afferent neurotransmitter of pain.     

Electrode recovery potential

In some instances the same electrodes are used for stimulation and then for recording a bioelectric event immediately after the stimulus. However, after the current pulse there remains an electrode potential that decays quasiexponentially. We have designated this falling potential the electrode-recovery potential. This study investigated the recovery potentials of single electrodes of rhodium, stainless steel, platinum and platinum-iridium in contact with 0.9% saline at room temperature (25°C) over a current density ranging from 0.1 to 100 mA/cm² using a constant-current pulse. In all cases, with increasing current density, there was a decrease in the time for the electrode potential to fall to one half of the immediate post-stimulus value. Above about 20 mA/cm² the decrease in recovery time was smooth with increasing current density. Below 20 mA/cm², the recovery time was slightly irregular. The shortest recovery times were for platinum and platinum-iridium. The largest decrease in recovery time with increasing current density was for stainless steel, which decreased 10 fold from 0.1 to 100 mA/cm². The recovery time for rhodium decreased about three-and-one half fold over the same current density range. It was found that the waveform of the recovery potential is not a simple exponential because the Warburg and Faradic components of the electrode-electrolyte interface are current-density dependent. In general, for all current densities studied (0.1–100 mA/cm²), there was a sudden initial fall in electrode potential with cessation of current flow, followed by a very gradual nonexponential decrease in potential.