P17 Pharmacology in the integrated course ＂Basic Medical Sciences＂ in Zhejiang University School of Medicine

According to traditional teaching mode, the courses in preclinical medicine including pharmacology are separately run. This mode causes a series of disadvantages including loose connection between knowledge in different disciplines and weak ability to bridge basic preclinical knowledge and clinical practice. In order to overcome the disadvantages and promote the teaching efficiency, we constructed a new integrated course-Course of Basic Medical Sciences, which includes 6 traditional courses, anatomy, histology and embryology, physiology, pathology, pathophysiology and pharmacology. We integrated these courses based on the human organ systems and according to the principle-＂ From macro to micro, From morphological to functional, From normal to abnormal and From disease to drug therapy＂ and published the series of textbook in 2004. The contents of pharmacology are taught just after pathology and pathophysiology in every organ system. In comparison with the traditional teaching mode, teachers of pharmacology need not spend a lot of time to review preceding knowledge of anatomy and histology, physiology, pathophysiology and pathology. This is helpful in saving time and improving the teaching efficiency.     

综合疗法治疗腰椎间盘突出症40例

目前治疗腰椎间盘突出症主要用椎间的旋转复位法，包括定点旋转复位和侧卧斜扳复位。自2004年8月以来，笔者在临床中遇到部分患者不配合或不能完成旋转复位法，因而采用自创凿击复位法，取得满意效果，现报告如下。     

Evaluation of modified hemodilution combined therapy in the treatment of acute ischemic stroke in the elderly

BACKGROUND: Thrombolysis therapy is not suitable for the elderly patients with acute ischemic stroke who delayed to be diagnosed for more than 3 hours, but traditional medicine is also not very ideal.OBJECTIVE: To observe the clinical therapeutic effect of modified hemodilution combined therapy applied in elderly patients with acute cerebral thrombosis and analyze the mechanism of this therapeutic method.DESIGN: 1:1 paired grouping according to gender and controlled observation.SETTING: Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University.PARTICIPANTS Totally 90 elderly patients with acute ischemic stroke who received the treatment in the Cadre Ward and Mental Ward, Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University from March 1996 to June 2004 were recruited. They all met the diagnosis criteria revised by the Fourth Academic Conference of National Cerebrovascular Diseases in 1995 and were diagnosed as acute ischemic stroke by skull CT. They were informed of therapeutic plan and detected items.According to 1:1 paired principle in gender, 90 enrolled patients were assigned into treated group (n=45)and control group (n=45). There were 39 male and 6 female in the treatment group, and they were aged (76±6)years, ranging from 71 to 84 years, and hospitalized at the 14th to 76th hours after onset. There were 39 male and 6 female in the control group, and they were aged (76±6)years , ranging from 70 to 82years, and hospitalized at the 16th to 72th hours after onset.METHODS: Therapeutic method: Patients of treated group received modified hemodilution combined therapy.200 mL whole blood of patients was exchanged with 500 mL dextran-40 (including 20 mL danshen parenteral solution and 32 mg heparin) at the beginning of therapy; From the 2nd day, compound huangqi tea bag (Huangqi mainly, including danshen, honghua, chuanxiong, shishao and a little acetyl salicylic acid) was made, twice a day, 1 bag once. At the same time, the above-mentioned dextran-40 liquid of 500 mL was intravenously injected, once a day, 14 days in total; On the 6th day after therapy, the above-mentioned aseptic autoblood stored in refrigerator at 4 ℃ was transfused back into the patients following pre-treatment of high-concentration oxygenation and ultraviolet irradiation by light quantum instrument. Patients of control group were intravenously injected of 0.4 g venoruton(Traditional Chinese medicine compound parenteral solution for promoting blood circulation and removing blood stasis ) and 50 g/L glucose of 500 mL, 75 mg coagulation index, change of platelet aggregation rate and change of hemorrheology of patients in two groups were monitored before and after therapy. The level of blood lipid of patients in two groups was measured with American Beckman automatic biochemistry analyzer. Blood flow rate of middle cerebral artery of resting electrocardiogram were measured with American HP SONOS 2500 sonoscope. Neuro-dysfunction score revised in the national conference (1995) was used to evaluate the recovery of neurological function effect were observed at the same time.effect of drug.RESULTS: Totally 90 patients were enrolled in the experiment. One patient from treated group died of hyperosmolar nonketotic diabetic coma of complicated diabetes mellitus. One patient from control group died ulation index and platelet aggregation rate: prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT) of patients after therapy were significantly longer than those before therapy in the treated group and those after therapy in control group [After therapy in treated group: (18.4±1.9),(41.8±2.1), (19.7±1.7)s, Before therapy in treated group: (13.4±1.3), (35.8±1.3), (12.5±0.9)s, After therapy in control group: (16.9±1.5), (39.1±1.1), (11.9±2.1) s, P ＜ 0.05] ;Concentration of fibrinogen (Fbg) after therapy was significantly lower than that before therapy in the treated group and that after therapy in control group[After therapy in treated group: (3.4±0.4) g/L; Before therapy in treated group: (4.3±0.7) g/L;After therapy in control group:(4.0±0.6) g/L; P ＜ 0.05]. Platelet aggregation rate decreased from (37.92of total cholesterol (TC), triacylglycerol(TG) and Iow density lipoprotein cholesterol (LDL-C) of patients after therapy were significantly lower than those before therapy in treated group and those after therapy in control group [After therapy in treated group: (5.2±0.9), (1.9±0.9), (2.08±1.1) mmol/L, before therapy in treated group:(5.9±1.2), (2.8±0.9), (3.94±0.5) mmol/L, After therapy in control group: (6.0±1.1), (2.6±0.8), (3.84±0.9) mmol/L,after therapy than before therapy [Before therapy: (43.84±4.55)% ;After therapy: (40.48±4.02)% ;P ＜ 0.05].cantly lower than of control group 14 days after therapy. The total effective rate after therapy was signifiadverse effect.CONCLUSION: Modified hemodilution combined therapy can improve hemorheology, decrease hematocrit,increase blood flow rate of middle cerebral artery, so as to improve the impaired clinical neurological function of elderly patients with acute cerebral thrombosis through anticoagulation and antiplatelet aggregative activity as well as regulating blood lipid.BACKGROUND: Thrombolysis therapy is not suitable for the elderly patients with acute ischemic stroke who delayed to be diagnosed for more than 3 hours, but traditional medicine is also not very ideal.OBJECTIVE: To observe the clinical therapeutic effect of modified hemodilution combined therapy applied in elderly patients with acute cerebral thrombosis and analyze the mechanism of this therapeutic method.DESIGN: 1:1 paired grouping according to gender and controlled observation.SETTING: Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University.PARTICIPANTS:Totally 90 elderly patients with acute ischemic stroke who received the treatment in the Cadre Ward and Mental Ward, Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University from March 1996 to June 2004 were recruited. They all met the diagnosis criteria revised by the Fourth Academic Conference of National Cerebrovascular Diseases in 1995 and were diagnosed as acute ischemic stroke by skull CT. They were informed of therapeutic plan and detected items.According to 1:1 paired principle in gender, 90 enrolled patients were assigned into treated group (n=45)and control group (n=45). There were 39 male and 6 female in the treatment group, and they were aged (76±6)years, ranging from 71 to 84 years, and hospitalized at the 14th to 76th hours after onset. There were 39 male and 6 female in the control group, and they were aged (76±6)years , ranging from 70 to 82years, and hospitalized at the 16th to 72th hours after onset.METHODS: Therapeutic method: Patients of treated group received modified hemodilution combined therapy.200 mL whole blood of patients was exchanged with 500 mL dextran-40 (including 20 mL danshen parenteral solution and 32 mg heparin) at the beginning of therapy; From the 2nd day, compound huangqi tea bag (Huangqi mainly, including danshen, honghua, chuanxiong, shishao and a little acetyl salicylic acid) was made, twice a day, 1 bag once. At the same time, the above-mentioned dextran-40 liquid of 500 mL was intravenously injected, once a day, 14 days in total; On the 6th day after therapy, the above-mentioned aseptic autoblood stored in refrigerator at 4 ℃ was transfused back into the patients following pre-treatment of high-concentration oxygenation and ultraviolet irradiation by light quantum instrument. Patients of control group were intravenously injected of 0.4 g venoruton(Traditional Chinese medicine compound parenteral solution for promoting blood circulation and removing blood stasis ) and 50 g/L glucose of 500 mL, 75 mg acetosal was taken orally, once a day, 14 days in total. ② Measurement and observation of index: Blood coagulation index, change of platelet aggregation rate and change of hemorrheology of patients in two groups were monitored before and after therapy. The level of blood lipid of patients in two groups was measured with American Beckman automatic biochemistry analyzer. Blood flow rate of middle cerebral artery of resting electrocardiogram were measured with American HP SONOS 2500 sonoscope. Neuro-dysfunction score revised in the national conference (1995) was used to evaluate the recovery of neurological function of the patients in two groups at the 3rd, 5th, 7th and 14th days after therapy. ③Therapeutic effect and adverse effect were observed at the same time.MAIN OUTCOME MEASURES: ① Changes of coagulation index, blood lipid level and hemorheology; ② Blood flow rate of middle cerebral artery and NDS of patients with acute ischemic stroke in two groups; ③Adverse effect of drug.RESULTS: Totally 90 patients were enrolled in the experiment. One patient from treated group died of hyperosmolar nonketotic diabetic coma of complicated diabetes mellitus. One patient from control group died of severe pulmonary infection. The rest 88 patients entered the stage of result analysis. ① Change of coagulation index and platelet aggregation rate: prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT) of patients after therapy were significantly longer than those before therapy in the treated group and those after therapy in control group [After therapy in treated group: (18.4±1.9),(41.8±2.1), (19.7±1.7)s, Before therapy in treated group: (13.4±1.3), (35.8±1.3), (12.5±0.9)s, After therapy in control group: (16.9±1.5), (39.1±1.1), (11.9±2.1) s, P ＜ 0.05] ;Concentration of fibrinogen (Fbg) after therapy was significantly lower than that before therapy in the treated group and that after therapy in control group[After therapy in treated group: (3.4±0.4) g/L; Before therapy in treated group: (4.3±0.7) g/L;After therapy in control group:(4.0±0.6) g/L; P ＜ 0.05]. Platelet aggregation rate decreased from (37.92±0.85)% before therapy to (26.42±1.01)% after therapy (P ＜ 0.01). ②Change of blood lipid level: Levels of total cholesterol (TC), triacylglycerol(TG) and Iow density lipoprotein cholesterol (LDL-C) of patients after therapy were significantly lower than those before therapy in treated group and those after therapy in control group [After therapy in treated group: (5.2±0.9), (1.9±0.9), (2.08±1.1) mmol/L, before therapy in treated group:(5.9±1.2), (2.8±0.9), (3.94±0.5) mmol/L, After therapy in control group: (6.0±1.1), (2.6±0.8), (3.84±0.9) mmol/L,P ＜ 0.05]. ③ Change of hemorheology index: Hematocrit of patients of treated group was significantly lower after therapy than before therapy [Before therapy: (43.84±4.55)% ;After therapy: (40.48±4.02)% ;P ＜ 0.05].④ Blood flow rate of middle cerebral artery of patients of treated group was significantly lower before therapy than after therapy [(90±1.2), (97±2.1) cm/s,P ＜ 0.01]. ⑤ NDS of patients in treated group was significantly lower than of control group 14 days after therapy. The total effective rate after therapy was significantly higher in the treated group than in the control group (93%,78%, P ＜ 0.05). ⑥There was no obvious adverse effect.CONCLUSION: Modified hemodilution combined therapy can improve hemorheology, decrease hematocrit,increase blood flow rate of middle cerebral artery, so as to improve the impaired clinical neurological function of elderly patients with acute cerebral thrombosis through anticoagulation and antiplatelet aggregative activity as well as regulating blood lipid.     

Risk factors profile and clinical outcome of ischemic stroke patients admitted in a Department of Internal Medicine and classified by TOAST classification.

AIM: A classification of ischemic stroke subtypes tailored for individual patients is hard to achieve. In 1993, the Trial of Org 10172 in Acute Stroke Treatment (TOAST) group developed a new system to classify the subtypes of ischemic stroke. In our study we applied the TOAST classification to a group of consecutive patients affected by ischemic stroke, to evaluate outcome and factors associated to each stroke subtype. METHODS: To evaluate the prognosis and the associated factors of ischemic stroke subtypes, we classified according to the TOAST classification a cohort of 159 consecutive patients affected by an acute ischemic stroke. We evaluated neurological deficit at admission by Scandinavian Stroke Scale and scored disability at discharge and 6 months after discharge using the Rankin disability scale. We determined 30 days survival and anamnestically evaluated major vascular risk factors. RESULTS: Patients with cardioembolic stroke and stroke of undetermined etiology had a greater neurological deficit on admission and the worst prognosis either in terms of disability or mortality. Lacunar stroke had the least neurological deficit at admission and the best prognosis. Hypercholesterolemia and smoking were more frequent among patients with large artery atherosclerotic stroke. Hypertension, a history of transient ischemic attack and diabetes were more frequent among patients with lacunar stroke. A weak association with hypertension and smoking was observed for cardioembolic stroke. CONCLUSIONS: The TOAST classification is useful in the clinical setting because it identifies ischemic stroke subtypes with different prognosis and with a different profile of associated factors.     

GENERAL SURGERY——Breast The effect of HO-1 activated via P38α pathway in the genesis and chemotherapy resistance of breast carcinoma

Objective To investigate the role of p38a pathway and HO-1 in the genesis and chemotherapy resistance of breast cancer. Methods The proliferation and apoptosis of human breast cancer cells were examined by MTT assay. The expression of p38a and HO-1 mRNA were examined by RT-PCR. Results The p38a mRNA level in 78 % of samples was significantly greater than that in the normal tissue and the p38a mRNA level in patients with lymph node metastasis was higher than that without lymph node metastasis （P 〈 0.01 ）. The HO-1 activated with 5 μmol/L pirarubicin increased more in MCF-7/adr cells than in MCF-7 cells, and was completely blocked by p38a inhibitor in MCF-7/ADR but only partially in the MCF-7 cell line.     

血管内皮生长因子与妊娠高血压综合征发病的关系

目的　探讨血管内皮生长因子 (VEGF)在妊娠高血压综合征发病中的作用。方法　分别采用酶联免疫吸附试验检测 40例妊高征孕妇的血清VEGF水平 ,免疫组化检测胎盘及蜕膜组织VEGF及CD3 4表达情况 ,35例正常孕妇作对照。结果　①妊高征组孕妇的外周血VEGF水平及胎盘组织MVD明显低于正常妊娠组 (P <0 0 5 ) ;②两组胎盘绒毛滋养叶细胞和蜕膜组织中均有VEGF阳性表达 ,胎盘组织强阳性表达高于蜕膜。与对照组比较 ,其胎盘组织VEGF强阳性表达的轻度妊高征无显著性差异 ;而中度和重度妊高征与对照组相比 ,则明显降低 ,差异显著 (P <0 0 5 )。各组孕妇蜕膜组织中VEGF的表达强度和差异无显著性。③孕妇外周血VEGF水平与新生儿出生体重 (r =0 2 9,P <0 0 5 )和胎盘重量 (r =0 34,P <0 0 1)均存在直线正相关关系。结论　妊高征患者血清VEGF水平和胎盘组织MVD降低 ,胎盘组织VEGF表达明显下降 ,都可能在妊高征的发病中起一定的作用。     

Genetic abnormalities and CNS tumors: report of two cases of ependymoma associated with Klinefelter’s Syndrome (KS)

Objects Genetic syndromes associated with ependymoma are uncommon, with the exception of NF2. We describe two cases of ependymoma presenting with Klinefelter’s Syndrome (KS) as co-morbid condition. Materials and methods The first patient was diagnosed for KS during pregnancy; he also presented a thyroid agenesis and a deficit of methyltetrahydrofolate reductase (MTHFR); at 30 months of age he was operated on for a grade II ependymoma of IV ventricle; after a multiple-stage surgery, he underwent oral chemotherapy and stereotactic radiotherapy, but after 15 months he presented a local recurrence and died. The second patient was diagnosed for KS at the age of 16 months; at 10 years of age, due to back pain, he underwent an MRI, which showed a cauda equine tumor. He underwent surgery and radiotherapy. Histology was of mixopapillary ependymoma. Conclusion In a review of literature, various neoplasms have been described in association with KS. To our knowledge, these are the first two cases reported of ependymoma associated to KS. A retrospective study of 44 monoinstitutional ependymoma cases demonstrated association with genetic syndromes in 22%.     

Pathophysiology of urinary dysfunction in multiple sclerosis

Neurological Sciences - Bladder and urethra are innervated peripherally by pelvic parasympathetic, lumbar sympathetic and pudendal nerves; but a complex of brain networks is involved in the...     

Correlation of serum metalloproteinase levels with lung cancer metastasis and response to therapy.

Cancer cells elaborate metalloproteinases which may play a role in invasion and metastasis. The serum level of the M(r) 72,000 type IV collagenase (MMP-2) was measured in 87 lung cancer patients. Stage IV cancer levels were significantly elevated (P less than 0.0001) compared to normal sera. A significant difference (P less than 0.01) was found between enzyme levels in the presence versus the absence of distant metastasis. For 29 patients treated with combination chemotherapy, a positive relationship was noted between response failure and elevated enzyme levels. Serum metalloproteinase levels may provide information relevant to prognosis as well as treatment decisions.     

Non-invasive detection of coronary artery disease by dobutamine-stress echocardiography in children after heart transplantation.

BACKGROUND: Coronary vasculopathy is the main cause of cardiac graft failure. Because yearly coronary angiography is invasive in children, a non-invasive method for detecting graft vasculopathy is needed. The aim of this study was to test dobutamine-stress echocardiography in a pediatric population to determine its feasibility, safety and reliability in the detection of graft coronary artery disease. METHODS: Eighteen patients, aged 2 days to 16.8 years at transplantation (mean 8.4 years), underwent 44 dobutamine-stress echocardiography (DSE) exams, at a follow-up of 1.1 to 11.8 years (mean 5.1 years). Selective coronary angiography was performed for comparison. Echocardiographic recordings were obtained in 4 standard views of the left ventricle and measurements carried out within the frames of a 16-segment model. Segmental scores of contractility were obtained for each segment and a total segmental contractility index was calculated at each stage. RESULTS: All patients reached the maximum dose stage. Maximum heart rate was 57% to 90% of predicted maximum. Maximum systolic blood pressure reached 190 mmHg. Segmental scores were normal in 37 and abnormal in 7 cases. Echographic results were concordant with angiography in 82% and discordant in 18% of the cases (4 negative DSEs with minor angiographic lesions, 2 positive DSEs with normal angiography), but there was no significant angiographic lesion with normal DSE. CONCLUSIONS: DSE is a safe and highly feasible non-invasive technique in transplanted children. A normal DSE study successfully predicts the absence of significant coronary artery disease in the post-transplant population.