基于PCR技术的中药DNA分子标记鉴别

综述基于PCR技术的中药DNA分子鉴别研究，重点论述了RAPD法和DNA直接测序法的应用，提出了DNA分子鉴别研究的思想和实验设计。     

IMPACT OF REHABILITATION START TIME ON FUNCTIONAL OUTCOMES AFTER STROKE

ObjectiveTo investigate the optimum rehabilitation start timing for improved functional outcomes after stroke in Japan.DesignA retrospective database study.SubjectsA total of 140,655 patients with stroke from 1,161 acute hospitals in Japan. Only data for those patients who were discharged alive was included in the analysis.MethodsActivities of daily living were assessed. Comparisons were made using the rehabilitation start day after hospital admission. Reference day 2 was compared with days 1, 3, 4, 5, and 6 or later. Modified Rankin Scale at time of discharge was used as the primary outcome. In addition, cases of ischaemic stroke and haemorrhagic stroke were analysed as separate subgroups.ResultsUnivariate and multivariate logistic regression analyses showed that starting rehabilitation on day 2 resulted in a better outcome than starting on day 3 or later. There was no significant difference in outcome between starting rehabilitation on days 1 or 2 in all cases and subgroup of patient with infarction stroke. For a subgroup of patients with haemorrhagic stroke, starting rehabilitation on day 2 resulted in a better outcome than starting on day 1.ConclusionStarting post-stroke rehabilitation on the day of admission or second day of hospitalization may be the optimum timing for functional outcomes. However, for haemorrhagic stroke, starting rehabilitation on the second day of hospitalization may be more effective than on the day of admission.LAY ABSTRACTThis study examined the effect on functional outcomes of the time after stroke of starting rehabilitation. A large national database was searched for eligible stroke patients, resulting in a total of 140,655 patients from 1,161 hospitals. Starting rehabilitation on the day of admission or second day of hospitalization after stroke was found to be associated with better functional outcomes at discharge than starting rehabilitation on the third day or later. For patients with haemorrhagic stroke, those who started rehabilitation on the second day of hospitalization had better functional outcome at discharge than those who started on the day of admission. Thus, starting rehabilitation on the day of admission or the second day of hospitalization after stroke may be the best timing for improved functional outcomes. However, among patients with haemorrhagic stroke, starting rehabilitation on the second day of hospitalization may result in better outcomes than starting on the day of admission.Key words: early ambulation, recovery of function, stroke, time factor

Stroke is a major factor in causing functional impairment and often requires more resources for long-term care according to the Comprehensive Survey of Living Conditions in Japan (1). The number of people requiring nursing care and support in Japan’s long-term care insurance system has been increasing every year, with more than 6 million elderly people in 2015. In recent years, there has been increasing emphasis on stroke prevention and quality stroke care to control the further expansion of the number of people requiring care (2).For good-quality stroke care, early rehabilitation after stroke onset has been proposed in several Stroke Treatment Guidelines (3–5). Mechanism that may support the effectiveness of early rehabilitation include restoration of brain function, which promotes neuroplasticity (6), and reduction of bedridden syndrome, infections, deep vein thrombosis, and pressure sores (7). However, some researchers are concerned that starting too early rehabilitation may be harmful. One reason is that a head-up position reduces reperfusion of the penumbra region (8). Another reason is that the destabilization of blood pressure with exercise can inhibit the recovery of brain function (9). In addition, most stroke specialists have concerns about very early rehabilitation, especially in cases of haemorrhagic stroke. A possible reason is that patients with haemorrhagic stroke tend to die early after the attack, although the evidence regarding the timing of rehabilitation is insufficient (10).Several randomized controlled trials (RCTs) have examined the effectiveness of early rehabilitation, but it remains a controversial topic. Two RCTs have provided evidence that early rehabilitation is effective for physical functioning (11, 12), while other RCTs (13, 14) have not found such evidence. The latest multicentre RCT (14) concludes that very early rehabilitation leads to poor outcomes for physical functioning. However, some researchers have criticized the study design due to the short mean difference in rehabilitation start times between the intervention and control groups, being only 4 h. In addition, the variation in the timing of rehabilitation initiation in each RCT makes it difficult to interpret the effectiveness of early rehabilitation. For example, in the AKEMIS study (13), the mean time from stroke onset was set at 13.1 h in the intervention group and 33.3 h in the control group, compared with 18 and 22 h in the AVERT III study, and 27 and 32 h in the VERITAS study (12). Hence, the results of these RCTs may lead many clinicians to query when is the optimum time to start early rehabilitation after stroke.From the clinician’s point of view, it is important to determine whether rehabilitation should be provided very early after stroke, and when is the optimum time to start rehabilitation for good physical functioning outcomes. This study aimed to clarify these clinical questions, by investigating the impact of the timing of rehabilitation initiation after acute stroke on functional outcomes, using patient data from a Japanese multicentre database.     

Characterization of epitopes on a 32 kDa merozoite surface protein of Theileria sergenti

Epitopes on a 32 kDa protein, which is an immunodominant major surface protein ofTheileria sergenti, recognized by anti-merozoite monoclonal antibodies were characterized. The results of a competetive binding assay between monoclonal antibodies indicated that there were at least three epitopes in this protein. The presence of repeated epitopes was suggested by using two-site enzyme-linked immunosorbent assay. The protein was partitioned into the detergent phase of Triton X-114 extracts, indicating that the 32 kDa protein is an integral membrane protein. Periodate treatment of 32 kDa protein implies that one epitope of the epitopes recognized by monoclonal antibody has a carbohydrate moiety.     

An Unusual Case of Portasystemic Encephalopathy Caused by Splenic Vein Occlusion Following Gastrectomy

A patient with recurrent episodes of consciousness disturbance following partial gastrectomy is presented. Angiographic examination revealed a great portasystemic shunt, which probably developed following the postoperative splenic vein thrombosis. This is suspected a rare cause of the condition. In chronic liver disease, recurrent encephalopathy which is caused by portasystemic shunt is well known as one of the most frequent complications. It is very uncommon in adults, however, when the liver is not concerned in the shunt formation. In the present paper the authors report an unusual case of recurrent consciousness confusion which is due to the great portasystemic shunt probably caused by postgastrectomy splenic vein thrombosis.     

A newly identified exonic mutation of the WT1 gene in a patient with Denys-Drash syndrome

An 11 month old boy with hypospadias and bilateral undescended testes developed renal failure. Denys-Drash syndrome was suspected and molecular analysis of the WT1 gene was performed, although no Wilms' tumor was identified. Direct sequencing analysis of genomic DNA from this patient revealed a G to A transition resulting in ³⁶⁶Arg to Leu substitution in exon 8 which has hitherto not been described. This newly identified mutation will help in the understanding of functional domains and in making a diagnosis of Denys-Drash syndrome.     

A Case of Ménétrier's Disease Accompanied by Severe Hypogammaglobulinemia

We describe a case of Ménétrier's disease accompanied by severe hypoproteinemia with marked decrease of gamma globulin. Roentogenograms and endoscopic findings of the upper gastrointestinal tract demonstrated enlarged gastric rugae and multiple small protuberances of the duodenal mucosa. Histological findings of gastric biopsy specimens showed mucosal thickening and hypertrophy. Plasminogen activator activities were increased in both gastric and jenunal mucosal biopsy specimens. Severe hypoproteinemia was proven by the Gordon test and by determination of ptotein content of gastric Juice to be due to protein loss into the gastric lumen.