胎龄<28周早产儿动脉导管未闭的治疗进展

动脉导管未闭(PDA)是早产儿常见疾病,目前早产儿PDA的自然发展过程仍未完全明确,PDA发生的有些高危因素仍存在争议,对PDA是否进行药物、手术干预,以及何时进行药物、手术干预仍存在争议。尽管已经有相当多的证据证实动脉导管持续开放可能有害,但目前尚缺乏关闭导管治疗方案的远期益处或害处的相关证据。大多数临床试验旨在评估短期导管开放对患儿的影响。目前尚无评估动脉导管持续开放对早产儿死亡率及并发症影响的临床试验。近年来PDA治疗上最大的变化是减少对PDA的治疗。该文重点总结胎龄28周早产儿PDA的治疗策略。     

Effect of Difference of Proliferative Ability on Fragmentation of Hertwig＇s Epithelial Root Sheath

Objective To verify a novel hypothesis that it is the difference of proliferative ability between Hertwig＇s epithelial root sheath （HERS） and the neighboring mesenchyme that leads to fragmentation of HERS. Methods Developmental processes of rat mandibular first molars from postnatal （PN） 10 to 25 days were observed. HERS was traced by immunohistochemistry for keratin 14. The activity of proliferation was examined by immunohistochemistry and immunofluorescence for proliferating cell nuclear antigen （PCNA） at PN 10 and 25 days respectively. Results At PN 10, HERS grew to its maximum length and maintained integrity. Subsequently, along with tooth root elongation, HERS was gradually fragmented. Either at PN 10 or 25 days, there were more PNCA-positive cells in the neighboring mesenchyme than in the HERS. Conclusion During rat tooth root development, the neighboring mesenchyme possesses higher proliferative ability than HERS, which results in the fragmentation of HERS.     

深圳市区域性连续性急救医疗网络体系的建设

具有深圳特色的急救医疗网络体系，突出表现在：①高度权威的急救医疗指挥体系；②覆盖全市的急救医疗纲络体系；③制定了确保急救医疗网络体系规范运作的制度保障体系。深圳市急救医疗网络体系建设向纵深发展，是要建立健全含社区急救、院前急救和院内救治三者有机结合的贯穿急救全流程的区域性连续性急救医疗网络体系。旨在充分利用街生资源，缩短急救半径，畅通急救绿色通道，减少中间环节，做到无“缝隙”急救，使伤病员尽早得到确定性治疗。     

TRAIL胸外段基因克隆及其表达与纯化

目的；克隆TNF相关的诱导凋亡配体胞膜外段基因（the extracellular region of the human TRAIL cDNA,TPAILex），构建表达载体并在大肠杆菌DH5α中高效表达有生物学活性的TRAIL蛋白胞膜外段。方法：抗CD3McAb刺激正常人外周血淋巴细胞，用RT－PCR、巢式－PCR方法从活化的淋巴细胞中获得人TRAIL基因及其胞膜外段cDNA，并克隆到pGEM-T Easy载体中，DNA测序鉴定，将TRAIL的胞膜外段基因插入表达载体pGEX-2T，构建重组表达质粒pGEX/TRAILex，用IPTG诱导表达TRAIL蛋白的胞膜外段，GST－Agarose 4B层析柱纯化GST－TRAILex融合蛋白，Western-blot鉴定纯化产物。结果：抗CD3 McAb能诱导正常人外周血核细胞TRAIL的高表达，成功地克隆了TRAIL胞膜外段基因，构建了重组表达载体pGEX/TRAILex，IPTG诱导后得到高效表达的TRAIL蛋白胞膜外段，经12％SDS－PAGE分析，可观察到一分子量和理论值相符（约54kD）的诱导表达。Kodak软件分析表达GST－TRAIL胞膜外段融合蛋白的表达量占菌体蛋白总量的28％，进一步分析证实TRAIL蛋白的胞膜外段主要以可溶性的形式表达，用GST－Agarose 4B层析柱纯化超声破菌后的上清，每升细菌培养液可得到9.8mg纯度的95％以上的GST－Tex。Western-blot结果证实54kD的表达带可与鼠抗TRAIL McAb起特异性反应。结论：成功地克隆了人TRAIL基因，并应用基因工程技术在大肠杆菌中高效表达人TRAIL蛋白的胞膜外段，为进一步研究TRAIL的功能及其在肿瘤生物治疗中的应用奠定了基础。     

COMPARATIVE STUDY OF AMINO ACID CONTENTS AND LDH ISOZYME BY ELECTROPHORESIS AND SLAB-PAGE IN ADULT WORMS OF ASCARIS LUMBRICOIDES, ASCARIS SUUM AND TOXOCARA CANIS^

Comparative studies are made on the relative percentages of amino acid content and LDH isozyme by electrophoresis and Slab-PAGE in adult worms of Ascaris lumbricoides, Ascaris suum and Toxocara canis. The results show that there are remarkable differences of Arg and His of 17 amino acids bet. ween Toxocara canis and human intestinal ascaris, human biliary ascaris and pig ascaris; there are also obvious differences of band positions of LDH isozyme electrophoretic patterns and band position and amount of slab-PAGE patterns among them, whereas no marked differences are found in these three indices in human intestinal ascaris, human biliary ascaris and pig ascaris.     

Related factors of cognitive impairment after stroke

BACKGROUND: Cognitive impairment after stroke associates with various factors, such as age, educational years, etc. Besides concerning about the recovery of limb function after stroke, we should also focus on the rehabilitation of cognition. Moreover, we'd better pay attention to the control of all the risk factors of stroke, and improve the quality of life in stroke patients. OBJECTIVE: To analyze the factors that affect cognitive impairment after stroke. DESIGN: A related factors analysis. SETTINGS: Department of Neurology of Dalian Port Hospital and Dalian Second People's Hospital. PARTICIPANTS: Totally 148 stroke inpatients were selected from Department of Neurology, Dalian Port Hospital and Dalian Second People's Hospital from April 2004 to December 2005, including 100 males and 48 females, aging 45-75 years with an average age of (67±8) years; Their educational years ranged 2-10 years with an average of (6.1±3.7) years; The disease course ranged 15-30 days; All were right-handed. Inclusive criteria: All were accorded with the diagnostic standard set by the Fourth National Academic Meeting for Cerebrovascular Disease; Confirmed by CT or MRI; Informed consents were obtained from all the subjects. METHODS: After the disease conditions were stable, the patients were assessed with Wechsler memory scale (WMS) and Wisconsin card sorting test (WCST). WMS included forward and backward recitation of numbers and short-term memory (verbal memory, visual recognition). The number of times for correct and wrong classifications in WCST and the time to complete the trail making tests A and B were recorded. The focal volume, area and layer were recorded at 24 hours after admission. The general data of the patients were recorded, including name, sex, age, educational years, history of hypertension, history of diabetes mellitus. Electroencepalograph (EEG) was examined to record the wave shape, blood lipids were detected, and the cognition related indexes were analyzed with the Pearson correlation analysis. The correlation between cognitive indexes after stroke and the influencing factors were analyzed with multiple linear regression analysis. MAIN OUTCOME MEASURES: ① Correlation between cognitive indexes and imaging indexes; ② Influencing factors for cognitive indexes after stroke. RESULTS: All the 148 stroke patients were involved in the analysis of results. ① Correlation between cognitive indexes and CT indexes: There were obvious negative correlations between numerical symbol and focal layer (r =-0.234, P < 0.05), as well as between verbal memory and the focal area and volume (r =-0.363, -0.279, P < 0.05); Trail making test A had obvious positive correlation with focal area and volume (r =0.256, 0.256, P < 0.05). Results of multiple linear regression analysis: Correct classification was correlated with triglyceride (partial wave and θ wave (partial regression coefficient=0.231-0.908, P < 0.05); Verbal memory was correlated with EEG α wave, focal volume, sex, educational years and diabetes mellitus (partial regression coefficient=0.219-1.017, P < 0.05-0.01). Visual recognition had correlation with educational years and hypertension (partial regression coefficient=0.326, -1.163, P < 0.01). Trail making tests A and B were correlated with focal volume (partial regression coefficient=4.680, -18.561, P < 0.05). CONCLUSION: The factors that affect the cognitive function after stroke include sex, age, educational years, hypertension, diabetes mellitus, triglyceride, EEG wave shape, and the focal area, volume and layer     

Doppler examination and cerebral arterial stricture in patients with ischemic stroke

With the development of interventional therapy, it is necessary for evaluating cerebral vessels to instruct treatment and determine prognosis of patients with ischemic stroke; however, correlation of distribution of infarction focus and clinical symptoms with degrees of cerebrovasoular stricture is still unclear.OBJECTIVE: To evaluate the characteristics of cerebral arterial stricture of patients with ischemic stroke with transcranial Doppler (TCD) and color duplex flow imaging (CDFI) and compare the correlation between distribution of cerebral infarction focus and clinical types with magnetic resonance imaging (MRI).DESIGN: Contrast observation.SETTING: Department of Neurology, the First Hospital of Jilin University.PARTICIPANTS: A total of 159 patients with ischemic stroke were selected from the Department of Neurology, the First Hospital of Jilin University from January to December 2005, including 106 males and 53 females aged from 27 to 88 years. Bases on diagnostic criteria of cerebrovascular disease established by Rao et al, clinical manifestations of all patients were evaluated with CT or nuclear magnetic resonance. All patients provided the confirmed consent.METHODS: The accepted patients received TCD and CDFI examination at 1 week after onset of ischemic stroke. Among them, 112 patients received cerebrovascular imaging examination simultaneously. MRI was used to check cerebral infarction focus and cerebrovascular stricture ＞ 50% was regarded as the accepted vessels. In addition, DWI-T2 TCD (Germany) was used to check middle cerebral artery, and degrees of middle cerebral artery were classified into mild, moderate and severe stricture based on blood velocity (140 cm/s,180 cm/s). Stroke was classified based on characteristics of infarction focus and clinical symptoms showed with MRI and correlation with degrees of cerebrovascular stricture was analyzed simultaneously.MAIN OUTCOME MEASURES: Correlation between the characteristics of ischemic stroke and clinical symptoms checked with TCD and CDFI.RESULTS: A total of 159 patients with ischemic stroke were involved in the final analysis; in addition, 112 oases received cerebrovascular imaging examination simultaneously. ① MRI results of 159 patients with cerebral artery occlusive disease (CAOD): There were 131 patients (82.3%) with cerebral infarction, 40 (25.2%)with transient ischemic attack and 4 (2.5%) with subclavian steal syndrome (SSS). ② Infarction types with MRI examination: There were 33 patients (20.8%) with solitary cerebral infarction and 98 (61.6%) with multiple-cerebral infarction. ③ Results of TCD, CDFI, MRI angiography, CT angiography and digital subtraction angiography (DSA): Among 112 patients, 181 lesion sites (61 .8%) were located in cranium and 112 lesion sites were located out of cranium; especially, lesion site was mostly observed in stem of middle cerebral artery (31.2%) and watershed of basilar artery (7.2%) in cranium and the beginning site of internal carotid artery (21 .4%) out of cranium. ④ Correlation of vascular stricture checking with TCD, MRI and clinical diagnosis: On one hand, MRI and clinical diagnosis demonstrated that 68 patients had a watershed infarction; meanwhile,TCD examination indicated that there were 3 patients with mild vascular stricture, 24 with moderate vascular stricture and 36 with severe vascular stricture. On the other hand, among 68 patients with non-watershed infarction, there were 27 patient with mild vascular stricture, 26 with moderate vascular stricture and 15 with severe vascular stricture. There were significant differences (x2 =26.854, P =0.001 ). Clinical diagnosis indicated that 40 patients had transient ischemic attack and TCD examination demonstrated that there were 8 patient with mild vascular stricture, 12 with moderate vascular stricture and 20 with severe vascular stricture. There were significant differences as compared with 68 patients with watershed infarction (x2 =21.258, P =0.001). ⑤Correlation of vascular stricture checking with CDFI, MRI and clinical diagnosis: On one hand, among patients who were determined as watershed infarction with MRI and clinical diagnosis, CDFI examination indicated that there were 32 patients with mild vascular stricture at neck, 25 with moderate vascular stricture and 6 with severe vascular stricture. On the other hand, among patients with non-watershed infarction, there were 48 patient with mild vascular stricture, 18 with moderate vascular stricture and 2 with severe vascular stricture.There were significant differences (x2 =6.018, P =0.019). Among patients with transient ischemic attack checking with clinical diagnosis, there were 23 patient with mild vascular stricture, 9 with moderate vascular stricture and 8 with severe vascular stricture. There were no significant differences as compared with patients with non-watershed infarction (x2 =0.597, P=0.440).CONCLUSION: ① TCD and CDFI are effective marks to determine cerebral arterial stricture and hemodynamical changes. ② Infarction and transient ischemic attack at watershed are generally clinical phenotypes of CAOD patients and infarction at watershed is correlated with degrees of cerebrovascular stricture.③ TCD, MRI and clinical analysis of stroke types are significant for instructing treatment and evaluate prognosis.     

游离腓肠神经移植修复上肢神经缺损

报告１９８７－１９９５年，我院骨科采用游离腓肠神经移植术修复上肢神经缺损８例，共１４条神经。经１－９年临床随访，功能恢复，优；２例，良；４例，可；１例，差；１例，优良率７５％。本文结合文献复习讨论了游离神经移植术克服周围缺损的适应症，手术时机、方式及影响术后神经功能的主要原因。     

Effect of water restrictions on the physiological parameters,psychological behavior and brain c-Fos expression in rat

1 Introduction Exposure to hostile stressors causes a series of coor- dinated responses in the body, such as alterations of neu- roendocrine secretion, immune reaction and behavioral manifestation to maintain homeostasis stability and sur-vival of the organisms. Stressors are divided into two main categories: physical, or systemic, and psychological, or emotional / processive. Each stressor might activate a spe- cific central pathway to induce a special neuroendocrine response, even cause stre…     

Long-term application of diethylstilbestrol upregulates expressions of μ- and m-calpains in pituitary intermediate lobe of female Wistar rats

BACKGROUND: During formation of prolactin neoplasia, how cells and its structure in adenohypophysis affect prolactin cells should be further studied. Intermediate lobe can be regarded as a driving region to release prolactin (PRL) and may promote formation of prolactin neoplasia in pituitary anterior lobe. OBJECTIVE: To observe the effect of diethylstilbestrol (DES) on the expressions of μ and m-calpains in pituitary intermediate lobe of female Wistar rats. DESIGN: Observational contrast animal study. SETTING: Beijing Neurosurgical Institute. MATERIALS: A total of 21 female Wistar rats, 3 weeks old weighing 70–80 g were housed with free access to tap water and standard pellet food. They were kept in a CL-grade condition, at (24±1)℃ and a humidity of (55±5)%, and with a 12 hours day-night cycle. Caprine anti-μ- and m-calpains antibodies were provided by Santa Cruz Biotechnology, CA, USA; rabbit-anti-PRL antibodies by Dako, Denmark; rabbit-anti-ACTH antibody by Boster Company, Wuhan. METHODS: The experiment was carried out in Pathophysiological Department and Animal Laboratory, Beijing Neurosurgical Institute from August 2006 to January 2007. ① Rats were randomly divided into groups with 7 in each group, including vehicle control group, in which rats were injected intraperitoneally with sun-flower seed oil (1 mL/kg, twice a week) for 16 weeks; DES group, where animals were administered with DES (5 mg/kg, twice a week) for 16 weeks; DES + vehicle control group, in which DES was administered for 12 weeks at the same dose with those in DES group, and then was discontinued and replaced by sun-flower seed oil (1 mL/kg, twice a week) for the following 4 weeks. ② At 16 weeks later, pituitary tissue was dealt with HE staining and PRL immunohistochemical examination to observe evoke of tumor; meanwhile, immunohistochemical examination was used to observe expression of PRL of pituitary anterior lobe, expressions of μ- and m-calpains of pituitary intermediate lobe and distribution of adrenocorticotropin. MAIN OUTCOME MEASURES: ① Expression of PRL of pituitary anterior lobe, expressions of μ- and m-calpains of pituitary intermediate lobe and distribution of adrenocorticotropin. ② Morphological observation of pituitary tissue. RESULTS: All 21 rats were involved in the final analysis. ① Results of immunohistochemical examination: Morphological changes of neoplasia in DES group were strongly positive to PRL, and this suggested that formation of prolactin adenoma was observed in pituitary tissue. As compared with vehicle control group, expression of adrenoeorticotropic hormone (ACTH) was increased in both DES group and DES + vehicle control group. In addition, expressions of μ- and m-calpains in pituitary intermediate lobe were higher in DES group than that in vehicle control group. Otherwise, expressions of m-calpains in pituitary intermediate lobe was decreased in DES + vehicle control group, but expression of μ-calpains was still increased. ② Morphological observation of pituitary tissue: Gland tubes were orderly arranged in rats in vehicle control group. Anterior pituitary gland in rats of DES group demonstrated an apparent disappearance of gland tubes and a relatively large-scaled vasculature formation, namely the vascular lake lined by tightly arranged endothelial cells. Local integrated tumor cell arrangements were also detected. In addition, the border between the IL and the anterior lobe was locally blurred. The definite tumor-like changes in pituitary tissues were confirmed in 6 of 7 female Wistar rats in DES group, and one spontaneous occurrence of tumor formation was found in vehicle control group. In DES + vehicle control group, DES withdrawal led to the subtile emergence of gland tube cavity, although tumor-like cells still existed in 4 of 7 rats, suggesting occurrence of the tumor regression due to the withdrawal of DES. CONCLUSION: A long-term application of DES can enhance the expressions of ubiquitours neutral cysteine protease in pituitary intermediate lobe and this suggests that both of them play a key role in release of hormone and formation of prolactin neoplasia through directly promoting PRL expression and release of neighboring pituitary intermediate lobe.