Volume 86  ·   Issue 37  ·  2006

A large amount of evidence-based medical evidence shows that neurological rehabilitation plays a very positive role in improving the functional disorders caused by nervous system diseases, improving daily living ability and quality of life [1]. The clinical research project on early rehabilitation of acute stroke carried out during the "Ninth Five-Year Plan" period in China proves that early rehabilitation of stroke is effective, can significantly reduce the degree of disability and improve the quality of life [2]. The research on the three-level rehabilitation program of stroke carried out during the "Tenth Five-Year Plan" period further demonstrates the effectiveness and necessity of continuous rehabilitation of stroke [3], and an article published in this issue also confirms this point. The development of stroke rehabilitation in China is very rapid, especially the understanding of neurologists on stroke rehabilitation has been further improved, which lays a good foundation for stroke rehabilitation, and the recognition of the efficacy of stroke rehabilitation by the majority of patients makes the development of stroke rehabilitation guaranteed. Nevertheless, compared with foreign developed countries, There is still a significant gap in stroke rehabilitation work in China, which mainly focuses on: (1) the popularity is limited, that is, the breadth of stroke rehabilitation work is not enough. (2) the level of rehabilitation clinical and basic scientific research work needs to be further strengthened, that is, the depth is not enough. Therefore, the future stroke rehabilitation work should be carried out around these two aspects.

Lung cancer is a serious disease that threatens human health seriously. Lung cancer has become the first malignant tumor in the world. According to WHO estimates, the number of new lung cancer deaths in China will exceed 1 million every year by 2025; By 2030, 10 million people will die of lung cancer every year worldwide. Lung cancer is one of the malignant tumors with the worst prognosis. Although a lot of manpower and material resources have been invested in the diagnosis and treatment of lung cancer for several decades, the overall 5-year survival rate of lung cancer is only 15% in the United States [1], and it is even lower in China. Compared with 50 years ago, the diseases that mainly threaten human health, such as heart disease, cerebrovascular disease and infectious diseases, have decreased by about 2/3, but the age-adjusted mortality rate of lung cancer is rising continuously. Stop smoking can reduce the incidence of lung cancer, and standardized comprehensive treatment can prolong the survival time of patients. However, under the existing diagnosis and treatment methods, the prevention and treatment effect of lung cancer is far from the fundamental improvement. To obtain a breakthrough in the diagnosis and treatment of lung cancer, fundamentally speaking, it needs to deepen and explore basic research.

With the development of molecular biology technology, the understanding of lung cancer has been deepened from macroscopic cytology and histology to more microscopic genetics and molecular biology in recent years.It has been found that the abnormal expression or mutation of oncogene, tumor suppressor gene and growth factor family and their receptors play an important role in the occurrence and development of lung cancer, and there has been some breakthrough in the research of molecular mechanism of tumor angiogenesis,invasion and metastasis. At present, the therapeutic drugs for the above-mentioned molecular biology events of lung cancer have become a hot spot of research, and important progress has been made. Many molecular targeted drugs are moving from laboratory to clinic, some of which have been applied in clinic or are in clinical trials, which preliminarily confirms that molecular targeted drugs have a good prospect in the treatment of lung cancer.

It is undoubtedly necessary to comprehensively understand the mortality rate of respiratory diseases in China and its differences between urban and rural areas, and to study the dynamic change of mortality rate of respiratory diseases and its ranking and evolution trend in the total causes of death of the population. However, there are still few researches in this area. Respiratory doctors should not only deal with every patient with respiratory diseases carefully, but also understand the overall situation of respiratory diseases from a macroscopic perspective and pay attention to its longitudinal change law. In addition, deep research on the macroscopic development law of respiratory diseases is undoubtedly of reference value for government health decision-making. Therefore, with the help of certain tools, we conducted a retrospective study on the mortality rate of respiratory diseases in China and its ranking of causes of death in the total population in the past 20 years (1982-2003). The results are reported as follows.

Objective to evaluate the difference in efficacy of carboplatin-based or cisplatin-based combination chemotherapy regimens in the treatment of advanced non-small cell lung cancer. Methods Randomized controlled clinical trials comparing carboplatin-based and cisplatin-based combination chemotherapy regimens in the treatment of advanced non-small cell lung cancer between 1995 and 2005 were searched in CENTRAL, PubMed and Chinese Biomedical Literature Databases.Then, the inclusion criteria and quality of these literatures were evaluated, and the literatures meeting the criteria were meta-analyzed.Results 18 literatures (including 6478 patients) met the inclusion criteria, and the overall response rate was 27% in both groups, with an RR of 0.93 (95% CI, 0.86-1.01; P =0.10); The one-year survival rate was 36% in the carboplatin group and 35% in the cisplatin group, and the RR was 1.04 (95% CI, 0.93-1.17; P =0.5); Conclusion Carboplatin-based and cisplatin-based combined chemotherapy regimens have similar efficacy in the treatment of advanced non-small cell lung cancer.

Objective to investigate the prospect and clinical application of tumorigenic growth factor (PCDGF) and breast cancer drug resistance protein (BCRP) derived from PC cells in predicting the efficacy of chemotherapy in non-small cell lung cancer (NSCLC). Methods The pathological tissue sections of 87 patients with advanced NSCLC initially treated by chemotherapy were stained by immunohistochemistry to observe the expression of PCDGF and BCRP, and the relationship between their expression intensity and the therapeutic efficacy of platinum-based chemotherapy was analyzed. Results The total effective rate (OR) of chemotherapy was 41.4% (36/87) in NSCLC patients, 41.4% (36/87) in chemosensitive patients and 58.6% (51/87) in chemoresistant patients. The expression rate of PCDGF was 52.9%, and the expression intensity of PCDGF in chemoresistant patients (74.5%) was significantly higher than that in chemosensitive patients (19.4%) (P =0.000). The strong positive expression intensity of PCDGF was significantly correlated with chemotherapy efficacy (P =0.000), and the sensitivity of positive expression was 74.5% and the specificity was 84.8%; The expression rate of BCRP was 67.8% (59/87), and the expression intensity of chemotherapy resistant patients (90.2%) was significantly higher than that of chemotherapy sensitive patients (36.1%) (P =0.000). The strong positive expression of BCRP was all chemotherapy resistant patients, and the expression intensity of BCRP was significantly correlated with chemotherapy efficacy (P =0.000). The sensitivity of positive expression was 90.2% and the specificity was 78.0%; The co-expression specificity of PCDGF and BCRP is 92.0%, which can improve the specificity of predicting the efficacy of chemotherapy. Conclusion PCDGF and BCRP can be used as biomarkers to predict the efficacy of first-line chemotherapy in NSCLC by clinical immunohistochemistry.

Objective to investigate the difference of EGFR gene mutation and the efficacy of gefitinib in patients with non-small cell lung carcinoma between men and women. Methods 135 patients with non-small cell lung carcinoma who underwent surgery in Guangdong Provincial People's Hospital from 2002 to 2005 were collected and placed in liquid nitrogen immediately, and then stored at-80℃. Tissue DNA was extracted by Trizol method, and exons 18, 19 and 21 of EGFR gene were amplified by nested PCR. After purifying the PCR products, the sense and antisense strands of DNA were sequenced, and the clinical data of patients and the efficacy of gefitinib patients were analyzed. Results Among 135 patients, 29 patients (21.5%) had EGFR gene mutation, and the mutation rates of males and females were 19.1% and 26.8%, respectively (P =0.364). In the 20 patients treated with gefitinib, the disease control rate was 76.9% (10/13) and 100% (7/7) in males and females, respectively (P =0.521). There was no significant difference in the median time to disease progression between males and females (9 months and 14 months, respectively, P =1). Conclusion There was no significant relationship between gender and EGFR mutation, efficacy and prognosis of gefitinib treatment in NSCLC patients.

activities of daily living (ADL) seriously affect the quality of life of stroke patients [1]. Efforts to improve ADL is an important measure to improve the quality of life of patients and reduce the social and family burden. The study found that cognitive impairment after stroke affects the ADL of patients [2, 3], and the rehabilitation effect is poor [4]. The incidence of cognitive impairment is 28% 1 month after stroke [5], and it can reach 35% ~39% 3 months after stroke [6]. 39% of ischemic patients have cognitive impairment 1 year after disease [7]. This study explored the influence of cognitive impairment on ADL in ischemic stroke patients through prospective observation, so as to provide effective guidance for improving the quality of life of survivors.

Objective to observe the effects of transcranial magnetic stimulation (TMS) on nerve function recovery and dendritic and synaptic structures of the healthy cortex after focal cerebral infarction in rats, and to explore its mechanism.Methods Twenty-four male SD rats were randomly divided into TMS group and natural recovery group by suture method. The former was treated with TMS for 28 days, and the latter was routinely raised to observe the recovery of nerve function and the changes of dendritic and synaptic structural parameters of pyramidal cells in the healthy cerebral sensorimotor cortex. Results The Bederson neurological deficit score of rats in TMS group (0.58±0.49) was significantly lower than that in natural recovery group (0.92±0.28) (P<0.05); The total length of dendrites (898±127) μ m, the number of primary dendritic branches (6.6±1.5) and the density of dendritic spines per unit length (0.75±0.19) /μ m in motor cortical pyramidal cells in TMS group were significantly higher than those in natural recovery group (788±112) μ m, (5.8±1.5) and (0.60±0.16) /μ m (P<0.05 or 0.01); The curvature of synaptic interface (1.06±0.08) was significantly greater than that in the natural recovery group (1.02±0.06) (P<0.05), the thickness of postsynaptic dense substance (PSD) (64±13) nm was significantly thicker than that in the natural recovery group (54±12) nm (P<0.01), and the synaptic gap (19.5±2.1) nm was significantly narrower than that in the natural recovery group (23.3±2.3) nm (P<0.01).

Objective to investigate the effect of regressive walking plank training on lower limb motor function, balance function and walking speed in stroke hemiplegic patients. Methods Twenty-six patients with stroke hemiplegic who were classified as Brunnstrom grade 3 or 4 and could walk more than 10 m independently without using crutches and orthotics were randomly divided into an experimental group (13 cases) and a control group (13 cases). The patients in the control group received conventional walking training for 60 min, and the patients in the experimental group received conventional walking training for 30 min and regressive walking plank training for 30 min, 5 times a week for 3 weeks. The patients in the two groups were evaluated for lower limb motor function (Fugl-Meyer method), balance function (Berg balance scale) and walking speed (10 m maximum walking speed measurement) before and after 3 weeks of treatment. Results After 3 weeks of treatment, the improvement of lower limb motor function, balance function and walking speed in the experimental group was significantly better than that in the control group. The P values were 0.033, 0.001 and 0.034, respectively. Conclusion Regressive walking plank training can improve lower limb motor function, balance function and walking speed in stroke hemiplegic patients.

Objective to investigate the mechanism of post-stroke reflex sympathetic dystrophy and its clinical significance. Methods A clinical control study was conducted to observe the needle electromyography in patients with post-stroke reflex sympathetic dystrophy. Bilateral median nerve conduction velocity measurement and bilateral abductor pollicis brevis and abductor digitus minimi electromyography were performed in 50 patients with stroke. Among them, 30 patients were clinically diagnosed with reflex sympathetic dystrophy after stroke, and 20 patients with non-reflex sympathetic dystrophy were used as the control group. The amplitude, incubation period and spontaneous myoelectric activity scores of each wave were statistically analyzed. Results Compared with the non-reflex sympathetic dystrophy group, the amplitude of motor nerve compound action potential of the affected upper limb was significantly reduced in the reflex sympathetic dystrophy group (13.2mV±4.6 mV in the non-RSD group; 8.6mV±2.9 mV in the RSD group); The incidence of spontaneous potentials and the number of spontaneous potentials of abductor pollicis brevis and abductor digitorum minorum were significantly increased (100% in RSD group and 65% in non-RSD group), and the difference between the two groups was statistically significant (P<0.05).

Objective to study the effects of functional electrical stimulation (FES) on lower limb movement and walking ability in hemiplegic patients with acute stroke. Methods 46 patients with initial stroke, aged 71 ± 8 years, were randomly divided into FES group (13 cases), placebo electrical stimulation group (15 cases) and control group (13 cases) 9 days ± 4 days after the onset of stroke. The conventional treatment in the three groups was the same, and the FES group was given functional electrical stimulation once a day for 30 min each time for 3 weeks (15 times); Comprehensive spasticity scale (CSS) was used to evaluate the muscle tension of ankle plantar flexor, and surface electromyography was used to evaluate the torque, integral electromyography and synergistic muscle contraction rate of ankle dorsal extension and plantar flexor during maximum isometric contraction (MIVC), as well as the ability of patients walking alone during hospitalization. Results There was no significant difference in general data and evaluation results before treatment between the three groups. After 3 weeks of treatment, the spasticity of ankle plantar flexor was the lowest in FES group, and the increase rate of CSS was 30% ± 35%, 50% ± 88% and 65% ± 65% in the three groups, respectively. The MIVC of tibialis anterior muscle was significantly increased during ankle dorsal extension (9 Nm ± 5 Nm, 5 Nm ± 3 Nm, 4 Nm ± 5 Nm), and the synergistic contraction rate during ankle dorsal extension was significantly decreased (8% ± 5%, 27% ± 26%, 28% ± 19%). Within 3 weeks of treatment, the time of recovery of walking ability in FES group was 2~3 days earlier than that in the other two groups on average (18 days ± 8 days, 20 days ± 7 days, 21 days ± 8 days). Conclusion

Objective to explore the effect of tertiary rehabilitation therapy on neurological function of hemiplegic patients with stroke. Methods A large sample, multi-center, prospective randomized controlled study was used. Patients were randomly enrolled in each sub-center, and then randomly divided into rehabilitation group and control group at two levels of cerebral infarction and cerebral hemorrhage. The rehabilitation group was given tertiary rehabilitation therapy, while the control group was not given tertiary rehabilitation therapy. However, the general routine medical diagnosis and treatment group was evaluated by clinical neurological deficit score standard at 1 month, 3 months and 6 months after disease at the time of enrollment. Results 1209 patients were enrolled, including 610 in rehabilitation group and 599 in control group. There was no significant difference in neurological function scores between the two groups at the time of enrollment. The neurological function scores of the rehabilitation group of cerebral infarction and cerebral hemorrhage after rehabilitation were significantly lower than those of the control group (all P<0.01). The neurological function improvement values of each stage after enrollment in the rehabilitation group were significantly better than those of the control group (all P<0.01). After 6 months of treatment, The neurological function in the rehabilitation group of cerebral infarction and cerebral hemorrhage improved by 12.79 points and 15.23 points, respectively, while that in the control group improved by 8.30 points and 10.65 points, respectively. In addition, the decrease trend of the score in the rehabilitation group was significantly faster than that in the control group, especially in the early stage.

Cerebral hypoxia-ischemia is the main pathological basis of neurological injury diseases such as stroke. How to reduce the damage of cerebral hypoxia-ischemia to nerve cells, protect neurons and restore nervous system function is an important field of neuroscience research. Neuroprotectins can play an anti-injury role in vivo and in vitro, and reduce neuron death and neurological loss. After cerebral hypoxia-ischemia, nerve cells can synthesize and release more neuroprotectins, which may be the self-defense response of the body. Understanding neuroprotectins is beneficial to increase the content of neuroprotectins through exogenous pathways and strengthen their neuroprotective function, so as to protect damaged neurons and cure cerebral hypoxia-ischemia diseases.

The trend of aging in the United States is increasingly serious, and it is estimated that the number of elderly people (aged ≥75 years) in the United States will be four times that of the present in the next 50 years. Recent epidemiological data show that the incidence of mitral regurgitation (MR) increases with age. Previous views suggest that the risk of mitral valve surgery in elderly patients with MR is higher because of complicated symptoms of heart failure, coronary heart disease and other comorbid diseases before operation, and the operative mortality rate is high (about 10% ~20%). Therefore, surgical treatment is only considered for those patients with heart failure who are difficult to correct due to severe valve regurgitation.

hSnm1B is a member of β-CASP family, and its gene sequence is homologous to yeast SNM1. DNA is its main substrate, which plays a certain role in DNA damage repair. At present, its structure, function and mechanism are not well understood, and hSnm1B is one of the least understood proteins in β-CASP family.

Previous epidemiological studies have shown that obesity [BMI ≥30.0kg/m2] increases the risk of mortality. However, it is still inconclusive whether overweight (BMI between 25.0 and 29.9) increases the risk of mortality. Therefore, Adams et al. conducted a prospective study to further analyze the relationship between BMI and mortality risk, and the results were published in N Engl J Med, Volume 355, August 24, 2006.

In recent years, targeted therapy for tumor has attracted widespread attention from professionals engaged in tumor therapy with its astonishing development speed and unique therapeutic effect. Targeted therapy drugs can be said to be changing with each passing day, and new therapeutic schemes and strategies are emerging one after another. This trend was reflected in the 2006 ASCO conference. The research on lung cancer at this conference includes single-target drugs, multi-target drugs, targeted therapy combined with traditional chemotherapy, etc. This paper summarizes the latest research on molecular targeted therapy for lung cancer at the conference, hoping to be helpful to clinical researchers of lung cancer.

Pseudomona aeruginosa (Pseudomona aeruginosa) is a human opportunistic pathogen that uses N-acyl-homoserine lactone (AHL) as a signal molecule to regulate its own quorum sensing behavior [1]. In recent years, the detection rate of Pseudomona aeruginosa is the highest among the non-fermenting pathogens isolated in clinic [2]. The diagnosis and rational drug use of Pseudomonas aeruginosa depend on the confirmation of the pathogen, and the commonly used test method in China is still biochemical identification.

protein-losing enteropathy (PLE) is mainly caused by small intestinal lymphangiectasis, right heart failure, obstruction of hepatic venous return, lymphoma, abdominal tuberculosis or inflammatory bowel disease, and very few are caused by rheumatic diseases [1]. Since Waldman et al. [2] described the role of gastrointestinal tract in plasma protein metabolism in 1969, systemic lupus erythematosus (SLE) causes protein-losing enteropathy. There are only more than 30 cases reported abroad, and most of them are individual cases, but few reported in China at present. We retrospectively analyzed 15 cases of SLE complicated with PLE admitted to Peking Union Medical College Hospital, and studied their clinical characteristics, treatment plan and disease outcome, in order to find out the disease pattern.

The qualitative diagnosis and surgical treatment strategy of solitary pulmonary noule (SPN) have always been the focus and difficulty of pulmonary surgery. From April 1996 to June 2005, we operated 106 cases of solitary pulmonary noule (≤3 cm in diameter), which are summarized and analyzed and reported as follows.

Tuberculosis is one of the most important infectious diseases in the world, with about 8 million new tuberculosis patients [1] and about 2-3 million deaths every year [2]. In 1993, the World Health Organization declared "global emergency for tuberculosis". China is one of the 22 countries with high burden of tuberculosis in the world, with 4.5 million tuberculosis patients, among which 1.5 million are infectious tuberculosis patients, ranking second in the world in the number of patients. With the improvement of quality of life and health care level, people's life expectancy is constantly increasing, and the proportion of elderly people is constantly increasing. Many countries, including China, have entered an aging society. However, the proliferation and activity of T lymphocytes in the elderly decrease with the degeneration of thymus, and their resistance to Mycobacterium tuberculosis decreases [3], which makes them prone to tuberculosis. At the same time, the symptoms of elderly tuberculosis patients are atypical, and the diagnosis is difficult; The incidence of adverse drug reactions is high and the treatment compliance is poor.Therefore, tuberculosis in the elderly has received more and more attention in recent years.