Volume 86  ·   Issue 47  ·  2006

At present, there are 6 million patients with active epilepsy in China, of whom 20% ~30% are drug-refractory epilepsy. Surgical treatment of epilepsy provides a new treatment for this part of patients. It is estimated that about 15% of patients with drug-refractory epilepsy can be controlled or cured by surgery, which improves the prognosis of refractory epilepsy to some extent.

Objective to investigate the expression of promyelocytic leukemia protein (PML) in lung cancer and its relationship with clinical prognosis. Methods SP immunohistochemical staining was performed on tissue microarray to detect the expression of PML protein in 148 cases of lung cancer, 5 cases of benign lung tumor and 7 cases of normal lung tissues. Results 4 cases of lung cancer tissues did not meet the evaluation criteria and were excluded. 2 cases of benign lung tumor and 1 case of normal bronchial mucosa expressed PML clearly; The expression rates of PML in the nucleus of non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) were 31.4% and 8.7%, respectively (χ 2=4.968, P =0.026). The expression rates of PML in the cytoplasm of SCLC and NSCLC were 39.1% and 14%, respectively (χ 2=6.609, P =0.010). The 5-year cumulative survival rates of PML positive and negative SCLC were 50% and 23%, respectively (Log-Rank: χ 2=3.931, P =0.047). COX multivariate analysis showed that PML expression was an independent factor affecting the prognosis of SCLC. Conclusion PML expression may be related to the prolongation of survival of SCLC patients.

Objective to investigate the effect of tumor necrosis factor α (TNF-α) on the proliferation and apoptosis of alveolar type Ⅱ epithelial cell line A549 and the regulatory effect of retinoic acid (RA) on it. Methods the proliferation capacity of alveolar type Ⅱ epithelial cell line A549 cells was measured by MTF assay after 24 h and 48 h treatment with different concentrations of TNF-α, 1 μ mol/L RA and 10 μ g/L TNF-α +1 μ mol/L RA. The cell proliferation capacity was measured by MTF assay, and the cell apoptosis was detected by flow cytometry. After treatment with 10 μ g/L TNF-α for 24 h or 48 h, the number of viable cells was calculated by trypan blue staining at 24 h, 48 h and 72 h. Results The proliferation numbers (%) of A549 cells were measured by TNF-α at 0, 0.1, 1, 5 and 10 μ g/L concentrations at 24 h and 48 h, respectively: 95.0%, 90.0%, 79.6%, 72.4% and 59.6% at 24 h, respectively. The F value of ANOVA was 18.04,P<0.01,93.2%, 82.7%, 61.5%, 50.3% and 44.7% at 48 h, respectively, F value was 40.61,P<0.01. The retinoic acid and TNF-α groups were 4.8%±1.1%,5.2%±1.3% and 16.4%±2.3%, which were significantly less than those of TNF-α group.Conclusion Retinoic acid can alleviate the damage of alveolar epithelial cells and protect lung surfactants by inhibiting the destruction of TNF-α to alveolar type Ⅱ epithelial cells.

Objective to investigate the inhibition of erythromycin on the proliferation of cancer cells with high expression of potassium channel HERG and its synergistic effect with chemotherapeutic drugs. Methods The effects of erythromycin on tumor cells were observed by Western blot, tetramethylazolazole blue (MTT) assay, flow cytometry, cell adhesion assay and gelatin zymography. Results The expression of HERG potassium channel in both human colon cancer HT-29 cells and mouse colon cancer C26 cells was higher than that of control neuroblastoma SH-SY5Y with high expression of HERG potassium channel. Erythromycin inhibited the proliferation of HT-29 cells and C26 cells to different degrees in a concentration-dependent manner. Erythromycin can inhibit the release of gelatinase MMP-2 from tumor cells. Erythromycin and vincristine can synergistically inhibit the proliferation of mouse C26 cells. The IC50 of vincristine alone and vincristine combined with erythromycin (50 μ mol/L) were 62.65 nmol/L and 4.68 nmol/L, respectively. Erythromycin combined with paclitaxel and hydroxycamptothecin also showed synergistic effects. Conclusion Erythromycin can inhibit the proliferation of cancer cell HT-29 with high expression of potassium channel HERG and induce tumor cell apoptosis.

Objective to observe the complex culture of deproteinized bone and osteoblasts in vitro.Methods Osteoblasts cultured from fetal rabbit skull and deproteinized bone made from rabbit metaphyseal cancellous bone were cultured in vitro.The growth of deproteinized bone was observed by enzyme digestion,inverted microscope and scanning electron microscope.Results Osteoblasts could adhere to the outer surface of deproteinized bone and the inner surface of pores, and proliferated and differentiated well. Conclusion The complex of osteoblasts and deproteinized bone constructed in vitro has some biological characteristics of tissue engineered bone, which laid the experimental foundation for further observation of its revascularization and osteogenic activity in vivo and for repair of large segment bone defects.

Objective to investigate the appropriate proportion of resin-hydroxyapatite (EH) composite material for percutaneous vertebroplasty and the use of developer. Methods: Group Ⅰ, Ⅱ and Ⅲ were prepared according to the ratio of liquid to powder of 8:9, 8:8 and 8:7, and groups Ⅳ, Ⅴ and Ⅵ were prepared by adding 20% barium sulfate into the powder respectively; Measuring material state and heating temperature during mixing; Group Ⅰ ~ Ⅴ were made into cylinders with a diameter of 5 mm and a height of 20 mm, and X-ray radiographs were taken to observe the developability; The compressive strength of cylinders in groups Ⅰ, Ⅱ, Ⅳ and Ⅴ was tested. The osteoporotic vertebral body T8~ L5 was made into a compression fracture model, and the control group with a ratio of 8:8 and the experimental group with 20% barium sulfate were paired. Bone cement was injected in a water bath at 37℃, the temperature of the vertebral body center and the temperature of the posterior wall of the spinal canal (PT) were measured, and the amount of bone cement injected was recorded; X-ray was taken to observe the developability; The vertebral strength and stiffness of the two groups were measured on a mechanical material machine, and the ability of EH composite cement to restore vertebral strength and stiffness before and after adding contrast agent was compared. Results EH material added with 20% barium sulfate prolonged the atherosclerosis stage appropriately, about 60 s, the temperature decreased, the developability was good, the injection was easy, and the mechanical strength was higher. Both the control group and the experimental group recovered vertebral strength and stiffness well, and the developability of the experimental group was good, and the PT did not exceed 50℃. Conclusion EH material added with 20% barium sulfate liquid to powder ratio of 8:8 is a good and effective filling material for the treatment of painful vertebral compression fracture.

Objective to compare the stability and duration of fluorescent virus gene expression in bone marrow mesenchymal stem cells (rMSCs) infected with adenovirus and lentiviral vectors.Methods 293T cells were co-infected with lentiviral vector plasmid containing green fluorescent protein (GFP) gene and helper plasmid, and packaged recombinantly; The human bone morphogenetic protein 2 (hBMP2) gene sequence was extracted from GenBank, and the primers with NHE Ⅰ and Age Ⅰ double digestion sites were designed. Total RNA was extracted from human liver tissue, and then reverse transcribed into cDNA, and the full length sequence of hBMP2 gene was amplified. After sequencing and validation, the recombinant lentiviral vector was cloned into pHIV-CS-CDF-CG-PRE. The recombinant lentiviral vector was identified by PCR amplification, digestion and sequencing. The recombinant lentiviral vector plasmid and helper plasmid were co-infected with 293T cells, and the recombinant lentiviral vector was packaged into active lentivirus that can express hBMP2 gene by recombination. Results the expression of green fluorescent protein in the two viral vectors was 90% and 71%, respectively, 1 week after infection. At 5 weeks, the expression of green fluorescent protein in the lentiviral vector was significantly higher than that in the adenoviral vector, which was 79% and 0.05%, respectively The lentiviral vector pHIV-hBMP2 containing hBMP2 gene was successfully cloned and constructed, and the lentiviral vector was successfully packaged and analyzed. Conclusion the lentiviral vector containing hBMP2 gene can be successfully constructed. The transfection efficiency of lentiviral vector on rat bone marrow mesenchymal stem cells is significantly better than that of adenoviral vector.

Objective to observe the effect of lidocaine on learning and memory dysfunction and hippocampal neuropathological changes in mice induced by chronic stress.Methods Thirty-two male Kunming mice were randomly divided into normal saline control group,lidocaine control group,chronic stress group and lidocaine treatment group,8 mice in each group.The lidocaine control group and lidocaine treatment group were given daily intraperitoneal injection of lidocaine, and the other groups were given normal saline.The chronic stress group and lidocaine treatment group were given daily compound stress stimulation for 21 days, while the other groups did not receive stress stimulation.Then the mice were subjected to Morris water maze test; After the test, perfusion and fixation were performed, and the brain tissues of mice were taken for Nissl staining to observe the pathological changes of neurons in CA3 region of hippocampus. Results (1) Water maze test: The incubation period of animals in each group was shortened with the increase of the test days. The incubation period chronic stress group was significantly longer than the two control groups on the fifth day of the test (both P<0.01); The percentage of effective search strategies in the lidocaine-treated group was significantly shorter than that in the chronic stress group (P<0.05), but the difference was not statistically significant compared with the two control groups. Except for the chronic stress group, the percentage of effective search strategies in all groups increased with the increase of the number of days of test, and it was significantly higher on the fifth day of test than on the first day of test (P<0.05 in both control groups and P<0.01 in the lidocaine-treated group). (2) Neuropathological examination of hippocampal CA3 area: pyramidal cell count and mean absorbance of Nissl body were significantly lower or lower in the chronic stress group than those in the two control groups (both P<0.01); Conclusion Chronic stress induced learning and memory dysfunction and neuronal damage in hippocampal CA3 region in mice. Lidocaine significantly alleviated the learning and memory dysfunction and neuronal damage in hippocampal CA3 region in mice caused by chronic stress.

Objective to investigate the relationship between immune indexes and disease, classification and curative effect of patients with myasthenia gravis (MG), and evaluate its clinical significance. Methods Flow cytometry was used to detect CD3, CD4 and CD8 in peripheral blood and turbidimetry was used to detect IgG, IgA and IgM. Results IgG and IgA in systemic MG patients were higher than those in ocular muscle type, P<0.05, and the difference was statistically significant. In the humoral immunocompromised group, the remission rate of gamma globulin treatment was 95.2%, and that of pyridostigmine only was 28.8%, and the difference was statistically significant (P<0.01). The ratio of CD4/CD8 decreased in 48%, the ratio increased in 24.4%, and the ratio normal in 27.6%. According to the values of IgG, IgA and IgM, the low group accounted for 48.9%, the elevated group accounted for 20.4%, the disorder group accounted for 9.7%, and the normal group accounted for 21%. The difference of immune indexes before and after treatment was not statistically significant, nor was the difference of clinical data of each immune group statistically significant. IgG, IgA, IgM, CD3, CD4 and CD8 cannot be used as the only evaluation indexes of MG disease and efficacy, but they have certain reference value for guiding treatment.

Objective to analyze the risk factors affecting the prognosis of frontal lobe epilepsy in order to predict refractory frontal lobe epilepsy in early stage and provide theoretical basis for rational treatment in early stage.Methods A case-control study (including 47 cases in drug-refractory group and 92 cases in good drug-controlled group) was performed to retrospectively analyze the clinical data of the two groups, and the relationship between various influencing factors and prognosis was analyzed by univariate and multivariate analysis.The multivariate analysis was performed by Logistic stepwise regression and forward stepwise method.Results The univariate analysis showed that seven factors, such as early age of first onset, long course of disease before rational drug treatment, frequent seizures (>1 time/d), postural seizures, excessive exercise seizures, secondary generalized tonic-clonic seizures and previous drug history, had adverse effects on the prognosis of frontal lobe epilepsy (all P<0.05). The course of disease before rational treatment (OR =1.384, 95% CI: 1.133~1.689) and seizure frequency (OR =6.512, 95% CI: 1.637~25.911) were screened by Logistic stepwise regression analysis Conclusion Long course of disease and frequent seizures (>1 time/d) before reasonable drug treatment are important risk factors for refractory frontal lobe epilepsy, so early correct diagnosis and reasonable treatment may improve the prognosis of frontal lobe epilepsy.

Objective to analyze and summarize the clinical classification, etiological characteristics and clinical significance of temporal lobe epilepsia.Methods the clinical classification and etiological analysis of 190 cases of temporal lobe epilepsy were carried out according to clinical, EEG characteristics and neuroimaging data.Results 172 patients with medial temporal lobe epilepsy, 62.2% of them had precursors such as abnormal sensation in the upper abdomen; Oropharyngeal automatic syndrome was more common in 67.4% of patients; EEG showed epileptic discharge in the anterior or anterior middle temporal region; The causes were hippocampal sclerosis, intracranial infection, brain tumor, cerebrovascular disease, brain trauma, etc. 10 patients with lateral temporal lobe epilepsy showed aural hallucinations; Electroencephalogram showed epileptic discharge in the posterior or or middle posterior temporal region; Conclusion Temporal lobe epilepsy is a group of epileptic syndromes with common clinical characteristics, complicated etiology and diverse manifestations, and clinical classification is the prerequisite for choosing treatment methods. The clinical characteristics of patients and some non-invasive examination methods can be used to diagnose most temporal lobe epilepsy by medial lateral classification.

Objective to investigate the distribution and clinical characteristics of five new epileptic syndromes in epileptic population.Methods Computer search and manual search were used to investigate the new epileptic syndromes in 5300 patients who visited the Epilepsy Center of the First Affiliated Hospital of Chongqing Medical University in the past 30 years.Results the actual number of investigations in this study was 4894 cases.Among them, 111 cases had definite family history of epilepsy, including 2 cases of familial temporal lobe epilepsy,1 case of familial partial epilepsy with different lesions and 3 cases of general epilepsy with febrile convulsion superposition syndrome.Another 14 cases met the clinical characteristics of medial temporal lobe epilepsy and 5 cases met the clinical characteristics of shock epilepsy.No patients with hemiconvulsion-hemiplegic epilepsy syndrome and autosomal dominant nocturnal frontal lobe epilepsy syndrome were found. Conclusion The new epileptic syndromes proposed by the International Anti-Epileptic Alliance also exist in domestic epileptic population.Knowing the clinical characteristics of these syndromes is helpful for better diagnosis and treatment of these diseases.

Objective to investigate the expression changes of potassium channels Kv4.2, Kv4.3 and their interacting protein KChIP1 in amygdala electrical ignition model.Methods the right amygdala of SD rats was stimulated for 7 d to establish an electrical ignition model.Total amygdala RNA was extracted for RT-PCR to study the expression changes of KChIP1, Kv4.2 and Kv4.3 at mRNA level after epilepsy. The expression changes of KChIP1 and Kv4.2 at protein level were observed by Western blot. Results At the level of mRNA expression, the expression of KChIP1 in bilateral amygdala was significantly higher in the model group [including high seizure level (47.0±3.6) and low seizure level (41.3±10.2) with Racine classification] than in the sham operation group (20.0±10.6) (P high =0.000,P low =0.001), and Kv4.2 and Kv4.3 were also increased in the model group, and there was a more obvious tendency to increase in the high seizure level group. The changes of protein expression levels of bilateral KChIP1 and Kv4.2 were similar to the changes of mRNA expression. There was no significant difference in mRNA and protein expression between the ignited side and the non-stimulated side in each group. Conclusion Kv4.2, Kv4.3 and KChIP1 were all increased in bilateral amygdala of the electric ignition epilepsy model to varying degrees (the increase of KChIP1 was more obvious, and the changes of Kv4.2 and Kv4.3 were more obvious when the seizure level was higher), which suggested that the change of potassium channel was not the cause of ignition of epilepsy, but

The patient was a 19-year-old female who had no induced fever in 1995. The maximum body temperature was 39.5℃, with abdominal distension and no abdominal pain. The blood white blood cells (WBC) were 3.3~4.1×109/L, platelets (106~129) ×109/L, and hemoglobin 114~122 g/L were examined in other hospitals. Glutamate aminotransferase (ALT) 144 U/L, aspartate aminotransferase (AST) 197U/L, albumin 22 g/L; Erythrocyte sedimentation rate (ESR) 8 mm/1 h, type IV collagen (-); PCR of hepatitis A virus (HAV) and hepatitis C virus (HCV) antibodies (-) and hepatitis B virus (HBV) DNA (+). Abdominal ultrasound showed hepatosplenomegaly, ascites, bone marrow puncture showed no abnormalities. Bacterial culture and tumor cell examination of ascites were all (-).

Tourette's syndrome (Gilles de la Tourette syndrome, TS) was developed in 1885 by French neurologist Gilles de la Tourette The disease is a complex chronic neuropsychiatric disease, which is clinically characterized by multiple tics and explosive vocalization, and is related to somatosensory impulses. It mostly starts in childhood, the course of the disease is more than one year, and often has the characteristics of fluctuations and fluctuations. TS is often accompanied by a series of related behavioral and emotional symptoms, including obsessive-compulsive disorder and behavior (OCD), attention deficit hyperactivity disorder, learning difficulties, emotional disorders, self-injury behavior and lewd behavior, etc. These behaviors and symptoms are usually the source of functional impairment in TS patients, and increase the complexity and severity of the disease [1, 2]. The annual incidence rate of TS is generally 0.5~1.0/100,000, the male-female ratio is 4:1~6:1, the prevalence rate is about 0.05% ~0.10%, and some reports are as high as 3% [3]. At present, there is no authoritative epidemiological data of this disease in China.

Soft tissue defects of ankle and foot are common and refractory diseases in clinic. In recent years, good results have been achieved in repairing wounds with distal pedicled calf cutaneous neurotrophic vascular flap [1,2]. However, for some special types of soft tissue defects of ankle and foot, such as osteomyelitis, bone defect and dead space formation, covering the wound with skin flap is difficult to eliminate the dead space, and the postoperative appearance is not ideal. Based on the observation of 30 adult lower limb specimens infused with red latex, 12 cases of special types of soft tissue defects of ankle and foot were repaired with distal pedicled calf cutaneous neurotrophic vascular musculocutaneous composite tissue flap, with satisfactory results, which are reported as follows.

levetiracetam (LEV, trade name Keppra (R)) is a new anti-epileptic drug.There has been evidence that LEV is effective in the treatment of partial epileptic seizures in adults.To evaluate the role of LEV in the treatment of partial epileptic seizures in childhood, a randomized double-blind placebo-controlled trial was conducted in 60 medical centers in the United States and Canada, and it was found that LEV is not only safe as an adjuvant treatment for pediatric patients with partial epileptic seizures, but also effectively reduces the frequency of epileptic seizures.<J Neurology, 2006, 66:1654-1660.

A 45-year-old male was admitted to the hospital on 28 May 2004 due to cough, expectoration and sputum blood for 4 months. Chest CT showed a 4 cm ×3 cm ×2.5 cm mass in the posterior segment of left upper lung, with lobules and burrs. The enhanced CT value was 53 HU, and the hilar and mediastinal lymph nodes were not enlarged. Fiberoptic bronchoscopy showed stenosis of the bronchial opening and mucosal erosion in the posterior segment of left upper lung, and the pathological report was squamous cell carcinoma. On 4 June of the same year, the left upper lobectomy was performed under general anesthesia, and 2 lymph nodes in the hilar and aortic window were removed, 0.5 cm and 1.0 cm, respectively. The pathological report was squamous cell carcinoma of left upper lung, bronchial excision (-), and lymph node reactive hyperplasia.

A 52-year-old female was admitted to the China-Japan Friendship Hospital of the Ministry of Health on June 5, 2006, mainly due to recurrent rash, limb weakness for 7 years, and pain in the left lower abdomen for 1 month. Seven years ago, the patient developed red papules around the orbit, face, neck and upper chest, followed by symmetric muscle weakness of proximal limbs. At the beginning of the disease, she was treated with dexamethasone in a local hospital for 6 months. The specific results of muscle enzymes were unknown. Later, she was examined in Peking Union Medical College Hospital: lactate dehydrogenase (LDH) 530 U/L, α-hydroxybutyrate dehydrogenase (HBDH) 446 U/L, and normal creatine kinase electromyogram showed mild myogenic damage.

A 52-year-old female was admitted to the hospital on August 20, 2005 due to pain in her left abdomen for one month. In June 2005, she was found to have "miliary tuberculosis" on chest X-ray examination due to fever. After 2 months of anti-tuberculosis treatment, she developed abdominal pain symptoms, mainly in bilateral lumbar ribs and middle abdomen. Physical examination: tenderness in the left waist, side abdomen and lower abdomen, but the rest of the examinations were normal. Chest X-ray (Figure 1) showed miliary tuberculosis in both lungs, digital subtraction angiography (DSA) and MRI (Figure 2, 3) showed abdominal aortic pseudoaneurysm (5 cm ×4 cm), and cranial MRI showed multiple lesions in the brain, which was considered to be multiple cerebral tuberculosis. Before admission, the patient was given oral isoniazid, rifampicin, pyrazinamide and ethambutol quadruple anti-tuberculosis, and was also given anti-tuberculosis and liver protection before operation. Considering the poor physical condition of the patient, we chose endoluminal isolation with less trauma on August 22, 2005. The tumor was isolated with a 16 mm diameter covered stent. Intraoperative DSA showed no endoleak (Figure 4). The patient's abdominal pain and low back pain were significantly relieved, and CT scan showed that the stent position was fixed, but no endoleak was found. The patient was successfully discharged from hospital 10 days after operation. After 3 months after operation, the patient was re-examined and no complications occurred after endovascular isolation.

slow transit constipation (STC) is one of the common functional gastrointestinal diseases in clinic, and prolonged colonic transit time is an important factor in its pathogenesis. Because its etiology and pathogenesis are still unclear, its treatment is very difficult. Traditional treatment methods include the use of various laxatives, prokinetic drugs and surgical treatment. Usually, these methods are used successively in the treatment of constipation, but there is no long-term effective evidence [1].

hereditary nonpolyposis colorectal cancer (HNPCC) is a dominant hereditary syndrome [1]. Because of its special etiology and outstanding clinicopathological characteristics [2-4], HNPCC has become a hot spot in colorectal cancer research. Although HNPCC has an early onset age, poor pathological differentiation, and multiple primary cancers are more common, its prognosis is significantly better than that of sporadic colorectal cancer [5,6]. The reason is [7]: HNPCC has weaker invasion and less metastasis than sporadic colorectal cancer at the time of diagnosis. Matrix metalloproteinase-7 (MMP-7) and tissue inhibitory factor-2 (TIMP-2) are one of the important factors involved in the invasion and metastasis of colorectal cancer [8].

Polytrauma refers to the serious injury of more than two parts and organs caused by a single injury factor, and these injuries can endanger life even if they exist alone [1]. In recent years, due to the occurrence of traffic accidents and mine accidents, the number of polytrauma has also increased. Therefore, it is more important to actively do its treatment. We treated 675 patients with polytrauma, and the analysis and report are as follows.