Volume 87  ·   Issue 29  ·  2007

Since the 1990s, Western countries, led by the United States, have implemented the "10-year brain strategy" and invested a lot of manpower and financial resources into the field of neuroscience, which has made it develop rapidly and extremely active. The rapid development of diagnosis and treatment technology has made the quality and quantity of human knowledge accumulation of epilepsy take place a leap.

osteornecrosis of the femoral head (ONFH) is the main cause of non-traumatic femoral head necrosis (ONFH) in China, which mostly occurs in young and middle-aged people, with bilateral femoral head involvement ranging from 63% to 80%. Once femoral head necrosis occurs, the repair response of the necrosis site begins.

Objective to investigate the effect of polymorphism of uridine diphosphate glucuronyltransferase 1A6 (UGT1A6) gene on the plasma concentration of sodium valproate.Methods Sixty-seven patients with epilepsy who took sodium valproate alone and had no liver and kidney dysfunction were selected. The polymorphism of UGT1A6 gene at 552 locus was analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Fluorescence polarization immunoassay (FPIA) was used to determine the plasma concentration of sodium valproate.Results Among 67 patients, the genotypes of 552 loci of UGT1A6 were A/A,40 (59.7%), 24 (35.8%) and 3 (4.5%), A/C and C/C, respectively.The mean standard plasma concentration of A/A group (4.32±0.21) μ g·kg·ml-1·mg-1 and A/C group (3.43±0.30) μ g·kg·ml-1·mg-1 were statistically significant. Conclusion UGT1A6 is a metabolic enzyme of sodium valproate, and polymorphism of UGT1A6 gene can affect the metabolism of sodium valproate. Patients with UGT1A6 gene containing C allele at 552 locus should increase the dose of sodium valproate.

Objective to study the expression of cell-dividing cyclin 42 (Cdc42) in the brain tissue of patients with drug-resistant temporal lobe epilepsy, and to explore its significance in the formation of drug-resistant temporal lobe epilepsy.Methods The brain tissues of 20 patients with drug-resistant temporal lobe epilepsy were collected from the postoperative brain tissue bank established by Chongqing Epilepsy Prevention and Treatment Center, and the expression of Cdc42 was detected by immunohistochemistry and immunofluorescence, respectively, and compared with the control groups of the same sex and similar age.Results The mean absorbance (A) values of the temporal lobe of the case group and the control group were 0.038±0.016, 0.020±0.005, 0.049±0.009, 0.025±0.009, respectively, and t-test showed that there was a statistically significant difference between the case group and the control group (P<0.01). The fluorescence intensity of the hippocampus of the case group and the control group was 18.3±2.5, 11.8±2.9, 23.8±3.3, 10.1±2.6, respectively, and there was also a statistically significant difference between the case group and the control group (

Objective to investigate the effect of selective cyclin-dependent kinase inhibitor olomoucine on neuronal apoptosis after status epilepticus (SE). Methods Lithium chloride-pilocarpine SE model was established and randomly divided into normal saline group, SE group and olomoucine intervention group. The expression of neuronal core antigen (NeuN) and cyclin protein B1 was detected by immunofluorescence chemistry, and the apoptosis of neurons was detected by TUNEL method; The expressions of interleukin-1 β (IL-1 β) and tumor necrosis factor-α (TNF-α) mRNA in cortex and hippocampus were detected by reverse transcription-polymerase chain reaction (RT-PCR). The statistical methods were analysis of variance and t-test.Results (1) The TUNEL positive neurons in the saline group were scarce, and the positive neurons increased significantly after SE (P<0.05), and the olomoucine intervention group was significantly less than that in the SE group (P<0.05), especially in the dentate gyrus hilum area compared with the saline group (P>0.05); (2) Compared with SE group, the number of cyclin B1 positive neurons in olomoucine intervention group decreased, and the difference was statistically significant (P<0.05); (3) The expressions of IL-1 β and TNF-α mRNA in normal saline group were scarce, but increased significantly after SE (P<0.05). Except for cortical TNF-α mRNA, the expressions of IL-1 β and TNF-α mRNA in olomoucine intervention group were significantly lower than those in SE group (P<0.05). Conclusion olomoucine can regulate the cell cycle, inhibit neurons re-entering the cell cycle after status epilepticus, inhibit activated glial cells to secrete inflammatory cytokines, inhibit neuronal apoptosis after status epilepticus and reduce brain damage.

Objective to investigate the changes of platelet and endothelial cell-derived membrane microparticles during the pathogenesis of bone avascular necrosis caused by hormone-induced hypercoagulation and thrombosis. Methods 44 healthy adult Japanese white rabbits were randomly divided into two groups, 28 in the experimental group were injected with methylprednisolone once at 20 mg/kg gluteal muscle; In the control group, 16 rats were injected with normal saline once in gluteal muscle AT the same dose. Whole blood was drawn from vein before injection and AT 1, 2, 4 and 8 weeks after injection. Plasma prothrombin time (PT), activated partial thromboplastin time (APTT) and antithrombin-Ⅲ (AT-Ⅲ) were measured. CD31, CD42a, CD54 and CD62E were quantitatively and qualitatively measured by flow cytometry. Six and four rats were sacrificed in the test group and the control group AT 1, 2, 4 and 8 weeks respectively. Bilateral femoral heads were examined for histology, HE and microthrombus staining. Results AT 1 week, the coagulation function of the test group was enhanced, and the positive expression of CD31, CD42a, CD54 and CD62E particles was significantly higher than that of the control group (t =0.008, P<0.05), and lasted to 8 weeks; At 1 week of histology, bone marrow edema, cell necrosis fragments, hemorrhage, empty bone pits appeared, and microthrombosis staining was positive; Conclusion The increase of microthrombosis, osteonecrosis, steatosis of bone marrow cells, adipocyte diameter and adipose tissue area ratio in rabbits with high dose glucocorticoid may be one of the causes of hypercoagulation and thrombosis induced by high dose glucocorticoid, which may help to prevent or avoid the occurrence of hormone-induced avascular necrosis of femoral head.

Objective to investigate the efficacy of small aperture, multi-tunnel, low drilling rate drilling decompression and hip arthroscopic debridement in the treatment of early avascular necrosis of the femoral head (ANFH). Methods 226 cases (383 hips) of early avascular necrosis of the femoral head were treated by drilling decompression with Stein wire, including 169 males (296 hips) and 57 females (87 hips). Under C-arm monitoring, all cases were treated with small aperture, multi-tunnel, low drilling rate drilling decompression with 3.5 mm Stein wire. The follow-up time was 3-60 months (mean 35 months); The preoperative Harris score was 56-78 (mean 68), and the postoperative Harris score increased to 58-92 (mean 79). At follow-up, 198 hips (69.5%) had excellent curative effect (Harris score>80); 70 hips (24.5%) had moderate efficacy (Harris score 70-79); 17 hips (6.0%) had poor curative effect (Harris score<69), 17 hips with poor curative effect progressed in stages and femoral head collapse in different degrees at follow-up.139 hips with articular effusion underwent arthroscopic surgery, and 87 hips underwent MRI at postoperative follow-up.It was found that articular effusion decreased in 59 hips.A total of 10 complications occurred in this group, and all of them recovered after symptomatic treatment.Conclusion Drilling decompression with small hole diameter and multiple holes is more advantageous, and low drilling rate is superior to traditional core decompression in decompression effect; Small aperture decompression reduces the damage to the femoral head and can effectively delay the occurrence of femoral head collapse; Compared with traditional core decompression, multi-channel decompression is more beneficial to improve the blood circulation in the necrosis area of the femoral head. Hip arthroscopy is beneficial to remove pain-causing substances in the hip joint, improve the disturbance of the intra-articular environment, remove free or stealthily stripped cartilage fragments, and improve the postoperative effect.

Objective to investigate the clinical effect of minimally invasive vascular pedicled bone flap transfer in the treatment of avascular necrosis of femoral head.Methods 232 cases were operated in our hospital with complete data, with unilateral onset, aged 22-55 years (mean 39.8 years). According to the Ficat staging criterion, 114 cases were divided into stage Ⅱ, 96 cases were divided into stage Ⅲ and 22 cases were divided into stage Ⅳ. 83 cases were transferred with iliac bone flap with ascending branch of lateral circumflex femoral vessel; Transfer of greater trochanter bone flap of the ascending branch of the lateral femoral circumflex vessel to the middle gluteus muscle branch; Transfer of 54 cases of trochanter flap with transverse branch of lateral circumflex femoral vessel; Combined with the transverse and ascending branches of the lateral circumflex femoral vessel, 29 cases of greater trochanter bone flap were transferred. The average length of the incision was 9.8 cm. The patients were followed up for an average of 39 months (10-62 months). Clinical evaluation was carried out according to Harris hip function score, and imaging evaluation was carried out according to the changes of Ficat stage before and after operation. The survival rate of Ficat stage IV was significantly lower than that of Ficat stage Ⅱ and Ⅲ, and the difference was statistically significant (P<0.01, P =0.0084). The digital subtraction angiography (DSA) evaluation before and after the operation of 56 sides of femoral head reconstruction showed that the vascular pedicle was well filled and the bone flap was rich in blood supply. From 16 to 58 months after operation, 23 patients were changed to total hip arthroplasty, including 4 cases of Ficat stage Ⅱ, 11 cases of Ficat stage Ⅲ and 8 cases of Ficat stage Ⅳ The early and middle follow-up results were satisfactory.

Objective to investigate the relationship between the polymorphism of exon 10 C923T (Ala308Val) of P47phox gene and cerebral infarction and its effect on blood lipids.Methods PCR-single-strand conformational polymorphism technique and direct DNA sequencing were used to detect the polymorphism of exon 10 C923T of P47phox gene in 110 patients with cerebral infarction, 10 family members with cerebral infarction and 100 healthy controls. Total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) were determined by enzymatic assay, apoA-I and apoB100 were determined by immunoturbidimetric assay, and serum levels of lipoprotein A were determined by enzyme-linked immunosorbent assay. Results There were three genotypes of C923T polymorphism in exon 10 of P47phox gene: CC, CT and TT. The frequency distribution of C923T polymorphism in cerebral infarction group and its subgroups was not statistically significant (P>0.05). The serum TG level of CT genotype was significantly higher than that of CC genotype in cerebral infarction group and control group (P<0.05). Conclusion C923T polymorphism of P47phox gene may not be related to the susceptibility of cerebral infarction, but it has some correlation with blood lipid metabolism.

Objective to compare the success rate of subclavian brachial plexus block in locating posterior and lateral bundles of brachial plexus. Methods Seventy patients who underwent elective upper limb surgery were randomly divided into lateral bundle group and posterior bundle group. The coracular approach proposed by Wilson was adopted, and the distal motor response innervated by lateral or posterior bundles of brachial plexus was triggered by nerve stimulator, and then 0.5% ropivacaine was given 30 ml. The blocking of 5 terminal nerves (median nerve, musculocutaneous nerve, radial nerve, ulnar nerve and medial cutaneous nerve of forearm) was recorded at 5 min, 10 min, 20 min and 30 min after administration, respectively. Results The success rate of block in lateral bundle group was 53.1%, and that in posterior bundle group was 78.9%, and the power of posterior bundle group was significantly higher than that in lateral bundle group (P<0.05). Conclusion The success rate of block after triggering motor response innervated by posterior bundle was higher than that after triggering motor response innervated by lateral bundle.

Objective to compare the difference of early cognitive dysfunction and serum S100b after arrest and non-arrest open heart surgery Methods Sixty patients undergoing open heart surgery were divided into arrest group and non-arrest group, who underwent arrest and non-arrest open heart surgery, respectively. Neuropsychiatric tests were performed on the first day before surgery and the seventh day after surgery, respectively. Blood samples were taken before surgery and 24 hours after surgery, and serum S100b protein was determined by enzyme-linked immunosorbent assay. Results The incidence of postoperative cognitive dysfunction in arrest group and non-arrest group was 42.9% and 34.8%, respectively, and the difference between the two groups was not statistically significant. There was no statistically significant difference in serum S100b concentration between arrest group and non-arrest group 24 hours after surgery.

Objective to investigate the difference of β-centrosomal actin expression in human hepatocellular carcinoma dendritic cells with different metastatic potential and its relationship with the phenotype and function of dendritic cells (DC). Methods Hepatocellular carcinoma with different metastatic potential was loaded with DC and unloaded DC as controls.The phenotype was detected by flow cytometry, and the function of DC was detected by mixed lymphocyte reaction; The results showed that HLA-DR, CD80, CD83 and CD86 were significantly higher in loaded DCs than in unloaded DCs (P<0.05). The difference of HLA-DR and CD1a in loaded DCs was not statistically significant, but the expression of CD86 and the ability of mixed lymphocyte response (MLR) in loaded DCs were significantly lower than those in other loaded DCs (P<0.05). Western blotting and immunochemical methods showed that β-centractin was not expressed in unloaded DCs, but the expression of β-centractin in loaded high metastatic hepatocellular carcinoma DCs was lower than that in other loaded groups, which was consistent with its performance in two-dimensional electrophoresis patterns. Conclusion The down-regulation of β-centractin expression in loaded high metastatic hepatocellular carcinoma DCs is related to the phenotypic and functional defects of DCs, which may be one of the mechanisms causing immune escape in hepatocellular carcinoma.

Objective to investigate the mechanism of bronchiolitis obliterans after lung transplantation and the significance of transforming growth factor (TGF) β 1/Smad3 signaling pathway in this pathological process.Methods Smad3 wild-type and knockout mice were used for allogeneic tracheal ectopic transplantation in an animal model of bronchiolitis obliterans, and the existence and difference of α smooth muscle actin (α SMA), a marker of myofibroblast differentiation, were detected by immunohistochemistry.Primary cultured Smad3 wild-type and knockout tracheal fibroblast cells were treated with TGF-β 1, and the activation of Smad3 protein was detected by immunofluorescence, Western blotting and DNA gel electrophoresis mobility detection.The polymerization ability of cytoskeleton and the different expression of α SMA molecule were detected by immunofluorescence staining; The differences in transcription and protein levels of α SMA were detected by Western blot and RT-PCR. Results Myofibroblasts were found in the affected airways with bronchiolitis obliterans, and the number of them in the wild type of Smad3 was significantly more than that in the knockout type (t =2.125, P =0.040). In vitro studies on fibroblasts, TGF-β 1 induced the activation of Smad3, which was manifested by protein phosphorylation, nuclear translocation and increased DNA binding. In the wild type of Smad3 fibroblasts, TGF-β 1 increased the cytoskeletal polymerization ability and the expression of α SMA at the transcription and protein levels, that is, the differentiation to myofibroblasts increased; The differentiation of myofibroblasts induced by TGF-β 1 was significantly reduced in fibroblasts lacking Smad3 (t =2.080, P =0.027; t =1.982, P =0.032). Conclusion TGF-β 1 promotes the transformation of fibroblasts into myofibroblasts and the increase of α SMA protein by activating Smad3-dependent signaling pathway, which eventually leads to the development of bronchiolitis obliterans.

Objective to investigate the feasibility of constructing implantable engineered liver tissue by combining hepatocytes with liquid type Ⅰ collagen. Methods SD rat hepatocytes were combined with liquid type Ⅰ collagen and DMEM to form hepatocyte/collagen gel complex. The complex was inoculated and cultured in culture plates. The morphological characteristics of cultured hepatocytes were observed by phase contrast microscope and HE staining, and the activity and function of hepatocytes were detected by MTT assay and immunohistochemical staining, respectively. Hepatocyte/collagen complex was implanted into the subcutaneous cavity at the same time to observe the differentiation of hepatocytes and the formation of engineered liver tissue. The implanted engineered liver tissue was evaluated by HE staining and immunohistochemical staining. Results Hepatocytes were combined with liquid type Ⅰ collagen to form a gel-like complex, which showed that hepatocytes were evenly distributed in the whole complex and showed three-dimensional growth. The activity of hepatocytes decreased slightly at the initial stage of culture, and remained 87% of the activity until the 7th day. After that, the activity decreased gradually with the prolongation of culture time. After 2 weeks of culture, hepatocytes still had albumin synthesis function. One week after subcutaneous implantation, hepatocyte/collagen complex formed engineered focal liver tissue, and immunohistochemical staining confirmed that this engineered liver tissue had albumin synthesis function. Conclusion Liver-like engineered liver tissue can be constructed in vivo by using collagen gel as a scaffold for hepatocyte growth and differentiation. This engineered liver tissue can provide a new approach based on hepatocyte therapy, and is expected to be used for repair and reconstruction of damaged liver tissue.

A 55-year-old male, farmer, was admitted to the hospital on July 26, 2006 due to "chest pain for more than 1 month, headache, vision loss and hearing loss for 20 days". The patient developed severe needle-like pain in the left chest after spraying herbicides (paraquat and acetochlor) more than 1 month before admission, which lasted for 4-5 days and then relieved spontaneously.

A 23-year-old female was admitted to the hospital on August 11, 2006 due to "recurrent fever and rash for 22 years, accompanied by headache for 17 years". The patient was 1 1/2 years old (July-August 1984) and developed fever without obvious trigger, with a maximum of 39~40 ℃, accompanied by rash, concentrated on the trunk, head and face periphery and around the nose, large maculopapular rash, red, not itchy and not painful. The fever started at 4 o'clock in the morning, and the fever started to decrease after 10 o'clock in the morning. The fever subsided and the rash disappeared, and the fever returned the next day. Antipyretic and analgesic drugs could temporarily reduce the fever. The 7-year-old (spring 1990) complained of headache, with fever and nausea. She went to the local hospital after the autumn of that year. At that time, she was examined for lumbar puncture, and was diagnosed as "infectious meningitis". Antibiotic treatment was ineffective. After 1 month of hormone treatment, there was no fever, rash and headache. She spontaneously stopped taking the drug for more than 10 days, and the fever, headache and rash appeared again, the condition was the same as before. She spontaneously and irregularly applied hormone (5 mg dexamethasone intramuscular injection) or antipyretic and analgesic drugs to treat it until now, and she has continued to have headache, intermittent fever and rash, and the fever subsided and the rash disappeared. With sore throat and conjunctival hyperemia.

Alzheimer's Disease (AD) is a neurodegenerative Disease characterized by progressive cognitive decline, including memory impairment and dementia. The main pathological features include senile plaque (SP) formed by β-amyloid protein (A β) deposition as the core of nerve cells, neurofibrillary tangle (NFT) formed by hyperphosphorylated Tau protein as the core of nerve cells and loss of nerve cells.

Bayes theorem is one of the important mathematical models of decision-making science, which was first proposed by Thomas Bayes in 1761. With the development of evidence-based medicine in recent years, the practical value of Bayes theorem in clinical decision-making has attracted attention.

Since 2000, the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE) have been working to reconstruct a new framework of Epilepsy knowledge. In 2001, after a brand-new revision of the vocabulary of Epilepsy nouns, a new classification of Epilepsy and a new diagnostic scheme were soon put forward [1-2]. In 2005, ILAE and IBE put forward a new definition to replace the previous concept of Epilepsy [3]. Interpretation of this new definition will help the domestic epileptic community to better connect with the International standards and deepen their understanding of the progress of Epilepsy research.

A 65-year-old female was admitted to hospital on April 6, 2006 due to chest tightness and shortness of breath after activity for 30 years, and obvious symptoms of angina pectoris in the past 2 months. The symptoms of the patient did not improve after taking nitroglycerin.

A 30-year-old pregnant woman with 2 pregnancies and 1 delivery was found to have short long bones in the limbs and narrow thorax after 28+4 and 19 weeks of menopause in 2004 and 2005, respectively. She was admitted to hospital for induction of labor with suspicion of achondroplasia and fetal abnormal syndrome.