BACKGROUND: Selective posterior rhizotomy has been extensively acknowledged as an effective method of relieving lower limb spasticity in cerebral palsy. However, the postoperative complications such as reduced muscle strength and imbalance of the spine are of concern among surgeons and therapists. The combination of limited selective posterior rhizotomy (LSPR) with adductor tenotomy can decrease these complications without compromising the treatment effects.OBJECTIVE: To investigate the effects of combination therapy of LSPR with adductor tenotomy on lower limb spasticity, gait and movement of the patients.DESIGN: A self-controlled trial and observational follow-up taking children with cerebral palsy as the subjects.SETTING: Orthopedic Department of First Hospital Affiliated to Dalian Medical University.PARTICIPANTS: Thirty children patients with cerebral palsy treated in the Orthopedics Department of the First Affiliated Hospital of Jilin University from January 2001 to December 2002 were recruited in this trial. They presented scissors gait, flexed knee and tiptoeing of different degree. There were 18 cases of brisk tendon reflex and ankle clonus, and 15 cases of positive Babinski' s sign. All the patients had no immobile soft tissue contracture and could either accomplish walking and crouching independently or walk with arms on assistant devices.INTERVENTIONS: The patients received LSPR of L5 and S1 dorsal roots together with bilateral adductor tenotomy. Muscle tone and strength, knee and Achilles tendon reflexes, ankle clonus and pathologic signs were recorded before and after operation. X-ray examination on lumbar spine and pelvic was also taken for detection of deformity. The patients' movements were assessed according to their standing and walking postures, standing and crouching movements before operation and on follow-up. During follow-up all the mentioned indices were recorded by reference to the original case history, hospital reexamination and correspondence with the patients.MAIN OUTCOME MEASURES: The amelioration in lower limb spasticity and grading of lower limb()movements.RESULTS: During the follow-up for six months to three years(the mean of 11 months), the patients' lower limb spasticity was decreased by 2. 5 grades. The gait was also improved with disappeared scissors gait and tiptoeing, knee flexion was improved and the patients could walk with heels on the ground. All ankle clonus and pathologic reflexes disappeared. The brisk knee reflex in 12 patients became sluggish after operation. There was no decrease in lower limb strength or permanent hypesthesia. X-ray examination of lumbar spine and pelvic showed no deformity in 9 patients after over 2-year follow-up. The upper limb spasticity, salivation and aphasia in 8 patients were also ameliorated. The grading for postoperative standing, walking and crouching-standing alternation[(4.25±0.91), (3.92±0.65) and(4.02±0.74)] wasimproved(t=2.04-2.98, P ＜0.05-0.01).CONCLUSION: The combination of LSPR with adductor tenotomy can effectively ameliorate lower limb spasticity and movement with decreased operative damage.

Objective To observe the effects of aerobic exercise on the plasma content of homocysteine (Hcy),total nitric oxide synthase(T-NOS) and nitric oxide (NO) in rats fed a high methionine diet. Methods A total of 24 male Wistar rats were randomly divided into a normal diet(CR)group,a high methionine diet(MR) group and a high methionine diet plus swimming group(T+MR),and treated accordingly for 8 weeks.At the end of the treatment,all the animals were tested for plasma T-NOS,NO and homocysteine levels.Results Plasma homo-cysteine doubled,whereas T-NOS and NO levels in the MR group decreased significantly as compared with the CR group,suggesting that hyperhomocysteinemia was induced by the high methionine diet.Plasma homocysteine content decreased significantly in the T+CR group,but plasma T-NOS and NO increased significantly compared with the MR group.These indicators were not significantly different for the T+MR group from those of the CR group. Conclu-sion Adequate aerobic exercise can decrease the plasma level of homocysteine in rats fed a high methionine diet,and increase the plasma level of T-NOS and NO,helping prevent the development of hyperhomocysteinemia.

Aim To investigate the effects of miR-122a on blood-spinal cord barrier after spinal cord ischemia-reperfusion injury in rats.Methods Thirty-six SD rats were randomly divided into three groups:group of sham(S group),group of control(C group)and group of miR-122a antagomir(M group).Rats in S group were subjected to exposure of aorta arch but without occlusion.Spinal ischemia-reperfusion injury was induced by clamping the aorta arch for 14 min in C group and M group.Rats in M group and C group were intrathecally injected with miR-122a antagomir or antagomir control daily for three times after injury.The miR-122a expression in injured spinal cord tissue was detected by real-time PCR.The occludin expression in injured spinal cord tissue was detected by Western blot.The permeability of blood-spinal cord barrier was examined using evans blue as a vascular tracer.The neurological motor function was evaluated by Basso Beattie Bresnahan score.Results Compared with S group,the expression of miR-122a was increased,the expression of occludin was decreased,the permeability of blood-spinal cord barrier was increased,and neurological motor function score was decreased significantly in C group(P<0.05).Compared with C group,the expression of miR-122a was decreased,the expression of occludin was increased,the permeability of blood-spinal cord barrier was decreased,and neurological motor function score was increased significantly in M group(P<0.05).Conclusion miR-122a can regulate the expression of occludin and change the permeability of blood-spinal cord barrier.

Objective To analyze the colonization of Candida, Rhodotorula, Penicillium and Aspergillus in skin surfaces of patients with atopic dermatitis, and to assess the relationship between the four common fungal allergens and severity of atopic dermatitis. Methods Fifty patients with atopic dermatitis and 20 healthy controls were enrolled. Scales were scraped from lesional and non?lesional skin of flexural extremities of the patients, as well as from normal skin of the flexural elbow of healthy controls, then were subjected to microscopic examination and culture. Scale specimens were inoculated onto Sabouraud dextrose agar medium and cultured at 25 ℃ in a constant temperature incubator. Subsequently, suspected fungal or yeast?like colonies were collected for pure culture. Finally, fungal strains were identified according to colony morphology, color, growth speed, as well as microscopic features of spores and hyphae. Results No hyphae or pseudohyphae were found in any case by microscopic examination. Candida albicans and Rhodotorula were detected in 29(58%)and 17(34%)out of the 50 patients, respectively, and in 5(25%)and 2 (10%) out of the 20 healthy controls, respectively. The detection rates of Candida albicans and Rhodotorula were significantly higher in the patients than in the controls(χ2=6.23, 4.10, respectively, both P<0.05). Of 25 patients with severe lesions, 19(76%)and 12(48%)were colonized by Candida albicans and Rhodotorula respectively;among 25 patients with moderate lesions, 10 (40%) and 5 (20%) were colonized by Candida albicans and Rhodotorula respectively. An increase was observed in the detection rates of Candida albicans and Rhodotorula in the patients with severe lesions compared with those with moderate lesions(χ2=6.65, 4.37, respectively, both P<0.05). There was no significant difference in the detection rate of Penicillium or Aspergillus between the patients and health controls. Conclusion The colonization rates of Candida albicans and Rhodotorula on skin surfaces were higher in patients with atopic dermatitis than in healthy controls, and higher in patients with severe lesions than in patients with moderate lesions, indicating that the types of colonizing fungi are associated with the health status of skin and severity of symptoms in patients with atopic dermatitis.

Objective To establish the suspension cell line of Atractylodes lancea and to study the effect of two endophytic fungal elicitors on its essential oil production.Methods The essential oil was extracted by using ultrasonic wave after suspension cell was treated with endophytic fungal elicitors.Then,the determination of four compounds(atractylone,hinesol,?-eudesmol,and atractylodin) was carried out by gas chromatography.Results By testing in various conditions,the suspension cell line with a rapid growth rate was established.Its highest biomass(6.95 g/L) was obtained on day 21.?-Eudesmol was the only detection in the control suspension cell,and its highest content(17.469 ?g/g) was also reached on day 21.The effect of crude elicitors of two endophytic fungi(belong to Cunninghamella sp.and Gilmaniella sp.respectively,named AL4 and AL12) on the cell growth and the production of essentia1 oil were investigated.Overall AL4 elicitor got better effect.When suspension cell of 14-day-old cultures was exposed to AL4 elicitor(carbohydrate 20 mg/L medium) for 7 d,the biomass increased 3.31% over the control,and the four compounds(atractylone: 14.715 ?g/g,hinesol: 28.395 ?g/g,?-eudesmol: 38.794 ?g/g,and atractylodin: 8.310 ?g/g) were all detected.Among them,the content of ?-eudesmol reached 2.22 times as much as the control.Conclusion The cell growth and the accumulation of essential oil of A.lancea could also be promoted by adding crude elicitors of the endophytic fungi AL4 and AL12.

Carcinoma, Papillary ; classification ; pathology ; surgery ; Humans ; Neoplasm Recurrence, Local ; Urinary Bladder Neoplasms ; classification ; pathology ; surgery ; Urothelium ; pathology ; surgery ; World Health Organization

Objective To establish the weights of risk factors indicators for lower limbs deep vein thrombosis through the scientific research methods.Methods 21 experts were consulted for two rounds of questionnaires survey with Delphi method,according to the experts'opinion,analytic hierarchy process (AHP) was used to calculate the weights of indicators in grade one and the experts'evaluation was used to calculate the weights of indicators in grade two.Results The weight coefficients of grade one including vascular endothelial injury,blood high condensation state and slow blood stream were 0.3325,0.5278 and 0.1396 respectively.The items with maximal weights of the 21 indicators in grade two was vascular trauma,in particular vein injury(0.0770).The Kendall's W of the indicators in grade two was 0.422.Conclusions Through qualitative and quantitative research methods,the risk factors indicators which provide the reference for the prevention of lower limbs deep vein thrombosis are scientific and reliable.

Objective To compare the changes of detrusor physiological properties between the models of detrusor instability caused by neurogenic, obstructive and idiopathic factors. Methods Eighty female SD rats were enrolled in our study, including 17 rats of idiopathic detrusor instability (IDI), 33 for bladder outlet obstruction (BOO) by partial ligation of bladder outflow tract, 20 spinal cord injury (SCI) by transection of spinal cord at L1-2, 10 as normal control. Six weeks after insult, the change of detrusor excitability, autorhythmicity and contractility were examined by means of cystometry and the in vitro detrusor strip study. Results The occurrence rate of detrusor instability in BOO rats, SCI rats and IDI rats was 75.9%, 100% and 21.3%. The rats in three DI groups increased more significantly in excitability, autorhythmicity and contractility than control rats (P0.05). Conclusion Different types of DI have similarity in the detrusor myogenic changes, while the increase in spontaneous excitability of detrusor strip seems to be more important than others factors in the mechanism of DI.

Objective To investigate the value of urodynamic parameters in diagnosing female bladder outlet obstruction.Methods By follow-up investigation,36 out of 54 patients who underwent transurethral vesical neck incision for female bladder outlet obstruction(FBOO)were proven to achieve good therapeutic efficacy,so the clinical diagnosis as FBOO made before treatment was regarded as correct,as FBOO group.Anther 29 asymptomatic healthy female subjects were selected as controls.ROC curve was used to analyze the urodynamic parameters.Results The area under curve,cutoff for diagnosis and their sensitivity and specificity of the parameters were as follows:Q_ max:AUC=0.823,Q_ max≤15 ml/s(SEN=87%,SPE=81%);PdetQ_ max:AUC=0.826,PdetQ_ max≥28.5 cmH_ 2O(SEN=76%,SPE=72%);A-G value:AUC=0.922,A-G value≥1.1(SEN=86%,SPE=86%).Conclusion When Q_ max≤15 ml/s,PdetQ_ max≥28.5 cmH_ 2O and A-G value≥1.1,FBOO is likely to occur in female.

BackgroundRetinitis pigmentosa (RP) has the genetic and phenotype heterogeneity.To determine the disease-causing gene is a foundation of gene therapy.Objective This study was to localize the pathogenic gene and screen the gene mutation associated with Han Nationality autosomal dominant retinitis pigmentosa (ADRP) in a Chinese family.MethodsTwenty-one families enrolled this study,including 12 patients with ADRP and 9 individuals with normal phenotype.Perimetry,fundus examination,electrooculogram ( EOG ) and electroretinogram (ERG) were performed in 12 patients.Genetic linkage analysis was performed on the subjects in all known genetic loci related to ADRP with a panel of microsatellite markers.Subsequently,the mutation screening of rhodopsin gene was screened by direct DNA sequencing.This study was approved by Ethic Committee of Zhongnan Hospital of Wuhan University.Informed consent was obtained from each subject.ResultsThe fundus appearance of the proband was in accordance with the ADRP,and the EOG and ERG showed undetectable.Contractive visual field also was exhibited in the proband.Linkage analysis showed that the maximum logarithm of the odds(LOD) score reached 3.6671 at marker D3S1292 at recombination fraction θ =0.0.The results of direct DNA sequencing revealed a C→ G transversion mutation at codon 53 in exon 1 of rhodopsin gene,which resulted in a proline to arginine change (Pro53Arg) in 12 patients.However,no similar mutation was found in the unaffected members of this family.ConclusionsThe missence mutation Pro53Arg in rhodopsin gene cosegregate with the RP disease.It is determined to be a pathogenic factor of this ADRP family.