Death of nerve cells after cerebral ischemia have a variety of forms,including cell necrosis occurs immediately in ischemic core area and the subsequent apoptosis and autophagy induced by oxidative stress and inflammatory response in the course of reperfusion.After cerebral ischemia,a variety of different molecular mechanisms eventually lead to cell death,and the process involves several signaling pathways.Intervention of different forms and mechanisms of cell death may alleviate cell death after cerebral ischemia.

Objective To study the clinical characteristics of atlanto-axial dislocation and instability caused by different reasons. Methods 388 cases of atlanto-axial dislocation and instability admitted between Jan 1975 and Apr 2000 were reviewed retrospectively. Results 262 cases were caused by anomaly, 71 by trauma and 55 by other reasons. 238/262 had bony deformity, including anomaly of odontoid process, atlanto-occipital assimilation, skull basilar invagination and some others. Simple anomaly of odontoid was the most commonly seen etiology. Myelopathy occurred at similar morbidity among each kind of patients. But patients who presented symptoms for longer time were more likely to have myelopathy. It is difficult to reduce chronic fractures of the odontoid process compared with the fresh fractures. 19 cases with chronic fracture suffered from severe myelopathy. Patients with chronic atlanto-axial fracture over 1 year were more likely to have secondary damage of spinal cord than those within 1 year. Conclusion Atlanto-axial dislocation and instability is more commonly caused by anomaly than trauma. Once the patients with atlanto-axial anomaly present clinical signs, they should be treated as soon as possible. Traumatic atlanto-axial instability should be treated at the early stage to avoid myelopathy.

Objective To evaluate the value in following up the patients with clipped aneurysms with the subtraction CT angiography technique.Methods 30 consecutive patients with clipped aneurysms were followed up with 64-slice spiral CT angiography (CTA) and DS angiography 10 d later postoperatively.CT images were reconstructed with volume rendering (VR) and maximum intensity projection(MIP) techniques to display the vessels.The site of the clip and patency of the parent vessel on both CT and DSA were studies independently by two radiologists.Results The clips in 27 patients were showed clearly by the subtraction CTA.Subtraction CTA demonstrated a partial remnant of aneurysm in 2,28 cases were complete occlusion.The loading vessels were free in passing in 28 cases,occlusion and narrowing of a parent vessel were seen in one respectively.The sensitivity and specificity in detecting neck remnants on MSCT angiography were 67% and 100%,and the sensitivity and specificity in evaluating vessel patency were 100% and 100%,Inter-observer agreements were 0.78 and 1.00,respectively.Conclusion Subtraction CT angiography can be used as the mainly method in following up the patients with clipped aneurysms.

Objective To supply safe mechanic refererence for reduction of thoracolumbar burstfracture with pediclc screws and lay biomechanic foundation for developing a new type of digitizing pediclc screws. Methods The change of stress and its scope of pediclc screws during reduction of thoracolumbar burstfracture were tested to determine the relationship of the degree of reduction with stress and strain. Results A total of 15 burstfracture specimens were obtained successfully. Stress was small and changed mildly at the beginning of reduction stage. Stress presented transparent elevation tendency at the stage of body height of 75% of intact until at the stage of 90%. When the height of vertebral body restored from 90% to 95%, the curve of stress changed gently. The maximum stress of left screw was 98.4?10.3 and the right was 101.2?13.4. The stress of bilateral screws did not differ significantly. It was calculated that the left strain was (34.64?3.84)N and the right one was (35.544?3.61)N, the moment was (5.20?0.58)Nm of the left and (5.33?0.54)Nm of the right. There was not significant difference between the strain and the moment of bilateral screws. Conclusion The safe range of reduction force is between 4.5Nm and 6Nm. The burstfracture of vertebral body can be both reduced successfully and prevented from overpropping.

Objective Summarize the lesion characters, procedure results and clinical follow up results of the elderly patients with coronary heart disease who underwent coronary angioplasty Methods 53 cases of coronary heart disease patients undergoing PTCA and stenting were ≥65 years old 35 were male, 18 were female 33 patients were diagnosed acute Q wave myocardial infarction, 2 patients acute non Q wave myocardial infarction, 14 patients unstable angina pectoris, and 4 patients coronary heart disease with severe heart failure PTCA and stenting were performed with conventional method, and temporary pacemakers were used if necessary Heparin was used if target vessel were involved in small vessels or the patients had multivessel diffuse lesions or PTCA was performed in more than one vessel Results Multivessel diffuse severe atherosclerosis was common in elderly patients The lesions were complex, and the procedures were difficult The success rate was 98% and the mortality was 11% during hospitalization 30 patients were follow up in 8 7?5 4 months, during which 11 (36%) patients had angina, 1 (3 5%) patients suffered acute myocardium infarction, 1 (3 5%) patient died of cerebral infarction, and the other 17 patients were asymptomatic Conclusion PTCA for the elderly patients is feasible The lesions in elderly patients with coronary heart disease are complex, the procedures are difficult and the mortality in hospitalization and the recurrent of ischemic chest pain are higher However, if we sufficiently estimate the lesion′s characters, PTCA can be safely performed in the elderly patients, and PTCA is the better method for elderly patients than medicine treatment

Birth defects are the abnormalities in structure,function or metabolism of embryonic or fetal development.They are the main cause of early abortion,stillbirth,perinatal mortality,infant mortality and congenital disabilities.Birth defects affect not only the health and life quality of children,but also the population quality of the whole country.This paper reviews the current epidemic situation and possible causes and risk factors of birth defects.It also expounds on the importance of epidemiological study on birth defects,possibility of primary prevention of birth defects,and necessity of interdisciplinary and collaborative research.It may provide reference for prevention and control of birth defects.

Objective To further confirm the role of lipid-peroxidation caused by oxygen free radicals injury played in the pathogenesis of dilsted cardiomypathy. Methods The superoxide dismutase activities and lipids composi tion of erythrocytes in 18 patients with dilated cardiomyopathy and 16 healthy controls were measured. Results ① Su peroxide dismutase(SOD) activites of erythrocytes were lower in dilated cardiomyopathy(DCM) patients than that in healthy controls (P ＜0. 001). ②The lipids composition of erythrocytes has changed in the DCM patients compared with healthy controls: total lipids changed little (P＞0. 05); total phospholipids were lower, but not significantly (P ＞0.05); total cholesterol increased significantly (P ＜0. 05). The cholesterol to phospholipids molecular ratio of erythrocyte membrane has increased remarkably (P＞0. 05). Conclusion It can be supposed that decreased SOD ac tivities play an important role in the damage of membrane system and the pathogensis of DCM.

Objective To explore the effects of the application of targeted surveillance in the Deparment of Neurosurgery. Methods Someone was specially assignedd to work out both process and outcome goals by means of perspective investigation, clinical groups were formed and information feedback, evaluation of effects and correction of deviation were regularly conducted. Results The process goals were obtained: from July 1996 to June 1997, the rate of hospital infection in the Department of Neurosurgery droppoed from 26.07% to 21.32% (x2 = 4.3465,P ＜0.05). The outcome goals were also obtained: from July 1997 to June 1998, the rate of infection dropped from 21. 32% to 13.40% (x2 = 16.1193,P＜0.01). Conclusion Targeted surveillance is a really effective form of surveillance and information feedback and evaluation of effects are indispensable. Application of targeted surveillance in the Department of Neurosurgery has won initial success.

Objective To investigate the prevention and treatment mechanism of liver-smoothing and spleen-srengthening formula on hyperplasia of mammary gland,we study the effects of it on morphology,histology,serum sex hormone and its receptor of rats with hyperplasia of mammary gland.Methods Sixty female Wistar rats(SPF)were randomized into 5 groups:control group,disease model group,the tamoxifen group,small dose of medicine group and large-dose drug group.Estradiol Benzoate and Progesterone were used to establish animal model of breast hyperplasia.Rats in different groups were respectively maintained with Tamoxifen,small and large dose of liver-smoothing and spleen-srengthening formula.Then changes of morphology,histology,serum sex hormone and its receptor were obtained.Results Liver-smoothing and spleen-srengthening formula could reduce the number of breast lobular and the expansion degree of adenovirus catheter.It also narrowed the acinar cavity.In serum of rats with breast hyperplasia,Estradiol(E2)and PRL were declined ;Progesterone(P)and Testosterone(T)were increased;FSH and LH were partly increased.Positive expression degree of ER and PR were inhibited obviously.Conclusion Liver-smoothing and spleen-srengthening formula can reduce not only the content of estrogen receptors(ER)and progesterone receptors(PR)but also their sensitivity to estrogen of rats with breast hyperplasia by regulating the serum sex hormone.Our studies suggest that it can obviously inhibit hyperplasia of mammary gland.

Objective To understand the trend of the constituent ratio of atrial fibrillation(AF)and primary etiology in hospitalized cases with chronic heart failure(CHF)and complicated with AF in late 20 years.Methods 1 180 patients with CHF(thereinto,440 complicated with AF)were selected from the hospitalized cases during the past 20 years(1983—2002),and a retrospective analysis was performed with every 5 years interval.Results The constituent ratio of AF in the general cases with CHF was 37.3%,and it was higher in females than in males(41.3% vs 33.4%,P