Ultrastructural changes of the inner cell mass (ICM) in rabbit blastocysts from 4 to 7 days post coitum (p.c.) were observed with transmission electron microscope. It revealed that ICM of blastocyst on day 5 p.c. began to differentiate after they were arranged into a single layer, and under which the primitive endoderm appeared. It is suggested that the primitive endodermal cells in rabbit blastocysts are derived from the scattered ICM-like cells at the inner surface of the mural trophoblast rather than delaminated from ICM proper. In this paper, disruption and disappearance of polar trophoblast are described and discussed.

[Objective]To explore the optimal time for the surgical operation on patients with ossification of the posterior longitudinal ligament of the cervical spine. [Methods]The clinical symptoms,the persistent time of the symptoms and the interval from exacerbation to operation in 168 patients with OPLL were analyzed.[Results]The average time was 27.6 months from the onset of myelopathy to the operation on patients with OPLL,and 17.4 months from the decrease of muscle strength in extremities to the operation,and 5.3 months from the symptomatic exacerbation of the extremities especially the decrease of muscle strength in lower extremities to the operation.[Conclusion]The patient should be treated earlier by surgical operation after his/her illness has been diagnozed as OPLL.It is the optimal time for surgical operation when the patient has imaging change of hypertrophy or ossification of the posterior longitudinal ligament and severe compression of spinal cord(more than 60% spinal canal stenosis),or the decrease of muscle strength in extremities especially in lower extremities.

Community-based rehabilitation (CBR) is positioned to provide various strategies for people with disabilities for achieving the embracing development of the community. CBR is also the terminal of the three-level rehabilitation service system. This paper analyzed the status of domestic community-based rehabilitation based on the document, discussed the possible problems referred to the international concepts about CBR, and suggested a new service pattern of CBR based on the internet and information technology.

BACKGROUND: It is difficult to conduct the operation of ossification of ligamentum flavum (OLF) in thoracic spine, and the operation needs complecated operative skill, and unmerited disposal tends to worsen neurological dysfunction.OBJECTIVE: To analyze the operative method for OLF of thoracic spineand functional restoration.DESIGN: Case analysis.SETTING: Department of Orthopaedics, Changzheng Hospital, SecondMilitary Medical University of Chinese PLA.PARTICIPANTS: Totally 56 patients with OLF of thoracic spine, whowere treated at the Department of Orthopaedics, Changzheng Hospital fromAugust 1996 to August 2003.METHODS: The operative therapy was performed in all the patients, and the method was determined by the results of MRI and CT examination: ①The 19 patients, whose OLF in thoracic spine was focal type, and range of lesion did not exceed two segments, were treated with simple resection and decompres sion in posterior wall of vertebral canal. ②Fenestration and sledging-allocating manipulation in the whole piece unilateral lamina of vertebra were carried out in 29 cases involving more than 2 segments. ③If coplanar OLF in thoracic spine combined with protrusion of thoracic spine disc or ossification of posterior longitudinal ligament, decompression of posterior midline approach+posterior lateral approach was performed, totally 8 cases.MAIN OUTCOME MEASURES: Post-operation functional restoration was evaluated with Epstein standard, excellent: recovery of sensation and exercise was near to normal; good: spinal cord function was improved significantly, and permitted to walk with brace; fair: small partial restoration of sensory and motor function, unable to walk; bad: Inefficiency or becoming severe.RESULTS: A total of 55 cases were followed up for more than one year and 1 case only for two months after operation. ①Functional restoration: excellent: 39 cases; good: 8 cases; fair: 5 cases; bad: 4 cases. ②Symptom recovery after operation was confirmed by disappearance of tight sensation, reduction of muscular tension, relieving of numbness in order. ③The recovery was rapid for 3 to 6 months after operation. Part of patients' condition was still ameliorating during one year after operation, and rare advancement 2 years later. The recovery of complete paraplegics was bad, so was the severe paraplegia with long history. CONCLUSION: Compressive myelopathy caused by OLF in thoracic spine should be treated in an earlier period by operation. Resection and decompression of posterior wall of thoracic spine and decompression of posterior approach could be choosed according to different condition.

Objectives To explore the humoral immunologic mechanisms of the susceptibility to invasive pneumococcal diseases (IPD) in asthmatic children. Methods Plasma samples were collected from 43 asthmatic and 20 non-asthmatic chil-dren. Anit-pneumococcal capsular polysaccharide (PPS)-IgG concentrations were measured by enzyme-linked immunosorbent assays. Results The mean concentrations of anti-PPS 14, 19A and 23F-IgG were signiifcantly higher in asthmatic children than in non-asthmatic children (P<0.05). The ratios of the asthmatic children who had anti-PPS 14, 19A and 23F-IgG concentrations higher than the protective antibody level (≥0.2 μg/ml ) were 100%for all the serotypes. Conclusions The immune responses of producing anti-PPS IgG to defense IPD were normal in asthmatic children. Asthmatic children may be more susceptive to pneumococcal infection or colonization than non-asthmatic children.

The forced oscillation technique (FOT) is a noninvasive method for respiratory mechanics measurement. For the FOT, external signals (e.g. forced oscillations around 4-40 Hz) are used to drive the respiratory system, and the mechanical characteristic of the respiratory system can be determined with the linear system identification theory. Thus, respiratory mechanical properties and components at different frequency and location of the airway can be explored by specifically developed forcing waveforms. In this paper, the theory, methodology and clinical application of the FOT is reviewed, including measure ment theory, driving signals, models of respiratory system, algorithm for impedance identification, and requirement on apparatus. Finally, the future development of this technique is also discussed.
Algorithms ; Electric Impedance ; Oscillometry ; Physical Therapy Modalities ; Respiratory Mechanics

Objective To explore the distribution and localization of LPGDS (Lipocalin-type prostaglandin D synthase) in rat testis and epididymidis and gain further insight into LPGDS potential function in male reproduction. Methods The expression of LPGDS in rat testis and epididymidis was assessed using RT-PCR and immunobloting. Using immunohistochemistry to explore the distribution of LPGDS in rat testis and epididymidis. Results None of the LPGDS studied was present in the testis of 2 month old SD rat. LPGDS was strikingly expressed in the caput epididymidis, while moderate to weak expressing was observed in the corpus and cauda epididymidis. The result of immunohistochemistry displayed that LPGDS was mainly localized within the cytoplasm and the cilia of the epithelial cells in rat epididymidis. Conclusion LPGDS was mainly distributed in epididymidis and localized with in the cytoplasm and the cilia of the epithelial cells. There was no LPGDS expressed in the testis of 2 month old SD rat, but it was strikingly expressed in the epididymidis, and the dose of expression was different, which suggested that LPGDS may play some kind of role during the process of the spermatozoa maturation.

Orthopaedic surgery is a fast developing subject in clinical surgery.Based on the characteristics of the orthopaedic surgery and aiming to enhance the medical students’practical ability of basic skills and clinical thinking we adopt the explorative clinical teaching which can be helpful to training students’initiative of finding and working out a solution by themselves and cultivating their capability of innovation and creation.

Objective To summarize the clinical results of posterior fusion plus pedicle screw fixation in treatment of dens fracture combined with recoverable atlantoaxial dislocation. Methods Twenty-seven patients with dens fractures combined with recoverable atlantoaxial dislocation were treated with posterior pedicle screw fixation, reduction and fusion. In this series of patients, skull traction was made to restore the normal atlantoaxial joint before the operation. Results Atlantoaxial alignment or stability were restored, without complication due to instrumentation. A follow-up for 12-48 months (average 24 months) showed osseous union. Conclusion Posterior aflantoaxial pedicle screw and rod fixation provides immediate three-dimensional rigid fixation of aflantoaxial joint and is a more effective technique compared with previously reported techniques.

Objective To explore the TCM syndrome distribution characteristics of central obesity hypertension patients; To analyze its correlation with urinary microalbumin/creatinine (MA/Cr) ratio; To provide some proof for an efficient way to control central obesity hypertension and prevent and cure its early renal injury with integrated TCM and Western medicine.Methods It was performed in a cross-sectional epidemiological study. The age, gender, height, weight, waist circumference, blood pressure, medical history and symptoms of 359 central obesity hypertension patients were collected in Shanghai. Then according to the four diagnostic methods, TCM syndromes were recorded. The urinary MA/Cr ratio, fasting blood glucose, fasting insulin and hs-CRP levels were detected.Results The urinary MA/Cr detectable rate in Shanghai among central obesity hypertension was 33.4% (120/359), men accounting for 56% and women 44%. Among central obesity hypertension patients, the HOMA-IR and hs-CRP level of urinary albumin group were significantly higher than those of normal group, with statistical significance (P<0.05). Among 359 central obesity hypertension patients, 140 people had phlegm-dampness syndrome, accounting for 39%, the largest part; 108 had liver-yang hyperactivity syndrome, accounting for 30%; 61 had yin-yang deficiency syndrome, accounting for 17%; 50 had yin-deficiency and yang-hyperactivity syndrome, accounting for 14%; the number of four TCM syndromes had statistical difference (P<0.05). Urinary MA/Cr ratio of the patients with phlegm-dampness syndrome was significantly higher than that of other three syndromes (P<0.05).Conclusion The incidence rate of early renal damage with central obesity hypertension patients is high in Shanghai area, and the early stage of renal damage is associated with insulin resistance and inflammatory reaction. Among central obesity hypertension, phlegm-dampness syndrome and liver-yang hyperactivity account for the majority, and patients with phlegm- dampness syndrome are more likely to have early kidney damage.