In the teaching course of the clinic neurology,how to explore and foster the capability of the students and how to take the co-acting teaching in neurological clinica1 education is a key point for our probing.

Objective　The poststroke depression(PSD) is a common complication in the cerebrovascular diseases.Methods　Having used the monoamine oxidase inhibitor,procaine hydrochloride composite film-coating tablets,we observed the Hamilton rating scale for depression(HAMD) and selfrating depression(SDS) of the patients with poststroke depression.Results　Two weeks late after the procaine hydrochloride composite film-coating tablets administrated,the scales of HAMD and SDS have been improved obviously.Conclusion　This investigation has suggested that the monoamine oxidase inhibitor can improve the depression of the patients with poststroke and be beneficial to the brain stroke.

The aim of our study wasto investigated the changesof NO concentration in the ischemic and reperfutional brain tissues and the relationship between the NO and brain damage.The animal models of middle cerebral artery occlusion were established by suture method.The changesof NO concentration were researched with method of Hb O2 -NO during the permanent ischemia and ischemia/ reperfusion.The results showed that the NO level in the injured brain tissue after3hours of ischemia was increased.After reperfusion,the NO level increased progressively,but NO level showed decreased and then increased during the permanent ischemia.Although there wasa decrease of NO level at7days after ischemia and reperfusion,but the NO level was higher than that of preischemia.It indicated that the changes of NO concentration during the different process of cerebral ischemia and reperfu- sion are related to the differentisoform of NOS,which have respective characteristic forsyn- thesizing NO in biochemistry,and deal with the cerebral ischemic and reperfusional injury.

EZH2 is the catalytic subunit of polycomb repressive complex 2 (PRC2),which represses gene expression by catalyzing lysine 27 of histone H3.It is overexpressed in prostate cancer,breast cancer,bladder cancer,gastric cancer and several other cancers.There is a close correlation between overexpression of EZH2 and progression of malignancy,invasion and migration of cancer cells.With a thorough understanding of the function,up and down stream regulatory mechanism and clinicopathological features,EZH2 will be expected to as a target and provide a new way for the treatment of cancers.

Background Oxidative damage is a major cause of age-related cataracts,and the ubiquitinproteasome system is involved in lens differentiation and development.Ubiquitin carboxy-terminal hydrolase L1 (UCHL1),one of key enzymes of ubiquitin-proteasome system,was discovered to participate in the age related diseases and oxidative stress damage. Objective This study was to investigate the effects of UCHL1 on the formation and development of age-related cataract. Methods Lens capsule were collected from 24 patients with age-related cataract(including 12 cases of cortical cataract and 12 cases of nuclear cataract) during the surgery.Five normal lens capsule membranes were obtained from eye bank of Tongji University.Human lens epithelial cells (LECs) line (SRA01/04) was also collected in this study.Expression of UCHL1 in the lens epithelial layer of different samples was assayed using immunofluorescence technology.UCHL1 eukaryotic expressing vector was constructed and transfected into cultured SRA01/04 by liposome,and green fluorescent protein (GFP) eukaryotic expressing vector was transfected at the same method as the control group.UCHL1 over-expressing cells were then exposed to different concentrations (0.2,0.3,0.4 and 0.5 mol/L) of tert-butyl hydroperoxide (TBHP) for 24 hours and subsequently monitored for cell viability evaluation by MTT assay. Results Immunofluorescence showed that UCHL1 was expressed in human lens epithelial layer,but significantly different expressing levels were seen among normal lens capsular membrane,cortical cataract and nuclear cataract ( F =13.411,P =0.000),and UCHL1 expressing levels were lower in cortical cataract and nuclear cataract than the normal lens (P =0.000,P =0.000).No significant difference was found in UCHL1 expressing level between cortical cataract and nuclear cataract ( P =0.164).Western blot analysis verified that UCHL1 exhibited a stranger expression in the UCHL1 transfected group compared with the GFP transfected group,illuminating a successful transfection of UCHL1 in SRA01/04 cells.MMT assay revealed that the A570/630 value in UCHL1 transfected cells was significantly elevated in comparison with GFP transfected cells following the treatment of 0.3 mol/L TBHP. Conclusions UCHL1 has an antioxidative ability,and it might plays an important role in the progress of age-related cataract.

Objective To evaluate the correlation between the elastic modulus of prostate and the degree of bladder outlet obstruction (BOO) in benign prostatic hyperplasia (BPH) patients in order to build a new non-invasive diagnostic indicator for BOO.Methods From november 2011 to November 2012,a total of 34 BPH patients were enrolled in this prospective study.Clinical information of the patients including age,international prostate symptom score (IPSS) and quality of life (QOL) were collected.The morphological features of prostate including total prostate volume,transitaion zone volume and transition zone index were detected by transrectal ultrasound (US),and prostate elastic modulus was detected using shear wave sonoelastograhy.After US examination,urodynamic study was performed by the urologist and pressure-flow curves were used to determine the diagnosis and the degree of bladder outlet obstruction.The correlation of prostate elastic modulus and other features including clinical information,morphological features and urodynamic features with the degree of bladder outlet obstruction were evaluated.ROC curves were evaluated.The feature with the best diagnostic performance was obtained,the diagnostic values of which were calculated.Results 9 patients had no BOO,with the average prostate elastic modulus of (27.3±5.0) kPa; 12 patients had mild to moderate BOO,with the average prostate elastic modulus of (30.7±2.8) kPa; 13 patients had severe BOO,with the average prostate elastic modulus of (34.7±2.4) kPa.The prostate elastic modulus had higher correlation coefficient with the degree of bladder outlet obstruction than the other features (r =0.754,P=0.000).It also had the highest AUC of 0.853 (95％CI 0.720-0.986).At a cutoffof 31.65 kPa,the sensitivity,specificity and accuracy of the prostate elastic modulus for the diagnosis of BOO were 72％,90％and 81％ respectively.Conclusion The prostate elastic modulus is highly correlated with the degree of bladder outlet obstruction,which might serve as a novel,promising indicator to evaluate BOO in BPH patients.

Objective To explore the effect of different doses of irbesartan on osteopontin expression and fibrosis in diabetic rat kidney. Methods Sixty-three g-week old male Wistar rat were randomly divided into control group (Ctrl group,n=7),diabetes group (DM group,n=14),30 mg·kg-1d-1 hydralazine administrated group (DM+Hyd group,n=12),25 mg·kg-1·d-1 irbesartan administrated group (DM+Irb25 group,n=10),50 mg·kg-1 ·d-1 irbesartan administrated group(DM+Irb50 group,n=9) and 200 mg·kg-1·d-1 irbesartan administrated group (DM+Irb200 group,n=11).Four weeks after modeling,rats were administered with the corresponding dose of irbesartan.After 12 weeks,urinary albumin excretion rate (UAER),endogenous creatinine clearance rate (Ccr) were measured; morphology and collagen deposition in rat kidney were observed by PAS and Masson staining respectively; Ang Ⅱ content in kidney was measured by ELISA; renal tissue TGF-β1 and OPN mRNA expression were detected by real-time PCR. Results UAER and Ccr in the intervention groups of irbesartan were significantly decreased compared with DM group (P＜0.05).UAER and Ccr in DM+Irb200 group were significantly lower than those in DM+Irb25 group and DM + Irb50 group (P＜0.05).Glomerular hypertrophy,mesangial matrix expansion,tubular lesions and deposition of collagen fiber were siginficant in diabetic rats compared with Ctrl,and prevented after administration with different doses of irbesartan.Ang Ⅱ protein level and TGF-β1,OPN mRNA expression in renal tissue of diabetic rats were significantly higher than those in Ctrl group.Ang Ⅱ,TGF-β1,and OPN mRNA expression was significantly reduced after administration with different doses of irbesartan,and with the increase of irbesartan,the above indicators were decreased P＜0.05).Renal local Ang Ⅱ level was positively correlated with OPN mRNA expression (r=0.74,P＜0.01). Conclusion Irbesartan reduces renal TGF-β1,OPN mRNA expression by decreasing kidney local Ang Ⅱ in dose-dependent manner,and eventually reduces tubulointerstitial fibrosis,which plays a role in kidney protection.

Objective To assess the alterations of the systolic peak radial strain (RS) and the time to systolic peak radial strain(TRS) in ischemic myocardial segments with different extent of coronary artery stenosis using three-dimensional ultrasound speckle tracking imaging(3D-STI).Methods RS and TRS of 16 left ventricular segments were analyzed by 3D-STI in 87 patients,every left ventricular segment of all patients were divided into 5 groups according to coronary stenosis based on the results of selected coronary angiography:normal,≤25 ％,＞25 ％ - ≤50 ％,＞50 ％ - ≤ 75 ％,＞ 75 ％.All times were corrected by heart rate.Results In the coronary normal group,coronary stenosis extent ≤25％ group and coronary stenosis extent ＞25％ - ≤50％ group,the variance of RS was non-significant( P ＞0.05).Compared with the coronary normal group,coronary stenosis extent ≤25％ group and coronary stenosis extent ＞ 25％ -≤ 50％ group,RS was decreased in groups of coronary stenosis ＞50％ - ≤75％ and ＞75％.Between the coronary normal group and coronary stenosis extent ≤25 ％ group,the variance of TRS was non-significant( P ＞0.05).Compared with coronary normal and coronary stenosis extent ≤25 ％ group,TRS was increased in groups of coronary stenosis ＞25％ - ≤50％,＞50％ - ≤75％,＞75％.Compared with group of coronary stenosis ＞ 50％ -≤ 75％,TRS was shorter in group of coronary stenosis ＞ 75％,some variance was significant( P ＜0.05).Conclusions The RS was decreased along with the coronary stenosis increase,but TRS was increased along with the coronary stenosis increase.There is a tendency that TRS was decreased when the coronary stenosis is more than 75 ％ compared with the coronary stenosis ＞50％ - ≤75 ％ group.3D-STI can access the regional radial systolic function of the ischemic myocardial segment.

Objective To investigate the potential and early effect of hypertonic saline resuscitation on Tlymphocyte subpopulations in patients with traumatically hemorrhagic shock.Method Eighty-two patients with acute traumatically hemorrhagic shock admitted from Department of Emergency，Beijing Tongren Hospital，from De cember 2006 to July 2008 were randomly divided into：hypotonic saline(HS)group(n=43)and Lactated Ringer's solution(LR)group(n=39).The criteria of eligible patients were systolic blood pressure＜90mm Hg at admission with definite evidence of blood loss.Patients with immune system diseases and those who died within 24 hours of admission were excluded.Patients in HS group received intravenous administration of 200 mL of 7.5% sodium chloride withhin 15～20 minutes，and LR group received routine therapy with Lactated Ringer's solution.Blood pressure and heart rate were recorded 10，20，and 60 minutes after the start of resuscitation and compared between two groups.Before and 24 hours after treatment，peripheral blood levels of T-lymphocyte subpopulations including CD3+，CD4+，and CD8+ were measured by using direct immunofluorescence test and compared between two groups.The inter-group comparison was carried out by using independent sample t-lest and intragroup comparison using paired t-test.The numabers of operation，complication cases and death cases were conducted by using X2 test.SPAS version 11.0 software was used for statistical analysis.Results The volume of solution infused in HS group was(3820±623)mL and in LR group was(5430±1254)mL(P＜0.05).At 10 and 20 minutes after the sdministration of solution.the mean blood pressures in HS group were both significantly higher than those in LR group(P＜0.01).The levels of CD3+and CD4+lymphocytes in peripheral blood in HS group 24 hours after treatment were sinificantly higher than those in LR group(P＜0.01).Totally，63(76.8%)patients were cured and 19(23.2%)patients died.ARDS occurred in 10 patients and MODS occurred in 14 patiellts.The mortality，and the rates of ARDS and MODS in HS group were sinificantly higher than those in LP group(P＜0.05).Conclusiom In patients with acute traumatically hemorrhagic shock.HS can increase the effective circulating vol. ume，ameliorate the perfusion of tissues and organs，improve the immune fuction of T-lymphocytes，decrease the rats of ABDS and MODS，mad decrease the morality.HS is more effective than routine solution used for resuscitation.

Objective Analyse the influencing factors of early enteral nutrition support in patients of severe acute pancreatitis( SAP). Methods From April 2006 to August 2008, a total of 57 patients with SAP were analyzed in two aspects:the APACHE II scores, Ranson scores, Balthazar CT scores, and some frequent complications (shock, MODS, ACS, severe sepsis, paralytic ileus, etc.) were compared in two groups of A(≤5 d) and B( >5 d) according to the initial time of enteral nutrition:Hie initial timing of entend nutrition,the above scores and complications were also compared in two groups of nasojejunal feedingtube and jejunostomy feeding tube. Results The APACHE H scores, Ranson scores, Balthazar CT scores and the incidence of shock, MODS and ACS in group A were significant higher than those in group B; The APACHE II scores, Ranson scores and Balthazar CT scores in group of nasojejunal feeding tube were significant lower than those in group of jejunostomy feeding tube, and the initial time of enteral nutritionin nasojejunal feeding tube was significantly earlier. Conclusions Early enteral nutrition support in SAP is influenced by multiple factors, especially of pathogenetic severity, severe complications and feeding pathways.Homeostasis and intestines functions recover are the sign of enteral nutrition initiation, and to carry out enteral nutrition in ≤5 d after admission is feasible.The APACHE II scores may be helpful to guide the time of EN start.