Clinical teaching is an important link in cultivating clinician,Heuristic teaching can stimulate students'activeness of learning,enlighten their thoughts,arouse their positivity and creativity,find out their inner potential,and increase teaching effect.Intractable case discussion is an important method of heuristic clinical teaching,which can help strengthening theory knowledge,exercising correct clinical thinking,creating scrupulous scientism and satisfactory medical ethics.

Objective To discuss high dose methylprednisolone therapy in infantile spasm.Methods Sixty-six children with infantile spasm of the Third Affiliated Hospital of Zhengzhou University from Nov 2002 to Nov 2012,adopted intravenous methylprednisolone with 20 mg/(kg· d) for 3 to 5 days continuously,then changed to oral prednisone with 1 ～ 2 mg/(kg.d),4 ～ 8 weeks after drug withdrawal.The total course of 8 ～ 12 weeks of clinical curative effect was retrospectively studied.Results (1) Of 66 cases,51 cases were effective,total effective rate was 77.2％ ;28 cases achieved complete response,complete response rate was 42.4％.(2) The onset age had no influence on curative effect (P ＞ 0.05).(3) The beginning ages of the patients to use methylprednisolone therapy had no effect on curative effect (P ＞0.05).(4) Course of curative effect:23 cases within 2 months,the effective rate was 91.3％,43 cases more than 2 months,the effective rate was 69.7％.Difference of effective rate between the two groups had statistical significance (x2 =3.958,P ＜ 0.05).(5) Etiology of curative effect:50 cases of symptomatic,the effective rate was 78.0％,16 cases of cryptogenic,the effective rate was 75.0％ ;compared two groups,the effective rates had no statistical significance(x2 =0.008 7,P ＞ 0.05).(6) Long-term follow-up of 41 cases,14 cases had complete remission (34.2％),29 cases was effective(70.7％),3 cases had a recurrence (10.3％).Conclusion Application of methylprednisolone in the treatment for infantile spasm is simple,the recent control is effective,and it has a less adverse effect.The curative effect is related to the course,the shorter the duration,the better curative effect;and the long-term effect is good,the recurrence rate is low,the method can be recommended in clinical application.

Airway Remodeling ; physiology ; Animals ; Asthma ; metabolism ; Disease Models, Animal ; PPAR gamma ; biosynthesis ; Rats

Objective: To develop ~(99)Tc~m labeled dopamine transporter(DAT) imaging agent ~(99)Tc~m-(2?-[N,N~(,)-bis(2-mercaptoethyl)ethylenediamino]methyl,3?-(4-chlorophenyl)tropane(TRODAT-1) for evaluating changes of DAT in patients with Parkinson disease(PD). Methods: The SD rats were divided into control group(n=5),PD models group(n=22)and generalized cerebral infarction models group(n=5).~() Unilateral smashing and injecting autothrombo into carotid artery of SD rats were used.~(99)Tc~m-TRODAT-1 distributing in normal rat striatum was observed.The uptakes in sound side and smashed side of PD rats striatum and in two sides of multiple infarction rats striatum were compared. Results:~(99)Tc~m-TRODAT-1 distribution in normal rats striatum exhibited a obvious uptake in striatum.And PD rats results exhibited that the uptake was less in normal striatum than in smashed striatum obviously.The result of multiple infarction rats is same as normals rats. Conclusion: ~(99)Tc~m-TRODAT-1 might betaked specificly.Its imaging can provide a beneficial evidence for PD disease early diagnose.

Objective To investigate the expressions of Occludin in brain after bacterial meningitis and to discuss possible molecular mechanism of bacterial meningitis when brain edema occurs. Methods The models of bacterial meningitis and normal control were constructed via inoculating intracisternally with strain Ⅲ streptococcus pneumoniae and the same volume of normal saline solution, respectively. The expression of Occludin in brain was detected by immunohistochemistry and Western blot methods respectively and 24 h, 48 h and 5 days after inoculation. Results (1) Loeffler neurologic deficit score (NDS) in 24 h, 48 h and 5 d decreased significantly when compared with that of control group (P < 0.05). (2) After the brain received streptococcus pneumoniae injection, expression of Occludin began to decrease at 24 h and touch the bottom at 48 h,then increase at the 5th day, but still remained lower than that in control group, which indicated statistical difference (P < 0.05). Conclusions Expression of Occludin in the models of bacterial meningitis decreased firstly and then increased regularly. It suggests that Occludin plays a protective role during the development of infectious brain edema.

Objective To investigate the protective effect of melatonin and its possible mechanism for repairing in the immature white matter damage due to brain hypoxia-ischemia (HI).Methods Forty-eight three-day SD rats after birth were randomly divided into 3 groups:sham-operated(SHAM) group,HI group and melatonin treatment(MT) group.Periventricular white matter damage (PWMD) to animal models were estabished according to Rice modeling.MT group was treated with melatonin pre-operatively,immediately postoperation,1 hour postoperation and 24 hours postoperation via intraperitoneal injection,and the other groups were injected with the same volume of dissolvent.The rats were executed by decollation after 2 days and 14 days.The histological changes in periventricular white matter were observed by HE staining and immunohistochemistry.Results For the 3 groups,the structure in ope-ration side of the white matter in the peripheral ventricles of the brain 2 days postoperation were significant different (P ＜0.05).The O4 positive cells decreased one by one/greatest in the SHAM group[(75.548 ± 7.333)/hpf] followed by MT group [(59.971 ± 3.635)/hpf],and HI group [(40.511 ± 2.848)/hpf] (P ＜ 0.05).The expression of Casepase-3 increased in the SHAM group (107.724 ± 10.266),MT group (132.289 ± 8.537),and HI group (202.168 ± 14.367),and the difference was statically significant (P ＜ 0.05).Ventricular index was greater in operation side of the white matter in the peripheral ventricles of the 14-day-brain in the SHAM group(0.928 ±0.063),MT group (1.813 ± 0.110),HI group (2.752 ± 0.201),increasingly,while absorbance value of myelin basic protein decreased one by one in sequence(39.504 ± 1.673,21.729 ± 1.614,11.344 ± 1.118).Conclusions MT plays a role in protecting the periventricular white matter via inhibiting the apoptosis of oligodendrocyte progenitor cell,and thus benefits the PWMD.

Objective To investigate the expressions of aquaporin 4 (AQP4) in the bacterial meningitis in rats and to explore the molecular mechanism for brain edema caused by bacterial meningitis.Methods Totally 40 of 3-week-old-Sprague-Dawley healthy rats,body weight 60-80 g,male or female,were divided into a normal control group(n =10),and infection groups:24 hours after injection(n =10),48 hours after injection(n =10),and 5 days after injection(n =10).The expressions of AQP4 in the brain were detected by immunohistochemistry and Western blot methods respectively after 24 hours,48 hours,5 days of inoculation.Results Mortality rate:no rats in the control group and the infection group after 24 hours were dead.Two rats in the infection group after 48 hours and 4 rats in the infection group after 5 days were dead because of serious sickness,with the mortality rates 20％ and 40％,respectively.AQP4 expression was slightly positive under light microscope,and the positive cells mainly surrounded glial cells and blood vessels,while neurons were not dyed.Immunohistochemical staining showed that AQP4 expression in the model group increased with the severity of edema;compared with the control group,the AQP4 expression in the brain tissues increased in different periods after rats were infected,and the differences between groups were statistically significant (F--91.84,P ＜ 0.01).Western blot analysis showed that after the brain received streptococcus pneumoniae injection,expression of AQP4 began to increase in 24 hours after streptococcal injection,and reached to the peak in 48 hours,but decreased in 5 days,but the expression still remained higher than that of the normal control group.Each group had statistically significant difference(F =14.23,P ＜ 0.01).Conclusions Expression of AQP4 in the models with bacterial meningitis may increase initially and decrease later.It suggests that AQP4 plays a protective role during the development of infectious brain edema.

Objective Infantile spasms ( IS ) is the most common intractable epileptic encephalopathy during infancy,but there is the lack of animal experiment. By building IS animal model, the study discusses whether high-dose methylprednisolone has the protective effect on the immature rats of infantile spasms. Meth-ods Sprague-Dawley immature rats were randomly assigned to 3 groups on postnatal day 10 ( P10 ):control group、model groupⅠand model groupⅡ,thirty rats in each group. Immature rats in model groupⅠand mod-el group Ⅱ were injected NMDA intraperitoneally to induce seizures. The rats in the model groupⅡwere injec-ted intraperitoneally methylprednisolone on postnatal day 11,12 and 13. The clinical behavior of rats were ob-served and recorded. Neuronal apoptosis was detected by TUNEL. Immunohistochemistry and real-time PCR were used to analyze the expression of Bax,Bcl-2,caspase-3 in hippocampus. Results (1)83. 3% of rats in model groupⅠhad seizures,and none of rats in model groupⅡhad seizures on postnatal day 13. (2)The apop-totic cell number of brain tissues:model group Ⅱ( 14. 37 ± 2. 02 ) were lower than model group Ⅰ( 25. 67 ± 1. 52)and higher than control group(9. 00 ± 2. 50),the difference was statistically significant(all P<0. 05). (3)Bax protein and mRNA expression levels in model group Ⅱ(44. 55 ± 3. 58,2. 35 ± 1. 01)were lower than model group Ⅰ(58. 05 ± 4. 62,3. 27 ± 0. 95)and higher than control group (28. 90 ± 5. 14,1. 68 ± 0. 50),there was significant difference(all P<0. 05);(4)Caspase-3 expression levels of mRNA in model groupⅡ(5. 99 ± 1. 75) were lower than those in group model group Ⅰ(7. 88 ± 1. 60) and higher than those in control group (3. 60 ± 1. 70),there was significant difference(all P<0. 05). Conclusion High-dose methylprednisolone can reduce NMDA-induced seizures in the IS immature rats. High-dose methylprednisolone has protective effect on the NMDA-induced IS immature rats,which may be relation to weakening seizures and decreasing apoptosis.

Objective:To explore the feasibilitv of stereotactic minimally invasive aspiration of small thalamic bemorrhage.Methods:Twenty-two patients with small thalamic hemowhage(5 to 10 mL)were divided into two groups:a stereotactic group(n=10)and a control group(n= 12).The patients in the stereotactic group received stereomctic minimally invasive puncture and drainage of hematomas.According to the condition,repeated infusion of urokinase(10-20 kU) into the hematoma cavities were administered 12 hours after the procedure,and the hematomas were irrigated and drained so as to removal of them completely after retaining for 2-4 hours, The appropriate symptomatic treatment was administered in the patients in both groups.National Institutes of Health Stroke Scale(NIHSS)scores were determined 14 and 30 days before and after the treatment in all the patients.The reductiom of the NIJSS scores (as compared with those before treatment)were calculated at day 14 and 30 respectively after the treatment. Results:The reductiom of the NIHSS scores in the stereotactic group at day 14 and 30 were significantly higher than those in the control group.It was suggested that the neurological functional recovery of the patients was faster after stereotmtic minimally invasive puncture and drainage of intracranial hematorna in the stereotactic group.Concision:The stereotactic minimally invasive puncture and drainage of intracranial hematoma may significantly improve the outcome in patients with small thalamic hemorrhage.

Objective To compare the efficacy of adrenocorticotrophic hormone (ACTH) and methylprednisolone on the rat models of infantile spasms (IS).Methods The SD rats on postnatal 10 day (P10) were divided into blank group (n =18),control group (n =18) and model group (n =110) according to the random number table method.The rats of model group were prepared by adopting prenatal stress exposure and N-methyl-D aspartate (NMDA) injection.In the model group,after inducing epileptic seizures,the rats were divided into different groups (18 rats in each group) according to the random number table method as following:model group Ⅰ (subcutaneous injection ofACTH,50 IU/kg,at P10:14:00,21:00;P11,P12:7:00,14:00,21:00;P13:7:00),model group Ⅱ (subcutaneous injection of 9 g/L saline),model group Ⅲ (intraperitoneal injection of methylprednisolone,60 mg/kg,at P11,P12,P13:9:00,once per day),model group Ⅳ (intraperitoneal injection of 9 g/L saline) and model group Ⅴ (positive control group,with no drug or saline injection).Three days later,epilepsy was induced again,and the rats of model group were intraperitoneally injected with NMDA (12 mg/kg) at P13 (10:00).The rats of control group were injected intraperitoneally with same volume of 9 g/L saline,but the rats of blank group were not treated.Behaviors of rats with epilepsy seizures were observed and epilepsy scores were given.The expression of corticotropin-releasing hormone (CRH) in the hypothalamus of each group was detected by using immunohistochemistry and fluorescence quantitative polymerase chain reaction.The learning and memorizing capacity of the rats were measured by Y-maze experiment.Results There was no death in the model group after the onset of seizure.In the model group Ⅰ,13 cases were attacked(72.22％),and 14 cases were attacked in the model group Ⅲ (78.78％).The level of attack was decreased.The buckling state was not observed in model group and Ⅲ,but the latency period of epilepsy was prolonged and the epilepsy scores were significantly decreased.There were no significant differences of onset latency [(2 369.38 ± 628.70) s vs.(1 922.93 ± 462.36) s] and epilepsy score [(2.15 ± 1.14) scores vs.(2.07 ± 0.83) scores] between the 2 groups (all P ＞ 0.005).The rats of model group Ⅱ,Ⅳ,Ⅴ were all attacked completely and presented buckling state.There was no onset or death in blank group and control group.The number of CRH positive cells and CRH mRNA relative expression of each model group were higher than those in the blank group and control group.The number of CRH positive cells and CRH mRNA expression of model group Ⅰ and Ⅲ were lower than those in model group Ⅱ,Ⅳand Ⅴ,and the differences were significant (all P ＜ 0.002 4).There was no significant difference in the number of CRH-positive cells(39.12 ± 5.98 vs.41.48 ± 7.61) and CRH mRNA relative expression (1.92 ± 0.16 vs.2.06 ± 0.39) between model group Ⅰ and Ⅲ (all P ＞ 0.002 4).No significant difference was found between blank group and control group,or among model group Ⅱ,Ⅳ and Ⅴ (all P ＞ 0.002 4).There were no significant differences in the learning capacity among all groups (F =2.196,P ＞ 0.002 4).The correct response rate after 24 hours of the model group was lower than the blank group and control group,and ACTH and methylprednisolone pretreatment did not influence the memorizing capacity (P ＞ 0.002 4).Conclusion The effect of pretreatment of ACTH is similar to that of methylprednisolone in the rat model of IS.