BACKGROUND: With the development of thrombolysis therapy in recent years, there has been an increasing focus on the protective effect of ischemic reperfusion injury (IRI) and its mechanism at home and abroad,and aspirin is of great importance in the treatment of thrombus diseases owing to its powerful antiplatelet aggregative activity.OBJECTIVE: To explore the protective effect of aspirin on the gerbil brains with IRI and its influence on the intercellular adhesion molecule (ICAM) and calcitonin gene-related peptide (CGRP) expressions.DESIGN: A randomized controlled animal experiments.SETTING: Department of Neurology, Jinan Municipal Central Hospital,College of Clinical Medicine, Shandong University.MATERIALS: The experiment was performed at the Physiological Laboratory of Taishan Medical University from December 2001 to June 2002.Sixty-three healthy male gerbils of Mongolian specimen were randomly assigned into sham group, IRI group and aspirin group with 21 in each group. And each group was further divided into three subgroups according to the time after IRI: 24 hours, 3 days and 7 days, with 7 gerbils for each.METHODS: The models of global brain IRI were established by bilateral carotid artery occlusion. Sham group: The unfolded bilateral carotid artery was not occluded; IRI group: The unfolded bilateral carotid artery was occluded by bulldog clamp for 7 minutes, and then the blood circulation was recovered by removing the clamp. Aspirin group: Before the operation,50 mg/kg enteric-coated aspirin was infused via gastric canal. And the same procedures as IRI group were performed. The gastric infusion of aspirin was given daily until the gerbils were executed at 24 hours, 3 days and 7 days after IRI for brain tissue examinations. The immunohistochemistry SABC method was applied to detect the changes of ICAM 1 and CGRP expressions as well as the influence of aspirin on the two.MAIN OUTCOME MEASURES: The expressions of ICAM and CGRP in brain tissues.RESULTS: A total of 63 gerbils were involved in the result analysis.①Changes of ICAM expression: In IRI group, the expression of ICAM began to increase at 24 hours after IRI,enhanced remarkably at 3 days and maintained at high levels at 7 days,with the significant difference compared with sham group [IRI group: (3.36±2.26)%, (5.68±3.13)%, (4.98±2.10)%; Sham group: (1.53±1.07)%, (1.56±1.23)%, (1.62±1.33)%, P ＜ 0.05];However,the ICAM expression was significantly lower in aspirin group than in IRI group at different time points [(0.96±0.83)%, (2.76±2.10)%,(1.96±1.09)%, P ＜ 0.05].②Changes of CGRP expression: At the different time points after IRI,the CGRP expression was weakly positive in IRI group [(3.12±2.26)%, (2.68±2.04)%, (2.57±1.97)%], but strongly positive in aspirin group [(4.98±2.47)%, (5.97±2.35)%, (6.04±2.40)%].CONCLUSION: IRI can increase the ICAM 1 expression while inhibit the CGRP expression; Aspirin can make great impacts on brain protection by inhibiting ICAM 1 expression and reinforcing the CGRP expression.

Objective To study the effects of flunarizine on the contents of SOD、 MDA、 NO、 NOS in serum and brain tissue and pathological changes in gerbils of ischemia-reperfusion cerebral injury. Methods Twentyone gerbils were randomly divided into three groups: ischemia-reperfusion group, flunarizine pretreatment group and control group. There were seven gerbils in each group. The levels of SOD, MDA, NO and NOS in the serum and brain tissue were determined, and pathological changes of brain were observed by microscopy. Results It was found that the group of ischemia-reperfusion had characteristic changes of ischemia-reperfusion injury. Compared with the control group, serum and brain contents of MDA, NO and NOS were higher but the content of SOD was lower,and the differences were significant(all P

Objective To investigate the expression of heat shock protein 70(HSP70) and c-fos,the presence of apoptosis and the neuroprotective effects of Cudrania tricuspidata root extrate(Ecr) after focal cerebral ischemic reperfusion in rats.Methods Models of middle cerebral artery occlusion(MCAO) were used in this study.The rats in Ecr pretreated ischemia reperfusion(IR) group were fed with Ecr(2 ml tid) for 5 days before MCAO.The brain specimen were took at different reperfusion times: 1 h,6 h,12 h,24 h,3 d and 7 d after recirculation.Then immunohistochemistry,insitu hybridization,terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling(TUNEL) were used to detect the expression of HSP70,c-fos gene and cell apoptosis in the brains.Positive results were semiquantitatively analyzed.Results IR could induce the expression of HSP70 and c-fos.HSP70 was detected at 6 h following reperfusion and peaked at 24 h both in cortical and basal ganglia regions.c-fos was markedly expressed at 1 h and the level peaked at 6 h in the ischemic hemispheres,and then reduced gradually.The TUNEL positive cells were markedly observed at 6 h.After treatment with Ecr,the positive reaction cells both of HSP70 and c-fos were significantly increased(all(P

Objective To study the protective effect and molecular mechanism of trypsin inhibitor on reperfusion injury after cerebral ischemia. Methods The model of ischemia for 1h and repufusion for 24h of rat cerebrum was set by ligating MCAO described by zea-longa. 24 male rats were divided randomly into the sham operation group, the control group and trypsin inhibitor group. The presence of neurological function deficit was measured by Zea-Longa method, and the immunohistochemical staining and TUNEL were used to detect p53 protein expression and cell apoptosis in the brain tissues respectively. Results The score of neurological function deficit was zero in the sham operation group, 2 8?1 0 in the control group and 1 3?0 7 in trypsin inhibitor group. There were 12 3?2 5 p53 immunostaining positive cells in the control group and 5 5?1 3 in trypsin inhibitor group. The number of apoptotic cells was zero in the sham operation group, 7 6?1 0 in the control group, and 3 5?0 9 in trypsin inhibitor group. There was a significant difference in all above observing indices between the control group and trypsin inhibitor group(P

Objective To develop pain assessment scale for cognifively impaired elderly (PACIE) and to test its reliabihty and validity. Methods Based on the foreign related pain assessment tools, the pain as-sessment scale for cognitively impaired elderly was developed. Five experts specialized in pain, anaesthesia and nursing were invited to evaluate the content validity of the pain assessment instrument and made modification. Reliability and validity of the pain assessment instruments was evaluated. Results PACIE had 8 items, index of content validity (CVI) of PACIE was 0.978, factor analysis demonstrated that two factors soluted in PACIE, that cumulative explained 69.008% of the total variability, the two factors were named pain objective factor and pain subjective factor. PACIE and NRS were significantly correlated, it could identify pain and painlessness patients overtly that demonstrate the discriminate validity was fine. Adequate levels of inter-rater reliability of PACIE was achieved between two raters with the intra-class correlation coefficient as 0.954 (95%CI=0.812～ 0.989). Satisfactory test-retest reliability was achieved with the Cronbach'α ot as 0.851. Conclusions The pain assessment scale for cognitively impaired elderly (PAC1E) has satisfactory validity and reliability, is suit-able for assessing the pain indentity of cognitively impaired elderly.

BACKGROUND:There is no study about adjacent zygapophyseal joint stress distribution following two level artificial disc replacement (ADR) in China.OBJECTIVE:To explore cervical adjacent zygapophyseal joint stress distribution following two level ADR and anterior cervical discectomy and fusion (ACDF),so as to provide biomechanical reference for clinical application of two level ADR.DESIGN,TIME AND SETTING:In vitro contrast observation and biomechanical detection were performed at the National Key Laboratory of College of Material Science and Engineering,Central South University from January to February 2006.MATERIALS:A total of 11 fresh adult corpse cervical samples with intact cervical disc and ligament and the facet joint capsule ranged from C_3 to T_1 segment.METHODS:A total of 11 intact adult fresh-frozen multi-segmental cervical spine segments were utilized and biomechanically evaluated under the following C_(4～5),C_(5～6) cervical disc conditions:intact spine (intact group),Bryan disc prosthesis implantation (ACDR group) and intervertebral fusion (ACDF group).The testing was performed under axial load (25 N-150 N) on each group.The stress changes of the caudad (C_(5～6),C_(6～7)) zygapophyseal joint was tested.MAIN OUTCOME MEASURES:The pressure of the caudad (C_(5～6),C_(6～7)) zygapophyseal joint.RESULTS:Under axial loading,stress of the caudad (C_(5～6),C_(6～7)) zygapophyseal joint increased with the load and showed no difference between the intact group and ACDR group (P>0.05).Under axial loading,the ACDF group resulted in significant increase of the stress of the caudad (C_(5～6),C_(6～7)) zygapophyseal joint compared with intact group and ACDR group (P<0.05).CONCLUSION:Two level artificial cervical disc replacement can maintain stress in the caudad (C_(5～6),C_(6～7)) zygapophyseal joint,thus reconstruct biomechanical property of cervical spine.Two level cervical discectomy and fusion can increase stress in the caudad (C_(5～6),C_(6～7)) zygapophyseal joint,which may be one of the causes for adjacent cervical spondyiosis postoperatively.

Objective To investigate the prognosis of two decompression approaches for cervical spondylotic myelopathy. Methods 86 cases were divided into two groups. 40 cases were underwent decompression by anterior decompression, fusion and internal fixation with titanium screws and plate and 46 cases underwent posterior single opendoor laminoplasty. To investigate the prognosis of two decompression approaches for single compressive segment, two compressive segments, three compressive segments and four compressive segments. Results All cases were followed up for 20 ～ 73 months with an average of 43 months. The mean JOA recovery rate was significant different between single compressive segment group (P ＜ 0.05), and no significant difference between two compressive segments and three compressive segments(P ＞ 0.05), and significant difference between four compressive segments groups (P ＜0.05). Conclusion For single compressive segment, the anterior surgery has a good surgical result,for two or three compressive segments, anterior and posterior surgery had same effect, for the four compressive segments, posterior surgical effect was good.

Objective To investigate the clinical value of 18 F-FDG PET CT scan in the diagnosis of thin lung nodules. Methods 56 solitary cases of nodules in the lungs,nodule size ranged from 1～3 cm,conducted 18 F-FDG PET/CT imaging and thin layer CT scan at the same time, 18 F-FDG PET imaging using visual measurement combined with semi-quantitative method to determine the degree of malignant of the lesions; conducted MPR recon-struction after thin layer CT scan, based on the lesions morphology to determine the degree of malignant. Then com-pared the results of above,and the results of the combination of 18 F-FDG PET imaging and thin layer CT scan,with the pathological results after surgery. Results The sensitivities of PET imaging alone,thln layer CT alone,joint ima-ging diagnosis of SPN are 92.6% ,88.2% ,96.4% ,specificity are 73.3% ,57.1% ,85.7% ,accuracy percentage rate are 89.3% ,80.4% ,94.6% ,the positive predictive values are 92.6% ,91.8% ,96.4% ,and negative predictive val-ues are 84.6% ,61.5% ,92.3% ,respectively. Conclusion 18 F-FDG PET combined with thin layer CT scanning is a very effective method to clinical diagnosis the malignant degree of SPN.

BACKGROUND: The rehabilitative intervention accelerates the recombination and reconstruction of cerebral structure and function and then promotes the amelioration of function.OBJECTIVE: To evaluate the influence of early and late rehabilitative interventions on the motor function and activities of daily living (ADL) with neurologic deficit score (NDS), Fugl-Meyer assessment (FMA) and modified Barthel index in patients with cerebral infarction.DESIGN: A randomized controlled trial.SETTING: Department of Neurology, Qilu Hospital of Shandong University; Department of Rehabilitation, Jinan Great Wall Hospital; Department of Neurology, the Third People' s Hospital of Heze.PARTICIPANTS: Totally 216 inpatients with cerebral infarction (125 males and 91 females, aged 60-75 years), who were selected from Qilu Hospital of Shandong University, Jinan Great Wall Hospital and the Third People's Hospital of Heze from December 2000 to December 2003, were randomly divided into early rehabilitation group (n=108) and late rehabilitation group (n=108) after admission.INTERVENTIONS: In the early rehabilitation group, the patients began to receive rehabilitation at 48 hours to 14 days after the stability of vital signs and absence of the progress of neurological signs. In the late rehabilitation group, the patients began to receive rehabilitation at 15-30 days after attack. They were trained with Bobath method and motor relearning program, once a day, 45 minutes for each time, and 6 times every week.Before and 30 days after the rehabilitative treatment, the rehabilitation was evaluated with modified Barthel index (100 points as normal, 0-20 as extremely severe functional defect, 25-45 as severe functional defect, 50 -70 as moderate functional defect, 75-95 as mild functional defect), FMA (total score was 100 points, including the highest scores of upper and lower limb movement were 66 and 34 points respectively) and NDS (the highest and lowest scores were 45 and 0 point, 0-15 as mild, 16-30 as moderate, 31-45as severe).ter treatment.RESULTS: All the 216 patients with cerebral infarction were involved in obviously lower than that before treatment in both groups (P ＜ 0.01), lower in the early rehabilitation group than in the late rehabilitation group score at 30 days after treatment was obviously higher than that before treat ment in both groups (P ＜ 0.01), higher in the early rehabilitation group than in the late rehabilitation group [upper limb: (32.43±21.52), (26.69±19.79)dex: The modified Barthel index at 30 days after treatment was obviously higher than that before treatment in both groups (P ＜ 0.01), higher in the early rehabilitation group than in the late rehabilitation group [(54.23±30.33),(46.57±29.85) points, P ＜ 0.05].CONCLUSION: Both early and late rehabilitative interventions can obviously accelerate the recovery of neurological function, motor function and ADL, but the effect of early rehabilitative intervention is superior to that of the late one.

Objective To evaluate the value of multislice spiral computed tomography angiography (MSCTA) in differential diagnosis between epithelial ovarian carcinoma (EOC) and borderline epithelial ovarian tumor (BOT).Methods The MSCTA images of 39 EOC patients and 23 BOT patients confirmed by surgical pathology were reviewed retrospectively.Main characteristics of tumor vessels were analyzed: the number of feeding arteries, the existence of dilated draining veins, whether the tumor vessels were tortuous, whether the distribution of tumor vessels were disturbed, and whether there were accompanying microaneurysms or arteriovenous malformations (AVMs).Results Two or more feeding arteries of the EOCs and BOTs were 89.7% (35/39) and 8.7% (2/23), respectively.Dilated draining veins were observed in 87.2% (34/39) of the EOCs and 4.3% (1/23) of the BOTs.The tortuosity of tumor vessels was observed in 97.4% (38/39) of the EOCs and 13.0% (3/23) of the BOTs.79.5% (31/39) of the EOCs and 8.7% (2/23) of the BOTs were complicated by microaneurysms, and 74.4% (29/39) of the EOCs and 4.3% (1/23) of the BOTs were complicated by AVMs.The characteristics of tumor vessels were significantly different between the two groups (P<0.01), with relatively high sensitivity and specificity.Conclusion MSCTA can better show the distribution, number and pattern of tumor vessels and is of great value in differential diagnosis between EOC and BOT.