Because there are the fiber connections between striatum and substantia nigra, the striatal infarction may result in the secondary degeneration of the substantia nigra. In recent years, there have been a series of characteristics on secondary lesions of the substantia nigra, pathophysiological mechanisms, and the studies of how to detect the patients with striatal infarction in vivo. This article reviews the advances in this field.

A focal cerebral infarction results in anterograde and retrograde secondary degenera-tion in remote site. The secondary degeneration in remote site may progress gradually in a certain time and cause harmful effects on the neural function recovery of patients.

Objective To determine the content of anabasine in Fengshiding tablets.Methods RP-HPLC method was established.Diamonsil-C18 was used as chromatographic column,the mobile phase consisted of methanol and 0.1 %triethylamine(5 ∶95,adjust pH to 3.6 with H3PO4),the flow rate was 1.0 mL?min-1 and the detection wavelength at 259 nm.Results The average recovery for Anabasine was 99.0 %,RSD=2.8 %(n=6).Conclusion The method can be used to determine the content of anabasine in Fengshiding tablets.

Objective To investigate the efficacy and toxicity of bortezomib in combination with dexamethasone for the treatment of patients with multiple myeloma(MM).Methods Fourteen patients(11 males,3 females,mean age 65.1 yrs)with MM,who were hospitalized in the First Affiliated Hospital of Wenzhou Medical College from June 2005 to July 2007,were treated with bortezomib(1.3 mg/m2)by intravenous bolus twice a week for 2 weeks in a 21-day cycle,followed by an intravenous injection of dexamethasone 20～40 mg.The patients received one to eight courses.Response to bortezomib was evaluated according to the criteria of the European Group for Blood and Marrow Transplantation(EBMT)before initiation of each bortezomib chemotherapy course.Adverse effects were graded according to the National Cancer Institute Common Toxicity Criteria,version 3.0.Results The median follow-up duration from the begining of bortezomib treatment was 3.5 months.Clinical reponse was observed in 12 patients(86%),including complete response in 2,nearly complete response in 6,partial response in 3,minimal response in 1 and progressive disease in 2.The most common adverse effects were fatigue(10 patients),peripheral neuropathy(7 patients),gastrocnemius myalgia(2 patients),gastrointestinal symptoms(4 patients),thrombocytopenia(5 patients),disseminated herpes zoster(1 patient)and refractory hyponatremia(1 patient).The adverse effects were subsided on routine supportive care.Conclusion Bortezomib in combination with dexamethasone is an effective therapy with a high response rate for MM patients.All the adverse effects are more than common but are manageable with symptomatic therapy and(or)dose modification.

Objective A computerized clinical scenario imitating patients and clinical course variation for situation simulating teaching were established due to lack of typical patients,inadequacy of resourees in pediatric teaching probation and simplification in traditional teaching pattern.Methods Data of clinical typical patients were collected and recorded into video,and then these data were synthesized and put into computer,designing a computerized clinical setting imitating patients' set.216 uodergraduate students from grade 2008 were randomly divided into 2 groups.The patients in experimenial group were taught with computerized clinical scenario imitating patients,while traditional clinical probation in the hospital ward was carried out for those in the control group.Examination and questionnaire survey were performed at the end of the study.t test was used in statistical analysis.Results Comparison between the two groups using questionnaire survey showed that the learning motivation encouragement,active participation in teaching,guidance of clinical logical thinking and judgment,improvement of clinical thinking capacity,acceptance rate in classroom,preference rate were better in the experimental group than those in the control group (P ＜0.05).Student's performance in examination in the experimental group was higher than those in the control group ( P ＜ 0.05).Conclusion Teaching with computerized clinical scenario imitating patients is a teaching method closely related to clinical situation.It can significantly activate student's learning enthusiasm,improve clinical thinking and judgment capability,avoid risk of medical care and establish a new teaching setting for clinical pediatric teaching.

Objective To evaluate the efficacy and adverse effects of the three dimensional conformal radia- tion therapy(3D-CRT) concurrently combined with chemotherapy for limited stage small cell lung cancer(LSCLC). Methods 33 patients with LSCLC received 6 cycles EP(cisplatin,etoposide) chemotherapy and 3 weeks was a cy- cle. The conventional radiotherapy was given after the first cycle chemotherapy or the third cycle chemotherapy, then the 3D-CRT and the total dose of the primary tumor was 45Gy per 3 weeks,1.5Gy for once,twice for a day. Results Toxicity was durable in 33 patients received 3D-CRT concurrently combined with chemotherapy. The total re- sponse was 97 %. Median time was 21.9 months, and the 1-,2-, 3-year survival rates was 69.7 % ,51.5 %, 30.3 %. The 1-,2-, 3-year local progress ion-freely survival rates were 66.7 %, 45.5 %, 30.3 %, respectively, with the median local progression-freely survival time of 18.5 months. Respectively during three year follow-up visit. Conclusion The 3D-CRT concurrently combined with chemotherapy for patients with limited stage small cell lung cancer could be more effectively, and the patients could tolerate the side effects, this therapy method was secure and received.

Objective To explore the correlation between serum hs-CRP and β-cell finction in patients with gestational diabetes mellitus(GDM).Methods The levels of hs-CRP in 60 patients with GDM(GDM group)and 30pregnant women with normal glucose tolerance(NGT group)were detected.Insulin resistance was assessed by the homeostasismodel insulin resistance index(HOMA-IR),Insulin secretion by the homeostasis β-cell funetiOn index(HOMA-β).Results The levels of hs-CRP and HOMA-IR were higher in GDM group than in NGT group.There was significant difference between two groups(P＜0.01);HOMA-β was lower in GDM group than in NGT group,there was significant difference between two groups(P＜0.05).The level of hs-CRP was correlated with age,pre-pregnant bodymass-index(BMI),screening BMI,fasting blood glucose(FBG),fasting insulin(Fins),and HOMA-IR(r=0.222,0.649、0.862、0.923、0.935、0.941,P＜0.05 or P＜0.01),but was inversely related with HOMA-β(r=-0.872,P＜0.01).Multiple stepwise regression analysis indicated that HOMA-IR and HOMA-β was the most important effect factors of hs-CRP.Conclusion The level of hs-CRP increased in women with GDM.which was related to insulin resistance(IR)and insulin secretion,and it maybe participate in the pathogenesis of GDM.

Objective To evaluate the clinical effect in prevention of intravenous catheter-related infection(CRI) using antiseptic impregnated central venous catheter.Methods Intravenous catheter-related infection was retrospectively analyzed between 440 cases performed with general centrol venous catheter and 420 cases performed with antiseptic impregnated central venous catheter in ICU.Results There were 34 cases of CRI in 860 cases,28 cases were inserted general central venous catheter and 6 cases inserted antiseptic impregnated central venous catheter,the group of antiseptic impregnated was lower singificantly than the group of general in infection rate(P=0.0002).Conclusion Using antiseptic impregnated central venous catheter can reduce CRI,which has clinical effect in prevention of CRI.

The computerized imitating system constructed by the Second Affiliated Hospital of Guangzhou Medical University contains four blocks:administration of student infomation,administration of question bank,on-line tests and administration of score inquiry.It's designed to imitate typical pediatric cases,so that the medical students may put themselves into the practical clinical scenario and solve the challenges step by step in one-direction procedure.Teaching with computerized clinical scenario imitating patients can improve students' test resuhs and activate students' learning enthusiasm significantly.It not only helps to solve the contradiction between increasing number of medical students and clinical typical teaching case shortage but also improves the clinical thinking ability of the medical students.This system can also be used as a test bank for pediatric technical skills examination.

AIM: To investigate the changes of bladder volume , pressures and pelvic nerve firing induce by different speeds and ways of instillation .METHODS:Female SD rats (n=20) were randomly divided into 2 groups.The rats in group A was performed using 3-F polyethylene tubing inserted into the bladder through the urethra .The rats in group B were performed using 3-F tubing inserted into the dome of the bladder and secured by silk suture .The rats in both groups were infused with saline into the bladder at different speeds of 50, 100, 200 and 400μL/min.The changes of bladder vol-ume and pressure were recorded by urodynamic measuring devices .The changes of pelvic nerve firing during instillation were recorded by multi-channel physiologic recorder .RESULTS:In group A, the maximum firing frequency , bladder leak point pressure ( BLPP) and maximum voiding pressure ( MVP) were increased with the increase in the instillation speed . No significant difference of the maximum bladder capacity (MBC) at different speeds was observed .In group B, the maxi-mum firing frequency had no significant difference at different speeds .MBC was decreased with the increase in the instilla-tion speed , and exhibited significant decrease at 200 and 400 μL/min.No significant difference of BLPP and MVP at dif-ferent speeds was observed .Compared with group A , the maximum firing frequency and MBC in group B significantly de-creased at different speeds .However , BLPP and MVP in group B were higher than those in group A at the speeds of 50 and 100 μL/min.CONCLUSION:Different instillation speeds with the method of group A will not change the bladder volume but influence the pelvic nerve firing , so the process of method A may take various speeds according to different aims .How-ever, process of method B at the speed of over 200 μL/min may not be good to MBC, thus instillation under 200 μL/min is re-commended .