社区康复是机构康复的延伸，是康复的重要组成部分，让康复进入社区是工伤保险乃至工伤康复给予工伤职工的切实权益和福祉。因此，积极探索，因地制宜，多方式、多渠道建立社区康复服务模式是本文的主要目的，介绍资源中心社区服务模式是本文的重点。

BACKGROUND: Hyperhomocysteinemia has been suggested to be a possible independent risk factor for stroke.OBJECTIVE: To explore the relationship between hyperhomocysteinemia and cerebral infarction and hemorrhage, and analyze the factors that affect plasma homocysteine level.DESIGN: Case-controlled clinical trial.SETTING: Department of Neurology, Second Hospital Affiliated to Medical College of Zhejiang University.PARTICIPANTS: Totally 57 patients including 21 with cerebral hemorthage and 36 with brain infarction were treated in the Department of Neurology, Second Hospital Affiliated to Medical College of Zhejiang University Between January and November 2003. Twenty-eight healthy volunteers were also recruited from the subjects coming for routine physical examination.METHODS: Two milliliters of fasting venous blood was collected from all subjects in the morning for detecting the contents of plasma homocysteine,vitamin B12, folic acid, creatinine and so on. All patients were scored for clinical neurological impairment, with the hematoma volume calculated in patients with brain hemorrhage determined on the basis of CT scanning.acid, vitamin B12, clinical neurological impairment score and hematoma volume.RESULTS: Valid results were obtained from all the 57 stroke patients and in male and female patients of both cerebral infarction group and cerebral hemorrhage group than that of the subjects of the same gender in the control group [(25.2±21.4), (18.3±10.9), (11.5±2.9) μmol/L for male subjects;(22.8±18.9), (14.7±7.4), (10.8±2.6) μmol/L for female subjects, P＜ 0.05-0.01].The level of homocysteine was similar between cerebral infarction group and cerebral hemorrhage group, homocysteic acid level showed obvious inverse correlation with folic acid level (r=-0.442, -0.531, P ＜ 0.05), but without relation to vitamin B12 level (r=-0.086, -0.111, P ＞ 0.05). Homocysteine level was not obviously correlated to the neurological impairment scores in cerebral infarction group (r=-0.139, P ＞ 0.05), nor was it related to the scores or hematoma volume in cerebral hemorrhage group (r=0.225,0.425, P ＞ 0.05).CONCLUSION: Hyperhomocysteinemia is risk factor for cerebral infarction and hemorrhage. Plasma homocysteine level is inversely correlated with folic acid level, but not obviously related to vitamin B12, clinical neurologicla impairment score or hematoma volume.

Objective To analyze clinical characteristics of patients with juvenile myoclonic epilepsy in China. Methods Eighty-seven patients were retrospectively studied in the aspects of family history, febrile seizures, clinical features, EEG, treatment effect. Results There was a female preponderance of incidence. In contrast to the earlier studies we found a high incidence of febrile seizures and a low incidence of family history. myoclonic seizures began at age of ( 13.1?3.4) years. That combined with generalized tonoclonic seizures began at age (14.3?3.8) years. Absence seizures began at age (10.0?3.3) years. The correct diagnosis was delayed at a mean of 2.2 years from onset of the disease. The incidence of abnormal EEG discharge could be enhanced by hyperventilation, photic stimulation and sleep. Sixteen patients who had received carbamazepine or phenytoin were experienced aggravation of seizures. Forty-five patients who received monotherapy with sodium valproate remained seizure-free in a follow-up longer than 0.5 years. Conclusions Failure to recognize JME may result in uncontrolled seizures, and even aggravated of seizures by using antiepilepsy drugs. Effective treatment was achieved with small doses of sodium valproate.

Objective To evaluate the therapeutic effect of health education pathway on type 2 diabetic patients by using the Meta-analysis.Methods The domestic main databases were searched,the quality of included studies which screened by certain standards was evaluated.The Review Manager 5.0software was taken for analysis.Results Totally 12 studies were included,containing 2115 cases of type 2 diabetic patients.The Meta-analysis showed there were significant differences between the health education pathway group and the control group in hospitalization days and hospitalization expenses,rate of patients' satisfaction and rate of mastering knowledge of diabetes mellitus,fasting blood glucose and 2h postprandial blood glucose.Conclusions Health education pathway for type 2 diabetic patients can shorten hospitalization days,decrease hospitalization expenses,increase rate of patients' satisfaction and rate of mastering knowledge as well as lower fasting blood glucose and 2h postprandial blood glucose.

Objective To explore the effect of purification on monoclonal antibody (MAb) against PGRP by Protein A-Sepharose affinity chromatography, and to provide some based data for the purification of other antibody using the same method. Methods The ascites which include MAb was purified by Protein A-Sepharose affinity chromatography. The purity and activity of MAb was tested by SDS-PAGE and ELISA. The biological function was identified by flow cytometer and immunohistochemistry. Results The average concentration of protein in ascites before purification is 23.62 mg/ml. Before and after purification, the total protein is 148.79 mg and 146.67 mg, respectively. The recovery coefficient of protein is 98.58%. The concentration of MAb in ascites is 5.21 mg/ml averagely. The MAb purity is more than 95 %. The immunoactivity of purified antibody is higher than that of unpurified antibody. Conclusion The purity of MAb against PGRP purified by Protein A-Sepharose affinity chromatography is very high. The immunoactivity of purified antibody is higher than that of unpurified antibody. So the ProteinA-Sepharose affinity chromatography is a rapid, convenient and reliable method for the purification of MAb Against PGRP.

Objective The value of pro-gastrin releasing peptide ( PGRP) which is the tumor marker of small cell lung canc-er has become a hot topic in recent years .The research was to build a new enzyme-linked immune sorbent assay ( ELISA) method ai-ming at detecting the concentration of PGRP in patients′serum. Methods We utilized synthetic PGRP epitopes for the screening of the monoclonal antibodies , labeled the screened monoclonal antibodies with horseradish peroxidase by modified sodium iodide method , and then established double antibody sandwich ELISA which could be used to detect the serum concentrations of PGRP in cancer pa -tients. Results We successfully screened E 12 mAb which could be served as the coating antibody and ED 1 mAb as the labeled anti-body.The standard antibody density range of new ELISA was 33 pg/mL~1.7 ×104 pg/mL.The comparison experiments between our method and the commercially available ELISA kit showed no significant difference ( P>0.05).The specificity of our method was 50%, and the sensitivity was 100%, while IBL kit was 92.2% and 100% respectively. Conclusion New ELISA can be used to detect the serum PGRP concentration in patients with small cell lung cancer .

AIM: To observe the effects of different doses of L-dopa on the rotational behavior and amounts of cells expressing D_2 receptors in striatum in hemiparkinsonian rats.METHODS: A hemiparkinsonian model was established in rats by pretreatment with 6-hydroxydopamine.The D_2 receptor expression were detected by immunohistochemical staining.The numbers of rotations induced by apomorphine was counted within 30 min before and after L-dopa(10 mg?kg~(-1)?d~(-1),50 mg?kg~(-1)?d~(-1) or 100 mg?kg~(-1)?d~(-1),ip) was introduced to Parkinson's disease(PD) model rats for 15 days.RESULTS: In successful PD model rats,the increased percentage of D_2 receptor in lesioned side compared with intact side was associated linearly with the numbers of rotations within 30 min(r=0.927,P

AIM:To examine the expression profiles of both genes and proteins in hippocampus of rats with temporal lobe epilepsy(TLE)for revealing the molecular mechanisms of TLE and looking for the candidate targets and new therapeutic approaches in clinical practice.METHODS:Rat temporal lobe epilepsy was induced by administration of lithium chloride and pilocarpine(LiCl-PILO).The expression spectra of genes and proteins were constructed through the techniques of cDNA microarray,two-dimensional(2D)electrophoresis and Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry(MALDI-TOF MS).Subsequently,the differentially expressed genes and proteins were identified and analyzed.RESULTS:There were 192 genes of differential expression observed in hippocampal tissues of LiCl-PILO-induced temporal lobe epilepsy,and 159 genes have been registered in Genbank database,in which 84 genes were up-regulated while 75 genes were down-regulated.78 protein spots of differential display were screened out,in which 31 proteins were detected to be down-regulated and 47 were up-regulated.Finally,5 proteins were identified.CONCLUSION:These genes and proteins found in our study may play pivotal roles in the pathogenic mechanisms of epilepsy and may promise new therapeutic targets for refractory epilepsy in the future.

ObjectiveTo study the relationship between the homocysteine (Hcy) level and stroke. Methods57 cases, including cerebral haemorrhage (CH, 21 cases) and cerebral infarction (CI, 36 cases) , and 28 healthy cases as control group were selected to measure their level of Hcy, VitB12 , folic acid and creatinine(Cr). At the same time, the clinical neurological disfunction scale(CNDS) of all patients was evaluated and the hematom volume (HV) of the CH group was assayed. ResultsThe Hcy level of both CI and CH group was significantly higher than that of the control group(P<0.05 or P<0.01). No significant difference was found between CI and CH group on Hcy level. The Hcy level showed a very strong or strong reverse association with folic acid level in the CI and CH group (r=-0.442,P=0.007 or r=-0.531,P=0.013), but no significant correlation with VitB12 level. No correlation was found between Hcy level and CNDS in both the CI and CH group, either no correlation between Hcy level and HV in the CH group. ConclusionThere is a close relationship between hyperhomocysteine and stroke. Hcy level is reversely associated with folic acid level but not correlated with VitB12 level.

Objective To investigate the safety and efficacy of intravenous thrombolytic therapy with recombinant tissue plasminogen activator(rtPA)in patients with isolated penetrating artery territory infarct (IPAI).Methods Data of retrospectively collected clinical,laboratory,and radiological from 75 consecutive patients with acute ischemic stroke treated with intravenous rtPA therapy from June 2009 to April 2011.Etiological classification was carried out according to the Chinese Ischemic Stroke Classification of Subgroups(CISS).The rates of hemorrhagic transformation(HT)and clinical outcomes of patients were compared between IPAI group and non-IPAI group.Results All 75 patients with mean age of 67.4years and 25(33.3％)fenale,were treated with intravenous rtPA.Before treatment,their average score of the National Institutes of Health Stroke Scale(NIHSS)was 12.3 ± 6.4,and mean length of time from onset to treatment was 239.6 ±97.5 minutes.After thrombolytic therapy,the radiological HT was found in 24 patients(32％).Symptomatic intracraneal hemorrhage(ICH)occurred in 4 patients(5.3％).Of 22 (29.3％)patients with IPAI,only one experienced HT.Logistic regression analysis suggested that IPAI wasan individualized predictor used alone for determining the low risk of HT.In the patients with IPAI,82％ of them had an individual clinical outcome(mRS ＜ 2)one month after onset,and the neurological outcomes were better in patients with IPAI than those in patients with non-IPAI(P ＜ 0.01).Conclusions The risk of hemorrhagic complication was low and the clinical outcome was good in patients with isolated penetrating artery territory infarct after intravenous thrombolytic therapy with rtPA.Imaging diagnosis of IPAI might facilitate the treatment with rtPA in this cohort of patients.