Embolic stroke of undetermined source ( ESUS ) refers to non-lacunar brain infarcts without definite proximal arterialstenosis or major cardioembolic sources.Paroxysmal atrial fibrillation may be the most important cause of ESUS, thus anticoagulation may be more effective than antiplatelet therapy for secondary stroke prevention to this group of patients.This paper reviews the latest progress on the definition, epidemiology, diagnostic approach, relation to atrial fibrillation and management of ESUS.

Objective To investigate the changes in small-diameter sensory neuron (SNS)/ peripheral nerve type 3(PN3) Na+ channel transcript and in tetrodotoxin-resistant (TTX-R) Na+ current in dorsal root ganglion (DRG) neurons in a chronic constriction injury (CCI) model of neuropathic pain. Methods Eighteen rats were divided into 6 groups of 3 animals each. Chronic constriction injury model was established after Dib-Hajj et al. Pain threshold was significantly lowered after CCI as compared with that in control group. The animals were deeply anesthetized and rapidly decapitated 14 days after surgery. The L4-5 DRG of the operated side was removed and crushed and total RNA was extracted with trizol reagent. The DRG of the contralateral side was used as control. The change in SNS/PN3 Na + channel expression was determined by semi-reverse transcriptase-PCR. The DRG neurons were isolated enzymatically and the change in voltage-gated TTX-R Na+ current was recorded using whole-cell patch clamp technique. Results Sensory neuron specific TTX-R Na+ channel transcript SNS/PN3 was down-regulated by 60% 14 days after CCI as compared with that in control group. TTX-R Na+ current density was significantly reduced but its activation and steady state inactivation were unchanged. Conclusions Na+ channel SNS/PN3 is involved in the hyperextability of the primary sensory neurons after CCI.

Objective　To investigate the pattern of human neutrophil degranulation mediated by Fc alpha receptors. Methods　IgA immune complexes (IgA IC) and specific monoclonal antibody were used to stimulate neutrophil degranulation. Lactoferrin released by stimulated neutrophils was quantitatively determined. Results　Monoclonal antibody and IgA IC could both induce neutrophil lactoferrin release. However, monoclonal antibody induced rapid and strong degranulation whilst the effect of IgA IC was much weaker. Conclusion　The pattern of neutrophil degranulation induced by IgA IC and monoclonal antibody is different.

Insulinoma-glucagonoma clone 20 can express at least 6 isoforms in human cells.These isoforms can affect cell apoptosis and proliferation through apoptosis related signaling pathway,such as TRAIL or TNF signaling pathways.Furthermore,insulinoma-glucagonoma clone 20,as a GTP-GDP exchange factor,participates in the transportation of nerve synaptophysins.

Neovascular glaucoma is a rare and severe complication of hypoperfusion retinopathy.The appearance of hypoperfu- sion retinopathy complicating neovascular glaucoma in ophthalmolscopy and fundus fluorescein angiography shows a special feature. Neovascular glaucoma occurs when new fibrovascular tissues proliferate onto the chamber angle and obstruct the trabecular meshwork. The stenosis or occlusion of internal carotid artery is the most common reason of hypoperfusion retinopathy in elder people.Early recog- nition and treatment of patients with carotid occlusive diseases may prevent more serious complications.

The effects of ketamine on the hemodynamics in the postshock stage in 10 severely burn patients were observed.Their average burn area was 53.7?14% TBSA.Anesthesia was inducedwith 2 mg/kg of ketamine and then maintained with 50?g/kg/minute of ketamine.All the patients kept on spontaneous breathing.Measurements were performed before anesthesia,5 and 30 minutes after the induction of anesthesia.and 20 minutes after the discontinuation of ketamine.Our findings indicate that the severely burn patients in the postshock stage were in a state of active hemodynamics with increased cardiac output and decreased peripheral resistance.The plasma concentrations of epinephrine and norepinephrine were apparently increased.A small dose of ketamine could further increase the release of epinephrine,which is beneficial to the restoration of normal cardiovascular functions.

Objective:To explore the diagnosis and treatment of small intestine leiomyosarcoma. Methods:Ten patients with small intestine leiomyosarcoma in Changhai Hospital from 1993 to 2001 were retrospectively analyzed. Results:Radical resection was performed in 6 cases with the shortest survival time being over 1 year and the longest being 8.5 years (still in good health). One case received extirpation operation with the survival time being over 4 years.Partial resection was performed in 3 cases,and the 3 patients died 1,2,3 years after operation respectively.Conclusion:The small intestine leiomyosarcoma is rare and its diagnosis is difficult due to the lack of clinical feature. Final diagnosis should be based on pathology.The disease is not very sensitive to radiotherapy and chemotherapy,which makes surgical treatment the choice.

Benzene ; toxicity ; Gene Expression Profiling ; Oligonucleotide Array Sequence Analysis

Bile acid can not only emulsify fat and facilitate the absorption of fat soluble substances,but also it is an important signaling molecules that plays an important physiological role by activating specific bile acid receptors.Takeda G proteincoupled receptor 5 (TGRS) is a membrane receptor of the bile acid,it can activate G-protein effectors and promote the expression of the second messenger and activate a variety of signal transduction pathways to exert physiological functions.The obstructive jaundice bile acid can cause a series of pathophysiological reactions through activating TGR5,which plays a significant role in the obstructive jaundice.In this article,the latest researches about the function and molecular mechanism of TGR5 in obstructive jaundice were reviewed in order to provide a new idea for exploring the new method and strategy to cure the disease.

Objective To investigate the pharmacodynamic interactions between remifentanil and sevoflurane during general anesthesia for laparoscopic operation.Methods Sixty-five ASA I patients undergoing selective laparoscopic operations at the Department of Gynecology and the Department of General Surgery in People's Hospital were enrolled in this study.Sevoflurane was used for anesthesia induction with its expired concentration being kept stable,and different dosages of remifentanil(0,1,2,4,6,and 8 ng/ml)being added during the operation.When the expired concentration of sevoflurane reached an expected level(pseuto-state),the block somatic and cardiovascular responses to electrical tetanus stimuli(ETS;100 Hz,60 mA,5 s)were measured.The data were analyzed using NONMEM software to establish concentration-effect curves.Logistic regression was used to calculate the minimal alveolar concentration of sevoflurane under ETS(MACETS).Results In the cases received sevoflurane only,the somatic response was inhibited when MACETS reached 1.52%;while the cardiovascular response was inhibited when MACETS reached 2.24%.The MACETS was decreased significantly by adding low-dosage remifentanil.When the target-controlled concentration of remifentanil was 8 ng/ml,the MACETS for the inhibition of somatic and cardiovascular responses decreased by 70.0% and 76.3%,respectively.Conclusions There is a synergic effect between remifentanil and sevoflurane on the suppression of somatic and cardiovascular responses to ETS.Remifentanil produces a dose-dependent decrease of MACETS of sevoflurane.The effect is especially strong in low-dosage remifentanil group,but shows ceiling effect characteristics.