The basal and calmodulin stimulated Ca2+-Mg2+-ATPase activities in erythrocyte membranes were measured in 40 diabetic patients and 36 normal subjects as control. The results showed that the enzyme activity is significantly decreased in diabetics. The reduction of enzyme activity is inversely related to serum glucose as well as glycosylated hemoglobin. It is suggested that the function of Ca2+-Mg2+-ATPase in red cell membrane of diabetics is decreased. This may be one of the factors causing diabetic microangiopathy. Furthermore, the reduction of enzyme activity might casually be related with hyperglycemia.

Objective To investigate the clinical efficacy of L1 -S1 selective posterior rhizotomy (SPR)at the medullary conus level for the treatment of double lower extremities spastic cerebral palsy(CP).Methods A total of 1 09 double lower extremities spastic CP children underwent SPR at the level of medullary consul were selected in the Second Affiliated Hospital of Xinjiang Medical University from October 201 0 to May 201 4.The 4 groups were analyzed in terms of muscle tension and gross motor function of the lower limbs 6 months before and after operation,retrospective-ly.The SPSS 1 7.0 software was used for statistical analysis.Results Patients had different degrees of improvement in gross motor function and reduction of spasticity in all muscle groups of lower limbs after operation.Six months after the operation,the muscular tension of hip flexor,hip adductor,knee flexor and plantar flexors (modified Ashworth spastic scale score)were all improved compared with preoperation (t =1 6.635,27.41 1 ,31 .362,38.81 9,all P <0.01 ).Gross motor function of lower limbs (Gross Motor Function Measure)at 6 months after the operation was significantly im-proved compared with preoperation (51 .97 ±1 2.92 vs 41 .01 ±1 1 .46),and the difference was significant(t =26.67, P <0.01 ).The postoperative complications:intracranial hypotension headache (5 cases,4.59%),postoperative high fever (2 cases,1 .83%),incision fat liquefaction (2 cases,1 .83%),sensory barriers of lower limbs (1 case, 0.92%),and urine obstacles (1 case,0.92%).Conclusions SPR at the level of medullary conus has the advantages of minimal injury,rapid recovery and little influence on the stability of the spine.In addition,the procedure can relieve the spasticity of lower limbs of the CP patients effectively.

BACKGROUND: Some researches suggest that improvement of motor function is closely related to cognitive function. The better the cognitive status is, the better the recovery of motor function is. Early evaluation of cognitive function can predict prognosis of motor function and improve generalized ability, social communication abilities and quality of life (QOL).OBJECTIVE: To observe the correlation of cognitive function in hemiplegia and aphasia and analyze the prognostic factor of early cognitive dysfunction in patients with acute stroke.DESIGN: Contrast study.SETTING: Department of Neurology, Taian Central Hospital; Department of Neurology, Affiliated Hospital of Medical College of Qingdao University.PARTICIPANTS: Fifty patients with acute stroke were enrolled from Neurological Department of Taian Central Hospital and Neurological Department of the Affiliated Hospital of Medical College of Qingdao University from January 2002 to May 2005. They were 32 males and 18 females aged 34-78 years. All patients were coincidence with the Diagnostic Criteria of Acute Stroke established by the Fourth National Cerebrovascular Diseases Meeting and diagnosed with CT or MRI. Patients were told about the evaluation in details. Among them, 44 patients had hemiplegia, including 30 males and 14 females aged 34-78 years; 30 had aphasia, including 17 males and 13 females aged 34-78 years; 20 had non-aphasia, including 14 males and 6 females aged 38-70 years.METHODS: ① Aphasia was tested with Western Aphasia Battery (WAB).Aphasic quotient of ＜ 93.8 was regarded as aphasia; otherwise, it was regarded as non-aphasia. ② Motor function was evaluated with Fugl-Meyer (FMA).Motor function of upper and lower limbs was scored as 100 in total. The higher the points were, the better the motor function was. ③ Cognitive function was evaluated with Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), which contained 4 items (orientation, perceptibility, visual-motor organization and thinking ability) and 22 subtests in total. The higher the points were, the better the cognitive function was. Functional evaluation started at half-month treatment onset. Intergroup comparison of their mean value was tested using Student's test and one-way analysis of variance.MAIN OUTCOME MEASURES: ① Correlation between cognitive function and hemiplegia; ② correlation between cognitive function and aphasia.RESULTS: Fifty patients with acute stroke were all involved in the final analysis. ① Correlation between cognitive function and hemiplegia: Scores of orientation, perception, visual-motor organization and cognitive function of 44 patients with hemiplegia were positive positively correlated with FMA scores of motor function (r=0.534, 0.598, 0.500, 0.548, P ＜ 0.01); however,scores of thinking ability was not correlated with FMA scores of motor function (r=0.310, P ＞ 0.05). ② Correlation between cognitive function and aphasia: Scores of orientation, perception, visual-motor organization, thinking operation and cognitive function of patients with aphasia were (4.60±2.37), (15.10±6.02), (14.00±6.93), (12.33±6.77), (1.83±1.09) points,which were lower than those of patients with non-aphasia (7.30±1.08),(23.20±1.11), (24.25±4.08), (24.20±5.43), (3.50±0.76) points (t=5.44 to7.197, P ＜ 0.05).CONCLUSION: The more severe the cognitive dysfunction is, the more severe the hemiplegia is. Cognitive function in stroke patients with aphasia is significantly reduced.

Objective To analyse the relationship between insulin resistance and the pancreatic beta cell dysfunction in critically ill children with hyperglycemia,to investigate the relationship between the pancreas injury and pancreatic beta cells dysfunction.Methods Seven hundred and thirty-six critically ill children admitted in PICU of Hunan Children's Hospital from Nov 2012 to Mar 2013 were reviewed and analyzed.According to the maximum intravenous blood glucose within 24 h after admission,they were divided into severely elevated group (blood glucose ≥11.1 mmol/L,n =67),slightly elevated group(blood glucose 6.1 ～ 11.1 mmol/L,n =361) and control group (blood glucose ≤ 6.1 mmo/L,n =308).Serum insulin,C peptide,serum amylase,lipase,urinary amylase,HOMA-β,HOMA-IR were compared among 3 groups.According to the severity of sepsis,they were divided into non-sepsis group (n =414),sepsis group (n =237),severe sepsis group (n =64),septic shock group (n =21).Blood glucose,serum insulin,C peptide,HOMA-βand HOMA-IR were compared among 4 groups.Results (l)The levels of insulin,C peptide,blood amylase,lipase and urine amylase were gradually increased with elevated blood sugar(rs =0.235,P ＜ 0.05;C =0.142,P ＜ 0.05 ; rs =0.142,P ＜ 0.05 ; rs =0.119,P ＜ 0.05 ; r.s =0.093,P ＜ 0.05).The differences among 3 groups were significant (P ＜ 0.05).The levels of serum amylase (IU/L) [102.81 (10.48-191.69)],lipase(U/L) [69.75(10.67-121.85)] were higher than upper limit of normal in severely elevated group.HOMA-β fell to 18.75％ in severely elevated group.The level of HOMA-β was decreased with the increase of blood sugar level (rs =-0.108,P ＜ 0.05).The level of HOMA-IR was increased with the elevated blood sugar level(rs =0.455,P ＜ 0.05).(2) The levels of blood glucose,insulin,C peptide and HOMA-β were significantly different among 4 groups of non-sepsis,sepsis,severe sepsis and septic shock group (P ＜ 0.05),HOMA-IR showed no significant difference among 4 groups (P ＞ 0.05).The levels of blood sugar increased to 9.21 (6.21-19.60) mmol/L,HOMA-β declined to 10.52％ in septic shock group,and blood glucose,insulin,C peptide,HOMA-β were significantly different compared with the other 3 groups (P ＜ 0.05).Conclusion Hyperglycemia is associated with insulin resistance and pancreatic β cells dysfunction in critically ill children,the cause of beta cell dysfunction is secondary to pancremic injury.Pancreatic beta cells dysfunction inducing hyperglycemia is more significant than insulin resistance in sepsis children.

Objective To investigate the impact of paced QRS duration (pQRSd) on heart function in patients with right ventricular apical pacing. Methods Seventy-six patients with Ⅲ° atrioventricular block received pacemaker treatment were enrolled and randomized into group A (pQRSd < 190 ms, n = 52) and group B(pQRSd≥ 190 ms, n = 24). The concentration of brain natriuretic peptide (BNP),parameters of left atrial diameter (LAD), left ventricular ejection fracetion (LVEF), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic dimension (LVEDD) were measured before operation, at 12 months and 24 months after implanting, respectively. The parameters of echocardiography assay, the concentration of BNP and the incidence of heart failure event after implantation were compared between two groups. Results At 12 months after implanting, LVEF of the patients in the group B decreased significantly compared with that of group A (P < 0.05). However, the echocardiography paramenters and the concentration of BNP were not significantly different between the two groups (P > 0.05). At 24 months after implanting, LAD、LVEDD、LVESD of group B increased significantly compared with those of group A [LAD,( 44.5 ± 6.2) mm vs (41.6 ± 5.1) mm, LVEDD, (52.7 ± 9.3) mm vs (48.2 ± 7.5) mm, LVESD, (37.5 ± 5.6) mm vs (33.8 ± 4.9)mm, each P < 0.05, respectively]. The concentration of BNP of group B increased significantly [(408.2 ± 102.1)ng / L vs (243.7 ± 92.8)ng / L, P < 0.001], and LVEF of the patients in group B decreased significantly compared with those of group A [(46.3 ± 6.8)% vs (51.6 ± 5.2)%, P < 0.001], respectively. No significant difference in the incidence of heart failure event (41.7% vs 26.9%, P > 0.05)between two groups during 24-month follow-up. Conclusion The prolonged paced QRS duration has a detrimental effect on long-term cardiac function during RVA pacing in patients with Ⅲ°atrioventricular block.

Objective To evaluate the value of diffusion-weighted imaging (DWI) in the differential diagnosis of cystic pancreatic lesions.Methods Thirty-four cystic pancreatic lesions confirmed clinically or pathologically were collected,including 11 case of non-neoplastic pseudocyst,5 cases of simple cyst,6 cases of serous cystadenoma,10 cases of mucinous cystadenoma and 2 cases of mucinous cystadenocarcinoma.All the patients underwent routine serial MR and echo-planar DW imaging examination of the pancreas with b values of 0 and 600 s/mm2.The appearances of signal intensity of DWI with all cysts were recorded.ADC maps were reconstructed,and the ratio of the cysts and cyst-to-pancreas ADC (ADCR) were calculated.The receiver operating characteristic (ROC) curves were constructed to evaluate the diagnostic value of ADC and ADCR.Results Among all the 16 non-neoplastic cysts,2 cysts were slightly hyperintense in DWI,and 14 cysts were isointense.Among all the 18 neoplastic cysts,17 cysts appeared slightly hyperintense or hyperintense in DWI,and 1 cyst was isointense.The difference between the two groups was statistically significant (P ＜ 0.001).The ADC values of non-neoplastic and neoplastic cysts were (3.30 ± 0.30) × 10-3,(2.74 ± 0.34) × 10-3 mm2/s ; and the ADCR values of non-neoplastic and neoplastic cysts were 1.85 ± 0.20,1.31 ± 0.21,the difference between the two groups was statistically significant (P ＜ 0.001).The areas under the ROC curves of ADC and ADCR diagnosing neoplastic cysts were 0.94 ± 0.04,0.98 ± 0.02,respectively.An ADC of 3.105 × 10-3 mm2/s showed 81.3％ sensitivity and 94.4％ specificity for predicting neoplastic cysts.An ADCR of 1.525 showed 100％ sensitivity and 88.9％ specificity for predicting neoplastic cysts.Conclusions Diffusion-weighted imaging is of importance in the diagnosis and differential diagnosis of pancreatic cysts,and can be applied as a complementary tool for routine MRI.

Objective To evaluate the effects of penehyclidine hydroehloride as an atropine alternative on angioearpy and glandular secretions when premedieated in ketamine complex total intravenous anesthesia(TIVA)in children.Methods Forty patients aged 3-10 years undergoing ketamine and propofol complex TIVA were randomly divided into two groups.Penehyclidine hydrochloride(group P,n=20)or atropine(group A,n=20)was premedicated intramuscularly 30 min before anesthesia.Heart rate(HR),mean arterial pressure(MAP),breath rate(R)and the amount of saliva secretion(SS)were recorded before premedication(0 min),10 min,20 min,30 min,60 min and 150 min after.Results (1)SS reduced significantly 20 min,30 min and 60 min after premedication in both groups(P＜0.01),and in 150 min,it was still in a significantly reduced level in group P(P＜0.01),which was significantly lower than that in group A(P＜0.01).(2)MAP,HR and R in group P showed no significant differences before and after premedication(P＞0.05).But in group A,HR increased significantly at 20 min,30 min and 60 min after premedication(P＜0.05 or＜0.01),MAP increased significantly at 30 min and 60 min after premedication(P＜0.01),and meanwhile of them were also significantly higher than those in group P(P＜0.05 or＜0.01).Conclusions Penehychdine hydrochloride can effectively reduce respiratory glandular secretion with longer persistence,and nearly has no influence on HR and blood pressure,which suggests it could be a superior to atropine alternative as an anesthesia premedication in children.

Objective To study the effect of hypothemah on the early inflammatory reaction in acute lung injury induced by intestinal ischemia-repeffusion(IlR)in rabbits.Method Seventy-two healthy rabbits provided by Peking Union Medical Colege Hospital Anhnal center were randomly divided into four groups(n=18 pergroup):(1)normothermia control group (rectal temperature 37-38 C;sham group);(2)normothermia IlR group(rectal temperature 37-38 C);(3)mild hypothermia HR group(rectal temperature 32-35℃);and (4)moderate hypothermia IIR group(rectal temperature 28-31.9C).Acute lung injury was induced by claIllp.ithe superiornteric artery(SMA)for 1 hour and declamping the SMA for 6 hours.Hypothermia WaS induced by surface cooling.Before and 2.4 and 6 hours after IIR,the Olasmlevels o,IL-,IL-6 and IL10 were measured.All rabbits were killed 6 hours after IIR and water content in lung tissue Wttk'assessed.Iaght mieropic examination was performed tbr morphological assessment of the hmg.The data were analyzed by AN()VA.Statistical significance wag dned as a P of<0.05.Results In the IIR groups,the plasma levels ofTHE-a.IL-l,IL-6 and IL-10 and lung water were increased.There Was evidence of acute lung injury from morphologi-cal assessment of the lung.The acute lung injury induced by IIR was improved by hypethennia.Mild hypothermia Was similar to moderate hypothermia for the treatment of acute lung injury induced by IIR.ConclusiotMild hy-pothermia and moderate hypothermia Can significantly improve acute lung injury induced by IIR in rabbits.Mild hypothea had similar efficacy to moderate hypothermia for the treatment of acute lung injury induced by IIR.

Objective To investigate the effects of lanthanum chloride on proliferation and migration activity of human cervical cancer cells in vitro which may be a new anti-cervical cancer drug and provide experimental data for cervical cancer treatment. Methods HeLa cells cultured in vitro were divided into two groups: experimental group and control group. In experimental group, the cells were respectively treated with lanthanum chloride at different concentrations, 5, 50 and 100 μmol/L, while the cells in the control group were not treated with lanthanum chloride. The cell growth was observed by inverted microscope and the morphology changes of the cells were observed by the laser scanning confocal microscope (LSCM).Proliferation of HeLa cells in the two groups was detected by methyl thiazolyl tetrazolium (MTT) test;apoptosis rate was analyzed by flow cytometry (FCM). Cell migration test was applied to observe the effect of lanthanum chloride on migration. Reverse transcription (RT)-PCR was employed to evaluate the effects of lanthanum chloride on proliferation gene (cyclinD1), anti-apoptosis gene (zinc finger protein A20) and migration-related gene (matrix metalloproteinase 9, MMP-9). Results The status of cell growth was observed under the inverted microscope: with the increased of the lanthanum chloride concentrations, the cell density of reduced, the granule in cytoplasm increased, color intensifying and intercellular space enlarged; some cells became rounding and dead, floating in the culture media; the exfoliated cells increased gradually in the experimental groups. While In the control group, the cells grew adherently, with clear morphology and plump cytoplasm, and adjacent cell grew in lamellar. Observed with LSCM: the nuclear chromatin condensated and marginated with the volume of nuclear decreased in experimental groups. With the increase of the lanthanum chloride concentrations, nuclei in the experimental groups became pyknotic and then underwent karyorrhexis. However, the nuclear of the cells in control group were inact. The growth inhibition rates of lanthanum chloride groups (5, 50, 100 μmol/L) were 24%, 51% and 78%,respectively, in which each was significantly higher than that of the control group (P < 0. 05); the apoptosis rates of lanthanum chloride group were (4. 91 + 0. 39) %, (7. 30 + 0. 71) % and (13.48 + 0. 92) %,respectively, which were all significantly higher than that of the control group [(0. 89 + 0. 11) %, P <0.01]. The migration ability of the cells was also decreased by the treatment of lanthanum chloride, the number of migrated cells in lanthanum chloride groups were 22.2±4. 3, 12. 0±3.2 and 7. 8±2. 6 respectively, which were all significantly lower than that of the control group (41.2±5.4, P < 0. 01). The expression of genes of cyclinD1, A20 and MMP-9, were all decreased by the treatment of lanthanum chloride in a dose-dependent manner. Conclusion Lanthanum chloride can inhibit the proliferation and migration of cervical cancer cells, and induce apoptosis by down-regulating cyclinD1, A20, and MMP-9 expressions in vitro.

Objective To evaluate the effect of modified Maze lines plus pulmonary vein (PV) isolation created by radiofrequency catheter ablation (RFCA) on atrial wall guided by a novel geometry mapping system in the treatment of elderly patients with paroxysmal atrial fibrillation (PAF). Methods After regular electrophysiological study, transseptal punctures were achieved twice with Swartz L1 and R1 sheaths. PV angiographies were conducted to evaluate their orifices and branches. A balloon electrode array catheter with 64 electrodes was put in the middle of the left atrium. Atrium geometry was constructed using Ensite 3000 Navx system. Two RFCA lesion loops and three lines (modified Maze) were created on left and right atrial walls. Each lesion point was ablated for 30 seconds with preset temperature 50 (ae) and energy 30W. The disappearance or 80% decrease of the amplitude of target atrial potential and 10 to 20(|), decrease of ablation impedance were used as an index of effective ablation. Results A total of 11 patients (7 male and 4 female, mean age, 68.7±5.1 years) were enrolled. PAF history was 7.9±4.5 years. PAF could not be prevented by mean 3.1±1.6 antiarrhythmic agents in 6.3±3.4 years. None of the patients had complications with structural heart disease or stroke. Left atrial diameter was 41.3±3.6 mm and LVEF was 59.2±3.7% on echocardiography. Two loops and three lines were completed with 67.8±13.1 (73-167) lesion points. Altogether 76-168 (89.4±15.3) lesion points were created in each patient. PAF could not be provoked by rapid burst pacing up to 600 beat per minute delivered from paroxysmal coronary sinus electrode pair.Complete PV electrical isolation was confirmed by three-dimensional activation mapping. Mean procedure time was 2.7±0.6 hours and fluoroscopy time was 17.8±9.4 minutes. Patients were discharged with oral aspirin and without antiarrhythmic agents. During follow up of 6.5±1.8 months, seven patients were PAF symptom free (63.6%). PAF attacks were decreased more than 70% in two patients (18.2%). PAF frequency did not change in another two patients (18.2%). Conclusions Ensite 3000 Navx guided modified Maze lines plus PV isolation on the atrial wall is safe and feasible in the elderly patients. It has the advantages of exact procedural endpoint, shorter X-ray exposure, fewer complications and satisfied long-term effect PAF control.