In order to improve the quality of epilepsy teaching,the appropriate version of the international classification of epilepsy and epileptic syndrome were selected to teach in the different level students by the way of PBL and clinical case analysis.The clinical thoughts and enthusiasm were improved.The classification of epilepsy could be grasped and easily used in their clinical work.

BACKGROUND: Critical closing pressure (CCP) is recently thought to play a key role in cerebral blood flow autoregulation as an effective downstream pressure of cerebral circulation and can objectively reflect the cerebrovascular tone, namely the vascular smooth muscle contraction and diastole, which is subjected to dynamic modulation.OBJECTIVE: To dynamically assess the hypertension-induced damage of the contraction function of cerebral microvascular smooth muscles and its correlation with morphological changes based on CCP evaluation.DESIGN: Randomized controlled experiment.SETTING: Institute of Neural Science of Second Hospital Affiliated to Guangzhou Medical College and Department of Neurology, First Hospital Affiliated to Sun Yet-san University.MATERIALS: The experiment was carried out at the Laboratory of Physiological Science of Sun Yet-san University between July 2002 and August 2003. Totally 160 health male SD rats were randomized into control group and hypertension group with 80 rats in each group. METHODS: Stroke-prone renovas cular hyp ortonsive rats were established in rats of the hypertension group by bilateral renal artery occlusion with two clips. The rats in the control group were not subjected to the occlusion with other treatments identical to those of the hypertension group. At the time points of 2, 4, 6, 8, 10, 12, 14 and 16 weeks after operation, respectively, 10 rats were randomly selected from each of the two groups for determination of arterial pressure and CCP. After the measurements the frontal-parietal lobe was obtained from the anaesthetized rats and cut into slices for quantitative analysis of the morphological changes in cerebral microvessels.different postoperative time points.mean arterial pressure in hypertension group obviously increased from the 6th postoperative week with significant difference from that of the control after operation to a level significantly higher than that of the control group at postoperative 14 and 16 weeks [(63.75±7.43) vs (37.28±3.68) mm Hg and (67.37±15.57) vs (38.39t7.41) mm Hg, respectively, P ＜ 0.05].significance from that of the control group at the 8th postoperative week (Paverage arterial pressure and cerebral arteriole tunica media (r=0.906 93,0.811 36, respectively, P ＜ 0.05). The changes in CCP was more obvious in the early and advanced stages of blood pressure elevation, but not so manifest during obvious blood pressure increment, displaying an inverted S-shaped curve of changes (R2=0.996 2, P ＜ 0.05).CONCLUSION: Contraction of the cerebrovascular smooth muscles is enhanced with the dynamic increment of arterial pressure after the development of hypertension. Vascular tone increase is more manifest during the early and advanced stages of hypertension.

Objective To explore changes of the immune function of red blood cells in gastric disease.Methods RBC C3b receptor rosette(RBCC3bRR)and RBC immune complex rosette(RBCICR)were tested in chronic gastritis group(n =103),duodenal ball ulcer group(n =75)and control group(n =30)to evaluate the immune function of RBC.Results RBCC3bRR were(20.83 ± 5.16)％ in the control group,(16.26 ±5.17)％ in the chronic gastritis group and(13.65 ± 5.19)％ in the duodenal ball ulcer group.RBCICR were respectively(7.63 ± 4.09)％,(10.59 + 4.45)％ and(10.04 ± 4.13)％ in these three groups.RBCC3bRR of chronic gastritis and duodenal ball ulcer were lower than control group(P ＜0.0l),while RBCICR were higher than normal control group(P ＜0.05 and P ＜0.01 respectively).There was no significant difference on RBCC3bRR and RBCICR between HP negative chronic gastritis and HP negative duodenal ball ulcer and between HP positive chronic gastritis and HP positive duodenal ball ulcer(P ＞ 0.05).RBCC3bRR of HP positive chronic gastritis and duodenal ball ulcer was significantly lower than that of HP negative(P ＜ 0.05and P ＜ 0.01 respectively),RBCICR significantly higher than that of HP negative(P ＜ 0.01).After HP eradication,RBCC3bRR of patients with chronic gastritis and duodenal ball ulcer was increased significantly (P＜0.05 and P ＜ 0.01 respectively).RBCICR was significantly lower than before treatment(P ＜ 0.01).Conclusion HP infection,chronic gastritis and duodenal ulcer can decrease the immune function of red blood cells.

ObjectiveTo explore the diagnostic value of 16-slices CT in urinary calculus. Methods25 cases of suspected urinary calculus were examined by 16-slices CT and some of these images were reconstructed with MPR. ResultsIn the 25 casces CT found 21cases of urinary calculus,among them kidney calculus 22 cases,urinary tract calculus 13 cases.In 5 of 21 cases,urinary calculus were not found with US.In all 6 cases urinary calculus were not detected by KUB and/or IVP. Conclusion16-slices CT was a valuable method in diagnosing urinary calculus.

Objective To develop a molecular method to type coagulase-negative staphylococci(CNS) using 16S～23S internal transcribed spacer-PCR(ITS-PCR)Methods ITS-PCR was performed to identify six control strains and a collection of 171 clinical strains, identified as CNS by AutoScan-4 System The API Staph system also tested the discrepant strainsResults A total of 11 CNS species from control strains and clinical ones confirmed by the API Staph system were resolved by their unique ITS-PCR patterns These results constructed the primary database of CNS in the laboratory They were obtained with Staphylococcusepidermidis, Shaemolyticus, Shominis, Ssaprophyticus, Sxylosus, Swarneri, Scapitis, Scohhni subspurealyticum,S sciuri, Sauricular, Ssimulans Only S sciuri showed intraspecific polymorphism on its ITS-PCR pattern 9357%(160/171) clinical isolates can be identified by this ITS-PCR data base and the accuracy is 9375%(150/160) The coincidence of the API Staph system and ITS-PCR was better than that of AutoScan-4 system results There is at lest 936%(16/171) CNS results from AutoScan-4 system are falseConclusion ITS-PCR is verified as a valuable, easy to perform, rapid, high reliable and low cost molecular typing method for coagulase negative staphylococci

Over one half the patients with rheumatoid arthritis (RA) are being treated with methotrexate (MTX). Although well proven, the efficacy of MTX varies in individual patients. This study examined the metabolic biomarkers that can be used to predict the therapeutic effect of MTX by using metabolomic analysis. Rats were immunized with collagen to rapidly cause collagen-induced arthritis (CIA) and then treated with 0.1 mg/kg MTX for 4 weeks. The clinical signs and the histopathological features of CIA were observed to evaluate the therapeutic effects. Urine samples of CIA rats were collected, and analyzed by using 600 M (1)H-nuclear magnetic resonance ((1)H-NMR) for spectral binning after the therapy. The urine spectra were divided into spectral bins, and 20 endogenous metabolites were assigned by Chenomx Suite. Multivariate analyses were performed to identify the spectral pattern of endogenous metabolites related to MTX therapy. The results showed that the clustering of the spectra of the urine samples from the responsive rats (n=20) was different from that from the non-responsive rats (n=11). Multivariate analysis showed difference in metabolic profiles between the responsive and non-responsive rats by using partial least squares-discrimination analysis (PLS-DA) (R(2)=0.812, Q(2)=0.604). In targeted profiling, 13 endogenous metabolites (uric acid, taurine, histidine, methionine, glycine, etc.) were selected as putative biomarkers for predicting therapeutic response to MTX. It was suggested that (1)H-NMR-based metabolomic analysis can be used to predict the therapeutic effect of MTX, and several metabolites were found to be related to the therapeutic effects of MTX.

Objective To analyze the therapeutic effect of noninvasive mechanical ventilation in chronic obstructive pulmonary disease (COPD) patients with respiratory failure.Methods Sixty patients with COPD respiratory failure were randomly divided into two groups.30 cases in the conventional treatment group used conventional comprehensive therapy.30 cases in the nonfinvasive mechanical ventilation group were given noninvasive mechanical ventilation based on conventional treatment.The total effective rate,time to correct the abnormal breathing,hospitalization time were compared between the two groups.Before and after treatment,the arterial blood gas analysis indicators and heart rate,respiratory rate,probability,mortality for ventilator ventilation were compared in the two groups.Results The total effective rate of the noninvasive mechanical ventilation group was 96.67％,which was higher than 73.33％ of the conventional treatment group(x2 =6.405,P ＜ 0.05).The time to correct the abnormal breathing,hospitalization time of noninvasive mechanical ventilation group were (5.51 ± 1.41) d,(9.51 ± 2.13) d,respectively,which were shorter than (9.39 ± 2.56) d,(12.99 ± 3.57) d of the conventional treatment group (t =8.223,9.633,all P ＜ 0.05).Before treatment,the arterial blood gas analysis parameters and heart rate had no statistically significant differences between the two groups (all P ＞ 0.05).After treatment,the frequency of PaCO2,PaO2,heart rate and respiratory rate in the conventional treatment group were (60.45 ± 3.94)mmHg,(60.24 ± 4.12)mmHg,(92.58 ± 0.61)times/min,(22.45 ± 3.14)times/min,respectively,which in the noninvasive mechanical ventilation group were (52.24 ± 1.23) mmHg,(76.24 ± 5.26) mmHg,(83.92 ± 0.62) times/min,(17.26 ± 2.23) times/min,respectively,the differences between the two groups were statistically significant(t =5.133,3.734,5.166,6.360,all P ＜ 0.05).The invasive rate of invasive ventilator and mortality of noninvasive mechanical ventilation group were 3.33％ and 0.00％,respectively,which were lower than 20.00％,13.33％ of the conventional treatment group (x2 =7.214,6.247,all P ＜ 0.05).Conclusion Noninvasive mechanical ventilation is effective in treatment of patients with COPD respiratory failure,which can effectively improve the indicators of arterial blood gas and heart rate and respiratory rate,improve the prognosis of patients,improve the ventilation probability of invasive ventilator.

ObjectiveTo study the regulatory effect of Tripterygium wilfprdii polyglycoside (TWP) on the expression of EGFR and ErbB-2 induced arthritis rats.The effect of TWP on arthritis was also explored.MethodsAfter the model of CIA rats were established,the expression of EGFR and ErbB-2 in the synovium and articular cartilage were tested by immunohistochemical stain and real time PCR.ANOVA was used for statistical analysis.ResultsThe protein and mRNA expression of EGFR and ErbB-2 in the synovium (EGFR 0.268±0.059,ErbB-2 0.25±0.04,EGFR mRNA:14.2±0.55,ErbB-2 mRNA 23.46±3.64) and articular cartilage (EGFR 0.193±0.018,ErbB-2 0.217±0.033,EGFR mRNA:4.16±0.50,ErbB-2 mRNA 9.23±0.66) of the model group were significantly higher than those of the control group(P＜0.01).After being treated with TWP and MTX,the protein and mRNA expression of the EGFR and ErbB-2 decreased markedly (P＜0.01).Conclusion EGFR and ErbB-2 may play an important role in the pathogenesis of arthritis development.The molecular mechanism that TWP can treat synovitis and bone destruction of RA is related to the inhibition of EGFR and ErbB-2.

Objective To investigate the killer cell immunoglobulin-like receptor (KIR) genes, KIR2DS4 and its variant KIR1D for an association with syphilis in the comparison between syphilis patients and unrelated healthy subjects. Methods One hundred and ninety syphilis patients and 192 unrelated healthy subjects were performed to determine the KIR genotypes by PCR-SSP method. The gene frequencies of KIR2DS4 and KIR1D were analyzed for an association with syphilis in the patients and healthy people who belonged to KIR gene haplotype A. Results Of 192 healthy individuals, 187 were identified with a KIR2DS4 gene. And 91 individuals were classified as homozygous haplotype A with the percent of 48.7% (91/187) in 187 KIR2DS4 positive individuals. Of 190 syphilis patients, 181 were identified with a KIR2DS4 gene. And 89 individuals were classified as homozygous haplotype A with the percent of 49.2% (89/181) in 181 KIR2DS4 positive individuals. The frequency of KIR1D/KIR1D in syphilis patients classified as haplotype A was 16.9%, and was significantly higher than that in the control group (6.6%, P=0.032). However, there was no significant difference for the frequencies of KIR2DS4/KIR2DS4 and KIR2DS4/KIR1D between the two groups (P>0.05). Conclusion KIR1D/KIR1D might be associated with syphilis in the comparison between syphilis patients and unrelated healthy controls who were classified as homozygous haplotype A.

Objective To analyze the clinical results and early complications of corpectomy and reconstruction with titanium mesh cage implantation and pedicle screw fixation via a single posterior approach for severe thoracic and lumbar fractures.Methods Forty-four patients treated by reconstruction with titanium mesh cage implantation and pedicle screw fixation via a single posterior were studied retrospectively.There were 35 males and 9 females,with an average age of 37.3 years(range,19-66 years).The injury segments include 1 case at T11,5 cases at T12,20 cases at L1,11 cases at L2,5 cases at L3 and 2 cases at L4.According to AO classification,there were 24 cases of A3,17 cases of B1 and B2,and 3 cases of C1.According to ASIA,there were 10 cases of grade A,17 cases of grade B,10 cases of grade C and 7 cases of grade D.The neurologic function and effectiveness of correction of preoperative,immediate postoperative and 2years follow-up were compared,and the clinical outcome and early complications were analyzed.Results The follow-up time was 24 to 58 months,mean 38.9 months.At the time of 2 years postoperation,43 cases of incomplete neurologic deficit had improved 1 or 2 ASIA grades except 1 case of grade A.The results of decompression and reduction were satisfactory from the postoperative radiographic examinations.The correction maintained well and the implant loosening was not seen in 43 cases(97.7%)at the last follow-up.The com plications include:excessive blood loss(＞1500 ml)in 9 cases,transient nerve root injury in 4,cerebrospinal fluid leakage in 3,instrumentation failure in 1,mesh cage malposition in 3,iatrogenic leaving of free bone granula into the canal in 2,and superficial infection in 1.Conclusion This technique is effective for decompression and fusion,less invasive than combined anteroposterior procedure,and may be another good alternative for the treatment of severe thoracic and lumbar fractures.The early complications are not rare,but most of them are not serious and are relative to techniques.