Clinical practice guidelines for post-stroke depression in China

Post-stroke depression (PSD) is a very common complication that leads to increased physical disability, poor functional outcome, and higher mortality. Therefore, early detection and treatment are very important. Since there are currently no specific guidelines for this disorder in China, the purpose of this study was to develop PSD guidelines and provide suggestions for clinicians and related workers.

Increased orexin expression promotes sleep/wake disturbances in the SOD1-G93A mouse model of amyotrophic lateral sclerosis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Sleep/wake disturbances in patients with amyotrophic lateral sclerosis (ALS) are well-documented, however, no animal or mechanistic studies on these disturbances exist. Orexin is a crucial neurotransmitter in promoting wakefulness in sleep/wake regulation, and may play an important role in sleep disturbances in ALS. In this study, we used SOD1-G93A transgenic mice as an ALS mouse model to investigate the sleep/wake disturbances and their possible mechanisms in ALS.</p><p><b>METHODS</b>Electroencephalogram/electromyogram recordings were performed in SOD1-G93A transgenic mice and their littermate control mice at the ages of 90 and 120 days, and the samples obtained from these groups were subjected to quantitative reverse transcriptase-polymerase chain reaction, western blotting, and enzyme-linked immunosorbent assay.</p><p><b>RESULTS</b>For the first time in SOD1-G93A transgenic mice, we observed significantly increased wakefulness, reduced sleep time, and up-regulated orexins (prepro-orexin, orexin A and B) at both 90 and 120 days. Correlation analysis confirmed moderate to high correlations between sleep/wake time (total sleep time, wakefulness time, rapid eye movement [REM] sleep time, non-REM sleep time, and deep sleep time) and increase in orexins (prepro-orexin, orexin A and B).</p><p><b>CONCLUSION</b>Sleep/wake disturbances occur before disease onset in this ALS mouse model. Increased orexins may promote wakefulness and result in these disturbances before and after disease onset, thus making them potential therapeutic targets for amelioration of sleep disturbances in ALS. Further studies are required to elucidate the underlying mechanisms in the future.</p>

Effects and mechanism of baicalin on apoptosis of cervical cancer HeLa cells in-vitro

The objective of this study was to observe the apoptosis-inducing effect and mechanism of baicalin on human cervical cancer HeLa cells. The inhibitory effect of baicalin on the growth of HeLa cells was measured by MTT assay, and cell proliferation and migration was analyzed by cell scratch assay. Morphological changes of apoptotic cells were viewed by the light microscope and electron microscope, and cell growth arrest was confirmed by flow cytometry. Moreover, Western blot was used for investigating the expression of apoptosis related proteins; spectrophotometry was used to examine Caspase-3 activation. Our results showed that baicalin could inhibit the proliferation of HeLa Cells via induction of apoptosis in a time and dose-dependent manner [P<0.01]. Apoptotic signaling induced by baicalin was characterized by up-regulating Bax, Fas, FasL and Caspase-8 protein expression, and down-regulating of Bcl-2 protein expression. These results indicated that baicalin-induced apoptosis involved activation Caspase-3 in HeLa cells through the intracellular mitochondrial pathway and the surface death receptor pathway

Analysis of genetic characteristics of ECHO6 virus isolated from an epidemic outbreak of encephalitis in Longyan, China / 病毒学报

This study aimed to analyze the etiology of the encephalitis outbreak in Longyan, Fujian Province, China in 2010, in order to provide valuable information for this prevention and control of this disease. Pathogens were confirmed from cerebrospinal fluid samples with fluorescent RT-PCR, virus isolation (RD cells), and neutralization tests. Then, the VP1 fragments or whole genome nucleotide sequences were determined for four virus strains using PCR. Homology was assessed using the MegAlign software, and a phylogenetic evolutionary tree was drawn using Mega 4.0 software. The results confirmed that the etiology of the outbreak was the ECHO6 intestinal virus, and the nucleotide sequence of the VP1 segment indicated that the C2 subtype was responsible. The genome sequence consisted of 7407 nucleotides, and resembled the genome of other ECHO and CoxB viruses with homology levels of 78.5%-87.3%. The encephalitis outbreak in Longyan in 2010 was caused by the ECHO6 C2 subtype intestinal virus, and its complete genome sequence length is similar to the standard strain (U16283) with a sequence homology of 80.4%.

The application of a new method of microvascular anastomosis: a review of 109 microvascular anastomosis surgery / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and clinical significance of the new method for microvascular anastomosis.</p><p><b>METHODS</b>Between February 2013 and May 2013, 108 patients aged 31 to 73 years underwent free flap reconstruction of the defects as a result of resection of oralmaxillofacial tumors. Of 108 patients, 78 were men and 30 were women. The cases were divided into experimental group(46 flaps) and control group (63 flaps) according to different methods of microvascular anastomosis.Isometric double notches end to end microvascular anastomosis was used for artery anastomosis in experimental group, conventional end to end anastomosis was used for artery anastomosis in control group and venous anastomosis was performed in both groups.</p><p><b>RESULTS</b>The entire procedure of artery anastomosis took (7.3 ± 1.7) min in experimental group, (14.5 ± 2.6) min in control group, the difference between the two groups was significant (P = 0.00). There was only one venous compromise which was complete failure in experimental group. There were two venous compromise and one artery compromise in control group, and one of the venous compromise was a complete failure.</p><p><b>CONCLUSIONS</b>The isometric double notches end to end microvascular anastomosis proved successful and clinically feasible with advantages of fixed-point accuracy, time-saving and high patency rate.</p>

Features of a Chinese family with cerebral cavernous malformation induced by a novel CCM1 gene mutation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Familial cerebral cavernous malformations (CCMs), characterized by hemorrhagic stroke, recurrent headache and epilepsy, are congenital vascular anomalies of the central nervous system. Familial CCMs is an autosomal dominant inherited disorder and three CCM genes have been identified. We report a Chinese family with CCMs and intend to explore clinical, pathological, magnetic resonance imaging (MRI) features and pathogenic gene mutation of this family.</p><p><b>METHODS</b>Totally 25 family members underwent brain MRI examination and clinical check. Two patients with surgical indications had surgical treatment and the specimens were subjected to histopathological and microstructural examination. In addition, polymerase chain reaction (PCR) and direct sequencing were performed with genomic DNA extracted from 25 family members' blood samples for mutation detection.</p><p><b>RESULTS</b>Brain MRI identified abnormal results in seven family members. All of them had multiple intracranial lesions and four cases had skin cavernous hemangioma. T2-weighted sequence showed that the lesions were typically characterized by an area of mixed signal intensity. Gradient-echo (GRE) sequence was more sensitive to find micro-cavernous hemangiomas. There was a wide range in the clinical manifestations as well as the age of onset in the family. The youngest patient was an 8-year-old boy with least intracranial lesions. Histopathological and microstructural examination showed that CCMs were typically discrete multi-sublobes of berry-like lesions, with hemorrhage in various stages of illness evolution. They were formed by abnormally enlarged sinusoids and the thin basement membranes. A novel T deletion mutation in exon 14 of CCM1 gene was identified by mutation detection in the seven patients. But unaffected members and healthy controls did not carry this mutation.</p><p><b>CONCLUSIONS</b>The clinical manifestations were heterogenic within this family. We identified a novel mutation (c.1396delT) was the disease-causing mutation for this family and extended the mutational spectrum of CCMs.</p>

Perfluorocarbon attenuates lipopolysaccharide-mediated inflammatory responses of alveolar epithelial cells in vitro / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Toll-like receptor-4 (TLR-4) is integrally involved in lipopolysaccharide (LPS) signaling and has a requisite role in the activation of nuclear factor-κB (NF-κB). The exact mechanisms that lend perfluorocarbon (PFC) liquids a cytoprotective effect have yet to be elucidated. Therefore we examined in an in vitro model the cytoprotective effect of PFC on LPS-stimulated alveolar epithelial cellls (AECs).</p><p><b>METHODS</b>AECs (A549 cells, human lung adenocarcinoma cell line) were divided into four groups: control, PFC, LPS and LPS + PFC (coculture group) groups. Intercellular adhesion molecule-1 (ICAM-1) was detected by ELISA, tumor necrosis factor-α (TNF-α) and interleukin-8 (IL-8) were detected by radioimmunological methods. The expression of TLR-4 mRNA and protein was detected by real time PCR and Western blotting, respectively. The activation of NF-κB was detected by Western blotting (proteins of I-κBa and NF-κB p65).</p><p><b>RESULTS</b>ICAM-1, TNF-α and IL-8 were significantly increased in LPS-stimulated AECs groups. The expression of TLR-4 mRNA and protein in LPS-stimulated groups was markedly increased. Meanwhile, NF-κB was activated as indicated by the significant degradation of IκB-α and the significant release of NF-κB P65 and its subsequent translocation into the nucleus. There were no significant effects of PFC alone on any of the factors studied while the coculture group showed significant downregulation of the secretion of ICAM-1, TNF-α and IL-8, the expression of TLR-4 mRNA and the activity of NF-κB.</p><p><b>CONCLUSIONS</b>Taken together, our results demonstrate that LPS can induce AEC-related inflammatory injury via the activation of TLR-4 and subsequent activation of NF-κB. PFC is able to protect AECs from LPS-induced inflammatory injury by blocking the initiation of the LPS signaling pathway, which is indicated by the significant decrease of TLR-4 expression and NF-κB activation.</p>

Multi-factor analysis of radiation-induced esophagitis in three-dimensional conformal radiotherapy for non-small cell lung cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the clinical and physical factors that might give rise to radiation-induced esophagitis in three-dimensional conformal radiotherapy for non-small cell lung cancer.</p><p><b>METHODS</b>To collect the clinical and physical records and follow-up information of 106 NSCLC patients without undergoing surgery in our hospital. χ(2) test, linear tendency test and analysis of variance were employed to analyze the relationship between occurrence of radiation-induced esophagitis and clinical and physical treatment. Logistic analysis was also used for multivariate analysis.</p><p><b>RESULTS</b>Among the 47 cases of radiation-induced esophagitis, 31 cases were of grade I, 11 of grade II, 5 of grade III, and with a total occurrence rate of 44.3% (47/106). Radiation-induced esophagitis was correlated with Karnofsky scores, radiation sensitization and tumor location (χ(2) = 11.30, 8.45, 7.67, P < 0.05). Radiation-induced esophagitis was correlated with the length of irradiated esophagus and average dose of irradiated esophagus (F = 20.82, 83.08, P < 0.001). With the increase of the irradiated volume percentage from V20, V30, V40 up to V50, the occurrence rate of radiation-induced esophagitis was also increased, almost with a linear trend (P < 0.05). Application of all the above factors to logistic model indicated that radiation sensitization,length of irradiated esophagus, average dose and V50 were all statistically significant foactors in the occurrence of radiation-induced esophagitis (OR = 0.321, 2.850, 7.307 and 8.558, P < 0.05).</p><p><b>CONCLUSIONS</b>Radiation sensitization,length of irradiated esophagus, average dose of irradiated esophagus and V50 are independent factors in the occurrence of radiation-induced esophagitis. V50 is of greater importance in the judgement of occurrence of radiation-induced esophagitis.</p>

Preparative technique of anterolateral thigh flap / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the surgical techniques and methods of anterolateral thigh (myocutaneous) flap.</p><p><b>METHODS</b>Two hundred and forty-five consecutive free anterolateral thigh (myocutaneous) flaps for reconstruction of the defects of oral and maxillofacial region following the malignant tumors resection from January 2007 to August 2009 were reviewed. The incision was designed in the upper, middle or lower part 3 cm medial of the iliac-patella line according to the thickness of flaps needed. The perforators with suitable vessel diameter and strong pulse were chosen to make flaps with muscular tissue to fill dead space. More than one perforators were taken when large flaps were harvested. The size of the flaps ranged from 4 cm × 4 cm to 10 cm × 25 cm. Eighteen fat flaps were made thinned.</p><p><b>RESULTS</b>Of the 245 flaps harvested, 3 complete necrosis occurred, and the survival rate was 98.8%. Blisters occurred in 8 thinned flaps, but they all survived. All the wounds were closed directly except 5 cases, which needed skin graft because of too large defects of skin. All the skin graft came from the upper part of the wound of donor site. The shape and function were satisfactory after the reconstruction.</p><p><b>CONCLUSIONS</b>When anterolateral thigh (myocutaneous) flaps are harvested, the incision should be designed 3 cm medial of the iliac-patella line according to the thickness of flaps needed. It is helpful to find the perforators. All of the lower, middle and upper parts of anterolateral thigh region have cutaneous perforators. The skin defects within 8 cm can be closed directly, while the skin defects more than 8 cm often need skin grafting. The skin grafts can be taken from the upper part of donor site wounds.</p>

99Tcm-MIBI SPECT in estimation of the treatment response to three-dimensional conformal radiotherapy in patients with non-small cell lung cancer / 中华核医学杂志

Objective To explore whether the degree of 99Tcm-methoxyisobutylisonitrile (MIBI) uptake in non-small cell lung cancer (NSCLC) could be correlated with the treatment response to three-dimensional conformal radiotherapy.Methods A total of 102 patients with NSCLC were studied with 99Tcm-MIBI SPECT before radiotherapy.The patients were classified by a follow-up CT as responders (complete or partial remission) and non-responders (stable or progressive disease).After intravenous administration of 740 MBq 99Tcm-MIBI, SPECT imaging at 10-30 min (early) and 2-3 h (delayed) were performed.Region of interest (ROI) was placed over the tumors and contralateral normal lung tissue.The uptake ratio of tumor to contralateral normal lung (T/N) was obtained from both early (ER) and delayed (DR) SPECT images.The retention index (RI) was measured as:RI = (DR - ER)/ER×100%.Statistical analysis was performed by two independent-sample t-test and Mann-Whitney U test using software SPSS 13.0.Results 99Tcm-MIBI uptake was significantly higher in responders than in non-responders:2.36 ±0.17 vs 1.82 ±0.14 (ER) and 2.48 ± 0.20 vs 1.94 ± 0.16 (DR), respectively (t = - 13.1,- 12.7, both P＜ 0.05).The median RI in the responders group was also significantly higher than that in the non-responders group (6.60% vs 5.13%, z = - 6.83, P ＜ 0.05).Conclusion ER, DR and RI of 99Tcm-MIBI SPECT might be useful to estimate the treatment response to three-dimensional conformal radiotherapy in patients with NSCLC.

Expressional changes of CLC-2 and CLC-3 chloride channel in the hippocampus of rats with lithium-pilocarpine-induced epilepsy / 中华神经医学杂志

Objective To investigate the distribution and expression changes of voltage-gated chloride channel CLC-2 and CLC-3 in rat models with lithium-pilocarpine-induced chronic epileptic,and discuss the significance of these changes in epileptic pathogenesis.Methods Eighty Wistar rats were randomly divided into status epilepticus(SE,n=60)and control(n=20)groups and rats in the SE group were assigned to 3 subgroups according to the different sacrificed times(24 h,14 d and 30 d).Rat models with chronic epileptic in the SE group were induced by lithium-pilocarpine.Immunohistochemistry was employed to observe the changes of voltage-gated chloride channel CLC-2 and CLC-3 in rat's hlppocampal formation different time points after seizure.The mRNA changes of chloride channel CLC-2 and CLC-3 at different time points after seizure were observed by RT-PCR.Results Compared with those in the control group,the quantity of CLC-2 immune positive neurons and the average optical density in the SE group decreased obviously 14 and 30 d after seizure;so was the mRNA expression of CLC-2(P<0.05).Compared with the control group,the SE group showed obviously increased quantity of CLC-3 immune positive neurons and optical density at each area of the hippocampus 24 h after seizure;so was the mRNA expression of CLC-3(P<0.05).Conclusion Seizures at chronic phase have relation with the decreased expressions of CLC-2.

Interventional therapy for atherosclerotic occlusive disease of the superficial femoral artery / 中华普通外科杂志

Objective To explore the methods and mid-term results of interventional therapy for atherosclerotic occlusive disease of the superficial femoral artery(SFA).Methods From January 2005 to August 2008,Nineteen cases with 22 diseased lower limbs were admitted.According to Fontaine stage system,there were 6 stage Ⅱb limbs(moderate to severe intermittent claudication),8 stage Ⅲ limbs(rest pain),and 8 stage Ⅳ limbs(6 with ulcer and 2 with gangrene).The mean lesion length was 8.8 cm(5～13 cm).On the basis of the TransAtlantic Inter-Society Consensus(TASC)femoropopliteal classification,the lesions were classified as type B in 4 limbs,type C in 17,and D in 1.Follow up examinations with color duplex ultrasound and/or arteriography were carried out to determine the patency.The improvement of clinical symptoms after operation was analyzed.Results 17 limbs were revascularization successfully,2 limbs were turned to bypass operation,3 limbs were judged untreatable.The technical success rate is 77.3%,and the clinical improvement of symptoms was achieved in 100% of the 17 limbs on which the procedure was successful.The 17 limbs were followed up for a mean of 12.5 months(range 3-33 months).One patient died of cardia infarction one month postoperatively.SFA occlusion happened in 4 limbs.At one year postoperatively,the patency rate was 75%(13/17)after primary operation.Conclusions Primary endovascular treatment of SFA occlusion diseases is a safe,minimally invasive,and effective method.

Clinical application of free anterolateral thigh flap in the reconstruction of oromaxillo-facial defects / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the possibility and practicality of using free anterolateral thigh flap to repair defects of oromaxillo-facial region.</p><p><b>METHODS</b>One hundred and seventy-two patients underwent anterolateral thigh flap (ALP) reconstruction from Jan. 2007 to Dec. 2008. The size of the defect ranges from 4 cm x 4 cm to 10 cm x 25 cm. One hundred and six flaps were used for tongue reconstruction, 14 flaps for buccal reconstruction, 15 flaps for mouth floor reconstruction, 1 flap for lower lip and mental region reconstruction, 6 flaps for hard and soft palate reconstruction, 3 flap for maxillary part reconstruction, 18 flaps for submaxilla part reconstruction, 2 flaps for pharynx oralis reconstruction, 3 flaps for repairing large-area defect of facial, 1 flap for repairing neck and shoulder region and 3 flaps for repairing defect of Infratemporal fossa. Of these flaps, 151 were musculocutaneous flaps, 13 were fasciocutaneous flaps and 8 were chimeric flaps.</p><p><b>RESULTS</b>The success rate reaches 98.3% (169 of 172). Postoperatively, 4 cases encountered vascular crisis, 1 of which survived completely with successful vessel exploration, 3 cases with partial necrosis; and 3 cases with complete necrosis. One case with bleeding after operation. Six cases with parotid fluidly and parotid fistula, 8 cases with mouth floor fistula, 6 cases with infection, 3 cases with infection and partial necrosis on the lateral thigh. All patients achieved acceptable contour, appearance and function.</p><p><b>CONCLUSION</b>Free anterolateral thigh flap can repair kinds of complicated defects on oromaxillo-facial region.</p>

The chimeric perforator flap pedicled with descending branch of lateral circumflex femoral artery for reconstruction of oromaxillary soft tissue defect / 中华整形外科杂志

<p><b>OBJECTIVE</b>To report the application of the chimeric perforator flap pedicled with descending branch of lateral circumflex femoral artery for large and complicated oromaxillary soft tissue defect.</p><p><b>METHODS</b>Based on the anatomic study of descending branches and cutaneous perforators of lateral circumflex femoral artery, the perforator vessels were found and used as flap pedicle. The perforator flap was made as chimeric flap for repairing the oromaxillary soft tissue defect in 8 cases. The chimeric perforator flaps were divided into three types as anterolateral thigh flaps and anteromedial thigh flaps, anterolateral thigh flaps and rectus femoris perforator flaps, and anterolateral thigh flaps and anterolateral thigh flaps.</p><p><b>RESULTS</b>All the 16 flaps in 8 cases survived completely with no complication. The wounds in donor sites were all primarily closed with no skin graft. The patients were followed up for 1-9 months with good functional and esthetic results. There was no morbidity in donor sites.</p><p><b>CONCLUSIONS</b>The chimeric perforator flap has a large tissue volume for large and complicated oromaxillary defect. There is no need for extra donor site and extra blood vessel anastomosis.</p>

Clinical study on effect of sanqi tongshu capsule in treating ischemic stroke: multicenter clinical trial / 中国中药杂志

<p><b>OBJECTIVE</b>To observe the clinical effect and security of Sanqi Tongshu capsule in treating ischemic strkoe.</p><p><b>METHOD</b>A multicenter, no dummy, open labeled clincal trail was conducted. 1 753 patient were enrolled in this clinical trial. All patients were treated with the Sanqi Tongshu capsule (200 mg, three times a day) for 28 days. The score of Europe Stroke Score (ESS) and Barthel Index (BI) were evaluated before and after treatment. The adverse reaction occurred in the therapeutic course was also observed.</p><p><b>RESULT</b>Finally, 1742 cases and 1676 cases were respectively assessable by Full analysis set (FAS) analysis and Full analysis set (FAS) analysis. Clinical symptoms markedly improved in patients after treatment, and the score of ESS and BI had significantly improved (P<0.05). According to the score of ESS and BI, the total effect analysis indicated that the total effective rate in FAS and PPS were 81.86% and 84.43% respectively. The rate of adverse reaction was 3.44%, and the raction was so slight that didn't need to receive therapy or withdral drug.</p><p><b>CONCLUSION</b>Sanqi Tongshu capsule is effect and secure in treating ischemic stroke without obvious adverse reaction.</p>

Cerebral cavernous angiomas:clinical,pathophysiological and imaging features in one Chinese family / 中华神经科杂志

Objective To investigate clinical symptoms,pathophysiology and brain imaging features of Chinese familial cerebral cavernous angiomas.Methods Head MRI examination,clinical and pathophysiological examination were performed in a Chinese family with one proband of cerebral cavernous malformation.The disease atlas of the family was drawn.The patients indicative of a surgery underwent resection of hemangioma whose pathophysiology and microstructure were observed.Results Nine familial cerebral cavernous angiomas patients were found to have multiple intracranial lesion in the 18 family members,the penetrance being 50%,conforming to the feature of autosomal incomplete dominance inheritance.Four patients with skin cavernous hemangioma had familial cerebral cavernous angiomas.MRI was the most sensitive modality for the diagnosis of cavernous angioma.With T_2-Weighted sequences,the lesion was typically characterized by an area of mixed signal intensity,with a central reticulated core and a peripheral rim of decreased signal intensity related to deposition of hemosiderin.Gradient-echo(GRE)MRI could find microcavernous hemangiomas that would not be found in other sequences.Cavernous angiomas were typically discrete multilobulated berrylike lesions that contained hemorrhage in various stages of evolution.Histological homogeneity and overlap with other vascular malformations such as capillary telangictasia was common.Cavernous angiomas were composed of endothelial-linked sinusoidal spaces not separated by significant amounts of neural tissue.Hemorrhagic residua were common.Clots at different stages of evolution within the lesion were seen.The basic membranes of sinus became thick and soft.Parts of it were layered.Conclusions Familial cerebral cavernous angiomas is an autosomal incomplete dominance inheritance disease.Cavernous angiomas are composed of endothelial-linked sinusoidal spaces not separated by significant amounts of neural tissue.There are more than one focus in every patients and the skin cavernous angiomas is the foundation of diagnosing familial cerebral cavernous angiomas.Gradient-echo imagine sequence MRI(3.0 T)could be the"golden standard".