目的 探讨微小RNA-20a-5p(miR-20a-5p)是否通过下调骨形成蛋白2型受体(BMPR2)基因调控人脑微血管内皮细胞增殖和抑制凋亡.方法 在永生化人脑微血管内皮细胞(hCM EC/D3)中分别转染miR-20a-5p mimics,BMPR2小干扰RNA(si-BMPR2)或过表达质粒(pcDNA-BMPR2).实时定量PCR(qRT-PCR)测定miR-20a-5p表达,免疫印迹(Western Blot)检测BMPR2、细胞周期蛋白D1(CyclinD1)、活化的的天冬氨酸特异性半胱氨酸蛋白酶3(Cleaved-caspase-3)、磷酸化-磷脂酰肌醇-3激酶(p-PI3K)、磷酸化蛋白激酶B(p-AKT)蛋白水平,噻唑蓝(MTT)检测细胞增殖,流式细胞仪检测细胞凋亡.生物信息学预测与荧光素酶报告基因检测分析miR-20a-5p和BM PR2之间的关系.共转染miR-20a-5p mimics和pcDNA-BMPR2,利用上述方法评估其对细胞增殖、凋亡和PI3K/AKT信号通路的影响.结果 过表达miR-20a-5p明显增加hCMEC/D3的细胞活性,CyclinD1、p-PI3K、p-AKT蛋白表达水平,显著减少细胞凋亡率和Cleaved-caspase-3蛋白表达水平(P<0.05).低表达BMPR2明显提高hCMEC/D3的细胞活性、CyclinD1蛋白表达水平,显著减少细胞凋亡率和Cleaved-caspase-3蛋白表达水平(P<0.05),高表达BM PR2时具有相反的效果.miR-20a-5p靶向BMPR2,并调控BMPR2蛋白的表达.高表达BMPR2可以逆转miR-20a-5p促hCMEC/D3增殖、PI3K/AKT信号通路活性和抑凋亡的作用.结论 miR-20a-5p通过靶向BMPR2激活PI3K/AKT信号通路,促进人脑微血管内皮细胞的增殖,并抑制凋亡.

Objective To investigate the effects and safety of intravenous thrombolytic therapy with rt-PA and anti-platelet for acute ischemic stroke with consciousness disorders.Methods 32 cases were included in anti-platelet group and treated with 0.3g/d by oral.The rt-PA group included 24 cases with 0.9mg/Kg rt-PA by intravenous and the maximum dose was 90mg.The national institutes of health stroke scale(NIHSS) were used to assess neurological function at pre-treatment and 24h,14d,90d after treatment.Oxford Handicap Scale(OHS) was scored at 90d after therapy.The efficacy was compared between the two groups.Mortality and causes were observed at 24h,14d and 90d post therapy.Survival rate of coma subgroup were compared at post-therapy 14d.Results The scores of NIHSS at each time point or OHS at 90d of rt-PA group were lower than that of the anti-platelet group,and survival rate of coma subgroup at 14d was higher than the anti-platelet group.All of these scores had statistical difference between the two groups.Mortal rate had no statistical difference between the two groups.Conclusion Intravenous thrombolytic therapy with rt-PA for acute ischemic stroke with consciousness disorder is effective and safe.

Objective To study factors used to predict 30-day mortality and favorable outcomes to intracerebral hemorrhage (ICH) in young adult subjects and to estimate the reliability of these predictors.Methods Data of 175 acute ICH patients selected from 201 patients admitted to our hospital from 2008 to 2011 were reviewed retrospectively.Patients were assessed with Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) and routine laboratory examinations after admission.Independent predictors of 30-day mortality or good outcome (modified Rankin score,0-2) were identified by stepwise logistic regression.Results There were 90 male and 85 female,and 142 survivals and 33 deaths.The modified Rankin score (mRS) of survival group was ＜6 and mRS =6 in death group,and mRS ＜3 in good outcome group and mRS ＞ or =3 in poor outcome group.Independent factors for 30-day mortality were hypertension (P =0.023) or hyperglycemia (P =0.007),infra-tentorial ICH (P =0.000),large ICH volume (P =0.008),low Glasgow Coma Scale (GCS) scores (P =0.000),high white blood cell count (P =0.000),higher blood glucose level (P =0.039) and prothrombin time (PT) (P =0.001) after admission.Independent factors for 30-day good outcome were younger age (P =0.001),normal blood pressure (P=0.010) or absence of hyperglycemia (P=0.028),lower NIHSS scores (P=0.000),small ICH volume (P =0.000),low white blood cell (WBC) count (P =0.000),lower blood glucose level (P =0.012) or lower systolic blood pressure (SBP) level (P =0.000) at admission.The NIHSS score and GCS score were excellent predictors,while the SBP level,WBC count and ICH volume were fine predictors.Conclusions Overall prognostic factors should be integrated to get high reliabilities for predicting the outcomes of ICH in young people.

最近有新闻报道,一爱吃柿子的男子患了胃结石,不愿做手术的他,连续2个月每天大量喝可口可乐,此后复查时发现,胃结石神奇地消失!这消息让人惊奇,同时也让人困惑:胃酸是溶解能力了得的强酸,为什么胃里还能有结石呢?而胃酸也溶解不了的胃结石,可乐真的能溶解?果如此,其他人得了胃结石是不是也可如法炮制,只要喝可乐就可以了?

不知从哪天开始,小文起床后总觉得眼睛不舒服,左眼皮一个劲儿地跳。姥姥告诉他说老家有首歌:"左眼皮跳跳,好事要来到,不是要升官,就是要发财",还说这是好兆头。尽管眼皮跳得挺难受,但听了姥姥的话,小文也就没怎么在意。随后几个月,他的眼皮跳逐渐加重,也越来越频繁,范围也逐渐扩大,由起初的左眼皮蔓延到整个左面颊部。家里人这才急了,催着小文去医院检查,医生诊断为"面肌痉挛"。然而,小文吃了一周的药,症状没见明显好转,后来转入神经外科,通过手术才治好。

Objective To investigate the relationship between plasma oxidized low-density lipoprotein(ox-LDL),high-sensitive C-reactive protein(hs-CRP) level and carotid artery stenosis(CAS)in acute cerebral infarction(ACI),and the relationship between ox-LDL and hs-CRP.Methods A total of 66 patients with ACI and CAS were selected to determine plasma ox-LDL and hs-CRP levels.Another 30 healthy adults served as normal controls.In ACI cases,the patients were grouped to compare the relationship between ox-LDL,hs-CRP levels and the degree of CAS or neurologic impairment,and the correlation between ox-LDL and hs-CRP was analyzed.Results The ox-LDL and hs-CRP levels in ACI group were significantly higher than those in control group,they were significantly higher in the severe stenosis group than those in the moderate stenosis group and the mild stenosis group,and were significantly higher in the moderate stenosis group than those in the mild stenosis group(P0.05).They were significantly higher in the severe neurologic impairment group than those in the medium grade group and the light grade group,and were significantly higher in the medium grade group than those in the light grade group(P0.05).There was significantly positive correlation between ox-LDL and hs-CRP(r=0.426,P0.05).Conclusion The plasma ox-LDL and hs-CRP levels are associated with the degree of CAS or neurologic impairment,they may take cooperative effect in the genesis and development of CAS in patients with ACI.

目的分析多巴反应性肌张力障碍(DRD)的临床特点,探讨有效的临床诊治对策。方法回顾性分析我院2008～2012年间收治的19例多巴反应性肌张力障碍患者的临床资料,总结临床诊治经验。结果本组19例多巴反应性肌张力障碍患者经队长治疗后,临床症状及体征有显著缓解,治疗起效时间为1～12d,平均(4.6±1.1)d,治疗总有效率为94.7%。所有患者治疗后均未出现肌张力障碍、运动障碍、开关现象等不良反应。对所有患者进行1～4年的随访发现2例患者出现复发,复发率为10.5%,其中1例患者于治疗后5个月复发,另1例患者于治疗后2年复发。结论临床医生应掌握该病的临床特点,并结合患者的临床症状、病史及相关辅助检查结果 ,以明确诊断,降低漏诊率和误诊率。采用美多巴治疗多巴反应性肌张力障碍患者,临床疗效显著,能够显著改善患者的临床症状,且不良反应发生率低,值得临床医师进一步推广使用。

Objective To investigate the value of color Doppler ultrasound examining carotid artery in health people.Methods Carotid artery intimal-medial thickness(IMT),the numbers and properties of plaques and the hemodynamic changes were examined by color Doppler imaging in 538 healthy 40-year-older people.Results The IMT and the numbers of plaques,including the unstable plaques increased with ages increasing,which were wider in man than women.Conclusion Blood quantity of brain artery in people with different ages could be dynamically observed by ultrasonically examining carotid artery,which can supply reliable information on early diagnosis of ischemic cerebrovascular disease.

Objective :To study serum levels and their clinical significance of platelet microparticle in patients with acute cerebral infarctions.Methods The serum levels of PMP were detected and compared between acute cerebral infarction group consisting of 80 patients and control group consisting of 80 health persons.Also the PMP levels of patients with different infarction areas and of different TOAST subtypes were compared and the PMP levers before treatment,after three-days',one-weeks' and two-weeks' treatment were detected,too.Results Compared with the control,the serum levels of PMP were higher in patients with acute cerebral infarctions,and the larger the infarction areas were,the higher the PMP levels were.There was significant difference among patients of different TOAST subtypes.After treatment,the PMP levers of the patients decreased dynamically.Conclusion Platelet is activated in patients with acute cerebral infarctions.Testing the serum levels of PMP helps to diagnose and treat cerebral infarctions.

中药汤剂沿用至今已有数千年的历史,现在,许多人生病了依然会选择中药治疗。然而,中药用之得当,可防病治病;用之不当,不但疗效不好,还有可能加重病情,甚至危及生命。其中,不会选用熬药工具,就是用药不当的情况之一。那么,瓦罐沙锅,不锈钢锅,铝、铁、铜等器皿,甚之是微波炉,陶瓷自动中药煲,哪一种才是熬药的最佳选择?

Objective To provide community health service center with epidemiology data to carry out chronic diseases prevention and control measurements through acquiring the information about people over 55 years old with cardiacerebrovascular disease and its correlated diseases in HeHua community of Yangzhou city.Methods 397 people over 55 years old were surveyed by questionnaires.And we measured the volunteers' blood pressure,tested serum lipids and glucose,performed electrocardiogram and screened carotid artery by Btype ultrasound,then graded risk scores of cardiacerebrovascular disease according to the medical results.Results 291 people were voluntarily done physical examinations and performances.Morbidity of chronic diseases in order were hypertension(62.54%),hyperlipidemia(52.23%),obesity(15.46%),diabetes mellitus(9.97%),cerebrovascular diseases(4.12%).51.77% of tested people had carotid artery plague and 14.12% had carotid stenosis while 47.76% had high risks getting cardiacerebrovascular diseases.Conclusion Hypertension,hyperlipidemia and cardiac vascular diseases are major chronic diseases affecting the people over 55 years old in this community.Therefore,we should take actions actively to prevent and control the diseases.

肌阵挛-肌张力障碍综合征(myoclonus-dystonia syndrome, MDS)是一种常染色体显性遗传,以肌阵挛和肌张力障碍为特征性表现的罕见运动障碍病[1].本病由位于7q21的Epsilon-Sarcoglycan (SGCE)基因突变所致[2].

<正>遗传性痉挛性截瘫(hereditary spastic paraplegia, HSP)是以缓慢进行性双下肢肌张力增高和轻瘫为特征表现的一种神经变性疾病[1]。根据临床表现分为单纯型和复杂型。现将我院近两年收治的来自四川地区的3个单纯型HSP家系报道如下。

AIM: To understand the distinct,clinical features of myotonia congenita in China.METHODS: Case reports of myotonia congenita were retrieved from the Chinese Journal Full-text database, dating between 1980 and 2007 and analyzed for clinical characteristics of myotonia congenita.RESULTS: There were 35 published reports and 258 cases about myotonia congenita. Six reports (62 cases) were excluded due to lack of clinical data, imprecise diagnosis, or duplication. Finally 29 published reports and 196 cases (140 males and 56 females) were included in this analysis. About 78.6 % of patients were diagnosed with myotonia congenita before the age of 20 and among these 86.1% were classified as dominant inheritance. Lower and upper extremities were frequently affected with severe symptoms. Eyelids, mouth and lingual muscles and trunk muscles and cervical muscles were less frequently involved. However muscles for swallowing sphineter muscles and smooth muscles were not involved. There were no reports of cataracts, cardiac conduction block or dyscrinism myotonia congenita symptoms were induced or aggravated by cold temperatures in 71.9% of the patients and warming-up effect occured in 95.6% of the patients. Muscle hypertrophy was observed in 69.6% and percussion of muscles in 76.5% of the patients. Myotonia potential or myotonia-like potential was detected in all patients using electromyography. Muscle fiber swelling or hypertrophy was frequently detected through muscular biopsy.CONCLUSION: Myotonia congenita frequently occurs in males before the age of 20, in particular as the autosomal dominant form of myotonia congenita. Skeletal muscles throughout the body especially the lower and upper extremities are involved. Warming-up effect is the main characteristic of myotonia congenita.

先证者(Ⅲ1) 男,25岁.因颈部不自主向左侧扭转伴阵发性的肢体抖动7年到我院就诊.患者于18岁开始出现短暂发作的双上肢肌阵挛,半年后出现了阵阵颈部不自主向左侧扭转.