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Objective:To confirm the efficacy and safety of cinepazide maleate injection in acute ischemic stroke patients with obvious motor function deficit.Methods:This study is a subgroup analysis of multi-center, randomized, double-blind, placebo-controlled phase Ⅳ clinical trial. A total 812 patients of acute ischemic stroke with obvious limb motor deficit [motor function of limbs score in National Institutes of Health Stroke Scale (NIHSS) ≥4] were enrolled in this subgroup analysis. Patients received either cinepazide maleate injection or placebo. The treatment period was 14 days and follow-up was 90 days. The efficacy endpoints included the proportions of patients with a modified Rankin Scale (mRS) score ≤2, mRS score ≤1 and Barthel Index <95 on day 90. Safety was evaluated by recording all adverse events, monitoring vital signs, laboratory parameters and electrocardiogram.Results:A total of 732 patients were involved in the final efficacy analysis (361 in cinepazide maleate group and 371 in control group). The baseline limb motor function score of NIHSS was 5.23±1.43 in the cinepazide maleate group whereas 5.20±1.36 in the control group. Logistic regression analysis showed that following treatment for 90 days, the proportion of patients with a mRS score ≤2 was significantly higher in the cinepazide maleate group than in the control group [56.0% (202/361) vs 44.2% (164/371), OR=0.60, 95% CI 0.44-0.82, P=0.002]. The proportion of patients with a mRS score ≤1 was higher in the cinepazide maleate group than in the control group [43.3% (139/361) vs 35.2% (118/371), OR=0.69, 95% CI 0.50-0.97, P=0.031]. The proportion of patients with a Barthel Index <95 on day 90 was significantly lower in the cinepazide maleate group than in the control group [45.2% (145/361) vs 55.2% (185/371), OR=0.64, 95% CI 0.46-0.88, P=0.007]. During the treatment and follow-up period, the incidence of the most common adverse events in the cinepazide maleate group was 50.4% (199/395). Constipation and abnormal liver function were more common, but there were no statistically significant differences between the two groups. Conclusion:Cinepazide maleate injection is superior to placebo in improving neurological function and activities of daily living, reducing disability, and promoting functional recovery and safe in patients with acute ischemic stroke with obvious limb motor deficit.
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Objective:To observe the effect of edaravone dexborneol on anxiety and depression after stroke in rats, and to explore its possible mechanism.Methods:Totally 120 healthy adult male SD rats were randomly divided into sham operation group (sham), ischemia-reperfusion group (MCAO), edaravone group (Eda) and edaravone dexborneol group (ED) with 30 in each group.The middle cerebral artery occlusion (MCAO) model was established by thread occlusion.Rats in ED group and Eda group were intraperitoneally injected with edaravone(8 mg·kg -1·d -1) and edaravone dexborneol(edaravone: 8 mg·kg -1·d -1, dexborneol: 2 mg·kg -1·d -1) respectively.And rats in the other two groups were intraperitoneally injected with the same volume of normal saline.Some rats were killed after continuous administration for 3 days to detect molecular indexes, and the remaining rats were tested for behavior after continuous administration for 14 days.The levels of neclear factor κB(NF-κB)、phosphorylated NF-κB(p-NF-κB)、tumor necrosis α(TNF-α)、interleukin 1β(IL-1β) were detected by Western blot.The mRNA levels of TNF-α, IL-1β, cluster of differentiation 86(CD86), cluster of differentiation 206(CD206), inducible nitric oxide synthase(iNOS) were detected by RT-qPCR.M1 type microglia labeled with CD68, microglia labeled with ionized calcium binding adaptor molecule 1(Iba1) and neurons labeled with microtubule-associated protein 2(MAP2) were detected by immunofluorescence staining.The cerebral infarction volume was measured by TTC staining.Depression and anxiety behavior after stroke in rats was observed by the open field test and elevated plus maze test.SPSS 17.0 software was used for statistical analysis of the data.One-way ANOVA was used for multiple group comparison, and LSD-t test was used for pairwise comparison. Results:(1) The behavioral results showed that 14 days after ischemia-reperfusion, the number of entering into the open arm, the time spent in the open arm, and the time spent in the central area of the open field in the MCAO group were lower than those in the sham group ( t=20.77, 6.02, 14.63, all P<0.05). The number of entering into the open arm, the time spent in the open arm, and the time spent in the central area of the field in the ED group ( (16.22±0.49) times, (69.11±17.08) s, (3.80±0.37) s) were higher than those in the MCAO group ( (8.14±0.60) times, (41.18±9.81) s, (0.33±0.39) s) ( t=4.69, 0.38, 2.27, all P<0.05) and Eda group ( (11.11±0.26) times, (45.26±17.16) s, (1.14±0.19) s) ( t=8.63, 2.50, 7.86, all P<0.05). (2) Western blot results showed that 3 days after ischemia-reperfusion, p-NF-κB/NF-κB, TNF-α, and IL-1β levels in the MCAO group were higher than those in the sham group ( t=15.35, 12.35, 7.23, all P<0.05). The levels of p-NF-κB/NF-κB (0.49±0.02), TNF-α (0.73±0.03), IL-1β (0.61±0.01) of ischemic penumbra cortex in ED group were significantly lower than those of the MCAO group ( (1.14±0.05), (1.13±0.07), (1.34±0.14)) ( t=14.58, 7.86, 5.65, all P<0.05) and Eda group ( (0.93±0.03), (0.89±0.02), (1.04±0.36) ) ( t=9.82, 3.07, 3.30, all P<0.05). (3) RT-qPCR results showed that the level of TNF-α mRNA (1.98±0.18), IL-1β mRNA (2.00±0.35), CD86 mRNA (1.56±0.20) and iNOS mRNA (2.01±0.12) in the peri-infarct cortex of ED group were lower than those in the MCAO group ( (5.12±0.24), ( 8.15±0.22), (6.03±0.13), (7.20±0.09) ) ( t=7.86, 16.88, 16.55, 37.25, all P<0.05) and Eda group ( (2.85±0.07), (5.43±0.26), (2.67±0.27), (3.58±0.11) ) ( t=3.71, 9.41, 4.13, 11.30, all P<0.05). The level of CD206 mRNA in the peri-infarct cortex of the ED group (3.98±0.25) was higher than that in the MCAO group (2.00±0.11) ( t=7.08, P<0.05) and Eda group (3.17±0.09) ( t=3.25, P<0.05). (4) The results of immunofluorescence staining showed that the ratio of polarized M1 microglia in the peri-infarct cortex and striatum in the ED group ((20.36±9.23)%, (18.26±5.98)%)were lower than those in the MCAO group ( (83.69±12.79)%, (61.25±33.26)%) ( t=5.23, 3.02, both P<0.05) and Eda group((42.16±13.13)%, (40.23±14.22)%)( t=3.12, 2.08, both P<0.05). In addition, the number of neurons marked with MAP2 of peri-infarct cortex in the MCAO group was lower than that in the sham group( t=8.02, P<0.05), and the number of neurons marded with MAP2 of peri-infarct cortex in the ED group ((53.07±17.90) /scope) was higher than that in the MCAO group ( (26.27±9.95) /scope) ( t=6.89, P<0.05) and Eda group ( (38.69±12.03)/scope) ( t=5.26, P<0.05). (5) The results of TTC staining showed that the cerebral infarction volume in ED group ( (10.31±1.03)%) was lower than that in the MCAO group ( (34.71±1.74)%) ( t=15.31, P<0.05) and Eda group ( (26.05±1.00)%) ( t=9.88, P<0.05). Conclusion:Edaravone dexborneol can alleviate anxiety and depression in rats with cerebral ischemia-reperfusion, which may be related to the inhibition of M1 microglial polarization, the down-regulation of NF-κB signaling pathway and the enhancement of neuronal structural stability.
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Objective:To investigate the relationship of neutrophil/lymphocyte ratio (NLR) and early hematoma enlargement (HE) of intracerebral hemorrhage (ICH).Methods:Retrospectively analyzed the clinical data of 360 patients with ICH who were diagnosed and admitted to the Affiliated Hospital of Xuzhou Medical University from January 2017 to December 2017.Among them, 198 patients were selected for this study. According to the 24 h checked CT, they were divided into the hematoma expansion (HE) group (87 patients) and the non-HE group (111 patients). The clinical data of the two groups and the changes of hematology and imaging were compared.Results:Univariate analysis showed statistically significant differences of two groups in systolic blood pressure, diastolic blood pressure, Glasgow coma scale (GCS) score, hematoma volume at admission: (180.45 ± 25.90) mmHg(1 mmHg = 0.133 kpa) vs. (171.81 ± 25.87) mmHg, (103.29 ± 14.26) mmHg vs. (97.98 ± 14.81) mmHg, (11.05 ± 2.02) scores vs. (13.04 ± 1.58) scores, (25.14 ± 14.88) ml vs. (13.57 ± 11.98) ml; and GCS score, NLR , hematoma volume at 24 h after admission: (7.54 ± 2.04) scores vs. (11.04 ± 2.12) scores, 12.79 ± 7.24 vs. 5.59 ± 3.59, (17.07 ± 8.95) ml vs. (7.97 ± 3.56) ml, there were significant differences ( P<0.05). Logistic regression analysis showed that NLR, GCS, hematoma volumeat 24 h after admission and number of island sign were independent correlated factors of HE ( P<0.05). Receiver operation characteristic(ROC) curve analysis showed that when the NLR at 24 h after admission cut off value was 7.65, the sensitivity of predicting HE in patients with ICH was 78.16%, the specificity was 81.98%, and the area under the ROC curve was 0.852 (95% CI 0.798-0.907, P<0.001). Conclusions:HE have association with NLR, hematoma volume change.
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Objective:To investigate the blood pressure change in patients with acute ischemic stroke (AIS) and hypertension treated with cinepazide maleate injection.Methods:This was a subgroup analysis of post-marketing clinical confirmation study of cinepazide maleate injection for acute ischemic stroke: a randomized, double-blinded, multicenter, placebo-parallel controlled trial, which conducted in China from August 2016 to February 2019. Eligible patients fulfilled the inclusive criteria of acute anterior circulation ischemic stroke with National Institutes of Health Stroke Scale (NIHSS) scores of 7-25. The primary endpoints were mean blood pressure of AIS patients treated with cinepazide maleate or control, which were assessed during the treatment period (14 days), and the proportion of the patients with normal blood pressure was analyzed after the treatment period. Furthermore, a subgroup analysis was performed to investigate a possible effect of the history of hypertension on outcomes.Results:This analysis included 809 patients with hypertension. There was no significant difference in patients blood pressure and the proportion of patients with normal blood pressure (60.5% vs. 59.0%, P>0.05) between cinepazide maleate group and control group. Conclusion:Administration of cinepazide maleate injection does not affect the management of clinical blood pressure in patients with AIS.
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Objective:To investigate the diagnostic value of cerebrospinal fluid interleukin-6 (IL-6), neuron-specific enolase (NSE) and S100B protein in patients with central nervous system infection.Methods:The clinical data of 78 patients with central nervous system infection (infected group) from October 2015 to February 2019 in the Department of Neurology, Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed. Among the patients, viral meningitis was in 41 cases, tuberculous meningitis was in 23 cases, and purulent meningitis was in 14 cases. Another 100 patients who were admitted to the hospital during the same period for cerebrospinal fluid and other related examinations and excluded central nervous system infection (control group) were selected. Enzyme-linked immunosorbent assay was used to detect the levels of IL-6, NSE and S100B protein.Results:The cerebrospinal fluid levels of IL-6, NSE and S100B protein in infected group were significantly higher than those in control group: 16.70 (8.54, 228.18) ng/L vs. 6.64 (4.96, 8.21) ng/L, 13.62 (11.50, 19.01) μg/L vs. 9.95 (7.54, 12.39) μg/L and 3.07 (0.24, 11.57) μg/L vs. 0.16 (0.12, 0.21) μg/L, and there were statistical differences ( P<0.05). The cerebrospinal fluid levels of IL-6, NSE and S100B protein in patients with tuberculous meningitis were significantly higher than those in patients with viral meningitis and patients with purulent meningitis: 173.30 (13.74, 503.80) ng/L vs. 9.37 (4.80, 113.55) and 89.96 (14.02, 239.60) ng/L, (30.82 ± 14.09) μg/L vs. (12.00 ± 2.33) and (17.62 ± 5.63) μg/L, (18.29 ± 16.05) μg/L vs. (2.12 ± 1.24) and (5.79 ± 4.82) μg/L; the indexes in patients with purulent meningitis were significantly higher than those in patients with viral meningitis, and there were statistical differences ( P<0.05). Conclusions:Cerebrospinal fluid IL-6, NSE and S100B proteins have different expressions in patients with different types of central nervous system infection, and have certain clinical application value for the diagnosis of central nervous system infection.
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Objective To investigate the correlation between the progression of cerebral microbleed (CMB) and their distribution patterns in patients with lacunar infarction (LI) and the worsening of chronic kidney disease (CKD).Methods A prospective cohort study was used.Two hundred and fourteen patients with LI from June 2014 to June 2016 in Siyang People's Hospital of Jiangsu Province were consecutively selected.The clinical,laboratory and imaging-related data of patients were recorded in detail.The chronic kidney disease epidemiology collaboration (CKD-EPI) formula was used to estimate the estimation glomerular filtration rate (eGFR).After admission and 1-year'follow-up,head MRI (including gradient echo sequences) was performed,and the CMB distribution pattern was evaluated using the microbleed anatomical rating scale (MARS).Results Among the 214 patients with LI,90 patients were in CMB-positive group,of which simple lobe of brain CMB was in 16 cases,and deep/subtentorial CMB was in 74 cases,and 124 patients were in CMB-negative group.The baseline eGFR and eGFR classifications in CMB-negative group were significantly better than those in CMB-positive group,and there were statistical differences (P＜0.01 or ＜0.05).After 1 year'follow-up,worsening of CMB was in 45 cases,and worsening of CKD was in 22 cases.Multivariate Logistic regression analysis result showed that age and stroke history were independent risk factors for worsening of CMB in LI patients with simple lobe of brain CMB (OR =1.14 and 2.91,95％ CI 1.06 to 1.23 and 1.14 to 7.42,P＜0.01 or ＜0.05),and baseline eGFR and worsening of CKD were independent risk factors for worsening of CMB in LI patients with deep/subtentorial CMB (OR =0.90 and 4.11,95％ CI 0.87 to 0.94 and 1.04 to 16.21,P＜0.01 or ＜0.05).Conclusions Renal function in LI patients with CMB negative is significantly better than that in LI patients with CMB positive.In LI patients with deep/subtentorial CMB,the worsening of CMB is associated with worsening of CKD;in LI patients with simple lobe of brain CMB,the worsening of CMB is not associated with worsening of CKD.
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OBJECTIVE@#To explore the genetic basis for a patient with episodic ataxia and pyramidal tract signs.@*METHODS@#The patient was subjected to high-throughput sequencing, Sanger sequencing and analysis of dynamic variant site associated with spinocerebellar ataxias (SCA).@*RESULTS@#The patient was an adolescent male presenting with episodic ataxia, bilateral knee hyper-reflexia and ankle clonus. By genetic testing, he was found to harbor a c.1159-1162dupAAGT variant of PDHA1 gene. The same variant was not found in his parents and elder sister. No abnormalities were found by SCA dynamic variant screening. The patient was diagnosed as pyruvate dehydrogenase E1alpha deficiency due to variant of the PDHA1 gene.@*CONCLUSION@#The de novo c.1159-1162dupAAGT variant of the PDHA1 gene probably underlies the disease in the proband. Patients with pyruvate dehydrogenase E1alpha deficiency have complex phenotypes and very few have pyramidal tract involvement, which may be attributed to abnormal early neuronal development.
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Objective:To assess the efficacy and safety of cinepazide maleate injection in the treatment of patients with acute ischemic stroke.Methods:A multicenter, randomized, double-blind, placebo-controlled phase Ⅳ clinical trial, led by Peking Union Medical College Hospital, was conducted in 65 Hospitals in China. The efficacy of cinepazide maleate injection in patients with acute anterior circulation cerebral infarction with onset time of ≤48 hours, 7≤National Institute of Health stroke scale (NIHSS) score ≤25 was assessed from August 2016 to February 2019, using the proportion of modified Rankin scale (mRS) score≤1 and Barthel index (BI) score≤95 on day 14 as efficacy endpoint. The patients were divided into treatment group who were treated with cinepazide maleate injection and control group who were treated with placebo.Results:A total 937 patients were involved in the final efficacy analysis (466 in treatment group and 471 in control group). The proportion of subjects with mRS score≤1 on day 14 after treatment were higher in the treatment group than that in the control group (102/466(21.89%) vs76/471(16.14%)). Logistic regression analysis showed that patients treated with cinepazide maleate were significantly more likely to have a favorable outcome (mRS score≤1) than patients treated with placebo on day 14 ( OR=0.677, 95% CI 0.484-0.948 , P=0.023), and patients treated with cinepazide maleate were more likely to reach independence in activities of daily living (Barthel Index ≥95) than those treated with placebo on day 14 (125/466(26.82%) vs 91/471(19.32%); OR=0.632, 95% CI0.459-0.869, P=0.005). The rate of adverse events was similar between the treatment and control groups. Conclusion:The 14-day treatment with cinepazide maleate injection could reduce the degree of disability whereas did not increase the risk of adverse events.
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Objective To explore the changes of brain structure network in patients with Parkinson's disease with mild cognitive impairment(PD-MCI),and to provide novel markers for the early recognition of PD-MCI. Methods Total 47 patients with primary PD were continuously enrolled at the De-partment of Neurology,Affiliated Hospital of Xuzhou Medical University from May 2017 to May 2018. Twenty-four healthy volunteers were selected as the healthy control (HC) group. General demographic data were col-lected from all subjects. The overall cognitive function and the five cognitive domains (attention and working memory,executive function,language,memory and visual spatial function) were comprehensively evaluated, then the patients with PD were further divided into PD-MCI group(n=22) and PD-NC group(n=25) based on their cognitive evaluation results. All subjects completed the diffusion tensor imaging( DTI) scan and the individual structural brain connection was obtained by deterministic diffusion-tensor tractography. By graph theory analysis technology,the network properties (global properties and node properties) and edge-wise dis- tributions were compared to assess structural connectivity differences among the three groups. Results Com-pared with the PD-NC and HC groups,the PD-MCI group had a larger characteristic path length(PD-NC:(8. 33±0. 95),HC:(8. 18±1. 35),PD-MCI:(9. 20±1. 52),F=4. 14,P<0. 05) and reduced global efficien-cy (PD-NC:(0. 13±0. 05),HC:(0. 13±0. 04),PD-MCI:(0. 10±0. 04),F=3. 73,P<0. 05) in addition to a lower nodal efficiency in frontoparietal areas,thalamus,cingulate gyrus,and insular(P=0 . 003-0. 040,FDR correction). Compared with the HC group,the PD-MCI group had a large frontotemporoparietal areas,basal ganglia,and insular network with decreased connection strength (P<0. 05,FDR correction). Compared with the PD-NC group,the PD-MCI group had a lower network connection strength in the frontoparietal areas (P<0. 05,FDR correction). Conclusion A disruption of structural connections that make up the brain network can lead to changes in information integration and delivery,leading to cognitive dysfunction in patients with PD. The distribution pattern of brain network structure connection changes is expected to become a new marker for identifying PD-MCI.
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Objective To confirm the mediation effect of trait coping styles between childhood a-buse and psychosomatic symptoms among college students. Methods 262 medical students were investiga-ted by Psychosomatic Health Questionnaire( PHQ) ,Personal Report of Childhood Abuse( PRCA) ,Trait Cop-ing Styles Questionnaire(TCSQ),Self-rating Anxiety Scale(SAS),Suicide Ideation Scale(SIS) and Beck Depression Inventory(BDI).Structural equation models were established by Amos 7.0. Results The positive coping scores of medical students were (34.70±4.50),and (27.48±5.68) for negative coping,(7.79±5.58) for depression,(29.40±6.22) for self rating anxiety,(1.33±1.75) for suicidal ideation,(1.26±0.51) for mental symptoms,(1.27±0.52) for somatic symptoms and (3.17±4.26) for behavioral problems.Abuse total score was positively correlated with negative coping style, depression, self rating anxiety, suicidal ideation, mental symptoms and behavioral problems ( r=0.148-0.417,P<0.05) ,and negatively correlated with positive coping style(r=-0.148,P<0.05).Negative coping style was positively correlated with Beck depression,self rating anxiety,suicidal ideation,mental symptoms and somatic symptoms( r=0.252-0.350,P<0.01) ,and neg-atively correlated with positive coping style(r=-0.309,P<0.01).Positive coping style was negatively correla-ted with Beck depression,self rating anxiety,suicidal ideation,mental symptoms and somatic symptoms ( r=-0.208--0.271,P<0.01).Structural equation modeling showed that childhood abuse had an direct effect on psychosomatic symptoms( B=0.290,P<0.01) ,positive coping styles( B=-0.129,P<0.05) and negative cop-ing styles(B=0.243,P<0.01) among medical students.Positive coping styles and negative coping styles had direct effect on psychosomatic symptoms(B=-0.194,P<0.01;B=0.263,P<0.01).The model fit indexes were χ2/df=1.576,PGFI=0.585,PCFI=0.689,PNFI=0.645,RMSEA=0.047,GFI=0.951,AGFI=0.920, NFI=0.900,RFI=0.858,IFI=0.960,TLI=0.943,CFI=0.959. Conclusion The results indicate that trait coping styles as a mediator mediating the relationship between childhood abuse and psychosomatic symptoms in medical students.
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Objective To explore the influences of serotonin transporter promoter region (5-HTTLPR)polymorphism on hypersensitive C-reactive protein(hs-CRP)in patients with depression. Method 5-HTTLPR polymorphism was detected by polymerase chain reactive-restriction fragment length polymorphism(PCR-RFLP)in 103 patients with depression and 103 healthy controls.The severity of depres-sion was evaluated by Hamilton Depression Scale(HAMD).The hs-CRP level was tested by immunofluores-cence.The influence of different genotypes on hs-CRP and the interaction of genotype and hs-CRP on the pathogenesis of depression were analyzed. Results The frequency of genotype and allele in 5-HTTLPR was no statistical significant(P=0.81,0.121)among the three groups.There were statistically significant differ-ences in hs-CRP concentration(P=0.007)among the three genotypes of the study group,and the concentra-tion of hs-CRP in SS genotype((8.1±2.7)mg/L)was significantly higher than that in LS((4.9±1.8)mg/L) and LL genotype((5.2±1.3)mg/L)(P=0.002,0.001).The retardation factor in patients were significantly differences in different genotypes(F=4.637,P=0.033).SS genotype(9.3±3.1)was significantly higher than LL(6.1±2.7)and LS genotypes(5.8±2.1)in retardation factor(P=0.008,0.007).Logistic regression analy-sis showed that SS genotype was associated with hs-CRP.The interactive effect was positive related to the morbidity of depression.The correlation of interaction between SS genotype and hs-CRP was greater than LL/LS(OR=1.890,95%CI=1.011-3.396). Conclusion SS genotype of 5-HTTLPR has strengthen effect on hs-CRP.The interaction of genotype and hs-CRP affects the onset of depression.The interaction of SS geno-type and hs-CRP is more likely to effect the onset of depression.
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Objective To explore the risk factors of osteoporosis in elderly patients with ischemic stroke by intracranial atherosclerotic stenosis(ICAS). Methods 342 elderly patients(≥ 65 year)with ischemic stroke by ICAS were divided into osteoporosis group and non-osteoporosis group,multivariate unconditional Logistic re-gression analysis was used to analyze the risk factors for elderly patients with ischemic stroke by ICAS. Results Univariate analysis shows that female,unilateral anterior circulation infarct,involvement of vessels of more than two branches,complete paralysis,delayed paralysis,BI index were significantly associated with osteoporosis in el-derly patients with ischemic stroke by ICAS between the two groups(all P < 0.05). Multiple Logistic regression analysis revealed that gender,disease duration,involvement of cerebral circulation,paralysis degree,muscle ten-sion state were independent risk factors for the development of osteoporosis in elderly patients with ischemic stroke by ICAS(OR = 3.459,2.486,4.540,3.819,3.699,P < 0.05). Conclusions Gender,disease duration,in-volvement of cerebral circulation,paralysis degree,muscle tension state are independent risk factors of osteoporo-sis in elderly patients with ischemic stroke by ICAS,provides a theoretical basis for the prevention of osteoporosis in elderly patients with ischemic stroke by ICAS.
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Objective To investigate anxiety of clinicians in tertiary hospitals,and discuss the fac-tors that influence clinicians'anxiety in order to provide reference for further effective intervention measures. Methods 427 clinicians from various departments in tertiary hospitals selected by cluster sampling method were investigate by self-rating anxiety scale ( SAS) .Statistical software SPSS 17.0 was used to analyze data for multivariate logistic regression analysis of its relevant influencing factors.Results 38.2%of the clini-cians had anxiety symptoms (55.0%was mild anxiety,26.1%was moderate anxiety,18.9%was severe anxi-ety) .Factors like education (χ2=7.3, P=0.03) ,job title (χ2=53.24, P<0.01) ,divisions (χ2=46.46, P<0.01) ,work experience (χ2=9.78, P=0.04) ,work overtime (χ2=4.29, P=0.03) ,worry of medical mal-practice (χ2=9.54, P<0.01),doctor-patient relationship tension (χ2=7.50, P<0.01),fear for personal safety (χ2=10.27, P<0.01) ,job promotion competition (χ2=11.40, P<0.01) ,labor and payment situation (χ2=6.36, P=0.01) ,colleagues'understanding and support (χ2=15.77, P=0.01) ,work environment (χ2=21.85, P<0.01) and leaders'attention (χ2=7.17, P=0.01) had significant differences between anxiety and non-anxiety clinicians.Multivariate logistic regression analysis revealed that factors like divisions ( com-pared with internal medicine,OB&GYNβ=0.98,surgeryβ=0.95,pediatricsβ=0.86,emergencyβ=0.69) , work overtime (β=0.18),fear for personal safety (β=0.86),fear of medical malpractice (β=0.79) and doctor-patient relationship tension (β=0.28) had a negative impact on anxiety,while factors like education ( compared with bachelors,mastersβ=-1.38,doctorsβ=-1.65) ,job title ( compared with primary,intermedi-ateβ=-0.33,highβ=-0.45,advancedβ=-0.59) ,work experience (β=-0.18 ) and work environment (β=-0.32) were protective factors.Conclusion There is a certain degree of anxiety among clinicians in tertiary hospitals,resulting in a heavy psychological burden on them.Active measures should be taken to improve the clinicians'psychological health.
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Objective To analyze the drug resistance genes and homology in nosocomial infection caused by carbapenem‐resistant Acinetobacter baumannii(CRAB) .Methods Forty strains of CRAB were collected and the minimal inhibitory concentration (MIC) was detected by the agar dilution method .The main carbapenemase genes were detected by PCR .The PCR products were performed the DNA sequencing .The enterobacterial repetitive intergenic consensus (ERIC)‐polymerase chain reaction(PCR) was performed to analyze the genotypes and homology of these strains .The plasmid conjugation experiment was carried out to investigate the trans‐mission of resistant genes .Results Forty strains of CRAB maintained the good sensitivity only to polymyxin B (100% ) and cef‐operazone/sulbactam(57 .5% ) .All of them had different degrees of resistance to other drugs .The OXA‐23 and OXA‐51genes were detected by PCR amplified in all of the CRAB strains .The homology analysis showed that the strains could be divided into 4 types according to 80% of cluster similarity coefficient ,the type A1 (19 strains) was the major epidemic strain ,moreover the various de‐partments had cross infection ;the plasmid conjugation experiment failed .Conclusion There is an endemic spread of CRAB in our hospital and its resistant mechanism is mainly related with OXA‐23 gene expression ;in the rational antibiotics use at the same time , the isolation and prevention measures should be done well for avoiding the hospital cross infection .
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Objective To investigate MRI appearances of aquaporin(AQP) and its effect in different brain regions of patients with Parkinson's disease(PD).Methods A prospective study was carried out in 33 PD patients(PD group) and 23 gender-and age-matched healthy controls (control group).Clinical data of PD patients were collected.The aquaporin imaging of diffusion-weighted magnetic resonance imaging (MRDWI) with multiple b-values in different brain regions were performed to detect the apparent diffusion coefficient(AQP-ADC) values of aquaporin.The PD patients were assessed and graded by modified Hoehn-Yahr grading,then the AQP-ADC values of control group,mild PD group,moderate and severe PD group were analyzed using one-way analysis of variance.The correlation analysis was carried out to detect the relationship between AQP-ADC values in different brain regions and Hoehn-Yahr grading of PD patients.Results Compared with control group,mild PD group had significantly higher AQP-ADC values in red nucleus(RN) and globus pallidus(GP) ((0.24±0.04) vs (0.21±0.04),(0.21±0.04) vs (0.16±0.04);both P＜0.05);while the AQP-ADC values in RN and GP of moderate and severe PD group were significantly lower than that of mild PD group((0.21±0.02) vs (0.24±0.04),(0.18±0.03) vs (0.21±0.04);both P＜0.05);but there was no significant difference between moderate and severe PD group and control group(P＞0.05);and there was also no significant difference in substantianigra (SN),putamen (Pu) and thalamus (THA) among control group,mild PD group and moderate and severe PD group(P＞0.05).The correlation analysis showed that there were negative correlations between the AQP-ADC values in RN and GP and Hoehn-Yahr grading(r=-0.479 and-0.395,P＜ 0.05),while there was no correlation in SN,Pu and THA (P＞ 0.05).Conclusion The AQPADC values are increased in RN and GP of mild PD patients,and decreased in moderate and severe PD patients,while there is no significant change in SN,Pu and THA of the two groups,suggesting that the expression of AQP in different brain regions may be related to the severity and pathological stage of PD.
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Objective To investigate the treatment of octanol on matrix metalloproteinase-9(MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) protein expression,cerebral water content,infarction volume after ischemia-reperfusion in rats.Methods 150 SD rats were randomly divided into sham operated group (n=24),MCAO group (n=24),DMSO solvent control group (n=24) and octanol treatment group (n=24).A model of middle cerebral artery occlusion was induced by suture method.TTC stain was used to detect the infarction volume,dry-wet weight method to determine the brain water content.The expression of MMP-9 and TIMP-1 protein was detected by immunofiuorescence and Western blot.Results At 24 h of reperfusion after ischemia for 2 h,the octanol treatment group compared with MCAO group brain infarction volume obviously decreased(P＜0.05),water content significantly reduced ((78.16± 1.47) ％ vs (80.88±0.73) ％,P＜0.05),the number of MMP-9 positive cells obviously decreased((10.67±2.16) vs (29.00±3.40),P＜0.05),the expression of MMP-9 protein significantly reduced ((0.14±0.01) vs (0.21±0.02),P＜0.05)and the number of TIMP-1 positive cells significantly increased ((27.83 ±2.13) vs (5.67± 1.03),P＜0.05),the expression of TIMP-1 protein obviously increased((0.42±0.01) vs (0.28± 0.01),P＜0.05).The difference between MCAO group and DMSO solvent control group was not statistically significant(P ＜0.05).Conclusion Octanol may reduce brain edema,brain infarction volume.Up-regulation the expression of MMP-9 and down-regulation the expression of TIMP-1 may be one of the underlying mechanisms of the octanol neuroprotection.
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Objective To investigate the expressions of c-Fos,5-HT and spontaneous activities in single prolonged stress (SPS) stress rats,and to study the possible mechanism of posttraumatic stress disorder(PTSD).Methods forty-eight male SD rats were randomly divided into 6 groups:Individual living + SPS group (IS group),Individual living+control group (IC group),Enriched environment+SPS group (ES group),Enriched environment+control group (EC group),control+SPS group(CS group),control group(C group),8 rats in each group,spontaneous activities were measured before the experiment and post experiment at week 1,2.And the expressions of c-Fos,5-HT in the hippocampus were examined by immunohistochemical staining.Results (1) Spontaneous activity:there were no differences of crossing number and distance among 6 groups before experiment (P＞0.05).On SPS 14 days the crossing number and distance of IS group (12.12±9.64,(2.71 ± 1.99)m) decreased compared with the CS group(45.25±8.37,(6.37± 1.18) m,P＜0.05),and ES group (69.75± 10.05,(10.69± 1.50) m)showed significant increase compared with CS group (P＜0.05).(2)5-HT:the expression of 5-HT in the hippocampus of IS group(0.1125±0.0095) was significantly higher than that in CS group(0.6138±0.0059,P＜0.05),menwhile lower in ES group(0.0495±0.0074,P＜0.05).(3)c-Fos:compared with CS group(0.3108±0.0074),the expression of c-Fos in the hippocampus of IS group(0.3585±0.0150,P＜0.05) significantly increased,but decreased in ES group (0.2613±0.0063,P＜ 0.05).Conclusion Enriched environmental can improve the level of activities in PTSD rats,and to reduce the the expression of c-Fos and 5-HT in the hippocampal neurons.
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Translational medicine emerging as a new concept in medical field, concentrates on the integration of theory and practice , and the conjunction of basic medical science and clinical medicine. Barriers between the basic medicine and clinical medicine existing in medical education in China make students possess limited intelligence, narrow perspectives and low creativity etc., causing the medical teaching unable to conform to the demand of translational medicine. The article introduces the basic conception of translational medicine and the necessity of medical teaching reform, the meth-ods of promoting teaching reform by integrating the curriculum systems, bettering experimental teach-ing systems, strengthening humanities education, improving faculty construction and optimizing eval-uation system for students.
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Objective To investigate the effects of olfactory bulb(OB) lesion on neural stem cells proliferation and expression of NMDA receptor subunit 2B in subventricular zone(SVZ) of rats.Methods Sixty adult female SD rats were randomly divided into normal group,saline group and OB lesion group.OB lesion was induced by N-methyl-D-aspartic acid (NMDA) injection.Each group was respectively divided into four time points including 3 d,7 d,14 d and 28 d.Immunohistochemistry staining was used to detect the number of Nestin,Ki67 and NR2B-positive cells in the SVZ.Results (1) Nestin positive cells in the SVZ were shown at the different time of three groups.Seven days after OB lesion,IOD value of nestin-positive cells began to increase((29601± 1788)/0.01 mm2,P＜0.05),reached the maximum at 14 d((49800±3701)/0.01 mm2,P＜0.05) and still sustained a high level at 28 day((27600±3209)/0.01 mm2,P＜0.05).(2)Ki67 positive cells in the SVZ were shown at the different time of three groups.The number of Ki67-positive cells was increased significantly at 7 d,14 d and 28 d after OB lesion compared to normal group and saline group (P＜0.05).(3)NR2B immune expression in the SVZ was shown at the different time of three groups.The NR2B-positive cells increased at 3 d after OB lesion(58.80±2.95,P＜0.05),reached the maximum at 14 d(68.40±4.04,P＜0.05).At 28 d of OB lesion,the number of positive cells was reduced,but still sustained a high level(62.20±3.56,P＜0.05).(4)The positive cells of NR2B and Ki67 were highly positive correlation at different time after OB lesion(r=0.968,P＜0.05).Conclusions OB lesion can stimulate neural stem cell proliferation and increases the expression of NR2B.The increased mode of NR2B is in accordance with the schedule of the neural stem cells increase induced by OB lesion.Therefore,it indicates that the NMDA receptor subunit 2B may be involved in neural stem cell proliferation.
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In order to set up a base for stem cells to be widely used in clinical medicine, we tried to optimize, in this study, the technique that induces human mesenchymal stem cells (hMSCs) to differentiate into neural stem cells by using cerebrospinal fluid (CSF) from the different groups. After the induction, presence of neural stem cells was confirmed with microscope observation, flow cytometry analysis, immunohistochemistry and fluorescent immunohistochemistry. At the same time, we also compared and analysed the data of the number of stem cells when it totally met the requirements for clinical treatment and the days required. At last, we confirmed that hMSCs could be induced to differentiate into neural stem cells, and that the number of cells totally met the requirements for clinical treatment. But there were some differences both in the number of cells and the days required. Among the groups, the group that marrow mesenchymal stem cells from patients own induced by CSF from healthy volunteers used the shortest time and the quantity of the cells was significantly higher than those of the others.