Complement system is a reaction system comprising 35 proteins with enzyme activity common in serum,tissue fluid and cell membrane. It plays an important role in anti-infection. Abnormal complement activation is involved in incidence and progression of many inflammatory diseases. The complement is activated through typical,alternative and agglutinin pathways. Following cardiovascular stent implantation,the vessel endothelium of patients with coronary atherosclerotic heart disease is damaged; serum complement C3 could enter the arterial wall to damage arterial cells to enhance the permeability release antigenic components of vessel wall,and induce antibody production. The fixing immune complex is formed and induces platelet aggregation,attachment or lipidoses. Although humoral immunity becomes accentuated following cardiovascular stent implantation,the capability to resist microorganism is reduced,which stimulates self-protection of C3,aggravates inflammation,increases circulation complex,activates complement system and aggravates endothelial injury. C3 plays an essential role in occurrence and development of ischemic cardiovascular disease,and is an important cause for restenosis and thrombosis following cardiovascular stent implantation.

Objective To evaluate the safety and efficacy of OUR Rotating Gamma System in neurosurgical clinical application. Methods Based on the results of animal experiments, 2381 patients with intracranial disease were treated using OUR Rotating Gamma System in Aohai Gamma Knife Center of Navy General Hospital of PLA betwean December 1996 and November 2002. There were 1288 males and 1093 females and their age ranged from 3 to 84 years (mean 45.8 years). 1020 patients had benign intracranial tumors, and of them 446 suffered from pituitary tumors, 254 meningioma, 148 craniopharyngioma and 103 vestibular schwannomas. Malignant tumors were diagnosed in 796 patients, among them glioma was found in 360 and metastasis in 360. 374 patients had cerebral arteriovenous malformations (AVMs) and 191 functional neurological disorders. Treatment technique of Gamma Knife Stereotactic Radiosurgery, dose prescription and precise orientation performed in intracranial tumor or foci were analyzed, and the preliminary outcome of treatment was evaluated in this study. In addition, the management of the possible complication and adverse reaction was studied. Results Gamma Knife Stereotactic Radiosurgery alone, or combined with other treatment procedures, could cure some of selected patients with benign brain lesions including pituitary neoplasms, meningioma, vestibular schwannomas, AVMs, and craniopharyngioma etc. And this treatment was also beneficial to some patients with malignant tumors. The incidence of radiation edema was 0.75%. Conclusions The clinical results suggest that Gamma Knife Stereotactic Radiosurgery is a very effective, accurate and relatively safe neurosurgical tool used either as a primary or adjuvant procedure for treatment of intracranical pathologic processes. However, it might lead to some severe or fatal complications if used inappropriately. Thus, optimal result would not be obtained unless a careful and precise Gamma treatment based on the operative rules and the effective management for postoperative complications are well planned.

Objective:To treat the mixed and deeper infantile hemangioma with ladder dosage propranolol, and to explore its efficacy and safety.Methods:A total of 98 infants with hemangioma were treated by ladder treatment of propranolol.Before treatment,comprehensive assessments of electrocardiogram(ECG),heart color ultrasound, blood glucose,liver function,kidney function,myocardial enzymes and blood routine were conducted.After excluding contraindications,the dose of propranolol incrementally doubled from 0.5 mg·kg-1·d-1 to 4.0 mg·kg-1·d-1.Propranolol was taken 3 times a day.Before and after medication for 1 and 2 h,ECG was monitored.The changes of tumor size,texture,color and other changes or an onset of adverse reactions were dynamicly observed.The infants were visited every month.The efficacy was evaluated using Achauer system.Results: After medication,98 cases had different degrees of color changes or tumor consistency softening.After the dosage of propranolol was increased to 4.0 mg·kg-1·d-1,the change of tumor was the fastest.According to the 4-grade method, there were 84 cases(85.71%) as gradeⅣ (excellent),2 cases (2.04%) as grade Ⅲ (good),4 cases (4.08%) as gradeⅡ (medium)and 8 cases (8.16%) as gradeⅠ (poor).The curative effect of mixed hemangioma was better than that of deeper hemangioma(P<0.05).The recovery time of 74 cases of hemangiomas was 6 months.The major adverse reactions were heart rate decline(5/98,5.10%),drowsiness(3/98,3.06%),diarrhea(7/98,7.14%),loss of appetite (1/98,1.02%), and convulsions (2/98,2.04%).After treatment,all adverse reactions disappeared.Two months after drug withdrawal there were 4 cases of recurrence,and they were continously treated with propranolol.Conclusion: The efficacy of oral ladder dosage propranolol in treatment of mixed and deeper infantile hemangioma is increased significantly and there are no significant adverse reactions.

Objective To explore the optimal falling height parameters for single-leg drop jump,so as toaddress the bilateral imbalance in the lower limbs of athletes and provide a reference for coaches to design training plans accurately and effectively.Methods Twelve first-grade male athletes were re-cruited for the study,including five track and field sprinters and seven basketball players(age:20.41±1.11 years,height:189.19±9.15 cm,weight:83.50±12.08 kg).The vertical jump platform was used to test the optimal counter-movement jump(CMJ)height for the dominant and non-dominant sides of the subject's lower extremities,and to determine the three falling heights of the low height(medium height minus 5 cm),medium height(50%of the optimal unilateral lower-limb CMJ height)and high height(medium height plus 5 cm).Six parameters of the drop jump performance,including buffer time,leg stiffness,peak vertical ground reaction force(vGRFpeak),the rate of force development(RFD),power,root mean square(RMS)of surface electromyogram signals were collected synchronous-ly using the Vicon Motion Capture System(200 Hz),Delsys portable wireless telemetry EMG test sys-tem and Kistler three-dimensional force platform(1000 Hz).Results(1)At the medium height,the av-erage buffer time,leg stiffness,vGRFpeak,RFD,RMS and power of either leg were significantly bet-ter than at the other two heights(P<0.05),and the leg stiffness of the non-dominant leg was signifi-cantly inferior to the dominant leg(P<0.05).(2)At the high height,the average buffer time,vGRFpeak and RMS of the dominant leg were significantly better than at low height(P<0.05),while the average buffer time,leg stiffness,vGRFpeak,RFD,power and RMS of the non-dominant legs were significant-ly worse than the dominant legs(P<0.05).Conclusion Coaches or athletes can choose the medium height(50%optimal unilateral lower-limb CMJ height)designed in this study and schedule unilateral lower limb drop jump training to optimize the athletic performance of the dominant or non-dominant legs to the greatest extent.However,as the falling height increases,the gap in athletic performance between the bilateral lower limbs tends to become more pronounced(especially at high height),thus the training should focus on strengthening the eccentric contraction ability and stability of the non-dom-inant side to avoid bilateral imbalance.

Objective:To explore the effect of macrophage-derived exosomes on the activation of hepatic stellate cells and its possible mechanism.Methods:Differential ultracentrifugation was used to extract macrophage exosomes. The exosomes were co-cultured with the mouse hepatic stellate cell line JS1, and a control group was established with phosphate buffered saline (PBS). Cell immunofluorescence was used to observe the expressional conditions of F-actin. Cell counting kit-8 (CCK8) was used to detect the survival rate of JS1 cells in the two groups. The activation indices of JS1 cells [collagen type Ⅰ (Col Ⅰ) and α-smooth muscle actin (α-SMA)] and its key signal pathway activation index expression level [transforming growth factor (TGF)-β1/Smads, platelet-derived growth factor (PDGF)] in the two groups were determined using Western blot and RT-PCR. Data comparison between two groups was performed using an independent sample t-test.Results:The membrane structure of exosomes was clearly observed by transmission electron microscopy. The expression of exosome marker proteins CD63 and CD81 was positive, suggesting that exosomes were successfully extracted. Exosomes were co-cultured with JS1 cells. Compared with the PBS control group, there was no statistically significant difference in the proliferation rate of JS1 cells in the exosomes group ( P＞0.05). The expression of F-actin was significantly increased in the exosome group. The mRNA and protein expression levels of α-SMA and ColⅠwere significantly increased in exosome group JS1 cells (all P＜0.05). The mRNA relative expression levels of α-SMA in PBS and exosome group were 0.25±0.07 and 1.43±0.19, respectively, while that of ColⅠ was 1.03±0.04 and 1.57±0.06, respectively. The mRNA and protein expressions of PDGF were significantly increased in exosome group JS1 cells ( P＜0.05). The mRNA relative expression levels of PDGF in the PBS group and exosome group were 0.27±0.04 and 1.65±0.12, respectively. There were no statistically significant differences in the mRNA and protein expressions of TGF-β1, Smad2 and Smad3 between the two groups ( P＞0.05). Conclusion:Macrophage-derived exosomes significantly promote the activation of hepatic stellate cells. JS1 cells may be the underlying mechanism for the up-regulation of PDGF expression.

Glioblastoma multiforme (GBM) is the most common primary brain tumor and the most malignant astrocytoma in adults, with rare extra-cranial metastases, especially for subcutaneous metastases. It could be easily misdiagnosed as primary subcutaneous tumor. In this report, we describe a patient with pontine GBM who developed a subcutaneous swelling at the ipsilateral posterior cervical region 8 months after operation, and the pathological and immunocytochemical examination carry the same characteristics as the primary intracranial GBM cells, which defined it as subcutaneous metastasis. GBM with subcutaneous metastasis is extremely rare, and knowledge of a prior intracranial GBM, pathological examinations and immunocytochemical tests with markers typically expressed by GBM are of vital importance for the diagnosis of GBM metastasis. Surgical resection of subcutaneous swelling, followed by chemotherapy and radiotherapy, could be the best strategy of treatment for the patients with GBM subcutaneous metastasis.
Adult ; Astrocytoma ; Brain Neoplasms ; Glioblastoma ; Humans ; Neoplasm Metastasis

Objective To detect the expression of EIF5A2 in hepatocellular carcinoma(HCC) and to explore its relation with clinicopathological characters and prognosis of HCC patients. Methods The expression of EIF5A2 mRNA and protein in 12 pairs of fresh HCC and corresponding non-tumor tissues adjacent to the cancer was examined by qRT-PCR and Western blot. The expression level of EIF5A2 in 284 pairs of HCC and adjacent non-tumor tissues was detected by IHC staining. Then we analyzed between EIF5A2 expression and clinical pathological parameters and prognosis of HCC patients. Results The relative expression levels of EIF5A2 mRNA and protein in fresh HCC tissues were significantly higher than those in the corresponding adjacent non-tumor tissues (t=5.305, P=0.0003; t=10.120, P < 0.001); EIF5A2 expression in 284 HCC tissues was significantly higher than that in the corresponding adjacent non-tumor tissues (z=-12.186, P < 0.001). The expression of EIF5A2 was significantly correlated with tumor size (χ²=13.079, P < 0.001), tumor multiplicity (χ²=4.589, P=0.032) and differentiation degree (χ²=4.844, P=0.028). The 3- and 5-year overall survival time and disease-free survival time of the patients with high expression of EIF5A2 were significantly shorter than those with low expression of EIF5A2 (P < 0.001). EIF5A2 was an independent prognostic factor affecting the 3- and 5-year overall survival time and disease-free survival time of HCC patients (P < 0.05). Conclusion The up-regulation of EIF5A2 expression may be related with the occurrence and development of hepatocellular carcinoma. The high expression of EIF5A2 is an independent influence factor for poor prognosis and EIF5A2 can be used as a potential molecular marker for predicting the prognosis of HCC patients.

Objective:To detect the expression of Myc-induced nuclear antigen 53 (Mina53) and liver tissue >5 cm from the edge of the tumor (LTM5), and analyze its relationship with tumorigenesis, clinicopathological characteristics, and patient survival and prognosis in hepatocellular carcinoma (HCC).Methods:The expression levels of Mina53 mRNA and protein in 18 pairs of fresh HCC and LTM5 were assessed by qRT-PCR and Western blot, respectively. The expression of Mina53 in 284 pairs of HCC and LTM5 sample was determined by immunohistochemistry. Paired-sample t-test was used for the comparison of measurement data among groups, and heterogeneity of variance was tested using Wilcoxon rank-sum test. χ2 test was used for the comparison of measurement data among groups. Kaplan-Meier method and log-rank test were used for survival analysis. Cox regression model was used for single factor and multi factor analysis. Results:The relative expression levels of Mina53 mRNA and protein in 18 fresh HCC tissues were significantly higher than those in LTM5 tissues (mRNA: -4.41 ± 1.48 and -5.93 ± 1.65, t = 3.100, P = 0.007; protein: 1.12 ± 0.29 and 0.46 ± 0.21, t = 10.616, P < 0.001). The relative expression level of Mina53 in 284 HCC tissues was higher than that of LTM5 ( z = -18.739, P < 0.001). The expression level of Mina53 was associated with tumor size ( χ2 = 5.474, P = 0.019), vascular invasion ( χ2 = 8.965, P = 0.003), pathological grade ( χ2 = 12.006, P = 0.002), and TNM stage ( χ2 = 16.686, P < 0.001). The overall postoperative survival time and disease-free survival time of patients with high expression of Mina53 (28.5 months and 22.7 months, respectively) were shorter than those with low expression (33.0 months and 31.8 months, respectively) ( P < 0.05) in HCC. Cox multivariate regression analysis showed that Mina53 and multiple tumors were independent prognostic factors affecting the overall postoperative survival time and disease-free survival time of HCC patients ( P < 0.05). Conclusion:Mina53 may play an important role in the occurrence of HCC and participate in the process of tumor growth as well as invasion and metastasis. The high expression of Mina53 signifies that the patient has a poor prognosis and thus can be used as a potential marker for judging the prognosis of HCC patients.

Objective:To summarize the best evidence for exercise intervention in elderly patients with sarcopenia in intensive care unit (ICU) through literature search, and provide a reference for clinical implementation of early exercise intervention in this population through evidence-based practice.Methods:① Summary of best evidence: relevant literature on exercise intervention for elderly patients with sarcopenia in ICU, including guideline, evidence summary, expert consensus, systematic review, and original study [quasi-experiment and randomized controlled trial (RCT)] from UpToDate Clinical Advisor, Ovid database, National Guideline Clearinghouse (NGC), National Institute for Health and Care Excellence (NICE), Cochrane Library, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed/Medline, SinoMed, CNKI, Wanfang Database, VIP, and Yimai Tong Guideline Network were systematically searched. The search period covered from the establishment of these databases up to August 24, 2023. The quality of the literature was evaluated by two researchers with methodological expertise in evidence-based medicine, and the evidences were extracted and summarized. ② Evidence-based practice: the elderly patients with high risk of sarcopenia who had been hospitalized in the ICU for more than 7 days from January to April 2024 were enrolled as the research subjects, and they were divided into a control group and an intervention group using convenience sampling method. The control group received routine intensive care nursing. The intervention group implemented exercise intervention based on the actual situation of the patients, the baseline review was conducted before evidence application, and the effectiveness of evidence application at 7 days and 14 days was evaluated.Results:① A total of 19 pieces of literature were included, including 4 guidelines, 1 summary of evidence, 4 expert consensuses, 4 systematic reviews, and 6 original studies (1 quasi-experiment, 5 RCT). After literature quality evaluation, all 19 articles were enrolled. Finally, 31 pieces of best evidence were extracted from eight aspects, including assessment and diagnosis, multidisciplinary cooperation, indication, preparation before intervention, intervention program, safety monitoring, post-intervention evaluation, and special task. ② Finally, a total of 30 patients were enrolled in the intervention group, of which 17 completed 14 days of rehabilitation exercise, and 13 completed 7 days of rehabilitation exercise. Twenty-seven patients were enrolled in the control group, of which 17 completed 14 days of monitoring, and 10 completed 7 days of monitoring. Clinical evidence application results showed that the patients in the intervention group did not experience adverse events such as increased heart rate, extubation, or physical discomfort. The skeletal muscle mass index (SMI) in both groups was gradually decreased with the prolongation of intervention duration, but the 7-day SMI in the intervention group was significantly higher than that in the control group (kg/m 2: 8.61±2.66 vs. 6.65±1.50, P < 0.01). Conclusion:By summarizing the best evidence and evidence-based practice of exercise intervention for elderly patients with sarcopenia in ICU, this study confirmed the feasibility due to safe and effective of implementing early exercise intervention for elderly sarcopenia patients in ICU.

Anesthesia, General/adverse effects* ; Hypertension/etiology* ; Humans