Objective:To investigate the expression of serum caspase-cleaved cytokeratin 18(CCCK-18) in patients with cerebral ischemic stroke and its diagnostic value.Methods:One hundred and six patients with cerebral ischemic stroke who were diagnosed and treated in Affiliated Dongfeng Hospital from October 2018 to October 2019 were selected as the study group. Ninety patients who underwent digital subtraction angiography (DSA) during the same period and showed no other abnormalities inside or outside the skull were selected as control group. The baseline data of gender, age, drinking history, smoking history, hypertension history, diabetes history, coronary heart disease, and other subjects in the two groups had no significant differences ( P>0.05). Cubital venous blood of 5 ml from two groups of subjects were collected, and the level of serum CCCK-18 was detected by enzyme-linked immunosorbent assay. The levels of total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) were detected by enzymatic method. The receiver operating characteristic curve (ROC curve) was used to analyze the diagnostic efficacy of serum CCCK-18 in patients with ischemic stroke, and the relationship between serum CCCK-18 and TC, TG, LDL-C, HDL-C were analyzed by Pearson test. Results:The levels of serum CCCK-18, TC, TG, and LDL-C in the study group were significantly higher than those in the control group: (158.10 ± 50.89) U/L vs. (85.57 ± 35.25) U/L, (4.26 ± 0.92) mmol/L vs. (3.92 ± 0.80) mmol/L, (2.34 ± 0.53) mmol/L vs. (1.83 ± 0.47) mmol/L, (3.12 ± 0.73) mmol/L vs. (2.61 ± 0.67) mmol/L, and HDL-C level was lower than that in the control group: (1.20 ± 0.24) mmol/L vs. (1.32 ± 0.28) mmol/L, and there were significant differences ( P<0.05). Logistic regression analysis showed that CCCK-18, TC, TG, LDL-C, and HDL-C were independent risk factors for patients with ischemic stroke ( P<0.05). The area under the curve(AUC) of serum CCCK-18 to distinguish ischemic stroke from the control group was 0.878, with a sensitivity of 84.91% and a specificity of 78.89%. The AUC of serum CCCK-18 to identify patients with mild ischemic stroke was 0.763, with a sensitivity of 70.37% and a specificity of 78.89%. Correlation analysis showed that serum CCCK-18 was positively correlated with TC, TG, and LDL-C in patients with ischemic stroke ( r = 0.711, 0.722, 0.705), and negatively correlated with HDL-C ( r = - 0.714), and there were significant differences ( P<0.01). Conclusions:Serum CCCK-18 levels are significantly increased in patients with cerebral ischemic stroke, which can be used as a biomarker for diagnosis and judgment of disease severity.

Objective: To investigate the effect of oxidized low-density lipoprotein (ox-LDL) on expression of lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1), transforming growth factor beta 1 (TGF-β 1), and secretion of extracelluar matrix (ECM) in cultured rat glomerular mesangial cells (GMCs), and to investigate the influence of LOX-1 inhibitor polyinosinic acid (PIA) on the effect of ox-LDL. Methods: Rat glomerular masengial cells were cultured in vitro. RT-PCR was employed to determine the LOX-1 mRNA expression in GMCs incubated with different concentrations of ox-LDL (0, 25, 50, 100 μg/ ml). The expression of LOX-1 and TGF-β1, mRNA was also determined by RT-PCR in the blank control group, ox-LDL (50 μg/ml) group and PIA(50 μg/ml ox-LDL+250 μg/ml PIA) group. The contents of TGF-β1 fibronectin (FN), and collagen IV (Col IV) in the supernatants of the above 3 groups were determined by ELISA. Results: RT-PCR showed that LOX-1 mRNA expression in 25, 50 and 100 μg/ml ox - LDL groups was significantly higher than that of blank control group(P<0.05), with the highest expression found in the 50 μg/ml ox-LDL group; the expression of LOX-I and TGF-β 1 mRNA was significantly higher in 50 μg/ml ox-LDL group than that in the other 2 groups (P< 0.01). ELISA results demonstrated that the supernatant contents of TGF-β1, FN and Col IV were significantly higher in 50 μg/ml ox-LDL group than those in the other 2 groups (P< 0.05). Conclusion: Ox-LDL can upregulate the expression of LOX-1 and TGF-β1, mRNA and the secretion of extracelluar matrix in GMCs. Polyinosinic acid can antagonize the above effect of ox-LDL, suggesting that LOX-1 may participate in ox-LDL-induced GMCs damage and is involved in the development and progression of glomerulosclerosis.

Objective To investigate the clinical features of Hashimoto′s Encephalopathy(HE).Methods To retrospectively analyze the clinical data of 6 HE patients,admitted in Shanghai Changhai Hospital between 2010 and 2013.Results The age of onset were between 41 and 71 years;the male-to-female ratio was 1:5;the most common manifest was memory loss (5 patients);the ATPO of all the patients were significantly high ,but the test of ce-rebrospinal fluid ,electroencephalography and iconography were all non -specific;all of 6 patients responded well to the steroid therapy .Conclusion HE should be considered in those whose memory deteriorated and ATPO elevated , especially when they were sensitive to steroid treatment .

Objective To evaluate the diagnostic efficacy of MR urography(MRU) in the diagnosis of urinary diseases. Methods MR urography was performed in 58 patients with urologic diseases,inclu- ding :renal tuberculosis(6),various congenital anomalies of urinary tract(27),renal pelvis carcinoma(2), ureteral carcinoma (10),ureteral polyp(2),ureteral calculi(8) and iatrogenic ureteral stricture(3). Results MR urography provided high-resolution images of the kidneys and urinary tract in all patients.The characteristics of renal tuberculosis,urinary tract dilation and the various anatomic anomalies were depicted well.MR urography was successful in localizing the level of obstruction in all of the 58 patients(100%),although MR urography alone could not reliably determine the cause of obstruction in some cases. Conclusions In diagnosing urinary diseases,MR urography has its advantages and limitations.It should be used appropriately in diagnosing urinary diseases.

Objective To investigate the expression and clinical significance of peroxisome proliferator activated receptor γ(PPARγ)in bladder urothelial cancer tissues.Methods Parafflin‐embeded specimen of bladder urothelial cancer tissues from 50 cases and normal tissues near the bladder urothelial cancer from 5 cases were harvested from the Pathology Department of the Renmin Hospital of Wuhan University between 2006 and 2009.Those cases had complete pathological and clinical data.The ex‐pression of PPARγ was detected by immunohistochemical SP method.Quantitative analysis of the PPARγ was measured by high definition pathological graphics context report system (HPIAS‐1000).One‐way analysis of variance and SNK (q)tests were used to analyze the mean density and the positive area rate of the immunohistochemical results.All data were processed by SPSS 13.0.Results The expression of PPARγwas significantly higher in bladder urothelial cancer tissues than in para‐carcinoma tis‐sues(P<0.05).Correlation between expression of PPARγ with TNM stag of bladder urothelial cancer was as follows :Positive rate of PPARγin the tissues with primary tumor size ≥3 cm was 72.4% ,significantly higher than 33.3% in the tissues with tumor size <3 cm(P<0.05);positive rate of PPARγin the cases with lymph node metastasis was 72.7% ,significantly higher than 46.4% in the cases without lymph node metastasis(P<0.05);positive rate of PPARγin patients at stage T3‐4 group was 75.0% ,significantly higher than 41.9% and 45.5% in patients at clinical stage T1 and T2(P<0.05);positive rate of PPARγin patients with poor differentiation was 68.2% ,significantly higher than 42.9% in patients with high or middle differentiation group(P<0.05).Conclusion PPARγ plays an important regulating role in the onset and progress of bladder urothelial cancer ;PPARγexpression level was correlated with primary tumor size ,pathological types and differentiation degree ,lymph node me‐tastasis and clinical stage.This result suggested that PPARγ was closely correlated to metastasis of bladder urothelial cancer.

Objective To investigate the drug induced liver injure(DILI)associated with Chinese herbal medicine and herbal related food supplements.Methods From 1982 to 2005.8.9 consecutive pa- tients were diagnosed as DILI based on their medication history,clinical manifestation,liver function and other laboratory tests.The final retrospection confirmatory diagnosis was made according to the interna- tional scoring system for DILI.Results The 82 DILI patients(28 men,54 females,age ranging from 16 to 81 years old)accounted for 2.2% of hospitalized patients with liver dysfunction.Among those patients with DILI,30.5% was caused by weight reducing drugs or food supplements,12.2% by drugs of derma tology,8.5% by drugs for cardiovascular disease,8.5% by drugs of rheumatology,7.3% by drugs of gynecology,6.1% by drugs for liver disease,6.1% by blood-lipids modulators,3.7% by drugs for thy- roid disease,3.7% by drugs for hyperplasia of mammary glands and 13.4 % by the others.The duration of medication was from 6 clays to 6 months and the incubation period was from 6 days to 3 months.DILI could be classified as acute hepatocellular injury(36.59%),acute cholestasis(39.02%)and mixtures (24.39%).About 10% patients were accompanied by allergic manifestations.All patients recovered rap- idly after stopping the relevant medicine.Conclusion Chinese herbal medicine and herbal related food supplements are a common cause of DILI in China.The awareness and monitoring improving DILI during herbs treatment is a critical issue in daily practice.

Objective To investigate the specific CT findings of gastrointestinal stromal tumors (GIST).Methods The CT imaging of 12 cases of GISTs confirmed operatively and pathologically were reviewed and analyzed.The gross pathologic findings of the tumors were compared with the manifestations of CT study.Results Two of the GIST were from the stomach,2 from the duodenum,4 from jejunum,and 1 from the junction of jejunum and ileum,ileum,rectum and mesenterium respectively.5 of 8 cases with GIST from intestine had history of hemafecia or positive of fecal occult blood test.9 of the 12 GISTs were malignant,1 of them was potentially malignant,1 was not sure to be malignant or benign.CT studies of 11 of the 12 tumors showed as exogenous mass of 3-20 cm,only 1 with less than 5 cm and 8 of them with over 5 cm.in the max diameter the tumors were cystic-solid with inhomogenous attenuation.The solid potion of tumors enhanced moderately to markedly after the contrast media administered.Ulcer was seen in the tumors of 2 cases,and the diameter of both of them were over 12 cm.Punctate calcification was seen in 1 GIST.Conclusion CT findings of GIST were specific to a certainty.CT study is helpful for locating the tumor and observation of the relationship of the tumor and surrounding structures.

Objective To compare the response of haemodynamics and intraocular pressure (IOP) to laryngeal mask airway (LMA) and tracheal intubation (TT) in children with glaucoma.Methods A prospective,randomized study was conducted in 50 glaucomatous children,scheduled to undergo trabeculectomy and divided into LMA group (25 cases) and TT group (25 cases) by random digits table method.Endotracheal intubation or placement of the laryngeal mask operation time and the dosage of midazolam was noted in each patient.Heart rate (HR),mean arterial pressure (MAP),tip perfusion index (TPI),IOP were measured after anesthesia induction (T1),endotracheal intubation or placement laryngeal mask immediately (T2),endotracheal intubation or placement after laryngeal mask 1 min (T3),2 min (T4),3 min(T5),5 min(T6).Results There was no significant difference in endotracheal intubation or placement of the laryngeal mask operation time and the dosage of midazolam between two groups (P ＞ 0.05).Compared with T1,HR,IOP were increased at T2-T4,MAP was increased at T2-T3,TPI was decreased at T2-T5 in TT group,there was significant difference(P ＜ 0.05).There was no significant difference in HR,MAP,TPI,IOP among different points in LMA group (P ＞ 0.05).HR,MAP,IOP in LMA group at T2-T4 were lower than those in TT group [HR:(119.3 ±8.9),(117.6 ±8.5),(115.2 ±6.9) beats/min vs.(131.3 ±7.1),(128.1 ±6.8),(123.2 ± 8.6)beats/min,MAP:(36.9 ± 5.1),(37.1 ±4.8),(34.7 ±4.6) mmHg (1 mmHg =0.133 kPa) vs.(44.1 ± 4.9),(42.8 ± 5.5),(41.9 ± 7.1) mmHg,IOP:(27.6 ± 2.5),(27.0 ± 2.0),(25.9 ± 2.3) mmHg vs.(34.2 ± 2.2),(32.9 ± 1.6),(31.1 ± 2.2) mmHg],TPI at T2-T5 was higher than that in TT group (3.25 ± 0.28,2.99 ± 0.26,3.15 ± 0.31,3.40 ± 0.30 vs.2.69 ± 0.29,2.22 ± 0.27,2.41 ± 0.30,2.66 ± 0.33),and there was significant difference (P ＜0.05).Conclusion Insertion of LMA in glaucomatous children is not associated with significant changes in haemodynamics and IOP response and offers advantages over tracheal intubation.

BACKGROUND:Insulin-like growth factor-1 (IGF-1) is an important mitogen and an indispensable regulator during normal hair cell development. Extracellular signal regulated kinase 1/2 (ERK1/2) is also expressed in mammalian vestibular organs.OBJECTIVE: To investigate the changes of the expression and the distribution of IGF-1, IGF-1 receptor (IGF-1R) and ERK1/2 in guinea pig's vestibular epithelium following gentamycin injury.DESIGN: A randomly controlled study.SETTING: Department of Otorhinolaryngology, General Hospital of Chengdu Military Area Command of Chinese PLA.MATERIALS: Twenty healthy and adult guinea pigs, weighing 300 to 350 g, provided by the Experimental Animal Center,Fourth Military Medical University of Chinese PLA, were randomly divided into four experimental groups and a control group with 4 in each group.METHODS: The experiment was performed at Department of Otorhinolaryngology Research Laboratory of Xijing Hospital,Fourth Military Medical University of Chinese PLA from January 2002 to May 2002. In the experimental groups,gentamycin was intraperitoneally administered daily (80 mg/kg) for 10 consecutive days. For the control group, 1 mL of 0.9% sterile saline was administered in the same way. The guinea pigs, in which unsteady gait or nystagmus appeared,could be involved in the further experiments. Before being sacrificed, the animals' gait, nystagmus and the amount of food-intake were observed every day. The animals were anesthetized deeply with 50 mg/kg pentobarbital 1, 7, 14 or 21days after the last gentamycin administration and then decapitated. Bilateral otic vesicles were harvested and immersed in 4% paraformaldehyde. Then the specimens were decalcified in 10% ethylenediamine tetraacetic acid (EDTA),thereafter embedded in OCT gel and serially sectioned at a thickness of 10 μm in the cryostat. The behavioral changes of guinea pigs were observed. The morphological changes of vestibular epithelium were examined by hematoxylin and eosin (HE) staining. The expression and distribution changes of IGF-1/1R and ERK1/2 were investigated immunohistochemically. MAIN OUTCOME MEASURES: The behavioral, morphological, expression and distribution changes of IGF-1/1R and ERK1/2 of guinea pigs in each group.RESULTS: Twenty involved guinea pigs entered the stage of final analysis. ① All the guinea pigs' vestibular functions were impaired after gentamycin treatment, then partially restored without any pharmaceutical treatment. ②Morphological injury was obvious after gentamycin treatment, and improved 1 week later. ③The expression of IGF-1/1R was low in the control group, and in the 1-day group it increased significantly to its maximum. After that, its expression decreased gradually, but was still higher in the 21-day group than that in the control group. There were significant differences in the expression of IGF-1/1R among different groups (F =51.8,45.7,P ＜ 0.05). The expression changes of IGF-1 and its receptor were similar. ④The expression of ERK1/2 was low in the control group, and increased gradually after gentamycin toxicity. In the 7-day group, the immunoreactivity reached its maximum. Then the levels of ERK1/2 decreased gradually, but were still higher in the 21-day group than that in the control group. There were significant differences in the expression of ERK1/2 among different groups (F =103.7,106.4, P ＜ 0.01), but no significant differences existed in the expression between ERK1 and ERK2 among different groups (P ＞ 0.05).CONCLUSION: The expression of IGF-1/1R and ERK1/2 in vestibular epithelium increased after gentamycin treatment,and IGF-1 may play an important role as an endogenous mitogen through a paracrine or autocrine manner in the early stage of hair cell self-repair of guinea pigs. ERK1/2 may play an important role in signal transduction during vestibular hair cell self-repair after gentamycin toxicity in guinea pigs.

OBJECTIVETo observe the effect of using polytetraflouroethylene (e-PTFE) tube with self-Schwann cells implanted to repair facial nerve defect.

METHODSEnzymatic digest method was used to get pure Schwann cells in short time. The e-PTFE membrane tube was used to bridge the 1.0 cm defect of facial nerve and pure self-Schwann cells were injected into the tube. As control group, the e-PTFE tube without self-Schwann cells was used in the same way. Electric physiological and histological examinations were taken in different times.

RESULTSThe effect of nerve regeneration of the experimental group was better than control group at any time. The nerve conduction velocity of the experimental group was 29.70 m/s in the 16th week, while the control groups was 23.00 m/s respectively at the same time.

CONCLUSIONIt is possible to obtain sufficient active Schwann cells by enzymatic digest method. Using e-PTFE tube to bridge the defect of facial nerve with self-Schwann cells implanted can get effect of nerve regeneration.