Objective To investigate the associations of serum soluble CD40 ligand (sCD40L) levels with stroke risk,severity,and infarct volume.Methods Consecutive inpatients with acute ischemic stroke were recruited as a patient group.Healthy subjects were used as a control group.The demographics,vascular risk factors,and clinical data were collected from the patient group and control group.The serum sCD40L levels were measured by enzyme linked immunosorbent assay.According to the baseline National Institutes of Health Stroke Scale (NIHSS) scores,they were divided into a mild stroke group (＜ 8) and a moderate to severe stroke group (≥ 8).According to the median of infarct volume,the patients with ischemic stroke were divided into either a large infarction group or a small infarction group.Results A total 106 patients with acute ischemic stroke were recruited,including 47 females (44.3％) and 59 males (55.7％),and the mean age was 71.31 ± 11.27 years.There were 86 healthy subjects in the control group,including 41 females (47.7％) and 45 males (52.3％),the mean age was 73.56±9.32 years;there were.41 patients (38.7％) in large infarction group (≥1.8 cm3) and 65 (61.3％) in the small infarction group (＜1.8 cm3);there were 69 patients (65.1％) with mild stroke and 37 (34.9％) with moderate to severe stroke.The baseline serum sCD40L level in the patient group was significantly higher than that in the control group (5.61 ± 1.68 mg/L vs.3.56 ± 1.32 mg/L;t =9.236,P ＜0.01),the serum sCD40L level at day 14 after admission (4.19 ± 1.45 mg/L) in the patient group was significantly lower than the baseline level (P ＜0.01),but it was still higher than the control group (P ＜ 0.01).Multivariate logistic regression analysis showed that the higher low-density lipoprotein cholesterol (odds ratio [OR] 3.358,95％ confidence interval [CI] 2.681-4.056;P＜0.001) and serum sCD40L (OR 5.103,95％ CI 2.317-8.903;P＜0.001) levels were the independent risk factors for ischemic stroke;the higher serum sCD40L level (fourth vs.first quartile,OR 4.017,95％ CI 1.608-10.037;P =0.003),large atherosclerotic stroke (OR 2.321,95％ CI 1.014-5.314;P =0.046),cortical-subcortical infarcts (OR 2.679,95％ CI 1.111-6.460;P =0.028),and larger infarct volume (OR 3.216,95％ CI 1.398-7.395;P=0.006) were the independent risk factors for moderate to severe stroke;the higher serum sCD40L level (fourth vs.first quartile,OR 3.142,95％ CI 1.274-7.745;P =0.013),large atherosclerotic stroke (OR 2.956,95％ CI 1.299-6.767;P =0.010),cortical-subcortieal infarcts (OR 4.750,95％ CI 1.909-11.818;P ＜0.001),and baseline NIHSS score ≥8 (OR 8.509,95％ CI 3.432-21.094;P ＜ 0.001) were the independent risk factors for large infarction.Conclusion The serum sCD40L levels are closely associated with the risk,severity and infarct volume of ischemic stroke.

Objective To evaluate the acute side effects and efficacy of three dimensional conformal radiotherapy (3D-CRT) combined with gemcitabine chemotherapy for locally advanced non-small cell lung cancer (NSCLC). Methods From January 2006 to December 2007, 90 cases with advanced NSCLC were divided into two groups, treatment group of 45 patients were tre.ated with 3D-CRT and gemcitabine, control group of 45 patients were treated with gemcitabine and conventional radiotherapy. Chemotherapy consisted of intravenously gemeitabine 350 mg/m2 on day 1, 8, 15, 22, 29, 36. Radioactive source was used with X ray of 6 MV or 15 MV. Irradiatial target area were lung site and mediastinal node. Results The complete remission (CR)and remission rate(RR) in centrol group were 5 cases (11.1%) and 28 cases(62.2%), but in treatment group were 13 cases (28.9%) and 38 cases (84.4%), respectively. The difference of response rate in two groups was significant(P < 0.05). The rate of acute radiation-induced pneumonifis and esophagitis in control group (28.9%, 35.6%)were higher than those in treatment group (11.1%, 17.8%), there were significant difference between two groups (P < 0.05). Conclusions Concurrent application of gemcitabine and 3D-CRT can improve the RR for locally advanced NSCLC, and the acute toxicity are lower than those of gemcitabine and conventional radiotherapy. The clinical study is needed, but the late effect shoud be followed.

Objective To compare the changes in energy metabolism in 2-chloroethyl ethryl sulfide(CEES)-poisoned bronchial epithelial cell 16HBE cultured in media at different glucose concentrations .Methods Bronchial epithelial cell 16HBE was cultured in high (4.5 mg/ml) or low (1.1 mg/ml) glucose medium and exposed to a sulfur mustard simulant CEES of 0.2, 0.5, 1.0 mmol/L.Cell growth and cytotoxicity were tested using MTS .ATP, ADP and AMP were detected by HPLC and the value of ATP/ADP, total adenine nucleotides ( TAN) and energy charge ( EC) was subsequently calculat-ed.Mitochondrial oxidative phosphorylation-related proteins, COX-10 and ISCU, were detected using Western blotting . Rhodamine 123 was applied to detect the mitochondrial membrane potential using flow cytometry .Results Low glucose accelerated the growth and energy metabolism of 16HBE cells in regular culture , and the contens of ADP , TAN, COX-10 and ISCU in low glucose group were significantly higher than those in high glucose group .CEES exposure (≥0.5 mmol/L) significantly affected cell viability in both high and low glucose groups , with significant difference between the two groups exposed to 1.0 mmol/L CEES.In high glucose group, 24 h after 0.5 or 1.0 mmol/L CEES exposure, the contents of ATP, ADP and TAN were significantly increased , while ATP/ADP and EC decreased .In low glucose group , ADP, AMP and TAN significantly decreased, while ATP/ADP and EC increased 24 h after 1.0 mmol/L CEES exposure.The mi-tochondrial membrane potential (MMP) also changed differently after 0.5 mmol/L CEES exposure.MMP in high glucose group marginally increased at 3 h, and significantly increased at 8-12 h (P<0.05), and returned to normal at 24 h. MMP in low glucose group showed a transient decrease at 5 h (P<0.01), and back to normal at 8 h.The protein levels of COX-10 and ISCU were significantly increased in high glucose group 24 h after 0.5-1.0 mmol/L CEES exposure , but sig-nificantly decreased in low one 24 h after 1.0 mmol/L CEES exposure .Conclusion When 16HBE is cultured at a high or low glucose concentration , the cell growth, stress responses and energy metabolism including MMP , COX-10, ISCU and ATP production are in different status before or after CEES exposure .High glucose could protect against CEES exposure .

Objective To explore the effect of 2-chloroethyl ethyl sulfide(CEES) poisoning on keratinocyte migration and the regulatory role of microRNA(miR)-34a.Methods MTS was used to detect the viability of cells exposed to CEES in order to select an appropriate dose of CEES exposure in this in vitro model.The protein level of keratin 5 and keratin 10 was detected to assess cell differentiation status .Scratch assay was applied to evaluate cell migration ,and miR-34a silencing in keratinocytes was achieved by transfecting chemically synthesized miR-34a specific miRNA inhibitor.t-ERK1/2 and p-ERK1/2 levels closely related to cell migration were detected using Western blotting .Results An in vitro CEES exposure model of keratinocytes was established at the optimal concentration of 0.5 mmol/L CEES in the viability test , and this dose was chosen to evaluate cell migration changes .The migration of cells was significantly inhibited 24 h after CEES exposure , accompanied by no changes in morphology and keratin 5/10 levels.Silencing of miR-34a significantly increased the migration of cells exposed to CEES , which could be blocked by adding 5 μmol/L U0126 , an ERK1/2 phosphorylation selective inhibitor.Conclusion Silencing of miR-34a can significantly increase keratinocyte migration and partially reverse the inhibition of CEES-caused migration , which could be mediated by ERK 1/2 pathway activation .

Nerve agent not only inhibit acetylcholinesterase ( AChE) at an early stage, but also induce prolonged and progressive neuroinflammation and delayed neurodegeneration.Recently, the US National Institute of Health ( NIH) has sponsored some major programs of toxic mechanisms and treatment of nerve agents, which aims at the development of quick and effective treatment to acute intoxication and delayed effect.The experimentally effective new antidotes mainly include AChE-targeting drugs, broad-spectrum reactivators and scavengers, antiinflamatory and nerve protection drugs.

Objective To investigate the clinical effects and influencing factors of the outcomes of early microsurgical treatment in patients with intracerebral hematoma from ruptured intracranial aneurysm. Methods From 2010 to 2016, patients with intracerebral hematoma from ruptured intracranial aneurysm admitted to the Department of Neurosurgery, Xinyu People's Hospital were enrolled retrospectively. The demographic data, Hunt-Hess grade,Glasgow coma scale(GCS)score,imaging data,and procedure-related complications were collected. Glasgow outcome scale (GOS) score was used to evaluate the outcomes. Four to 5 were defined as good outcome and 1 to 3 were defined as poor outcome. The Hunt-Hess gradesⅡ-Ⅲ were used as the low-grade group and the Ⅳ-Ⅴ grades were used as the high-grade group. The survival rate and quality of life of both groups of patients were compared according to the GOS scores. Results A total of 36 patients were enrolled during the study, including 32 with subarachnoid hemorrhage and intracerebral hematoma and 4 with simple intracerebral hematoma. Hunt-Hess grade was grade Ⅱ in 2 cases, Ⅲ in 18 cases, Ⅳ in 14 cases, and Ⅴ in 2 cases. Distribution of responsible aneurysms:18 patients in middle cerebral artery, 9 in anterior communicating artery, 6 in anterior cerebral artery, 3 in posterior communicating artery, including 4 patients with multiple aneurysms. All patients underwent aneurysm clipping+hematoma removal under the general anesthesia within 36 h after onset,24 of them were treated with decompressive craniectomy. One patient died of severe brain swelling after intraoperative reruptureof the aneurysm,1 died of postoperative massive cerebral infarction, and 1 died of severe pulmonary infection and diabetes after giving up further treatment. Thirty-three survivors were followed up for 1 year, 29 had good outcome(80.5％) and 7 had poor outcome (19.5％). There were significant differences in survival rate and quality of life between the low-grade group and the high-grade group (P=0.001). There were significant differences in the Hunt-Hess grade, baseline GCS score, and proportion of patients receiving decompressive craniectomy between the good outcome group and the poor outcome group.Conclusion The Hunt-Hess grade, baseline GCS score, and decompressive craniectomy were the influencing factors of the outcomes in patients with intracerebral hematoma from ruptured intracranial aneurysm. Removal of hematoma and aneurysm clipping should be performed as early as possible,and decompressive craniectomy should be performed if necessary.

Objective To investigate the clinical effect of treat severe brain trauma combine hernia with standard hemi-craniectomy and canopy incision surgery. Methods Selected 76 cases of severe brain trauma combine hernia patients as research subjects, which were randomly divided into study group and control group, 38 cases in each group, the con-trol group received standard hemicraniectomy treatment,study group received standard hemicraniectomy and atrium in-cision treatment. The clinical effects were compared for the two groups. Results The rates of severe disability or long-term coma, mortality in the study group were lower than the control group, the differences was statistically significant(P<0.05). The scores of GCS of the study group were better than the control group after operation for 4 weeks and 6 months (P<0.05). Conclusion Patients with severe brain trauma associated with hernia use standard hemicraniectomy and canopy incision treatment can effectively improve the patient's brainstem around the pool,and help to improve the survival rate of patients who received treatment.

OBJECTIVETo observe the changes in serum transforming growth factor-β1 (TGF-β1) in patients with early-stage nasopharyngeal carcinoma (NPC) after radiotherapy and explore the correlation of serum TGF-β1 with radiation injury and disease-free survival.

METHODSThe average serum TGF-β1 level (50.2∓3.2 ng/ml) determined from 32 healthy volunteers was used as the standard value for NPC patients in this trial. Fifty-seven patients with early-stage (T1-2N0-1M0) NPC without prior treatment were divided into two groups with serum TGF-β1 level before treatment lower than or equal to the standard value (group A, 29 cases) and a level beyond the standard value (group B, 28 cases). Serum TGF-β1 level was determined in all the patients before, during and after the radiotherapy to evaluate the radiation injury and therapeutic effect.

RESULTSThe serum TGF-β1 level before radiotherapy was significantly lower in group A than in group B (35.4∓1.4 vs 58.8∓1.0 ng/ml, P<0.05). After radiotherapy, acute radiation mucositis and skin reaction was significantly severer in group B (P<0.05). The serum TGF-β1 level before radiotherapy was significantly higher in patients with grade 3 acute radiation mucositis and skin reaction than in those with injuries below grade 3 (54.0∓2.2 vs 42.0∓2.3 ng/ml and 54.3∓2.4 vs 43.4∓2.2 ng/ml, P<0.05). The two groups showed no significant differences in the locoregional failure rate (3.4% vs 7.1%), distant metastasis rate (3.4% vs 10.8%) or disease-free survival (P>0.05).

CONCLUSIONSRadiotherapy can significantly decrease serum TGF-β1 level in early NPC patients. Serum TGF-β1 level before radiotherapy can help predict the degree of acute radiation mucositis and skin reaction, but shows no correlation with disease-free survival of early-stage NPC patients.

Carcinoma ; Case-Control Studies ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; blood ; mortality ; radiotherapy ; Radiation Injuries ; blood ; Survival Rate ; Transforming Growth Factor beta1 ; blood

Objective To investigate the efficacy and clinical value of balloon-assisted clipping for the treatment of giant unruptured intracranial aneurysms of internal carotid artery. Methods Patients with giant unruptured intracranial aneurysm of intracranial segment of internal carotid artery treated with balloon-assisted clipping in the Department of Neurosurgery, Xiangya Hospital, Central South University from September 2017 to May 2018 were enrolled retrospectively. The proximal internal carotid artery or the aneurysm neck were temporarily blocked by balloon, and then the aneurysm was clipped in the hybrid operating room. Demographic data, preoperative symptoms, aneurysm characteristics, position of balloon placement, intraoperative angiography, complications, and follow-up results were collected. Results A total of 12 patients with giant (diameter >2 cm) unruptured intracranial aneurysm of intracranial segment of internal carotid artery were enrolled. They were all successfully clipped using balloon-assisted clipping in the hybrid operating room. Among them, 1 was located in the ophthalmic segment, 3 in the supraclinoid segment, 4 in the posterior communicating segment, 2 in the anterior choroidal artery segment, and 2 in the bifurcation of the internal carotid artery. The balloons were placed in the proximal end of internal carotid artery in 9 cases and in the neck of aneurysm in 3 cases. Intraoperative angiography showed that 12 aneurysms were completely occluded; 1 had severe stenosis of parent artery, and 1 had mild stenosis. Postoperative complications included cerebral infarction in 1 case, temporary diabetes insipidus in 1 case (returned to normal 1 week after operation), hemiplegia in 1 case, and epilepsy in 1 case. Glasgow Outcome Scale score at discharge showed 5 in 9 cases, 4 in 2 cases, and 3 in 1 case. The patients were followed up for 2.3 to 12 months after operation (median 7.5 months). Reexamination of CT angiography showed no recurrence of aneurysm. Glasgow Outcome Scale score was 5 in 11 cases and 4 in 1 case. Conclusions The use of balloon-assisted clipping technique in the hybrid operating room for the treatment of giant intracranial segmental aneurysms of the internal carotid artery is safe and effective, and has a good long-term outcome.

Objective:To investigate the correlation between the number of circulating tumor cells (CTC) in peripheral blood and clinicopathological features of patients with breast cancer.Methods:The clinical data of 104 breast cancer patients at Guangzhou Panyu Central Hospital between January 2017 and May 2020 were retrospectively analyzed. The number of CTC in peripheral blood, the levels of serum tumor markers [alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), carbohydrate antigen (CA)125, CA153] were detected. In blood samples, the number of CTC ≥ 2/ml was defined as CTC positive. Immunohistochemistry was used to analyze the protein expression of Ki-67 in tumor tissues. The association of CTC with clinicopathological features, serum tumor markers and Ki-67 protein expression was also analyzed.Results:The CTC positive rate was 80.77% (84/104). There were statistically significant differences in composition of whether there was vascular tumor thrombus (χ 2 = 0.860, P = 0.009), axillary lymph node metastasis (χ 2 = 12.382, P<0.01), N staging ( P = 0.002) and TNM staging (χ 2 = 7.698, P = 0.006) between patients with CTC positive and negative. However, there were no statistically significant differences in composition of age ( t = 0.634, P = 0.528), tumor quadrant (χ 2 = 6.523, P = 0.163), molecular subtyping (χ 2 = 4.164, P = 0.384), histological grade (χ 2 = 1.901, P = 0.387), T staging ( P = 0.099) and whether there was nerve invasion (χ 2 = 0.092, P = 0.761). The levels of serum CEA and CA125 in CTC positive patients were higher than those in CTC negative patients [median ( P25, P75): 2.50 ng/ml (2.21 ng/ml, 2.92 ng/ml) vs. 1.89 ng/ml (1.61 ng/ml, 2.35 ng/ml); 13.81 U/ml (11.79 U/ml, 16.28 U/ml) vs. 11.17 U/ml (8.91 U/ml, 12.80 U/ml); all P < 0.05], and CTC was positively correlated with serum CEA and CA153 levels ( r = 0.520, P<0.01; r = 0.497, P<0.01); CTC was not related to Ki-67 protein expression (χ 2 = 0.512, P = 0.474). Conclusion:The number of CTC in peripheral blood is closely related to clinical staging, lymph node or hematogenous metastasis, tumor markers CEA and CA153 levels of breast cancer. The increased number of CTC may cause tumor progression and metastasis.