To mitigate penumbra injury is the key factor in the treatment ofischemic stroke.Blood reflow and neuroprotection against time are premise to achieve this.Due to time window, thrombolysis rate is low(less than 5% in developed country).However, all neuroprotectants haven't been demonstrated to be effective in human, till now.Based on guidance ofwholism concept ofTCM and analysis ofrelative studies in western medicine.We found that functional status ofnon-ischemic areas can impact on injury degree offocal ischemia.One ofthe reasons that lead to failure in neuroprotective studies may be without considering this impaction.We put forward that non-ischemic areas can impact on the injury degree ofischemic area through the complex neuronal network, and effective regulating the functional status ofnon-ischemic areas is one ofthe key factors which can ameliorate focal ischemic injury.

Based on fundamental theory, literatures of TCM and clinical practice, we have found that there are some errors in the theory of stroke. We put forward several views on it: Firstly, the key reason of stroke is the hidden pathogenic factor which is phlegm and stasis, but not wind and fire. Secondly, the production of wind is due to the liver-blood injury caused by phlegm and stasis; the production of f ire is due to whether the liver-blood injury caused by phlegm and stasis or the f ire stagnated by phlegm and stasis in pericardium. Thirdly, the disease location of stroke is in the level of spirit, not in channels and collaterals. Liver soul injury leads to paralysis and aphemia. Lung soul injury leads to numbness. Kidney will injury leads to sensory aphasia. Pericardium invaded by phlegm and stasis, mind disorder will exists. Fourthly, spirit injury is a def icient syndrome, and supplementing blood and qi is the key of treatment, and expelling phlegm and stasis, balancing yin and yang are also needed. The main treatment principles of liver soul injury, lung soul injury, kidney will injury and pericardium injury are tonifying blood, cultivating qi, replenishing essence and nourishing both qi and blood respectively.

Objective To evaluate the antitumor effects of chenodeoxycholic acid-verticinone ester ( CDCA-Ver ) on tumor growth and immune system of H22-bearing mice. Methods Antitumor activity against a solid tumor mass was evaluated in Kunming mice. H22 cells were transferred into the abdomen cavity of Kunming mice. H22 cells were inoculated through subcutaneous injection at the right armpit of the mouse to establish a solid tumor model. At 24 h after H22 tumor cells inoculation, 40 tumor-bearing Kunming mice were randomly divided into 4 groups according to random number table ( n=10 each group):model control group, cyclophosphamide ( CTX) group, intraperitoneal CDCA-Ver injection group and intravenous CDCA-Ver injection group. In model control group, sterile 0. 9% sodium chloride solution (10 mL·kg-1 ) was intraperitoneally injected once daily. In CTX group and intraperitoneal CDCA-Ver injection group, CTX (20 mg·kg-1 ) and CDCA-Ver (20 mg·kg-1 ) was intraperitoneally injected once daily, respectively. In intravenous CDCA-Ver injection group, CDCA-Ver ( 20 mg · kg-1 ) was injected through tail vein once daily. CDCA-Ver, CTX and NS were injected into the mice of the experimental groups once daily for 10 days, respectively. The dose volume was 0. 1 mL · ( 10 g )-1 body weight. The positive control drug was cyclophosphamide. Ten mice were treated with 20 mg · kg-1 CDCA-Ver through intravenous injection ( i. v. ) . Ten mice were treated with 20 mg·kg-1 CDCA-Ver through intraperitoneal injection. The thymus and spleen indices and the tumor inhibition rate were assessed, and histopathological examination with haematoxylin and eosin ( H&E) staining was carried out to evaluate the antitumor effects of CDCA-Ver. Results CDCA-Ver ( ivor ip) suppressed the growth of solid tumor in H22-bearing mice. The inhibition rate was 48. 3% at the dose of 20 mg·kg-1 CDCA-Ver (ip). There was no significant difference between CDCA-Ver (ip) and CTX treated group (P<0. 05). Compared with the control, the weight of thymus and spleen of CDCA-Ver (ip) treated group was not obviously changed. But a significant weight loss of thymus and spleen in CTX group was observed, which was attributed to the immune suppression from CTX. The thymus and spleen indices in the CTX-treated mice were significantly lower than those of the control group (P<0. 01). We further conducted histopathological examination to confirm the results. The immune system was not suppressed by CDCA-Ver ( ip ) in tumor-bearing animals. The low toxicity of CDCA-Ver was an outstanding advantage for the development of newly anticancer drug. Conclusion CDCA-Ver treatment can significantly inhibit tumor growth in mice.

A 29-year-old woman was admitted to the Department of Rheumatology,Peking Union Medical College Hospital due to intermittent rashes,fever and headache.Palpable purpura were symmetrically distributed on the extremities and trunk.Other manifestations included headache with nausea and vomiting.Elevated white blood cell (WBC) count,platelet (PLT) count,erythrocyte sedimentation rate (ESR) and C-reactive protein were the main laboratory findings.Antinuclear antibodies and antineutrophil cytoplasmic antibodies were negative.Examination of the cerebrospinal fluid (CSF) revealed high intracranial pressure,while routine cytology and biochemical tests of CSF were normal.Head MRI scan and PET-CT did not detect remarkable findings.A diagnosis of systemic vasculitis was confirmed by the biopsy of skin lesion which showed inflammatory infiltration of the muscular vessel wall.Combination therapy of corticosteroids and cyclophosphamide lead to a rapid improvement in clinical symptoms and laboratory parameters.The patient was in stable remission till 6 month follow-up.

Objective To analyze the clinical information of a family with one patient who have systemic lupus erythematosus (SLE) and Fabry disease,as well as the enzymatic activity and gene mutation in these family members.Methods Clinical characteristics were collected from the proband and her family members.Peripheral blood samples from three members of this family were collected and the enzymatic activity was measured by fluorimetrie substrate assay.Genomic DNA was extracted from one male member with significantly decreased enzyme activity,the 7 exons and their flanking introns of GLA gene were amplified by PCR and directly sequenced.Results The enzyme activity of two family members was significantly decreased,the genetic analysis of the male member revealed a missense mutation in exon 2:c.334C＞T (CGC＞TGC)( p.R112C ).Family members except the proband had no definite evidence to support the presence of SLE.Conclusion The coexistence of SLE and Fabry disease is extremely rare.Immunological test,enzymatic activity and gene mutation analysis seem to be helpful for the differential diagnosis.

Objective To explore the relationship among personality traits,aggression,depression,anxiety and suicide ideation by developing a structural equation model.MethodsA total of 2141 participants derived from a stratified random cluster sampling were investigated with Eysenck personality questionnaire(EPQ),aggression questionnaire(AQ),patient health questionnaire depression scale(PHQ-9) ,generalized anxiety disorder scale(GAD-7) and Beck depression inventory(BDI-13).ResultsIn EPQ,the scores of neuroticism,extroversion and psychoticism were (40.00±5.84),(59.84±7.02)and (36.63±6.41) respectively.In AQ,the scores of physical aggression,verbal aggression and anger were (32.41±5.15),(30.43±7.24),and (34.39±6.09) respectively.The median scores of PHQ-9 and GAD-7 were 5 and 6,and the inter-quartile range were 4 and 5.The suicide ideation was correlated with measurement indicator respectively(r=-0.19-0.40,P<0.01).Aggression and depression directly affected suicide ideation(direct effect was 0.27,0.24 respectively) and aggression indirectly affected suicide ideation trough anxiety(indirect effect was 0.02).Personality traits indirectly affected suicide ideation through aggression,anxiety and depression(indirect effect was 0.40).Anxiety indirectly affected suicide ideation through depression(indirect effect was 0.13).ConclusionPersonality traits,aggression,anxiety and depression affect suicide ideation,and these factors have different effecting mechanism.

Objective To investigate the clinical characteristics in patients with primary antiphospholipid syndrome (PAPS) and to identify potential predictors of thrombotic events.Methods A total of 107 patients with PAPS were enrolled in our study, who were admitted in Peking Union Medical College Hospital from January 2004 to December 2014.Demographic data, age at onset, disease duration, past history of hypertension and regular cigarette smoking, clinical manifestations, imaging characteristics, management and prognosis were retrospectively collected.Bivariate statistical analysis and logistical regression test were performed to compare the discrepancy between patients with or without thromboembolic events.Results In 107 patients, there were 65 female and 42 male patients, with mean age (39.8 ± 15.8) years old, median disease duration 10.5 (2.0, 48.0) months.A total of 72(67.3％) patients reported episodes of thromboembolic events, including 72 venous thromboses and 29 arterial thromboses.The most frequent venous thromboses were deep vein thromboses (35.5％), pulmonary embolism the second common (29.9％), with cranial venous sinus thromboses the following (8.4％).In arterial thromboembolic events, the incidence of transient ischemic attack (TIA) and ischemic stoke was the highest (14.0％), embolism of lower extremities the second (6.5％) ,and 4 patients (3.7％) with acute myocardial infarction.Sixty seven patients (62.6％)had positive lupus anticoagulant, 60 patients (56.1％)with positive anticardiolipin antibody,32 patients (29.9％, 32/74) with positive β2 glycoprotein Ⅰ (β2GP I).Forty patients(37.4％)had double positive antibodies, while 19 cases (17.8％)with triple positive.In logistical regression, aging (per 10 years) and hypocomplementemia were significantly related to venous thrombosis (OR =1.421, 95％ CI 1.066-1.894, P ＜ 0.05, and OR =6.435, 95％ CI 1.374-30.130, P ＜ 0.05, respectively).Cigarette smoking and triple positive antibodies were independent risk factors of arterial thrombosis (OR =3.996, 95％ CI 1.079-14.795, P ＜ 0.05 and OR =3.166, 95％ CI 1.102-9.097, P ＜ 0.05, respectively).Conclusion Alas is an autoimmune disorder characterized by recurrent arterial and venous thromboembolic events.Venous thromboembolism is more common than the arterial.Age and hypocomplementemia are predictors of venous thromboembolism;while smoking and triple positive antibodies are independent risk factors of arterial thromboembolism.

Objective:Longitudinally extensive transverse myelitis (LETM) could be seen in patients with connective tissue disease (CTD), especially systemic lupus erythematosus (SLE) or primary Sj?gren′s syndrome (pSS). Some patients are combined with neuromyelitis optica spectrum disorders (NMOSD)(termed CTD-LETM-NMOSD) while others without (termed CTD-LETM-non-NMOSD). The aim of this study is to compare the clinical characteristics of CTD-LETM-NMOSD patients to CTD-LETM-non-NMOSD patients.Methods:We retrospectively collected data from 40 CTD patients with LETM who were admitted to the Department of Neurology or Rheumatology at Peking Union Medical College Hospital from Jan, 2006 to Dec, 2016. They were divided into CTD-LETM-NMOSD and CTD-LETM-non-NMOSD two groups. Demographic characteristics, clinical and laboratory features were obtained from the database. Relapse rates and clinical outcome were analyzed by Kaplan-Meier method.Results:Among 40 patients with CTD, 28 (70.0%) were NMOSD while 12 (30.0%) were not. The positivity rates of anti-SSA, antibodies to aquaporin-4 (anti-AQP4) were significantly higher in patients with NMOSD than those in patients with non-NMOSD ( P<0.05). Age, gender, clinical features, disease duration, anti-double-stranded DNA antibody, anti-ribosomal P antibody, antiphospholipid antibodies, expanded disability status scale (EDSS) scores, and magnetic resonance imaging (MRI) features were all comparable between two groups. CTD-NMOSD patients had significantly higher disease relapse rate (75.0% vs. 3/12, P<0.01). Conclusion:Anti-SSA and anti-AQP4 positivity is associated with NMOSD and higher relapse rates, which suggests that NMOSD in CTD-LETM patients may represent distinct characteristics and pathogenesis from patients with CTD-LETM-non NMOSD.

Objective Immune and inflammatory mechanisms could play a significant role in genesis or progression of interstitial lung disease and pulmonary arterial hypertension,especially in patients with connective tissue diseases.Specific antibodies may predict the occurrence of this condition.Methods The plasma of patients with systemic sclerosis(SSc)or mixed connective tissue disease(MCTD)were screened with enzyme linked immunoserbent assay(ELISA)and Western blotting using recombinant mocsin.The clinical data were recorded and pulmonary function tests(PFTs)were performed in 78 consecutive individuals in order to identify the difference in clinical manifestations between anti-mocsin positive group and negative group.Results Our results showed high titers of anti-mocsin antibodies in 21(53%)of 40 patients with SSc,and 15(39%)of 38 patient with MCTD.The presence of anti-moesin antibodies was significantly correlated with pulmonary involvement(ILD and PAH)in SSc and MCTD patiens(P=0.001).Comparing with the antibody negative group,the total lung capacity[(82±10)% vs(90±14)%,P=0.027),forced vital capacity [(76±13)% vs(85±17)%,P=0.040]and diffu-sing capacity of the lung for carbon monoxide[(58±16)% vs (72±23)%,P=0.014]of PFTs in anti-moesin antibodies positive group were noted to be significantly decreased(P＜0.05).Conclusion Specific antibodies to moesin is prevalent in patients with SSc and MCTD,so it may be an early predictor of pulmonary involvement in patients with SSc or MCTD.

Objective To identify a novel auto-antibody in sera of systemic sclerosis (SSc) patients and to analyze its relevance with SSc-associated interstitial lung disease (ILD). Methods The anti-moesin antibody in the sera of 62 SSc patients, who had participated the European League Against Rheumatism's Scl eroderma Trial and Research Group (EUSTAR), were tested by enzyme linked immunosorbent assay (ELJSA). Patients were grouped by high resolution computerized tomography (HRCT) features, pulmonary function test (PFT) abnormalities, inflammatory markers and disease course. The prevalence and titer (Optical density value) of anti-moesin antibody were compared between groups with t and χ2 test. Results The titer of anti-moesin antibody was significantly higher in the SSc-ILD group than non-ILD group (0.156±0.062 vs 0.107± 0.026, P=0.005). Among SSc patients, the diagnostic sensitivity and specificity of the anti-moesin antibody for ILD was 44.0% and 91.7% respectively (Kappa=0.2, P=0.022). Anti-rnoesin antibody was more prevalent in SSc patients with HRCT features of honeycomb-like lesion, lobular septal thickening and mediastinal lymphadenopathy (P<0.05). SSc patients with deteriorated total lung volume (TLC %) had higher titer of anti-moesin antibody significantly (0.172±0.067 vs 0.133±0.039, P=0.011), as the same tendency in patients with decreased diffusing capacity of the lung for carbon monoxide (DLco% ) but without statistical significant difference (0.153±0.580 vs 0.120±0.340, P=0.089). The anti-moesin antibody was equally prevalent between abnormal ESR, C reactive protein, immunoglobulin and complements groups and their normal controls (P> 0.05). Group of patients who had SSc courses more than or less than 5 years demonstrated similar anti-moesin antibody titers (0.146±0.047 vs 0.164±0.077, P=0.272). However, patients with ILD courses less than 12 months had higher liter of the antibody than controls (0.182±0.073 vs 0.138±0.049, P=0.040). Conclusion This study suggests that the novel anti-moesin antibody has comparatively high specificity for SSc-associated ILD patients, which may contribute to further understanding the pathogenesis of ILD in SSc patients. Further investigations are deserved to evaluate the application of anti-moesin antibody in facilitating early screening and evaluation of ILD.