Infection is one of the most important complications of acute stroke, and it is an independent risk factor for resulting in stroke worsening. Growing evidence has indicated that acute stroke patients suffer an impaired peripheral immune response, i.e. stroke-induced immunodepression system (SIDS). SIDS is characterized by the rapid and sustained cellular immunodepression after acute stroke, which is mainly presented as wide apoptosis and dysfunction of lymphocyte. Multiple reasons activate the sympathetic nervous system, and thus cause SIDS. SIDS weakens the effective defense against the invasion of pathogens in the human body, resulting in the increased infection and mortality rate. However, SIDS also has protective effect on the human body. It can prevent the excessive inflammatory response in the injured brain tissue. A better understanding of the complex relationships between the central nervous system and the immune system are promising to provide more effective treatment methods for patients with acute stroke.

The RD-1 locus has been considered crucial in the pathogenesis of M.tuberculosis, the RD-1 locus is 9.5 kb and spanning open reading frames Rv3871 to Rv3879c encoding 9 different proteins separately.The RD-1 locus is missing in all bacillus Calmette-Guerin(BCG) strains, and is one of the key virulence factor in M.tuberculosis.The RD-1 locus participates in a new secreting system named ESX-1, which can facilitate the secretion of some special proteins.The two important proteins encoded by the RD-1 locus named CFP-10 and ESAT-6 can form a tight 1∶1 complex, and has been shown to be coordinately secreted and lead to a strong T cell response, which suggests that these two proteins may act as ideal target antigens in diagnosis and prevention of tuberculosis(TB).

Objective To investigate the effect and underlying mechanism of single,fractioned and continuous low dose rate radiation on CL187 colorectal cancer cell line.Methods CL187 cells were exposed to 6 MV X-rays at a high dose rate of 4 Gy/min and 125Ⅰ seed at a low dose rate of 2.77 cGy/h with three groups:single dose radiation group (SDR),fractioned dose radiation group (FDR) by 2 Gy/f,and continuous low dose rate radiation group (CLDR).The radiation doses were 0,2,4 and 8 Gy.Total cell number and cell viability were determined by trypan blue.Clone forming assay was used to evaluate the cell proliferation ability.The percentage of apoptosis cells was analyzed by flow cytometry.Western blot was used to detect the protein expression levels of PHLPP2,PTEN and Bax.Results Compared with SDR and FDR groups,the total cell number and survival fraction of CLDR group decreased.The relative biological effect (RBE) for 125Ⅰ seeds compared with 6 MV X-rays was 1.41.The percentage of apoptosis cells of CLDR group was significantly increased (t =-15.08,-11.99,P ＜ 0.05).The expression level of Bax increased in CLDR group,while no obvious changes were observed on PHLPP2 and PTEN among three groups.Conclusions The expression level of PHLPP2 increaseS in SDR,FDR and CLDR group,while it seems that it was not influenced by dose rate.The expression level of Bax increased in three groups,while more colorectal CL187 cells in CLDR group may be killed due to the increase of Bax expression.

Objective To investigate the combination effect of cetuximab and irradiation on colorectal carcinoma CL187 cell line and underlying molecular mechanism.Methods CL187 cells with or without cetuximab treatment were irradiated by 0,4 and 8 Gy X-rays,then cell death percentage was determined by MTT 24 and 48 h post-irradiation.Clone forming assay was used to evaluate the cell reproliferation ability.Cell cycle distribution,apoptosis,and necrosis were analyzed by flow cytometry.Western blot was used to detect the protein expressions of DNA-PKcs,Ku70 and Ku80.Results The cetuximab enhanced the percentage of radiation-induced cell death,while descreased the cloning formation capacity and increased radiosenvtivity (t =-6.14、-6.53,P ＜0.05).The SER of cetuximab on CL187 cell line approached to 1.38.In addition,cetuximab also increased radiation-induced G0/G1 phase arrest (t=-4.64,P＜0.05) and the percentage of apoptosis and necrosis (t=-9.16,P ＜0.05),but it descreased the expression levels of DNA-PKcs,Ku70 and Ku80 proteins.Conclusions The cetuximab treatment might enhance the inhibitory effect of irradiation on colorectal carcinoma CL187 cell line by influencing cell cycle distribution,cell apoptosis,and the expression of DNA repair proteins.

ObjectiveTo evaluate endovascular repair(EVAR) of penetrating atherosclerotic ulcer (PAU) of the thoracic aorta.MethodsThere were 12 cases of PAU treated at our department. All the cases had severe acute thoracic pain. Computer tomography angiography (CTA) showed well outlined ulcer in 12 cases, intramural hematoma in 8 cases. EVARs were done under general anaesthesia and 12 stent grafts were used. Two cases received by-pass procedure ahead of EVARs because of main branches involved.Patients were followed up with CTA from 12 months to 4 years( median 36 months).ResultsA total of 12 stent grafts were implanted to 12 patients.The average diameter of stent graft was ( 35.7 ± 2. 5 ) mm(32-40 mm) , length was ( 163 ± 19) mm ( 152-202 mm). There was a very small internal leakage in one case with large size ulcer after implantation of stent graft, other ulcers were excluded completely. Primary technical success rate was 100％. There were no perioperative death and severe complications. All cases were free from symptoms after operation and alive during follow-up. CTA showed satisfactory results without internal leakage.The small leakage in the case disappeared within 3 months.ConclusionsBeing miniinvasive and effective, EVAR is the choice of therapy for symptomatic PAU.

Objective To explore the independent risk factors related to acute post-stroke pneumonia.Methods A total of 545 inpatients with acute stroke in Shanghai First People's Hospital Affiliated to Shanghai Jiaotong University and East Hospital Affiliated to Tongji University during July 1,2009 to June 30,2011 were enrolled.Single-factor analysis was performed to identify the risk factors of acute post-stroke pneumonia. According to the results of single-factor analysis and relevant professional knowledge,fitting multi-factor non-conditional Logistic regression model,adjusting the relevant confounded factors,the independent risk factors were analyzed.Results The incidence of acute post-stroke pneumonia was 11.0％ (60/545).The independent risk factors of acute post-stroke pneumonia were:age ≥ 80 year ( OR =6.024,95％ CI:1.923 - 18.868,P =0.002 ),hemorrhagic stroke ( OR =3.546,95％ CI:1.266 -9.901,P =0.016),stay in bed ( OR =4.295,95％ CI:1.642 - 11.233,P =0.003 ),baseline Glasgow coma scale ≤8 ( OR =5.127,95％ CI:1.377 - 19.090,P =0.015 ),baseline Barthel index ＜50 ( OR =8.403,95％ CI:1.468 -47.619,P =0.017 ),malnutrition ( OR =10.625,95％ CI:3.260 -34.631,P =0.000 ),baseline fasting plasma glucose ≥ 7.0 mmol/L ( OR =10.000,95％ CI:3.115 -32.258,P =0.000); and early rehabilitation was the protective factor (OR =0.159,95％ CI:0.055 -0.466,P =0.001 ).Conclusions The incidence of acute post-stroke pneumonia is high,and it is relatedwith many independent risk factors.Comprehensive interventions may contribute to early identify and prevent acute post-stroke pneumonia.

Objective To investigate the clinical value of preventive analgesia in patients with radical gastrectomy for gastric cancer.Methods The clinical data of 161 patients undergoing radical gastrectomy for gastric cancer at the Xijing Hospital from July 2012 to June 2013 were prospectively analyzed.A single-blind,randomized,controlled study was performed in the eligibe patients who were randomly divided into the preventive analgesia group and the control group based on a random number table.All the patients received major gastrectomy + Billroth Ⅱ anastomy or total gastrectomy + esophagojejunastomy,and then they received vein combined anesthesia and tracheal intubation.In the preventive analgesia group,10 mg dexamethasone and 200 mg parecoxib were administered by intravenous infusion before operation,7-8 mL ropivacaine (0.5％) were injected at the incisional site and transversus abdominis infiltration at open and close surgery and celecoxib was taken orally for 3 days.In the control group,vein analgesia pump was used after operation.The visual analogue scale (VAS),proportion of patients with postoperative out-off-bed activity time ＞ 8 hours,time of flatus,time of defecation and duration of hospital stay were recorded between the 2 groups.The measurement data with normal distribution were presented as x ± s.The comparison between groups was evaluated with the t test and repeated measures ANOVA.The data with skew distrubution and ordinal data were analyzed by the analysis of variance,and the count data were analyzed using the chi-square test.Results All the 161 patients who were screened for eligibility were randomly divided into the preventive analgesia group (87 patients) and the control group (74 patients).The scores of the VAS at postoperative day 1,2 and 3 were 2.8 ± 0.6,2.6 ± 0.4 and 1.8 ± 0.4 in the preventive analgesia group,and 5.3 ± 0.5,4.2 ± 0.6 and 2.4 ± 0.3 in the control group,with a significant difference between the 2 groups (F =4.25,P ＜ 0.05).The proportion of patients with postoperative first abmulation time ＞ 8 hours at postoperative day 1,2 and 3 were 8,17 and 20 in the preventive analgesia group,and 0,3 and 11 in the control group,with a significant difference between the 2 groups (x2 =7.60,10.26,3.16,P ＜ 0.05).The time of flatus,time of defecation and duration of hospital stay were (51 ± 24) hours,(61 ± 24) hours and (5.5 ± 3.0) days in the preventive analgesia group,compared with (71 ± 23) hours,(83 ± 30) hours and (6.3 ± 2.1) days in the control group,showing a significant difference between the 2 groups (t =5.32,5.04,0.17,P ＜ 0.05).All the patients in the 2 groups normally survived after surgery without respiratory depression,incision infection and adverse drug reaction.Conclusions Preventive analgesia in the perioperative treatment of patients with radical gastrectomy for gastric cancer could relieve the postoperative pain of patients,improve the bowel function and enhance the recovery of patients.Registry This study was registered with the Chinese Clinical Trial Registry with the registry number of ChiCTRTRC-11001440.

Physical training induces beneficial adaptations,but long excessive exercise may lead to severe damage to the skeletal muscles,liver,heart,kidneys and immune functions. Over the past few decades,health scholars have been searching for natural components that can prevent or improve the damage induced by hyperkinesis. The mechanisms of organ damage induced by long overtraining include immunosuppression,metabolism disorder,hormone disturbance,oxidative damage, etc. Natural poly-saccharides have interventional effects on these injuries,possibly by improving immunity,regulating metabolism and ameliorating free radical damage.

Objective To investigate an X-ray total body irradiation (TBI) technique using anterior-posterior opposed fields with patients at the side-lying position,and to analyze the real-time in vivo dosimetry results.Methods The accelerator with 10 MV X-rays of Varian Trilogy was used for the TBI with the extended source to skin distance of 390 cm.The percent depth dose,off axis factors and absolute dose output were measured.The dose accuracy and homogeneity was monitored real-time using multichannel diode dosimeter for 10 patients.The monitored sites included forehead,mandible,suprasternal fossae,xiphoid,umbilicus,pelvis,middle of thigh,knee,middle of leg and ankle.The patients were irradiated at the side-lying position,with the prescription dose of 1 200 cGy/6 f during 3 days,the middle line dose rate of 5.0 cGy/min.Solid water was used for the compensation of the dose homogeneity.Results The off axis dose homogeneity was less than ± 5.0％ for the TBI geometry.The absolute dose output was 0.072 1 cGy/MU at the maximum dose point.The total body irradiation was finished smoothly for the 10 patients lying on side.The deviation of monitored total dose from the total prescription dose was within -4.9％ to 6.7％ for the 10 monitored sites.The monitored dose homogeneity was less than 5.0％.Conclusions The fractionated anterior-posterior opposed parallel TBI can be finished smoothly with patients side-lying.Accurate and homogenous dose distribution can be obtained using real-time dose monitoring and compensation with solid water.

Objective To evaluate the clinical effects of AO clavicula hook plate in treatment of acromioclavicular dislocation. Methods According to the specific anatomic, physiological and biomechanical conditions of the patients, 43 cases of complete acromioclavicular dislocation were treated either by AO clavicula hook plate (23 cases),or by Kirschner pin and steer wire tension band (20 cases). Results The results were evaluated by radiographic representations and joint function recovery according to Karlsson's criteria. The excellent results of the 2 methods were 95.6% and 65% respectively. There was significant difference. Conclusions The AO clavicula hook plate can meet the clinic requirements and be used with satisfactory results in the treatment of acromioclavicular dislocation.