Objective To clarify whether the mRNA expression level of glucocorticoid receptor (GR) in the peripheral blood mononuclear cells (PBMCs) can predict the clinical response to glucocorticoid (GC) in patients with pemphigus. Methods Reverse-transcription polymerase chain reaction (RT-PCR) was applied to determine the mRNA expression of GR? and GR? in PBMCs from 30 patients with pemphigus and 30 healthy volunteers. Results GR? mRNA was detected in all patients and all healthy volunteers, and the expression of GR? mRNA in pemphigus patients was significantly lower than that in healthy volunteers (P = 0.044), but no significant difference was found between patients insensitive and sensitive to glucocorticoid. In contrast, GR? mRNA was detected in 10 of 12 patients insensitive to glucocorticoid, 3 of 18 patients sensitive to glucocorticoid, and 9 of 30 healthy Volunteers. The positive rate of GR? in the insensitive group was significantly higher than that in the sensitive group (P

Objective:To evaluate the results of 25 cases of cervical spondylotic myelopathy treated by the bilateral backward displacement of lamina and expansion of the nerve root canalsince 1994. Method: Thepostopera tire and preoperative CT and MR imaging were used to compare the efficacy of backward displacement and decompression of the spinal cord. Result: According to the criteria for assessment set up by Dr Yin Huafu, the result was excellent in 13 cases, good in 8 and acceptable in 3; one case failed to get any improvement. Conclusion: This operation is a safe and an effective procedure for the treatment of the majority cases of cervical spondylotic myelopathy. In some cases this procedure should be done in combination with anterolateral decompression.

Objective To evaluate feasibility and reliability of using Simplified Acute Physiology Score Ⅱ (SAPS Ⅱ)in predicting mortality in critically ill patients with neurological diseases.Methods All 653 patients hospitalized in neurological intensive care unit (N-ICU) from Jan 2005 to Dec 2007 were retrospectively studied.SAPSⅡ scores were scaled upon admission at 24,48 and 72 h,and possibility of hospital mortality (PHM) was calculated based on SAPS Ⅱ score.Neurological diseases diagnosis made initially at time of hospitalization was classified into five categories:intracranial hemorrhage,cerebral infarction,neurologic infection,neuromuscular diseases and other neurologic diseases.At each of four time points,the SAPSⅡscores were compared between the survival group and death group,and the relationship of SAPS Ⅱ score and prognosis were analyzed.The calibration of the SAPS Ⅱ were accessed with the Hosmer-Lemeshow goodness-of-fit chi-squared statistic and the discrimination with area under the receiver operating characteristic curve (AUROC).Multivariate logistic regression was used to analyze the relationship between disease category and prognosis.Results SAPS Ⅱ scores in the death group (46.53±12.22,47.28±13.84,48.58±14.18 and 49.06±14.61)at each time point were significantly higher than those in the survival group (34.70±11.78,30.28±12.24,29.79±12.36 and 29.69±12.96;t=11.12,14.02,14.43 and 13.49 at 0,24,48 and 72 h,respectively,P＜0.01).Furthermore,univariate logistic regression analyses demonstrated that SAPS Ⅱ score was correlated with prognosis (OR=1.080,1.100,1.109,1.100 at 0,24,48 and 72 h,respectively,P＜0.01).The scores at 48 and 72 h were more accurate in predicting mortality.SAPS Ⅱ had good calibration at each time points (x2=5.305,7.557,6.369 and 8.540,P＞0.05),however,the consistency of expected mortality with observed mortality was satisfactory only at 48 and 72 h(82.6%,83.4%),so was the discrimination ( AUROC=0.825,0.847 respectively).There was no correlation between disease categories and outcome.Conclusion SAPS Ⅱ scoring,best evaluated at 48 and 72 h after hospitalization,can be used as a reliable predictor of probability of mortality in patients hospitalized in N-ICU and prediction can be applied in these patients with all different neurology diseases.

Background:Conventional gastrointestinal endoscopy is incapable of determining the deriving layers,size and nature of submucosal lesions,however,mini probe ultrasonography(MPS)is effective for mural stratification and determining the deriving layers and nature of lesions within gastrointestinal wall,and is considered to be an optimal examination for suspected submucosal tumors before endoscopic or surgical operation. Aims:To assess the diagnostic value of MPS for gastrointestinal submucosal lesions and the significance of MPS-assisted endoscopic therapy. Methods:A total of 69 patients with presumed gastrointestinal submucosal protruded lesions were retrospectively enrolled. All of them underwent MPS and then endoscopic therapy,such as cyst incision,high frequency electric snare resection,endoscopic mucosal resection and endoscopic submucosal dissection were performed according to the deriving layers,size and nature determined by MPS. The ultimate diagnosis was confirmed by histopathological examination. Results:In the 69 cases of lesions,MPS showed that 15 were derived from muscularis mucosa,40 from submucosa,and 14 from muscularis propria;10 of them were considered as cyst,18 were stromal tumor,8 were leiomyoma,6 were ectopic pancreas,15 were neuroendocrine tumor,and 12 were lipoma. Compared with pathological diagnosis,an overall coincidence rate of 91. 3%(63 / 69)was achieved by MPS. Conclusions:The accuracy rate of MPS is high for determining the deriving layers and nature of gastrointestinal submucosal protruded lesions prior to the attempting of endoscopic removal. It might be helpful for selecting treatment modalities for this kind of lesions.

Objetive To investigate physicians'knowledge regarding intravenous fibrinolytic therapy for acute ischemic stroke and whether their hospitals could meet the requirements for the therapy. Methods Questionnaires were mailed to 500 physicians from 153 hospitals in Shanxi including 112 secondary and 41 tertiary hospitals. 370 physicians returned valid questionnaires. Results One hundred thirty-four hospitals (87.6%) could provide 24-hour computed to?mography service, including 95 (84.8%) secondary hospitals and 39 (95.1%) tertiary hospitals. Alteplase stock was avail?able in 59 hospitals (38.6%), containing 25 (22.3%) secondary and 34 (82.9%) tertiary hospitals. Accuracy rates of 13 questions regarding intravenous fibrinolytic therapy for acute ischemic stroke ranged from 30.8% to 82.9%. Accuracy rates of 6 questions were lower than 50.0%. Conclusions The present study has revealed that physicians in this study have poor knowledge regarding the therapy. The situation can not meet the demand of healthcare, which partially ac?counts for the low rate in fibrinolytic therapy in Shanxi. Relevant training and suitable assessment should be carried out compulsively to ensure that physicians grasp necessary knowledge and skills.

Objective:To investigate the correlation between low-density lipoprotein cholesterol (LDL-C) and hemorrhagic transformation (HT) after intravenous thrombolysis in patients with acute ischemic stroke (AIS).Methods:Patients with AIS received intravenous thrombolysis using standard dose alteplase in the First Hospital of Shanxi Medical University from January 2014 to December 2019 were enrolled retrospectively. Head CT scan was performed within 24 h after thrombolytic therapy to identify the occurrence of HT. The demographic and baseline clinical data were compared between the HT group and the non-HT group. Multivariate logistic regression analysis was used to determine the correlation between LDL-C and HT after thrombolysis. Results:A total of 323 patients with AIS who received intravenous thrombolytic therapy were enrolled, their age was 65±12 years (range, 54-78 years), and 219 were males (67.8%). The median baseline National Institutes of Health Stroke Scale (NIHSS) score was 4 (interquartile range, 3-9). Ninety one patients (28.17%) developed HT, of which 8 (2.48%) had symptomatic intracerebral hemorrhage. Univariate analysis showed that there were significant differences in LDL-C, age, baseline NIHSS score, baseline systolic and diastolic blood pressure, baseline fibrin degradation products, and the proportion of patients with atrial fibrillation and stroke etiology between the HT group and the non-HT group (all P<0.05). Multivariate logistic regression analysis showed that lower LDL-C (odds ratio [ OR] 0.531, 95% confidence interval [ CI] 0.358-0.788; P=0.002), higher baseline NIHSS score ( OR 1.063, 95% CI 1.010-1.120; P=0.020) and higher baseline systolic blood pressure ( OR 1.015, 95 CI 1.004-1.026; P=0.008) were the independent risk factors for HT after intravenous thrombolysis in patients with AIS. Conclusions:Low LDL-C is an independent risk factor for HT in patients with AIS after intravenous thrombolysis. The patients with lower LDL-C should be cautious in lipid-lowering therapy and be alert to the occurrence of HT.

Objective To compare the effects between the impact of IL-7Rα,bacterial flagellin alone to the acute graft-versus-host disease and the combination of both,and to explore its possible mechanism.Methods The BALB/C (H-2d) female mice as recipients were divided into alone irradiation transplantation group (group A),IL-7Rα intervention group (group B),bacterial flagellin intervention group (group C),IL-7Rα combined with bacterial flagellin intervention group (group D),and 6 mice in each group.All mice were accepted 9 Gy 60Co total body irradiation,and 1×107 bone marrow cells and 2× 107 spleen cells of donors C57BL/6 (H-2b) mice were infused via the tail vein to recipient mice.The symptoms,signs,survival time and hematopoietic function recovery of the recipient mice were observed.Results Mice survival of group A was (22.5±2.30) d,30 d survival rate was 50.0 ％ (3/6),and aGVHD performances inculding the fatigue,anorexia,hair removal,arched,and so on appeared obviously.Survival of group B was (25.83±3.49) d,30 d survival rate was 33.3 ％ (2/6),aGVHD performances compared with group A was lighter.Survival of group C was (26.33±3.52) d,30 d survival rate was 33.3 ％ (2/6),also appeared aGVHD performance,which degree was same to the group B.survival of group D was (30.17±2.86) d,30 d survival rate was 66.7 ％ (4/6),aGVHD performances compared to the other three groups was lightest.The white blood cell count of four groups were reduced to minimum at +7 d,then the three intervention groups gradually recovered.The WBC recovery at 14,21,28,30 day after the transplant of group A compared with slowly was the intervention groups (P ＞ 0.05),WBC recovery of B was roughly equal to group C (P ＞ 0.05),while the WBC recovery of group D was faster than group B or C (P ＜ 0.05).At 2nd week after transplantation,CD3+ T cells was significantly decreased in 4 groups,and at 3rd week began gradually rised.Compared with group A,the proportion of CD3+ cells of other three groups were increased significantly,there was no statistical signifiance of CD3+ cell proportion between group B and group C at 2nd,3rd,4th week after transplantation (P ＞ 0.05),while the CD3+ T cell recovery in group D was faster than group B or C (P ＜ 0.05).Conclusions The stable aGVHD mouse model was established.Exogenous IL-7Rα and bacterial flagellin may reduce the incidence of aGVHD.There was no significant difference for aGVHD when they was used alone,but when combination of them,aGVHD is slighter and the hematopoietic recorery is faster.

Objective To evaluate the expression of WWOX gene in breast cancer and its relation to hypermethylation of WWOX gene CpG island. Methods The expression of WWOX protein was evaluated by immunohistochemical staining in breast cancer cell line and breast cancer tissues.Methylation specific PCR(MSP)was used to check whether it Was methylated in the promoter and exon 1 of WWOX.Results Deletion in the WWOX expression was observed more frequently in invasive breast tumors,(32.2%)than normal breasttissues(5.4%)(P＜0.01).20.3% of premenopause eases were completely negative for WWOX expression compared to 57.2% of postmenopause breast carcinomas(P＜0.01).Furthermore,23.1% of Stage Ⅰ(6/26),28.6%of Stage Ⅱ(10/35),46.2%of Stage Ⅲ(12/26)tunlors showed negative WWOX protein expression.In breast cancer specimens.methylation rate of promoter and exon 1 CpG island of WWOX gene was 55%and 45%respectively.Whereas.WWOX CpG islands of normal mammary tissues were completely unmethylated in all cases.CpG islands of WWOX promoter and exon 1 were methylated in MDA-MB-231 cell line but not MCF-7 cell.Conclusions Some deletion in WWOX expression is common in breast cancer and methylation of WWOX DNA CpG islands plays a crucial role in the silence of WWOX.WWOX may play a role in the carcinogenesis and development of breast cancer.

Objective To establish a mouse model of acute graft-versus-host disease (aGVHD) after allogeneic bone marrow transplantation,and using exogenous interleukin-7 receptor alpha (IL-7Rα) intervene mice aGVHD and analyse its possible mechanism.Methods The BALB/C (H-2d) female mice as recipients were grouped by rat: the irradiation group (group A),irradiation transplantation group (group B) and IL-7Rα in the intervention group (group C),each 10.ALL mice were accepted 9 Gy60Co total body irradiation.1×107 bone marrow cells and 2×107 spleen cells of donor C57BL/6 (H-2b) via the tail vein were infused to recipient mice.The signs of the recipient mice,hematopoietic functional recovery and survival time of change,and pathology,chimerism and cytokine levels in checkwere observed.Results Mice in A group after irradiation were gradually death,in group B and group C mice after transplantation had typical aGVHD symptoms,but lighter signs and a longer survival time of Group C than in group B.WBC count in Group C was +14 d (4.53± 0.21) ×109/L,+21 d (3.63±0.06) ×109/L,+28 d (4.31±0.04) ×109/L,was hematopoietic recovery compared with Group B [+14 d (1.81±0.05) ×109/L,+21 d (1.32±0.04) ×109/L,+28 d (1.76±0.04) ×109/L],the difference was statistically significant (t =0.237,0.108,0.359,P ＜ 0.05).The pathological results of liver,spleen,skin histopathology in group C were better than group B.Chimera implants,plasma IL-7 levels after transplant +7 d,concentration was significantly increased.IL-7 concentration in group C was +14 d (194.32±1.02) pg/ml,+21 d (131.63±1.54) pg/ml and in group B was +14 d (330.24±8.08) pg/ml,+21 d (184.09±2.05) pg/ml,the difference was statistically significant (t =1.590,1.285,P ＜0.05).Conclusion The stable aGVHD mouse model was established.In aGVHD early,plasma IL-7 levels were significantly increased.Exogenous IL-7Rαcan reduce the plasma IL-7 levels,thereby reducing the incidence of aGVHD after allogeneic bone marrow transplantation.

BACKGROUND: Smoking is an important cause of cardiovascular disease, its definite mechanism in inducing cardiovascular disease is still unclear, and whether there is linear correlation between the amount of cigarette smoking and cardiovascular risk still needs to be investigated.OBJECTIVE: To analyze the association between cigarette smoking and the severity of coronary atherosclerosis.DESIGN: A retrospective investigation and comparative study.SETTING: The First Affiliated Hospital of Nanjing Medical University.PARTICIPANTS: Totally 500 consecutive patients, who underwent coronary angiography for suspected or known coronary atherosclerosis, were selected from the First Affiliated Hospital of Nanjing Medical University from April 2004 to April 2005. The inclusive criteria included patients with history of chest pain and/or ischemic changes of electrocardiography (ECG), and those with suspected or known coronary artery disease by coronary angiography. Patients with spastic angina pectoris (acetylcholine-positive) were excluded. Patients with infectious processes within 2 weeks before catheterization, heart failure (Killip Class≥ 2 after acute myocardial infarction), hepatic dysfunction, vascular disease (aortitis should be treated with prednisolone), familial hypercholesterolemia, thyroid dysfunction, or adrenal dysfunction were also excluded. There were 370 males aged 42-76years with an average of (61±11) years and 130 females aged 45-75 years with an average of (61±12) years. There were no significant differences in the sex, age and general information among all the patients. This study was approved by the ethics committee of the First Affiliated Hospital of Nanjing Medical University and informed consent was obtained from each patient.METHODS: ① According to the smoking habit, 500 patients with suspected or known coronary artery disease were divided into smoking group (n=254) and non-smoking group (n=246). ② All the patients received anthropometric measurements including body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressure (DBP). Blood samples were drawn from every patient at admission to the detect the leukocyte counts in peripheral blood, including total leukocyte count, neutrophil count, eosinophil count, lymphocyte count, monocyte count and basophil count. ③ The severity of coronary atherosclerosis was defined by the Gensini score system, based on the hypothesis that the severity of coronary artery disease should be considered as a consequence of the functional significance of the vascular narrowing and the extent of the area perfused by the involved vessel or vessels. In this scoring system, a greater reduction of the lumen diameter was assigned a higher score than a distal lesion. ④The association of smoking amount with Gensini score, anthropometric measurements and leukocyte count were studies with the Spearman correlation analysis.MAIN OUTCOME MEASURES: ① Results of BMI, SBP, DBP, leukocyte count and Gensini score; ② Results of the Spearman correlation analysis on the association of smoking amount with Gensini score, anthropometric measurements and leukocyte count.RESULTS: ① The total leukocyte count, neutrophil count, monocyte count in peripheral blood and Gensini score were significantly higher in the smoking group than in the non-smoking group.② The Spearman correlation analysis indicated that the amount of cigarette smoking was significantly associated with the total cigarettes smoked, total leukocyte count,neutrophil count, monocyte count and Gensini score (r=0.109, 0.100,0.135, 0.139, P ＜ 0.05-0.01).CONCLUSION: Smoking is significantly associated with the severity of coronary atherosclerosis, and the inflammatory response may be part of the mechanisms underlying the association between coronary artery disease and cigarette smoking.