Objective To investigate the best time to establish the enteral nutrition (EN) in elderly patients with se?vere craniocerebral diseases. Methods Eighty-one elderly patients were divided into groups A, B and C. The EN support were given 24 h, 25-48 h, and 49-72 h after surgery. Changes of serum biochemical indexes, complications and GCS score were detected and statistical analysed. Results The serum levels of albumin and hemoglobin were significantly increased in group B than those of group A and group C. The total number of lymphocytes was significantly higher in group A and group B than that of group C (P<0.05). The amount of diarrhea was significantly fewer 7-day after operation in group B than that of group A (3.6%vs 26.9%). The amount of stress ulcer was significantly fewer in group B than that of group C (0 vs 22.2%). The amounts of lung infections (10.7%vs 38.5%) and stress ulcer (3.6%vs 25.9%) were significantly fewer 14-day after oper?ation in group B than those of group A. The scores of GCS were significantly higher 14-day after operation in group B than those of group A and group C (10.2±1.3 vs 9.5±1.2 vs 9.4±1.2, P<0.05). Conclusion The establishment of EN support 25 to 48 hours after surgery may meet the need of nutritional and metabolic support, reduce complications, be conducive to the consciousness recovery in elderly patients with severe craniocerebral diseases.

Objective To investigate the level of urinary TGF-β1 and evaluate its clinical significance in patients with chronic nephritis.Methods 22 healthy people and 40 patients with chronic nephritis were selected,the levels of urinary TGF-β1 were measured by RT-PCR and ELISA.Results Urinary TGF-β1 were significantly increased in Mesangial Proliferative Glomerulonephritis (76.44± 24.29 ng/mmol.Cr vs 31.53 ± 11.59 ng/mmol.Cr,P<0.01);Focal Glomerular Sclerosis (65.07±20.59 ng/mmol.Cr vs 31.53±11.59 ng/mmol.Cr,P<0.01)and IgA Nephritis (67.01±21.95 ng/mmol.Cr vs 31.53±11.59 ng/mmol.Cr,P<0.01),comparing with normal group.Conclusion The levels of urinary TGF-β1 could be a predictor in reflecting the sate of renal diease,estimating pathological type,diagnosing the renal diease and observing the therapeutic effects.

Objective To compare the clinical efficacy and safety of esomeprazole in treatment of elderly and young patients with gastric ulcer.Methods 120 cases of elderly patients with gastric ulcer and 95 cases of young and middle-aged patients with gastric ulcer were selected this study.Two groups of patients were treated with amoxicillin and clavulanate potassium dispersible tablets 0.457 g,tinidazole tablets 0.5 g and esomeprazole magnesium enteric coated tablets 20mg orally,once daily treatment 1 week for a course of treatment,1 week after continue to every morn-ing fasting taking esomeprazole 20mg,1 times/D,treatment for 3weeks.The clinical curative effect,Hp clearance rate and incidence of adverse reactions between two groups of patients after treatment were compared.Results The total effective rate in the treatment of elderly group patients (87.50%)compared with young and middle -aged group (92.63%),there was no significant difference (χ2 =1.52,P>1.52).Elderly group of patients with helicobacter pylori clearance rate (71.67%)compared with young and middle-aged group (76.84%),there was no significant difference (χ2 =0.74,P>0.74).The incidence of adverse reactions (8.33%)of elderly group had obvious differ-ences by comparing with young and middle -aged group (2.1 1%),and the difference was statistically significant (χ2 =3.90,P<0.05).Conclusion Application of esomeprazole based triple therapy in the treatment of the elderly and young people in the gastric ulcer could heal ulcers and eradicate Hp,but young and middle -aged patients is superior to the elderly group in terms of adverse reactions.

Objective To analyze the safety and effectiveness of using lumbar drainage (LD) in patients with subarachnoid hemorrhage (SAH).Methods Data from 44 patients with SAH were collected.Of these patients,the LDs group consisting 19 patients in whom a lumbar drain had been placed for cerebro-spinal fluid (CSF) drainage,whereas the control group was composed of 25 patients who received no form of CSF drainage or treated solely with an external ventricular drainage (EVD).Incidence of new cerebral infarction of the two groups was measured on sequential CT and complications of LDs group.Results This retrospective review demonstrated a statistically significant beneficial effect in LDs group on CT,reducing the incidence from 32％ to 5％.A similar degree of benefit was observed in two group patients with hydrocephalus.Complications with lumbar drains were rare and yielded no permanent sequelae.Conclusion With rare complications and definite safety,LDs are effective to reduce vasospastic cerebral infarction of SAH patients when appropriate patient selection and good technique are employed.

Objective To investigate the correlation between serum C-reactive protein (CRP) level and carotid atherosclerotic plaque calcification in patients with ischemic stroke or transient ischemic attack (TIA).Methods The patients with non-cardiogenic ischemic stroke or TIA in anterior circulation performed head and neck vascular CTA at 1-6 months from the time of onset were enrolled prospectively.The demographic and clinical data were collected and serum CRP levels were detected.Univariate and multivariate logistic regression analyses were used to determine the correlation between the serum CRP level and the carotid atherosclerotic plaque calcification.Results A total of 165 patients were enrolled.Their age was 62.4± 10.6years,male patients accotnted for 66.7％;113 patients (68.5％)had carotid atherosclerotic plaque calcification (calcification group),52 (31.5％) did not have carotid atherosclerotic plaque calcification (non-calcification group).The age of the calcification group (median,interquartlle;66 [58-73] years vs.58 [51-66] years;Z=-3.738,P＜0.001) and CRP levels (1.9 [0.5-3.8] mg/L vs.0.0 [0.0-2.2] mg/L;Z =-4.126,P ＜ 0.001) were significantly higher than those of the non-calcification group.There were no significant differences in other baseline clinical data between the two groups.Multivariate logistic regression analysis showed that age (odds ratio 1.063,95％ confidence interval 1.024-1.104;P =0.001) and CRP levels (odds ratio 1.209,95％ confidence interval 1.030-1.419;P=0.020) were still significantly correlated with the plaque calcification after adjusting for other confounding factors.Conclucions Carotid plaque calcification was correlated with older age and increased serum CRP level in patients with ischemic stroke or TIA.

Objective:To validate the predictive function of Field Assessment Stroke Triage for Emergency Destination (FAST-ED) score on large vessel occlusion (LVO) in Chinese population.Methods:The information about the patients who had the disease onset within 24 hours, were treated in the Emergency Department of Jinling Hospital, and diagnosed as ‘acute ischemic stroke’ was collected. Via the emergent brain computed tomography angiography or digital subtraction angiography, the patients were divided into LVO group and non-LVO group. The scores of FAST-ED were calculated according to the National Institutes of Health Stroke Scale (NIHSS) scores and compared with Rapid Arterial oCclusion Evaluation (RACE), 3-item Stroke Scale (3I-SS), Cincinnati Stroke Triage Assessment Tool (C-STAT), and Prehospital Acute Stroke Scale (PASS) scores. Moreover, the patients were further divided into anterior and posterior circulation lesion groups to explore whether the FAST-ED scale can differ the anterior or posterior circulation effectively.Results:Three hundred and eighty-one patients were eventually included, among whom 284 were diagnosed as LVO, and 97 were diagnosed as non-LVO. Receiver operating characteristic curves showed that cut-off value of 4 optimized the scale (sensitivity: 0.76, specificity: 0.69, area under the curve: 0.78). The area under the curve of FAST-ED score(0.78) showed no statistically significant difference with NIHSS (0.79), RACE (0.77), 3I-SS (0.78) and C-STAT scores (0.75), and exhibited statistically significant difference with PASS score (0.74; 95% CI 0.69-0.78, P=0.01). FAST-ED score showed no statistically significant difference in predicting anterior and posterior circulation lesions. Conclusions:FAST-ED score can predict LVO in a rather accurate manner. It can predict anterior and posterior circulation lesions with similar effectiveness. So FAST-ED is able to be a prehospital screening tool and make assistance to the prehospital treatment.

Objective To investigate the protective role of human serum albumin in treatment of monocyte-inducible C-type lectin (Mincle)-associated neuroinflammation in subarachnoid hemorrhage (SAH) rats and its underlying mechanisms.Methods Vascular perforation model was used to induce SAH.Ninety-two male SD rats were randomly assigned to sham (n =23),vehicle (n =23),low-dose albumin (0.63 g/kg,n =23) and high-dose albumin (1.25 g/kg,n =23) groups.Saline and albumin were intravenously injected into rats two hours after surgery.Modified Garcia scale was employed to assess neurological functions.Iba-1 and myeloperoxidase (MPO) staining was used to examine the activation of microglial cells and infiltration of neutrophils.Real-time PCR was applied to determine the changes of IL-1β,inducible nitric oxide synthase,CD11b,monocyte chemoattractant protein-1,cytokine-induced neutrophil chemoattractant-1 and CXC motif chemokine ligand-2 mRNA levels.Co-immunoprecipitation was conducted to assess the binding ability of albumin with Mincle.Immunoblotting was carried out to evaluate protein levels of Minlce,Syk and p-Syk.SAH severity measurement was performed before conductions of all the experiments.Results SAH severity scores were 11.4 ± 1.6,12.8 ±2.5 and 11.2 ±3.2 in the vehicle,low-dose albumin and high-dose albumin groups,respectively,without statistically significant difference among groups (F =0.694,P =0.516).Neurological score was 7.5 ± 2.9 in the vehicle group,while the low-dose albumin (14.6 ± 2.2) and high-dose albumin groups (13.6 ± 2.7) exhibited better neurological perfomance (P ＜ 0.01).Immunostaining showed that albumin significantly inhibited the activation of microglia,and reduced the percentage of MPO positive cells from 20.7％ ± 1.9％ in the vehicle group to 12.1％ ±2.1％ in the low-dose albumin group and 9.8％ ±0.9％ in the high-dose albunin group (F =32.216,P =0.001).mRNA levels of pro-inflammatory cytokines and chemotactic factors were also suppressed by albumin (P ＜ 0.05).The results of co-immunoprecipitation displayed that albumin could directly bind Mincle and disrupt the association between Mincle and SAP130.Immunoblotting demonstrated that albumin depressed the protein levels of Mincle,Syk and p-Syk.Conclusion Human serum albumin can inhibit Mincle/Syk-induced neuroinflammation via directly binding Mincle receptor in SAH rats.

Objective:To discuss the clinical characteristics,diagnosis and treatment experience of a case of lateral ectopic thyroid.Methods:The patient with lateral ectopic thyroid was diagnosed by thyroid color ultrasound and single-photon emission computed tomography(SPECT)-CT examination.The right thyroidectomy and the thyroid tissue in cervical section Ⅳ of the patient were removed by received the operation.The pathological examination after operation was performed.The daily usage of euthyrox after operation was 50 μg.Results:The patient recovered well,who accepted 10 months follow-up with normal life and stable condition,and had no recurrence and metastasis.Conclusion:The mechanism of lateral ectopic thyroidy is not clear yet,the surgical treatment can result in good effectiveness and better prognosis.

Objective To study the effect and mechanisms of TW-37 on cell proliferation,apoptosis,invasion and angiogenesis in pancreatic cancer cells in vitro and further explore the potential mechanism.Methods BxPC3 and HPAC cells were pretreated with TW-37 using untransfected or transfected with NF-κB p65 cDNA(p65 cDNA)or NF-κB p65 siRNA(siRNA-p65)cells as controls.Cell viability was determined by MrTT assay.Cell apoptosis was assessed by enzyme-linked immunosorbent assay (ELISA).Cell invasion and angiogenesis was detected by Transwell and endothelial tube formation assay of HUVECs.ELISA assay was used to measure the activity of NF-κB,and its target proteins of MMP-9 and VEGF were detected by western blot.Results TW-37 suppressed cell growth and induced apoptosis (A405:1.29 ± 0.21 vs 0.09 ± 0.01,1.07 s0.18 vs 0.08 ± 0.01),inhibited NF-κB activity and protein expression of NF-κB p65,VEGF and MMP-9(all P ＜0.05)in a dose-and time-dependent manner.The number of cells that invaded across the matrigel in the transwell chamber was (46.7 ±5.24) and (10.3 ± 1.26)/×200 in BxPC3 control and 0.75 μmol/L TW-37 group (P=0.001).The number of tube formation was (39.4 ±4.36) and (7.84 ± 1.25)/×200,(P =0.001).NF-κB activity was increased by p65 cDNA transfection,and decreased by TW-37 treatment in both of the two cell lines (P ＜0.05).However,NF-κB activity was decreased by p65 siRNA transfection,and greatly decreased by TW-37 treatment in both two cell lines (P ＜0.05 or P ＜0.01).Transfection of p65 cDNA did not significantly affect cell apoptosis.Transfection of p65 siRNA increased cell apoptosis,and greatly increased by TW-37 treatment in both two cell lines (all P ＜ 0.01).Conclusions TW-37 could inhibit the proliferation,invasion and angiogenesis in pancreatic cancer cells by regulating NF-κB signal pathway.

Objective The expression and neuroprotective effect of meteorin in neurons and astrocytes after cerebral infarc-tion have yet to be clarified.This study was to investigate the expression and location of meteorin in the rat model of middle cerebral ar -tery occlusion (MCAO) and its neuroprotective effect against oxygen -glucose deprivation (OGD)-induced injury in cultured neurons or astrocytes. Methods Forty-two healthy adult male SD rats were randomly divided into 6 groups of equal number:sham operation and 6 h, 12 h, 24 h, 3 d, and 7 d MCAO.The cortical tissue was harvested for determination of the expression and location of meteorin by Western blot and immunohistochemistry as well as the meteorin expression in the neurons and astrocytes subjected to OGD. The neuroprotective effect of meteorin on the neurons and astrocytes was e-valuated by CCK8 and PI/Hoechst33342 staining. Results Com-pared with the sham operation group, the expression of meteorin was decreased after MCAO and reached the lowest level at 3 days ( P<0.01) , mainly in the neurons and astrocytes.Exogenous meteorin helped the survival of the astrocytes subjected to OGD, with the A value decreased in the groups of OGD ( 0.63 ) , OGD +meteorin
(0.78), and OGD+PBS (0.60) as compared with the sham control ( 1.51) (P<0.01), with no statistically significant differences among the former three groups (P>0.05).Concerning the effect of meteorin intervention on the OGD-induced injury of the astrocytes, the A value was significantly reduced in OGD (1.24 ±0.17), OGD+meteorin (1.51 ±0.30), and OGD+PBS (1.23 ±0.16) in comparison with the sham control (2.43 ±0.12) (P<0.01), lower in the OGD and OGD+PBS groups than in the OGD+meteorin group ( P<0.05) . Conclusion Meteorin is mainly expressed in the neurons and astrocytes after MCAO and it promotes the survival of the astrocytes with OGD-induced injury.