Objective To investigate the protective effect of Limb ischemic postconditioning ( LIPostC) on blood brain barrier (BBB) and explore the influence on the the expression of tight junction protein claudin-5,occludin in cerebral ischemia-reperfusion injury of mice.Methods Ninety male CD1 mice were divided into three groups randomly:Sham-operated group(sham group), ischemia-reperfusion group(I/R group) and LIPostC group.Mouse middle cerebral artery cerebral ischemia-reperfusion model was established by modified-occlusion method. Neurological deficit scores, brain water content, infarct volume, BBB dysfunction were measured at 24 h after reperfusion.Western blot and RT-qPCR were used to analyze the expressions of claudin-5, occludin.Results Compared with I/R group, neurological deficits scores were significantly decreased, brain edema was relieved, infarct volume was reduced, and the expression of claudin-5, occludin up-regulated, the differences were statistically significant(all P<0.05).Conclusion LIPostC can protect the BBB of cerebral ischemia-reperfusion injury mice by increasing the expression of claudin-5,occludin, and that will provide a theoretical basis for its clinical application.

Objective To observe the effect of Hawthorn Jiangzhi powder on blood lipids in hyperlipidemia patients.Methods Four hundreds and eighty-four patients with hyperlipidemia were selected from Department of Cardiology in Huanghuai University Affiliated Hospital from January 2011 to June 2016,and they were divided into observation group and control group by random number table,each group 242 cases.The observation group took orally Hawthorn Jiangzhi powder (including ingredients:hawthorn 6 g,salvia miltiorrhiza 18 g,black soybean 16 g,hoelen 6 g,ganoderma lucidum 9 g,kudzuvine root 6 g,Chinese yam 6 g,fructus amomum 9 g,coix seed 16 g,cassia seed 6 g) once 6-9 g powder,twice a day,once in the morning and another in the evening;the control group was given simvastatin,20 mg each day during taking dinner;the therapeutic period lasted 2 months in both groups.The differences in serum lipid and serum inflammatory factor levels were compared before and after treatment in the two groups;the changes of lymphocyte subsets of the two groups were observed and compared with the changes of the subset results of 100 normal healthy subjects aged 35-80 years old in the same period in our hospital,and the total efficiency,the situations of adverse reactions and liver and kidney functions of two groups were observed.Results In the observation group and the control group,before treatment the levels of CD4+,CD8+,CD4+/CD8+ were lower than those of healthy control group,but after treatment the levels of CD4+,CD8+ and CD4+/CD8+ were higher than those before treatment,and the changes of the observation group were more significant than those of the control group(CD4+:0.47±0.11 vs.0.40±0.10,CD8+:0.28 ± 0.10 vs.0.26 ± 0.08,CD4+/CD8+:1.67 ± 0.79 vs.1.53 ± 0.45);After treatment,the levels of hypersensitive C-reactive protein (hs-CRP),interleukin-6 (IL-6),von Willebrand factor (vWF) and homocysteine (Hcy) in the two groups were significantly lower than those before treatment,and the levels of hs-CRP,IL-6 and vWF in the observation group were obviously lower than those in the control group [hs-CRP (mg/L):5.1 ± 1.8 vs.5.8 ± 1.7,IL-6 (ng/L):2.9 ± 1.6 vs.3.7 ± 1.8,vWF:(126.8 ± 12.8)％ vs.(156.5 ± 11.3)％,all P ＜ 0.05].After treatment,Hcy in the observation group was lower than that in the control group,but there was no significant difference between the two groups (μμmol/L:5.2 ± 1.8 vs.5.4 ± 2.6,P ＞ 0.05).In the observation group after treatment at each time point,the levels of total cholesterol (TC),triglyceride (TG) and low density lipoprotein cholesterol (LDL-C) were lower than those before treatment,while the levels of high density lipoprotein cholesterol (HDL-C) and high density lipoprotein cholesterol/total cholesterol (HDL/TC) were higher than those before treatment;after treatment in the control group,the levels of TC,TG and LDL-C were decreased,and the levels of HDL-C and HDL/TC were obviously increased compared with those before treatment;The levels of TC,TG and LDL-C in the observation group after treatment for 2 months were significantly lower than those in the control group [TC (mmol/L):1.26 ± 0.57 vs.2.26 ± 0.56;TG (mmol/L):3.45 ± 0.78 vs.5.45 ± 0.75,LDL-C (mmol/L):2.40±0.65 vs.2.72±0.85;all P ＜ 0.05),and HDL/TC was obviously increased (1.19±0.15 vs.0.62±0.35,P ＜ 0.01).The total therapeutic effective rate of the observation group was significantly higher than that of the control group [90.1％ (218/242) vs.73.4％ (178/242),P ＜ 0.01].Adverse reactions and changes of liver and kidney functions during the period of treatment in the two groups were minimal.Conclusions Hawthorn Jiangzhi powder can effectively reduce the blood lipids and serum inflammation cytokines in patients with hyperlipidemia,improve blood rheological situation,reduce serum levels of inflammatory factors,inhibit the formation and development of atherosclerosis and enhance the immune function obviously in patients with high lipid abnormalities.

Objective To investigate the relationship between the polymorphisms of plasminogen activator inhibitor-1(PAI-1)gene and the level of endothelium-dependent vasodilatation (EDF) in patients with type 2 diabe- tes(T2DM).Methods The polymorphisms of PAI-1(4G/5G)gene were determined by polymerase chain reaction (PCR)and the EDF was assessed by non-invasive hish resolution B-mode ultrasonography in 66 T2DM patients and 33 controls.Plasma plasminogen activator inhibitor type-1(PAI-1)and fibrinogen(Fg)were measured.Results Frequencies of PAI-1 alleles and genotypes in T2DM patients and controls were all in accordance with the Hardy Weinberge quilibrium,without significant differences between T2DM patients and controls(P>0.05).PAI-1 and Fg were significantly higher in T2DM patients than in controls.There were significant differences in EDF and PAI- lamong different genotypes of PAI-1(P<0.05).Conclusion The PAI-1 genotype may affect EDF in T2DM pa- tients.

Objective To investigate the diagnosis and treatment value of laparoscopic surgery in tubal obstruction infertility patients with endometriosis.Methods Retrospective analysis was done in 381 cases underwent laparoscopic treatment for tubal obstruction from May 2005 to May 2010,,of which 119 cases were combined with endometriosis.The treatment results were analyzed,including the decomposition of the umbrella side tubal obstruction adhesions,lesions of endometriosis electrocoagulation,endometriosis cystectomy and pregnancy and so on.Results Hysterosalpingography(HSG)showed tubal occlusion in both side or one side in the distal end in 381 cases,and these patients were treated with laparoscopic surgery.There were 262 cases showed distal tubal occlusion not companied with endometriosis,of which 82 cases clinically pregnanced,accounting for 31.3％.Surgical treatment of endometriosis found in 119 cases,accounting for 31.2％ ; and 29 cases pregnaced,which accounted 24.4％.We found 42 cases of tubal adhesions grade Ⅰ-Ⅱ and endometriosis stage Ⅰ-Ⅱ,16 cases of clinical pregnancy,accounting for 38.1％ ;Twenty-six cases of tubal adhesions grade Ⅰ-Ⅱ and endometriosis stage Ⅰ-Ⅱ,7 cases of clinical pregnancy,accounting for 26.9％ ;Twenty-eitht cases of tubal adhesions grade Ⅲ-Ⅳ and endometriosis stage Ⅰ-Ⅱ,4 cases of clinical pregnancy,accounting for 14.3％ ;Twenty-three cases of tubal adhesions grade Ⅲ-Ⅳ and endometriosis stage Ⅲ-Ⅳ,2 cases of clinical pregnancy,accounting for 8.7％.The clinical pregnancy rate in the first group was significantly higher than the other groups,chnical pregnancy rate of the last group was the lowest.Conclusion Laparoscopic surgery is an effective treatment of tubal obstruction infertility combined with endometriosis.After laparoscopic surgery,the clinical pregnancy rate is significantly higher in Tubal obstruction without endometriosis than patients with endometriosis.After surgery,the clinical pregnancy rate in patients with the light stage tubal adhesions and endometriosis is better than those severely.

Objective:To explore the relationship between the lipid accumulation product index (LAP) and the risk of carotid atherosclerosis in different gender groups.Methods:The data of 2 740 employees of Dalian municipal government and institutions, including 1 583 males and 1 157 females, who had underwent physical examination in Dalian Municipal Central Hospital Affiliated of Dalian Medical University from January to June 2018 were analyzed retrospectively. The general data, laboratory indexes and carotid ultrasound data of the population were collected, and the body mass index (BMI) and LAP value were calculated. According to carotid intima-media thickness (IMT), the subjects were divided into carotid atherosclerosis group (IMT ≥ 1.0 mm) and carotid normal group (IMT<1.0 mm). The clinical indicators between the two groups were compared. Independent risk factors for carotid atherosclerosis were analyzed by binary Logistic regression, and the cutoff point for predicting carotid atherosclerosis by LAP was calculated by receiver operating characteristic (ROC) curve.Results:The age, waist circumference (WC), hip circumference (HC), LAP, BMI, total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), fasting plasma glucose (FPG), systemic blood pressure (SBP), diastolic blood pressure (DBP) and the prevalence of hypertension and diabetes in the male and female population carotid atherosclerosis groups were significantly higher than those in the normal group ( P<0.05). The results of binary Logistic regression analysis showed that after adjusting age, BMI, HC, WC, smoking, drinking, hypertension, diabetes, TC and LDL-C, the risk of carotid arteriosclerosis still increased 1.316 times with each quartile interval of LAP in women ( OR= 1.316, 95% CI 1.063 to 1.629, P = 0.012). In men, after adjusting for these factors, the independent effect of LAP on the risk of carotid atherosclerosis disappeared. In women, the area under curve (AUC) of LAP in predicting carotid atherosclerosis was 0.713, significantly higher than that of BMI (AUC 0.614) and WC (AUC 0.654), and the differences were statistically significant ( P<0.05). But there was no significant difference among the three indexes in the male population in predicting carotid atherosclerosis. According to ROC curve, the best cut-off value of LAP for predicting carotid atherosclerosis was 32.13 cm·mmol/L in men and 33.70 cm·mmol/L in women. Conclusions:LAP is an independent risk factor for carotid atherosclerosis in female population, and its predictive ability for carotid atherosclerosis is higher than that of body mass index and waist circumference. LAP ≥ 33.70 cm·mmol/L can be used as the best cut-off value for screening carotid atherosclerosis in female population.

Plasma plasminogen activator inhibitor 1 (PAI-1) antigen level in 204 patients with type 2 diabetes mellitus (DM) was higher than that in 60 healthy subjects (P

Objective:To evaluate the outcome and prognostic factors of conventional radiotherapy followed by intensity-modulated radiation therapy (IMRT) as a boost combined with chemotherapy in the treatment of high-grade gliomas (HGG). Methods:From Nov. 2004 to Nov. 2006, 112 HGG patients were treated with conventional radiotherapy followed by IMRT as a boost combined with chemotherapy. The radiotherapy regimen included first-course conventional radiotherapy and latE-course IMRT as a boost with the total radiation dosage of 57.5- 62.5Gy (27-29 fractions in 37-45 days). All the patients received chemotherapy. Sixty-three patients received temozolomidE-based chemotherapy and 49 patients received semustine plus teniposide chemotherapy. The treatment reaction was recorded. The overall survival rate and local progression-free survival rate were calculated. The prognostic factors were analyzed by using multivariate COX regression model. Results:The acute treatment toxicity was the most at grade 1 to grade 2 and no grade 4 adverse reaction was observed. Three cases had late radiation-induced brain necrosis. The overall 1-, 2-, and 3-year survival rates were 78.9%, 54.7%, and 30.8%, respectively. Multivariate analysis revealed that tumor location (P=0.001) and KPS score (P=0.011) were independent prognostic factors. The 1-, 2-, 3-year local progression-free survival rates were 63.8%, 38.9%, and 10.5%, respectively. Multivariate analysis revealed that tumor location (P=0.001), KPS score (P=0.001), and histologic type (P=0.005) were independent prognostic factors. Multivariate analysis did not reveal the significant correlation of temozolomide chemotherapy with the prognosis of the patients. Conclusion:Postoperative conventional radiotherapy followed by IMRT as a boost combined with chemotherapy has better short-term efficacy in the treatment of HGG and the adverse reaction is tolerable. KPS score, tumor location, and histologic type are important prognostic factors. Temozolomide chemotherapy is not associated with the prognosis of patients.

Objective To observe the outcomes of fast track surgery program applied in thoracoscopic/laparoscopic esophagectomy.Methods From March 2010 to December 2012,99 esophagus cancer patients were randomly allocated to receive thoracoscopic/laparoscopic esophagectomy[minimally invasive esophagectomy (MIE) group,50 cases] and open esophagectomy [open esophagectomy (OE) group,49 cases].Same fast track surgery program was applied in both groups.Perioperative data of all patients were collected and analysized.Results The baseline of both groups was similar.Compared with OE group,MIE group got more abdominal lymph nodes resection,13(6-40) vs.4(0-20),P ＜0.05.In both groups,the level of the total albumin,hemoglobin and total cholesterol in the 8th postoperative day was higher than that of the 1 st postoperative day,P ＜0.05.Statistical difference was observed in the 48 h patient controlled analgesia usage,24 h and 48h visual analogue scales score of motion and less motion,postoperative creatine kinase level,the white cell count and C-reaction protein level in the 8th postoperative day,of which the MIE group got better results,P ＜ 0.05.Patients in MIE group took less time to begin oral nutrition (6 days vs.9 days P ＜ 0.05),besides,the parenteral nutrition duration [(7.9 ± 2.4) days vs.(8.6 ± 2.9)days,P ＜ 0.05] and postoperative hospital stay [(12.5 ± 3.1) days vs.(17.1 ± 6.3) days,P ＜ 0.05] were also shorter,P ＜0.05.Conclusion Fast track surgery program is safe and feasible for patients receiving esophagectomy.MIE combined with fast track surgery program can promote early rehabilitation by easing pain,reducing inflammatory response,improving nutrition state,lowering postoperative morbidity,shortening hospital stays,and as a result,have more obviously advantages.

Objective:To study of change of Th17 cell and IL-17 caused by bacteria biofilm after infection.Methods: To detect biofilm formation ability of bacteria isolated from bronchus alveolus washing-water of patients;to detect expressing ratios of Th17 cells and IL-17 level in peripheral blood of patients and healthy person;to detect expressing ratios of Th17 cells and IL-17 level in bronchus alveolus washing-water of patients;to analyze the above data using SPSS17.0 software.Results: Expressing ratios of Th17 cells and IL-17 level in peripheral blood of patients infected by producing biofilm and non-producing biofilm bacteria and healthy person are respectively(0.59±0.18)%and(108.8±20.5)pg/ml,(0.58±0.18)%and(100.1±20.7)pg/ml,(0.55±0.17)% and(100.0± 21.4)pg/ml,they were not different among data from patients and healthy person,P>0.05,expressing ratios of Th17 cells and IL-17 level in bronchus alveolus washing-water of patients infected by producing biofilm and non-producing biofilm bacteria were respective (1.37±0.34)%,(157.4±30.8)pg/ml and(1.11±0.21)%,(136.2±24.3)mg/ml,the data between patients infected by producing biofilm and non-producing biofilm bacteria were distinctly different, P<0.05.Conclusion: Bacteria biofilm can cause Th17 cell expressing ratio and IL-17 level to become high in infected part,this may be mechanism that infection become chronic.

Objective To analyze the early outcomes of the Sun' s procedure,which is an approach integrating total arch replacement using a 4-branched graft with implantation of a special stented graft in the descending aorta,and observe the mortality,morbidity and mid-term clinical results of postoperative in patients with acute type A aortic dissection (AAAD).Methods Clinical data of 61 consecutive AAAD patients undergoing the Sun' s procedure were analyzed.There were 53 male and 8 female,aged (54 ± 12) years.61 patients had postoperative follow-up and the clinical effect of Sun' s procedure were retrospectively analyzed.Results Cardiopulmonary bypass time was (229 ± 46) min,aortic clamping time was (147 ± 37) min and unilateral selective cerebral perfusion time was (35 ± 9) min.Reoperation for excessive bleeding in 5 cases (8.2％),acute renal failure in 3(4.9％),tracheotomy patients for pulmonary infection in 3(4.9％),and spinal cord injury in 2 (3.3％),delayed thoracic incision healing in 1 (1.6％),and osteofascial compartment syndrome of the right lower limb in 1 (1.6％).The 30 day mortality is 8.2％,and the leading causes was low cardiac output syndrome in 2(3.3％),multi-organ failure in 1 (1.6％),pulmonary infection in 1 (1.6％) and ruptured of abdominal aortic dissection in 1 (1.6％).The average follow-up time is(5.1 ± 0.7) years.Postoperative 1 year survival rate was 91.8％,5 year survival rate was 83.6％.Conclusion The Sun' s procedure has generated a relatively lower mortality rate in 61 patients with AAAD.Postoperative survival rate is high,and the reoperation rate is low.