Objective To explore the CT perfusion imaging with acetazolamide (ACZ) challenge test in the diagnosis of chronic cerebral insufficiency.Methods 100 patients undergoing health examination in our hospital from Aug 2009 to Feb 2011 were chosen,52 patients diagnosed as chronic cerebral insufficiency were defined as the case group,and the remaining 48 cases of healthy elderly people were defined as the control group.The brain CT perfusion imaging with acetazolamide challenge test,and the cerebral blood flow (CBF),cerebral blood volume (CBV),mean transit time (MTT) and time to peak (TTP) in anterior cerebral artery (ACA),middle cerebral artery (MCA)cortical branch supply area,MCA deep perforator region,posterior cerebral artery (PCA) and pons part blood supply area were examined in the elderly people of two groups.Results CBV and CBF values in ACA,MCA cortical branch supplyarea,MCA deep perforator region,PCA and pons part blood supply area after ACZ stimulation were significantly lower in case group than the control group (t=3.57,3.39,9.34,11.04,4.21,5.99,9.91,11.10,6.66,9.97,P＜0.01 or 0.001),while MTT and TTP values were significantly higher in case group than in the control group (t =7.21,6.94,16.53,4.82,11.67,6.46,6.11,6.71,6.87,4.82,all P＜ 0.001),CBV and CBF values in the control group were significantly higher after ACZ excitation than before the challenge (t=6.44,6.86,9.72,10.99,7.03,6.33,12.48,14.82,8.98,12.03,all P＜0.001),and the MTT and TTP values in the control group were significantly lower after ACZ excitation than before the challenge (t=7.98,5.77,17.29,8.28,9.74,7.01,7.52,6.32,6.01,5.54,all P＜0.001).Conclusions CT perfusion imaging with acetazolamide challenge test can increase the detection rate of chronic cerebral insufficiency with better clinical significance,and is worthy of promotion.

Objective To investigate the changes of CT perfusion (CTP) imaging and the risk factors for CTP abnormality in patients with transient ischemic attack (TIA).Methods TIA patients were enrolled; CTP and CT angiography were performed.The parameter values of cerebral blood flow (CBF),cerebral blood volume (CBV),mean transit time (MTT),and time to peak (TTP) were obtained.CTP abnormalities were identified by comparing the contralateral mirror area.Demography and baseline clinical data were compared in a CTP imaging abnormal group and a normal group.Multivariate logistic regression analysis was used to identify the risk factors for CTP abnormality in patients with TIA.Results A total of 69 patients with TIA were enrolled,and 52 of them had perfusion abnormalities corresponding to clinical symptoms.Their TTP and MTT were prolonged,but the decreased CBF and CBV was not obvious.Multivariate logistic regression analysis showed that the higher National Institutes of Health Stroke Scale (NIHSS) score (odds ratio [OR] 1.991,95％ confidence interval [OR] 1.113-3.564; P=0.020),the longer duration of symptoms (OR 1.062,95％ OR 1.013-1.114; P =0.013),and intracranial vascular stenosis (OR 15.410,95％ OR 2.118-112.116; P=0.007) were the independent risk factors for CTP abnormality in patients with TIA.The correlation analysis showed that the prolonged TTP (r =0.389,P =0.001) and MTT (r =0.413,P=0.001) were significantly associated with the NIHSS score.Conclusions TTP and MTT may sensitivity reveal cerebral perfusion abnormalities in patients with TIA.The more severe the disease is,the higher the CTP abnormal rate will be.

Objective:To investigate the effect of resveratrol ( Res ) on endoplasmic reticulum stress induced by cerebral ischemia/reperfusion(I/R)injury in rats.Methods:The seventy-two male SD rats were divided randomly into three groups(n=20):sham operation group ( group S ) , I/R group and Res-treatment group ( group R ) .Focal cerebral I/R model was induced by electrocoagulation of left middle cerebral artery and occlusion of bilateral common carotid arteries followed by reperfusion after 30 min.The rats in Res group were treated with Res(50 mg/kg)i.p.7 d before the operation,once a day for 7 d.Neurological deficits were assessed at 24 h post-injury,followed by collecting the brain tissues.Cerebral infarct size was detected by TTC staining,and the water content of brain tissue were measured by wet-dry weight method.The expression of GRP78,p-PERK and CHOP proteins were deter-mined by immunohistochemistry and Western blot analysis.Results:Compared with sham group,the neurological deficit score and the brain water content were significantly increased(P<0.05),cerebral infarct size was enlarged(P<0.05),and the expression of GRP78, p-PERK and CHOP were up-regulated in I/R group(P<0.05).At the corresponding time,compared with I/R group,the neurological deficit score and the brain water content were markedly decreased(P<0.05),cerebral infarct size was smaller(P<0.05),the level of GRP78 was notablely increased(P<0.05),while the expression of p-PERK and CHOP were down-regulated in Res group(P<0.05). Conclusion:Resveratrol plays a protection role in ischemia-reperfusion injury, through inhibiting the endoplasmic reticulum stress in rats.

ObjectiveTo evaluate the effect and safety of different thrombolytic therapies for acute cerebral infarction due to occlusion of middle cerebral artery(MCA).MethodsOne hundred and thirty-two cases of acute cerebral infarction in territory of MCA were randomly divided into 3 groups,all of which were treated with alteplase.Group A (48 cases) was treated by intra-venous therapy with alteplase,group B (43 cases) was treated by infusing alteplase at the site of the internal carotid artery,and group C(41 cases) was treated by infusing alteplase into the thrombus.The improvement of neurological function,complications and mortality rate were recorded and statistically compared,with analysis of variance for counting data of normal distribution,x2 test for quantitative data,and the mean difference was significant at the 0.05level.ResultsThe effective rates of group A,B and C at 2 h,24 h,2 w were 18.8％ (9/48),39.6％ ( 19/48),45.8％ (22/48) ;39.5％ (17/43),53.5％ (23/43),58.1％ (25/43) ;78.0％ (32/41),85.4％ (35/41 ),87.8％ (36/41)respectively.The effective rate of group C was obviously better than group A( x2 =12.809,9.979,9.289,P ＜ 0.01 ) and B (x2 =31.295,19.425,17.161,P ＜ 0.01 ) with statistical significance.The effective rate of group B was better than group A at 2 h after thrombolytic therapy with statistical significance (x2 =4.801,P ＜ 0.05 ).The effective rate of group A and B did not have significant difference at 24 h,2 w after therapy ( x2 =1.765,1.375,P ＞ 0.05 ).The hemorrhage rates of group A,B and C were 14.6％ (7/48),14.0％ (6/43),7.3％ (3/41 ),the mortality rates of group A,B and C were 6.2％ (3/48),4.6％ (2/43),2.4％ (1/41),and there was no significant difference among the 3 groups ( x2 =1.328,0.786,P ＞ 0.05 ).ConclusionIt is suggested that the thrombus-imbeded thrombolytic therapy is a better way in treating acute cerebral infraction due to occlusion of MCA for its rapid and better therapeutic effect.

Objective To observe the effect of early using butylphthalide injection before and after thrombolytic therapy with intravenous recombinant tissue plasminogen activator (rt-PA) on the clinical prognosis of patients with ultra-early acute cerebral infarction (ACI). Methods A prospective study was conducted, 81 patients with ACI admitted to the Department of Neurology of Tangshan Worker's Hospital from September 2014 to March 2016 were enrolled, and they were divided into a control group (40 cases) and an observation group (41 cases) according to the random number table. Both groups were given routine treatments, such as drugs for lowering blood pressure and blood sugar, decreasing blood lipid to stabilize plaque, neuroprotection, activating blood circulation and removing blood stasis, etc. On the basis of conventional treatment, the control group was directly treated with rt-PA intravenous (IV) thrombolytic therapy according to the guidelines of thrombolytic therapy; in the observation group, the patients immediately underwent CT head examination after admission to decide whether the thrombolytic therapy was necessary, if the therapy was decided to be done, during doctors waiting for the laboratory results or transferring patients, IV drip of butylphthalide sodium chloride 100 mL. After IV drip thrombolytic therapy, if the disease condition was stabilized, the head CT was re-examined to exclude intracranial hemorrhage, if no such hemorrhage, IV drip of butylphthalide sodium chloride 100 mL was continuously given, twice daily for consecutive 14 days with the interval between the two times of IV drip being 7 hours daily. When patient's condition was changed, the re-examination of head CT could be done at any time; if the patient's condition was not changed, the head CT was routinely performed 24 hours after IV drip thrombolysis. After exclusion of intracranial hemorrhage, the patients in both groups were treated additionally by the platelet aggregation drug on the basis of their original treatment. The National Institutes of Health Stroke Scale (NIHSS) scores, Bartherl index (BI) scores were recorded before and after treatment, and the recovery situation of neurological function, hemorrhage conversion rate, mortality and adverse reactions were observed after thrombolysis. Results After treatment, the NIHSS scores were lower, and the BI index scores were higher than those before treatment in the two groups, and the change in the observation group after 14 days of treatment was more significant (NIHSS score: 3.87±3.46 vs. 7.37±4.18, BI score: 87.38±9.34 vs. 75.67±8.05, both P < 0.05); the total effective rate of the observation group was significantly higher than that of the control group [73.2% (30/41) vs. 55.0% (22/40), P < 0.05], the rate of bleeding conversion rate was lower than that of the control group [2.4% (1/41) vs. 7.5% (3/40), P < 0.05], the difference in fatality rate between the two groups was not statistically significant [2.4% (1/41) vs. 2.5% (1/40), P > 0.05]. Conclusion The clinical therapeutic effect of butylphthalide injection is relatively good for treatment of patients with ultra-early ACI.

Objective To explore the value of CT perfusion (CTP) at the interphase in patients with transient ischemic attack (TIA) by applying 16 multi-slice spiral CT.Methods Sixty-nine TIA patients,admitted to our hospital from October 1,2011 to December 30,2012,were performed CTP;cerebral blood flow (CBF),cerebral blood volume (CBV),mean transit time (MTT) and time to peak (TTP) were measured within specific regions of the brains.Staging was performed according to the CTP results;the relationship between abnormal CTP and clinical symptoms of TIA patients was analyzed.Results In 69 patients with TIA,persisting abnormal perfusion changes corresponding to clinical symptoms were found in 52 patients.According to the CTP results,stage Ⅰ TIA included 25 patients and stage Ⅱ included 27 patients;the TTP and MTT in stage Ⅰ patients were significantly different between the affected side and the contralateral side (P＜0.05),while the CBF and CBV showed no significant difference (P＞0.05);the TTP,MTT and CBF in stage Ⅱ patients were significantly different between the affected side and the contralateral side (P＜0.05),while CBV showed no significant difference (P＞0.05).The percentages of stage Ⅱ patients with National Institutes of Health Stroke Scale (NIHSS) scores higher or equal to 4 points (68.2％) and onset duration longer than 60 min during TIA (75.0％) were significantly higher than those of stage Ⅰ patients (31.8％,25％,P＜0.05).NIHSS scores and duration of TIA onset were negatively correlated with the CBF ratio (affected/contralateral side;r=-0.548,P=0.000;r=-0.848,P=0.000),positively correlated with the TTP ratio (affected/contralateral side;r=0.732,P=0.000;r=0.927,P=0.000),and positively correlated with the MTT ratio (affected/contralateral side;r=0.668,P=0.000;r=0.902,P=0.000) in 52 TIA patients.Conclusion CTP provides valuable hemodynamic information,which could be used as the imaging basis of TIA diagnosis and treatment.

The purpose of this paper is to investigate the osteogenesis and adipogenesis in bone marrow mesenchymal stem cells (MSCs) isolated from normal rats and osteoporotic rats by ovariectomy. Osteoporotic animal model was established in 3 month-old and 6 month-old female Sprague-Dawley (SD) rats by ovariectomy. Animal experiments were divided into 4 groups: 1) control-3 group; 2) ovx-3 group; 3) control-6 group and 4) ovx-6 group. MSCs were isolated by means of the density-gradient centrifugation method from each group, respectively. Colony-forming unit-fibroblast (CFU-Fs ) number, CFU-Fs size distribution and cell density in CFU-Fs of primary passage MSCs were measured at the inverted phase contrast microscope. The cell cycle and proliferation index (PI) as well as apoptosis idex (AI) of MSCs were studied by (FCM). After osteogenic induction (OSI), calcium nodes of MSCs were marked by alizarin red staining (ARS); The expression level of alkaline phosphatase(ALP) was detected by dynamics method with substrate of phosphoric acid para-Nitro benzene and the content of osteocalcin (OCN) was detected with the isotope labelling method. After adipogenic induction (ADI), lipid droplet in MSCs were detected by oil red O staining and the mRNA level of lipoprotein lipase (LPL) was measured by RT-PCR. The results showed that CFU-Fs and PI are obviously decresed and AI are increased of MSCs in OVX-3 and OVX-6 groups (P<0.05). The secretory volume of ALP and BGP of MSCs and the content of calcium nods of MSCs are lower in OVX-3 and OVX-6 groups than that in control-3 and control-6 groups after osteogenic induction (P<0.05). The number of lipid droplet and the expression level of LPL mRNA are higher in OVX-3 and OVX-6 groups than that in control-3 and control-6 (P<0.05). The result in our study suggested that depress of osteogenesis and the up-regulation of adipogenesis of MSCs in osteoporotic rats by ovariectomy may be relate close to the pathogenesis of osteoporosis.
Adipocytes ; pathology ; Animals ; Bone Marrow Cells ; pathology ; Cell Differentiation ; physiology ; Cells, Cultured ; Female ; Mesenchymal Stromal Cells ; pathology ; Osteoblasts ; pathology ; Osteoporosis ; etiology ; pathology ; Ovariectomy ; Rats ; Rats, Sprague-Dawley ; Stem Cells ; pathology

The purpose of this paper is to investigate the probable molecular mechanism in mechano-transduction of the regulation of integrins and the effects of cyclic biaxial mechanical strain on proliferation and synthetic function in the osteoblasts isolated from 3-month-old female Sprague-Dawley (SD) rats. The osteoblasts were cultured in F-12 medium contained with 10% fetal bovine serum(FBS) and grown to subconfluency in Flexercell type I dishes in a humidified incubator with 5% CO2 and 95% air at 37 degrees C. Mechanical strains were applied to the cells for periods of 30 min, 2, 4 and 8 hours every day, lasting 2 days. The amplitude of mechanical strain applied to the cells were 400, 1,000 and 4,000 mu strain respectively, at a frequency of one hertz(1 Hz). Unstrained cells were used as control. The expression of integrins alpha 2, beta 1, beta 3 on the membrane of osteoblasts and proliferation activity of osteoblasts were studied with Flow Cytometry(FCM). The content of osteocalcin, carboxyterminal propeptide of type-I procollage(PICP), total protein secreted by osteoblastes were detected with the isotope labelling method. The results showed that there are actual expressions of integrins alpha 2, beta 1, beta 3 on the membrane of osteoblasts without mechanical strain and that the expression of integrins beta 1 is highest. The mechanical strain increased the expression of integrins alpha 2, beta 1, beta 3 on the membrane of osteoblasts, but the strain-related up-regulation of expression of integrins alpha 2, beta 1, beta 3 are different in various amplitude and different duration of mechanical stains. The up-regulation of expression of integrins beta 3 is most sensitive to mechanical strain. The up-regulation of expression of integrins alpha 2, beta 1, beta 3 is higher at 4,000 mu strain than at 400, 1,000 mu strain. The mechanical strain can elevate the proliferation activity and the synthetic function of osteoblast at 400, 1,000 mu strain. However, the mechanical strain increased significant the proliferation in the osteoblasts and suppressed obviously the synthetic function in the osteoblasts. In the present study, the reaction of the osteoblasts in 3 month-old rat to the mechanical stimulation suggested that 1) expressions of integrins alpha 2, beta 1, beta 3 were increased in a amplitude of strain-dependent manner; 2) the changes of expression of integrins alpha 2, beta 1, beta 3 relate close to the changes of the proliferation and synthetic function of the osteoblasts. Low amplitude of strain can increase the proliferation and the synthetic function of the osteoblasts along with up-regulation of expression of integrins alpha 2, beta 1, beta 3; while higher amplitude of strain elevated significantly the proliferation of osteoblasts and suppressed obviously the synthetic function of the osteoblasts along with up-regulation of expression of integrins alpha 2, beta 1, beta 3. The amplitude of 4,000 mu strain is an optimal amplitude as stimulus for up-regulation of expression of integrins alpha 2, beta 1, beta 3 on the membrane of osteoblasts and increase the proliferation activity, but decrease the synthetic function of osteoblasts in the present study. Accordingly it indicates that integrins have a important role in regulation of signal transduction pathway in osteoblasts as a result of mechanical strain.
Animals ; Cell Division ; Cells, Cultured ; Female ; Integrin alpha2 ; biosynthesis ; Integrin beta1 ; biosynthesis ; Integrin beta3 ; biosynthesis ; Mechanics ; Osteoblasts ; metabolism ; physiology ; Rats ; Rats, Sprague-Dawley

Objective To explore the improvement of cognitive impairment in patients with mild and moderate vascular cognitive impairment( VCI) treated with cerebralcare granule ( CG) and basic treat-ment.Methods From October in 2014 to December in 2016 year,143 cases of VCI patients were admitted from six hospitals in some areas of Hebei Province as the research objects,and divided into CG treatment group (experimental group,n=98) and conventional treatment group (control group,n=66).Three months and six months after treatment,the score of mental state examination ( MMSE) ,the Montreal cognitive assess-ment scale ( MoCA) and the daily living capacity scale( ADL) of the two groups were compared after 3 and 6 moths of treatment.Results ①The total score of MMSE in the experimental group was higher than that of the control group for six months after treatment, and the difference was statistically significant ( ( 23. 76 ± 4.02) vs (21.52±5.13),P<0.05).②Six months after treatment,the total score of MoCA ((21.06±4.66) vs (18.32±5.20)) and visual spatial/executive function((3.05±1.37) vs (2.42±1.66)),calculation force ((2.24±0.84) vs (1.83±1.05)) and orientation ability((5.20±1.12) vs (4.06±1.35)) scores in the ex-perimental group were significantly higher than those in the control group (P<0.05) .③Six months after treat-ment,the ADL score in the experimental group was lower than that before treatment,and the difference was statistically significant((24.96±8.74) vs (29.20±11.55),P<0.05);while there was no significant difference in the ADL score between the experimental group and the control group after 6 months (P>0.05).Conclusion CG can improve cognitive function in mild to moderate VCI patients,mainly in visual space/execution func-tion,calculation ability and orientation ability,and with the extension of treatment time,the curative effect is more obvious.

Objective To study the therapeutic value of endoscopy for primary duodenal lesions. Methods Data of 79 consecutive patients with primary duodenal lesions, who underwent endoscopic treatment from January 2015 to January 2018 at Beijing Friendship Hospital, were retrospectively analyzed. Patients were divided into the complication group and the non-complication group, and further grouped according to lesion locations and endoscopic categories. Baseline data of patients, endoscopic treatment, wound closure method, pathological results, the occurrence and outcome of complications were studied. Results A total of 79 patients successfully went through endoscopic treatment, including 59 cases of endoscopic mucosal resection ( EMR) , 5 cases of endoscopic submucosal dissection ( ESD) , 6 cases of full-thickness resection with OTSC metal clips, and 9 cases of endoscopic piecemeal mucosal resection ( EPMR) . In all 79 cases, complications occurred in 8 patients ( 10. 1％) during the perioperative period, all at the duodenal descending segment and duodenal papilla. In all 47 cases whose lesions located at duodenal papilla and duodenal descending segment, the complication incidence was 17. 0％ ( 8/47) , significantly higher than that of non-descending and papilla part [ 0 ( 0/32 ) , P=0. 012 ] . Two ( 2. 5％) cases had complications requiring further intervention with endoscopy or surgery. Among 8 patients with complications, 1 patient ( 2. 1％) developed intraoperative perforation, 1 patient ( 2. 1％) developed delayed bleeding, 6 patients ( 12. 8％) developed mild acute pancreatitis, and these 8 patients recovered after treatment. These 47 patients were further divided into the duodenoscopy group and the gastroscopy group according to endoscopic categories, the complications incidence in the duodenoscopy group ( 28. 0％, 7/25) was also significantly higher than that in the gastroscopy group [ 4. 5％( 1/22) , P=0. 037] . Conclusion Endoscopic treatment is safe and effective for primary duodenal lesions. But for the operations in the duodenal descending segment and the duodenal papilla, as well as in the case of duodenoscopy, it is necessary to be more vigilant about the occurrence of complications.