Objective To investigate the risk factors for vascular cognitive impairment and the effet of cerebral microbleeds (CMBs) on cognitive function in patients with ischemic stroke.Methods The data of patients with ischemic stroke over the age of 50 were collected.The Montreal cognitive assessment (MoCA) scale and Alzheimer's disease assessment scale-cognitive subscale were used to evaluate cognitive function.Hamilton depression scale (HAMD) was used to evaluate the depression status in order to exclude the patients with depression.The patients with ischemic stroke were divided into either a cognitive impairment group or a non-cognitive impairment group according to the scale evaluation results.The demographic and clinical characteristics in both groups were compared,and the multivariate logistic regression analysis was used to look for the independent risk factors for cognitive impairment in patients with ischemic stroke.The Spearman rank correlation method was used to analyze the degree of CBMs,total score of MoCA,and the correlations of all cognitive domains scores.Results A total of 169 patients with ischemic stroke were enrolled in the study.There were 80 patients in the cognitive impairment group and 89 in the non-cognitive impairment group; 34 patients had CMBs and 135 had no CMBs.The age was older (71.99 ±6.01 years vs.64.47 ±6.15 years; t =8.014,P =0.000),years of education were fewer (4.51 ± 1.534 years vs.6.94 ±2.357 years; t =8.023,P =0.000),systolic blood pressure was higher (156.19± 17.53 mm Hg vs.142.04± 16.03 mmHg,1 mmHg=0.133 kPa; t =5.479,P =0.000),scale of white matter lesion was higher (7.33 ± 2.04 vs.4.39 ± 2.17; t =8.951,P =0.000),cerebral infarction volume was larger (7 123.8 ± 1 587.1 mm3vs.5 628.4 ± 1 017.8 mm3;t =7.201 ; P =0.000),proportion of the patients with history of previous stroke or transient ischemic attack was higher (46.2％ vs.28.1％;x2 =5.982; P=0.014),and number of CBMs was larger (x2 =17.565; P=0.000) in the cognitive impairment group.Multivariate logistic regression analysis showed that the age (odds ratio [OR] 1.115,95％ confidence interval [CI] 1.013-1.227; P =0.026),years of education (OR 0.490,95％ CI0.325-0.793; P=0.001),systolic blood pressure (OR 1.048,95％ CI 1.014-1.083; P =0.005),scale of white matter lesion (OR 2.044,95％ CI 1.466-2.851; P =0.000),and cerebral infarction volume (OR 2.204,95％ CI 1.386-3.503; P =0.001) were all the independent risk factors for cognitive impairment in patients with ischemic stroke.Compared to the non-CBM group,the age was older (72.06 ± 5.59 years vs.67.01 ±7.15 years; t =4.427; P =0.000),years of education were fewer (3.97 ± 1.381 years vs.6.25 ±2.317 years; t =7.367,P =0.000),systolic blood pressure was higher (155.03 ±20.16 mm Hgvs.147.16 ±17.32 mm Hg; t =2.290,P =0.023),scale of white matter lesion was more higher (7.03 ±2.139 vs.5.47 ±2.591; t =3.247,P =0.001),cerebral infarction volume was larger (6 968.5 ± 1 507.4 mm3 vs.6 177.0 ±1 477.1 mm3; t =2.735,P =0.007),and proportions of hypertension (82.4％ vs.41.5％ ;x2 =18.149,P =0.000),hyperlipidemia (88.2％ vs.39.3 ％ ;x2 =26.067,P =0.000),history of previous stroke or transient ischemic attack (70.6％ vs.28.1％ ;x2 =21.061,P =0.000) and coronary heart disease (94.1％ vs.45.2％ ;x2 =26.278,P=0.000) were higher in the CBM group.The MoCA total score (M[Q1 ～ Q3]; 24 [24 ～25]vs.28 [27 ～ 28] ; Z =-7.092,P =0.000) as well as the scores of attention (6 [5 ～ 6] vs.6 [6 ～ 6] ; Z =-2.502,P =0.012),abstraction (2[1 ～2] vs.2[2 ～2] ; Z =-2.382,P =0.017) and visuoexecutive (2[1 ～2] vs.4[4 ～5]; Z=-7.321,P=0.000) in the CMB group were significantly lower than those in the nonCBM group.The Spearman rank correlation analysis showed that the CMB grade was negatively associated with the MoCA total score (rs =-0.879,P =0.000) as well as the scores of visuoexecutive (rs =-0.895,P =0.000),attention (rs =-0.337,P =0.005),and abstraction (rs =-0.333,P=0.006).Conclusions The age,years of education,systolic blood pressure,degree of white matter damage,and cerebral infarction volume are the risk factors for vascular cognitive impairment.The visuospatial executive dysfunction,attention and abstract thinking decline significantly in ischemic stroke patients with CBMs.CMBs and their numbers are closely associated with cognitive impairment.The more the CMB numbers are,the more obvious the cognitive impairment will be.

Objective To verify the ability of distal ends of internal mammary artery and vein used as recipient vessels on breast and chest wall reconstruction. Methods Four bilateral (left 2 and right 2) scent pig buttock island flaps pedicled circle deep iliac artery and vein were used by comparing the different hemodynamic parameters (pressure; flux volume; perfusion unions) between the original pedicl artery (deep iliac artery), proximal and distal ends of internal mammary artery. The free flaps were transplantated by anastomosed end-end to the distal-ends of internal mammary artery and vein after the proximal ends were ligated. Results The pressure of distal end of internal mammary artery was 61%-65% of the pressure with original pedicl artery (deep iliac artery), the immediate volume of anastomasis stoma was a little lower than that of original pedicl artery. The flap, 15 cm?30 cm?2 cm in size, completely survived more than 14 days after operation. Conclusion The slightly decreased distal arterial pressure does not compromise flap survival. Bilateral scent pig buttock island flap pedicled circle deep iliac artery and vein is an ideal animal flap model. This hymodynamic model can be widely used .

Objective To evaluate the safety and efficacy of treating bifurcation lessions with jailed-balloon technique in simple strategy. Methods Ninety patients with bifurcation lessions (Duke D or F type) who received the side branch protection technique with simple strategy were involved in a single center retrospective analysis. Patients were randomly divided into jailed-balloon protection group (n=48) and jailed guidewire group (n=42). The process operating, procedural success of percutaneous coronary intervention (PCI) and percutaneous transluminal coronary angioplasty (PTCA), complications and the results of follow-up were investigated. Results The clinical baseline date and the bifurcation lesions were not significant different between jailed-balloon group and jailed guidewire group (P>0.05). The procedural success rate of PCI was 100%in jailed-balloon group and 97.6%in jailed guidewire group, no significance difference user between two groups (P>0.05). The perioperative complications (the rate of no reflow) was lower in jailed-balloon group than those of jailed guidewire group (1.0%vs. 19.0%, P<0.05). The procedural success rate of PTCA were lower in jailed-balloon group than that of jailed guidewire group (4.2%vs. 23.8%, P<0.01). The total operation time [(56.40±11.71) s vs. (72.60±10.62) s],exposing time [(9.86±1.82) s vs.(12.24±2.32)s] or amount of used contrast agent [(90.54±15.26) mL vs. (118.16±18.64) mL] were significantly lower in jailed-balloon group compared with those of jailed guidewire group (P<0.05). At the 12-month follow-up, the MACE was lower in the jailed-balloon group than that of jailed guidewire group (16.7%vs. 38.1%, P<0.05). The restenotic rate (2.1%vs. 4.8%, P>0.05) and the maximum restenotic level (19.24%vs. 21.46%,P>0.05) in the main branch were not significant different between jailed-balloon group and jailed guidewire group. But the maximum restenotic level in the opening of side branch was lower in jailed-balloon group than that of jailed guidewire group (51.2% vs. 72.46%, P < 0.01). Conclusion The jailed-balloon technique reduces the operation complications, exposure time and amount of contrast agent, and also saves surgical consumables. The procedure of branch with simple strategy is safe and effective in treatment of bifurcation lesions.

Objective To investigate the effect of epidermal growth factor (EGF) on the proliferation of endometrial adenocarcinoma cells,phosphorylation of estrogen receptor α (ERα)and Ack1 in the absence of estrogen.MethodsIshikawa cell line was stimulated by EGF without estrogen settings, Cell Counting Kit-8 (CCK-8) was used to evaluate cell proliferation, Western blot was used to detect ER α phosphorylation and Ack1 phosphorylation.Giving tyrosine inhibitor dasatinib to assess the effect of EGF on cell proliferation,phosphorylation of ERα and Ack1 in Ishikawa cells.Results EGF enhanced the proliferation of endometrial adenocarcinoma cells (P<0.05).EGF induced ERα phosphorylation at Tyr-537 and phosphorylation of Ack1.Compared with untreated control, Dasatinib inhibited the proliferation of endometrial adenocarcinoma cells (P<0.05), phosphorylation of ERα Tyr-537 and Ack1.Conclusions EGF promotes Ishikawa cells proliferation in the possible way of activating ER α site-specific phosphorylation at Tyr-537 and phosphorylation Ack1, which could be blocked by dasatinib.

Objective The purpose of this study is to evaluate Surgical Procedure and Prognosis for elderly stage 1NSCLC patients above 70 years old.Methods The patients who were stage Ⅰ non-small cell lung cancer from 2003 to 2007were enrolled ( n =71 ).The median age was 74 years ( ranged from 70 to 84 years).The median follow-up of patients was 30months( ranged from 2 to 81 months).Results The percentages of postoperative complications after sublobar resection and lobectomy patients were 36.4％ and 46.9％,respectively.The period in hospital were 11.36 days and 12.24 days.The 3 year survival was 85.9％ for patients undergoing sublobar resection and 78.8％ for lobectomy.The 5 year survival was 56.4％ and 56.9％ respectively.No significant difference was observed between two types of surgical procedure in the elderly.Staging is the independent factor of prognosis.Conclusion Lobectomy is still the main therapy method for elderly stage Ⅰ NSCLC patients.Especially,for those who can undergo radical resection.But sublobar resection also appears to be a viable surgical treatment for patients with cardiopulmonary physiologic impairment.

Objective To investigate the mechanism of dasatinib,tyrosine kinase inhibitor,inhibiting androgen receptor (AR) phosphorylation in prostate cancer cells.Methods HEK-293T and COS7 cell lines were cotransfected by wild-type (WT)-AR,ARY267F or ARY534F with Ack1 or Src,respectively,and Western blot was used to detect the AR phosphorylation sites.LNCaP cells were treated by EGF or heregulin without androgen,then Western blot was used to detect AR phosphorylation.After these LNCaP cells were treated by dasatinib or transfection with siRNA to silence Ack1 or Src gene,Western blot was used to observe the effect on AR phosphorylation,and quantitative real-time reverse transcription polymerase chain (RT-PCR)was applied to detect PSA mRNA and hk2 mRNA.Results After transfection,Ack1 kinase mediated the phosphorylation of AR Tyr267 in HEK-293T cells,and Src mediated AR Tyr534 phosphorylation in COS7cells.When LNCaP cells were treated by heregulin,AR Tyr267 was phosphorylated,but its phosphorylation was inhibited after these cells were treated by dasatinib or ack1 gene was silenced.When LNCaP cells were treated by EGF,AR Tyr534 was phosphorylated,but its phosphorylation was inhibited after these cells were treated by dasatinib or Src gene was silenced.EGF or heregulin raised endogenous AR target gene,PSA and hK2,mRNA levels in LNCaP cells (P ＜ 0.05).However,after these cells were treated by dasatinib,PSA and hK2 mRNA levels induced by heregulin were decreased (P ＜ 0.05),but those induced by EGF PSA were no significant changes (P ＞ 0.05).Conclusion Dasatinib can inhibit AR Tyr267 and AR Tyr 534phosphorylation,and it may play a significant role in anti-prostate cancer cells by inhibiting Ack1-mediated AR Tyr-267 phosphorylation and the expression of PSA mRNA and hk2 mRNA induced by heregulin.

Objective: To investigate the impact for family history of hypertension on masked hypertension (MH) morbidity with relevant cardiac damage. Methods: Our research included in 3 groups: MH group, n=250 consecutive patients treated in our hospital from 2010-01 to 2015-04, Hypertension group, n=250 and Control group, n=250 subjects with normal blood pressure. The family history of hypertension, general clinical information, routine biochemical indexes and the findings of echocardiography were studied and compared among different groups. Results: ① There were 70 (28%) patients with family history of hypertension in MH group, 87 (34.8%) in Hypertension group and 26 (10.4%) in Control group. The ratio of family history of hypertension in MH group was higher than Control group, P<0.001, while it was similar between MH group and Hypertension group, P>0.05. Logistic regression analysis presented that family history of hypertension and body mass index were positively related to the morbidities of MH (r=1.468, r=0.173) and hypertension (r=1.195, r=0.086). ② Compared with Control group, MH group had increased left ventricular mass index (85.64 ± 17.7) g/m2 vs (80.50 ± 15.53) g/m2 and the maximum blood flow velocity of aortic valve (115.74 ± 16.54) cm/s vs (112.40±14.21) cm/s, all P<0.05. In MH group, compared with those without family history of hypertension, the patients with family history had the higher left ventricular mass index (89.22 ± 19.08) g/m2 vs (84.25 ± 16.99) g/m2 and the maximum blood flow velocity of aortic valve (119.19 ± 14.97) g/m2 vs (114.39 ± 16.96) g/m2, all P<0.05. Conclusion: The subjects with family history of hypertension had the higher risk of MH morbidity with more severe cardiac damage.

Objective The aim of the present study was to evaluate the clinical application of 2 μm thulium laser in pulmonary nodules resection under VATS.Methods 61 patients,undergoing thoracoscopic resection of pulmonary nodules in thoracic department of Xuanwu Hospital,were identified between January and December of 2016.Of those,30 underwent 2μm thulium laser dissection and 31 were treated with standard technique by using staplers.In terms of clinical characteristics,including gender,age and smoking history,there is no significant difference between the laser group and the stapler group,but the lesion size was slightly larger in the stapler group compared with the laser group.The lesions of the two groups were almost evenly distributed on the five lobes.Results All the procedures were performed successfully under VATS.The intraoperative evaluation of air leaks demonstrated that less than or equal to 2 grade air leaks were observed in 28 cases in the laser group and in 30 cases in the stapler group.Grade 3 air leaks requiring a rescue treatment were observed in 2 cases in the laser group and in 1 case in the stapler group.There were no significant differences in the postoperative hospital stay and total hospital stay between two groups.Chest tube duration was lower in the laser group compared with the stapler group even if it was not statistically significant (2.71 vs 3.55 days).Hospitalization costs was significantly lower for the laser group.Conclusion The use of 2um thulium laser to prevent intra-and postoperative air leaks and bleeding is effective and makes patients recover quickly,which allows a minimally invasive,accurate and safe application during thoracoscopic resection of pulmonary nodules.

Objective To investigate the value of liver imaging reporting and data system version 2018(LI-RADS v2018)features in predicting microvascular invasion(MVI)of hepatocellular carcinoma(HCC).Methods Ninety-two patients diagnosed as LR-5 and pathologically confirmed HCC were included and divided into MVI positive group and MVI negative group.The major and ancillary features of LI-RADS v2018 were compared between the two groups.Logistic univariate and multivariate regression analyses were used to obtain the independent risk factors for MVI,and the value of differential features in predicting MVI was also assessed using the receiver operating characteristic(ROC)curve.Results In the MVI positive group,the pathological grade of HCC was higher than that in the MVI negative group,with larger tumor diameter and higher incidence of mosaic architecture and corona enhancement.However,there was no difference in any other features.In logistic univariate analysis,tumor diameter,mosaic architecture and corona enhancement were independent risk factors for predicting the MVI,with area under the curve(AUC)values of 0.763 and 0.628 and 0.670 for the diagnosis of MVI,respectively.Conclusion In high-risk LR-5 population,tumor diameter,mosaic architecture and corona enhancement can help to predict the MVI.Accurate identification of LI-RADS v2018 features may facilitate personalized management of HCC patients.

OBJECTIVETo establish a blood glucose fluctuation model in diabetic rats.

METHODSMale SD rats were randomly divided into 2 groups, namely normal group and diabetes group. Rat model of diabetes was established by single intraperitoneal injection of streptozotocin (STZ) and then divided into sustained high blood glucose group and blood glucose fluctuation group. Rat model of blood glucose fluctuation was established by subcutaneous injection with regular insulin or gavaging of glucose twice daily in diabetic rats. The general condition, body weight, daily blood glucose levels of 5 different times, daily average blood glucose (MBG), standard deviation of daily average blood glucose (SDBG), the maximum amplitude of glycemic excursions (LAGE), fasting serum insulin (FINS) and pancreatic tissue pathology were observed.

RESULTSRats in blood glucose fluctuation group and sustained high blood glucose group developed symptoms of polyphagia, polyuria and polydipsia. Though significant differences in body weight were observed at different time (P<0.01), no significant differences were found among the three groups (P>0.05). After 6 weeks of blood glucose fluctuation, MBG, SDBG and LAGE in blood glucose fluctuation group and sustained high blood glucose group were increased significantly than those in normal group (P<0.01), the level of FINS decreased markedly (P<0.05). SDBG and LAGE in blood glucose fluctuation group were higher than those in sustained high blood glucose group (P<0.01). Islet of diabetic rat became atrophy, irregular shape, sparse distribution, and decreased in number, and the changes were more obvious in blood glucose fluctuation group.

CONCLUSIONRat model of blood glucose fluctuation can be successfully established by subcutaneous injection of regular insulin of gavage of glucose twice daily in diabetic rats.

Animals ; Blood Glucose ; analysis ; Body Weight ; Diabetes Mellitus, Experimental ; Fasting ; Glucose ; administration & dosage ; Insulin ; administration & dosage ; Male ; Rats ; Rats, Sprague-Dawley ; Streptozocin