Objective To determine collateral circulation in patients with acute ischemic stroke using capillary index score (CIS)in order to evaluate the prognosis of endovascular treatment. Methods From January 2013 to December 2015,46 consecutive patients with acute ischemic stroke treated with endovascular treatment at the Department of Neurology,Central Hospital of Baotou were enrolled retrospectively. Angiography was performed before endovascular treatment in order to complete CIS score. The patients were divided into a good prognosis group (n = 21)and a poor prognosis group (n = 25)according to the modified Rankin scale (mRS)scores. Univariate analysis was used to compare the baseline data and the clinical data of the two groups,including age,sex,history of diabetes,pretreatment systolic blood pressure,conducting intravenous thrombolysis or not,time from ictus to intravenous thrombolysis,National Institutes of Health Stroke Scale (NIHSS)score,Alberta stroke program early CT score (ASPECTS),vascular filling,time from onset to revascularization,and postoperative vascular recanalization (the modified Thrombolysis in Cerebral Infarction [mTICI]). Multivariate analysis was used to analyze the effect of CIS score on good prognosis. Results There were no significant differences in age,sex,history of diabetes,pretreatment systolic blood pressure,conducting intravenous thrombolysis or not,time from ictus to thrombolysis,and number of mechanical thrombectomy between the good prognosis group and the poor prognosis group (all P > 0. 05). There were significant differences in the NIHSS score (15 ± 3 vs. 19 ± 4),ASPECTS score (8 [7,10]vs. 6 [5,8]),filling well 85. 7% (18 / 21)vs. 44. 0% [11 / 25]),time from ictus to recanalization (363 ± 42 min vs. 398 ± 53 min),and postoperative vascular recanalization (mTICI≥Ⅱb)(100. 0% [21 / 21]vs. 68. 0%[17 / 25];all P < 0. 05). CIS (OR,8. 600,95% CI 2. 670 -33. 800)and mTICI grade (OR,5. 720, 95%CI 12. 170-22. 300)were significantly associated with the prognosis. Conclusion The CIS score can be used to evaluate brain perfusion. fCIS is closely associated with the good clinical prognosis. When screening the suitable patients for endovascular therapy,increasing the CIS score to evaluate the salvageable brain tissue is effective and feasible.

Objective To study the method of preparation and blood sugar lowering effect of oral chitosan-insulin nanoparticles (INS-NPs) in streptozotocin-induced diabetic Wistar rats. Methods The INS-NPs were prepared by an ionic gelation method. The changes in the morphology and size of the INS-NPs were observed with transmission electron microscope and Zetasizer 3000HS, respectively. The blood sugar lowering effect of the INS-NPs was evaluated by monitoring the blood glucose levels in healthy and streptozotocin-induced diabetic rats. Results INS-NPs were spherical in shape with a mean size of 220.6±15.9nm. Entrapment efficiency of INS-NPs was 75.4%±3.2% and the loading efficiency of INS-NPs was 19.5%±2.6%. In vivo blood sugar lowering study showed that the levels of blood glucose of healthy Wistar rats were significantly reduced from 6h to 12h after oral administration of INS-NPs(25U/kg). The blood glucose level of diabetic rats were significantly reduced at 6h after oral administration of INS-NPs (25U/kg), and this effect was maintained for more than 9h, and the levels of blood glucose were kept in normal range for 7h. Conclusion The INS-NPs prepared by ionic gelation method has the blood glucose lowering effect in streptozotocin-induced diabetic Wistar rats.

Objective To explore the diagnostic value of whole?body bone scan combined with SPECT/CT imaging for osteofibrous dysplasia( OFD) . Methods A total of 30 patients ( 14 males, 16 fe?males, age range 10-48 ( average age 29.2) years) with OFD confirmed by pathology from June 2007 to De?cember 2014 were included. The images of whole?body bone scan and SPECT/CT imaging were retrospec?tively analyzed. Results Nineteen patients (63.3%, 19/30) showed monostotic OFD, which mainly in?volved extremities (n=18), especially the femur. Eleven patients(36.7%, 11/30) showed polyostotic OFD, which frequently be seen unilaterally (n=7). Highly or obviously abnormal uptakes of radiotracer were shown in most lesions (95.3%, 81/85) on whole?body bone planar images, the ribs and extremities showed abnormal uptake along the backbone orientation, while the cranium, pelvis and spine showed irregu?lar bulky uptake of radioactivity. On SPECT/CT images, the lesions of high or obvious abnormal uptake of radiotracer mainly showed cystic expansion growth, ground glass, vegetable sponge and mixed appearance;and the higher the radioactive aggregation degree was, the more the morphological changes were. The density and morphological changes on CT were not obvious for lesions with moderately and mildly abnormal uptake of radiotracer. Conclusion The whole?body bone scan combined with SPECT/CT imaging is an effective diag?nostic method for OFD.

Objective To study the clinical significance of diffusion weighted imaging (DWI) positive lesions in transient ischemic attacks (TIA) patients,TIA patients with fully reversible lesions were compared with the other patients for investigating the predictive value of apparent diffusion coefficient(ADC) for distinguishing between TIA and stroke.Methods Fifty-seven patients hospitalized with TIA at Department of Neurology,Central Hospital of Baotou August 2009 to June 2011 were identified.All patients had brain magnetic resonance imaging within 24 h after onset,then they were divided into DWI positive group and negative group.A follow-up MR imaging or CT was available in patients of DWI positive group.According to MRI or CT,patients were divided into TIA group and cerebral infarction (CI) group.Clinical features and DWI Imaging were compared between the two groups.For each lesion,the quantitative parameters on initial DWI (ADC) were recorded,and comparisons between reversible and irreversible lesions were performed.Results The ADC values were (630.4 ±25.9) × 10-3 mm2/s in lesions with TIA and (495.2 ±60.0) x 10-3 mm2/s with brain infaction (t =6.669,P =0.000).The relative ADC ratio values were lower (62.6％ ±7.4％ vs 82.1％ ±5.6％,t =7.013,P =0.000) in lesions with subsequent infarct than in those that were fully reversible.Conclusions ADC values are moderately decreased in DWI lesions from TIA patients,while ADC values are significantly decreased in CI group.It is useful to early distinguish TIA from CI by comparing ADC and rADC values.

Objective To investigate the incidence of attention deficit hyperactivity disorder (ADHD)symptoms among 3-10-year-old children and its relationship with sleep.Methods Taking gender,grade (junior in kindergarten to third grade),and region(urban and rural areas) as stratification variable,1 535 children aged 3 to 10 years old were selected by random in six areas nationwide.ADHD Rating Scale-Ⅳ-Parent Version and Pittsburgh Sleep Quality Index were adopted to investigate ADHD symptoms and sleep of these children.Results 24.95％ of the investigated children had ADHD symptoms.Boys scored higher than girls in all indicators(boys:Inattention (IA):(9.21±3.75),Hyperactivity-Impulsivity (HI):(8.62± 3.87),Total:(17.82±7.01),girls:IA:(8.16±3.77),HI:(7.32±3.76),Total:(15.48±6.98)) while girls had higher incidence of ADHD symptoms than boys (girls:IA:16.19％,HI:27.02％,Total:32.51％,boys:IA:11.70％,HI:8.19％,Total:17.43％).Peak incidence occured in children aged 7-9 (7 years old group:IA:18.22％,HI:21.93 ％,Total:38.66％,8 years old group:IA:20.66％,HI:23.25 ％,Total:38.01％,9 years old group:IA:18.22％,HI:33.78％,Total:32.00％).Rural children had higher incidence of ADHD symptoms than urban children(rural children:IA:18.37％,HI:18.37％,Total:29.48％,urban children:IA:10.47％,HI:15.12％,Total:21.40％).Logistic regression results showed that sleep quality,sleep disorder and daily dysfunction can predict the incidence of ADHD symptoms to a certain degree.Conclusion The incidence of ADHD symptoms appear to be high in children evaluating by ADHD Rating Scale-Ⅳ-Parent Version.More attention should be paid to girls and rural children' s ADHD symptoms.7-9 years old children have the highest incidence of ADHD symptoms.The more problems in daytime dysfunction,sleep disorders and bedtime,the more ADHD symptoms will be observed.

OBJECTIVETo generate phage-displayed anti-idiotypic antibody single chain variable fragments (anti-Id ScFv) to MG7 monoclonal antibody (McAb) directed against gastric carcinoma so as to lay a foundation for developing anti-Id ScFv vaccine of the cancer.

METHODSBalb/c mice were immunized i.p. with MG7 McAb conjugated with keyhole limpet hemocyanin (KLH), and mRNA was isolated from the spleens of the immunized mice. Heavy and light chain (VH and VL) genes of antibody were amplified separately and assembled into ScFv genes with a linker DNA by PCR. The ScFv genes were ligated into the phagemid vector pCANTAB5E and the ligated sample was transformed into competent E. coli TG1. The transformants were infected with M13K07 helper phage to yield recombinant phages displaying ScFv on the tips of M13 phage. After 4 rounds of panning with MG7, the MG7-positive clones were selected by ELISA from the enriched phages. The types of the anti-Id ScFv displayed on the selected phage clones were preliminarily identified by competition ELISA.

RESULTSThe VH, VL and ScFv DNAs were about 340 bp, 320 bp and 750 bp respectively. Twenty-four MG7-positive clones were selected from 60 enriched phage clones, among which 5 displayed beta or gamma type anti-Id ScFv.

CONCLUSIONThe anti-Id ScFv to MG7 McAb can be successfully selected by recombinant phage antibody technique, which paves a way for the study of prevention and cure of gastric carcinoma by using anti-Id ScFv.

Animals ; Antibodies, Anti-Idiotypic ; biosynthesis ; genetics ; Antibodies, Monoclonal ; genetics ; immunology ; Bacteriophages ; genetics ; Cloning, Molecular ; Immunoglobulin Fragments ; biosynthesis ; genetics ; Immunoglobulin Heavy Chains ; biosynthesis ; genetics ; Immunoglobulin Light Chains ; biosynthesis ; genetics ; Immunoglobulin Variable Region ; biosynthesis ; genetics ; Mice ; Mice, Inbred BALB C ; RNA, Messenger ; genetics ; Stomach Neoplasms ; immunology ; Vaccines, DNA ; genetics ; immunology

OBJECTIVETo analyze the distribution and significance of occludin mRNA expression in human gastric cancer, as well as its relationship with gastric cancer pathology and multidrug resistance (MDR) in vivo.

METHODSIn situ hybridization (ISH) technique was used to evaluate the expression of occludin mRNA in 42 gastric carcinoma specimens obtained by surgery and 23 relatively normal gastric mucosa obtained by gastric endoscopy. All specimens had been stored in cryostatic section.

RESULTSOccludin mRNA was found positive in the cytoplasm of gastric glandulous epithelia as blue particles with intensive stain in 14 of 42 gastric carcinomas (33.3%), 23 of 42 paracancerous gastric tissues (54.8%), 14 of 23 relatively normal gastric tissues (60.9%), 9 of 16 well differentiated carcinomas (56.3%), 4 of 14 moderately differentiated carcinomas (28.6%), 1 of 10 poorly differentiated carcinomas (10.0%) and none of 2 mucosal carcinomas. There were significant differences in occludin mRNA positive rate between relatively normal gastric tissue and gastric cancer as well as between paracancerous gastric tissue and gastric cancer. The expression of occludin mRNA in moderately and poorly differentiated groups was gradually reduced when compared with well differentiated group, which suggests that there be a significant correlation between tumor differentiation and the expression of occludin mRNA. Furthermore, the positive signals of occludin mRNA distributed extensively in the cytoplasm of SGC7901/VCR cell, being vincristine resistant, derived from parental gastric cell line SGC7901. The positive signals of SGC7901/VCR were stronger than those of SGC7901 cells.

CONCLUSIONOccludin mRNA, being mainly located in epithelial cells and its expression correlated with tumor differentiation, may be involved in the development of multi-drug resistance in gastric cancer.

Drug Resistance, Multiple ; physiology ; Drug Resistance, Neoplasm ; physiology ; Humans ; In Situ Hybridization ; Membrane Proteins ; genetics ; metabolism ; Occludin ; RNA, Messenger ; metabolism ; Stomach Neoplasms ; metabolism ; Tight Junctions ; metabolism

Objective:To evaluate and compare the outcomes of maxillary protraction treatment assisted by temporary anchorage devices (TADs) and removable biteplate in cleft lip and palate patients using cephalometric analysis.Methods:Fifty-four cleft lip and palate patients were divided into 3 groups based on different maxillary protraction treatments: bitepalate removable appliance group (group A), maxillary protraction treatment assisted by TADs group (group B) and control group (group C). Lateral cephalograms were taken at the start and the end of maxillary protraction. Skeletal, dental and soft tissue changes were measured using Dolphin software and compared between groups.Results:The average protraction time of groups A and B were (8.51±1.33) and (9.20±1.45) months ( P=0.146), respectively. A point moved forward by 4.08 mm in group A and 4.83 mm in group B were noted, without significant differences between the two groups. Compared to group C, ANB and wits was highly improved after protraction in groups A and B. U6-VRmx increased by 0.46 mm and U1-pp increased by 0.63 mm in group B, both of which were significantly smaller than those of group A (both P<0.05), suggesting that maxillary protraction treatment assisted by TADs could reduce molar advancement and upper incisor protrusion. Conclusions:Both maxillary protraction treatment assisted by TADs and removable biteplate could significantly improve skeletal class Ⅲ malocclusion in unilateral cleft and palate patients. Maxillary protraction treatment assisted by TADs could reduce molar advancement and upper incisor protrusion.

Objective To investigate the safety and feasibility of robotic nephrectomy,work bench surgery with robotic kidney autotransplantation in the treatment of complex renal tumors.Methods The clinical data of 5 patients with renal tumors admitted from January 2018 to July 2018 were analyzed retrospectively.There were 4 males and 1 females.The median age was 49 years old,ranging 32-66 years.The median body mass index was 25.6 kg/m2,ranging 21.1-27.8 kg/m2.Serum creatinine level was 87.2 μmol/L,ranging 78.0-88.9μmol/L before bench surgery.5 patients had multiple bilateral renal tumors and had undergone laparoscopic or robotic partial nephrectomy on the contralateral kidney.For bench surgery kidney,4 cases were on the left side and 1 case was on the right side.Each kidney has more than 2 separate tumors,combined with complete endophytic tumors,tumors larger than 7 cm in diameter or hilar tumors.5 patients were all performed robotic nephrectomy,work bench partial nephrectomy with robotic kidney autotransplantation under general anesthesia.The patient was first in a lateral decubitus position for robotic nephrectomy,and the kidney was removed through a median 6 cm periumbilical incision.After kidney removal,kidney tumors were resected and kidney was reconstructed on a hypothermic working table.Then the kidney was packed in a plastic bag,filling with ice slush.The corresponding parts of the plastic bag were cut to expose the renal artery and vein.Finally,the patient was moved to lithotomy position with Trendelenburg tilt of 20°,and the autologous kidney wrapped in the plastic bag was placed through the previous periumbilical incision into the abdominal cavity for robotic kidney autotransplantation.The renal artery and vein were anastomosed end-to-side with the right external iliac artery and vein.The ureter and bladder were anastomosed.Autologous kidneys were placed in abdominal cavity in 4 cases,and placed in right iliac fossa with retroperitonealization in 1 case.Ice slush on the surface of the autologous kidney did not completely melt before the blood supply was restored during the operation,and the autologous kidney immediately urinated after the blood supply was restored.Results All surgeries were performed successfully without conversion to open surgeries.The total operation time was 460 min,ranging (415-645 min),the time of robotic nephrectomy was 120 min,ranging (74-300 min),the time of robotic kidney autotransphntation was 135 min,ranging(103-163 min),the warm ischemia time was 3 min,ranging (1.5-6.0 min),the cold ischemia time was 182 min,ranging(135-210 min),the rewarming time was 50 min,ranging(45-55 min),the estimated blood loss during operation was 100 ml,ranging(50-300 ml),and the hospital stay was 6 d,ranging(5-9 d).The number of resected tumors was 4,ranging(2-6).The pathology reveals clear cell carcinoma in 3 cases and chromophobe cell carcinoma in 2 cases.The surgical margins were all negative.The serum creatinine levels were 111.1 μmol/L (87-217.6 μ mol/L) and 106.1 μmol/L (87.1-172 μmol/L) on the 7th and 30th day after operation,respectively.One month after operation,CT showed that the function and morphology of the autologous kidneys were fine.No recurrence or metastasis was found in 5 patients during a median follow-up of 7 months,ranging (5.4-11.7 mon).Conclusions For patients with complex renal tumors who cannot undergo in situ partial nephrectomy,robotic nephrectomy,work bench surgery with robotic kidney autotransplantation can completely remove the tumors,maximize the preservation of renal function and minimize the trauma of patients,making the ultimate means of nephron-sparing surgery for patients with complex renal tumors more minimally invasive and safe.

Objective To explore the feasibility of robot-assisted laparoscopic inferior vena cava (IVC) thrombectomy in treating renal tumor with Mayo level Ⅲ-Ⅳ inferior vena cava thrombus.Methods From November 2014 to January 2017,5 cases of renal tumor with Mayo level Ⅲ-Ⅳ inferior vena cava tumor thrombus were treated with robot-assisted surgery.There were 4 males and 1 female with the median age of 59 years (range 54-71 years).Four cases had the renal tumor on the right side and one on the left side.The mean tumor size was 6.8 cm (range 5-9 cm) with 3 cases of T3b and 2 cases of T3c.There were 4 cases of level Ⅲ and 1 case of level Ⅳ inferior vena cava thrombus with the median length of 9 cm (range 7-11 cm).The surgical procedure for Mayo level Ⅲ inferior vena cava thrombus included mobilization of both left and right robes of liver,subsequently controlling the suprahepatic infradiaphramatic IVC and first porta hepatis simultaneously.The surgical procedure for Mayo level Ⅳ inferior vena cava thrombus included cardiopulmonary bypass by multi-disciplinary cooperation among urologists,hepatobiliary and cardiovascular surgeons.The procedures included live mobilization,control of the superior vena cava and first porta hepatis and remove thrombus in the atrium and IVC respectively.Results All operations were completed successfully.The median operative time was 440 min (320-630 min).The blood recovery device was used and the intraoperative estimated blood loss was 2 500 ml (500-6 000 ml) and all cases required intraoperative blood transfusion.The median time of intraoperative occlusion of IVC was 35 min (25-50 min).All patients were transferred to the intensive care unit for median of 4 days (2-8 days) after surgery.The median time to remove the postoperative drainage tube was 9 days (7-12 days).Postoperative pathological diagnosis revealed 5 cases of clear cell carcinoma.Postoperative renal dysfunction occurred in 3 patients and liver dysfunction occurred in 2 patients who improved after medical therapy.During median 19.6 months (12-48 months) of follow-up,1 patient died and 1 patient progressed.Conclusions Despite the high risk of surgery,robot-assisted laparoscopic IVC thrombectomy for renal tumor with Mayo level Ⅲ-Ⅳ thrombus is feasible for experienced surgeons in selected patients.However,the oncological outcomes need further investigation.