[Objective] The aim of the present study was to investigate the role of membrane estrogen receptor (mER) mediated pathway in the proliferation and apoptosis of endothelial progenitor cells (EPCs). [Methods] Bone marrow (BM)-derived EPCs were cultured. The cells were divided into different groups, plus or not plus estrogen receptor blocker (ICI 182,780), PI3K inhibitors (LY294002), and NOS inhibitor (L-NAME) to show the effect of E_2-BSA on EPCs. The proliferation of EPCs was determined by MTT and nitric oxide (NO) release was measured by chromatometry. Apoptotic cell death was determined using the Hochest 33258 staining. The expression of phosphorylated eNOS (p-eNOS) were detected by Western blot. [Results] E_2-BSA could increase EPCs proliferation, and this effect was inhibited by estrogen receptor blocker ICI 182,780, thus indicated that mER-initiated membrane signaling pathways were involved in the action of estrogen on EPCs. E_2-BSA increased nitric oxide production and inhibited apoptosis induced by serum withdrawal, and this effect also inhibited by PI3K inhibitor (LY294002), NOS inhibitor (L-NAME)and estrogen receptor blocker(ICI 182,780), thus indicated that PI3K/Akt/NO pathway was involved the effect of estrogen on EPCs apoptosis. Moreover, E_2-BSA treatment increased phosphorylation of eNOS (p-eNOS). PI3K inhibitors (LY294002) also blocked these effects. [Conclusions] The results of present study suggested that mER mediated EPCs proliferation and apoptosis were related to the PI3K/Akt/eNOS pathway.

AIM: To investigate the effect of 17?-estradiol(E2) on myocardial hypertrophy induced by endothelin-1(ET-1) and the related mechanism.METHODS: Myocardial cells from neonate rats were cultured in vitro and myocardial hypertrophy model was established with ET-1.The effects of 17?-estradiol on myocardial hypertrophy were observed.The role of ERK1/2 in the effects of 17?-estradiol was also detected.RESULTS: Compared with control group,ET-1 increased cell protein content,cell surface area and -Leucine(-Leu) incorporation.Pretreatment with E2 for 24 h could inhibit the increase in cell protein content,cell surface area and -Leu incorporation induced by ET-1.ET-1 significantly stimulated ERK1/2 activity,which was prevented by pretreatment with E2.Tamoxifen,estradiol receptor antagonist,partially inhibited the effect of E2.The ability of ET-1 to stimulate -Leu incorporation was significantly blocked by PD98059,which could enhance the inhibitory effect of E2 on the increase of -Leu incorporation in cardiomyocytes induced by ET-1.CONCLUSION: E2 can inhibit cardiomyocyte hypertrophy induced by ET-1.This effect is mediated by estrogen receptor.ERK1/2 signal pathway is closely correlated with the inhibitory effect of E2 on cardiomyocyte hypertrophy induced by ET-1.

Objective To investigate the clinical characteristics of cognitive impairment in the patients with asymptomatic unilateral severe internal carotid artery stenosis (ICAS). Methods A total of 80 patients with unilateral severe carotid stenosis (stenosis rate ≥70%)and 40 patients without carotid stenosis (control group)diagnosed by digital substract angiography (DSA)were analyzed retrospectively. According to the stenotic sides,the patients with severe ICAS were divided into a left stenosis group and a right stenosis group (n = 40 in each group). The North American Symptomatic Carotid Endarterectomy Trial (NASCET)criteria were used to grade the degree of stenosis. Montreal cognitive assessment (MoCA)was used to evaluate the cognitive function of the patients,and then the cognitive function of the patients in 3 groups was assessed. Results The MoCA total scores,visuospatial and executive functions,and language ability,and delayed memory scores of the patients in both left and right groups were lower than those of the control group. There were significant differences (21. 8 ± 3. 1,3. 4 ± 1. 3,1. 8 ± 0. 6,and 1. 6 ± 1. 3,respec-tively in the left stenosis group;22. 6 ± 2. 5,3. 5 ± 1. 1,1. 9 ± 0. 6,and 1. 7 ± 1. 4,respectively in the right stenosis group;and 26. 4 ± 1. 8,4. 2 ± 0. 9,2. 7 ± 0. 6,and 3. 8 ± 1. 0,respectively in the control group;all P < 0. 01). There were no significant differences in naming,attention,abstract ability,orientation ability scores compared with the control group (all P > 0. 05). There were no significant differences in the MoCA total scores and each single test score of the patients between the left stenosis and the right stenosis groups (P > 0. 05). Conclusion The patients with asymptomatic unilateral severe ICAS have cognitive impairment generally;it is characterized by delay memory,visuospatial and executive functions,and language dysfunction.

Objective To explore the relationship of GFAP, NDKA and PARK7 serum concentrations of patients with IS, and their diagnose and prognosis value in IS. MethodsThe serum concentrations of GFAP, NDKA and PARK7 were detected in 37 IS patients, 28 ICH patients and and 30 healthy persons by ELISA. These indexes of patients were detected in 12 hours, 3 d and 14th day after onset of ischemic stroke. Their neurological injury status were also evaluated by MESSS at corresponding time points, and their activities of daily living were evaluated by BI at 14 d discharge from hospitaL At the same time, the diagnostic efficiency was analysed for IS using the three biomarkers and the combined detection. ResultsIn IS group, the serum concentrations of GFAP in 12 hours, 3rd and 14th day after onset were (5. 49 ±2. 25 )μg,/L, (5. 17 ± 2. 29) μg/L and (5. 96 ± 2.39 ) μg/L, respectively. The serum concentrations of NDKA were 9. 15(6.28 -12.79) μg/L, 9. 13(6.31 - 12.23) μg/L, 9.31(6.40 - 11.83) μg/L respectively,and the serum concentrations of PARK7 were (32. 71 ±6. 34 ) μg/L, (31.23 ±6. 04) μg/L, (32. 79 ±6. 94) μg/L respectively. The serum levels of GFAP, NDKA and PARK were respectively (4. 62 ± 1. 56)μg/L, 4. 24(3. 30 -5. 61 ) μg/L, ( 14. 25 +2. 65) μg/L in healthy control group. The levels in IS groups were remarkably increased compared with the healthy control group except the level of GFAP in the 3rd day (t = 1. 129, P＞0. 05). The levels in other time points were significantly different between patients group and healthy control. t value of GFAP were respectively 2. 642, 1. 870,P＜0. 05; Z value of NDKA were 6. 173, 6.100, 6.278,P ＜0. 01; t value of PARK7 were 14.964, 15.367,16.060, P ＜0. 01. The specificity and sensitivity of the individual detection for diagnosis of IS was 46. 7％ (14/30) and 81.1％( 30/37 ) for GFAP, 90. 0％ ( 27/30 ) and 78.4％ ( 29/37 ) for NDKA, 96. 7％ (29/30) and 97.3％ ( 36/37 )for PARK7. The specificity and sensitivity for combined detection of 3 biomarkers was 96. 7％ (29/30) and 100％ (37/37). The combined detection achieved better specificity and sensitivity. Moreover, the risk of IS with higher level GFAP was 1. 3 times that of the controls ( OR = 1. 300, P = 0. 044 ). The risk of higher NDKA was 1.7 times higher( OR = 1. 668, P = 0. 036 ). The risk of higher PARK7 was 1.8 times higher (OR = 1. 809, P =0. 005 ). The serum levels of GFAP were significantly different between IS and ICH in 12 h(t= 4.097, P=0.000). The serum concentrations of GFAP, NDKA and PARK7 were positively correlated with MESSS score at different time points. In IS, r value were 0. 534, 0. 482, 0. 357 , P ＜ 0. 05at less than 12 h; r value were 0.433, 0.487, 0. 299,P value were 0. 007, 0. 002, 0.073 at 3 d;r value were 0. 394, 0. 200, 0. 084,P value were 0.016, 0. 236, 0.620 at 14 d. And the serum levels of GFAP,NDKA and PARK7 were negatively correlated with BI score at 14th day, r value were -0. 430, -0. 321,-0.076,P value were 0.044,0.050,0.657. Conclusions The concentrations of GFAP, NDKA and PARK7 in serum are closely related with IS. The increased seruro levels of these indexes are risk factors in IS. The detection of these indexes could be helpful for the early diagnosis, timely treatment and prognosis assessment for IS.

Objective To investigate the relationship between the evaluation of cerebral perfusion with CT perfusion (CTP)imaging and cognitive impairment in patients with asymptomatic severe internal carotid stenosis. Methods A total of 104 patients with asymptomatic severe unilateral internal carotid artery origin stenosis (the unilateral stenosis rate ≥70% and the contralateral stenosis rate < 30%)were enrolled respectively. After conducting Montreal Cognitive Assessment (MoCA)scores,they were divided into a non-cognitive impairment group (n = 24;MoCA ≥26)and a cognitive impairment group (n = 80;MoCA <26). All patients were performed digital subtraction angiography (DSA)and / or CT angiography (CTA)examinations. Their unilateral severe stenosis was confirmed,and they underwent brain CTP examinations. The relative cerebral blood flow (rCBF),relative cerebral blood volume (rCBV),relative mean transit time (rMTT),and relative time to peak (rTTP)were calculate by CTP. The presence rate of collateral circulation in 96 patients was calculated by DSA. The presence rate of collateral circulation,and relative perfusion parameters of the 2 groups were compared. Results (1)The MoCA score in patients of the non-cognitive impairment group was 27. 8 ± 1. 7,and the MoCA score in patients of the cognitive impairment group was 21. 4 ± 3. 1. There was significant difference between the 2 groups (t = 17. 959, P <0. 05). (2)The rate of 96 patients having collateral circulation was 68. 4% (52 / 76)in the cognitive impairment group,and in the non-cognitive impairment group was 60. 0% (12/ 20). There was no significant difference (P >0. 05). The CTP parameters rMTT,rTTP,rCBV,and rCBF in the non-cognitive impairment group were 1. 074 ± 0. 066,1. 103 ± 0. 032,1. 045 ± 0. 021 and 1. 066 ± 0. 040,respectively;the CTP parameters rMTT,rTTP,rCBV,and rCBF in the cognitive impairment group were 1. 241 ± 0. 169, 1. 328 ± 0. 248,1. 046 ± 0. 030,and 1. 093 ± 0. 058,respectively. The rTTP and rMTT of the cognitive impairment were longer than those of the non-cognitive impairment group. There were significant differences in rTTP and rMTT between the 2 groups (P < 0. 05),but there were no significant differences in rCBF and rCBV between the 2 groups (P >0.05). Conclusion Most of the patients with asymptomatic severe internal carotid stenosis has cognitive impairment,and cerebral perfusion caused by stenosis is significantly slower in patients with cognitive impairment than in those with noncognitive impairment.

Objective To investigate the related factors of the prognosis of arterial embolectomy of acute cardiogenic cerebral embolism caused by atrial fibrillation.Methods The clinical data of using vein thrombolysis bridging artery embolectomy or arterial embolectomy alone for the treatment of patients with acute cardiogenic cerebral embolism of cerebral large artery occlusion due to atrial fibrillation were analyzed retrospectively.From January 2015 to December 2016,22 consecutive inpatients with cardioembolic cerebral embolism caused by paroxysmal or persistent atrial fibrillation were enrolled,including 10 patients with the 90-day modified Rankin Scale (mRS) score 0-2 (good recovery group) and 12 patients with mRS scores 3-6 (poor recovery group).The clinical features,imaging data,and treatment of the patients in both groups were compared.The factors such as age,gender,preoperative international standardization ratio (INR),embolism position,whether bridging vein thrombolysis before thrombectomy,National Institutes of Health Stroke Scale (NIHSS) score at the onset,time of onset to reperfusion (TOR),whether using tirofiban,times of thrombectomy,modified Thrombolysis In Cerebral Infarction (mTICI) blood flow grade,and postoperative intracranial symptomatic intracerebral hemorrhage were analyzed.Results There were no significant differences in age,gender,preoperative INR,embolism position,the number of intravenous thrombolysis before thrombectomy,the number of using tirofiban in surgery,the proportion of the above mTICI 2b grade,and the proportion of symptomatic cerebral hemorrhage after surgery of the patients between the two groups (P>0.05).The NIHSS score 15.2±2.0 at the onset in the good recovery group was lower than 22.9±8.4 in the poor recovery group.There was significant difference between the two groups (P<0.05).The TOR time (307±86 min) in the good recovery group was less than that of the poor recovery group (426±145 min).There was significant difference between the two groups (P<0.05).Embolectomy was performed 1.5 (0.5,3.0) times in the good recovery group,which was less than the poor recovery group (4.0 [2.0,7.0] times).There was significant difference between the two groups (P<0.05).Conclusions Shortening the time of reperfusion and reducing the number of embolectomy during operation are the important factors for improving the prognosis of patients when atrial fibrillation causes arterial embolectomy in patients with acute cerebral embolism.However,a study of larger sample is needed for further exploration.

OBJECTIVETo investigate the causes and strategy of difficult intraarterial mechanical thrombectomy (≥3 times) in patients with acute ischemic stroke (AIS).

METHODSThe clinical data of 8 cases of AIS with thrombectomy ≥3 times admitted in Department of Neurology, the 306(th) Hospital of People's Liberation Army from June to October in 2015 was analyzed retrospectively. There were 7 male and 1 female patients, aged from 38 to 86 years with an average age of (70±15) years, in which 5 cases were cardiogenic cerebral embolism and 3 cases were large artery atherosclerotic infarction. The National Institute of Health stroke scale (NIHSS) score (M (QR)) was 16 (12) before procedure and modified thrombolysis in cerebral infarction (mTICI)score were 0 in all the patients. Solitaire AB was used in thrombectomy in the occlusion of the arteries.

RESULTSThe causes of difficult intraarterial thrombectomy included multiple thrombus, tortuosity in vascular paths, guiding catheter being placed below the internal carotid artery siphon leading to weak strength of suction and support of stent, embolus dropping in the thrombectomy and inadequate anesthesia. After successful thrombectomy 3 cases had mTICI score of 2a, 4 cases of 2b, 1 case of 3. The NIHSS score was 5 (24) at 7(th) day after treatment. At the 90-day follow-up 5 patients had good prognosis (modified Rankin score 0 to 2) and 3 had disability (modified Rankin score 3 to 4).

CONCLUSIONCases of AIS with difficult intraarterial thrombectomy can be treated by improving thrombectomy materials and technique, reasonable anesthesia and perioperative medication in decision-making strategy.

Adult ; Aged ; Aged, 80 and over ; Carotid Artery, Internal ; pathology ; Female ; Humans ; Intracranial Embolism ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Stroke ; surgery ; Thrombectomy ; Treatment Outcome

Objective ToinvestigatethecorrelationbetweenCTimagingfindingsoflungadenocarcinomaandepidermalgrowth factorreceptor(EGFR)genemutation.Methods Theclinicaldataof150lungadenocarcinomapatientsinthehospitalfrom October 2015toOctober2017werecollectedretrospectively.AccordingtotheEGFRgenemutation,thepatientsweredividedintononeffectivemutation group (n=78)andeffective mutationgroup (n=72).Univariateanalysisand multivariate L o g istic regression modelwereperformed toexplorethepredictionsignsofeffectiveEGFRgenemutationinlungadenocarcinoma.Results Univariateanalysisshowedthatthe proportionsoffemalepatients,smokinghistory,CTfindingsofspiculesign,necroticsign,pleuralindentationandnonfibrosisin theeffectivemutationgroupweresignificantlyhigherthanthoseinnoneffectivemutationgroup(P<0.05).However,therewereno significantdifferencesbetweenthesetwogroupsinage,diameteroflesions,locationoflesions,densityoflesions,lobulatedsign, cavitation sign ,air bronchogram and pleuralthickening sign (P>0 .05 ).M ultivariate L o g istic regression analysis showed thatfemale (OR=2.612),spiculesign(OR=2.476),necroticsign(OR=2.846),pleuralindentation(OR=2.221)andnonfibrosis(OR=2.476)were independentpredictorsofeffectiveEGFRgenemutationinlungadenocarcinoma(P<0.05).Conclusion FemaleandlungadenocarcinomaCT findingsofspiculesign,necroticsign,pleuralindentationandnonfibrosisarerelatedtoEGFRgenemutation,whichisofgreatsignificanceto distinguishingwildtypefrom mutanttypeofEGFRgeneandguidingtheclinicaltreatment.

Objective:To compare the efficacy of metaphyseal expansion and non-expansion when using proximal femoral nail antirotation（PFNA）in the treatment of severe osteoporotic intertrochanteric fracture in the elderly.Methods:A retrospective case-control study was conducted to analyze the clinical data of 66 elderly patients with severe osteoporotic intertrochanteric fracture admitted to Honghui Hospital, Xi'an Jiaotong University from January 2019 to January 2020, including 49 males and 17 females. The age ranged from 75 to 89 years［（80.9±3.3）years］. The AO types of fractures were 31-A1 in 23 patients, 31-A2 in 22 and 31-A3 in 21. A total of 34 patients were stabilized by the PFNA technique with metaphyseal expansion（metaphyseal expansion group）and 32 patients received PFNA fixation without metaphyseal expansion（metaphyseal non-expansion group）. The total blood loss, hidden blood loss, intraoperative blood loss, dominant blood loss, postoperative drainage, transfusion volume, transfusion rate, operation time, hospital stay and fracture healing time were compared between the two groups. The hip functional recovery was assessed by Harris hip score at 1, 3, 6 months postoperatively and at the last follow-up. The incidence of complications was observed.Results:All patients were followed up for 12-17 months［（13.5±1.1）months］. The total blood loss, hidden blood loss, intraoperative blood loss, dominant blood loss, postoperative drainage in metaphyseal expansion group were（976.3±210.1）ml,（712.4±224.4）ml,（139.4±21.0）ml,（263.8±36.3）ml,（124.4±29.5）ml respectively, significantly higher than those in metaphyseal non-expansion group［（799.0±119.5）ml,（603.0±136.4）ml,（94.1±18.8）ml,（195.9±35.4）ml,（101.9±27.5）ml］（ P<0.05）. The transfusion volume［2（0, 2）U］and transfusion rate［53%（18/34）］in metaphyseal expansion group ware increased compared to metaphyseal non-expansion group［0（0, 1.5）U, 25%（8/32）］（ P<0.05）. There were no significant differences in operation time, hospital stay, fracture healing time or hip Harris score at 1, 3, 6 months after surgery and the last follow-up between the two groups（ P>0.05）. No wedge-shaped distraction deformity, fracture nonunion, femoral head necrosis, wound infection, pulmonary embolism or fat embolism occurred in both groups. There was no significant difference in the incidence of iatrogenic lateral wall fracture, lower limb venous thrombosis or postoperative medical complications between the two groups（ P>0.05）. Conclusion:For elderly patients with severe osteoporotic intertrochanteric fracture, both PFNA with metaphyseal expansion and non-expansion can achieve satisfactory results, while the metaphyseal non-expansion is superior in perioperative blood loss and transfusion rate.

Objective:To investigate the clinical efficacy of neuroendoscopic hematoma removal versus soft channel drainage in the treatment of chronic subdural hematoma. Methods:The clinical data of 102 patients with chronic subdural hematoma who received treatment in Jincheng People's Hospital from May 2018 to May 2020 were retrospectively analyzed. They were divided into the neuroendoscopy group ( n = 50) and the soft channel group ( n = 52) according to different surgical methods. Perioperative indexes, hematoma clearance rate, China Stroke Scale score, the activity of daily living score, and oxidative stress indexes were compared between the two groups. All patients were followed up for 3 months. The incidence of complications during the follow-up period was calculated. Results:The retention time of the drainage tube in the neuroendoscopy group was shorter than that in the soft channel group [(2.45 ± 0.63) days vs. (3.30 ± 0.78) days, t = 6.06, P < 0.001]. The length of hospital stay in the neuroendoscopy group was shorter than that in the soft channel group [(7.14 ± 1.65) days vs. (9.07 ± 2.11) days, t = 5.15, P < 0.001]. The hematoma clearance rate at postoperative 7 days in the neuroendoscopy group was higher than that in the soft channel group [(93.45 ± 5.50)% vs. (81.86 ± 7.24)%, χ2 = 9.12, P < 0.001]. There were no significant differences in operation time and intraoperative blood loss between the two groups (both P > 0.05). At postoperative 30 days, the China Stroke Scale score in the neuroendoscopy group was lower than that in the soft channel group [(12.74 ± 2.23) points vs. (18.67 ± 2.45) points, t = 12.79, P < 0.001]. The activity of daily life score in the neuroendoscopy group was significantly higher than that in the soft channel group [(77.69 ± 7.11) points vs. (91.35 ± 7.25) points, t = 9.60, P < 0.001]. At postoperative 7 days, glutathione peroxidase level in the neuroendoscopy group was significantly lower than that in the soft channel group [(130.75 ± 13.66) U/L vs. (148.60 ± 14.64) U/L, t = 6.37, P < 0.001]. Malondialdehyde level in the neuroendoscopy group was significantly lower than that in the soft channel group [(5.11 ± 0.65) nmol/L vs. (6.19 ± 0.74) nmol/L, t = 7.83, P < 0.001]. Superoxide dismutase level in the neuroendoscopy group was significantly higher than that in the soft channel group [(275.60 ± 22.33) U/L vs. (254.60 ± 18.55) U/L, t = 5.15, P < 0.001]. There was no significant difference in the incidence of complications between the two groups ( P > 0.05). Conclusion:Compared with soft channel drainage, neuroendoscopic hematoma removal can obtain better short-term curative effects and less oxidative stress response in the treatment of chronic subdural hematoma. Neuroendoscopic hematoma removal does not increase the incidence of postoperative complications and is highly safe.