[Abstract ] Toll like receptor 4 (TLR4) is a key member of the Toll like receptor family , and is a major receptor for lipopo-lysaccharide ( LPS) .After stimulating with LPS , TLR4 activation could cause the release of a series of inflammatory factors , and acti-vate the immune response of the organism .In recent years , LPS/TLR4 signal transduction has been widely studied , and it has become the most important research hotspot in the inflammatory reaction and its control method .In this paper , we review the recent progress of molecules involved in TLR 4 signaling pathway and their regulatory mechanisms .

Objective To explore the influencing factors of gastrointestinal bleeding(GB) in secondary prevention patients with cerebral ischemic stroke(CIS).Methods A total of 616 patients were divided into bleeding group and control group according to the status (yes,no) of suffering GB during the 2years follow-up.Single factor analysis and Logistic regression analysis was used to explore the influencing factors of GB in CIS patients.Results The proportion of age≥65,a history of GB,gastric disease,renal insufficiency,sudden onset,NIHSS ≥12 and CIS ≥2 in the bleeding group was significantly higher than that in the control group (P ＜ 0.05) ; The proportion of combined with statins,proton pump inhibitors and gastric mucosal protective agent in the bleeding group was significantly lower than that in the control group (P ＜0.05) ; The Logistic regression analysis showed that age≥65,a history of GB,gastric disease,renal insufficiency,sudden onset,NIHSS≥12 and the times of CIS≥2 were risk factors of GB; however,combined with statins,proton pump inhibitors were protective factors.Conclusions Aging,a history of GB,gastric disease,sudden onset,higher NIHSS score and the times of CIS ≥ 2 were the risk factors of GB,combined with statins and proton pump inhibitors could reduce the risk of GB.

Objective:To study the short-term effects,toxic side effects and immune function of Aidi injection adjuvant GP methods chemotherapy for advanced non-small cell lung cancer(NSCLC).Methods:130 patients with advanced NSCLC were divided into study group and the control group according to treatment methods.The study group were given Aidi injection +GP,and the control group only treated with GP.The short-term effects,toxic side effects gradeⅢ-Ⅳand immune function changes were compared between the two groups.Results:The overall response rate was 40.28%in study group,higher than 37.93% in control group(P>0.05).The two groups showed differences in the rates of leucocyte decrease,gastrointestinal reaction and platelets decrease(P<0.05).The levels of CD4,CD8 and CD4/CD8 didn′t changed obviously in study group(P>0.05),while in the control group the levels of CD4,CD8 and CD4/CD8 changed more significantly than before(P<0.05).The two groups also produced differences in CD4,CD8 and CD4/CD8 after treatment( P<0.05 ) .Conclusion: The short-term effects of Aidi injection adjuvant GP chemotherapy regimen for advanced NSCLC is similar to only GP chemotherapy,but it can obviously reduce the incidence of toxic side effects and prevent the immune func-tion.

Objective To evaluate the clinical value of breast localization needle placed via mammary ductoscopy in surgical treatment of patients with intraductal neoplasms. Methods In this study,76 patients with intraductal neoplasms diagnosized by mammary ductoscopy from January 2009 to March 2010 in the Second Affiliated Hospital of Soochow University were randomly divided into two groups.For methylene blue group,ducts with the lesion were marked by methylene blue injection before operation.For localization needle group,ducts were marked by localization needle placed via ductoscopy.The operative time,specimen weight,incision length and diagnostic coincidence rate were compared among the two groups. Results Compared to the methylene blue group,the localization needle group had a significantly shorter operative time (31 ± 8 min vs.42 ± 9 min),lighter specimen weight (1.51 ± 1.36 g vs.2.95 ± 2.07 g),and shorter incision (23.2 ± 7.8 mm vs.34.4 ± 7.1 mm).All the breast cancer cases dianosised by mammary ductoscopy were confirmed by postoperative pathology,but the localization needle group had a higher diagnostic coincidence rate than the methylene blue group (94.7% vs. 76.3%). Conclusion Localization needle under mammary ductoscopy is a reliable technique for localizing intraductal neolasms.The surgical excision guided by localization needle is accurate and less traumatic,and should be a routine method marking the tumor involved duct before operation.

Objective To explore the scanning techniques of piriformis and different ultrasonographic characteristics of normal and abnormal piriformis.Methods A total of 40 cases diagnosed with unilateral piriformis syndrome underwent ultrasonic examination.Then ultrasonic scanning techniques of piriformis were summarized.Contours,thickness and smoothness of epimysium and ultrasonic echo of internal muscle texture of piriformis were compared between the normal and abnormal piriformis.The study was approved by the Third Affiliated Hospital Ethics Committee of Zhejiang Chinese Medical University (Approval no.ZSLL-JS-2016-18).Results Interruption of ultrasonic echo of ilium could be considered as ultrasonographic signs for locating piriformis quickly and accurately.Abnormal piriformis in suffering side of patients with piriformis syndrome showed obscure contours and being thicker than the other side [x2 =9.899,P =0.002;(25.81 ± 0.30)mm vs (22.29 ± 0.27)mm,t =13.604,P =0.000].Moreover,there were significant differences in comparing smoothness of epimysium and ultrasonic echo of internal muscle texture of piriformis between the two sides(x2 =23.226,P =0.000;x2 =54.848,P =0.000).Conclusions Interruption of ultrasonic echo of ilium may be an important sign for locating piriformis.Ultrasound can display piriformis clearly and distinguish ultrasonographic images of normal piriformis accurately from abnormal piriformis,which can be taken as an basis imaging for clinical diagnosis of piriformis syndrome.

Objective To explore the serum anti-Mullerian hormone (AMH) level in women of childbearing age with normal menstrual cycles. Methods A total of 1 423 women with regular menstrual cycles were selected and divided into 5 groups according to their ages, i.e.≤25, 26-30, 31-35, 36-40,≥41 years. Their serum levels of AMH were measured, and the relationship between AMH and age was analyzed. Results The serum AMH levels of 5 groups according to ages (≤25, 26-30, 31-35, 36-40, ≥41 years) were 3.62, 3.10, 2.27, 1.07, 0.45μg/L, respectively. The comparison of serum AMH levels in different age groups had significant difference (P<0.01). Serum AMH level declined with increasing age,and dropped significantly after 36. The serum AMH level and age showed a negative correlation with significant difference (r=-0.374, P<0.01). Quadratic regression of logAMH proximally reflected the relationship between AMH and age. Conclusion AMH determination for women of childbearing age could provide reference for the evaluation of ovarian function.

BACKGROUND: Hepatic myelopathy results from liver disease, which lacks of effective cure method. Liver transplantation has attempted to cure this disease; however, the long-term therapeutic effect is rarely reported. OBJECTIVE: To explore the long-term therapeutic effect of liver transplantation in patients with hepatic myelopathy. METHODS: The clinical data of 2 patients with hepatic myelopathy, who underwent orthotopic liver transplantation, in August 2002 and November 2004, at the 309 Hospital of Chinese PLA, were analyzed retrospectively. The time of follow-up was 18 and 43 months, respectively. The muscle strength of double lower limbs in 2 patients was assessed prior to and after operation. RESULTS AND CONCLUSION: Two patients recovered well at 4 weeks after transplantation, the clinical symptom and physical signs of patients were improved obviously, the blood routine examination and other biochemical index were normal,and the function of transplanted kidney was normal. Two patients discharged at 6 weeks after transplantation. Patient 1 could stand for a long time at months 6 after transplantation, walked slowly with the supporter after 12 months and without the supporter at 43 months. The muscular strength of two lower limbs was grade 4. And the liver function was normal. Patients 2 could move his lower limbs in bed at months 6 after transplantation, walked with the supporter at 18 months. The muscular strength of two lower limbs was grade 3. The liver function was normal. It demonstrated that liver transplantation is beneficial to control hepatic myelopathy and recover muscular strength of two lower limbs. It is a newly developed, effective curing method for treating hepatic myelopathy. However, the numbers were small with short time observation, thus, the long-term therapeutic effect still need to be explored.

Objective To investigate the correlation between neuronal injury and the expression of caspase-3 and caspase-activated deoxyribonuclease (CAD) after focal cerebral ischemia-reperfusion in rats, also to study the effect of caspase-3 particular inhibitor. Methods The focal cerebral ischemia model (occluding middle cerebral artery of the rats) was made by using modified inserting thread method and reperfusion after embolizing for one hour. Using HE staining, TUNEL staining and microscopy to observe the morphological changes of ischemic neurons at six different time points including 6,12,24,48 and 72 h, using immunohistochemistry to observe the changes of caspase-3 and CAD protein in two groups (model group and interfere group). Results There was no significant difference between the two groups using HE staining and microscopy. While there was difference of TUNEL staining positive cells in all time points, except 6 h time point; Both the two groups reached the expression peak of caspase-3 in 24 h, and the number was 2. 360± 0. 318 and 0. 804 ± 0. 206 respectively(t' = 10. 039, P < 0. 01), there was statistical significance from 12 h to 48 h between the two groups ; The expression peak time of CAD protein in two groups was 48 h, and the number was 3.061 ± 0. 567 and 0. 812 ± 0. 240 respectively (t' = 8. 960, P < 0. 01), there was statistical significance from 12 to 72 h between two groups. Conclusions Caspase-3-CAD-DNA degradation is one important way of neuronal injury in cerebral ischemia-reperfusion of rats, caspase-3 inhibitor can protect neuron in a certain degree.

Objective To study the chemical constituents of Abacopteris penangiana.Methods The compounds were separated and purified by various chromatographic techniques and their structures were elucidated on the basis of physiochemical properties and spectroscopic methods.Results Seven compounds were purified and their structures were identified as:(7'Z)-3-O-(3,4-dihydroxy phenylethenyl)-caffeic acid(1),caffeiein B(2),matteucinol(3),protocatechuic acid(4),p-methoxybenzoic acid(5),β-sitosterol(6),and daucosterol(7).Conclusion Compound 1 is a new phenolic acid compound named abacopteric acid,and the other compounds are isolated from the plant for the first time.

Objective To investigate the association of serum levels of matrix metalloproteinase-12 (MMP-12) and a functional polymorphism in the promoter - 82A/G of the MMP-12 gene with acute atherosclerotic cerebral infarction (ACI).Methods All 608 cascs of acute ACI and 374 healthy controls were included in the study.Serum levels of MMP-12 were measured using the enzyme-linked immunosorbent assay (ELISA). At the same time,polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was performed on the - 82A/G polymorphism in the MMP-12 gene.Results The serum levels of MMP-12 in ACI group (( 17.36 ± 9.12) ng/ml) were not significantly higher than those in the healthy control group ( ( 17.42 ± 7.70) ng/ml,t ＝ 0.047,P =0.962).The frequency of the AG + GG genotypes was not significantly different between the two groups (7.6％ vs 5.9％,x2 =0.281,P =0.584),and the frequencies of the G allele were 3.8％ and 2.9％ in the ACI group and the control group respectively which were also not significantly different between the two groups ( x2 =0.746,P =0.374).Conclusion There is no correlation between serum level with genetic polymorphism in MMP-12 promoter (-82A/G) and cerebral infarction.