Hemorrhagic transformation(HT) is the most severe complication after tissue-type plasminogen activator (tPA) thrombolysis. It greatly limits the clinical application of tPA. Early blood-brain barrier ( BBB) damage may be an important mechanism for HT. Maintaining the integrity of BBB can significantly decrease the risk of HT. This article review s the roles, mechanisms, and preventive measure of early BBB damage in HT after tPA thrombolysis.

Blood-brain barrier (BBB) injury is an important pathological change of ischemic stroke.Occludin constitutes the major component of the tight junction of BBB, which plays a significant role in maintaining the BBB integrity.Cerebral ischemia initiates occludin degradation through the induction of the activation of inflammatory mediators, reactive oxygen, and matrix metalloproteinases, and causes the changes of tight junction cytoskeletal protein interaction, resulting in BBB integrity destruction and increased permeability.This article mainly elaborates the relationships of occludin with BBB, brain edema and hemorrhagic transformation, as well as the possibility of occludin as an intervention target for ischemic stroke.

Atherosclerosis ; Humans ; Urotensins

Objective To investigate the curative effect of transpedicular screw fixation plus percutaneous vertebroplasty (PVP) for treatment of severe thoracolumbar osteoporotic vertebral compression fractures (OVCF).Methods Twenty-one patients with severe OVCF presenting to our hospital from July 2012 to May 2015 were analyzed retrospectively.There were nine male and twelve female patients,aged 50-78 years (mean,68.8 years).The level of injury was T1 1 in four patients,T12 in six,L1 in five,L2 in three,L3 in two and L4 in one.Time between injury and surgery was 2-16 d (mean,7.5 d).All patients underwent pedicle screw fixation at the injured level combined with PVP.Visual analogue scale (VAS) was used for evaluation of lower back pain after operation,Oswestry disability index(ODI) for lower back function,lateral thoracolumbar film for Cobb angle and anterior vertebral height compression ratio,and American Spinal Injury Association (ASIA) score for spinal cord nerve function.Postoperative complications were recorded.Results All patients were followed up for 12-21 months [(15.7 ± 2.9) months].Postoperative studies showed significant differences in VAS [(2.9 ± 1.1) scores],ODI [(30.8 ± 7.5) ％],Cobb angle [(21.5 ± 7.3) °] and anterior vertebral height compression ratio [(44.3 ± 13.9) ％] compared to the preoperative measures (P ＜ 0.05).Cobb angle and anterior vertebral height compression ratio at the final follow-up were (23.4 ± 7.7)° and (49.1 ± 13.7)％ respectively,and had no significant differences from the postoperative measures (P ＞ 0.05).According to the ASIA score,eight patients with neural function injury had one to two level recovery at the final follow-up.Asymptomatic cement leakage occurred in seven patients after operation.There was no internal fixation breakage at the final follow-up.Conclusions Transpedicular screw fixation plus PVP can not only restore the height and strength of the injured vertebrae and correct kyphotic deformity,but also relieve low back pain and improve function of the spine.Therefore,the technique is a safe,reliable and effective surgical treatment for severe thoracolumbar OVCF.

Objective:To study the interaction of the inflammatory cytokines expression between CD4+ T cells and primary human umbilical vein endothelial cells (HUVECs) infected by dengue virus (DENV-2).Methods:PBMC was extracted from white blood cells by density gradient centrifugation,CD4+ T cells were sorted by immunomagnetic beads.The expression of CD3 and CD4 molecules on the surface of cells was detected by flow cytometry to identify the purity of CD4+ T cells.First,HUVECs were pretreated by specific-S1 P1 receptor agonist CYM-5442 for 24 h,second,infected by DENV-2 on the titer of 103 TCID50,then co-culturing with CD4+ T cells,The relative expression of NS1 partial sequence and IL-6,L-8 mRNA of HUVECs,and IL-4,IL-17,TNF-α,IFN-γ of CD4+ T cells detected by Real-time RT-PCR.IL-6 and IL-8 secreted in cultured supematant analyzed by ELISA.Results:The purity of CD4+ T cells was (98.02±0.32) ％.The expression of NS1 gradually increased to 24 h (3.03±0.26,P＜0.001),decreased after reaching the peak.The relative expression of NS1 in the group of co-cultured with CD4+ T cells was lower than other groups.After infection,the expression of IL-6 and IL-8 were up-regulated,and the expression of IL-6 and IL-8 at each time point was significantly increased after co-culturing with CD4+ T (P＜0.01).IL-6 of CYM-5442 pretreatment group,in 24 h (28.91±2.34,P＜0.05),36 h(19.36±0.1,P＜ 0.05) and 72 h(13.84±0.82,P＜0.05) was significantly decreased,the expression of IL-8 also decreased significantly.The mRNA expression of IL-4,IL-17,TNF-α and IFN-γ in CD4+ T cells was significantly increased after co-culturing with HUVECs.After the treatment with CYM-5442 group,the expression was decreased.Conclusion:DENV-2 could infect the primary HUVECs,and the expression of NS1 was inhibited after co-culturing with CD4+ T cells.CD4+ T cells can not only enhance the activation of HUVECs infected by DENV-2,but also can be activated by the infected HUVECs infected with DENV-2.

Objective To summarize the clinical characteristics and evaluate the feasible treatments of primary breast lymphoma (PBL).Methods The clinical data of 34 PBL patients (age 24-79 years) who were treated in our hospital between April 2006 and December 2013 were reviewed.Of these 34 patients, 18 had stage ⅠE PBL and 16 had stage ⅡE PBL.Pathological types included diffuse large B cell lymphoma (29 patients), anaplastic large cell lymphoma (2 patients), marginal zone lymphoma (2 patients), and mantle cell lymphoma (1 patient).Two patients underwent surgery, four patients received chemotherapy alone, five patients received chemoradiotherapy, fourteen patients underwent surgery plus chemotherapy, and nine patients underwent surgery plus chemoradiotherapy.The 5-year overall survival (OS) and progression-free survival (PFS) rates were determined by the Kaplan-Meier estimator.Results During follow-up, 26 patients were alive without lymphoma and 8 patients had died by the end of follow-up (7 died from lymphoma and 1 died from chemotherapy-related hepatic failure).Among the 6 patients who relapsed, 5(83.3%) had recurrence within the first 2 years of treatment.In particular, 1 patient who had bilateral breast involvement developed left breast relapse after bilateral mastectomy and chemotherapy, 2 patients had bone marrow metastasis, 1 patient had lung and mediastinal lymph node metastases, and 2 had skin relapse.The 5-year OS and PFS rates of all patients were 75% and 75%, respectively.Conclusions Since PBL is a rare malignancy, its overall prognosis is fair and the incidence of local relapse is low with chemotherapy alone or in combination with other treatments.However, further studies on the development of more effective treatments will be required for patients who have failed the existing treatments.

Abstarct:Objective To evaluate mid-term efficacy and complications of Prestige LP cervical disc arthroplasty ( CDA) for treatment of single-level cervical spondylotic myelopathy .Methods Retrospectively analyzed the clinical data of 29 patients who underwent Prestige LP cervical disc arthroplasty from June 2009 to December 2013 and were followed up for 2 to 6 years.Among them, there were 19 males and 10 females, and the average age was (45.4 ±7.6)years old (ranged from 28 to 58 years old).Cardinal symptom of spinal compression occured in 20 cases of them,and nerve root compression occured in the other 9 cases.Clinical symptoms and functional outcomes were evaluated with Japanese Orthopaedic Association(JOA) scores,neck and arm visual analog scale(VAS) scores,and Neck Disability Index(NDI).Oerpation segmental range of motion(ROM) were evaluated with follow-up dynamic X-ray.Displacement,subsidence of the prosthesis,heterotopic ossifi-cation(HO) and other complications were also investigated .Results The 29 patients were followed up for 24 to 66 months,(35.5 ±10.4) months averagely .At the final follow-up,the JOA score,NDI,Neck-VAS and Arm-VAS were (15.62 ±1.12) points,(14.65 ±5.68)%,(1.93 ± 1.10) points,and (0.76 ±0.99) points respectively,which were significant improved compared with (12.03 ±2.23) points,(42.52 ± 16.31)%,(5.00 ±2.22) points,and (4.59 ±3.18) points preoperatively,and the differences were of statistical significance (P<0.05). The opreation segmental ROM was (7.37 ±3.11)°,which was better remained compared with (8.50 ±3.35)°before operation.After the surgery,there were 1 case of forward displacement ,3 cases of backward displacement ,1 case of subsidence of the prosthesis ,3 cases of adja-cent segment degenerations ,and 14 cases of heterotopic ossification .Conclusion The mid-term efficacy and safety of Prestige LP cervical disc arthroplasty is fine .But there is a high incidence of the prosthesis-related complications which may counteract the function of protecting the adjacent segment .Therefore,the indication,operation skills and perioperative period management of cervical disc arthroplasty are impor -tant aspects to avoid the adverse effect .

Objective To compare the dosimetric parameters between the use of Tandem and Ring (TR;Nucletron#090.617) or Tandem and Ovoid (TO;Nucletron#189.730) applicators during three-dimensional (3D) high-dose rate (HDR) brachytherapy (BT) for cervical cancer.Methods The records of 40 cervical cancer (ⅡB-ⅣA) patients treated with 3D-image-guided HDR-BT were reviewed.Of these 40 patients, 20 were treated with the TO applicator, and 20 with the TR applicator.The D100% and V150% of the clinical target volume (CTV) and the D2 cc of organs at risk (OAR)(the rectum, bladder, and small intestine) during 3D-HDR-BT using TO and TR were compared using the independent sample t-test.ResultsOverall metrics:CTV volume:66.04±13.86 cm3(TR) vs.65.67±15.08 cm3(TO)(P=0.052);CTV D100:3.71±0.34 Gy (TR) vs.3.37±0.49 Gy (TO)(P=0.016);CTV V150%:0.54±0.02(TR) vs.0.56±0.04(TO)(P=0.034);rectum D2 cc:3.38±0.30 Gy (TR) vs.2.95±0.80 Gy (TO)P=0.037);bladder D2 cc:4.33±0.39 Gy (TR) vs.2.93±1.27 Gy (TO)(P=0.00);and small ntestine D2 cc:3.04±1.02 Gy (TR) vs.3.41±0.57 Gy (TO)(P=0.171).Conclusions TR has better CTV coverage than TO during 3D HDR brachytherapy for cervical cancer.In addition, D2 cc of the rectum and bladder were both igher with TR than with TO, though there is no significant dosimetric difference in the small intestine between the two applicators.Therefore, tumor location, extent of invasion, and vaginal conditions should be considered when selecting the suitable pplicator for the treatment of cervical cancer.

Objective To study the diagnosis value of serum retinol binding protein (RBP),cystatin C(Cys C) and β2 microglobulin (β2-M) in early renal injures of gcstational diabetes mellitus (GDM) patients.Methods 85 case of GDM pregnant women admitted to Shiyan Maternal and Child Health-Care Hospital from Jan.2009 to Jan 2015 were chosen as research objects,and were divided into simple diabetes group (35 cases),micro proteinuria group (30 cases) and massive proteinuria group (20 cases) according to the urinary albumin excretion rate (UAER),while 30 cases of healthy pregnant women were recruited randomly during the same period as control group.The 24h urine protein,serum RBP and renal function indicators [blood urea nitrogen (BUN),creatinine (Ser),Cys C and β2 M],the positive rates of RBP,Cys C,β2-M and combined detection of RBP,Cys C,β2-M of the four groups were compared.Results The 24h urine protein in simple diabetes group,micro proteinuria group and massive proteinuria group were significantly higher than that in the control group (t=3.91～ 16.33,all P＜0.01),the difference between the 3 groups were statistically significant (t=6.78～ 16.94,all P＜0.01).The levels of BUN,Scr,Cys C,β2-M and RBP in micro proteinuria group and massive proteinuria group were significantly higher than those in control group and simple diabetic group (t=3.68 ～ 18.54,all P＜0.01),there were significant difference in above indexes between micro proteinurine group and massive proteinuria group (t=4.70～ 10.87,all P＜0.01).The positive rates of RBP,Cys C,β2-M and combined detection of RBP,Cys C and β2-M in micro proteinuria group and massive proteinuria group were significantly higher than those in control group and simple diabetic group (x2 =20.27～38.57,all P＜0.01).There was no significant difference in the positive rates between micro proteinuria group and massive proteinuria group (x2 =0.62～0.93,all P＞0.05).The positive rate of combined detection of the three indicators was higher than that of the single detection in the same group (x2=3.97～6.65,P＜0.05 or P＜0.01).Conclusion The detection of serum Cys C,RBP and β2-M has a high clinical value in the diagnosis of early renal damage in patients with GDM.The positive rate of combined detection of 3 indexes was higher than that of single index.

Objective To study the characteristics of neonatal sepsis caused by gram positive (G +) bacteria,gram negative (G+) bacteria and fungi.Method Clinical data of 202 neonates with sepsis hospitalized from Jan.2012 to May.2015 were studied.According to the different pathogens,202 neonates were divided into gram positive bacteria group,gram negative bacteria group and fungi group.The general information,clinical manifestation,laboratory examination and treatment outcome of the three groups were analysed with Chi square analysis,LSD,Fisher exact probability tests.Result A total of 202 cases of neonatal sepsis were recruited.The detection rate of gram positive bacteria,gram negative bacteria and fungi was 35.2％ (71 cases),56.4％ (114 cases) and 8.4％ (17 cases),respectively.Comparing with gram negative group and fungi group,gram positive group had older gestational age (36.0 ± 3.8 w,compared with gram negative 33.0 ± 3.9 w,fungi group 31.2 ± 3.2 w,P ＜ 0.05),larger birth weight (2 620 ± 925 g compared with gram negative group 1 999 ± 849 g,fungi group 1 595 ± 666 g,P ＜ 0.05),lower nosocomial infection rate (29.6％ compared with gram negative group 70.2％,fungi group 94.1％,P ＜0.05),lower rate of shock,blood glucose disturbance and thrombocytopenia (P ＜ 0.05).There was no statistics difference between the gram negative group and fungi group.Comparing with the other two groups,fungi group was older [20.0 (11.5,39.5) d compared with gram positive group 7.0 (2.0,17.0) d,and gram negative 10.0 (6.0,18.2) d,P ＜ 0.05].The rate of deep venous catheterization in fungi group was higher than that in gram positive group and gram negative group (88.2％ compared with gram positive group 25.4％,gram negative group 40.4％,P ＜0.05).The treatment course of fungi group was longer than that of the gram positive group and gram negative group [22.0 (12.0,37.5) d compared with the gram positive group 14.0 (10.0,17.0) d,gram negative group 14.0 (11.0,18.0) d,P ＜0.05].The incidence of apnea in the gram negative group was higher than that in gram positive group and fungi group (P ＜ 0.05).The rate of leukocytosis,leukocytopenia and elevated CRP were higher in gram negative and gram positive group (P ＜ 0.05).Conclusion The clinical manifestations and laboratory examinations in neonatal sepsis caused by different pathogens were different,which can help to early identification of different pathogenic infections.However,there is no specific indicators to differentiate neonatal sepsis caused by different pathogens.Early identification of the pathogen needs clinical acumen.