Carotid endarterectomy (CEA) can effectively treat symptomatic carotid stenosis, however, perioperative stroke is the most important complication of CEA. The microemboli generated before and after the operation are the most important reason for causing perioperative stroke. In addition, the hypoperfusion and postoperative hyperperfusion syndrome caused by intraoperative clipping of carotid artery, as well as carotid restenosis or occlusion after CEA are all the causes of perioperative stroke. As a non-invasive, real-time monitoring tool, transcranial Doppler (TCD) can be widely used in intraoperative monitoring of CEA, It is able to detect a variety of perioperative blood flow changes and the production of microemboli, and thus effectively predicts the occurrence of perioperative stroke, and decreases the risks of perioperative stroke.

Objective To study the expression of immune and non-immune related cytokine in corneal grafts of chronic graft dysfunction after penetrating keratoplasty and reveal the possible mechanism of it.Design Clinical experimental study.Participants Including two groups.In chronic corneal allograft dysfunction(CCAD) group,corneas of 8 patients fulfilling the diagnostic criteria for CCAD who underwent repeated PK operation.Three normal corneas supplied by Shandong provincial eye bank of China were used as control group.Methods The conreal graft were analyzed by immunohistochemical studies.Moreover,the comprehensive analysis was carried out combining the patient's clinical data.Main Outcome Measures CD4~+,CD8~+,F4/80,TGF-?,bFGF and?-SMA in cornea. Results The results of immnunohistochemical studies showed that compared with normal corneas,full-thickness corneal grafts of eight corneas which underwent repeated PK operation had no CD4~+ and CD8~+ T lymphocyte infiltration.F4/80 positive inflammatory cells were more abundant near the stroma of five corneal grafts which underwent once PK operation.Full-thickness corneal grafts of other three corneas which underwent no immune rejection had no F4/80 positive inflammatory cells.The TGF-?positive inflammatory cells were more abundant near the epithelium and stroma of all corneal grafts.The moderate bFGF positive inflammatory cells were present in stroma of all corneal grafts.The?-SMA positive inflammatory cells were more abundant near stroma and the elastic layer of all corneal grafts.Conclusions After PK operation,the results of immnunohistochemical studies of the corneal graft which underwent CCAD showed that there is no evidence of clinical acute rejection.The abnormal expression of antigen presenting cells and non-immune cell specific factors suggest that immune or non-immune factors maybe involve in the occurrence and development of CCAD.

Objective: To study the chemical constituents of volatile oil from Radix Flemingiae philippinensis. Methods: The oil was obtained by steam distillation. The chemical compositions were separated and identified by GC/MS. The relative contents in the oil were determined by area normalization method. Results: Thirty-nine compounds were gotten from Radix Flemingiae philippinensis. The compounds of its relative content that was more than 4% were as follows: ?-himachalene (1), ?-himachalene (2), ?-himachalene (3), ?-guaiene (4), Italicene (5). Conclusion: Volatile oil by steam distillation from Radix Flemingiae Philippinensis was separated and ideutified up to 80 percent in component analysis.

Objective To summarize the clinical course of acute interstitial pneumonitis (AIP) associated pediatric acute respiratory distress syndrome (PARDS) in 8 recipients after liver transplantation,and further discuss the potential risk factors and therapeutic highlights.Methods A total of 476 pediatric patients received liver transplantation in Tianjin First Center Hospital from January 2012 to September 2016.Among them,8 cases of AIP associated PARDS in ICU were recruited in this study.Medical data including clinical presentation,ICU management and outcomes were analyzed retrospectively.Results The onset time-window of AIP associated PARDS was (2.67 ± 0.77) months after liver transplantation,and the time interval between initial symptom and ICU administration was (6.75 ± 5.82) days.Five cases had the history of acute rejection therapy,and 5 cases had CMV and/or EBV viremia history.All 8 cases received mechanical ventilation,2 cases given nasal non-invasive ventilation and the rest 6 cases given invasive ventilation,3 of which were switched to high frequency oscillatory ventilation (HFOV) combined with inhaled nitric oxide.At the stage of hypoxic climax,the fraction of inspired oxygen (FiO2) was up-regulated to 1.0 to maintain the oxygenation index (OI) of (25.24 ± 5.94).Temporary replacement of immunosuppressants with intravenous glucocorticoids was implemented in all 8 cases without acute rejection episode.Of 8 cases,2 cases died from PARDS,1 case died from portal thrombosis associated hepatic failure,and the rest 5 cases survived.Conclusion AIP associated PARDS is a critical complication with high mortality in pediatric patients after liver transplantation.Excessively strong immunosuppression therapy at early post-transplant stage shows a risk factor for AIP.Lung protective ventilation strategy and HFOV are recommended to reduce ventilator induced lung injury in pediatric patients.Temporary intravenous glucocorticoids may reduce acute inflammatory reaction in PARDS patients without increasing the risk of acute rejection.

AIM: To screen the binding proteins to HMGB1 promoter by phage display technique. METHODS: HMGB1 promoter was incubated with phage display library. Unbound phages were eluted and phages bound to HMGB1 promoter were amplified. Twenty individual clones were randomly selected and identified by enzyme-linked immunosorbent assay (ELISA). Positive clones were characterized by DNA sequencing and the sequences were subjected for computer analysis. RESULTS: Positive phages binding to HMGB1 promoter were enriched after 4 rounds of biopanning. Twenty phage clones were selected and eleven clones of which were identified to bind specifically to HMGB1 promoter. The sequences in full length were obtained and searched for homologous sequences from GenBank. Altogether eight coding sequences were obtained, six of which were known proteins including activator protein-1(AP-1) and two of which were uncharacterized ones. CONCLUSION: Several proteins were obtained that bind specifically with HMGB1 promoter. The results will be useful for further studying the expression and regulation mechanism of HMGB1.

Objective To investigate the role of extracellular regulated protein kinase (ERK) signal pathway in mechanical stretch induced high mobility group box 1 protein (HMGB1) expression on alveolar epithelial cells (A549). MethodsA549 cells were cultured and seeded at 1×10~5 cells/ml in 6-well Bioflex cell culture plates. Subsequently, the cells were exposed to cyclic mechanical stretch at 14% (group B) elongation for 4 hours using Flexercell 4000T cell stretching unit. In group C, cells were pretreated with PD98059 for 2 hours before mechanical stretch. Cells in group A without stretch were served as control. The expression of HMGB1 protein and mRNA in A549 cells were detected by immunocytochemisty staining and RT-PCR, respectively. ERK activity was measured by Western blotting method. Results Immunocytochemisty staining indicated that the expression of HMGB1 protein in A549 cells was increased obviously in group B (P<0.05) and decreased in group C (P<0.05). Polymerase chain reaction (RT-PCR) showed that the expression of HMGB1 mRNA was also significantly increased in group B (P<0.05) and decreased in group C (P<0.05). Western blotting analysis confirmed the activation of ERK in A549 cells by mechanical stretch (P<0.05). PD98059, an inhibitor of ERK, might significantly inhibit mechanical stretch induced HMGB1 protein and mRNA expression in A549 cells (P<0.05). Conclusion Mechanical stretch could regulate the expression of HMGB1 gene and protein in A549 cells through ERK signal pathway.

Objective To investigate the therapeutic effect of self made balloon with side hole on no reflow ( NR) after emergency percutaneous coronary intervention ( PCI ) .Methods 48 patients with NR after PCI in our hospital were randomized into two groups , which were group A ( n=24 , patients received self made perfusion balloons with holes ) and group B ( n=24 , patients using direct guiding catheter ) and through respective devices intravascular tirofiban and verapamil were given .TIMI flow grade, recovery of myocardial enzymes and ST-segment elevation , LVEF and the incidence of MACE were compared between the 2 groups.Results Among patients in group A , the percentage of immediate postoperative TIMI Ⅲflow (79.2%vs.45.8%,P=0.032), ST segment resolution of more than 50% (83.3% vs.54.2%,P =0.029 ) and LVEF after 1 months [ ( 54.92 ±12.32 )% vs. ( 47.67 ±12.15 )%, P =0.046 ] were significantly higher than patients in group B .The CK peak value of patients in group A [ ( 1018.62 ± 732.34)mmol/L vs.(1497.75 ±858.63)mmol/L, P =0.043], CK-MB peak values [(113.84 ± 76.53 ) mmol/L vs.( 172.74 ±93.56 ) mmol/L, P=0.021 ] and MACE rates ( 0 vs.16.7%, P=0.037 ) were lower than those of patients in group B .Conclusions The use of self-made perfusion balloon with side hole for the treatment of NR patients after emergency PCI is convenient , easy and effective.

Objective To investigate the role of p38 MAPK pathway in the expression of high mobility group box 1 (HMGB1) in lung tissue in a rat model of ventilator-induced lung injury. Method Twenty-fonr healthy Sprague Dawley (SD) rats were randomly divided into 3 groups (n = 8 each) : group A, spontaneous breathing; group B, small tidal volume ventilation (Vt = 8 mL/kg) and group C, high tidal volume ventilation (Vt = 40 mL/kg). 1he animals in group B and C were mechanically ventilated for 4 hours and all animals were sacri-riced. The lungs were removed for: (1) lung lavage and determination of total protein contnt and WBC and neu-trophil counts in broncho-alveolar lavage fluid (BALF) ; (2) determination of W/D lung weight ratio and myelop-erexidnse (MPO) activity; (3) detennination of HMGB1 protein and mRNA expression and p38 MAPK activity in lung tissue. Differences within the groups were analyzed using One way ANOVA. Results The inflammatory re-sponse as evidenced by total protein (1.77 ± 0.68) g/L and WBC (106.55 ± 28.17) × 10~7/L in BALF, W/D lung weight ratio (7.16±1.02) and MPO activity (3.94±1.21) U/g were significantly higher in group C com-pared with group A (P <0.05); HMGB1 protein (0.64±0.17) and mRNA (1.17±0.45) expression and p38 activity (0.51±0.12) also significantly increased in group C (P <0.05). Of the above indexes, there were no statistical differences between group B and group A (P > 0.05). Conclusions High tidal volume ventilation in-daces acute lung injury, which may be related with upregulation of HMGB1 expression through p38 MAPK signal pathway.

Objective The intra-cranial arteries are more affected in Asian ischemic stroke patients. We thought that tandem or diffuse arterial occlusive disease may be more common among patients with extracranial internal carotid artery (ICAex) occlusive disease. In the current study, the frequency of other co-existing extracranial artery ( EA) or intracranial artery ( IA) stenosis in patients with ICAex occlusive disease and its risk factors were studied. Method One hundred and ninety-eight consecutive patients with ischemic stroke or TIA who were admitted to our hospital from Jan 2001 to May 2008 and who had stenosis (70% ) or occlusion of ICAex were enrolled in the study. All the patients were examined with carotid duplex and transcranial Doppler (TCD). Among them, 75 patients were also examined with DSA, 52 patients with intracranial MRA and 25 patients with extra- and intra-cranial CTA. Extracranial artery stenosis or occlusion were diagnosed with DSA/CTA in 93 patients, and with carotid duplex only in 105 patients. Intracranial artery stenosis was diagnosed with DSA/MRA/CTA in 118 patients, and with TCD only in 80 patients. Patients with presumably cardioembolism such as atrial fibrillation were excluded. Results Among the 198 patients, 172 (86. 8% ) had other combined EA or IA stenosis. One hundred and thirty-five patients (135/198, 68.2%) had other combined EA stenosis, which were more frequently found in the contralateral ICAex (71/198, 35.9%). One hundred and twenty-three patients (123/198, 62. 1%) had combined IA stenosis, which were more frequently found in MCA (75/198, 37.9%). 52 (52/198, 26. 3% ) had ipsilateral terminal ICA and/or middle cerebral artery stenosis. Conclusion Tandem or diffuse arterial occlusive disease is common among patients with steno-occlusion of ICAex . Therefore, it is important to evaluate other EA and IA stenosis before CEA or CAS in Chinese patients.

Objective To establish a stable and controllable model of acute regional cerebral ischemia in rats, and to evaluate it by CT perfusion imaging and histological study. Methods Twenty eight male Wistar rats were randomly divided into 4 groups, and there were 7 rats in each group. The sham operation rats were defined as the first group, rats suffered from cerebral ischemia for 15 minutes were classified as the second group, rats suffered from cerebral ischemia for 30 minutes and then reperfusion for 1 hour as the third group, and rats suffered from hypo perfusion for 6 hours as the fourth group. Cerebral ischemia or hypo perfusion were induced by inserting a nylon thread of different diameter into right middle cerebral artery (MCA) of rats under the monitoring of regional cerebral blood flow (rCBF) by the Laser Doppler Blood Perfusion Monitor (BPM). rCBF was also examined by dynamic CT perfusion imaging. At the end of the observation time, rats were decapitated, and three rats of each group were performed 2,3,5 triphenyltetrazolium chloride (TTC) staining and four rats were performed histological study. Results In the second group, rCBF was controlled within 5% to 22% under the monitoring by BMP and CT perfusion imaging showed the decreased rCBF in 7 rats, but TTC staining showed red appearance indicating no infarction focus formed. Electronic microscopic study revealed astrocytic swelling and a few of neuronal degeneration. In the third group, rCBF was controlled within 4% to 23% under the monitoring by BMP. There were more severe astrocytic swelling and a lot of neuronal degeneration. The abnormal areas in CT perfusion images were the same as TTC staining. In the fourth group, in accordance with less decrease ment of rCBF (from 38% to 55%) in 7 rats, there were obvious astrocytic swelling and subtle neuronal degeneration. TTC stain did not show ischemia area. All these abnormal changes were not observed in the sham operation rats. Conclusion The controllable acute regional cerebral ischemic model in rats is very stable and repeatable. It can be simulated into the ischemic state of different perfusion level. This model is suitable for the research of acute cerebral infarction and regional cerebral ischemia. The facts that parallel changes existed among BMP measurement, CT perfusion imaging, and brain histology indicated that CT perfusion imaging is accurate and sensitive in evaluating acute regional ischemia.