0.05).Conclusions In vivo ischemia models,the suitable dose GM can reduce the expression of iNOS,inhibit the cell apoptosis and protect the nerve cell.

Endovascular therapy has become a research focus for the treatment of acute ischemic stroke,mainly including intra-arterial thrombolysis,combined intravenous and intra-arterial thrombolysis,mechanical recanalization,angioplasty and stenting,etc.This article reviews the evidence of evidence-based medicine of endovascular therapy in patients with acute ischemic stroke.

BACKGROUND: It is difficult to conduct the operation of ossification of ligamentum flavum (OLF) in thoracic spine, and the operation needs complecated operative skill, and unmerited disposal tends to worsen neurological dysfunction.OBJECTIVE: To analyze the operative method for OLF of thoracic spineand functional restoration.DESIGN: Case analysis.SETTING: Department of Orthopaedics, Changzheng Hospital, SecondMilitary Medical University of Chinese PLA.PARTICIPANTS: Totally 56 patients with OLF of thoracic spine, whowere treated at the Department of Orthopaedics, Changzheng Hospital fromAugust 1996 to August 2003.METHODS: The operative therapy was performed in all the patients, and the method was determined by the results of MRI and CT examination: ①The 19 patients, whose OLF in thoracic spine was focal type, and range of lesion did not exceed two segments, were treated with simple resection and decompres sion in posterior wall of vertebral canal. ②Fenestration and sledging-allocating manipulation in the whole piece unilateral lamina of vertebra were carried out in 29 cases involving more than 2 segments. ③If coplanar OLF in thoracic spine combined with protrusion of thoracic spine disc or ossification of posterior longitudinal ligament, decompression of posterior midline approach+posterior lateral approach was performed, totally 8 cases.MAIN OUTCOME MEASURES: Post-operation functional restoration was evaluated with Epstein standard, excellent: recovery of sensation and exercise was near to normal; good: spinal cord function was improved significantly, and permitted to walk with brace; fair: small partial restoration of sensory and motor function, unable to walk; bad: Inefficiency or becoming severe.RESULTS: A total of 55 cases were followed up for more than one year and 1 case only for two months after operation. ①Functional restoration: excellent: 39 cases; good: 8 cases; fair: 5 cases; bad: 4 cases. ②Symptom recovery after operation was confirmed by disappearance of tight sensation, reduction of muscular tension, relieving of numbness in order. ③The recovery was rapid for 3 to 6 months after operation. Part of patients' condition was still ameliorating during one year after operation, and rare advancement 2 years later. The recovery of complete paraplegics was bad, so was the severe paraplegia with long history. CONCLUSION: Compressive myelopathy caused by OLF in thoracic spine should be treated in an earlier period by operation. Resection and decompression of posterior wall of thoracic spine and decompression of posterior approach could be choosed according to different condition.

Objective:To study the role of adhesion molecules in the pathogenesis of polymyositis. Methods:The abnormal expression of adhesion molecules on T cells in peripheral blood and muscle fibers from patients with myositis was analyzed by two colour immunofluoresence and RT PCR methods respectively. Results:The expression of adhesion molecules including lymphocyte function associated antigen 1(LFA 1 ),very late antigen 4(VLA 4) on T cells in peripheral blood and intercellular adhesion molecule l(ICAM 1) on muscle fibers from patients with myositis was markedly higher than that in the healthy control group. Conclusion: These findings suggested that adhesion molecules may be responsible for the migration of T cells and destraction of muscle fibers.

Objective Identification of anatomic structures are essential for totally thoracoscopic anatomic pulmonary segmentectomies, however sometimes the procedure are difficulty.This study was to assess whether three-dimensional computed tomography angiography(3D-CTA) could contribute to the preoperative arrangement of thoracoscopic complex segmentectomy.Methods Between September 2012 and August 2014, 29 patients were performed thoracoscopic complex segmentectomies under the guidance of preoperative 3D-CTA.The segmentectomies pattern were based on the nodules' diameter, location,and pathology.The targeted vessels and bronchus were marked in preoperative simulated segmentectomies.Results Of the 29 cases, 9 right upper lobe segmentectomies, 13 left upper segmentectomies, and 7 bibasilar segmentectomies were achieved, among which 6 subsegmentectomies were also inclued.The mean lesion diameter, operative time and intraoperative blood loss were(1.35 ± 0.80) cm, (190.53 ± 50.83) min, and (26.90 ± 32.24) ml respectively.Under the guidance of preoperative 3D-CTA , 8(27.5％) nodules were detected accurately, moreover 2(6.9％) aberrant arteries and 1 (3.4％) aberrant bronchus were observed.According to the marked vessels and bronchus preoperatively, 27 (93.1％) arteries, 25 (86.2％)veins,and 29(100％) bronchus were identified and dissected in the operation.Three cases converted to unplanned segmentectomies.No serious complications or death occurred.Conclusion 3D-CTA is an effective tool to enhance security and efficiency in thoracoscopic complex anatomical segmentectomy.

Objective Carotid artery stenosis is closely related not only with the cognitive function impairment, but also can cause patients to physical fatigue and a series of consequences.The aim of this study was to investigate the correlation between carotid artery stenting for carotid artery stenosis in patients with cognitive function improvement effect and fatigue and cognitive function in this paper. Methods One hundred cases of clinical data of patients with carotid artery stenosis of carotid artery stentingwere analyze pro-spectively.The cognitive scales of mini mental state examination (mini mental scale state examination, MMSE), Montreal cognitive as-sessment(Montreal cognitive, assessment, MoCA), activities of daily living scale (activities of dailyliving, ADL), fast vocabulary test ( verbal fluency) , Webster's count test, digit span test( working memory) , Digit Symbol Substitution Test ( speed) and the the fatigue scales of fatigue assessment scale-14 ( Fatigue Scale-14, FS-14) , fatigue severity scale ( FatigueSeverity Scale, FSS-9) were observed before and 3, 6 months after surgery.The correlation between fatigue and cognitive impairment was also analyzed Results Operation was successful in all patients, and no serious complications occurred after surgery.Patients'clinical symptoms were significantly im-proved compared with those on admission.MMSE, MoCA, ADL, verbal fluency test, Wechsler arithmetic, digit span and digit symbol substitution test results showed that, the scores were significantly improved compared with those on admission( P<0.05) , and with the time prolonging, cognitive function improved more obviously( P<0.001) .Compared with before operation,FS-14 score [ ( 7.11±1.37) vs (4.38±0.97)] and FSS-9 scores were significantly decreased6 months after operation, [(52.45±6.77) vs (43.29±7.21)](P<0.05). The correlation coefficient of FS-14 and MMSE, FFS 9 and MMSE were -0.357, -0.311 6 months after surgery, and the correlation coefficientof FSS-14 and MoCA, FSS-9 and MoCA were -0.547,-0.351, which showed a significant negative correlation (P<0.05). Conclusion Carotid artery stenting therapy can improve cognitive function and fatigue in patients with carotid artery stenosis, and the effect was more significant with the time prolonging, and there was a certain correlation between fatigue and cognitive impairment.

Objective: To analyze the correlation of miR-625 expression with clinicopathological characteristics in esophageal squa-mous cell carcinoma (ESCC) and to explore the effect of miR-625 on the migration and proliferation of ESCC cells. Methods:The expres-sion level of miR-625 was determined through real-time PCR in 86 paired human ESCC tissue specimens and tumor-adjacent normal esophageal tissue specimens, ESCC cell lines, and esophageal epithelial cell line. The associations of miR-625 expression with clinico-pathological characteristics and survival in ESCC patients were analyzed. Transwell and CCK-8 assays were performed to examine the effect of miR-625 expression on migration and proliferation of ESCC cells. Results:Compared with tumor-adjacent normal specimens, miR-625 was significantly downregulated in ESCC tissue specimens (P<0.05). MiR-625 expression was decreased in ESCC cell lines com-pared with human esophageal epithelial cell lines (P<0.05). Lower miR-625 expression was associated with poorer prognosis and sur-vival. The migration and proliferation abilities of ESCC cells were inhibited by miR-625 overexpression (P<0.05). Conclusion:MiR-625 acts as a tumor suppressor gene in the development and progression of ESCC, suggesting that miR-625 may serve as an efficient prog-nosis biomarker and a potential therapeutic target for ESCC.

Objective To assess the effectiveness of the Chinese herbal formula Tongxie Yaofang(TY) or its modified prescriptions in the management of irritable bowl syndrome(IBS).Methods A systematic review was carried out according to the Cochrane standards.A computerized literature search was carried out in main Chinese and English databases including CNKI,CBMdisc,Database of Chinese Doctorate Dissertation,Database of excellent Chinese Master Dissertation,MEDLINE and Cochrane Library.Studies were retrieved when they were randomized controlled trials(RCTs) whose interventions for IBS patients were TY or modified prescriptions of TY with placebos or conventional medicine as controls.Outcome measurement included the alleviation of main symptoms such as abdominal pain,diarrhea frequency,and(or) comprehensive effectiveness and quality of life(QOL).Meta-analysis was performed after evaluating the quality of included studies.Subgroup analysis was done between subgroups of diarrhea-predominant IBS and subtype-regardless IBS,and was also done between diarrhea-predominant IBS treated with TCM syndrome differentiation and that without TCM syndrome differentiation.Funnel plot analysis was used to analyze the publication bias.Results Forty-six studies met the inclusion criteria,and 4155 participants were included in the meta-analysis.The results showed that the effectiveness of TY or modified prescriptions of TY was better than that of conventional medicine or placebos[OR= 5.30,95%CI(4.38,6.41)].Subgroup analysis showed that the OR of TY or modified prescriptions of TY in the diarrhea-predominant groups[OR=5.61,95%CI(4.33,7.25)]was higher than that of subtype-regardless groups[OR=4.95,95%CI(3.74,6.55)],and OR of TY or modified prescriptions of TY in the studies of diarrhea-predominant IBS treated based on TCM syndrome differentiation [OR=6.50,95%CI(3.78,11.20)] was higher than that of the studies without TCM syndrome differentiation[OR=5.37,95%CI(4.01,7.19)],but the difference was insignificant.Funnel plot showed certain publication bias.Conclusion The effectiveness of TY or modified prescriptions of TY for IBS patients is better than that of western medicine and placebo.But their effectiveness for diarrhea-predominant IBS or with TCM syndrome differentiation was not proved to be better than those for other subtypes or without TCM syndrome differentiation.Biases may exist for overall quality of the studies is low;negative results in some high quality studies need further discussion.

Objective:To study the reliability and feasibility of intranasal(IN)pathway bypassing the blood-brain barrier (BBB) and observe the potential neuroprotective effects of intranasal NGF on acute cerebral ischemia. Methods:A blinded, vehicle-controlled study of IN NGF and IV NGF administration was performed by intraluminal middle cerebral artery occlusion (MCAO) model. Experiment 1: Rats were randomly divided into IN NGF, IV NGF and untreated group (n=4). The concentration of NGF in different brain regions was measured by ELISA. Experiment 2: Rats were randomly assigned into 4 groups: IN vehicle, IN NGF, IV vehicle, IV NGF (n=8 each). Treatments was initiated 30 min after the onset of MCAO and then again 24 h later. Three neurologic behavioral tests were assessed at 24 h and 48h. Corrected infarct volumes were determined 48 h after the onset of MCAO. Results:Olfactory bulb in IN NGF group obtained the highest concentration among all tissues, arriving at 3 252 pg/g, followed by hippocampus. The NGF concentrations of olfactory bulb and hippocampus in IN NGF group were significantly higher than that in IV NGF and control group. The infarct volume in IN NGF group was reduced significantly by 38.8% as compared with IN vehicle. The vestibulomotor function of IN NGF improved significantly at 24 and 48 h (P=0.02 and P=0.04, respectively). Conclusion:Intranasal NGF could bypass BBB, reach the CNS, reduce infarct volume and improve neurological function in rats following MCAO. Intranasal delivery of NGF holds a promising treatment for stroke and other CNS disorders.