Objective To investigate the impact of using antithrombotic drugs (anticoagulants or antiplatelet aggregation drugs)before the onset of cerebral infarction on hemorrhagic transformation after acute cerebral infarction. Methods The consecutive patients with acute cerebral infarction from Chengdu Stroke Registry Project admitted to the Department of Neurology,West China Hospital,Sichuan University from January 1,2004 to January 1,2014 were enrolled. The baseline data on admission,previous usage of anticoagulants and anti-platelet aggregation drugs,as well as CT/ MRI and other imaging data of all patients were collected. According to the results of CT/ MRI reexamined at 72 h after admission,the patients with hemorrhagic transformation were enrolled into a hemorrhagic transformation group;the patients with non-hemorrhagic transformation were enrolled into a non-hemorrhagic transformation group according to the ratio
of 1 ∶ 1. Their gender and age were matched with the hemorrhagic transformation group. The baseline data and drug used of the patients in both groups were compared. The differences of risk factors between the two groups were analyzed with multivariate Logistic regression analysis. The relationship between hemorrhagic transformation and premorbid use of antithrombotic drugs were observed. Results A total of 6 916 patients with acute cerebral infarction were enrolled,including 433 (6. 3%)hemorrhagic transformation (hemorrhagic transformation group)and 433 non-hemorrhagic transformation. (1)There were significant differences between the patients of the two groups on admission in the National Institutes of Health Stroke Scale (NIHSS)score,atrial fibrillation,previous cerebral infarction,and blood glucose levels on admission (all P < 0. 05). (2)The proportions of using anticoagulants and antiplatelet aggregation agents in the hemorrhagic transformation group were higher than those of the non-hemorrhagic transformation group (anticoagulants:14. 1% [n = 61]vs. 3. 9% [n = 17];P < 0. 01,OR,4. 01,95% CI 2. 303 -6. 993;anti-platelet aggregation drugs:14. 3% [n =62]vs. 8. 3% [n = 36];P = 0. 005,OR,1. 84,95% CI 1. 194 -2. 846). (3)The results of multivariate Logistic regression analysis showed that the use of anticoagu-lants,anti-platelet aggregation drugs,NIHSS score on admission,and random blood glucose on admission were the independent risk factors for hemorrhagic transformation (OR [95% CI]3. 302 [1. 860 -5. 862], 2. 081 [1. 281 -3. 382],1. 047 [1. 026 -1. 069],and 1. 055 [1. 011 -1. 100],respectively (all P <0. 05). Conclusion The NIHSS score and blood glucose levels on admission are the independent risk factors of hemorrhagic transformation. Using anticoagulants or anti-platelet aggregation drugs before symptom onset is independently associated with hemorrhagic transformation,however,its relationship with the long-term prognosis of acute cerebral infarction need to be further studied.

Objective To evaluate the short term outcome after mitral valve replacement with the Perimount bovine pericardial valve. Methods Eighty-eight patients underwent mitral valve replacement with the bovine pericardial valve in hospital were included in this study. Postoperative general condition including mortality and cerebral hemorrhage was observed. The hemodynamic and New York heart disease association (NYHA) heart function classification were recorded by Doppler echocardiograms before operation, postoperative 1 week, 3 months and 1 year after mitral valve replacement. Values of the different time points of NYHA, left atrial diameter (LA), left ventricular end diastolic diameter (LVDD), left ventricular end systolic diameter (LVSD), left ventricular ejection fraction (LVEF) and pulmonary artery pressure (PAP) were compared. The hemodynamic parameters were also compared including the peak cross valve pressure (PG), mean cross valve pressure (MG), peak cross valve velocity (PV) and effective orifice area (EOA) 1 week, 3 months and 1 year after surgery. Results There were two cases (2.3%) dead in one year (one died of cerebral hemorrhage and another one died of thromboembolism). There was 1 perivalvular leakage (1.2%). There was no endocarditis or structural valve deterioration. NYHA cardiac function was improved at postoperative 3 months and 1 year (P < 0.05). The values of LA, LVDD and PAP were significantly decreased at postoperative 1 week, 3 months and 1 year compared with those before operation (P<0.05). Values of LVSD and LVEF were significantly decreased at postoperative 1 week compared with those before operation (P<0.05). The value of LVEF was significantly increased at postoperative 3 months and 1 year (P<0.05). Compared with postoperative 1 week, the values of LA and LVEF were significantly increased at postoperative 3 months and 1 year (P < 0.05). There were no significant differences in PG, MG, PV and EOA between postoperative 1 week, 3 months and 1 year. Conclusion With the excellent performance of cardiac function recovery, left ventricular restoration and hemodynamic, the Perimount bovine pericardial valve remains a reliable choice as a mitral tissue valve.

BACKGROUND: During xenogenic liver transplantation, major histocompatibility antigen can induce immunological rejection, and immunosuppressant can cause adverse effect on organism. Recently, treatment prior to transplantation induces immune tolerance, which is perspective for organ transplantation.OBJECTIVE: To investigate the correlation between thymus induction and immunological rejection during liver transplantation. METHODS: A total of 40 male SD rats of clean grade were selected as donors. Moreover, 30 male Wistar rats of clean grade and 10 male SD rats of clean grade were selected as recipients. The donor rats were divided into allogeneic gene transplantation, allotransplantation, cyclosporine, and thymus induction groups, with 10 rats in each group. The modified Kamada and improved two-cuff technique was used to establish a stable rat orthotopic liver transplantation model. The cyclosporine group was given cyclosporine (50 mg/kg) for 5 successive days. Thymus induction group was injected with major histocompatibility antigens (50 pL) for 5 successive days. Other groups were not given any interventions. Survival time of rats was recorded in each group. Pathological observation and mixed lymphocyte cultured were performed at days 3, 7, 14, 21, and 28 after transplantation. RESULTS AND CONCLUSION: Survival time was longer in the thymus induced group compared with other groups (> 60 days), damaged level was mild, local immunological rejection was reduced, and lymphocytes were decreased. The effect after liver transplantation was similar to allogeneic gene transplantation but superior to cyclosporine intervention (P < 0.05). This suggested that thymus induction relieved immunological rejection following liver transplantation.

BACKGROUND: Most patients who underwent liver transplantation would suffer acute rejection or transplanted liver failure resulted by chronic rejection, therefore, inducing specific immune tolerance via varied pathways is the ideal method to solve this problem. OBJECTIVE: To treat rat transplanted liver by injecting transforming growth factor β1 (TGF-β_1) plasmid, and to analyze the relationship between TGF-β1 and allograft rejection from gene level. METHODS: A total of 30 male, Wistar rats were served as allogenic liver donors, and 10 male, SD rats served as syngeneic donors Totally 40 male SD rats were served as liver recipients, and divided into 4 groups by order number table: ailogenic transplantation, syngeneic transplantation, ciclosporin, and ciclosporin plus TGF--β_1 groups. In each group, rat orthotopic liver transplantation model was established by modified Kamada and improved two-cuff technique. After modeling, rats were received cyclosporine 1-5 days in the cyclosporine group, or intraperitoneal injected ciclosporin for 1-5 days, combined with TGF-β_1 plasmid 0-2 days in the cyclosporine plus TGF-β_1 group. No intervention was performed in the other groups. The survival time of rats were recorded, and the pathological changes was detected at days 3, 7, 14, 21, and 28 after transplantation, then the mixed lymphocyte culture was performed. RESULTS AND CONCLUSION: The survival time of rats in syngeneic transplantation group and cyclosporine plus TGF-1,β_1 group was more than 60 days, which was obviously greater than that of allogenic transplantation and cyclosporine groups (P< 0.05). The histopathologic slide showed that there was moderate and severe acute rejection, with evident intrahepatic inflammatory cell infiltration in the allogenic transplantation and cyclosporine groups. Few rejections were observed in the syngeneic transplantatior group, which was close to the normal lever tissues. Mixed lymphocyte culture of the cyclosporine plus TGF-β_1 group was superior to the syngeneic transplantation group or cyclosporine group (P < 0.05). The results demonstrated that cyclosporine combined with local injection of TGF-β_1 plasmid can relieve post-transplant immune rejection.

BACKGROUND: A small number of mesenchymal stem cells (MSCs) present in bone marrow, which would gradually drop with age. OBJECTIVE: To verify the effect of adherent method on culture of bone marrow-derived MSCs. METHODS: Under anaesthesia, bone marrow cells were obtained from femur and tibia of rats, cultured by DMEM containing calf serum, placed in an incubator containing 5% CO_2 at 37 ℃. The culture medium was renewed after 24 hours, and remained periodical medium change with once per week. The weakly adherent cells were passaged. The cell morphology, growth curve, and the expression of cell-surface markers were identified by flow cytometry and immunocytochemical staining. RESULTS AND CONCLUSION: After 24 hours of culture, the cells could adhere to the walls with fusiform or triangle shapes, proliferated faster after 2-3 days, and presented whirlpool-like or clustering. The cells reached a logarithmic growth phase after 2 days, and into the late stationary phase after 12 days, which covered the bottle after 15 days. The cultured cells were positive to CD90 and CD54. The results verified that bone marrow-derived MSCs can be isolated by adherent method. This method is easy operation, and can maintain cell activity preferably.

Objective To investigate the influencing factors of hemorrhagic transformation in non-thrombolysis patients after acute cerebral infarction. Methods According to Chengdu Stroke Registry Project,2598 consecutive patients with acute cerebral infarction admitted to the Department of Neurology,West China Hospital within 1 week of attack from January 2010 to December 2013 were enrolled prospectively. The patients were divided into a hemorrhagic transformation group and a non-hemorrhagic transformation group according to whether they had hemorrhagic transformation or not. As for patients with hemorrhagic transformation,they were divided into a symptomatic hemorrhagic transformation (SHT)group and an asymptomatic hemorrhagic transformation (ASHT)group according to whether they had aggravation of symptom and sign. The baseline data of all patients were collected and compared between the groups. The P<0. 1 variables of the univariate analysis result were enrolled in multivariate logistic regression analysis in order to identify the independent influencing factor of hemorrhagic transformation. Results In 2598 patients,249 (9. 6%)had hemorrhagic transformation,28 of them (1. 1%)were SHT and 221 (8. 5%)were ASHT. There were significant differences in male,hypertension,dyslipidemia,atrial fibrillation,drinking and smoking ratio,blood glucose,cholesterol,low density lipoprotein cholesterol, National Institutes of Health Stroke Scale (NHISS)scores,and the trial of Org 1072 in acute stroke treatment (TOAST)classification between the HT group and the non-HT group (all P<0. 05). There were no significant difference in the related influencing factors between the SHT group and the ASHT group (all P>0. 05). The results of multivariate logistic regression analysis showed that dyslipidemia (OR,0. 588, 95%CI 0. 374-0. 924,P=0. 021)was negatively correlated with hemorrhagic transformation. Atrial fibrillation (OR,3. 188,95%CI 2. 159-4. 707,P<0. 001),blood glucose (OR,1. 081,95%CI 1. 044-1. 119,P<0.001),and NHISS score (OR,1. 305,95%CI 1. 170-1. 455,P<0. 001)were positively correlated with hemorrhagic transformation. In TOAST classification,relative to the large atherosclerotic stroke,the small artery occlusive cerebral infarction was negatively correlated with hemorrhagic transformation (OR,0. 315, 95%CI 0. 167-0. 596,P<0. 001). After removing the influencing factor of atrial fibrillation,compared with the large artery atherosclerotic stroke,cardioembolism stroke was positively correlated with hemorrhagic transformation (OR,2. 823,95%CI 1. 946-4. 095,P<0. 001). Conclusion Dyslipidemia,atrial fibrillation,blood glucose,NHISS score and TOAST classification were independently associated with hemorrhagic transformation in non-thrombolysis patients after acute cerebral infarction.

Objective To investigate the effects of soft silicone foam dressing on the prevention of intraoperative pressure ulcer in patients undergoing spine surgery. Methods A total of 232 patients were divided into control group and experimental group (116 cases each group) by coin slot method. The control group was treated with conventional pressure ulcer prevention and treatment. The experimental group was treated with conventional intervention measures. Soft silicone foam dressing paste use, the end of surgery to observe the two groups of patients under the chin skin condition. Results In the control group, there were 10 cases at stage I in the lower part of the skin, and 5 cases (4 cases of skin blisters and 1 case of partial cortical absence) at stageⅡ. 2 cases in the experimental group were at stage I; no cases were at stageⅡ, the two groups were no stage Ⅲ and above pressure ulcer occurred in the experimental group under the chin pressure ulcer was significantly lower than the control group, The difference was statistically significant (χ2=10.727, P<0.05). Conclusion Conventional pressure ulcer prevention and control interventions combined with shaped soft silicone foam dressing for skin protection of special parts of chin under prone position surgery is beneficial to prevention of intraoperative pressure ulcers.

Objective To study the default mode network (DMN) of mild cognitive impairment (MCI) related to leukoaraiosis (LA) with resting-state functional magnetic resonance imaging (rs-fMRI). Methods 31 LA patients (Clinical Dementia Rating of 0.5) and 27 normal controls (Clinical Dementia Rating of 0, and matched in age, gender and lever of education) were scanned with the rs-fMRI. The data was analyzed with SPM5 software, using independent component analysis. The differences between the both groups were compared with two-sample t-test. Results The DMN during resting-state of normal controls was posterior cingulate cortex/precuneus, bilateral medial frontal cortex, bilateral middle temporal gyrus, bilateral inferior parietal gyrus, angular gyrus, bilateral hippocampus. The DMN of MCI group was consistent with the normal controls, but the activation decreased in anterior cingulate cortex/left medial frontal lobe, right parahippcampus/ uncus, right inferior temporal gyrus, left deep frontal white matter/head of caudate nucleus; and increased in the left caudate nucleus/anterior cingulate cortex, left frontal lobe, and left superior temporal gyrus/inferior parietal gyrus. Conclusion Activation of resting-state functional network is disorder in LA, which may relate to cognitive impairment.

Objective To find biological markers to predict the mathematical cognitive ability in order to set patients free from the pain and time-consuming behavioral tests. Methods 86 patients with stroke or brain traumatic injuries were recruited and acquired T1 and rest-ing-state functional MRI imaging data. And a mathematical task (7 calculation items, 2 counting items) and a word-reading task (140 items) was also finished. The partial correlative analysis was made between the score of mathematical task and the amplitude of low frequency fluc-tuation of each voxel of the whole brain with the word-reading performance as controlling task, and AlphaSim correction method was used with corrected P<0.05 (single voxel level:P<0.05;cluster size:>110 voxels). Results There were 5 cerebral regions whose amplitude of low frequency fluctuation significantly correlated with mathematical performance:left inferior parietal lobule (161 voxels, rpeak=0.34), left precu-neus/superior parietal lobule (141 voxels, rpeak=0.31), left middle temporal gyrus (359 voxels, rpeak=0.34), left middle frontal gyrus (491 vox-els, rpeak=0.36), and right middle frontal gyrus (156 voxels, rpeak=0.32). Conclusion The amplitude of low frequency fluctuation of left inferior parietal lobule, precuneus/superior parietal lobule, middle temporal gyrus, middle frontal gyrus, and right middle frontal gyrus could be used as predictors of mathematical cognitive ability for brain-damaged patients.

Objective To investigate the expression of T cell immunoglobulin-and mucin-domaincontaining molecule-3 (Tim-3) in peripheral CD8 +T cells and its significance in patients with chronic hepatitis B (CHB).Methods Fifty-eight CHB patients and 16 healthy controls were enrolled.Tim-3 expression in CDs + T cells was detected by flow cytometry,and quantities of IFNγ-producing HBV-specific cytotoxic T lymphocytes (CTLs) in HLA-A2 positive subjects were detected by enzyme-linked immunosorbent spot (ELISPOT) test before and after the blockade of Tim-3/Tim-3L pathway.Paired t test was performed to compare the quantities of CTLs before and after the blockade,and nonparametric Spearman correlation analysis was performed to explore the correlation in quantitive data.Results Tim-3 expression in CHB patients was (14.2 ± 8.98 )％,which was higher than that of healthy controls (4.80 ± 2.92)％,and the difference was of statistical significance (x2 =92.48,P ＜ 0.05 ) Tim-3 expressions in 16 severe CHB patients and 42 mild CHB patients were ( 19.54 ± 10.95) ％ and (9.58 ± 7.30) ％,respectively,and the difference was statistically significant (x2 =77.24,P ＜ 0.05 ). Before the blockade of Tim-3/Tim-3L pathway,IFNγ-producing HBV-specific CTLs were 7.27 ± 3.14,and it increased to 19.62 ± 4.97 after the blockade ( t =2.95,P ＜ 0.05 ).Conclusion The upregulation of Tim-3 on peripheral CD8 + T cells may inhibit HBV-specific CTLs,and the blockade of Tim-3 pathway can enhance the proliferation of IFNγ-producing HBV-specific CTLs,thus can enhance antiviral effect.