Objective To study the effect of Toll-like receptor 4(TLR4)on expression of IRF-3 and IFN-? during the inflammatory reaction induced by cerebral ischemia reperfusion in mice. Methods After blockade of TLR4 by TLR4 antibody,expression of TLR4,IRF-3 and IFN-? at the protein level in hippocampus was examined by Western blot,respectively. Mice were randomly divided into sham group,ischemia reperfusion group and TLR4 blocking group in different time points (1,2,3 and 4 day). Results In the right cortex,the expression of TLR4,IRF-3 and IFN-? of I group was distinctly higher than that of S and T group(P

Objective To observe the clinical effect of gifitinib combined with hydroxylcamptothecin pericardial perfusion in the treatment of patients with advanced non-small cell lung cancer(NSCLC) with pericardial effusion. Methods From January 2016 to September 2017,eighty-four cases of late NSCLC with pericardial effusion treated in the People′s Hospital of Jiaozhou were randomly divided into two groups according to the digital table,with 42 cases in each group.The control group was treated with gefitinib,and the observation group was treated with hydroxylcampto-thecin on the basis of the control group.The curative effect was evaluated after two courses of treatment in the two groups,and the clinical efficacy and adverse reactions were observed.Results The effective rates of the control group and the observation group were 47.6% (20/42) and 66.7% (28/42),respectively.The effective rate of the observa-tion group was significantly higher than that of the control group(χ2 =4.525,P<0.05).The effective rate of pericar-dial effusion was 33.3% (14/42) in the control group and 69.1% (29/42) in the observation group,the difference between the two groups was statistically significant( χ2 =10.720,P <0.05).There was no ststistically significant difference in the incidence rate of adverse reactions between the two groups during treatment(P<0.05).Conclusion Combination of gefitinib and hydroxylcamptothecin pericardial perfusion in the treatment of NSCLC with pericardial effusion has good tolerance and good safety for the patients.

Objective To investigate the feasibility and safety of endovascular recanalization of chronic occlusion of large intracranial artery.Methods From January 2009 to January 2017,the clinical and imaging data of 15 patients with chronic occlusion of large intracranial artery admitted to the Department of Interventional Neuroradiology,Xuanwu Hospital,Capital Medical University for endovascular recanalization were analyzed retrospectively.Twelve patients were V4 segment occlusion of vertebral artery and 3 were internal carotid artery occlusion.Preoperative whole brain digital subtraction angiography (DSA) was used to assess the occlusion length and location.High-resolution magnetic resonance imaging (MRI) was used to evaluate the nature of occlusion and the feasibility of recanalization.The intraoperative bilateral femoral artery sheath placement was conducted in 13 cases,one side was used for recanalization and stenting,and the other side was compensated by filling the distal occlusion of the artery through collateral circulation as the reference path map,and increased the feasibility of recanalization.According to the thrombolysis in cerebral infarction (TICI) grades after procedure,the forward flow after recanalization was systematically evaluated,and grade ≥2b was defined as the success of recanalization.Results The median time between the first onset of symptoms and recanalization was 50 (range,18-365) days.The occluded recanalization sites included intracranial segment of vertebral artery in 12 cases and intracranial segment of internal carotid artery in 3 cases.Recanalization was successful in 13 cases and recanalization failure of the intracranial segment of vertebral artery was in 2 cases.Recanalization was successful in 13 cases,and intracranial vertebral artery recanalization failed in 2 cases.Of the 13 patients of successful recanalization,the forward flow of angiography returned to grade TICI 3 in 12 cases after recanalization,and returned to TICI 2b in 1 case;the symptoms of 7 cases were improved,the symptoms of 4 cases did not have any change,and the symptoms of 2 patients aggravated after procedure and developed transient ischemic attack or stroke.After 11 patients were followed up for a median of 39 (3-89) months,the median mRS score was 1 (0-2).Conclusion For recanalization of chronic large intracranial artery occlusion,using preoperative high-resolution magnetic resonance imaging evaluation and intraoperative bilateral sheath placement technique may increase the patency rate and reduce the perioperative complications.

Objective To evaluate the imaging changes of the arterial wall and lumen at the site of intracranial large artery lesions with high-resolution magnetic resonance imaging (HR-MRI) before and after Wingspan stent implantation.Methods From December 2013 to December 2014,9 patients with symptomatic intracranial arterial stenosis (stenosis rate:70%-99%) admitted to the Department of Interventional Neuroradiology,Xuanwu Hospital,Capital Medical University were enrolled retrospectively.The sites of the lesions included middle cerebral arteries,basilar artery,and intracranial segment of vertebral artery.Head 3D HR-MRI technique was used to analyze and compare the changes of the tube-wall enhancement areas in the lesion sites through image registration and matching.The consistency of stenosis rates measured by HR-MRI and DSA was compared through Pearson correlation analysis and Bland-Altman Plot.Results The success rate of technique was 100% without related complications.(1) After Wingspan stent implantation,the gadolinium enhancement in the vascular walls of the stenosis sites was decreased significantly compared with that before procedure.The area of enhancement decreased was 87±16% after stent implantation compared with before implantation,and the difference was statistically significant (t=2.325,P=0.049).(2) Before stent implantation,the mean stenosis rates of the HR-MRI and DSA measurements were 82±6% and 82±8% respectively,and the difference was not statistically significant (t=0.051,P=0.961);after procedure,the mean stenosis rates of HR-MRI and DSA measurements were 16±12% and 21±12% respectively,and the difference was not statistically significant (t=1.345,P=0.216).(3) The Pearson correlation coefficients of HR-MRI and DSA for stenosis rate measurement before and after stent implantation were 0.347 (P=0.361) and 0.545 (P=0.129) respectively.Bland-Altman statistical images showed that most of the data points were within the consistency limit (x-±1.96 s).Conclusions As an in vivo noninvasive imaging means,HR-MRI can be used to assess the changes of vascular walls of the lesion sites,the vascular lumen,and the original plaques after the intracranial stent release.It can also be used to evaluate the reconstruction of intracranial arterial walls.

Objective To carry out bacteriological analysis between re-used and disposable oxygen humidification devices. Methods Reused oxygen equipment and disposable oxygen moisture bottles from 6 randomly selected elderly wards were collected, patients who used oxygen will be randomized into 3 groups, group A used cold water as the oxygen humidification liquid, group B used distilled water as humidification liquid, group C used AQUAPAK disposable oxygen humidification devices, sample taking in group A and group B happened on every Monday and Thursday before the replacement of sample moisture bottles, sample was taken in group C after the use of disposable oxygen humidification devices, according to "hospital disinfection health standards" (GB5982-1995)sampling method of disinfection liquid sample was taken and sent to test in the disinfectant laboratory. Results Of 61 samples in group A bacteria cartier rate was 81.97%, bacteria carrier rate of 71 samples in group B was 47.89%, of 52 samples in group C the carrier rate was 0. The comparing of bacterial contamination rate of three kinds of oxygen moisture bottles after using was statistically significant. Take group A, B for comparison, the average severity level of bacteria in group A is higher than group B. In group A, the level of the Gram-negative bacteria as well as Gram-positive bacteria colonization was higher than group B. Conclusions Whether use of cold water or distilled water, oxygen humidification liquids have different degrees of pollution. Currently there is no general criteria and norms in the context of sterilization of oxygen humidification, for patients on long-term oxygen using, to choose disposable oxygen humidification device to reduce the incidence of hospital infections is recommended.

Objective To prepare a thrombus-targeted ultrasonic contrast agent and to investigate its targeted ability to fresh blood clots. Methods We first synthesized FITC-KGDS-Palm compound, and then prepared thrombus-targeted microbubbles using "ultrasound & high speed shearing method".Fluorescence labeling thrombus-specific peptides and KGDS,directed at the activated glycoprotein(GP)Ⅱb/Ⅲa receptor of platelets were attached to the surface of lipid microbubbles. The concentration and size of TUCA were measured by Malvern Zeta Sizer Nano-ZS590 and Coulter counter.Immunofluorescence was applied to confirm the conjugation.The conjunct ratio was assessed by flow cytometer (FCM).Results The KGDS-TUCA was straw yellow turbid liquor,and the concentration was 1.5×10~9/mL,and the average size was 1.5 μm. The targeted microbubbles conjugated with the thrombus-specific peptides showed bright green rings by fluorescence microscope.FCM demonstrated that the wavelength of shell of KGDS-TUCA changed greatly,and the conjunct ratio was 90.04%.In vitro study showed KGDS-TUCA remained stable for 48 h at 4 ℃ and target-attached to blood clots and showed good stability.Conclusion The ultrasound & high speed shearing method to prepare TUCA is easy and in favor of purification.KGDS-TUCA has high specific biological activity.The conjunct ratio and stability of KGDS-TUCA are excellent.

Objective To evaluate the terminal segment of the intracranial vertebral artery (tICVA) fine and atherosclerotic lesions using high-resolution MRI (HRMRI) in order to guide endovascular interventional therapy.Methods From October 2015 to October 2016,4 patients with bilateral tICVA diagnosed with digital subtraction angiography (DSA) and admitted to Xuanwu Hospital,Capital Medical University were analyzed retrospectively.At the same time,time of flight (TOF) and black blood imaging were used.The bilateral tICVA imaging features in 4 patients were analyzed.Congenital dysplasia of vertebral artery and atherosclerotic lesions were identified.Results DSA revealed that bilateral tICVA fine or occlusion.HRMRI evaluation of the vascular wall structure showed that vascular dysplasia in 4 cases were all located on the right sides,showing no obvious thickening of the wall thickness,and the diameter was less than 1/2 of the contralateral side.One patient had atherosclerotic stenosis on the left and 3 had occlusion,showing local wall thickening,plaque formation,and resulting in the narrowing of the corresponding lumen and even occlusion.Three of the patients were treated with endovascular intervention.Conclusion HRMRI is helpful to differentiate hypoplasia in terminal intracranial vertebral artery and atherosclerotic stenosis or occlusion,identifying the dominant side of the vertebral artery and providing image basis for endovascular treatment of vertebral artery.

BACKGROUND: Gene therapy and cell transplantation therapy, especially their combined use, have certain therapeutic effects on retinitis pigmentosa. However, little attention has been paid to the combination of gene therapy and cell transplantation in the treatment of retinitis pigmentosa.OBJECTIVE: To investigate the protective effect of adipose-derived mesenchymal stem cells (ADMSCs) modified by growth-associated protein-43 (GAP-43) gene on the retina of rats with retinitis pigmentosa. METHODS: ADMSCs from rats with retinitis pigmentosa were isolated and cultured, and then transfected with GAP-43 lentiviral vector. Sixty retinitis pigmentosa rats were randomized into experimental group (subretinal injection of GAP-43-transfected ADMSCs), control group (subretinal injection of ADMSCs) and sham operation group (PBS injection). The expressions of GAP-43 protein, Rho protein and GS protein in the retina of rats were determined by western blot. The outer nuclear layer thickness of the retina was determined by hematoxylin-eosin staining. RESULTS AND CONCLUSION: After transfected cell transplantation, the expression of GAP-43 protein in the retina was gradually increased with time and showed significant differences at different time post-transplantation (P < 0.05).The expression levels of Rho protein and GS protein in the retina of experimental and control groups were higher than that in the sham operation group (P < 0.05). The expression of Rho protein in the retina of the experimental group was higher than that in the control group (P < 0.05). The expression of GS protein in the retina of the experimental group was lower than that in the control group (P < 0.05). The thickness of retinal outer nuclear layer was ranked as follows: the experimental group > the control group > the sham group, and there was significant difference between groups (P < 0.05). These results show that the ADMSCs modified by GAP-43 gene have protective effect on the retina of rats with retinitis pigmentosa.

Objective:To investigate the prevalence of frailty in elderly patients with stage 3-5 non-dialysis chronic kidney disease(ND-CKD)and to analyze its related factors.Methods:A cross-sectional study was conducted.Patients ≥65 years old with stage 3-5 CKD who had never undergone dialysis in the nephrology department and the internal medicine department of our hospital between October 2017 to September 2018 were enrolled.Patients were divided into the non-frail group and the frail group according to the Fried frailty phenotype.Clinical data and laboratory results were collected and comprehensive geriatric assessment was carried out to evaluate participants' medication, comorbidities, daily living ability, nutritional status, depression, cognitive and physical performance.The relevant factors for frailty were analyzed.Results:A total of 193 elderly patients with stage 3-5 ND-CKD were enrolled, 106 male and 87 female, including 68 outpatients and 125 inpatients, with a median age of 79.00(73.00, 85.00)years.There were 143 frailty patients(74.1%), including 41 outpatients and 102 inpatients, accounting for 60.3% and 81.6% of the eligible outpatients and inpatients respectively.Multivariable Logistic regression analysis showed that CKD stage( OR=9.74, 95% CI: 1.12-84.54)and polypharmacy( OR=3.69, 95% CI: 1.09-12.42)were associated with frailty in outpatients, and CKD stage( OR=11.75, 95% CI: 1.38-99.99)and malnourishment or risk of malnutrition( OR=4.22, 95% CI: 1.40-12.74)were correlated with frailty in inpatients. Conclusions:The prevalence of frailty is high in elderly patients with stage 3-5 ND-CKD.CKD stage, polypharmacy and malnourishment or the risk of malnutrition are closely correlated with frailty.

AIM: To investigate the effects of astragalus injection combined with puerarin injection on endo-plasmic reticulum stress through PERK pathway in diabetic nephropathy mice .METHODS: Male KKAy mice were ran-domly divided into model group ( injected with normal saline ) and treatment group ( injected with astragalus and puerarin ) . The male C57BL/6J mice served as normal group .The mice were sacrificed 4 weeks after treatments for observing morpho-logical changes under electron microscope .The renal tissues were collected to determine the expression of protein kinase R-like endoplasmic reticulum kinase ( PERK ) , eukaryotic initiation factor 2α( eIF2α) and glucose-regulated protein 78 (GRP78) at mRNA and protein levels by real-time PCR and Western blot.RESULTS: Under electron microscope, the renal tubular epithelial cells in model group and treatment group showed the swelling of the nucleus , endoplasmic reticulum and mitochondria .The results of real-time PCR and Western blot showed that the expression of PERK , eIF2αand GRP78 at mRNA and protein levels in model group was higher than that in normal group (P<0.05), while that in treatment group was lower than that in model group .CONCLUSION: Astragalus injection combined with puerarin injection reduces the mRNA and protein expression of PERK , eIF2αand GRP78, thus inhibiting the endoplasmic reticulum stress in type 2 dia-betic mice to protect the kidney function .