Patients with asymptomatic carotid stenosis (ACS) are the potentially high-risk population of stroke.Screening for high-risk patients with ACS and giving them appropriate interventions may have great significance for the prevention of the occurrence of stroke.This article reviews the advances in research of ACS screening in recent years.

AIM:To observe the expression and tissue localization of matrix metalloproteinase 9 (MMP-9) and transforming growth factor beta 1 ( TGF-β1 ) in the rat acute cerebral ischemia model.METHODS:Male Wistar rats were used to establish acute cerebral ischemia model by a suturing method.The rats were divided into normal control group, sham group and ischemia 6 h, 12 h, 1 d, 2 d, 6 d and 14 d groups.The rat cerebral cortex and hippocampus of the brain were collected at different time points.The mRNA and protein levels of MMP-9 and TGF-β1 in the brain tissues were detec-ted by real-time PCR and in situ histochemistry staining, respectively.The levels of MMP-9 and TGF-β1 in the plasma were also measured by ELISA.RESULTS:The results of real-time PCR showed that the mRNA levels of MMP-9 began to in-crease 6 h after acute ischemia and reached to a peak 2 d after acute ischemia.Similarly, the mRNA level of TGF-β1 began to rise 12 h after acute ischemia and reached to the highest level 6 d after acute ischemia.Compared with the sham rats, the mRNA levels of MMP-9 and TGF-β1 in the rat brains that collected at ischemic time of 12 h, 1 d, 2 d, 6 d and 14 d were significantly increased.Moreover, results of in situ histochemical staining showed that the expression of MMP-9 was detected at cerebral cortex and hippocampus 1 d after acute cerebral ischemia.Further studies showed that MMP-9 dyeing of the rat cerebral cortex was most obvious 2 d after the acute cerebral ischemia.Similarly, the rat cortex and hippocampus began to express TGF-β1 2 d after acute ischemia and TGF-β1 staining at rat cerebral cortex was most obvious 6 d after the acute cerebral ischemia.In addition, ELISA showed that the increase in MMP-9 and TGF-β1 was detected in the plasma 12 h after ischemia.Compared with the sham rats, the level of these 2 factors significantly upregulated since 1 d after ischemia. CONCLUSION:The brain tissue itself contributes to the upregulation of MMP-9 and TGF-β1 post acute cerebral ischemia, which shed light on the related research in the field.

BACKGROUND:Surface modification of titanium surface to improve its biological activity is the research hotspot. Strontium-doped coating is considered to be an effective approach to promote the implant osseointegration. OBJECTIVE:To introduce the research progress of strontium-modified biomedical titanium al oys.METHODS:Articles related to the medical titanium al oys modified with strontium published from January 2000 to April 2016 were retrieved from CNKI and PubMed databases. The keywords were“titanium (Ti), strontium (Sr), bone, osteogenic”in Chinese and English, respectively. RESULTS AND CONCLUSION:Titanium al oys have been widely used in bone implantation because of their good biocompatibility and similar elasticity modulus with human bones. However, pure titanium al oys have poor bioactivity which leads to weak bone-implant contact. Surface modification is a good approach to enhance implant osseointegration. Sr-doped surface treatment can promote new bone formation and osseointegration. Most of the studies about Sr-doped modification are ongoing at the extracorporeal and animal experiment stage;therefore, further investigation is required to seek rapid, stable, available, safe and effective methods.

BACKGROUND:Titanium alloy, a commonly used bone biomaterial, holds good biocompatibility and proper mechanical properties, but without osteointegration ability. Surface bioactive coating of titanium alloy can overcome such problems. OBJECTIVE:To review the application progress of surface bioactive coating on titanium alloys, and to explore the mechanism underlying its osteogenic induction. METHODS:PubMed and CNKI databases were searched for literatures concerning surface bioactive coating on titanium alloys published from January 2000 to March 2016, using the keywords oftitanium, titanium alloys, coating, surface modification, bonein English and Chinese, respectively. Through preliminary analysis, 42 eligible articles were selected. RESULTS AND CONCLUSION:The surface modification method has undergone the transition from surface roughening, oxidation, acidification treatment to the most widely used biomimetic coating technology. The surface biomimetic coatings of titanium alloys mainly include hydroxyapatite, bioactive glass, zeolite, which have been developed from a single coating to the composite coatings and gradient coatings. What's more, the bioactive factor or/and metal ions in the coating can improve the osteointegration of surface coating. Surface modification for titanium alloys is a complex process, during which, both the osteogenesis ability and the bonding strength between the coating and its substrate cannot be ignored. Improving the fabrication method of existing coatings and exploring new materials of biomimetic coatings are critical to achieve a high-quality surface coating modification.

BACKGROUND: Porosity has been proven to improve the stability of orthopedic implants, and the architecture of pores is considered as a significant factor to improve the osseointegration of implants. OBJECTIVE: To introduce the research advance in porous architecture. METHODS: WOS database was searched for the articles addressing the porous structure of the implants published from January 2000 to April 2016 using the keywords of scaffold, pore size, porosity, osteogenesis. The literatures were screened according to the inclusion and exclusion criteria.RESULTS AND CONCLUSION: (1) The stability of traditional implants cannot meet the requirements in some specific circumstances, while the implants with porosity can improve the stability due to its osteogenesis ability. (2) Porous structure is a hotspot, and the osseointegration of porous implants in vivo is explored through series of in vitro and in vivo experiments. (3) It has been shown that higher porosity, proper pore size, microporous morphology and microstructure of the pore wall may contribute to the growth and differentiation of bone tissue under enough mechanical support. (4) However, most studies on the porous implants are still on the in vivo and animal experimental stage, and its promoting effects on the osteogenesis and bone in-growth are needed to be investigated in depth.

Objective To observe the efficacy of endoscopic resection with thyroid benign tumor. Methods 60 cases of thyroid benign tumor were randomly divided into the endoscopic group and the traditional group, 30 cases in each group. The operation time, blood loss ,drainage volume, postoperative hospital stay, postoperative complications and hospitalization expenses in two groups were compared. Results There was no significant difference ( P >0. 05) between the two groups of postoperative hospital stay; endoscopic group blood loss (25.3 ± 15.6) ml significantly less than the traditional group (57. 2 ± 33. 8) ml, the difference was statistically significant ( P < 0. 05); endoscopic postoperative drainage volume ( 85.6 ± 53.2) ml significantly more than the traditional group ( 23. 5 ±37.2) ml (P < 0. 05); endoscopic operative time of ( 105.3 ± 23. 5) min, while the traditional group ( 80. 4 ±25. 3 ) min, the difference was significant ( P < 0. 05 ); hospitalization costs were significantly higher than conventional endoscopy group ( P < 0. 05). Both groups were not have obvious complications postoperation. Conclusion Compared with traditional open surgery, endoscopic surgery for benign thyroid tumors has advantages of superior cosmetic results and less bleeding,it is a good choice for the treatment of the disease.

Objective: To study the acute toxicity of Xiaobai capsules in mice after intragastric administration .Methods: The mice were randomly divided into two groups , the treatment group and the control group .The treatment group was given Xiaobai cap-sules by gavage, 3 times daily.The acute toxicity was recorded, and the median lethal dose (LD50) and the maximum dose were deter-mined.Results:The maximum daily dose of Xiaobai capsules was 141.6 g· kg-1(equivalent to 211.3 times of the clinical dose).At the dose, the mice showed no toxicity without death in 14 days or changes in organs after the dissection .Conclusion:Xiaobai capsules have very low acute toxicity in mice after intragastric administration with high security .

Objective To design and testify a novel strategy for acquiring mimetic epitope mapping by screening for a phage random peptide library using polyclonal anti keratin autoantibodies (AK auto Ab). Methods AK auto Ab were isolated and purified from pooled human sera by keratin affinity column in which keratin had been linked with CNBr Sepharose 4B,then biotinylated by the biotin ester. A 15 mer phage random peptide library was biopanned for 3 cycles and positive clones were identified by ELISA,competition assay and DNA sequencing. ResultsBy sequence comparison 23 positive clones were selected randomly and three epitopes were confirmed. Among the three epitopes SLSPMPTTNRR was the dominant epitope. The phages carrying positive clones reacted with AK auto Ab specifically and keratin could prevent interaction between AK auto Ab and positive phages. Conclusion The designed strategy is successfully applied in acquiring epitopes of polyclonal autoantibodies to keratin, which could provide a new approach for the discovery of epitope mapping which binds to natural autoantibodies.

Objective To evaluate the feasibility of lobectomy by completely Video-Assisted Thoracoscopic Surgery (cVATS) in the management of bronchiectasis.Methods Between June 2001 and October 2010,a total of 60 major lobectomies were performed in our single center on 32 female and 28 male patients of bronchiectasis,with a mean age of 43.4( range 17 to 69)years.All lobectomies were carried out anatomically and divided into thoracotomy group and cVATS group.Pulmonary vessels and bronchus were dissected by endo-cutters.Conversion to a thoracotomy took place if severe adhesion or bleeding was encountered.Results The operations included 5 lobectomies of right upper lobe,3 of middle lobe,6 of right lowerlobe,3 of left upper lobe,26 of left lower lobe,10 of left lower lobe plus lingular segment,4 of left pneumonectomy,1 of bi-lobectomy,1 of right middle lobe plus wedge resection of lower lobe and 1 of left lower lobe plus right middle lobe.There were 25 patients in the thoracotomy group and 35 patients in the cVATS group,in which 2 operations (5.7％) converted due to severe adhesion,poor differentiation of the fissure and/or the proliferation of tortuous vessels at hilus In thoracotomy and cVATS groups,the operative time were ( 207.6 ± 88.5 ) vs.( 168.7 ± 55.9 ) min ( P =0.041 ),the blood loss were ( 522.0 ±644.2) vs.(210.1 ± 213.1 ) ml ( P =0.009),the mean chest tube duration were ( 5.4 ± 4.4) vs.(6.3 ± 3.4 ) days ( P ＞0.05 ) and the mean length of hospitalization were ( 10.2 ±4.7 ) vs.( 8.5 ± 3.5 ) days ( P ＞ 0.05 ).No mortality or severe complication occurred in both groups.The morbidity was 25.7％ (9/25)vs.17.1％ (6/35) in thoracotomy and cVATS group,with no significant difference statistically (P =0.133 ) . There were 52％ vs.62.9％ patients achieved symptomatic completely relief and significant improvement was obtained in 40.0％ vs.31.4％ patients in thoracotomy and cVATS group separately.Conclusion cVATS lobectomy is safe and effective in the management of bronchiectasis.

Objective To analysis the clinical radiologic features of intrapulmonary lymph nodes,and to improve the diagnostic rate of intrapulmonary lymph nodes.Methods From May 2008 to September 2011,16 cases of pulmonary nodules were proved pathologically as intrapulmonary lymph nodes,including 9 males and 7 females,with an average age of 58.2 years (39-73 years).All patients accepted chest X-ray and HR CT scan prior to operation,identified of 11 solitary nodules,3 multiple nodules,and other 2 cases of multiple nodules with synchronous ipsilateral lung cancer.We retrospectively review the data as follows:the population and clinical characters,the subjective imaging diagnosis,the imaging characters of the nodule location,size,texture,shape,border,distance from the nearest pleural surface,and the appearance of the surrounding pulmonary parenchyma et al.Results Clinically,six of all the 16 patients are or were cigarette smokers or had an exposure history of inhaled particles,three patients else were all from a same oilfield area although they denied having the Aforementioned history of smoke or exposure.Lung cancer,metastatic tumor,lung cancer intrapulmonary metastasis were the common subjective imaging diagnosis,with a misdiagnosis rate of 56.3％.Radiologically,these intrapulmonary nodules could be seen in the chest X-ray in half of the 16 patients,with a discovery rate of 50％ in chest X- ray screening.The median size of the intrapulmonary lymph nodes was 7.1 mm (4 - 11 mm),all nodules located below the level of the carina,87.5％ ( 14/16 cases) were solid nodules,68.75％ ( 11/16 cases) were round or ovate in shape with a sharp border.87.5％ ( 14/16 cases) were attached to the pleura or within 1 cm from the nearest pleural surface,87.5％ ( 14/16 cases) appeared linear densities extending from the intrapulmonary lymph nodes.The linear denshy referred to the CT imaging feature that a linear soft-tissue density extended from the intrapulmonary lymph nodes,distinct from the normal lung marking like interlobular septa and bronchovascular bundles,with a diameter less than 5 mm; spiculation were detected in only 2 of the 16 patients ; no calcification and mediestinal lymphadenopathy was detect in all the nodules.Pathologically,All nodules contained anthracotic pigment,and follicular hyperplasia were seen in 8 cases.Conclusion Intrapulmonary lymph nodes are rare benign pulmonary nodules possessing certain clinical and radiologic features.Intrapulmonary lymph nodes should be suspected for small subpleural nodules below the level of the carina.