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.

OBJECTIVE:To discuss clinical efficacy and safety of alteplase combined with butylphthalide to the patients with acute ischemic stroke. METHODS:98 patients with acute ischemic stroke in our hospital were selected and divided into ob-servation group and control group according to random number table,with 49 patients in each group. Control group was addition-ally given Butylphthalide and sodium chloride injection 100 ml,ivgtt,bid,on the basis of routine treatment as controlling blood glucose,blood pressure,etc.;observation group additionally received Alteplase for injection 5 mg added into NS 10 ml,iv+Al-teplase for injection 45 mg added into NS 100 ml,ivgtt,qd,on the basis of control group. Both groups were treated for 2 weeks. Clinical efficacies of 2 groups were compared as well as cerebral infarction area,NIHSS score,ability score of daily liv-ing,the levels of IL-6,IL-8,IL-10,CRP,24 h urine protein,Scr and creatinine clearance rate before and after treatment. The occurrence of ADR was also recorded. RESULTS:1 patient of observation group and 2 patients of control group withdrew from the study due to severe hemorrhage. Total effective rate of observation group(95.83%)was significantly higher than that of con-trol group(80.85%),with statistical significance(P<0.05). Before treatment,there was no statistical significance in above in-dexes between 2 groups (P>0.05). The cerebral infarction area and NIHSS score were reduced significantly in observation group after treatment,ability score of daily living were increased significantly in observation group after treatment,and the im-provement of observation group was significantly better than control group,with statistical significance (P<0.05). 24 h urine protein and Scr of observation group was significantly lower than those of control group,with statistical significance(P<0.05). the level of IL-6 in observation group 1 week after treatment and the levels of IL-6,IL-8,IL-10 and CRP 2 weeks after treat-ment were significantly lower than in control group,with statistical significance(P<0.05). There was no statistical significance in the incidence of ADR between 2 groups (P>0.05). CONCLUSIONS:Alteplase combined with butylphthalide show signifi-cant therapeutic efficacy,can effectively reduce the level of serum inflammatory factors,control brain tissue ischemia and cere-bral infarction area,and improve neurologic function and pro-tect renal function in patients with acute ischemic stroke.

Objective To investigate the incidence,characteristics and risk factors of cognitive impairment in patients with transient ischemic attack(TI A) or minor stroke.Methods Montreal cognitive assessment(MoCA) was carried out in 279 patients with TIA or minor stroke and 150 healthy controls to assess their cognitive function.Results (1) Compared with the healthy controls,the TIA/minor stroke patients scored significantly lower on MoCA total score((23.98±2.55) vs (26.60±0.99),t=12.084,P＜0.01) and subtests including visuoexecutive function((3.68±0.94) vs (4.41±0.64),t=8.483,P＜0.01),digital span ((1.81±0.40) vs (1.95±0.23),t=3.771,P＜0.01),attention((0.84±0.37) vs (0.95±0.23),t=3.357,P＜ 0.01),repetition((1.59±0.62) vs (1.89±0.37),t=5.496,P＜0.01),verbal fluency((0.88±0.33) vs (0.95 ± ±0.23),t=2.286,P＜0.05),abstraction((1.55±0.64) vs (1.91±0.34),t=6.357,P＜0.01) and recall ((2.87±1.13) vs (3.18±0.41),t=3.281,P＜0.01) were significantly decreased.(2) Of 279 TIA/Minor stroke patients,213 (76.3％) suffered from cognitive impairment.The incidence of cognitive impairment was positively correlated with the gender,age,educational level,smoking,course,leukoaraiosis,comorbidities such as hypertension,diabetes mellitus(P＜0.05),and negatively correlated with hyperlipidemia(P＞0.05).Conclusion Extensive impairments of cognitive functions occur along with the incidence of TIA or minor stroke.It is thus suggested that cognitive assessment and interventions may be carried out at an early stage.

Vascular cognitive impairment has been a research hotspot in the field of neurology in recent years.The Montreal Cognitive Assessment is a rapid screening tool for detecting mild cognitive impairment.Now it has been widely used in the evaluation of vascular cognitive impairment.This article reviews the content,features,application status,and development prospects of the Montreal Cognitive Assessment.

Objective To investigate the changes of cognitive impairment with disease progression in patients with minor stroke/transient ischemic attack (TIA).Methods Consecutive patients with minor stroke/TIA were enrolled prospectively.Montreal Cognitive Assessment (MoCA) was used to conduct the cognitive function assessment within 7 d of the onset (baseline),at 1 and 3 months,respectively.Compared with the baseline,the total scores of MoCA in patients increased by ≥2 at 3 months were cognitive function improvement and increased <2 were no cognitive function improvement.Multivariate logistic regression analysis was applied to identify the independent risk factors for no cognitive improvement.ResultsA total of 112 patients with minor stroke/TIA were enrolled in the study,including 63 patients (56.2%) with TIA and 49 (43.8%) with minor stroke.At baseline,1 month,and 3 months,77 (68.8%),72 (64.3%) and 60 (53.6%) patients had cognitive impairment.At 3 months after the onset,the cognitive function of 25 patients (22.3%) were improved,in which 19 (76.0%) and 6 (24.0%) patients had TIA/minor stroke respectively;87 (77.7%) did not have any improvement.Compared with the improvement group,the level of education was significantly lower (3.29±3.48 years vs.5.63±4.26 years;t=2.814,P=0.006),the level of glycosylated hemoglobin was significantly higher (6.35%±1.26% vs.7.21%±1.26%;t=-3.088,P=0.003) in the no improvement group,and the proportions of patients with minor stroke (49.4% vs.24.0%;χ2=5.101,P=0.024),hypertension (52.9% vs.24.0%;χ2=6.509,P=0.011),hyperlipidemia (51.7% vs.24.0%;χ2=6.019,P=0.014),diabetes (41.4% vs.16.0%;χ2=5.448,P=0.020),and coronary heart disease (32.2% vs.8.0%;χ2=5.792,P=0.016) were significantly higher.Multivariate logistic regression analysis showed that the level of education (odds ratio [OR] 1.364,95% confidence interval [CI] 1.059-1.756;P=0.016),atrial fibrillation (OR 2.509,95% CI 1.020-6.167;P=0.045),and higher glycosylated hemoglobin level (OR 1.586,95% CI 1.021-2.034;P=0.030) were the independent risk factors for no cognitive function improvement at 3 months after the onset of minor stroke/TIA.As time went on,the MoCA score and visual spatial execution,memory,abstract and directional scores were increased significantly (P<0.001),while there were no significant differences in naming,attention,and language scores.Conclusion s About 2/3 patients with minor stroke/TIA had cognitive impairment,and as time went on,they were improved.The lower education level,atrial fibrillation and higher baseline glycated hemoglobin were the independent risk factors for affecting no cognitive impairment improvement after monor stroke/TIA.

AIM: To investigate the role of CagA and the effect of small interference RNA (siRNA) on the release of IL-8 in H. pylori-infected gastric epithelial cells. METHODS: siRNA were transferred into CagA positive strain H. pylori NCTC 11637 by using electroporation. The CagA positive strain NCTC 11637 and the CagA negative strain NCTC 11639 were co-cultured with gastric epithelial cells and the level of IL-8 in the supernatant was measure by ELISA. RT-PCR and Western blotting were performed to detect CagA expression. RESULTS: The level of IL-8 induced by CagA positive strain NCTC 11637 was higher than the level induced by CagA negative strain NCTC 11639 ( 1 200.00 ?32.51) ng/L vs (100.00?8.58) ng/L, P0.05). Meanwhile, CagA mRNA decreased significantly in siRNAⅢgroup. The levels of CagA mRNA at 6, 12, and 24 h after electroporation were 31.3% (0.270/0.861), 57.6% (0.496/0.861), and 73.9% (0.637/0.861) of the control levels, respectively. Inhibition rate by siRNAⅢ was 68.7%. The Western blotting result in siRNA Ⅲ group showed that the level of CagA protein degraded to 30.7% (0.4/1.3) at 12 h after electroporation. In siRNA V group, the expression of CagA mRNA at 6 h is suppressed by 23.1% (P

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.

BACKGROUND: At present, there are investigations on the expression of cytokines and adhesion molecular in ischemia-reperfusion injury at abroad,but they do not involve in the relative studies on endogenous cytokines and adhesion molecular on microvascular endothelial surface following injury.The expression of endogenous interleukin-1(IL-1) is limited only at mRNA level.OBJECTIVE: To prove into the mechanism of the expression of intercellular adhesion molecular 1 and its regulation factor IL-1 in spinal ischemia-reperfusion injury.DESIGN: A randomized grouping design, animal experiment.SETTING: Department of Sports Medicine, College of Physical Education Affiliated to Jilin UniversityMATERIALS: This experiment was carried out at the Central Laboratory,China-Japan Union Hospital, Jilin University between March 2003 and January 2004. Totally 77 healthy male Wistar rats were randomly divided into normal control group (n=7), simple ischemia group (n=14) and ischemia-reperfusion group (n=56). Among the rats in the simple-ischemia group, 7 rats suffered from blood flow block for 30 minutes and 7 rats for 60 minutes; Rats in the ischemia-reperfusion group were assigned into 8 subgroups according to 8 time phases, respectively at reperfusion for 30,60 minutes, 2, 4, 6,9, 12 and 24 hours following spinal ischemia, with 7 rats at each time phase.METHODS: Spinal ischemia-reperfusion injury animal models were created with Zivin method. The expressions of vascular endothelial intercellular adhesion molecule-1 (ICAM-1) mRNA and IL-1β mRNA following spinal ischemia-reperfusion injury were detected with reverse transcriptionpolymerase chain reaction, immunohistochemistry and immunofluorescent confocal laser scanning microscope technique.MAIN OUTCOME MEASURES: The expression of IL-1β mRNA, activity of IL-1 polypeptide, expression of ICAM-1 mRNA and protein and activity of myeloperoxidase (MPO).RFSULTS: Totally 77 animals were enrolled and all of them entered the stage of result analysis. ① The expression of IL-1β mRNA (A value)was significantly higher in the ischemia-reperfusion group than in the simple ischemia group and normal control group, with significant difference (respectively 1.07±0.33,0.60±0.22,0.57±0.12,t=3.751 7,11.852 6,P ＜ 0.01).② Activity of IL-1 polypeptide (A value )was significantly higher in the ischemia-reperfusion group than in the simple ischemia group and normal control group, with significant difference [respectively (33.7±3.2),(23.8±4.5), (23.1±2.1),t=2.798 8,9.962 7,P ＜ 0.01]. ③ ICAM-1 mRNA(A value)was significantly higher in ischemia-reperfusion group than in simple ischemia group and normal control group, with significant difference[respectively 0.94±0.12,0.52±0.11,0.51±0. 10,t=0.327 0,6.127 4, P＜0.01].④The expression of ICAM-1 protein was significantly higher at ischemiareperfusion for 4,6 and 12 hours than in simple ischemia group and normal control group, with significant difference [Respectively (316.90±26.00),(361.40±18.00),(406.00±23.00),(164.21±2.00),(180.00±32.00) μg/L,t=1.410 3,9.119 3 ,P ＜ 0.01]. ⑤ The activity of MPO was significantly higher at ischemia-reperfusion for 12 hours than in simple ischemia group and normal control group, with significant difference [respectively (15.00±2.00),(7.50±1.67),(6.67±1.00) nkat/g, t=3.012 2,P ＜ 0.01].CONCLUSION: Following reperfusion injury, inflammatory reaction in spinal cord is important molecular basis for causing blood spinal barrier impairment, and plays an important role in the process of secondary spinal cord injury.

Objective Analyze the clinical feature of patients failed for diagnosis through endobronchial ultrasound transbronchial needle aspiration(EBUS-TBNA).Optimize the indication and increase diagnosis rate of EBUS-TBNA.Methods A total of 669 patients failed for diagnosis of EBUS-TBNA were included.Fifty-three of them(7.92％) were not exactly diagnosed.Perioperation clinical data and clinical feature were collected and evaluated based on specific disease,lesion location,size and operator' s experience.Results The undiagnosis rate was higher in lymphoma (77.78％),tuberculosis (23.08％) and sarcoidosis(9.09％) when analyzed from specific diseases.If the lesion location was taken into consideration,15.38％ upper paratracheal lymph nodes(R2) could not be diagnosed exactly by EBUS-TBNA,and the bilateral hilar lymph nodes(15.00％ for right,11.54 for left) were followed.Size of the lesion was not associated with the diagnosis rate.The operator's experience could also affect the results.The undiagnosis rate was highest in the first 10 cases among all operators.After at least 10 EBUS-TBNA processes,the undiagonsis rate stayed near 7.50％,which was close to the average.Conclusion It is necessary to select suitable indications for EBUS-TBNA based on the disease,lesion location and operatior experience,and cooperate with mediastinoscopy to rise diagnosis rate.