Objective To investigate the relationship between blood vessel invasion (BVI) and clinicopathologic features and prognosis in patients with gastric cancer,and analyze related factors affecting the prognosis of patients.Methods The clinicopathological data of 206 patients with gastric cancer who were admitted to the Nanjing Hospital Affiliated to Nanjing Medical University from January 2007 to December 2010 were retrospectively analyzed.The BVI of surgical tumor specimens in all patients was detected by immunohistochemical staininng.All the patients were followed up via outpatient examination and telephone interview up to March 2014.The count data were analyzed using the chi-square test.The survival curve was drawn by Kaplan-Meier method.The survival analysis and univariate analysis were done using the Log-rank test,and multivariate analysis was done using the COX regression model.Results The BVI rate of 206 patients was 27.67％ (57/206).The BVI rate of tumor tissues,tumor differentiation,perineural invasion,T stage,N stage and TNM stage in all patients with gastric cancer were compared,showing significant differences (x2=14.396,9.569,15.579,43.453,30.732,P ＜ 0.05).After operation,188 patients were followed up for 6.0-60.0 months (median,34.0 months),with the follow-up rate of 91.26％ (188/206).Among 188 patients with follow-up,the median survival time and 5-year cumulative survival rate in patients with BVI and with negative BVI were 32.4 months and 19.6％,40.7 months and 42.0％,respectively,with a significant difference in the survival of patients (x2 =9.364,P ＜ 0.05).The results of univariate analysis showed that the diameter of tumor,tumor differentiation,perineural invasion,BVI,T stage,N stage and TNM stage were factors affecting the prognosis of patients with gastric cancer (x2=9.241,17.486,11.243,9.364,27.666,216.745,49.887,P ＜ 0.05).The results of multivariate analysis showed that the diameter of tumormore than 5 cm,BVI,stage T4,stage N3 and stage Ⅲ were independent risk factors affecting the prognosis of patients with gastric cancer (HR =0.502,0.456,0.052,0.001,0.735; 95％ confidence interval:0.334-0.754,0.289-0.720,0.004-0.664,0.000-0.006,0.159-3.398,P ＜ 0.05).Conclusions BVI in patients with gastric cancer is associated with the progression of tumors.The diameter of tumor more than 5cm,BVI,stage T4,stage N3 and stage Ⅲ are independent risk factors affecting the prognosis of patients with gastric cancer,and BVI may be a predictor of poor prognosis of patients with gastric cancer.

Objectives To observe the effect of continuous positive airway pressure (CPAP)for the treatment of patients with acute cerebral infarction combined with obstructive sleep apnea syndrome (OSAS)and to investigate the influence of CPAP therapy on the recovery of neurological function in patients. Methods From April 2014 to September 2015,68 consecutive patients with acute cerebral infarction combined with OSAS admitted to the Department of Neurology,General Hospital of Wanbei Coal and Electricity Group were enrolled retrospectively. According to whether received the CPAP therapy,they were divided into an observation group (n = 31)and a control group (n = 37). The control group was treated with conventional therapy,and on the basis of the treatment plan of the control group,the observation group was also treated with CPAP therapy. They were all the patients with cerebral infarction who were treated for 14 d. The oxygen desaturation index (ODI),lowest oxygen saturation (LS a O2 ),oxidized low-density lipoprotein (ox-LDL),and superoxide dismutase (SOD)concentration,National Institute of Health Stroke Scale (NIHSS)scores and Barthel index (BI)scores,and the modified Rankin scale (mRS)scores after 3 months before and after the therapy in the patients of both groups were documented. The total effective rate was assessed. Results (1)The ODI and LS a O2 in the observation group and the control group after treatment were better than those before treatment. There were significant differences between the 2 groups (ODI:16 ± 6% vs. 35 ± 21%,26 ± 15% vs. 36 ± 21 %;LS a O2:88 ± 6% vs. 75 ± 11%,80 ± 8% vs. 75 ± 11%;all P < 0. 05). (2)After treatment,ox-LDL of the observation group was lower than that of the control group. There was significant differences between the 2 groups (ox-LDL:487 ± 90 μg/ L vs. 548 ± 77 μg/ L,SOD:111 ± 10 kU/ L vs. 94 ± 15 kU/ L,all P < 0. 01). (3)After treatment,the NIHSS and BI scores of the observation group and the control group were better than those before treatment. There were significant differences (the NHISS scores:5. 2 ± 2. 2 vs. 12. 9 ± 3. 9;7. 6 ± 3. 1 vs. 12. 5 ± 4. 2;the BI scores:88 ± 10 vs. 52 ± 30;81 ± 4 vs. 58 ± 30;all P < 0. 01). The NIHSS and BI scores of observation group were better than those of the control group. There were significant differences (all P < 0. 01). They were followed up for 3 months,the mRS score (1. 3 ± 0. 4)of the observation group was lower than that of the control group (2. 0 ± 1. 1). There was significant difference between the 2 groups (t = 3. 362,P <0. 01). (4)The total effective rate of the observation group and control group was 74. 2% (23 / 31)and 48. 6% (18 / 37)respectively. There was significant difference between the 2 groups (χ2 = 4. 598,P <0. 05). Conclusion The CPAP therapy can alleviate the oxidative stress levels in patients with acute cerebral infarction combined with OSAS in short term and improve the neurological function of patients.

Objective To investigate the relationship between Helicobacter pylori (Hp) infection and carotid atherosclerosis (CAS) progression in patients with high risk of stroke,and to provide clinical evidence for the primary prevention of stroke.Methods Three hundred and thirty-two patients with high risk of stroke were screened from 2 800 people who were consecutively selected and had health examination from June to December 2014 in the Department of Medical Center,General Hospital of Wanbei Coal and Electricity Group.Their clinical information was collected.A total of 267 patients whose carotid ultrasound examinations showed plaques and stenosis were selected for the study.Two hundred and three of the 267 patients who met the screening conditions and completed the follow-up were selected as study subjects.The Hp infection status was detected by the 14C urea breath test and the dynamic progression of CAS was observed.The risk factors of CAS progression were also analyzed.Results Hp infection was found in 170 of 332 patients with high risk of stroke.Among the 267 patients who prompted plaques and stenosis in carotid ultrasound in 2014,203 patients were followed up for 1 year,and 133 patients (65.5％,133/203) were found infected by Hp.Forty-six patients had suggestive carotid stenosis and stenosis aggravating in 2015,31 (67.4％,31/46) of which were found infected by Hp.Logistic regression analysis showed that smoking (OR =1.632,95％ CI 1.275-1.940,P =0.011),systolic blood pressure (OR =1.343,95％ CI 1.105-1.632,P =0.019),low density lipoprotein (OR =1.590,95％ CI 1.188-2.005,P =0.005),oxidative low density lipoprotein (OR =1.732,95％ CI 1.325-2.170,P =0.000) and Hp infection (OR =1.672,95％ CI 1.180-2.154,P =0.016) were independent risk factors for carotid atheroslerosis progression.Conclusions Hp infection was found closely related to CAS progression in patients at high risk of stroke.Positive and effective prevention of Hp infection,advocating smoking cessation and controlling blood pressure and blood fat can effectively reduce the incidence of stroke.

Cryptogenic stroke refers to ischemic stroke that is not clear to the cause of the disease through routine examinations. With the development of medical technology, studies have found that most cryptogenic stroke is caused by embolism.Therefore,the concept of embolic stroke of undetermined source (ESUS) is proposed. The main causes of ESUS include subclinical atrial fibrillation, patent foramen ovale, aortic arch atherosclerotic plaque, non-stenotic complex carotid atherosclerotic plaques, and tumor-related embolism, etc. This article reviews the etiology and secondary prevention of ESUS.

OBJECTIVE To investigate the pharmacological effect and mechanism of Salvianolic acid A (SAA) on pulmonary vascular remodeling. METHODS In current study, we conducted a series of experiments to clarify the effect of SAA,a kind of polyphenol compound,in the process of EndMT in human pulmonary arterial endothelial cells and in vivo therapeutic efficacy on vascular remodeling in monocrotaline (MCT)-induced EndMT. EndMT was also induced by TGF-β1in human pulmonary arterial endothelial cells(HPAECs) in vitro.RESULTS SAA significantly attenuated EndMT,simul-taneously inhibited cell migration and reactive oxygen species(ROS)formation.In MCT-induced pulmonary arterial hypertension(PAH)model,SAA improved vascular function,decreased TGF-β1level and inhib-ited inflammation. Mechanistically, SAA stimulated Nrf2 translocation and subsequent heme oxygen-ase-1(HO-1)up-regulation.The effect of SAA on EndMT in vitro was abolished by ZnPP,a HO-1 inhibitor. CONCLUSION This study indicates a deleterious impact of oxidative stress on EndMT. Polyphenol antioxidant treatment may provide an adjunctive action to alleviate pulmonary vascular remodeling via inhibiting EndMT.

OBJECTIVE Salvianolic acid A (SAA) is one of the most bioactive compounds from a traditional Chinese medicine called Dan Shen(Salvia Miltiorrhiza Bunge)and exhibits many pharmaco-logical activities.Previous studies have indicated that SAA may inhibit endothelial dysfunction and vascular remodeling in spontaneously hypertensive rats. However, whether SAA improves vascular remodeling induced by pulmonary arterial hypertension (PAH) remains unknown. In this study we examined whether SAA attenuated vascular remodeling in a PAH rat induced by monocrotaline(MCT),and elucidated the underlying mechanisms.METHODS PAH was induced in rats by injecting a single dose of monocrotaline (MCT 60 mg·kg-1).The rats were orally treated with either SAA(0.3,1,3 mg·kg-1·d-1)or a positive con-trol Bosentan(30 mg·kg-1·d-1)for 4 weeks.Echocardiography and hemodynamic measurements were performed on d 28.Then the hearts and lungs were harvested,the organ indices and pulmonary artery wall thickness were calculated,and biochemical and histochemical analysis were conducted.The levels of apoptotic and signaling proteins in the lungs were measured using immunoblotting.RESULTS Treatment with SAA effectively ameliorated MCT-induced pulmonary artery remodeling,pulmonary hemodynamic ab-normalities and the subsequent increases of right ventricular systolic pressure (RVSP). Furthermore, the treatments significantly attenuated MCT-induced hypertrophic damage of myocardium,parenchymal in-jury and collagen deposition in the lungs.Moreover,the treatments attenuated MCT-induced apoptosis and fibrosis in the lungs.The treatments partially restored MCT-induced reductions of bone morphoge-netic protein typeⅡ receptor (BMPRⅡ) and phosphorylated Smad1/5 in the lungs. CONCLUSION SAA ameliorates the pulmonary arterial remodeling in MCT-induced PAH rats most likely via activating the BMPRII-Smad pathway and inhibiting apoptosis.Thus,SAA may have therapeutic potential for the pa-tients at high risk of PAH.

Objective To investigate the relationship between mismatch repair (MMR) protein expression and microsatellite instability (MSI) and tumor TNM staging in colorectal cancer. Methods The clinical data of 1351 patients who underwent radical resection of colorectal cancer at the Xijing Digestive Hospital of Air Force Military Medical University from January 2008 to December 2017 were retrospectively analyzed. The MMR and MSI status in patients with different gender, age and TNM staging were analyzed. Results Of the 1351 specimens, 291 (22％) didn't express MMR protein. Univariate analysis showed that there were significant differences in the deletion rates of MSH2, MSH6 and PMS2 between patients ≥60 years old and<60 years old (all P<0.05);there were significant differences in the deletion rates of MSH2 between stage T3 and the other stages (P<0.05); the deletion rates of MLH1, PMS2 among different N stages, and the deletion rates of MSH2 and MSH6 between stage N0 or N1 and the other N stages were significantly different (all P< 0.05); the deletion rates of PMS2 among different M stages were significantly different (P< 0.05). There were significant differences in PMS2 deletion rates among different TNM stages and MLH1, MSH2 and MSH6 deletion rates between stage Ⅱ or Ⅲ and the other stages (all P< 0.05). There was significant difference in MSI positive rates between patients ≥60 years old and<60 years old (P<0.05); there were significant differences in MSI positive rates between stage T3 or T4 and the other T stages, among different N or M stages, and between TNM stage Ⅱ, ⅢorⅣand the other TNM stages (all P<0.05). Conclusions The MMR protein expression and MSI in colorectal cancer patients are closely related to tumor TNM staging. Detection of MMR protein expression and MSI in colorectal cancer patients has certain reference value for judging TNM staging of colorectal cancer. To a certain extent, it can guide the diagnosis and treatment of patients with colorectal cancer and judge the prognosis.

Objective:To investigate the drug resistance and pathogenic mechanism of a uropathogenic Escherichia coli (UPEC) strain UPEC132 at the genome-wide level. Methods:The susceptibility of UPEC132 strain to 16 antimicrobial agents was determined by minimum inhibitory concentration (MIC) assay. The UPEC132 strain was genotyped by multilocus sequence typing (MLST). The three-generation sequencing platform was used to sequence and assemble the whole genome of the UPEC132 strain. Drug resistance and virulence gene function annotations were predicted by Prodigal software and screened by using genome database. Genome sequences of the UPEC132 strain and 23 other UPEC strains collected from GenBank were phylogenetically analyzed, and a phylogenetic tree was constructed by RAxML software.Results:The UPEC132 strain was resistant to ampicillin, ampicillin/sulbactam, tetracycline, erythromycin, chloramphenicol and cefazolin. Its genotype was ST10522 by MLST. The whole genome of the UPEC132 strain included one complete genome (chromosome) and two plasmid sequences. The sequence sizes of the chromosome and plasmids 1 and 2 were 5 234 468 bp, 117 139 bp and 101 356 bp, and the guanine-cytosine (GC) content was 50.48%, 49.05%, and 54.04%, respectively. There were 4 856, 140 and 116 genes annotated in the chromosome and plasmids 1 and 2, respectively. Drug resistance genes were mainly distributed in the chromosomal genome, mainly including the multidrug resistance efflux pump gene clusters. Only blaTEM-1 and tetG genes were carried in the plasmid 2. Virulence genes were also mainly distributed in the chromosome genome, including nine pilus adhesins, five iron uptake systems and three secretory toxins. Gene clusters encoding Afa and type Ⅳ fimbriae were located on plasmids 1 and 2, respectively. The phylogenetic tree showed that the UPEC132 strain was not in the same branch with either of the 23 UPEC strains. Conclusions:The UPEC132 strain belonged to ST10522, which was a newly named ST type of Escherichia coli and first reported at home and abroad. The genome-wide genetic information of the UPEC132 strain was fully revealed. The multidrug resistance genes and virulence genes carried by the UPEC132 strain were associated with its drug resistance and pathogenicity.

Objective:To observe the efficacy of 3D printing-assisted hematoma puncture and drainage in the treatment of hypertensive intracerebral hemorrhage and to explore the factors affecting postoperative brain dysfunction.Methods:A retrospective Case-control study was conducted to select 168 hypertensive intracerebral hemorrhage patients who were treated with 3D printing assisted hematoma puncture and drainage in the People′s Hospital of Yuechi County from January 2020 to September 2022 as the observation group, and 125 hypertensive intracerebral hemorrhage patients who were treated with CT guided hematoma puncture and drainage in the People′s Hospital of Yuechi County at the same time as the control group. The clinical efficacy of the two groups of patients was compared. According to the occurrence of postoperative brain dysfunction, the patients in the observation group were divided into normal brain function group ( n=121) and brain dysfunction group ( n=47). The clinical data of age, preoperative cerebral hernia, blood loss, ventilator-assisted ventilation, postoperative Glasgow coma index score (GCS) and postoperative complications were compared between the two groups. Multivariate Logistic regression was used to analyze the factors affecting postoperative brain dysfunction in the observation group, and a line chart model was constructed and its predictive efficiency was evaluated. The measurement data of normal distribution is expressed as mean ± standard deviation ( ± s), and independent sample t-test is used for inter group comparison. Chi-square test was used for comparison between count data groups. Results:The proportion of the drainage tube in the hematoma, hematoma clearance rate at 3 and 7 days after surgery, total effective rate of treatment, and GCS score at 1 week after surgery in the observation group were 88.69%(149/168), 54.17%(91/168), 96.43%(162/168), 92.86%(156/168), and 10.72±3.45, respectively, the control group was 75.20%(94/125), 36.80%(46/125), 81.60%(102/125), 76.80%(96/125), and 9.08±3.22, respectively, the difference between the two groups was statistically significant ( P<0.05). Advanced age ( OR=1.983, 95% CI: 1.169-2.732, P=0.017), preoperative cerebral hernia ( OR=1.532, 95% CI: 1.113-2.139, P=0.029), bleeding volume ≥ 50 mL ( OR=2.538, 95% CI: 1.802-3.347, P=0.003), postoperative GCS score 3-5 ( OR=2.874, 95% CI: 2.265-3.449, P<0.001), postoperative hypoxemia ( OR=2.251, 95% CI: 1.673-2.842, P=0.010) and postoperative chronic hydrocephalus ( OR=1.642, 95% CI: 1.214-2.021, P=0.022) were risk factors for postoperative brain dysfunction, while ventilator-assisted ventilation ( OR=0.656, 95% CI: 0.132-0.828, P=0.038) was protective factors. The internal verification of the line chart model by Bootstrap resampling method shows that the model has high differentiation, accuracy and validity. Conclusion:The application of 3D printing-assisted localization in hematoma puncture and drainage can improve the puncture condition and the hematoma clearance rate and clinical effect of patients with hypertensive intracerebral hemorrhage. Advanced age, preoperative cerebral hernia and bleeding volume are related to postoperative brain dysfunction. Clinical attention should be paid to patients with risk indicators of postoperative brain dysfunction.

Objective To evaluate the efficacy and safety of epalrestat, an aldose reductase inhibitor, and epalrestat plus methylcobalamine on diabetic peripheral neuropathy, as compared with methylcobalamine. Methods A total of 444 subjects with diabetic neuropathy were enrolled in the study, and divided into methylcobalamine group ( n= 145 ) , epalrestat group ( n = 143 ) , and methylcobalamine combined with epalrestat group ( n = 156 ) . Therapeutic efficacay was assessed in terms of clinical symptoms and physical examinations by using Michigan Neuropathy Screening Instrument ( MNSI ) , and electrophysiological assessments. Results After 4 to 12-weeks′treatment, symptoms and signs of neuropathy ( using MNSI ) are significantly improved in the three groups ( P<0. 01). The mean changes of MNSI ( questionnaire) score from baseline were higher in epalrestat group and methylcobalamine combined with epalrestat group as compared with that of methylcobalamine group(P<0. 05), but no difference was detected in the change of MNSI ( physical examination ) score from baseline among three groups. After treatment for 12 weeks, motor nerve conduction velocity ( MNCV ) was significantly improved in epalrestat group and methylcobalamine combined with epalrestat group(P<0. 05), but no difference was detected in MNCV at 12 week among three groups(P>0. 05). Conclusion Epalrestat is effective and safe in the treatment of diabetic neuropathy. Furthermore, epalrestat is more efficacious in ameliorating symptoms and MNCV of neuropathy than methylcobalamine. However, while no improved efficacy is shown with the combined treatment.