Objective To study the relationship between serum uric acid (UA) level and cerebrovascular stenosis in acute ischemic stroke (AIS) patients.Methods Five hundred and thirteen patients with AIS or old IS admitted to our hospital from April 2014 to April 2016 were divided into primary IS group (n=236),recurrent IS group (n=136),and old IS group (n=141).Venous blood samples were taken on admission for biochemical testing.The patients were further divided into serum UA≤255 μmol/L group (n=128),serum UA=256-312μmol/L group (n=129),serum UA=313-371 μmol/L group (n=129),and serum UA＞371 μmol/L group (n=127).Their cerebrovascular stenosis was assessed by CT angiography or magnetic resonance angiography after admission.Results The severity of cerebrovascular stenosis,hypertension,diabetes and hyperlipidemia was significantly different in primary IS group,recurrent IS group and old IS group (27.5％ vs 33.8％ vs 12.8％、24.2％ vs 28.7％ vs 46.8％、61.9％ vs 49.3％ vs 40.4％、71.6％ vs 61.8％ vs 46.8％,P=0.000).Logistic regression analysis showed that serum UA≤ 255 μmol/L was an independent risk factor for cerebrovascular stenosis (OR =2.787,95 ％CI:2.209-3.365,P=0.001).The risk of cerebrovascular stenosis decreased gradually with the elevated serum UA level.Conclusion Serum UA level is not directly related with recurrent IS.Low serum UA level is a risk factor for cerebrovascular stenosis in AIS.

Objective To analyze the related influencing factors of progressive ischemic stroke, and to investigate the value of serum markers for prediction of progressive ischemic stroke. Methods Three hundred and six patients with acute cerebral infarction were divided into progressive ischemic stroke (PIS) group (n=91) and non-progressive ischemic stroke (NPIS) group (n=215). Data of gender, age, past medical history, personal history and serum markers were collected and compared in two groups. Binary Logistic regression was used to analyze the influencing factors of PIS. The receiver operating characteristic (ROC) curves of neutrophils to lymphocytes ratio (NLR), fibrinogen and fasting blood glucose were analyzed in two groups. Results Positive rates of hypertension history, diabetes history, hypercholesterolemia history, incidence of large artery atherosclerotic (LAA) stroke were significantly higher in PIS group than those in NPIS group ( P<0.05). The levels of neutrophils, NLR, fibrinogen and fasting blood glucose were significantly higher, but the level of lymphocytes was significantly lower in patients with PIS than those in patients with NPIS (P<0.05). Logistic regression analysis confirmed that diabetes, LAA stroke, NLR, fibrinogen and fasting blood glucose were independent risk factors for the PIS ( P<0.05). The areas under ROC curve by NLR, fibrinogen and fasting blood glucose were 0.777, 0.560 and 0.574, respectively. The sensitivities of NLR, fibrinogen and fasting blood glucose were 72.5%, 59.8%and 47.3%, respectively;and the specificities were 76.7%, 51.2% and 69.8%, respectively. Conclusion The occurrence of PIS is related with blood pressure, blood lipids, inflammatory cells in peripheral bolld, fibrinogen and fasting blood glucose. The level of NLR in peripheral blood can predict the occurrence of PIS, which can be used as an important reference index for early diagnosis of PIS.

Objective To evaluate the effect of radical surgery with TME in the treatment of rectal carcinoma. Methods Ninety-six patients underwent radical resection with TME from July 2002 to July 2006 were analyzed and followed up for 1～46 months. Results In these 96 cases,18 cases underwent anterior resection,15 eases ultra-low anterior resection. During the postoperative follow-up period one case local recurrence oecun'ed,one ease was death. Four eases occurred anastomose leakage. Conclusion rIME is an effective measure in the treatment of rectal carcinoma.

Objective To determine the factors responsible for failed postnatal immunoprophylaxis for hepatitis B virus(HBV) in Qidong, China. Methods Eleven children who developed into chronic HBV infection after receiving HBIG and HBV recombinant vaccines were recruited into the study. Eleven paired mothers with chronic hepatitis and other 6 mothers whose children successfully generated anti-HBs after im-munoprophylaxis were included as the control in the study. Full-length HBV DNA was amplified through ser-um sample by PCR method and underwent cloning and sequencing. HBV DNA level was quantified by real-time PCR. Results The mean levels of HBV DNA in mothers who had HBV DNA positive children and healthy children were ( 1.2 ×107± 3.1 × 106 ) copies/ml and ( 1.6× 107±8.8×106 ) copies/ml, respec-tively. There was no significant difference between the groups (P >0.05). Meanwhile, viral load in chil-dren was unrelated to that in their mothers (r2 =0.2429). In 11 HBV DNA positive children, 4(36.4% ) demonstrated amino acid substitutions in HBsAg "a" determinant region with 6 different types, I.e. T125A, I126T, Q129H, M133V, D144V and G145A. All of the mothers showed the wild-type sequence in "a" epitope, indicating surface escape mutants were not acquired from the initial infection, but developed under the immune pressure. The mutation rates after immunoprophylaxis for preS1, preS2, S, X, preC/C and P genes were 0.38%, 0. 22%, 0.27%, 0.17%, 0.11%, and 0.11%, respectively, nt2999-3157 in preS1, nt529-677 in S, nt1955-2016 in C, nt923-1001 and nt2489-2602 in P genes were among the hottest muta-tional spots throughout the HBV genome. Conclusion HBV mutation may occur in all the open readingframes after passive and active immunoprophylaxis. In addition to S gene, HBV preS and P genes could alsoassociate with the escape mutants.

Objective:To explore the effect of Syncytin-1 overexpression in the skeletal muscle cells on changes of sodium-dependent neutral amino acid transporter 1 (ASCT1), inflammatory factors and neuroprotective factors in co-culture model of spinal cord anterior horn motor neurons, Schwann cells, and skeletal muscle cells.Methods:(1) Spinal cord anterior horn motor neurons, skeletal muscle cells, and Schwann cells were primarily cultured in vitro; the expressions of choline acetyltransferase (ChAT), α-smooth muscle actin (α-SMA) and calcium-binding protein B (S100B) in the neurons, muscle cells, and Schwann cells were detected by immunofluorescence staining, respectively. (2) Plasmids containing Syncytin-1 or control plasmids were transfected into the skeletal muscle cells, respectively; 24 h after that, these transfected skeletal muscle cells were co-cultured with spinal cord anterior horn motor neurons and Schwann cells, respectively (Syncytin-1 recombinant plasmid transfection group or control plasmid transfection group); changes of morphology and junction of co-culture cells were observed under inverted microscope. Forty-eighty h after co-culture, enzyme-linked immunosorbent assay (ELISA) was used to detect the tumor necrosis factor α (TNF-α), inducible nitric oxide synthase (iNOS) and vascular endothelial growth factor (VEGF) concentrations in the supernatant of co-culture cells; real-time quantitative (qRT)-PCR and Western blotting were used to detect the Syncytin-1, ASCT1, TNF-α, iNOS, and VEGF mRNA and protein expressions in the co-culture cells Results:(1) Immunofluorescent staining showed that more than 95% spinal cord anterior horn motor neurons were with positive CHAT expression, more than 95% skeletal muscle cells were with positive α-SMA expression, and more than 95% Schwann cells were with positive S100B expression; all of which were localized in the cytoplasm. (2) There were no obvious differences in number or morphology of co-culture cells between the Syncytin-1 recombinant plasmid transfection group and control plasmid transfection group. As compared with the control plasmid transfection group, Syncytin-1 recombinant plasmid transfection group had significantly increased concentrations of TNF-α, iNOS and VEGF in the supernatant of co-cultured cells, and statistically increased mRNA and protein expressions of TNF-α, iNOS, syncytin-1 and VEGF, and significantly decreased ASCT1 mRNA and protein expressions ( P<0.05). Conclusion:Syncytin-1 overexpression in the skeletal muscle cells may decrease the ASCT1 expression, induce the inflammatory factor release, and increase the neuroprotective factor VEGF expression.

Amyotrophic lateral sclerosis (ALS) is a series of upper and lower motor neuron degenerative disorders,characterized by muscle weakness and atrophy,bulbar paralysis and pyramidal signs.Recent studies showed that ALS may present with many atypical clinical manifestations,such as cognitive impairment,autonomic dysfunction,extrapyramidal disorders,paresthesia,and abnormal eye movements.This review summarized the recent understanding of atypical clinical manifestations in ALS.

Objective:To investigate the current use situation of hemostatics in preventing re-bleeding in the patients with sub-arachnoid hemorrhage. Methods:The records of patients with subarachnoid hemorrhage were selected from a hospital in 2016 and the types,dosage,course and drug adverse reactions of hemostatics were recorded and evaluated according to the drug information leaflets/related guideline,drug utilization researches and adverse drug actions monitoring. Results:Totally 81 cases with hemostatics involved 3 varieties of hemostatic drugs,the combination proportion was 16.05%,the reasonable use rate was 86.42%,the reasonable rate of administration route was 100%,the reasonable solvent rate was 98.77% and the course no more than 72 h was 88.89%. The drug uti-lization index of etamsylate injection and tranexamic acid injection was greater than one,indicating that the dosage was unreasonable. There were no adverse reactions in the 81 cases.Conclusion:The use of hemostatics in the patients with subarachnoid hemorrhage is common,and there is still unreasonable use (such as dosage and course etc) that we should pay attention to.

Hyperhomocysteinemia (HHcy) is one of the independent risk factors for youth cerebral infarction. Gene mutation of key enzymes in homocysteine metabolism is the main cause of HHcy. Few cases of cystathionine beta-synthase (CBS) compound heterozygous mutation complicated with pulmonary embolism and lower extremity artery embolism have been reported. This article reported a young cerebral infarction patient complicated with pulmonary embolism and lower extremity artery embolism, who was subsequently detected with significantly elevated blood Hcy, and finally etiologically diagnosed with CBS 833 T>C/1082C>T compound heterozygous mutation. With the treatment of folic acid, methyl cobalt amine, vitamin B 6 and anticoagulant, the blood Hcy has been gradually declined, and no new thrombotic events occurred during the follow-up period of a year.

Objective To analyze the effectiveness and safety of percutaneous screw fixation assisted by an orthopedic robot for treatment of pelvic and acetabular fractures.Methods Fifteen patients with fresh closed pelvic or acetabular fracture were hospitalized from September to December 2017 at Department of Orthopaedics,Foshan Hospital of Traditional Chinese Medicine.They were 10 men and 5 women,from 22 to 69 years of age (average,65.2 years).There were 9 pelvic fractures (5 cases of Tile type B and 4 ones of Tile type C) and 6 acetabular fractures (3 anterior column fractures,2 posterior column fractures and one transverse fracture).All patients underwent percutaneous transpedicular screw fixation with the assistance of an orthopaedic robot.Fluoroscopic frequency,number of guide needle adjustment and deviation between initial planning and the final screw position were recorded intraoperatively.Postoperative CT was performed to evaluate screw positions and incidence of adverse events.Functional recovery in the patients was evaluated in regular follow-ups.Results A total of 26 screws were implanted in the operation.The fluoroscopic frequency ranged from 12 to 49 times,with a mean value of 17.3 times per screw;the number of needle adjustment ranged from 0 to 2 times(mean,0.3 times);the deviation of the actual path from its initial planning ranged from 0.82 to 1.42 mm (mean,1.06 mm).No surgery-related neurovascular injury occurred in any patient.Postoperative CT examination revealed that no screws cut out of cortical bone,yielding a 100％ rate of excellent and good screw positions.Two patients were lost to the follow-up,and the remaining 13 patients were followed up for 12 to 14 months (mean,12.6 months).Their Majeed functional scores at the final follow-up averaged 88.6 points (from 68 to 96 points).No neurological symptoms were observed during follow-up.Conclusion Since percutaneous screw fixation assisted by an orthopaedic robot is accurate and safe and needs less fluoroscopic frequency,it will became a major minimally invasive surgical technique for pelvic and acetabular fractures.

BACKGROUNDEndostar™ (rh-endostatin, YH-16) is a new recombinant human endostatin developed by Medgenn Bioengineering Co. Ltd., Yantai, Shandong, P.R.China. Pre-clinical study indicated that YH-16 could inhibit tumor endothelial cell proliferation, angiogenesis and tumor growth. Phase I and phase II studies revealed that YH-16 was effective as single agent with good tolerance in clinical use.The current study was to compare the response rate , median ti me to progression (TTP) ,clinical benefit andsafety in patients with advanced non-small cell lung cancer ( NSCLC) , who were treated with YH-16 plus vi-norelbine and cisplatin (NP) or placebo plus NP.

METHODSFour hundred and ninety-three histologically or cy-tologically confirmed stage IIIB and IV NSCLC patients , withlife expectancy > 3 months and ECOG perform-ance status 0-2 , were enrolledin a randomized ,double-blind ,placebo-controlled , multicenter trial ,either trialgroup : NP plus YH-16 (vinorelbine 25 mg/m² on day 1 and day 5 ,cisplatin 30mg/m² on days 2 to 4 , YH-167.5mg/m² on days 1 to 14) or control group : NP plus placebo (vinorelbine 25 mg/m² on day 1 and day 5 ,cis-platin 30 mg/m² on days 2 to 4 ,0.9% sodium-chloride 3 .75 ml on days 1 to 14) every 3 weeks for 2-6 cycles .The trial endpoints included response rate ,clinical benefit rate ,time to progression,quality of life and safety .

RESULTSOf 486 assessable patients , overall response rate was 35.4% in trial group and 19.5% in controlgroup (P=0 .0003) . The median TTP was 6 .3 months and 3 .6 months for trial group and control group respectively (P < 0 .001) . The clinical benefit rate was 73 .3 %in trial group and 64.0% in control group (P=0 .035) .In untreated patients of trial group and control group ,the response rate was 40 .0% and 23.9%(P=0 .003) ,the clinical benefit rate was 76 .5 % and 65 .0 % (P=0 .023) ,the median TTP was 6 .6 and 3 .7months (P=0 .0000) ,respectively .In pretreated patients of trial group and control group ,the response ratewas 23.9% and 8.5%(P=0 .034) ,the clinical benefit rate was 65.2% and 61.7%(P=0 .68) ,the median TTP was 5 .7 and 3 .2 months (P=0 .0002) ,respectively . The relief rate of clinical symptoms in trial groupwas higher than that of those in control group ,but no significance existed (P > 0 .05) . The score of quality oflife in trial group was significantly higher than that in control group (P=0 .0155) after treatment . There were no significant differences in incidence of hematologic and non-hematologic toxicity , moderate and severe sideeffects betweentrial group and control group .

CONCLUSIONSThe addition of YH-16 to NP regimen results in significantly and clinically meaningful improvement in response rate , median time to tumor progression,and clinical benefit rate compared with NP alone in advanced NSCLC patients . YH-16 in combination with chemotherapy shows a synergic activity and a favorable toxic profile in advanced cancer patients .