BACKGROUND:The resorption and unprediction of fat transplantation directly influence the clinical application. The technology of reducing graft resorption by using various cytokines to promote early revascularization of fat transplantation needs to be improved. But the effect is not stable, as the cytokines losing with the bleeding and exudation thus cannot long-term affect the vascular endothelial cells. OBJECTIVE:To investigate the effect of alkaline recombinant basic fibroblast growth factor-dextran formed sustained-release system on the early revascularization of fat grafts. METHODS:The recombinant basic fibroblast growth factor solution 2 mg/L and basic fibroblast growth factor-dextran sustained-release granules were prepared. The fat tissues were selected from the inguinal region of 12 Sprague-Dawley rats for fat transplantation. The left backs of the rats were treated with subcutaneously injection of fat pearl plus recombinant basic fibroblast growth factor solution (control group), and the right backs of rats were treated with subcutaneously injection of fat pearl plus basic fibroblast growth factor-dextran sustained-release granules (sustained-release system group). At 7 and 14 days after treatment, one rat in each group was sacrificed randomly, then ink perfusion microvascular imaging was used to observe the inside of the graft and the density of early formed coated vessels. At 90 days after transplantation, the rest rats were sacrificed, and the grafts were obtained to measure the volume. RESULTS AND CONCLUSION:At 7 and 14 days after transplantation, the number of vessels in the capsule and grafts of the sustained-release system group was higher than that in the control group (P<0.01). At 90 days after transplantation, the volume of grafts in the sustained-release system groups was bigger than that in the control group (P<0.05). The recombinant basic fibroblast growth factor-dextran delivery system could better promote the early revascularization of fat grafts. The experimental results suggest that recombinant basic fibroblast growth factor-dextran sustained-release system can help to reduce the absorption of fat grafts after surgery.

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 observe the clinical efficacy of therapy of application of goserelin(Zoladex)com-bined with microwave on patients with endometriosis after laparoscopic surgery.Methods 188 patients with endome-triosis were randomly divided into two groups according to the randomized digital table method,with 94 cases in each group,as the observation group(Zoladex combined with microwave therapy group)and the control group(Zoladex treatment group).Among them there were 80 patients with infertility,45 cases in the observed group and 35 cases in the control group.After treatment,the clinical efficacy rate,recurrence rate and pregnancy rate of patients with infertil-ity were compared between the two groups.Results The efficiency of the observation group was significantly higher than that of the control group(80.12% vs.65.31%,χ2 =5.338,P <0.05),and the recurrence rate of the observa-tion group was lower than that of the control group(22.34% vs.38.56%,χ2 =8.325,P <0.05),the difference was statistical significance.The pregnancy rate of patients with infertility in the observation group were significantly higher than that of the control group,and the difference was statistically significant[64.38%(29 /45)vs.44.46%(16 /35)χ2 =4.531,P <0.05].Conclusion As for patients with endometriosis after laparoscopic surgery,the therapy of Zoladex drug treatment assisted with microwave treatment at the same time,could achieve good clinical curative effect and low recurrence rate,and could improve the pregnancy rate of patients with infertility.

AIM: To investigate the effect of phosphatidylinositol 3-kinase (PI3K) inhibitor wortmannin on expression of inducible nitric oxide synthase (iNOS) in bronchiole epithelial cells of asthma rat.METHODS: 24 male Sprague-Dawley rats were randomly divided into 3 group, namely control group, asthma group and PI3K inhibitor wortmannin+asthma group. The numbers of total cells and eosinophil cells in bronchoalveolar lavage fluid (BALF) were counted. The expression of inducible nitric oxide synthase was detected by immunohistochemistry method, and iNOS mRNA was detected by reverse transcription-polymerase chain reaction (RT-PCR). The activity of PI3K, iNOS and content of NO in lung homogenates were tested by spectrophotometry.RESULTS: The numbers of eosinophils and the ratios of eosinophils to total cells in BALF in asthma group were significantly higher than those in control group, while those in wortmannin+asthma group were decreased compared to asthma group. The activity of PI3K, iNOS and content of NO in lung homogenats in asthma group were significantly higher than those in control group, while those in wortmannin+asthma group were decreased compared to asthma group. The expression of iNOS protein in bronchiole epithelial cells and mRNA in lung homogenates in asthma group were markedly increased compared to control group, while those in wortmannin+asthma group were decreased compared to asthma group.CONCLUSION: PI3K regulates the expression of iNOS in airway of asthma rat and affects inflammatory reaction in airway.

AIM: To study the effect of hypoxia and hypercapnia on nitric oxide (NO) in plasma and superoxide dismutase (SOD), catalase (CAT), soluble guanylate cyclase (sGC), cyclic guanosine monophospholate (cGMP) in lung tissue in rats, and to explore the effect of NO- and H_2O_2-sGC pathway on the development of the pulmonary hypertension. METHODS: The model of hypoxic and hypercapnic 1, 2, 4-week group (HH 1 week, HH 2 weeks, HH 4 weeks) and control group was set up. NO content in plasma, CAT and SOD in rat lung were determined by spectrophotometry. The sGC activity in lung tissue was detected by enzyme kinetic analysis. cGMP content in lung tissue was examined with ~ 125 I-radioimmunoassay. RESULTS: The mean pulmonary artery pressure (mPAP) showed significantly higher in HH 1 week, HH 2 weeks and HH 4 weeks groups compared with control group (all P

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.

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 .

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.