Objective To explore the effect of carotid atherosclerotic plaque ( CAP) on severity and recurrence of patients with cerebral infarction ( CI ) .Methods The prospective cohort study was utilized in this research. Existence and type of CAP were detected by Doppler ultrasound, and patients were divided into plaque group and without plaque group.The patients was evaluated by NIHSS on admission and 7 d, 14 d after admission, and patients were followed up for 1 year.The condition of CI recurrence was be observed.Results According to the Doppler ultrasound, patients were divided into plaque group ( 173 cases, 70.3%) and without plaque group ( 73 cases, 29.7%) .Compared with without plaque group, age, NIHSS score and incidences of hypertension, diabetes, hyperlipidemia, hyperfibrinogenemia were significantly increased (P<0.05 -0.01).In the patients who were conducted follow-up, cerebral infarction recurrence was in 39 cases (24.84%) in plaque group, recurrence time was 10.12 month.The recurrence time was 11.82 month in patient with non-vulnerable plaque, it was 10.62 month in patient with mixed plaque, and it was 9.13 month in patient with vulnerable plaque.Cerebral infarct recurrence was in 7 cases (10.45%) in without plaque group, recurrence time was 11.56 month.The recurrence rate in plaque group was significant increased than that in without plaque, however, the recurrence time for without plaque group was longer than that for plaque group ( all P<0.05 ) .The recurrence rate and recurrence time in patient with vulnerable plaque was significantly earlier than that in patient with non-vulnerable plaque (P=0.034).Conclusion The CAP in patients with acute CI can exacerbate the disease, and increase recurrence rate.It is especially in patients with vulnerable plaque.

Objective To evaluate the association of magnetic resonance angiography (MRA),diffusion-weighted imaging (DWI) and the ABCD2 score assessments with secondary cerebral infarction after transient ischemic attack (TIA).Methods Intracranial vascular MRA,cranial DWI and ABCD2 score were retrospectively analyzed in 162 cases with TIA.The impact of TIA on survival time was assessed using the univariate Kaplan-Meier curve by Log-rank test.Hazard ratio (HR) and 95 ％ confidence interval (CI) of secondary cerebral infarction after TIA predicted by MRA,DWI and ABCD2 score were analyzed by Cox multivariable regression.Results Among the 162 patients with first attack of TIA,86 cases (53.1 ％) developed cerebral infarction within 90 d,of which 22 cases (13.6％) developed secondary cerebral infarction within 0 7 d,27 cases (16.7％) within 8～30d and 37 cases (22.8％) within 31-90 d.Single factor analysis by Kaplan-Meier curve showed that moderate to severe intracranial vascular stenosis diagnosed by MRA,positive DWI and moderate to high ABCD2 score were obviously related to cerebral infarction after first attack of TIA (all P＜0.001 or 0.01).Cox multifactor risk model indicated that age ≥70 y,moderate to severe intracranial vascular stenosis,positive DWI,moderate to high ABCD2 score were the risk factors for secondary cerebral infarction within 90 d after TIA (HR=1.782,2.245,1.964,1.204,95％CI:1.171-2.256,1.627 3.097,1.273-3.031,1.050-1.381,respectively,P＜0.05,0.01 or 0.001).Conclusions Intracranial artery stenosis examination may be more valuable than DWI and ABCD2 score in evaluating the outcome of TIA.

Objective To predict a value of ischemia modified albumin (IMA) levels for assessing secondary cerebral infarction in patients with transient ischemic attack (TIA) in anterior circulation.Methods 105 patients with TIA in anterior circulation admitted to the hospital within 3 hours were retrospectively studied.Combined with ABCD2 score,the correlations of IMA levels at 3 h,6 h and 12 h with secondary cerebral infarction after anterior circulation TIA were analyzed.Results IMA level was 75.28 u/L within 3h after TIA,and the sensitivity and specificity of TIA in anterior circulation were 66.7％ and 76.2％ respectively.In the total of 105 patients,16 cases (15.2％) suffered from secondary cerebral infarction within 7d,and 21 cases (20.0％) within 8～30d.The serum IMA levels were (87.43±19.89)U/L,(63.88±12.51)U/L and (61.21±12.28)U/L at 3h,6h and 12h after TIA,respectively.A simple analysis showed that there was a linear correlation between the IMA level and ABCD2 scores (P=0.000,r=0.666).Kaplan-Meier survival curve analysis showed that the increased IMA level within 3h,and moderate to high ABCD2 score were the risk factors for secondary cerebral infarction after TIA in anterior circulation (P=0.012,0.041).Conclusions Early detection of IMA has a clinical value similar to ABCD2 score to predict secondary cerebral infarction in patients with TIA in anterior circulation.

Objective To investigate the effects of changes of miR-126 and spouty related EVH,domain containing proteinl(SPRED1) after transient ischemic attack(TIA)on prognostic value for pathogenesis of secondary cerebral infarction.Methods Retrospective analysis of the clinical data of 106 patients with TIA was performed.The expression levels of miR-126,SPRED1 and vascular endothelial growth factor(VEGF)in peripheral blood were detected at 3 h,6 h and 12 h after TIA onset respectively.The specificity and sensitivity of miR 126 and SPRED1 in the diagnosis of TIA were analyzed.The miR-126 and SPRED1 levels versus ABCD2 score were compared for evaluating their predictive value in the diagnosis of secondary cerebral infarction within 30 days after TIA onset.Results The miR-126 level was declined after TIA onset at 3 h(9.41±1.04),especially at 12 h(6.59 ±2.78),versus in healthy control (9.35±1.76)(t =-7.764,P=0.000).The SPRED1 level after TIA onset was increased at 3 h(58.05 ± 17.53)pg/L,12 h(82.64 ± 18.60)pg/L versus in healthy control(52.38 ± 13.24)pg/L(t=12.374,P =0.000).A closely negative correlation was found between levels of miR 126 and SPRED1 at 12 h point but not at 3 h and 6 h(r=-0.278,P=0.004).Both miR-126 and SPRED1 levels at 12 h after TIA were implied to sensitivity and specificity evaluation.Additionally,VEGF was significantly increased at 3 h (345.61 ± 76.76) pg/L,6 h (461.65 ±103.87)pg/L and 12 h (519.22 ± 103.55)pg/L after TIA onset as compared with healthy control (107.77± 26.04) pg/L(t =26.569,29.756,34.699,all P =0.000).The decrease of miR-126 and increase of SPRED1 at 12h after TIA indicated high incidences of cerebral infarction but their significance was less than ABCD2 score.Combination of miR 126,SPRED1 and ABCD2 score significantly improved the prediction for cerebral infarction(Z=2.105,P =0.035).Conclusions After the onset of TIA,levels of miR-126 and SPRED1 expression in combination of ABCD2 score can improve predictive value for cerebral infarction development.

Objective To investigate the value of ischemic modified albumin (IMA) and microRNA-126 (miR-126) in diagnosis of posterior circulation transient ischemic attack (PTIA) and in prediction of secondary cerebral infarction.Methods The clinical materials of 112 patients with PTIA were retrospectively analyzed.Serum IMA and miR-126 levels were measured at 3,6 and 12 h,and the correlation between serum IMA,miR-126 levels and PTIA as well as secondary cerebral infarction was analyzed by ABCD2 score.Results Serum IMA level was (54.19 ± 10.10) U/L in 80 healthy controls,and were (85.81 ±20.21),(62.98 ±12.79),(57.66 ±13.39) U/L at 3,6 and 12 h,respectively,in 112 patients with PTIA.and its levels of miR-126 at 6,12 h after PTIA attack were significantly decreased compared with (9.35 ± 1.76) in the healthy controls(P =0.036,P =0.001).In the patients with PTIA,the level of IMA at 3 h was negatively correlated with the level of miR-126 at 12 h (r =-0.3 13,P =0.0 00).When IMA and miR-12 6 levels were 6 7.5 2 U / L and 8.64,the sensitivity and specificity were 73.20,96.20,82.10,81.20,respectively.The followed up was lasted for 30 days in 112 patients with PTIA,and there were 11 cases (9.82％) with secondary cerebral infarction within 7 days,17 cases (15.18％) within 8 to 30 days.The relative risk rate of IMA level at 3 h and miR-126 level at 12 h in secondary ischemic stroke after PTIA were Rr =8.45,9.84;CI:1.10 to 65.03,1.13 to 86.02;P =0.040,0.039.Conclusion The early detection of IMA and miR-126 levels is of great value in diagnosis of PTIA and in prediction of secondary cerebral infarction.

Objective To investigate the value of ischemic modified albumin (IMA) and microRNA-126 (miR-126) in diagnosis of posterior circulation transient ischemic attack (PTIA) and in prediction of secondary cerebral infarction.Methods The clinical materials of 112 patients with PTIA were retrospectively analyzed.Serum IMA and miR-126 levels were measured at 3,6 and 12 h,and the correlation between serum IMA,miR-126 levels and PTIA as well as secondary cerebral infarction was analyzed by ABCD2 score.Results Serum IMA level was (54.19 ± 10.10) U/L in 80 healthy controls,and were (85.81 ±20.21),(62.98 ±12.79),(57.66 ±13.39) U/L at 3,6 and 12 h,respectively,in 112 patients with PTIA.and its levels of miR-126 at 6,12 h after PTIA attack were significantly decreased compared with (9.35 ± 1.76) in the healthy controls(P =0.036,P =0.001).In the patients with PTIA,the level of IMA at 3 h was negatively correlated with the level of miR-126 at 12 h (r =-0.3 13,P =0.0 00).When IMA and miR-12 6 levels were 6 7.5 2 U / L and 8.64,the sensitivity and specificity were 73.20,96.20,82.10,81.20,respectively.The followed up was lasted for 30 days in 112 patients with PTIA,and there were 11 cases (9.82％) with secondary cerebral infarction within 7 days,17 cases (15.18％) within 8 to 30 days.The relative risk rate of IMA level at 3 h and miR-126 level at 12 h in secondary ischemic stroke after PTIA were Rr =8.45,9.84;CI:1.10 to 65.03,1.13 to 86.02;P =0.040,0.039.Conclusion The early detection of IMA and miR-126 levels is of great value in diagnosis of PTIA and in prediction of secondary cerebral infarction.

Objective To explore the mechanism of ferroptosis induced by endoplasmic reticulum stress(ERs)in acute respiratory distress syndrome(ARDS).Methods In order to determine the effects of LPS on oxidative stress and Fe2+level of mouse capillary alveolar epithelial cells(MLE12 cells),the cells were treated with LPS(0,1,2,5 μg/ml)for 24 h.To verify the role of ferroptosis in lipopolysaccharide(LPS)-induced cell death,MLE12 cells were divided into control(Con)group,iron removal inhibitor(Fer-1)group,LPS group and LPS+Fer-1 group.LPS+Fer-1 group was pretreated with 10 μmol/L Fer-1 for 6 h,then the cells were exposed to 5 μg/ml LPS for 24 h.Con group was treated with solvent DMSO for 24 h.Fer-1 group was pretreated with 10 μmol/L Fer-1 for 6 h,and then treated with DMSO for 24 h.The cells in LPS group were exposed to 5 μg/ml LPS for 24 h.The MLE12 cells were divided into three groups:Con+Vector group,Con+sequence similarity family 134 mem-ber B(FAM134B)group,LPS+Vector group and LPS+FAM134B group.After transfected with vector or FAM134B overexpression plasmid for 48 h,the cells were exposed or not exposed to 5 μg/ml LPS for 24 h.Cell vi-ability was measured by CCK-8.The levels of malondialdehyde(MDA),glutathione and iron,the protein levels of ferroptosis markers[cyclooxygenase 2(PTGS2),glutathione peroxidase 4(GPX4)]and ERs markers[glucose reg-ulatory protein 78(GRP78),activated transcription factor 4(ATF4)and C/EBP homologous protein(CHOP)]were measured in different groups.In order to further confirm the results of in vitro cell experiments,40 mice were randomly divided into Con+Vector group,Con+FAM134B group,LPS+Vector group and LPS+FAM134B group,with 10 mice in each group.LPS-induced sepsis models were established in LPS+Vector group and LPS+FAM134B group,and the levels of GPX4 and ERs in lung tissue were evaluated by immunofluorescence staining and protein blot.Results LPS treatment increased the levels of PTGS2 and MDA,and decreased the levels of GPX4 and GSH in MLE12 cells in a dose-dependent manner.Compared with LPS group,the cell viability,GPX4 and GSH levels in LPS+Fer-1 group increased significantly(P<0.05),while the PTGS2 protein level and MDA level decreased significantly(P<0.05).Compared with LPS+Vector group,LPS+FAM134B group significantly increased cell viability(P<0.05),decreased PTGS2 protein level(P<0.05)and increased GPX4 level(P<0.05).At the same time,the level of MDA in LPS+FAM134B group was lower than that in LPS+Vector group(P<0.05),and the level of GSH was higher than that in LPS+Vector group(P<0.05).In animal experiment,compared with LPS+Vector group,the expression levels of 4-HNE,ATF4 and CHOP in lung tissue of LPS+FAM134B group decreased significantly(P<0.05),and the expression levels of GPX4,FAM134B group in-creased significantly(P<0.05).Conclusion LPS induces ferroptosis and ERs in MLE12 cells in a dose-depend-ent manner.Activating the endoplasmic reticulum autophagy associated FAM134B receptor helps to inhibit ERs and alleviate cell ferroptosis.

Objective:To explore the differential diagnostic value of ultrasonic elastography for breast nodules with acoustic attenuation.Methods:A total of 105 cases with breast nodules with posterior echo attenuation from June 2017 to October 2019 in Shenzhen People′s Hospital were enrolled. Routine ultrasound examination and elastography were performed and maximum of elastography(Emax), mean of elastography value(Emean), minimum of elastography value(Emin) and strain ratio of fat/strain ratio of nodules(B/A) were recorded. With the pathological results as the diagnosed gold standard, elastic parameters different between benign and malignant breast nodules with posterior echo attenuation were compared. And the Emax value of elastic imaging was analyzed by the ROC curve.Results:There were 65 cases of benign nodules and 40 cases of malignancy. The difference of ultrasound E imaging were statistically significant for judging benign and malignant breast nodules with acoustic attenuation( P<0.05). When Emax 95 kPa was set as the cut-off value for the differential diagnosis of benign and malignat breast nodules, the area under the ROC curve was 0.817, and the sensitivity was 88% and the specificity was 72%. Conclusions:Ultrasonic elastrography is of great value for differential diagnosis of benign and malignant breast nodules with acoustic attenuation, and it is important for the decision making of clinical treatment plan.

Objective: To evaluate the efficacy and safety of intravenous thrombolysis with recombinant tissue-plasminogen activator (rt-PA) in elderly patients with early-stage mild ischemic stroke (IS). Methods: This was a prospective, open-label, controlled study.Ninety-four elderly patients with mild IS admitted to our hospital from January 2014 to December 2017 were randomized into a thrombolysis arm (TA, n=46) and a control arm (CA, n=48). The short-term endpoints were the National Institutes of Health stroke scale (NIHSS) scores on 3^rd, 7^th, 14^thday after admission and the secondary endpoints were the modified Rankin Scale (mRS) score and the morbidity of recurrence IS within 90 days.Safety was evaluated by the incidence of intracranial hemorrhage (IH) and early neurological deterioration (END) during hospitalization. Results: The baseline NIHSS scores of patients in the TA and CA groups were similar [(4.1±0.7) vs.(4.1±0.7)]. However, there were significant differences in the NIHSS score on 3^rd [(3.4±1.2) vs.(4.2±1.4)], 7^th[(3.0±1.8) vs.(4.1±1.6)] and 14^thday [(2.5±2.0) vs.(3.4±1.6)], respectively, between the TA group and the CA group.Furthermore, the TA group was associated with a significantly higher proportion of patients with good prognosis (mRS, 0-2), compared with the CA group (71.7% vs.35.4%, P<0.01). Receiver operating characteristic curve analysis showed that patients with baseline NIHSS>3 could benefit from thrombolytic therapy.There were 1 case of symptomatic IH and 1 case of progressive stroke in the TA group, and 1 case of IH and 2 cases of progressive stroke in the control group.There were no significant differences in the rate of either END or IH between the two groups (P>0.05). Two patients in the TA group and three patients in the control group had recurrent IS within 90 days and the recurrence rate of IS was also similar within 90 days (P>0.05). Conclusions Intravenous thrombolytic therapy with rt-PA can improve the prognosis of elderly patients with mild stroke without increased risk of END, IH, or recurrence of IS.

The "vicious cycle" established between tumor growth and osteolysis aggravates the process of breast cancer bone metastasis, leading to life-threatening skeletal-related events that severely reduce survival and quality of life. To effectively interrupt the "vicious cycle", innovative therapeutic strategies that not only reduce osteolysis but also relieve tumor burden are urgently needed. Herein, a bone-seeking moiety, alendronate (ALN), functionalized coordination polymer nanoparticles (DZ@ALN) co-delivering cisplatin prodrug (DSP) and antiresorptive agent zoledronate (ZOL)