Objective Tocomparetheefficacybetweenstentingandmedicationinpatientswith vertebralarteryoriginstenosis.Methods Theclinicaldataof82patientswithmoderatetoseverevertebral artery origin stenosis (stenosis rate >50%)from January 2011 to January 2013 were analyzed retrospectively. They were divided into either a stent+medication group (n=40)or a medication group (n=42)according to the different treatment methods. The degree of vascular stenosis,restenosis rate,incidence of cerebral ischemic events,and National Institutes of Health Stroke Scale (NIHSS)of the patients for DSA reexamination at one year were documented,and comprehensive analysis were conducted. Results (1 )44 stents were implanted in 40 patients,1 of the patients still had residual stenosis of 60% because of the stenosis plaque was harder despite twice balloon dilations. No serious perioperative complications occurred. The success rate of the operation was 97. 5%. The vascular stenosis rate of vertebral artery origins in patients of the stent+medication group was improved significantly,and decreased from 73 ± 13% to median 11%(8%,50%)at one year after stenting. (2)After 1 year,11 patients (27. 5%)had in-stent restenosis in the stent +medication group,including 2 patients (5%)had stent fracture at the same time. Four patients (9. 5%)in the medication group had complete occlusion of vertebral artery,but only 2 had corresponding clinical symptoms. (3)There was no significant difference in the NIHSS scores after the treatment between the stent+medication group and the medication group (Z=1. 678,P=0. 093). The total ischemic events in patients of the stent+medication group was 7 (17. 5%),compared with the incidence of ischemic events in 16 patients (38. 1%)in the medication group,there was significant difference (χ2 =4. 306, P=0.038).Conclusion Stentingissafeandeffectiveforpatientswithvertebralarteryoriginstenosis.It may significantly improve vertebral stenosis,and it is better than medication alone for preventing the occurrence alone of the posterior circulation ischemic events,however,the high in-stent restenosis rate for vertebral artery origin stenosis is still an important problem to be solved.

Objective To analyze the risk factors of preoperative lymph node staging (N-stage) deficiency in gastric cancer and establish a preoperative assessment model to assist in predicting preoperative N-stage. Methods A retrospective method was used to analyze the clinicopathological data of 268 patients with gastric cancer. The patients routinely underwent preoperative thin-section enhanced CT to assess preoperative N-stage. Results The risk factors for preoperative N-stage deficiency were analyzed in combination with postoperative pathological findings. Multifactorial logistic regression analysis was performed to determine influencing factors, and Kaplan-Meier analysis was used to plot the survival curves of preoperative N-stage accurate group and deficiency group. The nomogram plot and ROC curves of the prediction model were drawn using the R package. AUC, 95%CI, sensitivity, and specificity were calculated. Results Age, BMI, poor differentiation, and Lauren's classification as diffuse were independent risk factors for preoperative N-stage deficiency in gastric cancer (P < 0.05). Prognostic survival was significantly worse in the preoperative N stage-inadequate group than that in the accurate group (P=0.041). The AUC area was 0.935, with a sensitivity of 85.9% and specificity of 96.9%. Conclusion Young age, high BMI, poor differentiation, and Lauren's classification as diffuse are independent risk factors for preoperative N-stage deficiency. The established preoperative assessment model based on age, BMI, differentiation degree, and Lauren's classification in this study has relatively high credibility.

BACKGROUNDPulmonary embolism (PE) is a common and often fatal disease. Early after pulmonary thromboembolism, inflammation and associated intimal hyperplasia occur within the pulmonary arteries, similar to what is observed with chronic thromboembolic pulmonary hypertension. This study tested the hypothesis that thrombolytic and anticoagulant agents would have anti-inflammatory effects or inhibit intimal hyperplasia of involved pulmonary arteries.

METHODSSeventy-two male New Zealand white rabbits were randomly divided into two groups (54 rabbits in the PE group and 18 in the sham group). Experimental PE was induced in 54 rabbits by femoral vein injection of autologous blood clots and confirmed with pulmonary angiography, and other 18 rabbits underwent sham operations. Fifty-four rabbits in the PE group were randomly divided into three groups: a control group (treated with normal saline), a low-molecular- weight heparin (LMWH) group (treated with LMWH), and a urokinase (UK) group (treated with UK). Arterial blood gas was analyzed at 2, 7, and 28 days (n = 6 per time point by random group division), then lung tissues were removed and were analyzed for pro-inflammatory cytokines and chemokines, and were stained for intimal hyperplasia.

RESULTSThe overall survival of rabbits undergoing PE was 100%. PE distribution detected on digital signal angiography (DSA) and histopathology was shown in 67% of rabbits (36/54) in the bilateral low lobar pulmonary arteries (PAs). The results showed that alveolar-arterial partial pressure of oxygen (PO2) difference (PA-aO2) significantly increased and PO2 decreased in the control group compared with the sham group. Compared with controls, the UK group had a decreased level of PA-aO2 on day 2 (P < 0.05), however, there was no significant difference in the LMWH group. Compared with controls, the LMWH group had a decreased level of monocyte chemoattractant protein-1 (MCP-1) in affected tissue and serum samples on days 7 and 28 (P < 0.05), and the UK group had decreased levels on days 2 and 7 (P < 0.05). Compared with sham group, all PE groups had an increased level of interleukin-13 (IL-13) and transforming growth factor-β (TGF-β) in unaffected lung tissue samples at days 2 and 7. IL-13 in affected lung tissue in the LMWH group was decreased at all time points compared with controls (P < 0.05). However, TGF-β in affected lung tissue of the LMWH and UK groups increased at day 28. There was less intimal hyperplasia in involved pulmonary arteries at days 7 and 28 in the LMWH group compared with controls; there was no statistical difference in the UK group compared with controls.

CONCLUSIONSUK treatment can rapidly improve the V/Q mismatch in PE and appears a short-term anti-inflammatory benefit. However, LMWH maybe inhibit the later local inflammatory reaction and reduce intimal hyperplasia.

Animals ; Chemokines ; analysis ; Cytokines ; analysis ; Heparin, Low-Molecular-Weight ; therapeutic use ; Male ; Oxygen ; blood ; Pulmonary Artery ; drug effects ; pathology ; Pulmonary Embolism ; drug therapy ; immunology ; Rabbits ; Urokinase-Type Plasminogen Activator ; therapeutic use

OBJECTIVETo explore whether coal tar pitch smoke extract (CTP) induced pyroptosis in human bronchial epithelial cells (BEAS-2B).

METHODSBEAS-2B cells were treated with different concentrations of CTP (1, 3 µg/ml) for 8h and 24 h, respectively. Lactic dehydrogenase (LDH) activity and interleukin-1 beta (IL-1β) levels in the supernatants of cell culture media were measured with LDH activity or human IL-1β ELISA kit, respectively. The activity of Caspase-1 was measured with Caspase-1 colorimetric assay kit.

RESULTSThe activity of caspase-1 in 1 and 3 µg/ml CTP groups were (9.29 ± 0.30) and (8.67 ± 0.59) µmol/ml respectively which were both significantly increased compared to that (7.42 ± 0.59) µmol/ml in the control group (P < 0.05) after 8 h exposure, but there was no significant difference in the activity of LDH and levels of IL-1β in the cell culture media among the CTP and control groups. 24 h after exposure, the activity of LDH in the CTP (1, 3 µg/ml) groups were (1323.03 ± 28.53) and (1148.45 ± 16.42) U/dl respectively which were significantly higher than that (1091.93 ± 26.64) U/dl in the control group (P < 0.05), and the levels of IL-1β in the CTP (1 and 3 µg/ml) groups were (125.37 ± 25.00) pg/ml and (92.04 ± 19.09) pg/ml respectively which were significantly higher than that (46.20 ± 14.43) pg/ml in the control group (P < 0.05), but there was no significant difference in the activity of Caspase-1 among CTP and control groups (P < 0.05).

CONCLUSIONCTP treatment induced early increase in caspase-1 activity followed by the increase in LDH activity and IL-1 levels, indicative of pyroptosis in human bronchial epithelial cells.

Apoptosis ; Bronchi ; cytology ; Caspase 1 ; metabolism ; Cell Line ; Coal Tar ; adverse effects ; Epithelial Cells ; cytology ; Humans ; Interleukin-1beta ; metabolism ; L-Lactate Dehydrogenase ; metabolism ; Smoke ; adverse effects

Pulmonary vein thrombosis is a rare disease and is usually represented as a complication of atrial fibrillation, pulmonary tumors, and lobectomy. Although it is a potentially life threatening condition, the venous disease is easy to misdiagnose because of the non-specific symptoms. In this article, we present a 30-year-old patient who suffered from pulmonary vein thrombosis without any causes. He was diagnosed with other pulmonary disorders till the thrombus within the pulmonary vein extended into the left atrium. Left atrium mass resection and a left lower lobectomy were undertaken with relative urgency. The postoperative course was uneventful. The patient received a long course of oral anticoagulant therapy.
Adult ; Echocardiography, Transesophageal ; Heart Atria ; pathology ; Humans ; Male ; Pulmonary Veins ; Venous Thrombosis ; pathology ; surgery

BACKGROUNDSterol regulatory element binding protein (SREBP)-2 plays a key role in lipid homeostasis by stimulating gene expression of cholesterol biosynthetic pathways. The insulin-like growth factor binding protein (IGFBP) family regulates growth and metabolism, especially bone cell metabolism, and correlates with osteonecrosis. However, association of their gene polymorphisms with risk of avascular necrosis of the femoral head (ANFH) has rarely been reported. We determined whether SREBP-2 and IGFBP-3 gene polymorphisms were associated with increased ANFH risk in the Chinese population.

METHODSTwo single nucleotide polymorphisms of SREBP2 gene, rs2267439 and rs2267443, and one of IGFBP-3 gene, rs2453839, were selected and genotyped in 49 ANFH patients and 42 control individuals by direct sequencing assay.

RESULTSThe frequencies of rs2267439 TT and rs2267443 GA of SREBP2 and rs2453839 TT and CT of IGFBP-3 in the ANFH group showed increased and decreased tendencies (against normal control group), respectively. Interaction analysis of genes revealed that the frequency of carrying rs2267439 TT and rs2267443 GA genotypes of SREBF-2 in ANFH patients was significantly higher than in the control group (P < 0.05). Association analysis between polymorphisms and clinical phenotype demonstrated that the disease course in ANFH patients with the rs2453839 TT genotype of IGFBP-3 was significantly shorter than that of CT + CC carriers (P < 0.01). CT + CC genotype frequency in patients with stage III/IV bilateral hip lesions was significantly higher than in those with stage III/IV unilateral lesions and stage II/III bilateral lesions (P < 0.05 - 0.02).

CONCLUSIONSOur results suggested that interaction of SREBP-2 gene polymorphisms and the relationship between the polymorphisms and clinical phenotype of IGFBP-3 were closely related to increased ANFH risk in the Chinese population. The most significant finding was that the CT + CC genotype carriers of IGFBP-3 rs2453839 were highly associated with the development of ANFH.

Adult ; Asian Continental Ancestry Group ; genetics ; Female ; Femur Head Necrosis ; genetics ; Genetic Predisposition to Disease ; Humans ; Insulin-Like Growth Factor Binding Protein 3 ; genetics ; Male ; Middle Aged ; Polymerase Chain Reaction ; Polymorphism, Genetic ; genetics ; Sterol Regulatory Element Binding Protein 2 ; genetics

OBJECTIVETo investigate the blood lead levels (BLLs) in children after 10-year use of unleaded gasoline in Guangzhou and evaluate the effect of this measure.

METHODSThrough stratified random sampling method, 4 kindergartens and 4 elementary schools were selected from each of three districts among 12 districts of Guangzhou. Totally 2373 children were recruited into this survey and 1-2 ml blood was sampled from each child through vein. The lead concentration in blood samples was determined with Inductively Coupled Plasma Mass Spectrometry (ICP-MS) after diluted with 0.1% Triton X-100 and 0.1% HNO(3) in the ratio of 1:20.

RESULTSAmong 2373 children, the highest BLL was 330 microg/L, while the lowest was 10 microg/L. Geometric mean (GM) of BLL was 58.28 microg/L with 61.11 microg/L of male and 55.37 microg/L of female (t=8.671, P=0.000). Sixty (2.51%) children were identified as elevated BLLs (>or=100 microg/L), including 36 (2.90%) male and 24 (2.09%) female (chi2=1.594, P=0.207). Compared to the surveys conducted in China 10-year ago, the children with elevated BLLs decreased 96.28% and the GM of BLLs reduced 58.37%. BLLs in suburb children (60.33 microg/L) were higher than those in downtown (58.09 microg/L) or in countryside (56.72 microg/L).

CONCLUSIONThe BLLs in children and the ratio for children with elevated BLLs, had declined dramatically after 10-year implement of unleaded gasoline in Guangzhou.

Child ; Child, Preschool ; China ; Data Collection ; Environmental Exposure ; Female ; Gasoline ; Humans ; Lead ; blood ; Male

Objective To investigate the brain mechanisms of aging of the visual attention. Methods Through the precue-target visual search paradigm using the event-related potentials technique,16 young and 16 elderly subjects participated the electrophysiological experiment.The background was comprised of three homocentric black circles and eight English capital letters consisted of each circle.The letter “T” was designed as the target stimulus.T was a target only when it located the circle clued to the same size of the precue.For example,when the cue was the “large”,“T” may appear within 3 circles.When the cue was the “median”,“T” may appear within either the median or small circles.When the cue was small,the target “T” may appear only within the small circle. Results The reaction time of the two groups of subjects became quick with the reduction of the cue scale,while the amplitudes of P1 and N1 components of event-related potentials increased with the decrease of the cue scale.Old subjects showed longer response time than did young subjects,and the posterior P1 component was enhanced significantly and N1 component was inhibited obviously.The P2 component was manifested as significantly inhibitory effect not only in the amplitude but also in the abnormal and unstable waveform.Conclusions The cognitive function of elderly subjects declines in the research of target stimuli,which suggests that the age-related changes could lead to deficit in the posterior area of the brain to visual spatial attention (involuntary attention).

Objective To retrospectively study revisions for infected total hip replacements in 30 cases and discuss the bacteriological characters of the infected total hip replacements,difficulties and strategies in the revision.Methods Thirty revisions of infected total hip replacements were reviewed retrospectively.There were 12 males and 18 females,with mean age of 62.5 years(31-86 years)at revi- sion surgery.Infection was presented one month to four years(mean seven months)after THA operation. The diseases for initial operation included femoral neck fractures in 12 cases,femoral head necrosis in 11,hip osteoarthritis in five and rheumatoid arthritis in two.Twelve eases were treated by one-stage revi- sion and 18 by two-stage revision.Results Before the revision operation,the hip infection were diag- nosed by bacterial culture in 18 cases including five with Staphylococcus epidermidis,four with Staphylo- coccus aureus and nine with other bacteria.Bacteria growth appeared on the specimens from 23 hip joints during the revision surgery but not on the specimens from seven hip joints.Of 12 one-stage revisions,10 cases were followed for mean 16 months,which showed infection recurrence in two eases.Of 18 two-stage revisions,13 cases were followed for mean 20 months,which showed one case with infection recurrence. The mean Harris hip score was improved from preoperative 44 to 84 at follow-up.Conclusions 1) The main bacteria in the infected hip are antibiotic resistant Staphylococcus.2)Because the revision op- eration is difficult,careful preparation before revision is important for success.The fresh surgeon should not attempt.3)The revision strategies should vary according to specific status of the cases.The infection recurrence rate is lower when using a two-stage revision strategy.4)Application of antibiotic bone cement can help improve treatment effect and facilitate functional recovery of the joints.5)The scientific rehabil- itation after operation is very important to functional recovery.

Objective To report the experience of the application of microsurgery in joint replace- ment.Methods There were 22 cases,10 cases with segmental acetabular defects treated with the pedicle sartorius muscle iliac bone grafting,5 cases with vascular repair following major vascular injury of extremity during operation,6 cases with neural repair following neural injury during operation,1 case with serious injury reconstruction by elbow joint replacement and free flap.Results The operations succeeded in 22 cases without any postoperative infection.The mean follow-up was 40.1 months (3-72 months) in 22 cases,in which the joint function improved and the operative result was satisfactory with no joint pain.Conclusion Microsurgical technique can reconstruct bone and tissue defect effectively in joint replacement.