Objective To describe the clinical and radiological characteristics, the etiology, clinical course and MRI findings and prognosis of reversible splenial lesion syndrome ( RESLES) are analyzed.Methods Clinical and MRI findings of adult patients who presented with RESLES were retrospectively reviewed.Corresponding to severity of disability using Modified Oxford Handicap Scale ( MOHS ) , patients were classified into favorable outcome group (MOHS≤2)and poor outcome group(MOHS≥3),clinical and neuroimaging features between two outcome groups were compared.Results Eight patients fulfilled the criteria were included, who suffered from a broad spectrum of disorders, including mild encephalitis/encephalopathy, Marchiafava-Bignami disease and antiepileptic drug withdrawal.MRI found a high signal lesion in the splenium with or without the other parts of corpus callosum and extracallosal involved.The hyperintensity disappeared or lapsed comfirmed by repeated MRI.There is an significant difference on symptoms of severe disturbance of consciousness during clinical course and MRI showed extracallosal lesions between two groups (P<0.05).Conclusions RESLES is a rare entity with wide clinicoradiological spectrum due to varied diseases and conditions.Although overall symptoms of patients with RESLES trend to relieve, the prognosis of patients with severe disturbance of consciousness and extracallosal lesions are unlikely to be favorable.

Objective To assess cerebrovascular reserve ( CVR) function in patients with internal border zone infarction(IBZI) induced by severe middle cerebral artery (MCA) stenosis, and investigate the impact on progression and outcome of the disease .Methods A total of 84 patients with unilateral severe MCA stenosis were selected . Hypercapnia was induced by holding breath .The change of blood flow velocity in MCA was measured by transcranial Doppler ( TCD ) to calculate CVR .According to CVR , patients were divided into impaired regional CVR group ( CVR <10%) and normal CVR group ( CVR ≥10%) .The NIHSS was used to evaluate neurological function in both groups within 14 d, and mRS was used to evaluate acute stage outcome of the patients at discharge .All the patients were followed-up for 6 months, the incidences of recurrence , complications and mortality in the two groups were analyzed .Results The incidence of progressive cerebral infarction in the impaired regional CVR group (67.39%) was significantly higher than that in the normal CVR group (42.11%) ( P<0.05).The impaired regional CVR group showed higher proportion of patients with poor clinical outcome at discharge ( mRS≥3 ) (63.04%)compared to the normal CVR group (36.84%) (P<0.05).In the followed-up 6 months, the incidences of recurrence and complications were 34.78% and 45.65% respectively in the impaired regional CVR group , they were significantly higher than that in normal CVR group (15.79%,23.68%)(P<0.05).The overall mortality rates did not differ significantly between the two groups ( P>0.05 ) .Conclusion Impaired regional CVR may be predictive of subsequent progressive cerebral infarction and poor clinical outcomes in patients with IBZI induced by severe MCA stenosis .

Objective To investigate clinical significance and related factors of fluid-attenuated inversion recov?ery vascular hyperintensities (FVH) in transient ischemic attack (TIA) of carotid system. Method Data including general information and TIA risk factors was continuously collected from 142 patients with carotid system TIA from the depart?ment of neurology of Sheng jing Hospital affiliated China Medical University from January 2012 to February 2014.All pa?tients completed brain MRI including FLAIR and diffusion-weighted imaging (DWI)and MRA examinations within 72 hours after TIA. All patients were followed up for one month. Risk factors and FVH situations were analyzed based on clinical manifestations and DWI results. Result There were 87 male cases (61.27%)and FVH positive 57 cases (40.14%) among 142 cases with carotid system TIA (mean age 63.2±11.5). Logistic regression analysis revealed that the large intra?cranial carotid artery stenosis≥50%(OR=2.44,95%CI:1.09~5.49, P=0.03) and prior history of ischemic stroke (OR=3.88,95%CI:1.04~14.5, P=0.04) were independently associated with positive FVH. At one month followed-up, 40 cas?es (28.17%) of 142 patients progressed to acute cerebral infarction. Vulnerable plaque number in the contralateral carot?id artery (P=0.018), contralateral intracranial large vessel stenosis in MRA≥50%(P=0.007) and contralateral FVH oc?currence rate (P=0.001) were significantly higher in cerebral infarction group than in non-cerebral infarction group. Con?clusion FVH is common in carotid TIA patients, which is associated with intracranial carotid artery stenosis ischemic and previous history of ischemic stroke. Vulnerable plaque number of contralateral carotid artery, contralateral intracranial large vessel stenosis≥50%and the rate of occurrence of contralateral FVH may be associated with short-term progress leading TIA to acute infarction.

Objective Toinvestigatethecorrelationofsmallvesseldisease(CSVD)causedacute lacunarinfarctionandurinemicroalbumin.Methods Theclinicaldataof136patientswithacutelacunar infarction admitted to the Department of Neurology,Shengjing Hospital of China Medical University from November 2012 to April 2014 were analyzed retrospectively. They were divided into either a CSVD group (n=72)or a cerebral large vessel disease (CLVD)group (n=64)according to their carotid artery color Doppler ultrasound and head magnetic resonance angiography findings. The levels of urinary microalbumin in both groups were observed and compared. SAS 9. 1 software was used to conduct statistic analysis. A Logistic regression analysis was used to determine the independent risk factors for CSVD caused acute lacunarinfarction.Results TheconcentrationofurinemicroalbuminoftheCSVDgroup(22±13mg/L) was significantly lower than (29 ± 14 mg/L)that of the CLVD group. There was significant difference (P<0.05). There was significant difference in the increased urine microalbumin levels between the CSVD group and the CLVD group (P<0. 01). There was an increasing trend for the proportion of patients with urine microalbumin concentration 10- <30 mg/L (56. 9%[41/72])in the CSVD group compared with the CLVD group (26. 6%[17/64]). Logistic regression analysis showed that the slightly increased microalbuminuria was associated with CSVD caused acute lacunar infarction (OR,3. 130,95%CI 1. 481-6.618;P<0.01).Conclusion Theslightlyincreasedmicroalbuminuriaisanindependentriskfactorfor CSVD caused acute lacunar infarction.

Objective To evaluate the effects of ulinastatin postconditioning and combination of ulinastatin preconditioning and postconditioning on myocardial apoptosis in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Eighty New York Heart Association (NYHA) class Ⅱ or Ⅲ patients of both sexes,aged 21-59 years,scheduled for cardiac valve replacement with CPB,were randomly divided into four groups (n =20 each):normal saline control group (group C),ulinastatin preconditioning group (group U1),ulinastatin postconditioning group (group U2) and ulinastatin preconditioning plus postconditioning group (group U3).In group U1,uinastatin 20000 U/kg was infused via the central vein at 500-1000 U·kg-1 · min-1 after endotracheal intubation until 10 minutes before blocking the ascending aorta.In group U2,ulinastatin 10000 U/kg was infused via the aortic root at 4000-5000 U· kg-1 · min-1 at 5-7 minutes before opening the aorta.In group U3,ulinastatin preconditioning and postconditioning were performed as described in groups U1 and U2.In group C,the same volume of normal saline was infused instead of ulinastatin.Blood samples were taken from the radial artery at 10 minutes before blocking the ascending aorta,40 minutes after blocking the ascending aorta,45 minutes after opening the aorta and at the end of operation for determination of plasma concentrations of tumor necrosis factor-alpha (TNF-α) and soluble tumor necrosis factor receptor 1 (sTNF-R1).Myocardial tissues were obtained from the right atrial appendage at 45 minutes after opening the aorta for determination of the expression of TNF-α,bcl-2,bax,caspase-3,and apoptosis.The bcl-2/bax ratio and apoptotic index were calculated.Results Plasma concentrations of TNF-α and sTNF-R1 and the expression of TNF-α,bax,caspase-3 and apoptotic index were lower and the expression of bcl-2 and bcl-2/bax ratio were higher in groups U1,U2 and U3 than in group C and they were lower in group U3 than in groups U1 and U2 (P ＜ 0.05).Conclusion Ulinastatin postconditioning can inhibit myocardial apoptosis in patients undergoing cardiac valve replacement with CPB,and the efficacy of combination of ulinastatin preconditioning and postconditioning is stronger than that of ulinastatin postconditioning.The mechanism is involved in balancing the expression of bax and bcl-2 and down-regulating the expression of TNF-α and its receptor.

We studied the regulatory effects of the estragen receptorbeta (ERbeta) gene on the downstream estrogen signal transfection pathway in colon cancer cells and the possible mechanisms involved. A human ERbeta gene recombinant expression plasmid, pEGFP-C1-ERbeta, was constructed and transfected into the Caco-2 colon cancer cell line, a line with low ERbeta gene expression. The expression of ERbeta mRNA and protein was detected 72 h after transfection. RT-PCR was used to examine the expression levels of the progesterone recepror (PR) gene containing the classic estrogen response element (ERE), the C-fos oncogene containing the AP-1 site (a non-classical ER binding site), the epigenetic modifying genes, such as Dnmt1, Dnmt3a, Dnmt3b, and histone methyltransferase (HMT), and the human mismatch repair gene hMLH1. Methylation-specific PCR was used to detect the changes in the methylated sites of the CpG islands in the promoters of the ERbeta, PR, and C-fos genes. The results indicated that the human ERbeta gene recombinant expression plasmid pEGFP-C1-ERbeta was successfully constructed and transfected into Caco-2 cells. As compared with the control group, the mRNA and protein expression of ERbeta gene was increased significantly 72 h after the transfection of pEGFP-C1-ERbeta into the Caco-2 cells. As compared with the control group, the mRNA expression of the PR, C-fos, Dnmt3a and Dnmt3b genes was increased significantly 72 h after the transfection of pEGFP-C1-ERbeta into the Caco-2 cells, but the mRNA expression of the Dnmt1, HMT, and hMLH1 genes decreased significantly (P<0.05). As compared with the control group, different degrees of demethylation occurred in the promoters of the ERbeta, progesterone receptor (PR), and C-fos oncogene 72 h after the transfection of pEGFP-C1-ERbeta into the Caco-2 cells. The methylation index of the estrogen signal transfection pathway in Caco-2 cells was decreased significantly following the expression restoration of ERbeta gene (P<0.05). It is concluded that the restoration or up-regulation of the ERbeta gene in Caco-2 cells may significantly activate the expression of the related target genes in the downstream estrogen signal transfection pathway and may result in the demethylation changes of the pathway. During the process, the expression level and activity of the epigenetic modifying genes and the human mismatch repair gene have changed simultaneously. The regulatory effect of the ERbeta gene on the estrogen signal transfection pathway to a certain extent partly involves demethylation.

Objective To evaluate the effects of ulinastatin postconditioning and combination of ulinastatin preconditioning and postconditioning on myocardial apoptosis in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Eighty NYHA class Ⅱ or Ⅲ patients of both sexes,aged 21-59,scheduled for cardiac valve replacement with CPB,were randomly divided into 4 groups ( n =20 each):normal saline control group ( group C ),ulinastatin preconditioning group ( group U1 ),ulinastatin postconditioning group (group U2 ) and ulinastatin preconditioning plus postconditioning group(group U3 ).In group U1,uinastatin 20 000U/kg was infused via central vein at 500-1000 U·kg-1 ·min-1 from after tracheal intubation until 10 min before ascending aortic cross-clamping.In group U2,ulinastatin 10 000 U/kg was perfused via aortic root at 4000-5000 U· kg-1 · min-1 at 5-7 min before aortic unclamping.In group U3,ulinastatin preconditioning and postconditioning were performed as described in groups U1 and U2.In group C same volume normal saline was infused instead of ulinastatin.Blood samples were taken from radial artery at 10 min before ascending aortic cross-clamping,40 min after ascending aortic cross-clamping,45 min after aortic unclamping and the end of operation for determination of plasma concentrations of TNF-α and soluble tumor necrosis factor receptor 1 (sTNF-R1).Myocardial tissues were obtained from right atrial appendage at 45 min after aortic unclamping for determination the expression of TNF-d,Bcl-2,Bax and caspase-3 and apoptosis.The Bcl-2/Bax ratio and apoptotic index were calculated.Results Plasma concentrations of TNF-α and sTNF-R1 and the expression of TNF-α,Bax,caspase-3 and apoptotic index were lower,the expression of Bcl-2 and Bcl-2/Bax ratio were higher in groups U1,U2 and U3 thah group C and in group U3 than groups U1,U2 ( P ＜ 0.05 ).Conclusion Ulinastatin postconditioning can inhibit myocardial apoptosis in patients undergoing cardiac valve replacement with CPB,and efficacy of combination of ulinastatin preconditioning and postconditioning is stronger than that of ulinastatin postconditioning.The mechanism is involved in balancing the expression of Bax and Bcl-2 and down-regulating the expression of TNF-α and its receptor.

ObjectiveTo investigate the effects of ulinastatin postconditioning and combining ulinastatin postconditioning with pretreatment on myocardial inflammatory response in patients undergoing cardiac valve replacement under CPB.MethodsEighty NYHA class Ⅱ or Ⅲ patients of both sexes aged 21-59 yr undergoing cardiac valve replacement under CPB were randomly divided into 4 groups ( n =20 each): group control (group C) ; group ulinastatin pretreatment ( group U1 ) ; group ulinastatin postconditioning (group U2 ) and group ulinastatin pretreatment and postconditioning combined (group U3 ).Ulinastatin 20 000 U/kg was infused via central vein at 500-1000 U·kg-1 ·min-1 after tracheal intubation until 10 min before cross-clamping of ascending aorta in groups U1 and U3.Ulinastatin 10 000 U/kg was infused into root of aorta at 4000-5000 U· kg- 1 · min- 1 at 5-7 min before declamping of aorta in groups U2 and U3.Blood samples were obtained from radial artery before cross clamping of ascending aorta,at 40 min after aortic cross-clamping,at 45 min after declamping of aorta (T3) and at the end of operation for polymorphonuclear leukocyte (PMN) count,routine analysis of blood and determination of plasma concentrations of IL-10,TNF-α,IL-1 and IL-6 (by ELISA).Myocardial specimens were obtained at 45 min after declamping of aorta for determination of IL-1β and IL-6 expression by immune-histochemistry.Results Ulinastatin pretreatment and/or postconditioning significantly increased plasma IL-10 concentration and decreased plasma IL-1,IL-6,TNF-α concentrations and PMN count and myocardial IL-1β and IL-6 expression in groups U1,U2 and U3 as compared with group C.Plasma IL-10 concentration was significantly higher and plasma IL-1,IL-6 and TNF-α concentrations,PMN count and myocardial IL-1β and IL-6 expression were lower in group U3 than in groups U1 and U2.ConclusionUlinastatin postconditioning can inhibit myocardial imflammatory response in patients undergoing valve replacement under CPB.The protective effect can be augmented by combining ulinastatin postconditioning with pretreatment.

Objective To evaluate the effects of ulinastatin on cardiac function in heart valve replacement patients with cardio-pulmonary bypass (CPB).Methods 120 patients received valve replacements were divided into 4 groups at random.Group U 1,preconditioning group:ulinastatin parenteral solution (20 000 U/kg) was injected into the central veins for 10 min before the ascending aorta was clamped.Group U2,postconditioning group:ulinastatin ( 10 000 U/kg) was injected into the aortic root for 5 min before the aortic clamp was opened.Group U3,combined the treatments of group U1 and group U2.Group C was served as control without using ulinastatin.The ST-T of ECG at different 8 time points was recorded from preanesthesia to the end of operation.The dosage of vasoactive agents in the 4 groups was recorded after the aortic clamp was opened.Blood samples were taken from the radial artery at 4 time points during 1O min before the ascending aorta was clamed to the end of operation for determining the serum concentration of H-FABP,IMA,CK-MB,MDA and SOD.The changes in myocardium were examined by microscope.Results The automatic reheating rate of heart in group U1,group U2,and group U3 were 70％,73％ and 90％ respectively,which were all higher than group C (33％) after the aortic clamp was opened in 3 -5 min.The scores of reperfusion arrhythmia,change of ST segments in ECG ( elevation or depression),the dosage of vasoactive drugs ( dopamine and adrenaline) and their using time,the concentration of MDA,H-FABP,IMA and CK-MB in group U1 and group U2 were ＜ than those of group C ( P ＜0.05 ),but was ＞ than those of group U3 ( P ＜0.05 ).The activity of SOD in group U1 and group U2 were ＞ than those of group C ( P ＜ 0.05 ),but was ＜ than those of group U3 ( P ＜ 0.05 ).There were no significant differences between group U1 and group U2( P ＞0.05 ).The myocardium in group C had focal coagulative necrosis.The damage of myocardium in group U3 was minor,the cytoplasm and nucleus was homogeneous,and the boundaries were distinct.Conclusion Ulinastatin parenteral solution preconditioning and postconditioning could improve heart function after valves replacement on CPB.The protective effects were not significantly different regarding ulinastati was administered into the central veins before the ascending aorta was clamped vs.it was injected into the aortic root before the aortic clamp opening.Combined these 2 administration methods and dosages could produce collaborative protection.

Objective To study the effects of heat shock treatment of rat bone marrow mesenehymal stem cells(MSCs),the apoptosis ratio of treated-cells under low serum condition and the treated-cells transplantation on left ventricular function in rats with myocardiaIinfarction.Methods MSC8 were heat-treated under 42℃for 30 min,then the heat shock protein-70(HSP-70)was detected bv Western blot.The apoptosis ratio of heat-treated MSCs under low serum condition was tested by Annexin kit.The treated-MSCs labeled with Dil were transplanted into infarcted myocardium and 8 weeks later,the cardiac function of rats in each group was evaluated by echocardiography and cardiac catheterization.Results The immunophenotype of heat-treated MSCs did not vary,Western blot confirmed a higher level expression of HSP-70 in the treated-MSCs group as compared with that in the control group.The early apoptosis ratio was lower in treated-MSCs measured by flow cytometry with annexin staining than that of MSCs when cultured with low serum medium.After 8 weeks,LVEF,LVSP,+dp/dtmax,and-dp/dtmax were significantly higher,and the LVEDP was significantly lowar in heat-treated MSCs transplantation group than that in the control group.Conclusions Heat shock pretreatment of MSCs enhances the tolerance of MSCs to low serum medium,whereas does not lcad to the change of the cell immunophenotype.Transplantation of heattreated MSCs might improve the cardiac function in a rat myocardialinfarction model.