BACKGROUND:Transthoracic echocardiography and speckle tracking echocardiography parameters are closely related to stroke occurrence and prognosis.However,the role of transthoracic echocardiography and three-dimensional speckle tracking echocardiography parameters in predicting functional disability following acute ischemic stroke remains unclear.OBJECTIVE:To explore the relationship between transthoracic echocardiography and three-dimensional speckle tracking echocardiography parameters and functional disbility at 3 months post-stroke in patients with acute ischemic stroke.METHODS:A total of 299 patients with acute ischemic stroke admitted to the Second Affiliated Hospital of Soochow University between December 2020 and September 2022 were prospectively enrolled.Patients were divided into no disability(n=207)and disability(n=92)groups based on modified Rankin Scale(mRS)scores(≤ 1 as no disability;1＜mRS score ≤ 5 as disability)at 3 months.Baseline characteristics and transthoracic echocardiography and three-dimensional speckle tracking echocardiography parameters were compared between groups.Independent risk factors for disability were identified using multivariate logistic regression.Predictive models were developed by incorporating variables associated with poor prognosis,and their performance was assessed using the receiver operating characteristic curve analysis.The optimal cutoff value for left ventricular ejection fraction was determined from the receiver operating characteristic curve,and patients were stratified into high and low left ventricular ejection fraction groups.Chi-square test was used to compare prognosis rate between two groups.RESULTS AND CONCLUSION:(1)The disability group had significantly lower left ventricular ejection fraction compared with the no disability group(P=0.011).Significant differences in the National Institute of Health Stroke Scale scores,Trial of ORG 10172 in Acute Stroke Treatment,and Oxfordshire Community Stroke Project classifications were observed(P＜0.05).Multivariate logistic regression showed that left ventricular ejection fraction,National Institute of Health Stroke Scale scores,and Oxfordshire Community Stroke Project classification were independent predictors of 3-month disability(P＜0.05).(2)The National Institute of Health Stroke Scale scores and Oxfordshire Community Stroke Project classification at admission were included in model 1,which added the left ventricular ejection fraction as model 2,and all univariate significant difference variables were included in model 3.Receiver operating characteristic analysis showed the area under the curve values of 0.769,0.806,and 0.824 for the models used to predict the 3-month disability rate.(3)The optimal cutoff for left ventricular ejection fraction from the receiver operating characteristic curve was 60.25％,classifying patients into low left ventricular ejection fraction(≤ 60.25％)and high left ventricular ejection fraction(＞60.25％)groups.The 3-month disability rate was higher in the low left ventricular ejection fraction group than in the high left ventricular ejection fraction group(44％vs.26％,P=0.002).These findings highlight that reduced left ventricular ejection fraction plays an important role in the assessment of functional disability 3 months after acute ischemic stroke.Left ventricular ejection fraction can be incorporated into routine prognostic assessments when clinically evaluating the prognosis of ischemic stroke.

BACKGROUND:Transthoracic echocardiography and speckle tracking echocardiography parameters are closely related to stroke occurrence and prognosis.However,the role of transthoracic echocardiography and three-dimensional speckle tracking echocardiography parameters in predicting functional disability following acute ischemic stroke remains unclear.OBJECTIVE:To explore the relationship between transthoracic echocardiography and three-dimensional speckle tracking echocardiography parameters and functional disbility at 3 months post-stroke in patients with acute ischemic stroke.METHODS:A total of 299 patients with acute ischemic stroke admitted to the Second Affiliated Hospital of Soochow University between December 2020 and September 2022 were prospectively enrolled.Patients were divided into no disability(n=207)and disability(n=92)groups based on modified Rankin Scale(mRS)scores(≤ 1 as no disability;1＜mRS score ≤ 5 as disability)at 3 months.Baseline characteristics and transthoracic echocardiography and three-dimensional speckle tracking echocardiography parameters were compared between groups.Independent risk factors for disability were identified using multivariate logistic regression.Predictive models were developed by incorporating variables associated with poor prognosis,and their performance was assessed using the receiver operating characteristic curve analysis.The optimal cutoff value for left ventricular ejection fraction was determined from the receiver operating characteristic curve,and patients were stratified into high and low left ventricular ejection fraction groups.Chi-square test was used to compare prognosis rate between two groups.RESULTS AND CONCLUSION:(1)The disability group had significantly lower left ventricular ejection fraction compared with the no disability group(P=0.011).Significant differences in the National Institute of Health Stroke Scale scores,Trial of ORG 10172 in Acute Stroke Treatment,and Oxfordshire Community Stroke Project classifications were observed(P＜0.05).Multivariate logistic regression showed that left ventricular ejection fraction,National Institute of Health Stroke Scale scores,and Oxfordshire Community Stroke Project classification were independent predictors of 3-month disability(P＜0.05).(2)The National Institute of Health Stroke Scale scores and Oxfordshire Community Stroke Project classification at admission were included in model 1,which added the left ventricular ejection fraction as model 2,and all univariate significant difference variables were included in model 3.Receiver operating characteristic analysis showed the area under the curve values of 0.769,0.806,and 0.824 for the models used to predict the 3-month disability rate.(3)The optimal cutoff for left ventricular ejection fraction from the receiver operating characteristic curve was 60.25％,classifying patients into low left ventricular ejection fraction(≤ 60.25％)and high left ventricular ejection fraction(＞60.25％)groups.The 3-month disability rate was higher in the low left ventricular ejection fraction group than in the high left ventricular ejection fraction group(44％vs.26％,P=0.002).These findings highlight that reduced left ventricular ejection fraction plays an important role in the assessment of functional disability 3 months after acute ischemic stroke.Left ventricular ejection fraction can be incorporated into routine prognostic assessments when clinically evaluating the prognosis of ischemic stroke.

OBJECTIVE To study the correlation between color and inner quality during the processing of Prunus mume carbon， and provide reference for the determination of processing end point of P. mume carbon. METHODS The chromaticity value of P. mume carbon powder was measured by colorimeter， and the inner quality of P. mume carbon was measured by selecting the contents of water， water-soluble extract， citric acid and tannin. The dynamic change trend of the chromaticity value， water， water- soluble extract， the contents of citric acid and tannin in P. mume carbon under different processing time was analyzed. The correlation between color and the above indexe contents was analyzed， and the regression equation of inner quality-chromaticity value was established. Combined with principal component analysis （PCA）， hierarchical cluster analysis （CA） and partial least squares discriminant analysis （PLS-DA）， the difference of P. mume carbon at different processing times was analyzed to determine the processing end point. RESULTS With the extension of processing time， the sample color gradually deepened； the chromaticity values L* and E* of the samples increased at first and then decreased， the chromaticity values a* and b* decreased， and finally all tended to be stable. The content of water-soluble extract， citric acid and tannin in the sample increased at first and then decreased， the water content of the sample decreased with time and finally stabilized. Correlation analysis showed that water， water-soluble extract， citric acid and tannin were positively correlated with L*， a*， b* and E*（P＜0.001）. PCA and HCA showed that P. mume carbon under different processing time could be clustered into two categories： the processed samples of 0-30 min and those of 40-60 min. PLS-DA showed that water and water-soluble extract were important quality indexes and b* was an important chrominance index in the processing of P. mume carbon. The chromaticity value of the samples processed for 50 min and 60 min were not significantly different. The contents of water， water- soluble extract， citric acid and tannin in the samples processed for 60 min were less than those processed for 50 min. CONCLUSIONS There is a certain correlation between the color and the inner quality of P. mume carbon. The processing time of P. mume carbon should be 40-50 min.

Teaching rounds is an important part of clinical teaching practice, therefore, we established a demonstration team for teaching ward rounds. By formulating standard operation procedure for teaching rounds and encouraging innovation on teaching models, the team played a demonstration role in the clinical teaching rounds, which not only made up the shortcomings in teaching, but also improved the teaching level of clinical teachers and the quality of clinical training.

Objective: To report 3 cases of multiple myeloma (MM) with lung cancer.Combined with literature review to improve the understanding of MM with lung cancer. Methods: The clinical characteristics, treatment and prognosis of 3 cases of MM with lung cancer in Shijingshan Teaching Hospital of Capital Medical University from January 2017 to December 2018 and the relevant literature were retrospectively reviewed. Results: Among the 3 patients, 2 cases were male and 1 case was female, with an average age of 69.7 years.The pathological type of lung cancer patients was adenocarcinoma, of which 2 cases were positive for EGFR gene mutation and 1 case was positive for ALK fusion gene.Three cases of multiple myeloma were all IgG-kappa light chain type, with stage Ⅲ A. The chemotherapy regimens used in MM patients were all PD regimen 4-6 cycles; one patient died of pulmonary infection, one patient had MM CR, but lung cancer progressed, one patient had MM very good partial remission (VGPR), and there was no recurrence of lung cancer. Conclusion The pathogenesis of second primary malignancy in MM is not clear, which needs further study.

Objective To establish a method for concentration determination of garlic saponins PIEB in the rat plasma and study the pharmacokinetics of PIEB.Methods The separation was performed on a reverse phase Athena C18-WP (50mm×2.1mm, 3μm), with the mobile phase consisted of elution of acetonitrile-water (contain 0.05％formic acid) at a flow rate of 0.3ml/min.After intravenous and gavage administration, the blood samples of rats were collected in different time, and measured by LC-MS/MS.The pharmacokinetics parameters were calculated by Inna Phase Kinetica2000TMpharmacokinetics software.Results There was a good linearity of the calibration curves over the concentration range of 10-2 430ng/ml (r=0.999 1), and the investigation of methodology all accorded with the demands.After intravenous administration of 50mg/kg PIEB in rats, the maximum concentration of PIEB was achieved immediately.The t1/2of PIEB was about 322minutes and the MRT was 270minutes.After oral administration of low, medium and high concentrations of garlic saponin, the AUC and cmaxincreased with the increasing of dosage, which were consistent with the features of linear pharmacokinetics.Conclusion The established method was simple, accurate and sensitive, which could be suitable for the contents determination of garlic saponins PIEB in the rat plasma.

OBJECTIVETo compare the effects of neoadjuvant chemotherapy and adjuvant chemotherapy on the prognosis of patients with locally advanced gastric cancer using propensity score matching method.

METHODSClinical data of patients with locally advanced gastric cancer undergoing open D2 radical gastrectomy between January 2012 and December 2014 at the Affiliated Tumor Hospital of Zhengzhou University were analyzed retrospectively. Sixty-five patients receiving neoadjuvant chemotherapy (NAC) were allocated into the NAC group and 1243 patients receiving postoperative adjuvant chemotherapy (AC) were allocated into the AC group.

INCLUSION CRITERIA(1) age ranged from 18 to 75 years old, and biopsy specimen was confirmed as adenocarcinoma; (2) all the operative procedures were open D2 radical gastrectomy;(3)image examinations showed no distant metastasis or other unresectable factors.

EXCLUSION CRITERIAno open D2 radical gastrectomy, undergoing laparoscopic surgery, neoadjuvant chemotherapy course <2 cycles, without adjuvant chemotherapy, history of other malignancies, severe complications, incomplete data. SOX (tegafur-gimeracil-oteracil plus oxaliplatin) or XELOX (capecitabine plus oxaliplatin) was used as neoadjuvant and postoperative adjuvant chemotherapy regimen. One-to-two propensity score matching was performed to balance the covariance between two groups. Survival was analyzed using the Kaplan-Meier method. Differences between the curves were tested using log-rank test.

RESULTSAfter balancing the covariates including gender, age, tumor location, degree of differentiation, clinical stage, chemotherapy regimen, chemotherapy course and surgical approach, 195 patients were enrolled, including 65 patients of the NAC group and 130 patients of the AC group. The number of harvested lymph nodes in NAC and AC group was 22.3±4.6 and 22.6±5.1 respectively, without statistically significant difference(t=1.125, P=0.263). Pathological response assessment for NAC group showed TRG0 in 6 cases, TRG1 in 8 cases, TRG2 in 17 cases, TRG3 in 34 cases; sensitive (TRG 0 to 2) in 31 cases (47.7%), non-sensitive in 34 cases (52.3%). The 3-year progression-free survival rate of NAC and AC group was 73.6%(95%CI: 62.8-84.3) and 69.9%(95%CI:62.1-77.7) respectively, which was not significantly different(P=0.361). The 3-year overall survival rate of NAC and AC group was 80.0%(95%CI:70.2-89.8) and 74.6%(95%CI:67.2-82.0) respectively, which was not significantly different as well(P=0.387). Subgroup analysis revealed that the 3-year progression-free survival rate and 3-year overall survival rate of sensitive patients in NAC group were 83.3%(95%CI:70.0-96.6) and 87.1%(95%CI:75.3-98.9) respectively, which were significantly higher than 62.4%(95%CI:46.1-78.7, P=0.037) and 70.2%(95%CI:54.7-85.7, P=0.033) of non-sensitive patients in NAC group, and those in AC group(P=0.044 and P=0.040).

CONCLUSIONSEffects of neoadjuvant chemotherapy and postoperative adjuvant chemotherapy on the prognosis of patients with locally advanced gastric cancer are similar. Patients who are sensitive to neoadjuvant chemotherapy have better prognosis. It may be beneficial to improve prognosis that some appropriate patients with locally advanced gastric cancer are screened for neoadjuvant chemotherapy.

Objective To research the epithelial-mesenchymal transition (EMT) effects of cuprous oxide nanoparticles (CONPs) on melanoma.Methods Cuprous oxide nanoparticles were prepared hydrothermally.The B16 cells were cultured with cuprous oxide nanoparticlesat different concentrations (5,25,50 μg/ml).The changes of the morphology of the B16 cell were observed under the inverted microscope.The effects of CONPs on B16 cell migration ability were detected through the Wound healing assay and the Transwell assay.Then cell immunofluorescence and western blotting were used to test the EMT related molecular markers, including E-cadherin, N-cadherin, Cytokeratin, and Vimentin.Results The synthesized cuprous oxide nanoparticles distribute uniformly with a diameter of 40 nm.Our study indicated that CONPs inhibited the EMT of B16 cell.A conversion process was discovered in this study.In B16 cells, CONPs inhibited B16 cell migration, promoted the expression of E-cadherin, Cytokeratin and Desmoplakin, while the expression of N-cadherin and Vimentin was repressed in protein level.Conclusion Cuprous oxide nanoparticles can significantly restrain the invasion and metastasis of melanoma cells and inhabit the EMT of B16 cells.

Objective To prepare an in situ gel system for nasal delivery of menthol and to evaluate the safety of this formulation.Methods Menthol in situ gel was prepared with deacetylatedgellan gum.The nasal mucocilia toxicities of this formulation was evaluated using in situ toad palate model.Guinea pig skin sensitization test and the rabbit skin irritation test were conducted.Skin allergy and irritation reaction were monitored and scored.Results No significant effect on nasal mucosa ciliary movement and the morphology of rat nasal mucosa were observed.The formulation did not induce any dermal irritation in rabbits.Skin allergic reaction was not found in guinea pigs.Conclusion The preparation of menthol in situ nasal gel with low ciliary toxicity was easily achieved.This gel has good physiological flexibility.The further investigation was warranted for this formulation as an intranasal drug delivery system.

Objective To establish a method for concentration determination of menthol in the nasal in -situ gel spray. Methods Gas chromatography (GC) was performed on the column of Agilent DB-WAX capillary column (30m ×0.25 mm ×0.25μm), with the column temperature of 120 ℃.With nitrogen gas used as carrier gas , hydrogen flame ion detector (FID) was used, the detection temperature was 260℃, injection temperature was 220℃, injection volume was 1μl and column flow rate was 1.0 ml/min. Results For menthol, there was good linear relationship within the range of mass concentration at 0.02~0.20 mg/mL (r=0.9991). Precision, reproducibility and stability test were all lower than 2%, the sample recovery rate was 95.1%~103.4%and relative stand-ard deviation (RSD) was 2.3%(n=6).Conclusion The established method had the following advantages:easy operation, high re-liability and good reproducibility , and it could be used for the content determination of menthol in the nasal in -situ gel spray .