Objective:To investigate the mechanism by which homocysteine(Hcy)promotes the expression of mon-ocyte chemoattractant protein-1(MCP-1)and induces macrophage infiltration,exacerbating acute ischemic stroke(AIS).Methods:A focal cerebral ischemia-reperfusion mouse model was prepared using the suture method,and 2,3,5-triphenyl tetrazolium chloride(TTC)staining was used to detect the severity of cerebral ischemia,while HE staining was used to assess the extent of neuronal damage and inflammatory cell infiltration in ischemic brain tissue.High per-formance liquid chromatography(HPLC)was used to detect Hey expression in acute mouse brain tissue.Immunohisto-chemical staining,Western blot and real time RT-PCR were used to detect MCP-1 expression in mouse brain.Macro-phage migration was detected by Transwell chamber,and the effect of Hcy on endothelial cells was detected by TUNEL staining.The effect of MCP-1 neutralizing antibodies on macrophage migration was observed.Results:Compared with the sham group,the right cerebral hemisphere of the model group was significantly infarcted,ischemic brain tissue was severely damaged,nerve cells died and a large number of inflammatory cells infiltrated.The level of Hcy and the ex-pression of MCP-1 protein and mRNA were significantly increased.The treatment with Hcy can induce the nuclear translocation of p65,promote macrophage migration,and increase the endothelial cell apoptosis.Administration of p65 inhibitors reduced MCP-1 production.MCP-1 neutralizing antibodies significantly inhibited the macrophage migration.Conclusion:Hcy and MCP-1 is associated with the inflammatory response during cerebral ischemia-reperfusion,and Hcy may promote MCP-1 expression through NF-κB pathway,inducing macrophage infiltration and exacerbating cerebral ischemic injury.

Thyroid cancer is the most common endocrine malignancy.This report describes a rare case of giant follicular thyroid carcinoma(FTC)in a patient presenting with hyperthyroidism and multiple metastases involving the lungs,bones,and mediastinal lymph nodes.Such a presentation is extremely uncommon in FTC cases.The patient's treatment primarily involved surgery supplemented by radioactive iodine therapy and targeted therapy.The clinical course was complex,and therapeutic outcomes were limited.This case aims to provide diagnostic and therapeutic insights and offer relevant references for future research on such rare cases.

Thyroid cancer is the most common endocrine malignancy.This report describes a rare case of giant follicular thyroid carcinoma(FTC)in a patient presenting with hyperthyroidism and multiple metastases involving the lungs,bones,and mediastinal lymph nodes.Such a presentation is extremely uncommon in FTC cases.The patient's treatment primarily involved surgery supplemented by radioactive iodine therapy and targeted therapy.The clinical course was complex,and therapeutic outcomes were limited.This case aims to provide diagnostic and therapeutic insights and offer relevant references for future research on such rare cases.

Objective:To investigate the mechanism by which homocysteine(Hcy)promotes the expression of mon-ocyte chemoattractant protein-1(MCP-1)and induces macrophage infiltration,exacerbating acute ischemic stroke(AIS).Methods:A focal cerebral ischemia-reperfusion mouse model was prepared using the suture method,and 2,3,5-triphenyl tetrazolium chloride(TTC)staining was used to detect the severity of cerebral ischemia,while HE staining was used to assess the extent of neuronal damage and inflammatory cell infiltration in ischemic brain tissue.High per-formance liquid chromatography(HPLC)was used to detect Hey expression in acute mouse brain tissue.Immunohisto-chemical staining,Western blot and real time RT-PCR were used to detect MCP-1 expression in mouse brain.Macro-phage migration was detected by Transwell chamber,and the effect of Hcy on endothelial cells was detected by TUNEL staining.The effect of MCP-1 neutralizing antibodies on macrophage migration was observed.Results:Compared with the sham group,the right cerebral hemisphere of the model group was significantly infarcted,ischemic brain tissue was severely damaged,nerve cells died and a large number of inflammatory cells infiltrated.The level of Hcy and the ex-pression of MCP-1 protein and mRNA were significantly increased.The treatment with Hcy can induce the nuclear translocation of p65,promote macrophage migration,and increase the endothelial cell apoptosis.Administration of p65 inhibitors reduced MCP-1 production.MCP-1 neutralizing antibodies significantly inhibited the macrophage migration.Conclusion:Hcy and MCP-1 is associated with the inflammatory response during cerebral ischemia-reperfusion,and Hcy may promote MCP-1 expression through NF-κB pathway,inducing macrophage infiltration and exacerbating cerebral ischemic injury.

Objective:To discuss the efficacy and safety of endoscopic papillectomy of major duodenal papilla neoplasms.Methods:The clinical-pathological data of 21 patients who were admitted to the Department of Endoscopy, Cancer Hospital, Chinese Academy of Medical Sciences and underwent endoscopic papillectomy of major duodenal papilla neoplasms from January 2014 to January 2020 were retrospectively studied, their postoperative outcomes and complication were also analyzed.Results:Tweenty-one patients were successfully performed endoscopic papillectomy of major duodenal papilla neoplasms. The resected lesions varied between 0.5-2.8 cm. Completed lesion was resected in 19 cases and lesion blocks in 2 cases. The incidence of postoperative complication was 52.4% (11/21), including 8 cases of postoperative bleeding (38.1%). Five patients stopped bleeding after endoscopic hemostasis and 3 patients stopped after interventional embolization. Two patients experienced perforation (9.5%) and recovered after conservative treatment including anti-inflammatory treatment and abdominal drainage. Five patients had pancreatitis (23.8%) and recovered after treatment with pre-somatostatin and anti-inflammatory rectal suppository. Preoperative pathological results of 21 patients suggested that 11 were high-grade intraepithelial neoplasia and 8 were low-grade intraepithelial neoplasia, and 2 were chronic inflammation. Postoperative pathological results suggested that 4 were adenocarcinoma, and the rest 17 were adenoma. The coincidence rate of preoperative biopsy results and postoperative pathology was 38.1%(8/21), and underestimate of the pathological stage occurred in 11 patients (52.4%) during the preoperative biopsy, overestimate occurred in two patients (9.5%). Four cases had a positive incisal margin. All patients had good prognoses and no death event occurred during the follow-up period.Conclusions:Early-stage major duodenal papilla neoplasms should be treated with aggressive resection. Endoscopic papillectomy of duodenal papilla neoplasms is safe, effective, and can be recommended as the preferred procedure for major duodenal papilla neoplasms.

Objective:To discuss the efficacy and safety of endoscopic papillectomy of major duodenal papilla neoplasms.Methods:The clinical-pathological data of 21 patients who were admitted to the Department of Endoscopy, Cancer Hospital, Chinese Academy of Medical Sciences and underwent endoscopic papillectomy of major duodenal papilla neoplasms from January 2014 to January 2020 were retrospectively studied, their postoperative outcomes and complication were also analyzed.Results:Tweenty-one patients were successfully performed endoscopic papillectomy of major duodenal papilla neoplasms. The resected lesions varied between 0.5-2.8 cm. Completed lesion was resected in 19 cases and lesion blocks in 2 cases. The incidence of postoperative complication was 52.4% (11/21), including 8 cases of postoperative bleeding (38.1%). Five patients stopped bleeding after endoscopic hemostasis and 3 patients stopped after interventional embolization. Two patients experienced perforation (9.5%) and recovered after conservative treatment including anti-inflammatory treatment and abdominal drainage. Five patients had pancreatitis (23.8%) and recovered after treatment with pre-somatostatin and anti-inflammatory rectal suppository. Preoperative pathological results of 21 patients suggested that 11 were high-grade intraepithelial neoplasia and 8 were low-grade intraepithelial neoplasia, and 2 were chronic inflammation. Postoperative pathological results suggested that 4 were adenocarcinoma, and the rest 17 were adenoma. The coincidence rate of preoperative biopsy results and postoperative pathology was 38.1%(8/21), and underestimate of the pathological stage occurred in 11 patients (52.4%) during the preoperative biopsy, overestimate occurred in two patients (9.5%). Four cases had a positive incisal margin. All patients had good prognoses and no death event occurred during the follow-up period.Conclusions:Early-stage major duodenal papilla neoplasms should be treated with aggressive resection. Endoscopic papillectomy of duodenal papilla neoplasms is safe, effective, and can be recommended as the preferred procedure for major duodenal papilla neoplasms.

Objective To evaluate the efficacy,safety of rigid gas permeable contact lens (RGPCL) wearing for over 5 years in different degrees of keratoconus eyes.Methods A retrospective case study was performed.The clinical data of 217 eyes with different degree of keratoconus from 126 keratoconus patients who fitted with RGPCL in Beijing Tongren Hospital from 2000-2010 over 5 years were analyzed.The eyes were divided into mild keratoconus group (Ks≤45.0 D),moderate keratoconus group (45.0 D＜ Ks ＜ 52.0 D) and severe keratoconus group (Ks ≥52.0 D) according to the severity.Uncorrected visual acuity (UCVA,LogMAR),spectacle corrected visual acuity (SCVA) and RGP corrected visual acuity (RGPVA) was examined before RGPCL wearing and the end of followingup after RGPCL wearing.The refraction,corneal curvature,corneal astigmatism were measured with auto-refractomer/keratometer and keratoconus screening analysis system of computer-assisted corneal topography.Comparisons of the changes of corrected visual acuity and corneal parameters were assessed.Results The RGPVA was 0.09±0.17,0.05±0.07 and 0.07 ±0.07 in the mild,moderate and severe keratoconus group,respectively,showing a significant difference among the three groups (F=0.522,P=0.594);The △Ks was (2.25±5.42),(0.26±3.44) and (-4.52±3.44)D,and △Kf was (2.06±4.98),(1.02±3.41) and (-2.03±5.05)D,and the change value of corneal astigmatism was (0.19±2.87),(-0.78±2.84) and (-2.44±3.77)D in the mild,moderate and severe keratoconus group(all at P＜ 0.05),respectively,with the minimum amount of change in the severe keratoconus group.The variation of differential sector index (△DSI) was-0.33 ± 1.64,0.14±3.01 and-2.11 ±4.28;the variation of center/ surround index (△CSI) was-0.41 ± 1.07,0.03±2.22 and-2.49±4.15;the variation of standard deviation of power (△SDP) was-0.43 ±0.64,-0.02 ±0.89 and-1.67 ± 1.68;the variation of keratoconus prediction index (△KPI)was 0.00±0.07,0.03±0.09 and-0.05±0.11 in the mild,moderate and severe keratoconus group,respectively,and the reduced amount in above parameters was much more in the severe keratoconus group than that in the mild and moderate keratoconus group (all at P＜0.01).Mild conjunctivitis and corneal affection occurred in 12 eyes (5.5％)during the follow-up.Conclusions Long-term wearing RGPCL can improve the visual acuity and slow the tendency of corneal curvature increase in keratoconus eyes,and this procedure is safe and effective for the correction of different degree of keratoconus.

Objective To compare the efficacy and safety of a new low-dose oral contraceptive pill (YAZ) containing drospirenone 3 mg and ethinylestradiol 20 μg with placebo in reducing symptoms of premenstrual dysphoric disorder (PMDD). Methods This multicenter, double-blind, randomized clinical trial consisted of 2 run-in and 3 treatment cycles (84 days) with daily symptom charting; 187 women with symptoms of PMDD were randomized to either placebo group (n=94) or YAZ group (n=93), and assessed with daily record of severity of problems scale (DRSP) and clinical global impressions scale (CGI) before, during and after the treatments. Hormones were administered for 24 days, followed by 4 days of inactive pills. Results Compared with baseline level of DRSP, both groups got improvement after treatment; the YAZ group (median-28.7, range:-82.5 to 2.3) had greater improvement than that in the placebo group (median-23.7, range:-86.0 to 11.8), while there was not significant difference (P>0.05). The main adverse effects of YAZ included intermenstrual bleeding [13% (12/93) versus 3% (3/94)], menorrhagia [9% (8/93) versus 1%(1/94)], nausea [5%(5/93) versus 4%(4/94)] and skin rash [4%(4/93) versus 2%(2/94)]. Conclusions YAZ could improve symptoms of PMDD better than placebo, while without statistic significance in this study. The most common adverse effects are intermenstrual bleeding, menorrhagia, nausea and rash.