AIM:To investigate the effects of Panax notoginseng compound formula(PN)on endometrial fibro-sis by regulating inflammatory reaction and intestinal flora(IF)in a rat model of intrauterine adhesion(IUA).METHODS:The rat IUA model was established by following the mechanical injury method.A total of 50 rats were randomly divided in-to sham group,model group,low-dose(210 mg/kg)PN group,medium-dose(420 mg/kg)PN group and high-dose(840 mg/kg)PN group.After 8 weeks of intragastric administration,the uterus was collected to observe morphological changes with naked eye.The degree of uterine tissue damage and fibrosis was evaluated through hematoxylin-eosin(HE)and Mas-son staining.The collagen type Ⅰ(Col Ⅰ)was detected by immunohistochemistry.The interleukin-6(IL-6)and IL-10 pro-tein expression was detected by Western blot.The levels of IL-6,IL-1β,tumor necrosis factor-α(TNF-α)and vascular endothelial growth factor B(VEGFB)were detected by enzyme-linked immunosorbent assay(ELISA).The IF diversity and population structure were observed by 16S amplicon.RESULTS:Compared with the sham group,the uteruses of rats in the model group showed:reduced elasticity,accompanied by congestion and edema;decreased number of glands and blood vessels,and thinned endometrium(P<0.01);increased collagen fibers and Col Ⅰ protein expression(P<0.01);sig-nificantly increased IL-1β,IL-6,TNF-α and VEGFB levels in the uterine tissue(P<0.01);decreased IL-10 level(P<0.01);and reduced IF diversity(P<0.05).Compared with the model group,the drug intervention groups exhibited:re-covered elasticity of the uterus and relieved congestion and edema;increased number of endometrial glands and blood ves-sels(P<0.05);decreased collagen fibers and Col Ⅰ protein expression(P<0.01);reduced IL-1β,IL-6,and TNF-α lev-els to varying degrees in the uterine tissue(P<0.05);elevated IL-10 level(P<0.01);and improved IF diversity(P<0.05).CONCLUSION:The PN is able to significantly improve the endometrial tissue fibrosis in IUA rats.The under-lying mechanisms may be related to the inhibition of IL-6,IL-1β and TNF-α expression,up-regulation of IL-10,and im-provement of IF diversity.

Objective:To investigate the correlation between the homeostatic model assessment for insulin resistance index (HOMA-RI) and post-stroke cognitive impairment (PSCI) in patients with minor ischemic stroke (MIS) at 3 months after onset.Methods:Patients with acute MIS admitted to the Department of Neurology, Jiangsu Shengze Hospital from November 2019 to January 2022 were included prospectively. HOMA-RI was calculated based on fasting blood glucose and insulin. Cognitive function was evaluated using the Montreal Cognitive Assessment at 3 months after onset, and <26 points were defined as the presence of PSCI. Multivariate logistic regression analysis was used to determine the independent influencing factors of PSCI. Results:A total of 115 patients with MIS were enrolled, including 62 males (53.9%), aged 70.09±12.61 years. Among them, 71(61.74%) developed PSCI. Univariate analysis showed that there were significant differences in age, lipoprotein (a), HOMA-IR and its quartile classification, infarct side between PSCI group and non-PSCI group (all P<0.05). Multivariate logistic regression analysis showed that age (odds ratio [ OR] 1.052, 95% confidence interval [ CI] 1.015-1.089; P=0.005] and HOMA-RI (compared to the 1 st quartile, the 3 rd quartile: OR 1.012, 95% CI 2.306-4.171, P=0.043; the 4 th quartile: OR 2.125, 95% CI 1.085-4.163, P=0.028) were the independent risk factors for PSCI. Conclusion:High HOMA-RI is an independent risk factor for early onset of PSCI in patients with MIS, and the risk of PSCI increases with the increase of HOMA-RI.

Objective:To investigate the correlation between subclinical hypothyroidism (SCH) and clinical outcomes of patients with acute ischemic stroke.Methods:From July 2014 to October 2017, patients with acute ischemic stroke admitted to Jiangsu Shengze Hospital Affiliated to Nanjing Medical University were enrolled retrospectively. Their demographic and baseline clinical and laboratory data were collected. The modified Rankin Scale was used to evaluate the clinical outcome at 3 months after the onset of symptoms. Multivariate logistic regression analysis was used to determine the independent correlation between SCH and clinical outcome of patients with acute ischemic stroke. Results:A total of 200 patients with acute ischemic stroke were enrolled, including 107 males (53.5%) and 93 females (46.5%). Their age was 69.67±11.38 years. There were 45 patients (22.5%) with SCH, 160 (80.0%) with good outcomes, and 40 (20.0%) had poor outcomes. Univariate analysis showed that there were significant differences in the baseline National Institutes of Health Stroke Scale (NIHSS) score, stroke etiology classification and the proportion of patients with SCH between the poor outcome group and the good outcome group (all P<0.05). Multivariate logistic regression analysis showed that high NIHSS score (odds ratio 2.884, 95% confidence interval 2.005-4.147; P=0.001) and SCH (odds ratio 19.527, 95% confidence interval 2.334-163.386; P=0.006) were the independent risk factors for poor outcomes. Conclusion:High NIHSS score and SCH were associated with the poor outcomes at 3 months after the onset of acute ischemic stroke.

Objective　To study the correlation of NLRP3 with inflammatory factors and neurological function recovery in acute ischemic stroke (AIS) patients.Methods　Seventy-one AIS patients were enrolled,blood samples were collected at 3~72 hours after stroke onset.The mRNA levels of NLRP3 were detected by reverse transcription-quantitative polymerase chain reaction (RT-qPCR).Serum levels of inflammatory cytokines IL-6,IL-1β and TNF-α were detected by ELISA.The modified RanKin sore (mRS) was used to evaluate the recovery of AIS patients 3 months after stroke onset.Thirty-eight healthy normal people were recruited as a controls,blood samples were collected during recruitment.Results　The mRNA levels of NLRP3 in the blood of AIS patients were significantly higher than thos normal control group (P<0.05).Conclusion　Analysis showed that the NLRP3 mRNA levels were positively correlated with the mRS score (r=0.357,P=0.002).In addition,the levels of inflammation-related IL-1β,IL-6,and TNF-α in AIS patients were significantly higher than those in the normal control group,with P<0.05.The mRNA expression of NLRP3 was positively correlated with the levels of inflammatory factor IL-1β(r=0.31,P=0.016),but not significantly correlated with IL-6 (r=0.07,P=0.751) and TNF-α (r=0.14,P=0.186).The prognosis of AIS patients with higher levels of NLRP3 expression in the blood is worse.In addition,the inflammatory factor IL-1β mediates the pathogenesis of NLRP3.

Objective To investigate the correlation between subclinical hypothyroidism (SCH) and carotid atherosclerosis in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke admitted to Nanjing Shengze Hospital Affiliated to Nanjing Medical University from July 2014 to July 2017 were enrolled retrospectively.SCH was defined as elevated levels of serum thyroid stimulating-hormone (TSH),but the free thyroxine (FT4) and free-triiodothyronine (FT3) levels were normal.Carotid plaque and carotid stenosis were assessed using carotid ultrasound.Multivariate logistic regression analysis was used to determine the correlation between SCH and carotid atherosclerosis.Resuts A total of 176 patients with acute ischemic stroke were enrolled,including 81 females and 95 males;36 complicated with SCH,126 complicated with carotid atherosclerotic plaques,and 9 had carotid stenosis.High-density lipoprotein cholesterol (1.36±0.48 mmol/L vs.1.18 ± 0.30 mmol/L;t =2.090,P =0.039) and TSH (6.29[5.44-7.01]mU/L vs.1.87[1.31-2.67] mU/L;Z =9.243,P =0.001) levels in the SCH group were significantly higher than those in the non-SCH group.There were significant differences in age (73.5[65.0-80.0]years vs.68.0[56.0-75.0]years;Z =2.707,P=0.007),stroke etiology classification (x2 =9.270,P=0.038),TSH level (2.19[1.47-3.72]mU/L vs.2.18[1.24-2.62]mU/L;Z=3.230,P=0.001),and the proportion of patients with SCH (26.98％ vs.4.00％;x2 =11.622,P =0.001) between the plaque group and the non-plaque group.There was no statistical difference in demographic and clinical data between the stenosis group and the non-stenosis group (all P ＞0.05).Multivariatelogistic regression analysis showed that advanced age (odds ratio 1.050,95％ confidence interval 1.014-1.088;P =0.006) and SCH (odds ratio 5.328,95％ confidence interval 1.322-21.468;P =0.019) were the independent risk factors for carotid atherosclerotic plaques.Conclusion Advanced age and SCH were the independent risk factors for carotid plaque in patients with acute ischemic stroke.

Objective To investigate the clinical value of aspirin before pregnancy combined with low molecular heparin during pregnancy on treatment of patients with recurrent spontaneous abortion caused by prethrombotic state.Methods A total 60 patients with recurrent spontaneous abortion were randomly divided into treatment group and control group,30 cases in each group.The treatment group was treated with small dose of aspirin before pregnancy and low dosage molecular heparin during pregnancy,while the control group was treated with low dosage molecular heparin during pregnancy.Pregnancy outcome was compared between two groups.Results The partus maturus rate of treatment group was significantly higher than control group (P ＜ 0.05),and abortion rate was significantly lower than control group (P ＜ 0.05).Conclusion Aspirin before pregnancy combined with low molecular heparin during pregnancy is effective in treatment of patients with recurrent spontaneous abortion caused by prethrombotic state,which can increase partus maturus rate and reduce abortion rate.

Objective To explore clinical effect of compound danshen dropping pills,aspirin enteric-coated tablets combined with small dose of estrogen on treatment of patients with thin endometrium.Methods A total of 69 patients with thin endometrium were collected and divided into 3 groups.Group Ⅰ was treated with estrogen at 3 to 5 days after menstrual period,group Ⅱ was treated with aspirin and compound danshen dropping pills,and group Ⅲ was treated with estrogen,aspirin and compound danshen dropping pills.General condition,ovulation,drug use,endometrial growth before and after the use of drugs and pregnancy rate were compared.Results There were no significant differences in general situations and ovulation results before treatment among three groups (P ＞0.05).After medication,the endometrial thickness of the 3 groups improved significantly,and the endometrial thickness of group Ⅲ was significantly better than group Ⅰ and Ⅱ (P =0.005,0.012).In group Ⅰ,Ⅱ and Ⅲ,the proportion of endometrium more than 7 mm after treatment was 38.1％,16.7％ and 60％ respectively,and the success rate of group Ⅲwas significantly higher than that of group Ⅰ and Ⅱ (P =0.008).The clinical pregnancy rate in group Ⅲ was significantly higher than that in group Ⅰ and Ⅱ (P =0.049).Conclusion Compound danshen dropping pills,aspirin entericcoated metformin combined with small dose of estrogen can significantly improve endometrium and pregnancy rate in patients with thin endometrium,with less estrogen dosage.

Objective To investigate the clinical value of aspirin before pregnancy combined with low molecular heparin during pregnancy on treatment of patients with recurrent spontaneous abortion caused by prethrombotic state.Methods A total 60 patients with recurrent spontaneous abortion were randomly divided into treatment group and control group,30 cases in each group.The treatment group was treated with small dose of aspirin before pregnancy and low dosage molecular heparin during pregnancy,while the control group was treated with low dosage molecular heparin during pregnancy.Pregnancy outcome was compared between two groups.Results The partus maturus rate of treatment group was significantly higher than control group (P ＜ 0.05),and abortion rate was significantly lower than control group (P ＜ 0.05).Conclusion Aspirin before pregnancy combined with low molecular heparin during pregnancy is effective in treatment of patients with recurrent spontaneous abortion caused by prethrombotic state,which can increase partus maturus rate and reduce abortion rate.

Objective To explore clinical effect of compound danshen dropping pills,aspirin enteric-coated tablets combined with small dose of estrogen on treatment of patients with thin endometrium.Methods A total of 69 patients with thin endometrium were collected and divided into 3 groups.Group Ⅰ was treated with estrogen at 3 to 5 days after menstrual period,group Ⅱ was treated with aspirin and compound danshen dropping pills,and group Ⅲ was treated with estrogen,aspirin and compound danshen dropping pills.General condition,ovulation,drug use,endometrial growth before and after the use of drugs and pregnancy rate were compared.Results There were no significant differences in general situations and ovulation results before treatment among three groups (P ＞0.05).After medication,the endometrial thickness of the 3 groups improved significantly,and the endometrial thickness of group Ⅲ was significantly better than group Ⅰ and Ⅱ (P =0.005,0.012).In group Ⅰ,Ⅱ and Ⅲ,the proportion of endometrium more than 7 mm after treatment was 38.1％,16.7％ and 60％ respectively,and the success rate of group Ⅲwas significantly higher than that of group Ⅰ and Ⅱ (P =0.008).The clinical pregnancy rate in group Ⅲ was significantly higher than that in group Ⅰ and Ⅱ (P =0.049).Conclusion Compound danshen dropping pills,aspirin entericcoated metformin combined with small dose of estrogen can significantly improve endometrium and pregnancy rate in patients with thin endometrium,with less estrogen dosage.

Objective To investigate the risk factors for acute ischemic stroke in patients with lower extremity atherosclerosis (LEA).Methods The consecutive patients with acute ischemic stroke admitted to hospital within 7 d after onset were enrolled retrospectively.Color Doppler flow imaging was used to detect LEA.The demographic characteristics,vascular risk factors,and laboratory parameters were identified and analyzed.Results A total of 156 patients with acute ischemic stroke were enrolled,including 138 with LEA.Univariate analysis showed that age (69.5± 11.8 years vs.60.4± 11.5 years;t =3.063,P =0.003) and the proportion of patients with hypertension (81.1％ vs,55.6％;x2 =2.467,P =0.014) in the LEA group were significantly higher than those in the non-LEA group.Multivariate logistic regression analysis showed that after adjustment for confounders such as gender,baseline systolic blood pressure,diabetes mellitus,and ischemic heart disease,age (odds ratio [OR] 1.059,95％ confidence interval [CI] 1.016-1.105;P=0.007),and hypertension (OR 3.128,95％ CI 1.084-9.026,P =0.035) were the independent risk factors for acute ischemic stroke complicated with LEA.Conclusions Age and hypertension are associated with acute ischemic stroke complicated with LEA.