Objective: : The present study aimed to identify the function of ischemic stroke (IS) patients’ peripheral blood and its role in IS, explore the pathogenesis, and provide direction for clinical research progress by comprehensive bioinformatics analysis. Methods: : Two datasets, including GSE58294 and GSE22255, were downloaded from Gene Expression Omnibus database. GEO2R was utilized to obtain differentially expressed genes (DEGs). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis of DEGs were performed using the database annotation, visualization and integrated discovery database. The protein-protein interaction (PPI) network of DEGs was constructed by search tool of searching interactive gene and visualized by Cytoscape software, and then the Hub gene was identified by degree analysis. The microRNA (miRNA) and miRNA target genes closely related to the onset of stroke were obtained through the miRNA gene regulatory network. Results: : In total, 36 DEGs, containing 27 up-regulated and nine down-regulated DEGs, were identified. GO functional analysis showed that these DEGs were involved in regulation of apoptotic process, cytoplasm, protein binding and other biological processes. KEGG enrichment analysis showed that these DEGs mediated signaling pathways, including HTLV-I infection and microRNAs in cancer. The results of PPI network and cytohubba showed that there was a relationship between DEGs, and five hub genes related to stroke were obtained : SOCS3, KRAS, PTGS2, EGR1, and DUSP1. Combined with the visualization of DEG-miRNAs, hsa-mir-16-5p, hsa-mir-181a-5p and hsa-mir-124-3p were predicted to be the key miRNAs in stroke, and three miRNAs were related to hub gene. Conclusion : Thirty-six DEGs, five Hub genes, and three miRNA were obtained from bioinformatics analysis of IS microarray data, which might provide potential targets for diagnosis and treatment of IS.

Objective: To retrospectively analyze the characteristics of nasopharyngeal carcinoma, long-term efficacy, adverse reactions of intensity-modulated radiotherapy (IMRT) in non-endemic northwest China and summarize the experience of IMRT in the treatment of nasopharyngeal carcinoma in the past decade. Methods: Clinical data of 658 patients newly diagnosed with nasopharyngeal carcinoma without distant metastasis admitted to First affiliated hospital from January 2006 to December 2016 were retrospectively analyzed. All patients were treated with IMRT. The survival analysis was performed by Kaplan-Meier method. The multivariate analysis was conducted with Cox’s regression model. Results: In non-endemic northwest China, a large proportion of patients were newly diagnosed with locally advanced nasopharyngeal carcinoma, and a majority of them were pathologically characterized as differentiated subtypes. The 5-year overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS) and distant metastasis-free survival (DMFS) rates were 75.7%, 70.1%, 91.2%, 97.0% and 81.0%, respectively. Multivariate analysis showed that age, pathological type, nasopharyngeal tumor volume>23 cm³ and neck lymph node metastasis complicated with necrosis were the factors of poor prognosis of DFS (all P<0.05). Age, pathological type, neck lymph node metastasis complicated with necrosis were the factors of poor prognosis of OS (all P<0.05). N stage and neck lymph node metastasis complicated with necrosis were the factors of poor prognosis of DMFS (both P<0.05). Conclusions Similar clinical efficacy has been achieved in terms of IMRT for nasopharyngeal carcinoma in non-endemic northwest China compared with that in endemic area. Induction chemotherapy combined with concurrent radiochemotherapy can provide clinical benefits for patients with locally advanced nasopharyngeal carcinoma in non-endemic area.

This study was aimed to observe the therapeutic effect of qi-supplementing,blood-activating and phlegmresolving on chronic obstructive pulmonary disease (COPD) patients with blood stasis syndrome in the acute stage,and to evaluate the lung function improvement condition.Observation was also made on plasma fibrinogen and D-dimer,in order to provide references for traditional Chinese medicine (TCM) clinical treatment of COPD.A total of 174 acute COPD patients with blood stasis syndrome were selected from October 2015 to July 2017 in the Linqu County People's Hospital of Shandong Province.Patients were randomly divided into the control group and the study group.Conventional western medicine treatment was given to the control group.On the basis of routine western medicine treatment,the study group was treated with TCM qi-supplementing,blood-activating and phlegm-resolving method.The clinical efficacy,changes of lung function,plasma fibrinogen and D-dimer before and after treatment were observed in both groups.The results showed that the total efficacy of the study group was 95.4％,and the total efficacy of the control group was 79.3％.The difference was statistically significant (P ＜ 0.05).Pearson correlation study showed that plasma fibrinogen (r =-0.79,P ＜ 0.05) and D-dimer (r =-0.84,P ＜ 0.05) were negatively correlated with PaO2.Before treatment,there was no significant difference in lung function,plasma fibrinogen and D-dimer between two groups (P ＞ 0.05).After treatment,indicators of both groups were significantly improved,in which the improvement of the study group was more obvious.The difference between two groups was statistically significant (P ＜ 0.05).It was concluded that the expression levels of plasma fibrinogen and D-dimer were closely related to COPD.Qi-supplementing,blood-activating and phlegmresolving method can improve clinical symptoms,blood stasis status and lung function of COPD patients in the acute stage with remarkable curative effect.

Objective To investigate the effect oftopiramate on NACHT-LRR-PYD-containing protein 3 (NALP3) inflammasome and intedeukin (IL)-1β levels in trigeminal ganglion of migraine rats.Methods Forty adult male Sprague Dawley rats were randomly divided into blank group,saline group,model group,prevention control group,10 mg/kg topiramate group,30 mg/kg topiramate group,60 mg/kg topiramate group,and 90 mg/kg topiramate group (n=5).Inflammatory soup was used to stimulate the dual matter of rats repeatedly to induce migraine models:rats in the blank group were without any treatment,those in the saline group were given saline to stimulate the dual matter,different concentrations of topiramate group were given to migraine models of the 10 mg/kg topiramate group,30 mg/kg topiramate group,60 mg/kg topiramate group,and 90 mg/kg topiramate group,respectively,and migraine models of the prevention control group were given saline containing 1％ Tween80.Three h after the last treatment,the expressions of NALP3,caspase-1 precursor (pro-caspase-1),caspase-1 and IL-1β in trigeminal ganglion of rats were detected by Western blotting,and the best concentration oftopiramate was chosen for subsequent immunofluorescence experiments.Ten healthy male adult SD rats were randomly divided into control group and topiramate group (n=5);the expression levels of NALP3,caspase-1 and IL-1β in trigeminal ganglion of the two groups were detected by immunofluorescence.Results The expression levels ofNALP3,pro-caspase-1,caspase-1 and IL-1β were not significantly different between saline group and blank group (P＞0.05);the expression levels ofNALP3,pro-caspase-1,caspase-1 and IL-1β in the model group were significantly higher than those in the saline group (P＜0.05).The expression levels of NALP3,pro-caspase-1,caspase-1 and IL-1β in 60 mg/kg topiramate group and 90 mg/kg topiramate group were significantly lower than those in the prevention control group (P＜0.05).The fluorescence intensity ofNALP3,caspase-1 and IL-1β in topiramate group was significantly lower than that in control group.Condusion Topiramate can inhibit the expression of NALP3 inflammasome and IL-1β in the trigeminal ganglion of migraine rat models,and it is likely to be one of the important mechanisms for the prevention of migraine.

Objective To investigate correlation between demyelination and caspase-12 expression alteration after compressed spinal cord injury (CSCI) so as to discuss mechanism of demyelinating lesion after CSCI.Methods Seventy-five adult SD rats were randomly divided into five groups,ie,normal group,control group,compression 1 d,3 d and 7 d groups,with 15 rats per group.Models of spinal cord compression were established with a self-made device.Ultrastructure of the demyelinated nerve fibers was observed by electronic microscope and oligodendrocyte apoptosis was detected by TUNEL staining and double labeling immunofluorescence.Immunoblotting was used to defect caspase-12 that was related to cell apoptosis.Results Demyelination of nerve fiber occurred after CSCI and was aggravated with time.Apoptosis of oligodendrocytes was found after CSCI,and showed significant difference between compression 7 d group and normal group (P ＜ 0.05).Caspase-12 was also upregulated with extension of compression time.Conclusion Caspase-12 mediating oligodendrocyte apoptosis is one of the mechanisms of nerve fiber demyelination after CSCI.

Objective To investigate the role of demyelination and the alteration of chondrotin sulfate proteoglycan (CSPG,NG2) expression after compression injury of the spinal cord (CSCI).Methods Seventy-five adult Sprague-Dawley rats were randomly divided into a normal group,a sham-operation group,a CSCI 1 day group,a CSCI 3 day group,and a CSCI 7 day group.There were 15 rats in each group.The injuries in the CSCI groups were inflicted using a technique devised in our laboratory.Basso-Beattie-Bresnahan (BBB) neurological function assessment was used to assess the rats' motor function,osmic acid staining and transmission electronic microscopy (TEM)were used to observe any pathological changes of myelinated nerve fibers in the white matter at 1,3 and 7 days after CSCI.The amount of myelinated nerve fibers in the posterior funiculus of the spinal cord and the ratio of myelin sheath thickness to axon diameter (the G-ratio) were calculated.Any alteration in NG2 expression was observed by Western blotting.Results The average neurological function assessment scores in the CSCI groups were (1.23 ±0.45),(0.65 ± 0.35) and (0.00 ± 0.00) respectively.Compared with the normal group (21.00 ± 0.00) and the sham operation group (21.00 ± 0.00),the differences were all statistically significant.The rats' motor function deteriorated gradually with time after the CSCI.Osmic acid staining showed that the white matter was intact in the normal and sham groups.After being compressed the myelinated nerve fibers became swollen,degenerated and broke down.The amount of myelinated nerve fibers in the normal group,the sham operation group and the three CSCI groups was (2771 ± 108),(2675 ± 199),(2403 ± 161),(1708 ± 70) and (8 10 ± 95) respectively.The amount of myelinated nerve fibers decreased in the CSCI groups and reached a minimum on the 7th day.The difference was statistically significant.The TEM quantity analysis showed that the G-ratios in the normal,sham operation,and CSCI 1 day,3 day and7 day groups were (18.10±0.4),(17.70±1.0),(6.69 ±0.8),(5.73 ±0.4) and (4.95 ±0.5) respectively.Compared with the normal and sham operation groups,the G-ratios in the 3 CSCI groups were lower and reached their minimum on the 7th day after injury.The difference was statistically significant.TEM observation showed that the axons and myelin sheaths were intact in the normal and sham groups.After CSCI the axons became swollen and cell organelles in the axoplasm degenerated and decreased.The layers of myelin sheath shrank,folded and even wrinkled,which had an onion-like appearance.The oligodendrocytes exhibited chromatin condensation.Macrophages showed infiltration.Western blotting showed that the expression of NG2 in the CSCI groups reached a maximum on the 1st day after injury and then decreased with time.The expression of NG2 in the CSCI groups was higher than in the normal and sham groups,and the difference was statistically significant.Conclusion Demyelination occurs after CSCI-the amount of myelinated nerve fibers decreases and neurological deficits increase with time.The expression of NG2 was associated with changes in the myelin sheaths after CSCI and contributed to recovery of the myelin sheath through proliferation and differentiation to oligodendrocytes and perhaps other kinds of cells.

Objective To observe the effects of electro-acupuncture on the expression and inhibition of DNA binding protein 2 (Id2) and myelin basic protein (MBP),and to explore the mechanism of remyelinization after compressive spinal cord injury (CSCI) in rats.Methods Fifty-four SD rats were randomly divided into a control group and a treatment group,and each was further subdivided into 3 time point subgroups:3,7 and 14 days.There were 9 rats in each subgroup.The CSCI models were made with a self-designed method.The acupuncture points Jiaji (EX-B2),bilateral Zusanli (ST36) and Taixi (KI3) were selected for treatment.Electro-acupuncture (continuous wave,2 Hz,1.5 V)was applied to the bilateral Zusanli (ST36) and Taixi (KI3) points.The control group received the injury but no treatment.The changes in the ultrastucture of the nerve fibers＇ white matter were de-termined by transmission electron microscopy (TEM).The alterations in the expression of MBP and Id2 were observed by double labeled immunofluorescence and Western blotting on the 3rd,7th and 14th day after the injury.Results TEM showed that the myelin sheaths in the control group had degenerated,swollen,and even broken down after CSCI.Changes to the myelin sheaths in the treatment group were milder than those in the control group.The immunofluorescence results showed the amount of Id2-immunoreactive oligodendrocytes in the control group to be (20 ±2) on the 3rd day after CSCI,becoming (16 ± 1) on the 14th day.The differences among the 3 control subgroups were not statistically significant.The amount of Id2-immunoreactive oligodendrocytes in the treatment group was (13 ± 1) on the 3rd day,reaching a minimum the 14th day.The differences among the 3 treatment groups were statistically significant.The differences compared with the control group at the same time points were also statistically significant.Western blotting showed that the expression of Id2 in the contrast and treatment groups was (1.12 ±0.12) and (0.67 ±0.01) respectively on the 3rd day after CSCI,and both decreased with time.The expression of Id2 in both groups reached their minima ((0.86 ±0.02) and (0.25 ±0.01) respectively) on the 14th day.The difference between the treatment groups and the contrast group was statistically significant at each time point.The expression of MBP in the contrast and treatment groups at day 3 was (0.44 ± 0.02) and (0.67 ± 0.04) respectively,and these increased with time.The expression of MBP in both groups peaked at the 14th day (at (0.95 ± 0.04) and (1.74 ± 0.09) respectively).These differences were again statistically significant.Conclusion Electro-acupuncture can regulate the expression of Id2 and MBP after CSCI.The down-regulation of Id2 which controls MBP negatively and the up-regulation of MBP may contribute to remyelination in the injured spinal cord.

ObjectiveTo evaluate the therapeutic efficacy and prognostic factors of intensity-modulated radiotherapy combined with chemotherapy for early-stage nasopharyngeal carcinoma patients in northwest China. MethodsFrom January 2006 to December 2009,58 patients with early-stage nasopharyngeal carcinoma were treated with IMRT in Xijing hospital,the clinical data were analyzed retrospectively.Survival rates was calculated by the Kaplan-Meier method and the differences was compared by the Logrank test.Univariate analysis method was use to identify all significant factors.ResultsThe follow-up rate was 100％.The follow-up time of 46 patients was more than 3 years.The 1-,2 and 3-year survival were 98％,94％ and 91％,respectively.The 3-year overall survival (OS),local recurrence-free survival (LRFS),distant metastasis-free surv ival (DMFS) for T1N0-1,T2N0 and T2N1 stage were 100％,100％,100％ and 74 ％,81％,87 ％,respectively ( x2 =5.74,P =0.01 ; x2 =4.95,P =0.03 ; x2 =4.24,P=0.04).The 3-year OS,LRFS,DMFS for IMRT combined with chemotherapy and IMRT alone were 100％,100％,100％ and 85％,85％,88％ respectively ( x2 =4.02,P =0.04; x2 =4.12,P =0.03 ; x2 =4.84,P =0.02).In T2N1 stage,IMRT combined with chemotherapy and IMRT alone were 100％,100％,100％ and 79％,79％,80％ respectively (x2 =5.28,P =0.03 ;x2 =4.84,P =0.04;x2 =4.72,P =0.04).In univariate analysis,N stage,clinical stage,IMRT combined with chemotherapy were significantly associated with the survival ( x2 =5.39,P =0.02 ; x2 =5.74,P =0.01 ; x2 =4.02,P =0.04).Conclusions In all early-stage nasopharyngeal carcinoma,T2N1 stage is a sub-group of high risk of distant metastasis.Combination of IMRT and chemotherapy may improve the LRFS,DMFS and OS in those patients.

This paper proposed the idea of building the applied anatomical experiment and research platform for surgical postgraduates with professional degree,establishing double-tutorial system and applying applied anatomical teaching in basis course learning,clinical skill training and research capacity cultivating after analyzing the reasons of poor applied anatomical background of surgical postgraduates with professional degree.These ideas were intended to improve the cultivation quality.

ObjectiveTo evaluate the long term outcomes, toxicities and prognostic factors of the patients in Northwest China with nasopharyngealcarcinoma (NPC)treated by intensity-modulated radiotherapy (IMRT). MethodsFrom January 2006 to December 2009, 133 NPC Patients were treated by IMRT in Xijing Hospital, the Fourth Military Medical University. There were 22 treated by radiotherapy alone, 111 treated by platinum-based current chemo-radiothreapy. The prescription dose to the gross tumor volume was 66 - 76. 6 Gy/30 - 33 fractions, positive lymph nodes was 66. 0 - 72. 4 Gy/30 - 33 fractions.The higher and lower risk clinical target volume were irradiated with 56. 0 - 63. 5 Gy/28 - 33 fractions and 50. 4 -53. 2 Gy/28 fractions respectively. ResultsThe follow-up rate was 97. 7％. Follow-up time more than 2years,3years were 37cases ,44cases. The l-,2-and 3-year overall survival (OS) were 93. 8％, 88. 3％and 83.2％ ; local control rate were 99. 2％ ,95.4％ and 95.4％ ; regional control rate ( RC ) were 99. 2％,96. 8％ and 96.8％ ; and distant metastasis-free rate (DMFR) were 82. 8％, 79. 8％ and 79. 8％ ; the disease-free survival (DFS) were 84. 3％ ,76. 7％ and 76. 7％, respectively. Multivariate analyses revealed that N stage, age and anemia before radiotherapy were independent predietors for OS (x2 =5.56,9. 10,4.89,P=0. 018,0.003,0.027), and N stage was also independent predictors for DFS (x2 =8.98,P=0.003).Thegrade 3acutetoxicitiesweremueositis(34.7％),xerostomia(20. 1％ ), skin reaction ( 1.4 ％ ) and leucocytopenia ( 1. 4 ％ ). No grade4 acute and late toxieities were detected. Conclusions IMRT with or without chemotherapy achieved good long term survival in nasopharyngeal carcinoma treated by intensity-modulated radiotherapy, especially in LC and RC. Distant metastasis becomes the main treatment failure.N stage, age, and anemia before radiotherapy were the main prognostic factors in nasopharyngeal cancer patients.