Objective To investigate the effects of cinnamic aldehyde(CA)on Bcl-2-associated X protein(Bax)and Bcl-2 homologous antagonist/killer(Bak)in vascular endothelial cells of diabetic ulcer wound tissues,as well as on cell apoptosis.Methods ① Forty-eight healthy SPF-grade male SD rats(5 weeks old,weighing 180～220 g)were randomly assigned to a control group(12 rats)and a diabetes group(36 rats).The diabetic model was established with an intraperitoneal injection of 50 mg/kg STZ-citrate sodium solution and high-fat diet feeding.The diabetes group was further randomly divided into Model group,CA group,and the rb-bFGF group,with 12 animals in each group.Wounds in the Con and Model groups were disinfected and topically treated with normal saline,CA group received topical application of 4 μmol/L CA in PEG 400 gel,and those of the rb-bFGF group were treated with bevacizumab gel.The wound healing rate of each group was calculated at 3,7 and 14 d after intervention.At 14 d after intervention,pathological changes in the wounds were observed with HE staining,and the expression levels of Bax and Bak were detected by Western blotting.② Human umbilical vein endothelial cell line EA.hy926 was treated with 175 mmol/L glucose for 48 h to establish a cell model of high glucose injury.The experimental cells were divided into control group,model group and CA treatment group.Cell scratch test and tube formation test were performed respectively to determine the migration ability and angiogenesis of the cells.The expression levels of Bax and Bak was detected with immunofluorescence assay,and cell apoptosis was detected by TUNEL staining.Results ①The diabetic rats in the Model group exhibited significantly higher blood glucose level(P<0.05),declined wound healing rate at 7 and 14 d after intervention(P<0.05),and enhanced expression levels of Bax and Bak(P<0.05)when compared with the control group.Pathological observation revealed that,at 14 d after intervention,accompanied with inflammatory reactions,dense infiltration of inflammatory cells,fewer new blood vessels,and continuous fluid exudation in the wound were observed in the Model group,but the control group presented complete epithelialization in full-thickness skin.Compared with the conditions in the Model group,both CA and rb-bFGF treatment improved the epithelialization process,with mature granulation tissues,showing good healing condition,promoted wound healing rate(P<0.05),and decreased the expression levels of Bax and Bak(P<0.05).② The results of cell experiments showed that the cells of the model group showed significantly reduced migration ability and tube formation ability(P<0.05),reduced protein levels of Bax and Bak(P<0.05),and lower apoptotic rate(P<0.05)when compared with the cells in the model group.Conclusion CA can inhibit the expression of apoptosis-related proteins Bax and Bak,promote the migration and tube formation of vascular endothelial cells,and inhibit the cell apoptosis under high glucose condition,which may be an important reason for its promoting wound healing in diabetic ulcer rats.

To explore the association between hyperfibrinogenemia and prognosis in patients with acute ischemic stroke （AIS） receiving intravenous thrombolysis.Methods Patients with acute ischemic stroke who received recombinant tissue plasminogen activator （rt PA） intravenous thrombolysis within 4.5 h of onset from August 2018 to December 2021 in the Department of Neurology of Zhejiang Provincial People's Hospital were retrospectively collected.Hyperfibrinogenemia were diagnosed according to the fibrinogen （FIB） level before thrombolysis.The prognosis of these patients were evaluated according to the modified Rankin Scale （mRS） scores 90 d after discharge.Multivariate logistic regression analysis was performed to determine the independent risk factors for prognoses of acute ischemic stroke patients after rt PA intravenous thrombolysis.Results Among the 327 patients，52 patients（15.90%） in the hyperfibrinogenemia group and 275（84.10%） in the non hyperfibrinogenemia group；63 patients （19.27%） had a poor prognosis and 264 （80.73%） had a good prognosis.As compared with the patients in nonhyperfibrinogenemia group，the patients in hyperfibrinogenemia group had significantly higher levels of the baseline FIB，proportion of drinking history and a poor prognosis （P<0.05）.Compared with the good prognosis group，the poor prognosis group had significantly advanced age，significantly longer door to needle time （DNT），significantly higher level of the baseline FIB，significantly lower proportion of small artery occlusion type and lower proportion of early neurological improvement，significantly higher the proportion of use anticoagulants，significantly higher of large atherosclerotic type，significantly higher of cardioembolic type，significantly higher of PH hemorrhagic transformation，significantly higher of symptomatic intracranial hemorrhage and significantly higher of severe cerebral edema （P<0.05）.Multivariate Logistic regression showed that the levels of the baseline FIB（OR=0.566，95%CI 0.368-0.872，P<0.05），and the 7 d NIHSS scores （OR=0.638，95%CI 0.490-0.831，P<0.05） were independent risk factors for poor prognosis.Conclusion Hyperfibrinogenemia is associated with poor prognosis after intravenous thrombolysis in patients with acute ischemic stroke.Acute ischemic stroke patients with higher baseline FIB levels and higher 7 d NIHSS scores are prone to have poor prognosis.

Objective　The study is based on digital subtraction angiography to evaluate the capillary status and the correlation between the efficacy and prognosis of endovascular treatment of acute anterior circulation ischemic stroke,and to explore the protective effect of collateral circulation in the process of reperfusion therapy.Methods　A retrospective analysis of patients with acute anterior circulation aortic occlusion within 24 hours of onset from January 2020 to December 2020.The capillary index score (CIS) was used to evaluate the collateral circulation of the responsible vascular area of the ischemic brain tissue,and the final infarct volume and the DWI image results of the head MRI within 1 week after the operation were calculated based on the core infarct volume of CTP perfusion imaging and Progress in infarct volume,and follow-up to evaluate the clinical prognosis and long-term functional recovery of patients.Results　(1)Baseline ASPECTS score (OR=2.246,95%CI 1.084~6.328,P<0.05) middle cerebral artery M1 or M2 occlusion (OR=4.801,95%CI 2.047~11.261,P<0.001) is a collateral branch independent influencing factors of the cycle.(2)Baseline ASPECT score (OR=6.476,95%CI 1.618~21.921,P<0.001),collateral circulation (OR=12.304,95%CI 5.035~28.348,P<0.01) and discharge NIHSS score (OR=0.637,95%CI 0.473~0.858,P<0.01) is an independent factor influencing the 3-month prognosis of patients with thrombus removal.Conclusion　Assessment of capillary status based on DSA has a good predictive effect on the progression of infarct volume and clinical prognosis of patients with acute anterior circulation aortic occlusion within 24 hours of onset.The combination of collateral circulation and onset time window can help to screen the possible gains in endovascular treatment.Benefit of AIS patients.

Objective To investigate the correlation between the changes of serum neuron specific enolase(NSE) and hypersensitive C-reactive protein (hs-CRP) levels and the degree of neurological deficit (NIHSS)score in patients with cerebral infarction.Methods From January 2017 to January 2019,63 patients with cerebral infarction admitted to Lishui Central Hospital were selected.According to NIHSS score,they were divided into 13 mild cases,30 moderate cases and 20 severe cases.According to infarction area,they were divided into large area group(16 cases),small area group (27 cases) and lacunar infarction group (20 cases).Another 60 cases underwent health examination in our hospital from January 2017 to January 2019 were selected as the control group.Enzyme-linked immunosorbent assay (ELISA) was used to determine the content of NSE,and immunoturbidimetric assay was used to determine the content of hs-CRP.The changes of serum NSE and hs-CRP levels in the cerebral infarction group and control group,serum NSE,hs-CRP levels and NIHSS scores in different severity and infarction area,and the correlation between serum NSE and hs-CRP changes and NIHSS scores were compared.Results The serum levels of NSE [(21.34 ± 3.27) ng/mL] and hs-CRP [(10.48 ± 2.14) mg/L] in the cerebral infarction group were significantly higher than those in the control group [(6.23 ± 1.08) ng/mL,(2.83 ± 0.46) mg/L] (t =34.061,27.095,all P ＜ 0.05).The serum levels of NSE [(26.98 ± 3.64) ng/mL],hs-CRP [(15.36 ± 2.57) mg/L] and NIHSS score[(38.49 ±3.25) points] in the severe group were higher than those in the moderate group and mild group,which in the moderate group [(20.98 ± 3.21) ng/mL,(10.25 ± 2.09) mg/L and (22.18 ± 3.48) points]were higher than those in the mild group [(12.64 ± 2.78) ng/mL,(5.47 ± 1.40) mg/L and (7.38 ± 2.56)],the differences were statistically significant (F =14.975,9.132,15.873,all P ＜ 0.05).The serum levels of NSE[(25.43 ± 3.35) ng/mL],hs-CRP [(16.54 ± 2.71) mg/L] and NIHSS score [(37.34 ± 3.75) points] in the large area group were higher than those in the small area group and lacunar infarction group,which in the small area group [(21.67 ± 3.12) ng/mL,(10.86 ± 2.21) mg/L and (21.25 ± 3.26) points] were higher than those in the lacunar infarction group [(13.45 ± 2.97) ng/mL,(4.79 ± 1.35) mg/L and (8.49 ± 2.15) points],the differences were statistically significant (F =13.241,9.893,17.482,all P ＜ 0.05).The serum levels of NSE and hs-CRP were positively correlated with NIHSS score (r =0.829,0.713,all P ＜ 0.05).Conclusion The levels of serum NSE and hs-CRP in patients with cerebral infarction increase with the progression of the disease,and there is a linear positive correlation between NSE and hs-CRP and NIHSS score.It is considered that NSE and hs-CRP are of great value in evaluating the degree of neurological impairment,the severity of the disease and the size of the infarct.

Objective To investigate the clinical effects of liver transplantation including living related liver transplantation for Caroli's disease (CD). Methods Seven consecutive patients with diffused type of Caroli's disease had undergone liver transplantation (LT) from September 1999 to February 2007 in our single center. The clinical characteristics and survival of these patients were retrospectively reviewed. Results All 7 patients were diagnosed as Caroli's disease with diffused type which manifested recurrent cholangitis in clinical symptoms. Among them, 4 were female and 3 male.The mean age was 16 years old (ranging from 10 to 31 years old). Six patients were subjected to conservative therapy and only one patient had previously undergone cholecystectomy and T tube drainage before transplantation. In types of surgery, 4 patients accepted split liver transplantation with right liver lobe, two got whole liver transplantation and only one underwent living related liver transplantation. In two patients venovenous bypass was done during the operation. The mean duration of surgery was 9. 1 h. Post-transplant complications included pulmonary infection (3 cases), acute rejection (2 cases), pleural effusion (2 cases) and biliary leakage in the split section of donor liver (1 case). One patient died within 19 days caused by acute renal failure and multiple organs dysfunction.The rest six patients are alive without any signs of recurrence of protopathy and the longest survival time is 7 years. Conclusion Liver transplantation is a valuable treatment to Caroli's disease with diffused type. Due to the organ shortage, living related liver transplantation may own identical effects on LT.