OBJECTIVE To study the repair effect and mechanism of Zhixu burn ointment on deep second-degree burned model rats. METHODS The deep second-degree burned model was established with a temperature-controlled apparatus. The model rats were randomly divided into model group， Jingwanhong ointment group and Zhixu burn ointment high-dose， medium-dose and low-dose groups （specifications were 20 g core+20 mL wetting agent， 10 g core+20 mL wetting agent， 5 g core+20 mL wetting agent， respectively）. Another blank control group （only dehairing treatment， no modeling） was set up， with 10 rats in each group. The rats in each administration group were given corresponding drugs， the rats in the blank control group were not treated， and the rats in the model group were given normal saline once a day for 21 d. The healing of burn wounds and histomorphological changes of burned skin in each group of rats were observed， and the healing rate of wounds was calculated； the levels of vascular endothelial growth factor （VEGF）， interleukin-1β （IL-1β）， IL-6 and tumor necrosis factor-α（TNF-α） in the wound skin tissue of rats were detected by enzyme-linked immunosorbent assay； immunohistochemical method was used to detect the expression levels of VEGF and platelet endothelial cell adhesion molecule-1 （CD31） protein in burned skin tissue. RESULTS Compared with model group， the wound area of the rats in the Jingwanhong ointment and Zhixu burn ointment groups gradually decreased and healed significantly by day 21， and the wound healing rate was significantly higher （P＜0.05 or P＜0.01）； thicker new epidermal layer was seen in the skin tissue， and connective tissue and new blood vessels were significantly increased in the dermis； the expression levels of IL-1β， IL-6 and TNF-α were significantly decreased （P＜0.05 or P＜0.01）， and the expression levels of VEGF and CD31 protein were significantly increased （P＜0.05 or P＜0.01） in the burned skin tissue. CONCLUSIONS Zhixu burn ointment can repair the skin of deep second-degree burned model rats， and the mechanism may be related to reducing the inflammatory response of burn wound and promoting the angiogenesis.

Objective To investigate the clinical features and prognosis of antimyelin oligodendrocyte glycoprotein-IgG （MOG-IgG） associated disorders （MOGAD）.Methods Eight cases met the diagnostic criteria of MOGAD were reviewed，and the demographics，clinical manifestations，laboratory and imaging results，treatment and prognosis were analyzed. The Expanded Disability Status Scale （EDSS） and the modified Rankin Scale （mRS） were used to dynamically evaluate the neurological disability. Results The ratio of male to female in this 8-case series was 1∶1，the median onset age was 34 years old，and the median disease duration was 42 months. The most common initial symptom is optic neuritis （ON，50%），followed by meningitis and/or encephalitis （25%）. Recurrence occurs in 50% of cases，and the recurrence rate of patients with high serum MOG IgG titer （≥1∶32） is 60%. The white blood cells in the cerebrospinal fluid in cases with meningitis/encephalitis or longitudinally extensive myelitis is often>100×10-6/L，which is higher than other phenotypes. There are 6 cases （75%） of patients with different MRI abnormalities，including hypertensity on T-2/Flair image with enhancement at affected optic nerve and orbital tissue，asymptomatic diencephalon/thalamus lesions on T2 and contrasted image，and MRI findings mimic typical multiple sclerosis may also be present. Cases with myelitis can show short-segment eccentric lesions or long-segment central lesions on MRI. Cases with meningitis/encephalitis showed unilateral cortical high T-2/Flair lesions on cranial MRI with various enhancements. After medication and rehabilitation，the peak EDSS of this case series was 5±1.069，and 2.19±1.689 points at the last visit；mRS was 3.25±1.165 points at the peak and 1.25±1.035 points at the last visit. The difference was statistically significant.Conclusions MOGAD is a rare type of demyelinating disease in central nervous with various manifestations，which is highly treatable. Fully understanding of the clinical characteristics，making a early diagnosis through comprehensive tests，and initiating immunization and rehabilitation treatment in time，will contribute to better prognosis for patients.

Objective:To investigate the clinical features, treatment and prognosis of anti-γ-aminobutyric acid type B receptor (GABA B R) encephalitis. Methods:Retrospective analysis of five patients of anti-GABA BR encephalitis from the Department of Neurology, the University of Hong Kong-Shenzhen Hospital from September 2017 to June 2019 was carried out. Clinical manifestations, auxiliary examination, and treatment were analyzed. The patients were followed up for 3.5-23.0 months to assess their prognosis. Results:Five cases of anti-GABA BR encephalitis (19-81 years old) presented acute onset, with refractory epilepsy as the main clinical manifestation. There were hyperintensive signals on T 2/fluid attenuated inversion recovery in four patients′ temporal lobe and hippocampus. Electroencephalogram showed slow wave or epileptic discharge; Lung mass was found in four patients, and all were small cell lung cancer. Five cases had poor response to first-line immunotherapy (intravenous use of pulse methylprednisolone, high dose immunoglobulin or plasma exchange), then three patients received second-line immunotherapy (rituximab, cyclophosphamide), two of whom with tumor also received tumor chemotherapy. Patients who received second-line treatment and tumor chemotherapy showed better outcome than those who only received first-line treatment. Conclusions:Anti-GABA BR encephalitis present with limbic encephalitis syndromes characterized by refractory epilepsy. For patients with poor response to first-line immunotherapy, initiating second-line immunotherapy as soon as possible can improve the prognosis significantly.

Objective:To investigate the risk factors for 90 d death after endovascular mechanical thrombectomy (MT) in patients with acute anterior circulation large-artery occlusive stroke.Methods:From October 2015 to March 2018, patients with acute anterior circulation large-artery occlusive stroke treated with MT in People's Hospital of Shanghai Pudong New Area and the Second Affiliated Hospital of Soochow University were enrolled retrospectively. The primary outcome events were defined as death within 90 d after operation. Univariate and multivariate logistic regression models were used to identify the independent risk factors for death within 90 d after operation. Results:A total of 116 patients were enrolled, 23 (19.8%) of them died within 90 d after operation. Univariate analysis showed that there were significant differences in age, baseline National Institutes of Health Stroke Scale (NIHSS) score, the Alberta Stroke Program Early CT Score (ASPECTS), and the proportion of the baseline NIHSS score classification (≤8, 9-15, ≥16), ASPECTS ≤7, the number of attempts to pass >3 times, modified Thrombolysis in Cerebral Infarction (mTICI) blood flow grade 2b/3, hemorrhagic transformation (HT), and symptomatic HT in the death group compared with the survival group (all P<0.05). Multivariate analysis showed that after adjusting for age, fasting blood glucose, baseline NIHSS score, number of attempts to pass >3, and mTICI grade 2b/3, lower ASPECTS (odds ratio [ OR] 0.647, 95% confidence interval [ CI] 0.456-0.917; P=0.014), longer time from onset to vascular recanalization ( OR 1.004, 95% CI 1.000-1.007; P=0.046) and symptomatic HT ( OR 13.522, 95% CI 2.719-67.258; P=0.001) were the independent predictors of death within 90 d. Conclusion:The ASPECTS, time from onset to recanalization, and symptomatic HT were the independent risk factors for death within 90 d after MT in patients with acute anterior circulation large-artery occlusive stroke.

Objective To comparatively analyze the safety and efficacy of direct mechanical thrombectomy and bridging therapy for patients with acute anterior circulation large-artery occlusive stroke.Methods A total of 116 patients with acute anterior circulation large-artery occlusive stroke,admitted to our hospitals from October 2015 to March 2018,were chosen in our study;their clinical data were analyzed retrospectively.Among them,63 patients accepted direct mechanical thrombectomy and 53 accepted bridging therapy.The preoperative baseline data and the diagnoses and treatments of the two groups were analyzed;the degrees of modified thrombolysis in cerebral infarction (mTICI),incidences of hemorrhage transformation and symptomatic intracranial hemorrhage,and modified Rankin scale (mRS) scores and mortality rate 90 d after operation were compared between the two groups.Results The preoperative Alberta stroke program early CT scale (ASPECTS) and Glasgow Coma Scale (GCS) scores of the direct mechanical thrombectomy group were significantly lower than those of the bridge therapy group (P＜0.05),and the time from onset to admission was significantly longer than that of the bridging therapy group (P＜0.05).The incidence of postoperative hemorrhage transformation in the direct mechanical thrombectomy group was significantly higher than that in the bridging therapy group (34.9％ vs.17.0％,P＜0.05),but there were no significant differences in the effective recanalization rate (69.8％ vs.79.3％),intracranial symptomatic hemorrhage rate (15.9％ vs.7.6％),favorable outcome rate (28.6％ vs.35.9％) and mortality (22.2％ vs.17.0％) between the two groups (P＞0.05).Conclusion The clinical efficacy and safety of direct mechanical thrombectomy and bridging therapy for patients with acute anterior circulation large-artery occlusive stroke are similar.

Objective:To explore the influencing factors for intracranial hemorrhage (ICH) in patients with acute large vessel occlusion stroke (ALVOS) of anterior circulation after mechanical thrombectomy (MT).Methods:From October 2015 to March 2018, the clinical data of 116 patients with ALVOS of anterior circulation accepted MT were analyzed retrospectively in our hospitals. These patients were divided into ICH group ( n=31) and non-ICH group ( n=85) according to whether there was ICH after operation. Univariate and multivariate Logistic regression models were used to analyze the independent influencing factors for ICH after MT. Results:Univariate analysis showed that there were significant differences in preoperative Alberta Stroke Program Early CT (ASPECT) scores, baseline systolic pressure, and preoperative blood glucose level between ICH group and non-ICH group ( P<0.05). Multivariate analysis showed that after adjusting baseline Glasgow coma scale scores, preoperative ASPECT scores ( OR=0.770, 95%CI: 0.610-0.0.971, P=0.027), baseline systolic pressure ( OR=1.029, 95%CI: 1.005-1.054, P=0.017), preoperative blood glucose level ( OR=1.177, 95%CI: 1.010-1.372, P=0.036) were independent influencing factors for ICH. Conclusion:The patients with low preoperative ASPECT scores, high baseline systolic pressure, and high blood glucose are prone to have ICH after MT in patients with ALVOS of anterior circulation.

Objective To obtain a clear and qualified compound glycyrrhiza oral solution by using NaSO3 and EDTA as stabi-lizers and Tween80 as solubilizer so as to solve the problem of morphine content instability. Methods NaSO34g and EDTA 0.6 g as stabilizers,and Tween803 g as solubilizer were added in the traditional method. The pH of the solution was adjusted to 8.0. Then the solution was obtained and filled in the brown polyester bottle. Results The preparation was clear,qualified and the content of mor-phine was steady. Conclusion The improved method is feasible,simple,stabilized and suitable for manufacturing.

Objective To investigate the expression of neural-nitric oxide synthase (nNOS) in renal clear cell carcinoma and its clinical significance.Methods The expression of nNOS mRNA in 533 samples of TCGA database was analyzed with Student t test,and statistical analysis was performed to assess the relationship between nNOS expression and clinical prognosis with Kapla-Meier test.Western blot analysis of nNOS protein expression in 10 cases of clear cell renal cell carcinoma(ccRCC) from department of urology of Wuhan union hospital with student t test.Results The mRNA levels of nNOS in 72 cases of ccRCC in tumor tissues and adjacent tissues and were 2.99 ± 0.28 and-1.57 ± 0.17,it is significantly lower than those in adjacent tissues (P ＜ 0.01).The mRNA levels of nNOS in 533 cases of ccRCC,in tumor tissues and adjacent tissues and were 2.99 ± 0.28 and-1.76 ± 0.05,it is significantly lower than those in adjacent tissues (P ＜ 0.01).A total of 533 sample studies showed a low correlation between nNOS expression and clinical T stage,T1-1.59 ±0.08,T2-1.96 ±0.13,T3-1.90 ±0.09,T4-2.38 ±0.28 (P =0.0029) and -1.63 ±0.06 and-2.16 ± 0.13 between non-metastasis and no-metastasis (P =0.0009),and-1.57 ± 0.08 and-2.03 ± 0.11 between non-recurrence and recurrence (P =0.008).Survival analysis showed that the overall survival time were (40.3 ± 5.6) months and (48.3 ± 5.7) months in lower and higher nNOS expression,and disease free survival time were (37.1 ± 2.1) months and (40.3 ± 5.6) months in lower and higher nNOS expression,both with shorter time in low expression of nNOS (P ＜ 0.01).nNOS proteins were 1.02 ± 0.16 and 0.61 ± 0.1 1 in tumor tissues and adjacent tissues with significantly lower expression(P＜0.05).Conclusions The mRNA and protein of nNOS are lower in ccRCC with a poor prognosis of ccRCC.

[ ABSTRACT] AIM:To observe the effect of oleanolic acid ( OA) on the expression of Tumor necrosis factor-α( TNF-α) and collagen in silicotic rats in vivo and its possible mechanism.METHODS:Male Wistar rats were divided in-to 4 groups according to the randomized block design:control group, model group, OA group and solvent control group (20 rats in each group) .Except control group, the rats in other groups were induced by intratracheal instillation of silicon di-oxide (SiO2;250 mg/kg).The rats in OA group were intragastrically administered with OA (60 mg/kg) from the second day of giving SiO2 .The rats in solvent control group were gavaged daily with 0.6%sodium carboxymethyl cellulose solution (10 mL/kg).The rats in control group were given normal saline under the same condition for 56 consecutive days.All rats were killed at the 7th, 14th, 28th and 56th days.The lung coefficient was detected and the morphological changes were ob-served.The serum contents of TNF-αwere detected by ELISA.The content of total collagen in the lung tissue was meas-ured.The protein level of nuclear factor-κB ( NF-κB) in the lung tissue was determined by immunohistochemical method. RESULTS:(1) According to the morphological changes, the silicosis model was successfully established.Compared with control group, the lung coefficient and total collagen increased obviously in model group and solvent control group.The lung coefficient and total collagen content in OA group at each time point reduced compared with those in model group and sol-
vent group, and increased compared with those in control group at the corresponding time points.(2) The serum contents of TNF-αin model group and solvent control group significantly increased, peaking at the 14th day, slightly decreasing af-terward, and showing statistically significant difference at each time point compared with those in control group.No signifi-cant difference between model group and solvent group at different time points was observed.OA had inhibitory effect on the contents of TNF-αcompared with model group and solvent group at the corresponding time points.(3) NF-κB in model group and solvent control group significantly increased, peaking at the 28th day, and showing statistically significant differ-ence at each time point compared with those in control group.The NF-κB expression in OA group was similar to model group, but significantly decreased compared with control group at each time point.CONCLUSION: OA inhibits the ex-pression of TNF-αand collagen and attenuates the silicosis fibrosis, which may be related to the NF-κB pathway.

Objective To evaluate the efficacy and safety of pramipexole in treating restless legs syndrome (RLS).Methods A search for randomized,double-blind,and placebo-controlled clinical trials of pramipexole in treating moderate to severe RLS using CNKI,PubMed,Embase and Cochrane Library database was carried out. A meta-analysis of included clinical trials was performed with RevMan 5.0 software.The 2 outcomes that the weighted mean difference(WMD) of change from baseline in International RLS Study Group rating scale(IRLS) score and the relative risk (RR) of response based on the Clinical Global Impression-Improvement (CGI-I) scale score were calculated for efficacy.Safety was assessed with RR of the adverse event (AE).Results A total of 5 clinical trials were included in this meta-analysis,of which 1776 patients were randomly assigned (945 on pramipexole,831 on placebo).The records of patients were pooled.Overall WMD were - 6.34 ( Z =12.76,P ＜ 0.01 ) for the change from baseline in IRLS score,and RR of response based on CGI-I were 1.65 (Z =10.39,P ＜0.01).The overall RR of pramipexole versus placebo were 1.14 ( Z =1.87,P =0.06 ) for AE.Conclusion To treat RLS,pramipexole is an effective and safe drug.