Objective:To analyze the correlation between related indexes of serum lipid and insulin resistance and cognitive impairment in middle-aged and elderly people with mild cognitive impairment (MCI).Methods:In this cross-sectional study, 262 middle-aged and elderly patients with a Montreal Cognitive Function Scale (MoCA) cognitive score greater than or equal to 18 points who underwent physical examination in the Health Management Center of Beijing Tiantan Hospital Affiliated to Capital Medical University from January 1 to July 31, 2021 were selected as subjects. According to the cognitive function and MoCA score, the patients were divided into MCI group (143 cases) and normal cognition group (119 cases). Basic data, fasting blood glucose, triglyceride (TG), total cholesterol, apolipoprotein E(ApoE) genotype and other clinical indicators were collected. Hypothesis test was used to compare the differences in basic data, related indicators of blood lipid and insulin resistance between the two groups. Spearman correlation analysis was used to analyze the correlation between related indicators of blood lipid and insulin resistance and MoCA score in the two groups.Results:The age and the proportion of patients with hypertension, coronary heart disease and diabetes in the MCI group were all significantly higher than those in normal cognition group [(54.83±8.29) vs (50.76±6.34) years, 37.76% vs 31.93%, 4.20% vs 0.84%, 16.08% vs 8.40%] (all P<0.05). The elevation of serum TG ( r=-0.50, 95% CI:-0.88--0.12), TG glucose product index (TyG) ( r=-0.75, 95% CI:-1.29--0.20) and TG to high-density lipoprotein cholesterol ratio (TG/HDL-C) ( r=-0.52, 95% CI:-0.91--0.13) were all negatively correlated with MoCA score (all P<0.05). After adjusting for age and gender, the elevation of TG ( r=-0.39, 95% CI:-0.75--0.31) and TG/HDL-C ( r=-0.43, 95% CI:-0.80--0.05) were both still negatively correlated with MoCA score (both P<0.05). There was no significant correlation between all indexes and MoCA scores in the normal cognition group (all P>0.05). The elevated TG was negatively correlated with MoCA score in the MCI group ( r=-0.70, 95% CI:-1.23-0.16, P=0.017). There was no significant correlation between elevated TG and MoCA score in patients carrying ApoE ε2 and ApoE ε3 genotypes in MCI group (all P>0.05). Conclusion:Elevated related indexes of blood lipids and insulin resistance are negatively correlated with cognitive scores in middle-aged and elderly people with MCI, and it′s more obvious in patients with ApoE ε4 genotype.

Objective:To investigate the association of Subclinical Carotid AtheroSclerosis (SCAS) and prediabetes or Diabetes Mellitus (DM)in the healthy people.Methods:From September 2018 to June 2019, participants who underwent physical examination in the Health Management Center of Beijing Tiantan Hospitial were enrolled consecutively. The baseline characters were collected prospectively. Carotid Ultrasound was evaluated by radiologists according to the standard operating protocol. Univariable analysis and multivariable logistic analysis were used to estimate the association of prediabetes or DM with SCAS.Results:Totally 401 participants were eligible and enrolled. The mean age was (52.2±10.4) years and 43.7% (252/401) of them were females. The prevalence of DM and SCAS were 16.4% (66/401) and 48.9% (196/401) respectively. In the univariate analysis, elder age (≥60 years old) ( OR=5.93, 95% CI: 3.86-9.09, P<0.001), hypertension ( OR=2.76, 95% CI: 1.84-4.15, P<0.01), prediabetes( OR=1.67, 95% CI: 1.08-2.58, P<0.05) and DM ( OR=3.60, 95% CI: 1.97-6.58, P<0.01), cigarettes smoking ( OR=2.64, 95% CI: 1.82-3.81, P<0.001), lower HDLlevel<1.04 mmol/L ( OR=1.58, 95% CI: 1.04-2.42, P<0.001) and hyperhomocysteinemia (≥15 μmol/L)( OR=1.69, 95% CI: 1.17-4.04, P<0.01) were associated with higher prevalence of SCAS. On the contrary, female sex ( OR=0.53, 95% CI: 0.39-0.74, P<0.001) was associated with lower prevalence of SCAS. In the multivariable logistic analysis, elder age(≥60 years old) ( OR=6.04, 95% CI: 3.13-11.7, P<0.01), hypertension ( OR=2.14, 95% CI: 1.13-3.87, P<0.05), cigarettes smoking ( OR=2.19, 95% CI: 1.21-3.98, P<0.05) and DM ( OR=2.32, 95% CI: 1.16-4.67, P<0.05) were associated with SCAS independently. The association between prediabetes and SCAS was not statistically significant. Conclusions:DM is independently associated with SCAS in neurological healthy people, while prediabetes tended to increase the risk of SCAS.

Objective To explore the association between estimated glomerular filtration rate (eGFR) and prognosis of acute ischemic stroke (AIS) patients who were treated by intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA).Methods We consecutively screened AIS patients who were treated by intravenous thrombolysis with rt-PA from January 2006 to September 2016 in Tangshan Gongren Hospital.According to eGFR value of patients at admission,the eligible patients were divided into two groups:normal eGFR group (eGFR ≥ 90 ml ? min-1 ? 1.73 m-2) and decreased eGFR group (eGFR ＜ 90 ml? min-1 ? 1.73 m-2).The incidence of symptomatic intracerebral hemorrhage (SICH),early neurological deterioration (END) at 24 hours and seven days after thrombolysis,mortality within seven days and 90 days,and excellent recovery at 90 days were compared between the two groups.The OR with 95％ CI and the adjusted OR with 95％ CI were analyzed by univariate and multivariate Logistic regression models.Results A total of 258 patients were enrolled,including 182 cases in the normal eGFR group and 76 cases in the decreased eGFR group.After adjusting for the potential confounders,multivariate Logistic regression analysis showed that the rates of SICH (13.2％ (10/76) vs 3.3％ (6/182),OR =3.859,95％ CI 1.313-11.341),END at 24 hours (21.1％ (16/76) vs 8.2％ (15/182),OR =2.958,95％ CI 1.347-6.495) and seven days (32.9％ (25/76) vs 12.6％ (23/182),OR =3.129,95％ CI 1.555-6.293),mortality within seven days (22.4％ (17/76) vs 6.0％ (11/182),OR =4.079,95％ CI 1.588-10.477) and 90 days (23.7％ (18/76) vs 9.9％ (18/182),OR =2.457,95％ CI 1.050-5.749) were higher in the decreased eGFR group than in the normal eGFR group.On the other hand,the chance of excellent recovery at 90 days (22.4％ (17/76) vs 43.4％ (79/182),OR =0.435,95％ CI 0.229-0.824) was less in the decreased eGFR group than in the normal eGFR group.Conclusion Decreased eGFR may not only increase the risks of SICH,END and death,but also reduce the chance of 90-day excellent recovery in AIS patients after intravenous thrombolysis with rt-PA.

Objective To investigate the association between KRAS gene mutations and clinicopathological characteristics and prognosis of colorectal cancer (CRC) patients.Methods The retrospective casecontrol study was conducted.The clinicophathological data of 315 patients who underwent radical resection of CRC in the Yangpu Hospital Affiliated to Tongji University between January 2007 and July 2011 were collected.Nextgeneration sequencing was performed to identify KRAS gene mutations from surgical specimens.Observation indicators:(1) detection of KRAS gene;(2) association between KRAS gene mutations and clinicopathological characteristics of CRC patients;(3) follow-up and survival situations;(4) multivariate analysis of KRAS gene mutations in the prognosis of CRC patients.Follow-up using outpatient examination and telephone interview was performed to detect postoperative overall survival up to August 2016.Comparisons of count data were analyzed using the chi-square test.Measurement data with skewed distribution were described as M (interquartile range),and comparison between groups was analyzed using the nonparametric test.The survival rate was calculated using the Kaplan-Meier method,and survival was compared using the Log-rank test.The multivariate analysis was done using the COX regression model.Results (1) Detection of KRAS gene:all the 315 patients finished gene detection of surgical specimens,including 172 in wide-type mutations and 143 in mutant-type mutations (mutations at codon 12 and 13 of KRAS exon 2 and other mutant points were respectively detected in 80,24 and 40 patients,and 1 patient had simultaneous mutations at codon 12 and 13 of KRAS exon 2;missense and nonsense mutations were respectively detected in 141 and 2 patients).The major point mutations were at p.G12D and p.G13D.(2) Association between KRAS gene mutations and clinicophathological characteristics of CRC patients:tumors located in the proximal colon,distal colon and rectum were respectively detected in 34,48,90 patients with wild-type mutation and in 44,27,72 patients with mutant-type mutation,with a statistically significant difference (x2 =0.038,P＜0.05).(3) Follow-up and survival situation:315 patients were followed up for 3-115 months,with a median time of 78 months.The postoperative overall survival rate was 41.0％ in 172 patients with wild-type KRAS mutations,27.4％ in 80 patients with KRAS codon 12 mutations,26.3％ in 24 patients with KRAS codon 13 mutations and 48.2％ in 40 patients with other KRAS mutations,showing a statistically significant difference (x2=0.040,P＜0.05).(4) Multivariate analysis of KRAS gene mutations in the prognosis of CRC patients:the results of multivariate analysis showed that mutations at codon 12 of KRAS exon 2 was an independent factor affecting poor prognosis of CRC patients (Hazard ratio=1.543,95％ confidence interval:1.050-2.265,P＜0.05).Conclusions Most KRAS mutations of CRC patients are at codon 12 and 13 of KRAS exon 2,and the major point mutations are at p.G12D and p.G13D.KRAS gene mutations may be associated with tumor location.Mutations at codon 12 of KRAS exon 2 is an independent factor affecting poor prognosis of CRC patients.

Objective To investigate the influencing factors of in-hospital delay using alteplase for intravenous thrombolytic therapy in patients with acute ischemic stroke.Methods From January 2006 to May 2015,220 consecutive patients with acute ischemic stroke admitted to the Department of Neurology,Tangshan Gongren Hospital Affiliated to North China University of Science and Technology were enrolled retrospectively.They all received alteplase for intravenous thrombolytic therapy.Their mean National Institutes of Health Stroke Scale (NIHSS) score on admission was 16±8.According to door-to-needle time (DNT),they were divided into either a delay group (DNT >60 min;n=151) or a non-delay group (DNT ≤60 min;n=69).The baseline data,laboratory tests,onset-to-door (OTD) time,imaging,and etiology classification of trial of org 10172 in acute stroke treatment (TOAST) of both groups were recorded.Univariate analysis was performed on both groups,and further multivariate logistic analysis was performed.Results (1) The proportion of the past history of transient ischemic attack,blood glucose level on admission,time from onset to hospital in the non-delay group were significantly higher than those of the delay group.There were significant differences between the two groups (43.5%[30/69] vs.3.3%[5/151],7.9±3.0 mmol/L vs.6.9±2.1 mmol/L,95±53 min vs.80±34 min,all P<0.05).There were significant differences in the constituent ratio of TOAST classification between the two groups (P<0.05).There were no significant differences in other baseline data and clinical features between the two groups (all P>0.05).(2) Multivariate Logistic regression analysis showed that the risks of patients with the past history of transient ischemic attack (OR,0.330,95%CI 0.109-0.998,P=0.046),elevated blood glucose levels on admission (OR,0.775,95%CI 0.657-0.914,P=0.005),prolonged onset-to-door time (OR,0.648,95%CI 0.504-0.831,P=0.013),internal carotid artery lesions (OR,0.192,95%CI 0.038-0.960,P=0.044) for occurring in-hospital delay after thrombolysis were low.Systolic pressure on admission(OR,1.275,95%CI 1.091-1.491,P=0.027)and cardioembolism(OR,3.892,95%CI 1.661-9.112,P=0.006) for occurring in-hospital delay after thrombolysisin were high.Conclusion The patients with past history of transient ischemic attack,higher blood glucose,prolonged onset-to-door time,and having internal carotid artery lesions may be cause the attention of family members and doctors,and were less prone to having thrombolytic in-hospital delay,whereas those with higher systolic blood pressure on admission and cardioembolism were prone to having in-hospital delay.

BACKGROUND: Tendon injury is common in clinic, which is mainly treated by surgical anastomosis. Postoperative tendon healing is usually assessed through surgeons' experience due to high cost and application restrictions of MRI examination. Thus there is still a lack of a convenient and objective imaging support. With the advancement and widespread application of high-frequency ultrasound, the diagnosis rate of tendon injury has been improved remarkably; thereafter, high-frequency ultrasound used for assessing tendon injury and repair has become an issuehas become an issue of concern.OBJECTIVE: To clarify the ultrasonic imaging features of tendon repair through high-frequency ultrasound scancombined with histological examination.METHODS: This was a single-central, preoperative and self-controlled animal experiment and finished in the Central People'sHospital of Siping, China. 130 adult male Highbrow chickens were selected and were then randomized into 13 groups (n=10per group). One side of each chicken hind foot was randomly selected as experimental limb to undergo achillotomy followedby repair using the modified Kessler method (groups 2-13) or no treatment (group 1); the contralateral limb served as control.Moreover, passive flexion-extension functional training targeting the experimental limbs was performed in the groups 8-13beginning at the 1st day after surgical anastomosis, several times a day. The high-frequency ultrasound and hematoxylineosinstaining were conducted before and after chillotomy (group 1), and at 3 (groups 2 and 8), 7 (groups 3 and 9), 14 (groups4 and 10), 21 (groups 5 and 11), 35 (groups 6 and 12) and 42 (groups 7 and 13) days after surgical anastomosis, respectively.RESULTS AND CONCLUSION: The primary measurement outcomes were the repair and healing of the injured tendonas assessed by high-frequency ultrasound; the secondary outcomes were the pathological manifestations of the injuredtendon detected by hematoxylin-eosin staining. Our findings will provide preclinical proof for high-frequency ultrasounduse in the assessment of tendon injury, repair and healing as well as for the rehabilitation therapy that promotes functionrecovery in the future.

OBJECTIVETo investigate the association between receptor-interacting kinase protein 4 (RIPK4) relative copy number (RCN) and prognosis of stage III( colorectal cancer (CRC) patients treated with oxaliplatin-based chemotherapy.

METHODSRIPK4 RCN was determined by real-time PCR and then dichotomized into high RIPK4 RCN group(n=35) and low RIPK4 RCN group (n=104) using the third quartile as the cut-off point. Overall survival (OS) and recurrence-free survival (RFS) were compared between high and low RIPK4 RCN groups. The subgroup prognostic analysis was also conducted based on tumor site.

RESULTSThe median follow-up period was 49 months (ranged 4 to 98 months). Patients with high RIPK4 RCN had poorer OS than those with low RIPK4 RCN, which reached marginal significance(median OS, 43.0 months vs. 53.5 months, P=0.074). Meanwhile there was no significant difference of RFS between two groups (P=0.352). In colon cancer subgroup, high RIPK4 RCN was significantly associated with poor OS (median OS, 31.5 months vs. 56.6 months, P=0.015) but not with RFS (P=0.135). In rectal cancer subgroup, RIPK4 RCN was not associated with both OS and RFS (P=0.981, P=0.738). Multivariate analysis revealed that high RIPK4 RCN was an independent prognostic factor of OS in stage III( CRC patients treated with oxaliplatin-based chemotherapy (HR=2.903, 95% CI: 1.275 to 6.610).

CONCLUSIONRIPK4 RCN is significantly associated with OS in stage III( colon cancer patients receiving oxaliplatin-based chemotherapy and may be a novel biomarker that can predict the efficacy of oxaliplatin in colon cancer patients.

Objective To discuss the safety and operation effect of cesarean sectionof patients with early onset severe preeclampsia.Methods Clinical data were retrospectively analyzed,the treatment group made up of 236 patients with severe preeclampsia whose gestational age from 28 to 33 +6 weeks and the control group with 399 pregnancy women above 34 weeks.Main analytical items included:onset of gestational age,gestational age of termination of pregnancy,protensive of gestation,methods of termination of pregnancy,status of the occurrence of serious complications,fetal and neonatal mortality and the rate of neonatal asphyxia.Results The average conservative treatment time of treatment group was was significantly longer than that of control group [ ( 13.5 ± 1.2) d vs (9.6 ± 1.0 ) d,t =3.760,P ＜ 0.001].There was no significant difference on the cesarean section rate[70.8％ (167/236) vs 71.2％ (284/399),x2 =0.012,P =0.911 ] and neonatal mortality(2.5％vs 2.8 ％,x2 =0.026,P =0.871 ) between these two gourps.However there was significant difference on the rate of neonatal asphyxia(25.8％ vs 10.8％,x2 =20.792,P ＜ 0.001 ) and perinatal mortalit (22.0％ vs 6.9％,x2=27.782,P ＜ 0.001 ) between these two groups.Conclusion For the patients with severe early onset preeclampsia,to take conservative expectant treatment appropriately based on the safety of motherhood could avoid or reduce the possibility of the occurrence of serious complications,could extend the gestational age appropriately as well as reduce fetal and neonatal prevalence and mortality.Cesarean section is proper for the termination of pregnancy.

BACKGROUND:Foreign scholars have obtained a success to cure fracture by implanting the complex of red bone marrow and formation factor.Due to the in vitro culture process is not necessary,the complex of red bona marrow and scaffold formation factor is only required to be implant immediately,called uncellular tissue engineered bone.OBJECTIVE:This study innovatively constructs uncellular tissue engineered bone with autologous red bone marrow wrapped by fascial flap with pedicle,and validates the superiority of repairing bone defects.DESIGN,TIME AND SETTING:Homebody controlled animal experiment was performed in the Hebei North University and the Experiment Center of the Affiliated Hospital to Hebei North University from December 2007 to February 2009.MATERIALS:A total of 24 News Zealand albino rabbits,aged 4-5 months; uncellular tissue engineered bone was a mixture of autologous red bone marrow and osteoinductive absorbing materials containing bone morphogenetic proteins.METHODS:Bone defect models were induced on adult New Zealand rabbits' right radial bone,left side served as control group,only implanted with osteoinductive absorbing materials complex,while right side served as experiment group,which contained fascial flap with pedicle.A fascial flap prepared with capillary network containing nameless blood vessel pedicle was located to be adjacent to the bone defect using micro-surgical technique,to wrap the tissue engineered bone and to fill the bone defect.MAIN OUTCOME MEASURES:At 4,8,12,16 weeks postoperation,six rabbits were tested by radiograph,spectrodensitometry,gross morphology observation,histological inspection,quantitative analysis of bone morphometry in bone defect area and analysis of vessels image in the junctional zone.RESULTS:①X-ray determination:At 16 weeks,the implant surrounding bone defects formed bone shaft structure in the control group,cortical bone was not continuous and medullary cavity was obstructed; in the experiment group,normal bone shaft structure was formed and recanalization of medullary cavity was observed.②Histological observation:At 16 weeks,few vessels grew into implant in the control group,mature bone trabecular were observed,and medullary cavity was obstructed; in the experiment group,the implanting materials were completely degraded and substituted by new bone,mature bone structure formed and recanalization of medullary cavity was observed.③Quantitative analysis of bone morphometry in bone defect area:At 4,8,12,16 weeks postoperation,the volume of bone trabecula in the experiment group was more than that in control group (P ＜ 0.05).④Analysis of vessels image in the junctional zone:The area of vessels in the unit area in the experiment group was greater than that in control group in every time stage (P＜0.05).CONCLUSION:The uncellular tissue engineering complex constructed by autologous red bone marrow wrapped by fascial flap with pedicle shows double effects of hymeno-inducing regeneration of bone and the vascularization.It is feasible to repair large-segment bone defects.It has obvious therapeutic effect in the aspects such as reducing the bone defect reparation time and advancing the quantity and quality of the bone generation.

Objective To study the effect of fascial flap with vessels inducing the vascularization of uncel-lular tissue engingeering complex and the regenration of bone on the repair of bone defect, so as to provide the basis for the clinical application. Methods An animal model of bone defect on adult Newzland rabbits'right radial bone was established .and autologous red bone marrow were taken out and mixed into uncellulax tissue engineering comple-xes with OAM which contained BMP. The experiment animals were divided into two groups : experiment group and control group( n = 12 for each ). The control group was only implanted with complexes, meanwhile, the experiment group had fascial flap with vessels. By microsurgery technology,a non-named fascial flap with vessels was prepared, which belonged to capillary net,around the bone defect,and let it wrap tissue engineering complex,fill up bone de-fect. In a certian time, radiograph(X-ray) and light density measure was conducted, gross morphology and histological inspection was exmained. Bone shape measurement analysis and image of vessel analysis were conducted. All the sta-tistics were analyzed by the SPSS 11.5 software. Results Because of mechanically preventing fiber connective tis-sues and surrounding soft tissues from entering the areas of bone defect by fascial flap, it can keep bone defect having a relative stable environment ;The subfascial space itself, and also the shape and mass of filled-in subject had the de-cisive effect on the results of the regeneration of the bone; Owing to the establishment of blood supply during the con-structing tissue engineering complex. The experiment group was obviously superior to the control group. Compared with control group,the absor bance obviously increased in experiment group [(0. 732 ± 0. 021 ) vs (0. 651± 0.018)] (P < 0. 001 ) four weeks after the operation; also the bone trabecular body was significantly increased [(2.32±2.57)% vs(19.37±3.52)% ,(8.37±3.52)% vs(30.24±3.42)% ,(28.57±2.98)% vs(58.76± 4.62)% ,(47.24±3.42)% vs(88.72±5.84)%] ,and capillary area [(5.04±1.62)% vs(17.53±2.86)%, (10.37 ±2.96)% vs(35.24±1. 13)%,(18.20±2. 12)% vs(48.76±4. 62)%,(17.82 ±2. 74)% vs (57.72 ±5.84)%] (P <0.05) at each time period(4 weeks,8 weeks,12 weeks,and 16 weeks after operation). Despite of growth of implant's internal vessel, the number and speed of forming bone trabecula and cartilaginous tis-sue, even developing of mature bone structure, recreating of diaphysis structure, reconstructing of marrow cavity, ab-sorbing and decomposing of implant, the experiment group was obviously superior to the control group. Conclusions The induction of fascial flap with vessels shows double effects, one of which is the vascularization of uncellular tis-sue engineering complex and the other is membrane guided bone regeneration, So the method has a wonderful effect on the repair of bone defect.