Early brain injury (EBI) is a series of pathophysiological changes occurring within 72 h after subarachnoid hemorrhage (SAH) and before cerebral vasospasm, which is a key factor affecting the outcome of SAH. The possible pathological mechanisms include cell metabolism, oxidative stress and immune inflammation, in which inflammatory response plays an important role. As the important immune cells in the central nervous system, microglia undergo M1/M2 polarization after brain injury. On the one hand, microglia secrete proinflammatory cytokines through Toll-like receptor 4 (TLR4), calcium sensing receptor (CaSR) and triggering receptor expressed on myoid cells 1 (TREM-1) mediated signaling pathways, which are involved in neuronal apoptosis, blood-brain barrier damage and brain edema after SAH. On the other hand, microglia play the anti-inflammatory and protective effects through the expression of neuroglobin and heme oxygenase 1. This article reviews the M1/M2 polarization process of microglia in EBI after SAH and its dual mechanisms of action.

Objective To investigate the efficacy and safety of percutanous transhepatic intrahepatic portosystemic shunt(PTIPS)for chronic portal vein occlusion and cavernous transformation with symptomatic portal hypertension.Methods The clinical and imaging data of 38 patients with chronic portal vein occlusion and cavernous transformation with symptomatic portal hypertension, who received PTIPS in our hospital from November 2009 to June 2016,were analyzed retrospectively.The differences of the portosystemic pressure gradient(PPG)measured before and after PTIPS procedure was analyzed by a paired samples t-test. All the patients were followed up and the curative effect and operation-correlated complications were observed.Results The PTIPS procedure was technically successful in 36 patients.The other two patients with unsuccessful PTIPS underwent medical treatment,and one of them died of recurrent variceal bleeding 25 months later. Effective portal decompression and free antegrade shunt flow were achieved in 36 patients with successful PTIPS.And the mean PPG was decreased from(25.2±2.9)to(13.2± 1.3) mmHg (1 mmHg=0.133 kPa) before and after PTIPS respectively and the difference was statistically significant(P<0.05).During the procedure,arterial hemorrhage occurred in two patients who subsequently underwent embolization. Biliary injury occurred in one case and percutanous transhepatic biliary drainage (PTBD)was then performed.The mean follow-up period of the 36 patients was(26.7±10.4)months(range from 3.0 to 74.0 months).Hepatic encephalopathy appeared in 4 cases,among which,3 patients recovered after receiving medical treatment, while 1 patient experienced Grade 3 hepatic encephalopathy and recovered after implanting a smaller cover-stent.Shunt dysfunction occurred in 10 cases,of which 8 cases recovered after shunt revision with stent implantation or ballon angioplasty, while 2 cases underwent anticoagulation by warfarin only. During follow-up period, 7 patients died of liver failure(n=4), hepatic cellular carcinoma(n=1), recurrent varicose vein bleeding(n=1), and renal failure(n=1). The other patients remained asymptomatic and shunt patency. Conclusions PTIPS is both safe and effective for the treatment of symptomatic portal hypertension caused by chronic portal vein occlusion and cavernous transformation.The technical success rate is high,and the short-term curative effect is satisfied.

Objective To investigate the technique,efficacy,and safety of percutaneous interventional treatments for biliary complications (BC) after liver transplantation (LT).Methods The clinical and imaging data of 127 patients with BC after LT,who received percutaneous interventional treatments in the Third Affiliated Hospital of Sun Yat-sen University from January 2006 to December 2015,were analyzed retrospectively.On the basis of the cholangiographic appearance,patients were classified into 5 groups:biliary leakage group (n =11),anastomotic biliary strictures group (n=28),hilar biliary strictures group (n =30),multifocal biliary strictures group (n =51),and bilomas group (n =7).The modality of interventional treatments was percutanous transhepatic biliary drainage (PTBD),PTBD combined with balloon dilation,PTBD combined with balloon dilation and stent implantation.The methods of biliary drainage included external drainage and external-internal drainage.All the patients were followed up after treatment.The curative effect and operation-correlated complications were observed.Results The first successful rate of PTBD was 97.6％ (124/ 127).The total curative rate,improvement rate and inefficacy rate of interventional treatments were 37.8％ (48/127),44.9％ (57/127) and 17.3％ (22/127) respectively.In biliary leakage group,all the patients were cured by percutaneous interventional treatments with the curative rate being 100％.In anastomotic biliary strictures group,the cure and improvement rates were 64.3％ (18/28) and 35.7％ (10/28) respectively.The efficacy rate was 100％ (28/28).In hilar biliary strictures group,the cure,improvement and inefficacy rates were 40％ (12/30),53.3％ (16/30) and 6.7％ (2/30) respectively.The efficacy rate was 93.3％ (28/30).In multifocal biliary strictures group,the cure,improvement and inefficacy rates were 13.7％ (7/51),54.9％ (28/51) and 31.4％ (16/51) respectively.The efficacy rate was 68.6％ (35/51).In bilomas group,3 cases (3/7) obtained improvement and treatment of 4 cases was inefficative.The efficacy was the best for the patients with bilary leakage,and it was the worst for the patient with bilomas (P＜0.001).The main operation-correlated complication was bile tract infection during drainage.The rates of bile tract infection were 32.4％ (34/105) and 81.8％ (18/22) in patients with external drainage and external-internal drainage,respectively.There was statistically significant difference between these two items (P＜ 0.001).Conclusion PTBD combined with balloon dilation and biliary stent implantation is a safe and effective therapeutic modality for BC after LT,which can improve patients' clinical symptoms,improve patients' quality of life.The patients with bilomas should be treated by retransplantation as soon as possible.The biliary external drainage can decrease the rate of biliary tract infection significantly.

Objective To study the feasibility and efficacy of percutaneous transhepatic intrahepatic portosystemic shunt (PTIPS) in patients with portal hypertension due to chronic portal vein occlusion after splenectomy.Methods 27 patients who had portal hypertension due to chronic portal vein occlusion after splenectomy underwent PTIPS between December 2010 and March 2015.These patients were enrolled in this retrospective study.The success rates,efficacy,and complications were evaluated.Significance in the differences in the portosystemic pressure gradient (PPG) as measured before and after PTIPS procedure was assessed.Results PTIPS was successfully carried out in 25 patients but failed in 2.No fatal procedural complications were observed.The mean PPG dropped from (22.3 ± 5.7) mmHg to (12.4 ± 3.1) mmHg after successful PTIPS (1 mmHg =0.133 kPa,P ＜0.05).The median follow-up in the 25 patients with successful PTIPS were 22 months and there were 3 (12.0％) deaths from liver failure due to severe cirrhosis,and 1 death (4.0％) from stroke during the follow-up period.Shunt dysfunction happened in 4 (16.0％) patients.The original symptoms reoccurred in 2 patients (8.0％) and the remaining patients were diagnosed by routine CT or US examination.Three patients recovered after shunt revision with stent implantation or balloon angioplasty,while one patient refused any further therapy except oral medication.This patient suffered from the first episode of rebleeding 36 months after PTIPS.Hepatic encephalopathy developed in 2 (8.0％) patients,1 patient recovered after medical treatment,while the other who developed Grade 3 hepatic encephalopathy recovered after implanting a smaller cover stent.The remaining patients were asymptomatic with patent shunts.Conclusion PTIPS was a feasible,safe,and efficacious treatment for portal hypertension due to chronic portal vein occlusion after splenectomy.

To investigate the effect of berberine on glycemia regulation in rats with diabetes and the related mechanisms.Diabetic-like rat model was successfully induced by intraperitoneal injection of streptozotocin in 50 out of 60 male SD rats, which were then randomly divided into 5 groups with 10 rats in each:control group (received vehicle only), positive drug control group (sitagliptin 10 mg·kg·d), low-dose berberine group (30 mg·kg·d), moderate-dose berberine group (60 mg·kg·d), and high-dose berberine group (120 mg·kg·d). All animals were fed for 3 d, and fasting blood sampling was performed on day 3 of administration. Rats were given glucose (2 g/kg) by gavage 30 min after the last dose. Blood and intestinal samples were obtained 2 h after glucose loading. Fasting blood glucose (FBG) and 2-h postprandial plasma glucose (2h-PPG) were detected by using biochemical analyzer, and insulin, glucagon-like peptide-1 (GLP-1) and dipeptidyl peptidase-Ⅳ(DPP-Ⅳ) were measured by using ELISA kit.No significant difference in FBG and serum DPP-Ⅳ level were found between berberine groups and control group (all>0.05). Compared with control group, serum levels of GLP-1 and insulin were increased in high-and moderate-dose berberine groups, while 2h-PPG was decreased (all<0.05); GLP-1 levels in the intestinal samples were increased, while DPP-Ⅳ levels were decreased in all berberine groups (all<0.05).Short-term berberine administration can decrease 2h-PPG level in streptozotocin-induced diabetic rat model through local inhibition of intestinal DPP-Ⅳ. The efficacy of DPP-Ⅳ inhibitor may be associated with its intestinal pharmacokinetics.
Animals ; Berberine ; pharmacokinetics ; pharmacology ; Blood Glucose ; drug effects ; Diabetes Mellitus, Experimental ; chemically induced ; drug therapy ; Dipeptidyl Peptidase 4 ; analysis ; drug effects ; pharmacokinetics ; Dipeptidyl-Peptidase IV Inhibitors ; Dose-Response Relationship, Drug ; Glucagon-Like Peptide 1 ; analysis ; blood ; Hypoglycemic Agents ; Insulin ; blood ; Intestines ; chemistry ; drug effects ; Male ; Rats ; Rats, Sprague-Dawley ; Sitagliptin Phosphate

Objective: To investigate the effect of berberine on glycemia regulation in rats with diabetes and the related mechanisms .Methods: Diabetic-like rat model was successfully induced by intraperitoneal injection of streptozotocin in 50 out of 60 male SD rats, which were then randomly divided into 5 groups with 10 rats in each:control group (received vehicle only), positive drug control group (sitagliptin 10 mg· kg-1 · d-1 ) , low-dose berberine group ( 30 mg · kg-1 · d-1 ) , moderate-dose berberine group (60 mg· kg-1· d-1), and high-dose berberine group (120 mg· kg-1· d-1).All animals were fed for 3 d, and fasting blood sampling was performed on day 3 of administration .Rats were given glucose (2 g/kg) by gavage 30 min after the last dose . Blood and intestinal samples were obtained 2 h after glucose loading .Fasting blood glucose ( FBG) and 2-h postprandial plasma glucose (2h-PPG) were detected by using biochemical analyzer , and insulin , glucagon-like peptide-1 ( GLP-1 ) and dipeptidyl peptidase-Ⅳ( DPP-Ⅳ) were measured by using ELISA kit .Results: No significant difference in FBG and serum DPP-Ⅳ level were found between berberine groups and control group ( all P>0.05 ) .Compared with control group , serum levels of GLP-1 and insulin were increased in high-and moderate-dose berberine groups , while 2 h-PPG was decreased ( all P<0.05 );GLP-1 levels in the intestinal samples were increased , while DPP-Ⅳlevels were decreased in all berberine groups ( all P<0.05 ) .Conclusions:Short-term berberine administration can decrease 2h-PPG level in streptozotocin-induced diabetic rat model through local inhibition of intestinal DPP-Ⅳ.The efficacy of DPP-Ⅳinhibitor may be associated with its intestinal pharmacokinetics .

Objective To investigate the clinical effect of percutaneous transluminal angiography in diabetic infrapopliteal arterial disease patients and the influence of post-procedural intraluminal small dose urokinase infusion on infrapopliteal arterial blood flow.Methods From January 2011 to September 2013,37 limbs (16 left and 21 right) in 28 diabetic patients inflicted with infrapopliteal critical limb ischemia underwent endovascular recannalization at our institution and were retrospectively analyzed.Stenotic or occlusive lesions were demonstrated in 74 infrapopliteal vessels,including 30 anterior tibial arteries (ATA),22 posterior tibial arteries (PTA),and 22 peroneal arteries (PA).In 30 limbs,tandem lesions in iliac-femoral arteries were also diagnosed.Antegrade ipsilateral femoral access,retrograde contralateral femoral or brachial arterial access had all been adopted as well as both angioplasty and stenting.Case specific decisions were made based on pre-procedural computed tomographic angiogram (CTA).Ankle-brachial index (ABI) was recorded before and after each procedure.Urokinase was continuously infused through arterial sheath catheter into vessels of target limb from a microinfusion pump at 200 000 to 300 000 units per 24 hour for 48 hours after procedure.Angiogram was performed before and after thrombolysis therapy aiming to ascertain the number of frames of images obtained during the period of time it took blood flow to carry contrast medium from the level of tibial plateau to ankle,which was recorded as index frame count (IFC).Patients were followed up for at least 3 months.ABI and ultrasound or CTA were performed on each follow-up visit to validate patency.Quantitative data such as ABI value and IFC were analyzed using paired samples t-test.Results Thirty two limbs were radiographically recanalized by angioplasty or stenting.Technical success rate was 86.4％ (32/37).Average ABI of all limbs increased significantly from 0.70±0.31 to 0.90± 0.21 (t=10.734,P＜0.05).Of the 32 limbs recanalized,IFC decreased significantly from 6.3 ± 1.6 before thrombolysis to 4.7± 1.4 after thrombolysis (t=12.136,P＜0.05).Six rest pain patients reported significantly alleviated symptoms.Fourteen limbs presented with feet ulcers or gangrene.Of these patients after endovascular treatment,1 underwent ankle level amputation,3 underwent toe amputation and 3 patients who did not seek further treatment reported spontaneous autoamputation and wound healing.The remaining 9 patients reported wound healing within 1 to 3 months.Secondary angioplasty was needed for symptom recurrence in 3 limbs of 3 patients 3 to 24 months after first procedure.Conclusions Endovascular treatment of diabetic infrapopliteal arterial diseases exhibited significant short term effect and was safe to perform.Small dose urokinase infusion after recanalization procedure was safe and effective in helping to improve infragenicular blood flow.

OBJECTIVE: To investigate the feasibility and clinical characteristics of small partial laryngectomy without tracheotomy for T1-2 stage glottic carcinoma. METHOD: Forty-five patients with laryngeal squamaous cell carcinoma in T1-2 stage received small partial laryngectomy without tracheotomy. RESULT: All patients were primarily healed and were hospitalized for an average of 11.5 days post-operatively. In all patients, the function of respiration and the reflection of cough were normal, and laryngeal obstruction did not happen. The only postoperative complication was subcutaneous emphysema noted in 29 patients. Among them, subcutaneous emphysema extincted after 4-6 days in 26 patiens, only 3 patiens suffered from delayed healing because the subcutaneous emphysema extincted after 2 weeks. Mild subcutaneous emphysema did not affect the function of respiration and deglutition, healing of wound, and psychology of patients. All patients had been followed-up for 1-13 years. Only 2 patients died of tumor recurrence or metastasis. The function of respiration and deglutition were normal in the living patients, and no implanting metastasis on surface of trachea were found. CONCLUSION The theoretical foundation of small partial laryngectomy without tracheotomy for T1-2 stage glottic carcinoma has been well established. This surgical technique is feasible, safe and effective. It can significantly improve clinical outcome of T1-2 stage glottic carcinoma with minimal invasiveness. Furthermore, it can obviously abate the surgical, physiological and psychological trauma on patients.
Adult ; Aged ; Aged, 80 and over ; Glottis ; Humans ; Laryngeal Neoplasms ; surgery ; Laryngectomy ; methods ; Male ; Middle Aged ; Tracheotomy

Objective To study the clinical significance and diagnostic value of anti-proliferating cell nuclear antigen (PCNA) antibodies.Methods A retrospective analysis was conducted for the diagnoses and clinical features of 102 patients with anti-PCNA antibodies.Line immunoassay was used to detect anti-PCNA antibody of 536 systemic lupus erythematosus (SLE) patients.Possible relationship between anti-PCNA anti-body and clinical features and other antibodies in SLE were analyzed.Comparisons between groups were performed by t-test or x2 test.Results In the 102 patients with anti-PCNA antibodies,49 had SLE (48.0％).Other disorders associated with anti-PCNA antibodies included primary Sj(o)gren's syndrome(24.5％),systemic sclerosis (12.7％),primary biliary cirrhosis (3.9％),auto-immune thyroiditis (6.9％),polymyositis/dermatomyositis (2.0％) and hepatitis C virus infection (1.0％).9.1％ of SLE patients showed positive anti-PCNA antibody.Compared with those SLE patients with negative anti-PCNA antibody,the occurrences of rash,neuropsychiatric SLE,renal involvement was significantly higher in the anti-PCNA positive patients.In addition,the SLEDAI score was significantly higher in the latter.The positive rates of anti-Rib-P,anti-dsDNA,anti-Ro52,anti-RNP/Sm were higher in patients of SLE with positive anti-PCNA antibody.Conclusion Sera anti-PCNA antibody is not specific for SLE and it is associated with the occurrences of rash,Raynaud's phenomenon,neuropsychiatric SLE,renal involvement and positive rates of anti-Rib-P,anti-dsDNA,antiRo52,anti-RNP/Sm.In addition,anti-PCNA antibody is associa-ted with the disease activity of SLE.

OBJECTIVE: To synthesize 3, 5, 4' -trimethoxystilbene (TMS) by methylation of resveratrol (Res), a natural compound extracted from polygonum cuspidatum, to identify the chemical structure of TMS, to test its pharmacokinetics, and to determine the effects of TMS on the growth inhibition and apoptosis in pulmonary artery smooth muscle cells (PASMCs). METHODS: The chemical structure of TMS was analyzed by UV- and IR- absorption spectrometry, (1)H-NMR and (13)C-NMR spectroscopy and mass spectrometry. We measured the bioavailability, the characteristics of intestinal absorption, and the distribution of TMS in body and excretions of SD rats after oral administration of TMS. The acute toxicity of TMS in mice was tested. PASMCs were prepared from pulmonary artery of SD rats. The PASMCs were divided into 8 groups. Group of A (control) was cultured without TNF-α, TMS, or Res. Group of B (TNF-α) was cultured with 100 pg/mL TNF-α. Groups of C-E (low-high concentrations of TMS) were cultured with 100 pg/mL TNF-α and 5, 10, 20 μmol/L TMS, respectively. Groups of F-H (low-high concentrations of Res) were cultured with 100 pg/mL TNF-α and 50, 100, 200 μmol/L Res, respectively. The proliferation of PASMCs after treatment was determined by MTT assay. The apoptosis of PASMCs after treatment was determined by flow cytometry. RESULTS: The UV absorption map of TMS showed λmax(MeOH) at 318, 306.2, and 217.8 nm. Analysis of infrared spectrum of TMS showed IRvKBr max /cm at 2999, 2935, 2836, 1591, 1511 and 1456/cm. The (1)H-NMR map showed that the synthetic product contained three hydroxy groups, while (13)C-NMR map showed 17 carbon signals and some symmetrical structural fragments. Electospray ionization mass spectrometry of the productshowed m/z peaks corresponded to 271[M+H](+), 256[M+H-CH(3)](+) and 241[256-CH(3)](+); the implied relative molecular weight is 270 and the implied molecular formula is C17H18O3. These data confirm the product is 3,5,4' - trimethoxystilbene. The absolute bioavailability of TMS was 45.4%. TMS was well absorped in the upper small intestine; it was excreted in stool and bile and distributed into several tissues. The maximal tolerance dose (MTD) of TMS was 5.85 g/kg. MTT assay showed TMS inhibited the proliferation of PASMCs in a dose-dependent manner. The extent of growth inhibition in A-H groups were (4.07±2.12)%, (6.54±4.78)%, (9.35±4.26)%, (16.75±5.34)%, (23.74±7.07)%, (6.78±5.58) %, (8.81±5.16) %, and (17.81±6.03) %, respectively. Flow cytometry showed the extent of apoptosis in PASMCs (after being treated with TMS for 24 h) was significantly higher than that in PASMCs treated only with TNF-α. The apoptosis rates of A-H groups were (2.63±0.74)%, (3.54±0.81)%, (5.77±4.62)%, (11.68±5.35)%, (18.79±4.15)%, (4.11±3.59)%, (6.33±4.8) %, and (12.47±5.06)%, respectively. CONCLUSION We have confirmed our synthetic product as 3,5,4'-trimethoxystilbene (TMS), with the molecular formula of C17H18O3 and appropriate molecular weight and absorbption and NMR spectra. The bioavailability of TMS was to 45%. It strongly inhibits the proliferation of PASMCs in a dose-dependent manner and induces apoptosis of PASMCs.
Animals ; Anti-Inflammatory Agents ; pharmacology ; Apoptosis ; drug effects ; Cell Proliferation ; Cells, Cultured ; Male ; Myocytes, Smooth Muscle ; cytology ; drug effects ; metabolism ; Pulmonary Artery ; cytology ; drug effects ; metabolism ; Rats ; Rats, Sprague-Dawley ; Resveratrol ; Stilbenes ; chemical synthesis ; chemistry ; isolation & purification ; pharmacokinetics ; pharmacology