Objective To investigate the effect of different doses of statins on the clinical efficacy and safety outcome of intravenous thrombolytic therapy of urokinase in patients with acute ischemic stroke (AIS). Methods Based on a large prospective, multicenter study, the Chinese Intravenous Thrombolysis Registry for AIS within 4.5 h of onset (INTRECIS) database, clinical data of 898 patients with urokinase intravenous thrombolysis for AIS were retrospectively analyzed. According to the amount of statin used during hospitalization, the patients were divided into 132 patients in no-statin group, 591 patients in conventional statin group and 175 patients in intensive statin group. Clinical outcome measures included 14-day improvement in the National Institutes of Health Stroke Scale (NIHSS) and 90-day excellent prognosis (improved Rankin score ≤1 point). Safety measures included recurrent stroke, bleeding events, and 90-day all-cause mortality. Results After adjusting for differences in baseline characteristics (age, coronary heart disease, diabetes, atrial fibrillation, systolic blood pressure, OTT, DNT, previous anti-plate use, blood glucose, and treatment in Class A hospitals), NIHSS scores improved at 14 days after admission and excellent prognosis at 90 days after admission in convention-dose and intensive statin groups were superior to those in no-statin group (P<0.05); Univariate and multivariate analysis of safety outcome indicators showed no statistically significant differences in stroke recurrence and bleeding events among the three groups (P>0.05); The 90-day all-cause mortality was significantly higher in no-statin group (10.6%) than in convention-dose statin group (2.0%) and intensive dose statin group (2.9%) (P<0.01). Conclusions In patients with AIS who were treated with intravenous urokinase thrombolytic therapy, intensive statin use was associated with improved 14-day NIHSS score and near-term prognosis without increasing the risk of stroke recurrence and bleeding events. Statin use is beneficial to reduce mortality.

Objective To report a case of synovial sarcoma of the liver and review the literature for improving the understanding of the disease. Methods The clinical data of a patient with liver synovial sarcoma admitted to the First Affiliated Hospital of Henan University were analyzed retrospectively. The imaging, pathological features, treatment and prognosis of this disease were summarized by searching the database (CNKI, Wanfang Data, PubMed, untill July 2022) and the literature results analyzed comprehensively. Results The patient was a 71-year-old female who was admitted to the hospital due to abdominal pain. Computed tomography (CT) scan showed a mass with mixed density in the right lobe and caudate lobe of the liver. The large cross section size was about 115 mm×87 mm and the mass showed continuous heterogeneous enhancement, being considered as malignant hepatic tumors with multiple metastasis of the liver and lung. Ultrasound-guided needle biopsy was performed, and microscopy showed the tumor cells were obvious atypical, and some were spindle-shaped. Immunohistochemistry showed that the patient was positive for vimentin (VIM), epithelial membrane antigen (EMA), methylation of histone at lysine 27 (H3K27Me3), and negative for pan cytokeratin (CK-pan) and S-100, and pathological diagnosis of synovial sarcoma was made. The patient did not undergo subsequent treatment and was lost to follow-up after discharge. A total of 12 cases of hepatic synovial sarcoma were reported after searching the database. The clinical manifestations were abdominal pain or distention. The lesions were mostly located in the right lobe of the liver, usually large, heterogeneous density, and heterogeneous enhancement on enhanced CT or magnetic resonance imaging (MRI). Spindle-shaped cells were found at histopathologic examination. Immunohistochemistry showed the patient was positive for VIM, EMA, H3K27Me, B-cell leukemia/lymphoma-2 (BCL-2) and transducer-like enhancer of split 1 (TLE1). SS18-SSX fusion gene or SS18 gene isolation were detected. Eleven patients received surgical treatment, 5 received adjuvant chemotherapy, and 4 had recurrence or metastasis during the follow-up period. Conclusions Synovial sarcoma of the liver is a rare malignant tumor of the liver. The clinical and imaging features are not specific. The diagnosis depends on pathology. At present, the main treatment is surgery, and comprehensive treatment such as adjuvant chemotherapy can be performed. The prognosis of the patient is poor.

Objective To investigate the clinical value of coronary computed tomography angiography (CCTA) based CT derived fractional flow reserve (CT-FFR) and ΔCT-FFR in improving the diagnostic efficiency for coronary abnormal hemodynamics in patients with severe calcification. Methods We retrospectively analyzed the clinical data of coronary artery disease (CAD) patients who underwent CCTA, CT-FFR, invasive coronary angiography (ICA) and FFR during hospitalization from January 2018 to June 2019 in Chinese PLA General Hospital. Severe calcification was defined as coronary artery calcium score (CACS) ≥100 on single vessel level. A total of 107 CAD patients with 149 coronary arteries were included in the present study. The enrolled coronary arteries were assigned to CACS≥100 group (n=56) and CACS<100 group (n=93). CT-FFR was performed on the deep FFR platform based on machine learning (ML) algorithms and ΔCT-FFR was defined as CT-FFR difference between proximal and distal to the coronary lesion. The correlation and consistency between CT-FFR and FFR values were analyzed by Pearson and Bland-Altman methods. We attempted to analyze the incremental value of ΔCT-FFR for coronary functional evaluation, especial for coronary arteries with severe calcification, regarding FFR≤0.8 as the diagnostic gold standard. Comparison of receiver operating characteristic curves (ROC) between different diagnostic methods was presented by Delong test. Results Pearson and Bland-Altman analyses showed appreciable correlation (CACS≥100 group, r=0.71, P<0.01; CACS<100 group, r=0.73, P<0.01) and consistency (CACS≥100 group, Mean=-0.01, P=0.25; CACS<100 group, Mean=0, P=0.96) between CT-FFR and FFR values in both groups. FFR (0.80±0.08 vs. 0.84±0.09, P=0.004) and CT-FFR (0.81±0.06 vs. 0.85±0.06, P<0.001) levels were significant lower in CACS≥100 group than those in CACS<100 group, while ΔCT-FFR (0.14±0.06 vs. 0.09±0.06, P<0.001) levels were significant higher in CACS≥100 group. Moreover, the diagnostic efficiency of CT-FFR in CACS≥100 group was inferior to that in CACS<100 group [AUC=0.792(95%CI 0.663-0.889) vs. AUC=0.929(95%CI 0.856-0.972), P=0.04], while it achieved significant improvement after ΔCT-FFR adjustment [AUC=0.876(95%CI 0.760-0.949) vs. AUC=0.792(95%CI 0.663-0.889), P=0.02] and was similar to that in CACS<100 group (P=0.37). Conclusion For coronary arteries with severe calcification, CT-FFR demonstrated significant incremental value in improving the diagnostic efficiency of coronary abnormal hemodynamics after ΔCT-FFR adjustment.

Objective To evaluate the clinical effect of total optic nerve canal decompression in the treatment of traumatic optic neuropathy (TON) without photoreceptor. Methods The clinical data of 67 patients with no photoreceptor TON admitted to Department of Neurosurgery of the Shanghai Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine from January 2015 to December 2021 were selected for retrospective analysis, in which 37 cases in observation group received total optic nerve canal decompression surgery and 30 cases in control group received non-total optic nerve canal decompression surgery. Both groups received high-dose glucocorticoid therapy and oral administration of methylcobalamin before surgery. The visual acuity changes and complications after admission and treatment were examined and recorded in both groups. The effective rate, unblinding rate and complications after treatment were compared between the two groups. Results There were no statistically significant differences between observation group and control group in terms of age, gender, time from injury to surgery, preoperative GCS score, operative time, and intraoperative bleeding volume (P>0.05). After treatment, the effective rate of observation group was 54.1% and the unblinding rate was 35.1%, while the effective rate of control group was 46.7% and the unblinding rate was 33.3%; there was no statistically significant difference between the effective rate and unblinding rate of the two groups (P>0.05). No serious complications such as cerebrospinal fluid leakage, epilepsy, and intracranial infection occurred in both groups after surgery. In observation group, the effective rate after treatment was significantly lower in those with optic nerve canal fractures than that in those without optic nerve canal fractures (P<0.05); the effective rate was significantly higher in patients with injury-to-operation time ≤7 d than that in patients with injury-to-operation time >7 d (P<0.05). Conclusion Total optic nerve canal decompression can improve the visual acuity of patients without photoreceptor TON and reduce the blinding rate, which is an effective surgical treatment method.

Objective To investigate the predictive value of new simplified insulin resistance (IR) assessment indexes in identifying subclinical left ventricular systolic function impairment in patients with type 2 diabetes mellitus (T2DM). Methods A total of 150 T2DM patients with preserved left ventricular ejection fraction (LVEF≥50%) who were admitted to Department of Endocrinology of the First Affiliated Hospital of Air Force Medical University from June 2021 to December 2021 were retrospectively analyzed. All patients underwent two-dimensional speckle tracking echocardiography to measure left ventricular global longitudinal strain (GLS). According to GLS value, the subjects were divided into the normal group (GLS≥18% group, n=80) and the impaired group (GLS<18% group, n=70). Some new simplified IR assessment indicators were calculated and compared between the two groups, including body mass index (BMI), TG/HDL‑C ratio, triglyceride-glucose (TyG) index, TyG‑BMI index, TyG‑WHR and metabolic score for IR (METS‑IR). Correlation between the GLS and the new simplified IR assessment indexes was analyzed. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficacy of different simplified IR assessment indexes, with the area under the curve (AUC) calculated. Furthermore, according to whether the subjects were complicated with hypertension, binary logistics regression analysis was performed to explore the independent correlation between the simplified IR assessment index and GLS <18%. Results Total 150 were included with aged (54.5±13.7) years with 96 (64.0%) men and 54 (36.0%) women. Compared with the GLS≥18% group, the TG/HDL‑C ratio, TyG index, TyG‑BMI, and METS‑IR of subjects in the GLS<18% group were significantly increased (P<0.05). Pearson correlation analysis showed that TG/HDL‑C ratio, TyG index, TyG‑BMI, TyG‑WHR, and METS‑IR were negatively correlated with GLS (P<0.05). ROC analysis showed that TyG index had a certain predictive value for the evaluation of GLS<18% (AUC=0.678, 95%CI 0.591-0.765, P<0.001). Stratification based on hypertension and further adjusting for confounding factors, TyG index remains significantly associated with GLS<18% (OR=3.249, 95%CI 1.045-10.103, P=0.042). Conclusions The novel simplified insulin resistance evaluation indexes are closely associated with left ventricular subclinical systolic dysfunction in T2DM patients with preserved ejection fraction. TyG index is an effective index to identify left ventricular subclinical dysfunction in these populations.

Objective To observe the effects of amyloid-β (Aβ) receptor PirB on mouse astrocyte proliferation and reactive astrogliosis in vitro. Methods Mouse primary astrocytes were cultured, and divided into control group, Aβ group, Aβ+0.2 μmol/L PEP group, Aβ+0.4 μmol/L PEP group, Aβ+Fluspirilene group, Aβ+GFP-LV group, and Aβ+mPirB-LV group. The mouse astrocytes were treated with soluble PirB extracellular peptide PEP or PirB inhibitor Fluspirilene, respectively, to inhibit endogenous PirB receptor, or overexpressed PirB gene via lentivirus transfection and then treated with Aβ_1-42 oligomers. The proliferation of astrocytes was observed by RTCA and EdU methods, and the mRNA expression levels of S-100 calcium-binding protein B (S-100β), Vimentin, Nestin and amyloid precursor protein (APP) associated with reactive astrogliosis of astrocytes were observed by real-time PCR, and the expression level of glial fibrillary acid protein (GFAP) was detected by Western-blotting. Results The results of RTCA monitoring showed that normalized cell index (NCI) values of each group decreased sharply after treatment, and then increased gradually and tended to be stable. The results of EdU staining showed that the proliferative activity of astrocytes was significantly enhanced in the Aβ group (P<0.05) compared with control group; Compared with Aβ group, cell proliferation activity in Aβ+0.2 μmol/L PEP group, Aβ+0.4 μmol/L PEP group and Aβ+Fluspirilene group were significantly decreased (P<0.01 or P<0.001). The results of real-time PCR showed that compared with control group, mRNA expressions of GFAP, S-100β, Vimentin, Nestin, APP and PirB in Aβ group were significantly increased (P<0.05); Compared with Aβ group, mRNA expressions of GFAP, S-100β, Vimentin, Nestin, APP and PirB in Aβ+0.4 μmol/L PEP group were significantly decreased (P<0.01); Compared with Aβ+GFP-LV group, mRNA expressions of GFAP, S-100β, Vimentin, Nestin, APP and PirB in Aβ+mPirB-LV group were significantly increased(P<0.05). The results of Western blotting showed that compared with control group, the expression of GFAP in Aβ group was significantly increased (P<0.05); Compared with Aβ group, the expression of GFAP in Aβ+0.4 μmol/L PEP group was significantly decreased (P<0.05). Conclusions PirB is an upstream molecule which could regulate astrocyte proliferation and reactive astrogliosis, and inhibiting PirB receptor in astrocytes may be a potential treatment for Alzheimer's disease.

Objective To summarize the epidemiological and clinical features of infectious diseases of the central nervous system (CNS) by a single-center analysis. Methods A retrospective analysis was conducted on the data of 1247 cases of CNS infectious diseases diagnosed and treated in the First Medical Center of PLA General Hospital from 2001 to 2020. Results The data for this group of CNS infectious diseases by disease type in descending order of number of cases were viruses 743(59.6%), Mycobacterium tuberculosis 249(20.0%), other bacteria 150(12.0%), fungi 68(5.5%), parasites 18(1.4%), Treponema pallidum 18(1.4%) and rickettsia 1(0.1%). The number of cases increased by 177 cases (33.1%) in the latter 10 years compared to the previous 10 years (P<0.05). No significant difference in seasonal distribution pattern of data between disease types (P>0.05). Male to female ratio is 1.87︰1, mostly under 60 years of age.Viruses are more likely to infect students, most often at university/college level and above, farmers are overrepresented among bacteria and Mycobacterium tuberculosis, and more infections of Treponema pallidum in workers. CNS infectious diseases are characterized by fever, headache and signs of meningeal irritation, with the adductor nerve being the more commonly involved cranial nerve. Matagenomic next-generation sequencing improves clinical diagnostic capabilities. The median hospital days for CNS infectious diseases are 18.00(11.00, 27.00) and median hospital costs are ¥29,500(¥16,000, ¥59,200). The mortality rate from CNS infectious diseases is 1.6%. Conclusions The incidence of CNS infectious diseases is increasing last ten years, with complex clinical presentation, severe symptoms and poor prognosis. Early and accurate diagnosis and standardized clinical treatment can significantly reduce the morbidity and mortality rate and ease the burden of disease.

Objective To investigate the effect and mechanism of pomalidomide (POM) on airway inflammation and mucus hypersecretion in rats with chronic obstructive pulmonary disease (COPD). Methods Thirty-six SD rats were randomly divided into control group, model group and POM group, with 12 in each group, half male and half female. The COPD model was established by smoke exposure combined with Klebsiella pneumoniae infection in model group and POM group. The rats in POM group were treated with POM (0.5 mg/kg, once a day for 1 week). The lung function, lung tissue pathology, the proportion of inflammatory cells in bronchoalveolar lavage fluid (BALF) and the levels of serum inflammatory factors tumor necrosis factor-α (TNF‑α), interleukin (IL)‑1β, IL-6 and IL‑13 were observed and detected in each group. AB-PAS staining and immunohistochemistry were used to analyze the proliferation of goblet cells and the secretion of mucin (MUC) 5AC and MUC5B in airway epithelium of rats. The expression levels of TNF‑α receptor 1 (TNFR1), IκB kinase (IKK), phosphorylated IKK (p-IKK) and P65 protein in lung tissue were detected by Western blotting. Results Compared with control group, model group showed significant decreased of tidal volume (TV), minute ventilation (MV), forced expiratory vital capacity (FVC), 0.1s forced expiratory volume (FEV0.1) and 0.3 s forced expiratory volume (FEV0.3) (P<0.05), increased of the mean linear intercept (MLI) of the alveoli (P<0.01), decreased of the mean alveolar number (MAN) (P<0.01), increased of the proportion of neutrophils and lymphocytes in BALF sediment (P<0.05), and decreased of the proportion of macrophages in BALF sediment (P<0.01);increased of the levels of serum inflammatory factors TNF-α, IL-1β, IL-13 and IL-6 (P<0.05), the proportion of goblet cells in airway epithelium (P<0.01), the secretion of MUC5AC and MUC5B in lung tissue (P<0.01), the content of TNFR1 and the ratio of p-IKK / IKK (P<0.01), the content of P65 in nucleus (P<0.01); and decreased of the content of P65 in cytoplasm (P<0.05). Compared with model group, after one week of POM treatment, POM group showed significant improved of the TV, MV, FVC, FEV0.1, FEV0.3, MLI and MAN of rats (P<0.05); decreased of the proportion of neutrophils and lymphocytes in BALF (P<0.05); increased of the proportion of macrophages (P<0.01); decreased of the levels of serum TNF-α, IL-1β, IL-6 and IL-13 (P<0.05), the proportion of goblet cells in airway (P<0.01), the secretion of MUC5AC and MUC5B (P<0.01), and the expression of TNFR1, P-IKK and P65 (nucleus) (P<0.05); and increased of the level of P65 (cytoplasm) (P<0.01). Conclusions POM can improve airway inflammation and mucus hypersecretion in COPD rats, which may be achieved by inhibiting TNF-α/NF-κB signaling pathway.

Helicobacter pylori (HP) infection is a Class Ⅰ carcinogen in gastric cancer, closely related to the occurrence of gastric cancer. Many studies have shown that HP eradication has a preventive effect on gastric cancer. However, 2.7%-6.1% of patients with early gastric cancer who have been eradicated after endoscopic submucosal dissection (ESD) can still develop metachronous gastric cancer (MGC), and the mechanism of its occurrence is still unclear. In this review, the atrophy of gastric mucosa and intestinal metaplasia cannot be completely reversed after HP eradication, the excessive proliferation of gastric mucosa epithelial cells, the accumulation of genetic abnormalities, the homeostasis imbalance of the epigenetic group, changes in immune microenvironment, the abnormality of stem cells in gastric mucosa, chromatin accessibility, and changes in chromosome remodeling were discussed in the mechanism of carcinogenesis caused by the above molecular changes after ESD and HP eradication in early gastric cancer.

Based on the background of a multidisciplinary treatment team and the increasing high-quality life aspirations of patients, the preservation of anal function for patients with low rectal cancer has undergone changes in recent years. With the optimization of neoadjuvant therapy, refinement of surgical techniques, and the deepening of the concept of anal preservation after surgery, the concept of anal preservation for low rectal cancer has gradually shifted from traditional simple surgery to comprehensive treatment, and anal preservation surgery tends to be more accurate preservation. The goal of comprehensive treatment is to preserve good anal function and reduce surgical damage. However, comprehensive treatment for anal preservation in low rectal cancer is still in its infancy, and there is no consensus on the strategy planning for anal preservation. Therefore, summarizing various preoperative, intraoperative, and postoperative treatment strategies for low rectal cancer is of great significance for the selection of anal preservation schemes for patients with low rectal cancer. This article focus on exploring the optimization of neoadjuvant therapy models, "watch and wait" plans, the development of anal preservation techniques, and postoperative and preservation strategies, aiming to review the current status of anal preservation strategy planning for low rectal cancer.