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Interleukin 17A (IL-17A), vascular endothelial growth factor A (VEGF-A) and tumour necrosis factor alpha (TNF-α) are important cytokines detected mostly within two weeks after stroke in previous clinical studies. Longer clinical studies investigating these cytokines are lacking. We aimed to explore the roles of these cytokines in patients within 35 days after cerebral infarction.Thirty patients with cerebral infarction and 30 healthy individuals were enrolled. Venous blood was collected from each patient at specific times and from each healthy individual only once. Coma and neurological functional deficits of the patients were evaluated by the Glasgow Coma Scale (GCS) and the National Institutes of Health Stroke Scale (NIHSS), respectively. Three cytokines were measured. The correlations among the three cytokines and between each cytokine and the GCS/NIHSS scores were analysed.IL-17A and TNF-α began to increase on day 1 after cerebral infarction, peaked on day 4, then decreased, and increased again on day 18. IL-17A returned to normal on day 35, but TNF-α remained higher than normal on day 35. VEGF-A began to increase on day 1, peaked on day 7, and returned to normal on day 35. From days 18 to 35, IL-17A was positively correlated with the GCS scores, and both IL-17A and VEGF-A were negatively correlated with the NIHSS scores.After cerebral infarction, VEGF-A from the acute phase and IL-17A from the early stage of recovery may be important for nerve protection and repair; TNF-α plays a complex role within 35 days.

BackgroundAdenocarcinoma of the ampulla of Vater (AAV) is standardly treated using a complex operation, a pancreatoduodenectomy (PD), to remove the tumor. However, dicision-making in AAV clinical treatment remains difficult due to the broad range of AAV types, outcomes, and responses to special chemotherapeutics. Thus, this study aimed to explore clinicopathological prognostic factors associated with overall survival, as well as post-chemotherapeutic effects related to curative resection of AAV.MethodsWe retrospectively reviewed data for clinicopathological outcome of 47 patients diagnosed with AAV that had underwent a PD. Overall survival probabilities were obtained using the Kaplan–Meier estimate method and a Cox proportional hazards model.ResultsForty-five patients underwent LPD (laparoscopic pancreatoduodenectomy) and two patients underwent PD. The patient group was composed of 31 males (66%) and 16 females (34%) with a mean age of 65(34–91)years. We selected 45 patients for long-term survival analysis. One- and three-year overall survival rates after resection were 97.6% and 58.9% respectively. The median survival was 37.7 months for the intestinal-type and 26.9 months in pancreatobiliary-type ampullary tumors. Serum carbohydrate antigen (CA) 19-9 greater than 37 U/ml (HR 0.140, P = 0.007), perineural invasion (HR 0.141, P = 0.003), and classification as pancreatobiliary-type (HR 6.633, P = 0.006) were independently associated with poor survival. Serum carcinoembryonic antigen (CEA) greater than 5 µg/ml (P = 0.031), serum CA 19-9 greater than 37 U/ml (P = 0.002), tumor sizes greater than 2.5cm (P=0.002), and positive perineural invasion (P=0.003) were all associated with a poor prognosis in the histopathological subgroup. Serum CA 19-9 greater than 37 U/ml (P=0.002) and positive perineural invasion (P=0.001) were significantly associated with poor survival in of patients with intestinal-type ampullary tumors. Serum CEA greater than 5 µg/ml (P=0.013) and tumor sizes greater than 2.5cm (P=0.002) were significantly associated with poor survival in patients with pancreatobiliary-type ampullary tumors.ConclusionsPancreatobiliary-type ampullary tumors were associated with poor survival. Serum CA 19-9 in the intestinal-type and CEA in the pancreatobiliary-type were significantly associated with poor survival. Ajuvant chemotherapy could not predict the survival of AAV patients.

Chao Lu,1– 3 Weiwei Jin,1,2 Yiping Mou,1,2 Hongliang Shao,4 Xiaosan Wu,4 Shaodong Li,5 Biwu Xu,4 Yuanyu Wang,1,2 Qicong Zhu,1,2 Tao Xia,1,2 Yucheng Zhou1– 3 1Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang Province, People’s Republic of China; 2Key Laboratory of Gastroenterology of Zhejiang Province, Hangzhou, Zhejiang Province, People’s Republic of China; 3School of Medicine, Soochow University, Suzhou, Jiangsu Province, People’s Republic of China; 4School of Medicine, Bengbu Medical College, Bengbu, Anhui Province, People’s Republic of China; 5School of Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, People’s Republic of ChinaCorrespondence: Yucheng Zhou; Yiping MouDepartment of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang Province, People’s Republic of ChinaEmail drzhouyc@163.com; yipingmou@126.comBackground: Gastrointestinal stromal tumors (GIST) of the duodenum are rarely reported and optimal minimally invasive management has not been well proposed. Pancreaticoduodenectomy and different types of pancreas-sparing duodenectomy can be chosen; however, which to choose and its corresponding clinical outcomes and oncological concerns remain controversial.Patients and Methods: Patients diagnosed with GIST of duodenum underwent laparoscopic pancreaticoduodenectomy (L-PD) or pancreas-sparing duodenectomy (L-PSD) in Zhejiang Provincial People’s Hospital were enrolled. All prospectively maintained data were analyzed retrospectively. Patients were grouped into the L-PD group or the L-PSD group, and the clinical outcomes and oncological outcomes were analyzed.Results: Between June 2013 and March 2019, a total of 22 patients (11 males/11 females) underwent surgical management, including 13 L-PDs and 9 L-PSDs. The average age was 58.2± 9.5 year-old (median 60.5 year-old). The most common presentations were GI bleeding (54.5%) and abdominal discomfort (27.2%), and the dominant lesion located in the second portion of duodenum (59.1%). Compared with L-PD group, L-PSD group showed much shorter operation time (364.2± 58.7min vs. 230.0± 12.3min, P< 0.001), less blood loss (176.9± 85.7mL vs. 61.1± 18.2min, P< 0.001), faster recovery to off-bed (2.6± 1.3d vs. 1.1± 0.3d, P=0.003), anus flatus (4.5± 1.0d vs. 2.4± 0.5d, P< 0.001) and liquid intake (4.9± 1.3d vs. 2.3± 0.5d, P< 0.001). Lymph node retrieval was much less in L-PSD, but no lymph node metastasis was observed in any patients. L-PSD had much Lower morbidity of both minor (Grade I/II) and major (III/IV/V) complications than that of L-PD (11.1% vs. 61.6%, P=0.02), resulting in shorter hospital stays (10.9± 3.8d vs. 20.6± 11.1d, P=0.021) and less total cost (76,972.4± 11,614.8yuan vs 125,628.7± 46,356.8yuan, P=0.006). The median follow-up was 42 months (range from 12 to 82months) without loss. Only 1 L-PD patient suffered hepatic metastasis 36months after surgery, and given sunitinib to stabilize the disease, none of the rest observed recurrence or metastasis.Conclusion: For GIST located opposite the major papilla, L-PSD showed comparable safety and oncological benefits when compared to L-PD, with shorter operation time, less blood loss and much faster recovery time, resulting in much less total cost. L-PSD should be applied in selected patients with experienced hands.Keywords: GIST, duodenum, pancreaticoduodenectomy, pancreas-sparing duodenectomy

Whether minimally invasive total knee arthroplasty (MIS-TKA) could offer better and faster recovery without the deviation of post-operative prosthesis position and limb alignment is still controversial. This prospective and randomized study was conducted to compare the clinical and radiological outcomes between patients who underwent the mini-subvastus approach of MIS-TKA and those who underwent the medial parapatellar approach of traditional TKA.Fifty patients, including 50 knees, who required TKA due to osteoarthritis were randomized to the mini-subvastus group (group I) or the medial parapatellar group (group II). All patients accepted the same method of anaesthesia, equal support therapy and identical rehabilitation exercise after surgery. The evaluation system included operation time, tourniquet time, blood loss, skin incision length in flexion, straight leg raising time, the time of lower limb muscle strength up to grade 4, the time of walking with aid or without aid, the time of walking up and down the stairs, the active flexion angle, range of movement (ROM), the Knee Society Scores (KSS), visual analogue score for pain (VAS), hospital stays and radiographic outcomes.The mini-subvastus approach offered smaller skin incision length in flexion, but at the cost of operation time (P 0.001). No significant difference was found in tourniquet time and blood loss. The patients in group I could achieve straight leg raising, the lower limb muscle strength up to grade 4, walking with or without aid, and walking up and down the stairs earlier (P 0.001). The active flexion angle, ROM, VAS and KSS in group I were superior to those in group II until six months post-operatively (P 0.001), but the differences was not apparent at 12 months post-operatively. More importantly, there was no significant difference between the two groups on radiological outcomes (P 0.05).The mini-subvastus approach could offer faster recovery, less pain and shorter hospital stays without compromising the principles of proper prosthesis position and limb alignment compared with the medial parapatellar approach.

Cerebral ischemia is caused by various disorders, such as stroke, myocardial infarction, or peripheral vascular disease. The purpose of this paper was to investigate the effects of glycyrrhizic acid (GA) on cerebral ischemia/reperfusion (I/R) injury. Middle cerebral artery occlusion was established to evaluate the effects of GA on cerebral ischemia. In this study, our results showed that GA could dramatically decrease cerebral edema, reduce the neurological deficits, and smaller brain infarct volume was found in the GA treatment group. In serum and brain tissue, GA also increased superoxide dismutase activity. In addition, in serum and brain tissue, GA also dramatically inhibited the secretion of inflammatory cytokines, including interleukin-1β (IL-1β), IL-6, and tumor necrosis factor-α. Moreover, GA inhibited the expressions of high-mobility group protein box-1 (HMGB1)-mediated TLR4/NF-κB pathway. Our data determined that GA may provide protective effect on the I/R-induced cerebral ischemia disease.

OBJECTIVE To investigate the relationship of microRNA 616 (has-miR-616) single nucleotide polymorphisms (SNPs) and its target gene paraoxonase 1 (PON 1) with the prognosis of patients with premature coronary artery disease (pCAD). METHODS 266 pCAD cases in the case group and 300 cases in the control group were collected. Using the polymorphism method of polymerase chain reaction and restriction fragment length, the has-miR-616 rs3735590 genotypes of target gene PON 1 were detected. RESULTS In the changes of rs3735590 C/T SNPs, compared with CC genotypes, the risk of coronary heart disease of the individuals carrying CT and TT genotypes were reduced by 42% and 31%, respectively (p < 0.05). The risk of developing coronary heart disease in individuals carrying CT and TT genotypes were reduced significantly in the population with levels of total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. CONCLUSION Target gene PON 1 of hsa-miRNA-616 rs3735590C-T SNPs is associated with the reduced incidence risk of pCAD, and carrying C alleles is an independent risk factor for pCAD.

Introduction Thromboembolism, usually originating from the left atrium (LA) and left atrial appendage (LAA), is a major complication of atrial fibrillation and may result in transient ischemic attack and stroke. Computed tomography (CT) is a noninvasive test for detection of LA and LAA thrombus. We sought to conduct a meta-analysis to evaluate the accuracy of CT in detecting LA/LAA thrombus.

BackgroundAtrial arrhythmia (AA) is the most common complication after coronary artery bypass grafting (CABG). Only beta-blockers and amiodarone have been convincingly shown to decrease its incidence. The effectiveness of magnesium on this complication is still controversial. This meta-analysis was performed to evaluate the effect of magnesium as a sole or adjuvant agent in addition to beta-blocker on suppressing postoperative AA after CABG.MethodsWe searched the PubMed, Medline, ISI Web of Knowledge, Cochrane library databases and online clinical trial database up to May 2012. We used random effects model when there was significant heterogeneity between trials and fixed effects model when heterogeneity was negligible.ResultsFive randomized controlled trials were identified, enrolling a total of 1251 patients. The combination of magnesium and beta-blocker did not significantly decrease the incidence of postoperative AA after CABG versus beta-blocker alone (odds ratio (OR) 1.12, 95% confidence interval (CI) 0.86-1.47,P= 0.40). Magnesium in addition to beta-blocker did not significantly affect LOS (weighted mean difference −0.14 days of stay, 95% CI −0.58 to 0.29,P= 0.24) or the overall mortality (OR 0.59, 95% CI 0.08-4.56,P= 0.62). However the risk of postoperative adverse events was higher in the combination of magnesium and beta-blocker group than beta-blocker alone (OR 2.80, 95% CI 1.66-4.71,P= 0.0001).ConclusionsThis meta-analysis offers the more definitive evidence against the prophylactic administration of intravenous magnesium for prevention of AA after CABG when beta-blockers are routinely administered, and shows an association with more adverse events in those people who received magnesium.

Introduction Thromboembolism, usually originating from the left atrium (LA) and left atrial appendage (LAA), is a major complication of atrial fibrillation and may result in transient ischemic attack and stroke. Computed tomography (CT) is a noninvasive test for detection of LA and LAA thrombus. We sought to conduct a meta-analysis to evaluate the accuracy of CT in detecting LA/LAA thrombus. Material and methods The PubMed, Medline, ISI Web of Knowledge and Cochrane Library databases up to June 2012 were searched for studies comparing CT and transesophageal echocardiography as the reference standard in detecting LA/LAA thrombus. Meta-analysis methods were used to pool sensitivity and specificity and to construct summary receiver operating characteristic (SROC) curves. Results A total of 9 studies with 1646 patients were included in this meta-analysis. The publication years spanned from 2007 to 2012. For CT diagnosis of LA/LAA thrombus, the mean sensitivity and specificity were 81% (95% CI: 70-90%) and 90% (95% CI: 88-91%), respectively. The SROC analysis showed an area under the curve of 0.93. Conclusions Computed tomography shows a good diagnostic accuracy in detecting LA/LAA thrombus with high sensitivity and specificity. Thus CT should be considered the foremost noninvasive alternative to transesophageal echocardiography for detecting LA/LAA thrombus. Randomized studies at the patient level are needed to address the potential use of CT in detecting LA/LAA thrombus.

A relatively large GMR effect associated with antiferromagnetic (AFM) coupling in sputtered Fe/Si multilayers was observed and the dependence of transport properties on Si layer and Fe layer thickness and on the number of bilayers at room temperature and 77 K were studied. Our data suggests that the mechanism of AFM coupling and GMR effect in Fe/Si multilayers is the same as that in metal/metal systems.