Volume 94  ·   Issue 20  ·  2014

More than 50% of new and dead liver cancer cases in the world occur in China every year, and my country has the highest incidence of liver malignant tumors and surgical resection rate in the world. More than 40,000 cases of hepatobiliary tumors have been diagnosed in the pathology department of our hospital alone, of which more than 80% are liver malignant tumors, the top two are hepatocellular carcinoma (HCC, 86%) and intrahepatic cholangiocarcinoma (ICC, 8%)^[1]。 After the surgical resection technique has been basically solved in liver surgery, the biological characteristics of liver cancer have become one of the most important factors in clinical improvement of long-term curative effect^[2]。

As an emerging interdisciplinary specialty, health law has strong cross-cutting, professional and practical characteristics. It is an important part of the training system of legal personnel in China, and has been highly valued by the medical and legal education circles in recent years. The cultivation of health legal talents must adhere to the direction of improving students' practical ability to solve medical disputes cases, and the ultimate goal is to obtain applied and compound legal professional talents. However, there are still many unavoidable problems in the current training system of health legal personnel, such as the unclear training goal and orientation, the lack of students' practical ability and the unreasonable curriculum setting and teaching content. Some scholars propose to realize the innovation of training mode of health legal personnel by integrating educational resources^[1]Some scholars have also put forward the countermeasures to improve the health law curriculum in view of the irrationality of the current health law curriculum in medical colleges^[2]。 However, in terms of the difficulty of reform, the innovation of training mode and the reform of curriculum setting can by no means be completed overnight; As far as the effect of reform is concerned, the adjustment of training mode and curriculum setting is difficult to achieve outstanding results in the short term, and it is easily restricted by many uncertain factors. Therefore, we put forward a practical and feasible way of training talents in combination with the "Outstanding Legal Talents Education and Training Program" launched by the Ministry of Education in 2012.

To evaluate the anti neoplastic effects of p21^WAF1/CIP1 transcriptional activation induced by duplex RNAs in hepatocellular carcinoma (HCC) cell line BEL-7402.

Cells were treated with dsRNAs complementary to promoter sequences of p21^WAF1/CIP1. Quantitative polymerase chain reaction (qPCR) and Western blot were employed to detect the expression of p21. At various timepoints post-transfection, cell viability assay and apoptosis analysis were used to determine the effect of RNA activation. After transfection Western blot was also performed to detect the expression of Bcl-xL, cleaved caspase-3, cleaved caspase-9 and cleaved PARP.

DsP21-322 transfection significantly inhibited cell viability. And, at Day 5, dsP21-322 inhibited cell growth by 65.84% versus control. Flow cytometry revealed that dsP21-322 caused a significant increase of cell apoptosis. The total percent of apoptotic cells (UR+ LR) increased to 36.86% versus 11.51% and 14.06% in mocks and controls respectively. Such phenomena correlated with a decrease of anti-apoptotic protein Bcl-xL and an increase of cleaved caspase-3, cleaved caspase-9 and cleaved PARP.

Activation of p21 gene expression by saRNA may offer therapeutic benefits for HCC and other cancers.

To explore the expression of NVM-1(novel metastasis-promoting gene 1) in hepatocellular carcinoma (HCC) tissue and examine its clinical significance.

The expression of NVM-1 in 92 cases of HCC tumor tissues and non-tumor tissues was detected by immunohistochemical staining with SP (streptavidin-perosidase). And its clinical significance was evaluated.

The staining of NVM-1 was predominantly located in the nucleus of HCC tumor tissue. The positive rate of NVM-1 was 52.2% in all detected cancers and it was higher than that in control non-tumor tissues(28.3%) and benign hepatic lesions(0). A significant difference of positive rates existed between tumor and non-tumor tissues (P<0.05). The expression of NVM-1 in HCC was not correlated with hepatic B virus (HBV), size, amount or cirrhosis, etc. However, it was correlated with TNM(P=0.016), BCLC stage (P=0.015), poor differentiation (P=0.000), intrahepatic metastasis (P=0.002), portal vein tumor thrombus (P=0.023) and recurrence (P=0.001). By Kaplan-Meier analysis, the median tumor-free survival time was 5 months in positive expression group and it was significantly shorter than 13 months in negative expression group (P=0.001).

There is probably a close relation between recurrence and metastasis and the expression of NVM-1 in HCC.

To compare the long-term survival of hepatocellular carcinoma (HCC) patients within the Milan criteria who underwent hepatic resection (HR) or transarterial chemoembolization (TACE).

A total of 159 HR and 42 TACE patients with HCC within the Milan criteria were retrospectively evaluated. Propensity-score matching(PSM)was used to generate matched controls. Long-term survival was evaluated by the Kaplan-Meier method. And independent prognostic predictors were determined by the Cox proportional hazard model.

After adjusting for baseline differences, 84 HR and 42 TACE patients were selected. Median survival time was 42.9 months in HR group versus 34.8 months in TACE group. The 1, 3 and 5-years survival rates were significantly higher in HR group (87.8%, 64.0%, 41.9%) than those in TACE group (85.7%, 47.6%, 26.0%; P=0.028). Subgroup analysis showed that the patients with single-tumor HCC ≤ 5 cm had 1, 3 and 5-year overall survival rates of 86.3%, 61.3% and 42.9% after HR versus 90.3%, 61.3% and 33.2% after TACE (P=0.332). Among those with multinodular HCC involving 2-3 tumors ≤ 3 cm, 1, 3 and 5-years survival rates were 93.8%, 75.0% and 39.3% after HR versus 72.7%, 45.5% and 9.1% after TACE (P=0.002). Body mass index ≥23 kg/m², serum level of alpha-fetoprotein (AFP) ≥ 400 μg/L and TACE treatment significantly predicted poor survival according to the Cox proportional hazard model (all P<0.05).

Hepatic resection provides better long-term survival than TACE for HCC patients within the Milan Criteria. In fact, HR provides significant long-term survival benefits for patients with multinodular HCC involving 2-3 tumors ≤ 3 cm. In contrast, both HR and TACE have similar survival rates among patients with single-tumor HCC ≤ 5 cm.

To explore the development approach of donation after brain death through analyzing the cognition status of donation after brain death among medical staff and potential donor (PD) family members of intensive care unit (ICU).

Analysis was conduced for the cognition of donation after brain death among 149 ICU professionals and 879 PD family members at 89 hospitals from July 2011 to April 2013.

Medical staff: 100%(149/149)recognized the significance of donation after brain death, 96.6%(144/149)approved of donation after brain death, 85.9%(128/149)knew about brain death criteria, 94.0%(140/149)accepted the equivalence of brain death as death. Awareness of standard of potential donor: 13.4%(20/149)were aware of donation age, 40.9%(61/149) familiar with the donation criteria of liver and kidney function and 44.3%(66/149)knew the hepatitis B donation criteria. Necessity of brain death legislation: 79.2%(118/149)considered it necessary, 14.8%(22/149)unimportant and 6.0%(9/149)not necessary. How to manage donation after brain death: 43.6%(65/149)did not know how, 79.2%(118/149)were afraid and 30.9%(46/149)never considered. Family members: 0/879 knew about brain death, 98.6%(867/879)accepted the equivalence of brain death as death, 99.5%(875/879)approved the significance of donation after brain death and 47.0%(413/879) agreed with donation after brain death. The reasons for approving the significance of donation after brain death but not agreeing with donation: 80.5%(372/462)required a full corpse after death and 19.5%(90/462)for other reasons. Reasons for agreeing with donation but refuse: 50.1%(207/413) were opposed by other family members, 11.4%(47/413) beware of neighbors′ chat about their organ trading, 9.2%(38/413) hoped to be paid and 8.0%(33/413) for the others.

The cognitive deficits of donation after brain death for medical staff and family members, medical staff′s worries about brain death legislation and traditional thoughts of family members are the main reasons for a low conversion rate of PD. A professional transplant coordinating team should be built for national organ donation knowledge education.

To summarize retrospectively developmental dysplasia of the hip (DDH) screening of children within 36 months.

Newborn infants underwent initial DDH screening at First Affiliated Hospital, Zhengzhou University from September 2011 to May 2013. The examinations included double hip function, abduction test and Ortolani/Barlow test. After initial DDH screening, suspected and abnormal infants were transferred to our department for re-screening. And clinical physical examinations, type B ultrasound or radiological imaging were performed for confirmation or elimination.

A total of 10 428 children were DDH screened. And 1 260 children were examined with ultrasound and 346 suspected and abnormal children (445 hips) were transferred for further assessments. Among them, 33 children (49 hips) were positive with Ortolani or Barlow test, 61 children (88 hips) had dysplasia of hip and 48 children (14 boys, 34 girls) (69 hips) received a final diagnosis of DDH. Left (n=52) and right hip (n=17) were involved with a disease incidence of DDH at 0.46%.

Ultrasonic examination is both simple and cost-effective for DDH screening of children within 6 months. And meticulous medical examinations and imaging studies are effective DDH screening for children from 6 to 36 months.

To explore the roles of ribavirin aerosol in the prevention and treatment of hand-foot-mouth disease (HFMD).

For this prospective, multicenter, randomized, double-blind and placebo-controlled trial, a total of 300 HFMD outpatients from 3 class 3A hospitals from July 2011 to June 2013 were divided into treatment (ribavirin aerosol) and control (placebo) groups (n=150 each). The age range was 6 months to 6 years. The proportion of male and female was 1.5∶1. Temperature, herpes of mouth and skin rash were observed before and after treatments. Before treatment and 6-7 days after, their specimens of throat swab were collected and the levels of EV71 and CA16 detected with reverse transcription (RT)-PCR. The software SAS 9.2 was used for statistic data analyses.

Before treatment, no significant statistical difference existed in parameters between treatment and control groups (all P>0.05). After treatment, the degree of herpes of mouth and papulovesicle of skin in treatment group was better than that in control group(100.0%(147/147)vs 83.9%(120/143), χ²=109.21, P<0.01); (100.0%(147/147)vs 95.9%(139/145), χ²=6.38, P<0.05). The virus negative conversion rates had significant inter-group difference (80.0%(102/110)vs 41.8%(41/98), χ²=37.06, P<0.01). The temperature, compliance and differences were not significant (allP>0.05). The effective rate of comprehensive efficacy in treatment group was higher than that in control group(93.9%(122/130) vs 52.0%(64/123), χ²=111.08, P<0.01). No obvious adverse drug reaction was observed.

Ribavirin aerosol has multiple advantages of lower dose, quicker onset, higher local concentration, better clinical efficacy and fewer side-effects. Its therapeutic effect for local lesion is better than that for systemic lesion. Thus it may shorten the duration of oropharyngeal and skin lesions and lower the number and time of viral release.

To explore the expression of CD160, a costimulator, on CD4⁺ and CD8⁺ T cells in chronic human immunodeficiency virus-1 (HIV-1) infected patients.

A total of 23 chronic HIV-1 infected patients were enrolled into 302 Hospital of People′s Liberation Army from January 2010 to December 2011. Meanwhile, 20 healthy individuals were selected as healthy controls (HC). Peripheral blood was collected, peripheral blood mononuclear cells (PBMC) were isolated by density gradient centrifugation and CD160 was stained with fluorescent antibody. The expressions of CD160 on CD4⁺ and CD8⁺ T cell subsets were detected by flow cytometry and its correlation with CD4⁺ T cell absolute number and HIV RNA viral load were analyzed.

The expressions of CD160 on CD4⁺ and CD8⁺ T cell increased versus HC (on CD4⁺ T cells, percentage: (14.3±7.5)% vs (3.9±2.2)%, median fluorescent intensity (MFI): 26.4±11.0 vs 12.4±2.9; on CD8⁺ T cells, percentage: (40.9±13.2)% vs (12.9±6.6)%, MFI: 52.5±17.4 vs 18.2±5.0). Furthermore, the expression of CD160 on CD4⁺ T cells was negatively correlated with CD4⁺ T cell absolute number (r=-0.550, P=0.010) and positively with HIV RNA load (r=0.522, P=0.015). However, the expression of CD160 on CD8⁺ T cells was not correlated with CD4⁺ T cell absolute number or HIV RNA load. The expressions of CD160 on CD8⁺ T cell subsets Tn, Tcm and Tem in patients with chronic HIV-1 infection increased compared with HC (25.3±17.6 vs 5.0±3.1, 45.8±13.0 vs 20.4±4.3, 37.0±13.6 vs 20.0±10.8). In addition, Tn subset decreased while Tcm subset increased in CD160⁺ CD8⁺ T cell subset distribution in patients with HIV-1 infection compared with HC subjects.

CD160 may contribute to the exhaustion of CD4⁺ and CD8⁺ T cells and influence the distribution of memory CD8⁺ T cell subsets.

To explore the correlative factors and clinical characteristics of digestive system injury during the treatment of anticoagulant and (or) antiplatelet-agents.

A total of 1 443 hospitalized patients on anticoagulant and (or) antiplatelet-agents from January 2010 to December 2013 at Renmin Hospital of Wuhan University were analyzed retrospectively.

Their length of hospital stay was from 5 to 27 days. Most of them were elderly males (n=880, 61.0%) with an average age of(62±6)years. 1 138 patients (78.9%) were farmers, workers or someone without a specific occupation. During the treatment of anticoagulant/antiplatelet-agents, statistical difference existed (P=0.01) between positively and negatively previous digestive disease groups for actively newly occurring digestive system injury (16.0%(41/256) vs 15.9%(189/1 187)). After the dosing of anticoagulant and (or) antiplatelet-agents, 57 (66.3%, 57/86) patients were complicated by hemorrhage of digestive tract, taking 62.9% (61/97) of all positive result patients for Helicobacter pylori test. Comparing preventive PPI group with no PPI group, there was no marked statistical differences (P=2.67) for digestive system complication (including hemorrhage of digestive tract) while receiving anticoagulant and (or) antiplatelet-agents (13.9%(74/533) vs 17.1%(156/910)). During anticoagulant and/or antiplatelet-agent therapy, 185 patients (12.8%) were complicated by peptic ulcer or peptic ulcer with bleeding, 40 patients (2.8%) had erosive gastritis and 5 (0.3%) developed acute gastric mucosal lesions. And 42 of 76 patients complicated by hemorrhage of digestive tract underwent endoscopic hemostasis while 2 patients were operated. Ninety-seven patients(6.7%)died, including 61 (62.9%, 61/97) from hemorrhage of digestive tract. The remainder became cured, improved and discharged. Moreover, no significant statistical differences existed (P=2.29) among three combination group (aspirin, clopidogrel, warfarin), two combination group (aspirin, clopidogrel), exclusive aspirin group and exclusive warfarin group in short-term (<27 d) mortality.

It is necessary to clearly dictate the details of medication to the patients not highly educated. Elder, male, history of digestive system disease and Helicobacter pylori infection are possibly highly risk correlative factors for digestive system complications during anticoagulant/antiplatelet-agent therapy. The short-term protective effect of routine dose of PPI is inconspicuous. No significant correlation exists between short-term mortality and the dosage (or type) of anticoagulant/antiplatelet-agents.

To evaluate the long-term outcomes of childhood stage 4 neuroblastoma (NB) and its correlative prognostic factors.

Comprehensive protocols including tumor resection, intensive chemotherapy, radiotherapy, autologous bone marrow transplantation and 13-cis-retinoid were designed and implemented. A total of 112 newly diagnosed NB stage 4 patients at Shanghai Children′s Medical Center collected from June 1998 to December 2010 were treated. Their clinical features, therapeutic efficacies, long-term outcomes and prognostic factors were analyzed.

There were 69 males and 43 females with an age range of 4 months to 15 years. Among them, 12 improving patients didn′t complete treatment because of parental decisions. Among those completing the comprehensive protocols, 62 cases (62.0%) achieved very good partial remission (VGPR), 20 (20.0%) achieved partial remission (PR) while another 18 (18.0%) progressed during treatment. The efficiency rate (including VGPR+ PR) of treatment was 82.0 % (n=82). The median follow-up period was 78(56, 120)months. And 13 cases were lost after a median follow-up of 16 months. The 2, 3, 5-year event-free survival (EFS) was 56.2%(59/105), 40.8%(40/98) and 21.1%(19/90)respectively. Age (>18 months), poor curative effect (achieving no VGPR at the end of treatment), elevated level of lactate dehydrogenase (LDH) (> 5 times normal value), bone marrow involvement and brain metastasis were poor prognostic factors(χ² = 12.01, 13.66, 6.29, 5.44, 16.18, all P<0.05). According to the multivariate estimates of hazards, age, high levels of LDH, poor curative effect and brain metastasis were associated with a worse survival(OR=3.54, 1.89, 3.08, 3.45, all P<0.05). Brain metastasis predicted a worse outcome with 100% mortality rate (n=6). Compared to traditional chemotherapy, topotecan-based chemotherapy could not improved the efficiency (52.6%(10/19)vs 63.2%(36/57), P>0.05) and long-term outcome (2 ys-EFS 42.1%(8/19)vs 56.4%(31/55),P>0.05).

The prognosis remains poor for neuroblastoma of stage 4. Age (>18 months), poor curative effect (achieving no VGPR at the end of treatment), elevated LDH level (>5 times normal value) and bone marrow infiltration are associated with worse prognosis. Brain metastasis predicts the worst with 100% death rate. Topotecan included chemotherapy can not be proved more effective in this study.

To explore the level of soluble programmed death ligand 1 (sPD-L1) in pleural effusion and peripheral blood of patients with tuberculous pleural effusion (TPE) and elucidate its clinical implications.

Patients with newly diagnosed pleural effusion at the Second Affiliated Hospital of Soochow University from June 2012 to March 2013 were enrolled and divided into 3 groups of TPE, malignant pleural effusion (MPE) and non-tuberculous non-malignant pleural effusion (non-TPE non-MPE) according to the nature of pleural effusion. The level of sPD-L1 in pleural effusion and peripheral blood was analyzed by enzyme linked immunosorbent assay (ELISA) kit. Flow cytometry was used to detect the changes of immune cell subsets in pleural effusion. And the gene expressions of programmed death ligand 1 (PD-L1) and matrix metalloproteinase-3 (MMP-3) were detected in different effusions by reverse transcription-polymerase chain reaction (RT-PCR).

A total of 77 newly diagnosed patients with pleural effusion were enrolled, 24 patients with TPE, 39 patients with MPE, 14 patients with non-TPE non-MPE. The level of sPD-L1 in TPE was higher than that in MPE and non-TPE non-MPE (4.2 (2.6-6.3), 1.4 (0.8-2.1), 1.8 (1.2-2.6) μg/L, P<0.001). No significant difference existed in the levels of sPD-L1 in peripheral blood samples (P=0.811). The average content of sPD-L1 in pleural effusion in all patients was statistically higher than that in peripheral blood (2.0 (1.4-3.7), 1.5 (1.0-2.0) μg/L, P=0.004). The proportion of CD8 subset, PD-L1 on CD14⁺ monocytes and the mRNA level of PD-L1, MMP-3 in TPE were higher than in MPE and non-TPE non-MPE (P=0.001, P<0.001,P<0.001), and the mRNA level of PD-L1 in TPE was positively correlated with the level of MMP-3 (r=0.887, P<0.001). Receiver operating characteristic (ROC) curve analysis showed that sPD-L1 had a sensitivity of 82.6%, a specificity of 83.8% and an area under curve (AUC) of 0.854 for differential diagnosis of TPE from other conditions. Combinations of sPD-L1, PD-L1 on CD14⁺ monocytes and adenosine deaminase (ADA) measurements further increased the sensitivity up to 91.3%, specificity up to 89.2% and AUC up to 0.989.

The elevated expression of sPD-L1 in tuberculous pleural effusion may aid the diagnosis of TPE.

To explore the role of interleukin-17 (IL-17) in the pathogenesis of severe aplastic anemia (SAA).

Peripheral blood samples were obtained from 40 SAA patients (25 untreated, 15 recovery) and 10 normal controls from October 2012 to October 2013. The level of IL-17 in peripheral blood was measured with cytometric bead array (CBA). The correlations between IL-17 and T cells subset (CD4⁺/CD8⁺), dendritic cells (DC) subset (mDC/pDC), regulatory T cells (Treg) and hemogram were analyzed.

The serum level of IL-17 in untreated patients was higher than that in recovery patients and normal controls ((17.07±15.18) vs (7.09±3.84) and (3.53±2.08) ng/L, both P<0.01). Also significant differences existed between the latter two groups (P<0.05). The ratio of CD4⁺/CD8⁺ was (0.32±0.08) in untreated patients and it was lower than that in recovery patients (1.11±0.31, P<0.01) and normal controls (1.07±0.26,P<0.01). The ratio of mDC/pDC was (3.16±0.55) in untreated patients was higher than that in recovery patients (1.60±0.43,P<0.01)and normal controls (1.43±0.38,P<0.01). The percentage of Tregs in peripheral blood lymphocyte (CD4⁺CD25⁺CD127^dim/PBL) was 0.80%±0.31% in untreated patients and it was lower than that in recovery patients (1.78%±0.69%, P<0.01) and normal controls (2.23%±0.66%,P<0.01). The serum level of IL-17 in untreated SAA patients was related positively with mDC/pDC ratio (r=0.414, P<0.05) and negatively with CD4⁺/CD8⁺ ratio (r=-0.421, P<0.05) and CD4⁺CD25⁺CD127^dim/PBL(r=-0.650, P<0.01). And significant negative correlations existed between serum IL-17 and white blood cells in untreated patients (r=-0.689, P<0.01) and recovery patients (r=-0.640, P<0.05).

The elevated serum level of IL-17 in SAA is related with the immunological status and disease severity.

To observe the effects of chemokines CXCL9 and CXCL10 on cardiac allograft acute rejection mediated by alloreactive memory T cells in a retransplantation model.

Heart transplantation was performed 6 weeks after skin grafting. The mice were divided into 3 groups of control (direct heterotopic heart transplantation without skin grafting); experimental (heart transplantation after skin grafting) and syngraft (C57BL/6→C57BL/6, heterotopic heart transplantation) (n=12 each). Graft survival and the pathological changes of cardiac graft were observed. And related gene expression in cardiac grafts and serum concentration of CXCL9/CXCL10 were detected.

The mean survival time of control and experimental groups was 7.75 and 3.25 days respectively (P<0.01). Serum concentrations of CXCL9 and CXCL10 in recipient mice were higher in the experimental group than those in the control group. Compared with the control group, the relative gene expressions of CXCL9 and CXCL10 were higher in the experimental group. According to pathological examinations, the histological rank of cardiac allograft was Grade 2.27±0.25 in the control group versus Grade 4.12±0.03 in the experimental group (P<0.01).

CXCL9 and CXCL10 play critical roles in retransplantation mediated by alloreactive memory T cells. And acute rejection of cardiac allograft is more extensive in retransplantation.

To explore the mechanism of endocannabinoids system (ECS) in glucose metabolism of rats with chronic intermittent hypoxia (CIH).

According to random permutation table and experiment time, a total of 48 Wistar rats were randomly divided into 6 groups of 4/6-week control (filling with compressed air with 21% oxygen), 4/6-week CIH (CIH exposure for 8 hours per day) and 4/6-week CIH plus rimonabant group [an intraperitoneal injection of CB₁ receptor antagonist rimonabant into liver (1 mg·kg^-1·d^-1) before CIH exposure] (n=8 each). The levels of fasting plasma glucose, serum insulin, serum C-peptide and the expression of CB₁ receptor in liver were detected after 4/6 weeks to evaluate the effects of CIH on the indices of glucose metabolism.

The levels of the following indices in 4/6-week CIH group were significantly higher than those in 4/6-week control group: fasting plasma glucose (8.91±0.40), (10.61±0.36) vs (6.48±0.23), (6.51±0.25) mmol/L; serum insulin (16.72±3.76), (20.25±3.64) vs (9.02±2.05), (9.19±2.35) U/L; serum C-peptide (3.53±0.26), (5.23±0.29) vs (1.37±0.26), (1.41±0.41) μg/L; the expression of CB ₁ receptor in liver (0.290±0.026), (0.342±0.030) vs (0.214±0.023), (0.221±0.026) (all P<0.05). Notably 6-week CIH group was significantly higher than 4-week CIH group (P<0.05). And the above indices in 4/6-week CIH plus rimonabant group were significantly lower than others (bothP<0.05). The level of CB₁ was significantly positively correlated with the levels of fasting plasma glucose, serum insulin and serum C-peptide(r=0.856, 0.758, 0.827, all P<0.05).

ECS may contribute to abnormal glucose metabolism caused by CIH.

To explore the effects of postconditioning on autophagy of lung injury in situ during lung ischemic reperfusion.

Twenty-four male Sprague-Dawley rats were randomly divided into 3 groups of sham-operated (S), ischemic-reperfusion (I/R) and ischemic postconditioning (IpostC) (n=8 each). All underwent left thoracotomy after anesthesia. In the S group, a line was only placed around left hilum but not fastened. In the I/R group, a line was fastened to block the blood flow of left lung for 30 min and then loosened for reperfusion for 120 min. In the IpostC group, after blocking the blood flow of left lung for 30 min, left hilum was fastened for 30 sec and loosened for 30 sec. Lung tissues were measured by Western blot. Histopathological changes of lung tissues were observed, lung injury scores calculated and autophagic vacuoles determined by electron microscope.

The relative expression levels of mammalian target of rapamycin (mTOR) and phosphorylated mTOR (p-mTOR) in group I/R (0.40±0.03, 0.33±0.10) were not different with those of group S (0.37±0.07, 0.31±0.10) (both P>0.05). However, both significantly increased in group IpostC (0.46±0.09, 0.55±0.07) (bothP<0.05). As compared with group S, the relative expression level of LC3-Ⅱand lung injury score significantly increased in groups I/R and IpostC (0.53±0.08, 0.38±0.03 vs 0.25±0.06; 15.79±1.33, 11.67±1.55 vs 5.58±0.39) while obviously decelined in group IpostC versus group I/R (allP<0.05). In group I/R, neutrophil infiltration, interstitial edema, atelectasis and hyaline membrane formation were observed microscopically in lung tissues and the formation of autophagic vacuoles was evident under electron microscope. The changes of group IpostC were milder than those of group I/R.

Ischemic postconditioning has protective effects on lung ischemic reperfusion injury by attenuating autophagy. It may be related with strengthening mTOR.

To observe the effects of continuous sedation with propofol on peripheral blood mononuclear cell (PBMC) and intercellular adhesion molecule 1 (ICAM-1) in beagles with combined burn-blast injuries.

A total of 32 male beagles were randomly divided into 4 groups of normal control (NC), combined injury control (CC), propofol 1 (P1) and propofol 2 (P2) (n=8 each). Except for NC group, the other 3 groups were subject to severe combined burn-blast injury. And sodium lactate Ringer′s solution was infused after trauma according to the Parkland formula, including NC group. At the same time, P1 and P2 groups received continuous intravenous infusions of 2 mg·kg^-1·h^-1, 5 mg·kg^-1·h^-1 doses of propofol respectively for 72 hours. The serum concentrations of ICAM-1 and lymphocyte function associated antigen-1 (LFA-1) were measured by enzyme-linked immunosorbent assay (ELISA) at 6, 24, 48, 72 h post-injury. Flow cytometry was used to detect the major histocompatibility complex (MHC) antigen expression on CD14⁺ monocytes, CD4⁺/CD8⁺ T lymphocyte rate and PBMC apoptosis rate.

The level of ICAM-1 in CC group ((10.5±1.1), (10.8±1.3), (12.3±1.4) ng/ml) was significantly higher than that in NC group ((7.4±1.4), (7.4±1.1), (7.4±1.6) ng/ml) at 12, 24, 48 h post-injury (all P<0.05). The level of ICAM-1 in P1 group was significantly lower than that in CC group ((10.7±1.3) vs (12.3±1.4) ng/ml) while the level of ICAM-1 in P2 group was significantly lower than that in P1 group at 72 h post-injury ((8.8±1.4) vs (10.7±1.3) ng/ml) (bothP<0.05). The level of LFA-1 in CC group ((7.3±1.3), (8.4±1.3), (9.6±1.7) ng/ml) was significantly higher than that in NC group ((5.1±1.2), (5.4±1.3), (5.8±1.2) ng/ml) at 24, 48, 72 h post-injury (allP<0.05). MHC antigen expression on the CD14⁺ monocytes of P2 group was obviously higher than that of CC and P1 groups ((46±13)% vs (26±15)% and (32±12)%, both P<0.05). The CD4/CD8 rate in P1 and P2 was significantly higher than that in CC group (1.71±0.26, 1.82±0.31 and 1.81±0.24, 1.96±0.24 vs 1.41±0.34, 1.34±0.26) at 48, 72 h post-injury (allP<0.05). At 72 h post injury, the PBMC apoptosis rate in CC and P1 group was obviously higher than that of the NC group ((2.57±0.21)% and (1.64±0.10)% vs (0.81±0.11)%) (bothP<0.01); the apoptosis rate in P2 group was significantly lower than that in P1 group ((1.09±0.15)% vs (1.64±0.10)%) (P<0.01).

Propofol may improve the immune function after combined burn-blast injuries through suppressing an excessive release of ICAM-1 and PBMC apoptosis in a concentration-dependent manner.

Budd-Chiari syndrome is an obstruction from the hepatic venule to the confluence of the inferior vena cava and the right atrium^[1,2]This definition was proposed by the European Hepatic Vascular Disease Research Group (EN-VIE) in 2003 and consolidated in the 2005 Baveno IV Portal Hypertension Consensus and the 2009 Clinical Practice Guidelines for Hepatic Vascular Diseases developed by the American Society of Hepatology^[3,4]。 Hepatic sinus obstruction syndrome and obstruction of the outer hepatic venous flow channel due to right heart failure and constrictive pericarditis do not fall into the category of Budd-Chiari syndrome^[1,2]。 Its naming is derived from the surnames of British physician George Budd and Austrian pathologist Hans Chiari, who first reported the disease. The epidemiology, clinical manifestations, diagnosis and treatment of Budd-Chiari syndrome are reviewed.

Long-chain non-coding RNAs (lncRNAs) are a class of RNAs whose transcripts exceed 200 nucleotides in length. They do not or rarely encode proteins themselves. These lncRNAs are involved in regulating stem cells, maintaining their pluripotency and cell differentiation^[1]。

Autophagy is an active cell extinction that provides new material and energy for the survival of eukaryotic cells by eliminating old material. The selectivity of autophagy is reflected in substrate specificity.