Hepatocellular carcinoma (HCC) is a complex and heterogeneous tumor with various genomic alterations.In most patients,HCC is associated with cirrhosis which contributes to treatment morbidity and mortality.Cirrhosis adds difficulties to clinical management of HCC.Over the past decade,several molecular targets which are involved in the etiology of HCC have been identified.Among them,treatment with sorafenib,an antiangiogenic and Raf kinase inhibitor,has shown survival benefit.This represents a breakthrough in treatment of this complex disease,and proves that molecular therapies can be effective in HCC.It is becoming apparent that to overcome the complexity of genomic aberrations in HCC,combination therapies are essential.Several ongoing clinical trials show encouraging results.Future researches are necessary to identify new compounds to block important undruggable pathways,and to identify new oncogenes as targets for therapies through novel high throughout technologies.Ultimately,a molecular classification of HCC based on genome investigations and identification of patient subclasses using drug responsiveness will lead to a more personalized treatment.Although molecular therapy is a promising treatment for HCC with cirrhosis,surgery,if applicable,remains the first choice of treatment.

Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. In ad-dition to genetic alterations, epigenetic inactivation of (tumor suppressor) genes has been recognized as an important and alternative mechanism in tumorigenesis. In recent years, increasing evidence has shown that ep-igenetic silencing of those genes is essential to carcinogenesis and metastasis. Epigenetics include two main forms: histone acetylation and DNA methylation, histone acetylation and DNA hypomethylation can promote gene expression,otherwise, they will inhibit gene expression. It is important to the methylation especially the hypermethylation of the tumor suppressor gene during the hepatocarcinogencsis. The study of epigenetics will be proved valuable for early diagnosis and disease monitoring at hepatocell.

Objective To investigate the inhibitory effects of PPARγ ligand rosiglitazone in vivo of mice which were transplanted the human gastric carcinoma cells line MGC803 into subrenal-capsule.Methods To establish kunming mouse tumor modles of MGC803 cells transplanted into subrenal-capsule and assay the inhibiting growth effects of 50 mg／kg rosiglitazone which were continuously poured into mice gastric for five days by the dissect microscope and HE stain.Results Rosiglitazone could inhibit the growth of MGC803 cells transplanted into subrenal-capsule of mice in vivo by inhibiting proliferation and inducting apoptosis,the tumor inhibitory rate was 62.9％.Conclusion PPARγ ligand rosiglitazone can inhibit the growth of MGC803 cells transplanted into subrenal-capsule of mice in vivo.

In intensive care units (ICU) , the occurrence of acute hypotensive episodes (AHE) is the key problem for the clinical research and it is meaningful for clinical care if we can use appropriate computational technologies to predict the AHE. In this study, based on the records of patients in ICU from the MIMIC II clinical data, the chaos signal analysis method was applied to the time series of mean artery pressure, and then the patient's Lyapunov exponent curve was drawn ultimately. The research showed that a curve mutation appeared before AHE symptoms took place. This is powerful and clear basis for AHE determination. It is also expected that this study may offer a reference to research of AHE theory and clinical application.
Humans ; Hypotension ; diagnosis ; Intensive Care Units ; Nonlinear Dynamics ; Software

Objective To analyze the clinical value of laparoscopic ultrasonography (LUS) in laparoscopic hepatobiliary surgeries. Methods A total of 156 cases of laparoscopic hepatectomy, hepatic abscess fenestration, and complicated cholecystectomy were analyzed. LUS was used during all the 156 operations; the anatomy and stage of the tumors were investigated. Results In 19 cases of hepatectomy and 39 cases of hepatic abscess fenestration, the direction of critical intrahepatic and extrahepatic ducts were indicated by using LUS, and the operations were performed under the guidance of LUS. Moreover, in 15 cases of complicated cholecystectomy, the tumor was precisely located and further distinguished by LUS. Conclusions Laparoscopic ultrasonography can precisely locate the tumor, guide the treatment, and resolve the problem of reduced feedback in touching for surgeons during laparoscopic hepatobiliary surgeries. It is of value to improve the operative outcomes.

Objective To explore the causes and treatment measures of hyponatremia after liver transplantation. Methods The clinical data of 27 patients with hyponatremia after liver transplantation were analyzed retrospectively. Results Among the 27 patients, postoperative hyponatremia occurred in 25 cases in about one week, and preoperative hyponatremia occurred in 2 cases and severe ~hyponatre -mia occurred immediate after operation. Acute hyponatremia occurred in one case. Blood natrium was 130 to 135 mmol/L in 10 cases, 120 to 130 mmol/L in 12 cases and less than 120 mmol/L in 5 cases. The levels of blood potassium, phosphor and calcium were all normal. Urinary natrium, potassium and chlorine levels were all normal. The ascites natrium level was higher than blood natrium at the same time. Hyponatremia was treated by supply of hypertonic saline via gastrointestine an/or veins. Conclusion Various causes could result in hyponatremia after liver transplantation. The hyponatremia was treated by supply of hypertonic saline constantly and slowly.

Objective: To explore the relationship between prevalence of atrial fibrillation (AF), iskhemia stoke and CHA2DS2-VASc score in patients≥65 years in order to provide prevention and treatment basis in clinical practice. Methods: A total of 5016 patients admitted in our hospital from 2013-10 to 2015-10 were enrolled. The patients were divided into 2 groups: AF group, n=437 and Non-AF patients, n=4579; according to age, the patients were further assigned into 4 subgroups as <65 years subgroup, (65-74) years subgroup, (75-84) years subgroup and ≥85 years subgroup. The risk factors for AF occurrence were retrospectively studied. Results: Compared with the Non-AF group, the patients in AF group had the elder age and more male gender, both P<0.001; more patients combining with hypertension, coronary artery disease (CAD), diabetes, sick sinus syndrome and rheumatic heart disease, all P<0.001. Age, male gender, CAD, sick sinus syndrome and rheumatic heart disease were the independent risk factors for AF occurrence. Compared with Non-AF group, AF group showed the higher prevalence rate of ischemic stroke and the elder onset age, both P<0.01. For non-valvular AF, the ratio of patients with CHA2DS2-VASc score≥2 was higher than those with CHA2DS2-VASc score<2 and the rate of anticoagulant therapy was decreasing by age increasing, all P<0.001. Conclusion: Age, male gender, CAD, sick sinus syndrome and rheumatic heart disease were independently related to AF occurrence. Non-valvular AF patients had the higher risk for ischemic stroke than non-AF patients, anticoagulation therapy should be conducted at the early stage.

Objective The aim of our study was to investigate the effects and mechanisms of ghrelin on neovascularization in atherosclerosis plaque. Methods 30 male New Zealand rabbits were randomly divided into normal control group ( CON group) , atherosclerosis model group ( AS group) , and ghrelin treatment group ( ghrelin group) , and each group of 10 rabbits. The AS group and ghrelin group underwent balloon-induced arterial wall injury and then fed with high fat diet, the CON group was fed only on a regular diet. They were all fed for 3 months. Then the ghrelin group was given ghrelin 25μg·kg-1 ·d-1 , the other two groups received the same amount of sterile normal saline only. Four weeks later, body weight and blood lipids were detected. The thickness ratio of the intima to media was measured by HE staining. Degree of intra-plaque angiogenesis was evaluated by CD31+ cells immunohisto-chemistry. The vascular endothelial growth factor ( VEGF ) and vascular endothelial growth factor receptor 2 ( VEGFR2) were detected by quantitative realtime PCR and Western blot. The expressions of matrix metalloproteinase ( MMP)-2 and MMP-9 were detected by immunohistochemistry and Western blot. Results ( 1 ) No significant differences in body weight and blood lipids were found between the AS group and the ghrelin group(P>0. 05), but both items were significantly higher than those of the CON group(P<0. 05). (2)The thickness ratio of the intima to media in the ghrelin treated group was distinctly less than that in the AS group(P<0. 05). (3)Compared with the AS group, the ghrelin group showed significantly decreased microvascular density and the expressions of VEGF and VEGFR2 (P<0. 05). (4)Compared with the AS group, ghrelin dramatically inhibited the plaque contents of MMP-2 and MMP-9 ( P<0. 05 ). Conclusions Ghrelin is able to inhibit the growth of neovascularizationin in the atherosclerotic plaque and the development of plaque. And these beneficial effects derive from downregulation of VEGF, VEGFR2, MMP-2, and MMP-9 at the advanced stage of atherosclerosis in rabbits.

The long-term use of immunosuppressive agents after organ transplantation is associated with many undesirable side effects which may limit the survival of patients and transplanted organs.To patients and transplant surgeons,organ transplantation tolerance is the ultimate goal to improve patient's quality of life.The clinical state of allograft acceptance termed operational tolerance has remained infrequent in clinical transplantation because of the lack of validated assays or biomarkers predictive of tolerance and the concerns about the safety and ethics of complete withdrawal of immunosuppression.Despite these barriers,a number of investigators have continued to conduct well-designed studies with the long-term goal of inducing clinical transplantation tolerance.This review provides an overviewof the currently successful approaches to achieve clinical operational tolerance,including using immunosuppression slow withdrawal in organ transplantation,transplantation tolerance through mixed chimerism and clinical application of T regulatory cells in tolerance.

Traditionally,antigen presenting cells were shown to express MHC Ⅱ antigens.However,some researchers have demonstrated that a subset of T lymphocytes could express MHCⅡ antigens in some situation.Its regulatory mechanism and biological effects remains challenging to researchers.This review provides an overview of the results of these MHC Ⅱ + T lymphocytes regarding to the generation,mechanisms,and the role in immune tolerance induction,aim to provide some insights in clinical immune tolerance induction.