Objective To investigate the protective effect of propofol (Pro) in combination with ligustrazin (Lig) on the liver against ischemia-reperfusion (I/R) injury and the mechanisms involved.Methods Fifty male SD rats weighing 240-280 g were randomly divided into 5 groups of 10 animals each: group Ⅰ received sham operation (sham); group Ⅱ I/R; group Ⅲ Pro + I/R; group Ⅳ Lig + I/R and group Ⅴ Pro + Lag + I/R. The animals were anesthetized with intraperitoneal pentobarbital 20 mg?kg-1 . Liver ischemia was produced by clamping the hepatic hilum for 30 min, then the clamp was removed for 60 min reperfusion. In group Ⅲ propofol was infused at 20 mg?kg-1 ?h-1 starting from 20 min before ischemia until hepatic hilum was clamped. In group Ⅳ a bolus of ligustrazin 60 mg?kg-1 was given i.v. 20 min before ischemia. In group Ⅴ propofol was infused and a bolus of ligustrazin was given i.v. as in group Ⅲ and Ⅳ 20 min before hepatic ischemia. Blood samples were taken at the end of 60 min reperfusion for determination of serum activities of ALT, AST and LDH and meanwhile a liver specimen was obtained for determination of MDA content, SOD and XOD activities and for electron microscopic examination. Results Serum ALT and AST activities were significantly higher in group Ⅱ , Ⅲ , Ⅳ and Ⅴ than in group Ⅰ (sham) (P

Competency-based medical education and personnel training isbecoming a global trend, and the United States has developed a set of competence evaluation system to evaluate a pack-age of emergency, orthopedics, thoracic surgery physicians etc. in 26 specialties. This paper introduces the development background of the evaluation system, the structure of specialist competency evaluation form, content and methodologies , and uses emergency physicians for further evaluation to illustrate this. American physician competency evaluation system provides a unified framework for the country's medical graduates after graduating from medical education training. It helps tocombine process control withthe results ofthe evaluation, self-evaluation with the evaluation of others to makethe evaluation more objective and comprehensive . It can provide new reference to the evaluation and training of physicians in our country.

ObjectiveTo investigate the effects of prenatal taurine supplementation on the Rho-ROCK signaling pathway activity and synaptophysin (Syp) expression in brain tissues of rats with intrauterine growth restriction.MethodsEighteen pregnant Sprague-Dawley rats were randomly divided into control group, fetal growth restriction (FGR) group and taurine group, with six rats in each group. Low-protein diet was given in FGR and taurine groups to establish an FGR model. Taurine 300 mg/(kg·d) was supplemented from gestational day 12 until delivery in taurine group. The mRNA expression levels of neurite growth inhibitor-A(Nogo-A), neurite growth inhibitor receptor (NgR), Rho-A and ROCKⅡin fetal rat brain were detected using reverse transcriptase polymerase chain reaction (n=24), which are the key signaling molecules of the Rho-ROCK signal pathway. The protein expression levels of Nogo-A and NgR were detected by Western blot (n=12). The mean optical density in Nogo-A, NgR and Syp was determined by immunohistochemistry (n=18). One-way analysis of variance and LSD-t test were used for statistical analysis.Results(1) Expression of mRNA: the expression levels of Nogo-A, NgR, Rho-A and ROCKⅡ mRNA in fetal rat brain were 4.09±1.34, 3.01±0.77, 39.89±7.71 and 7.82±1.83, respectively in FGR group, and were significantly higher than in control group (1.00±0.13, 1.00±0.10, 1.02±0.30 and 1.00±0.10) (t=4.735, 5.204, 7.682 and 10.675, allP<0.05). The expressions in taurine group (1.07±0.30, 1.20±0.27, 5.36±0.41 and 1.89±0.43) were significantly lower than in FGR group (t=4.645, 4.690, 6.687 and 9.485, allP<0.05), and there was no statistical difference between taurine group and control group (allP>0.05). (2) Expression of protein by Western blot: the expressions of Nogo-A and NgR protein in fetal rat brain were 1.51±0.09 and 0.31±0.05 in FGR group, 0.82±0.06 and 0.06±0.01 in taurine group, and 1.04±0.10 and 0.09±0.12 in control group. The expression was significantly higher in FGR group than in control group (t=9.644 and 5.285, bothP<0.05). The expression was significantly lower in taurine group than in FGR group (t=14.163 and 5.825, bothP<0.05), and there was no statistical difference between taurine group and control group (allP>0.05). (3) Positive expression of protein: the positive expressions of Nogo-A and NgR protein in fetal rat brain were 0.28±0.06 and 0.11±0.02 in FGR group, 0.10±0.02 and 0.04±0.01 in taurine group, and 0.07±0.01 and 0.04±0.01 in control group. The expression was significantly higher in FGR group than in control group (t=9.778 and 7.645, bothP<0.05). The expression in taurine group was significantly lower than in FGR group (t=8.679 and 7.413, bothP<0.05), and there was no statistical difference between taurine group and control group (bothP>0.05). The positive expression of Syp protein in fetal rat brain was 0.08±0.01 in FGR group, and was significantly lower than in control group (0.16±0.04,t=4.600,P<0.05). The expression in taurine group (0.14±0.36) was significantly higher than in FGR group (t=3.181,P<0.05), and there was no statistical difference between taurine group and control group (P>0.05).ConclusionsPrenatal taurine supplementation can improve neural axon development via down-regulating the expressions of the key molecules of Rho-ROCK signal pathway in fetal rat brain tissue.

Objective To construct and assess the competency scale for emergency physicians in our country. Methods Learning from the milestone project in America, we developed the scale through Delphi method . The application effect was evaluated among 81 emergency physicians by questionnaire survey. Excel was used to do data entry. SPSS 20.0 was adopted to do data analysis. Factor analysis method was employed to verify the structure validity of the scale. Results The competency scale comprises six dimensions and 13 items. The scale of total Cronbach's alpha coefficient was 0.98 and the split half reliability was 0.95. Two factors were extracted by principal component analysis with cumulative contribution rate of 86.5%. The differ-ences of competency score on six aspects of different ages, titles, working years and training situation were tested and all had statistically significant differ-ence (P<0.01). Conclusion The scale developed in our study can reflect the growth stage of the emergency physicians and serve the purpose as an evaluation tool for the competency of emergency physicians in our country.

Objective To compare postoperative complications between endoscopic thyroidectomy via breast areola approach and open thyroidectomy.Methods From June 2011 to June 2014,475 patients underwent thyroidectomy.Patients were divided into traditional open group (251 cases) and endoscopic thyroidcctomy group (224 cases).Postoperative complications were recorded and compared.Results All operations were successfully completed.There was no case in endoscopic thyroidectomy group converted to traditional open surgery.There was no serious postoperative complication occurred,including injury to trachea,mediastinal emphysema,intraoperative massive hemorrhage and cardiopulmonary accidents.The difference of postoperative complication between two groups had no statistical significance (all P ＞0.05) as to permanent recurrent laryngeal nerve injury,Homer syndrome,permanent hypoparathyroidism,chyle leakage,postoperative hemorrhage and infection of incision.However,postoperative ecchymosis was more often in endo group (P ＜0.05).Conclusions Compared to traditional open thyroidectomy,endoscopic thyroidectomy via breast areola approach has significant cosmetic advantages without increasing the incidence of major postoperative complications.

Objective To investigate the galectin-3 (Gal-3) and osteopontin (OPN) expression in esophageal carcinoma and analyze its clinical significance.Methods Thirty-seven patients who suffered from esophageal carcinoma were selected from 2006 to 2008.There were 28 males and 9 females,aged from 41 to 82 vears old.The levels of Gal-3 mRNA and OPN mRNA in tissues were detected by Fluorescent PCR,and the levels of Gal-3 and OPN in blood plasma were measured by ELISA.Result The expression of Gal-3 mRNA and OPN mRNA were significantly different between the esophageal carcinoma,side of carcinoma and normal esophagus tissues (F=11.934,F=4.269,P<0.05);The expression of galectin-3 and osteopontin were correlated with pathological grading (F=3.216,P

Aim: To study the therapeutic effects of ZK_(14), a novel nitric oxide donor, on hepatic fibrosis in rats. Methods: Rats were injected intraperitoneally with CCl_4 and induced to hepatic fibrosis, followed by intra-gasrtic administration with high dose of 20 mg/kg and low dose of 10 mg/kg of ZK_(14) for 4 weeks. The effects were evaluated in the content of nitric oxide of serum and nitric oxide synthases of liver, in serum levels of the hepatic functions indices and hepatic fibrotic index and in liver histopathology. Results: The biochemical indices and pathology grade were effectively improved in the group of ZK_(14) 20 mg/kg, and liver function was also effectively protected in this group. Conclusion: ZK_(14), a novel nitric oxide donating biphenyldicarboxylate derivative, showed preferable therapeutic effects on hepatic fibrosis of rats induced with CC14, and it may be of potential value in the treatment of hepatic fibrosis.

Objective To discuss the effect of pericardial devascularization plus gastric fundus transaction in advance schis?tosomiasis patients with portal hypertension. Methods Thirty?six advanced schistosomiasis patients with portal hypertension treated with devascularization plus gastric fundus transaction(a portal hypertension group),as well as 10 patients treated with modified Sugiura operation(a modified Sugiura operation group)in the Third People’s Hospital of Yangxin County since 2006 were chosen as the observation objects,and the clinical effects of the two groups were observed and compared. Results The op?eration time,indwelling time of stomach tube,time to taking food after operation,drainage tube removal time of the portal hy?pertension group were all shorten than those of the modified Sugiura operation group(all P<0.05). The hospitalization expenses of the two groups were(25 466.00 ± 2 888.48)Yuan and(34 517.10 ± 4 948.39)Yuan respectively,and the difference was al?so statistically significant(P<0.05). The incidence rates of portal thrombosis of the portal hypertension group and modified Sug?iura operation group were 33.33%(12/36)and 40.00%(4/10),respectively,and the incidence rates of rehaemorrhagia of the two groups 12 months after the operation were 16.67%(6/36)and 10.00%(1/10),respectively,but the differences had no sta?tistically significance(both P>0.05). In addition,1 case with delayed gastric emptying and 1 case with stomal leak of esopha?gus happened in the modified Sugiura operation group,while no corresponding complications happened in the portal hyperten?sion group. Conclusions Pericardial devascularization plus gastric fundus is a relatively easy procedure which has a good short?term clinical effect,and therefore it is suitable for application in primary hospitals. However,its long?term effect still needs fur?ther observation.

Objective To compare the differences in metabolites between newborns with intrauterine growth restriction (IUGR) and appropriate for gestational age (AGA) in order to understand the changes in metabolites of newborns with IUGR and explore the possible metabolic mechanism of tissue and organ damages in patients with IUGR,with the ultimate goal of providing the basis for clinical intervention.Methods A total of 45 newborns with IUGR and 56 AGA newborns who were hospitalized in the Neonatal Intensive Care Unit of Bayi Children's Hospital,the General Hospital of the Chinese People's Liberation Army between July 2009 and June 2015 and who underwent metabolic disease screening were enrolled in this study.The differences in of 21 amino acids and 55 carnitines in peripheral blood,as well as the changes in the ratios of free carnitine and acylcarnitine to total carnitine,were compared.Results (1)According to the comparison of birth weights (＜ 3rd percentile,3rd-＜ 5th percentile,5th-＜ 10th percentile,and 10th-90th percentile),peripheral blood of the IUGR newborns with birth weight ＜ 3rd percentile contained lower concentrations of alanine (F =2.94,P =0.03),homocysteine (F =3.83,P =0.01),methionine (F =2.88,P =0.04),ornithine(F =3.32,P =0.02),serine (F =3.09,P =0.03) and tyrosine (F =4.76,P =0.00) than those of the AGA newborns.In the peripheral blood of the IUGR newborns with birth weight of 3rd-＜ 5th percentile,the diversity of alanine concentrations showed compensatory increase,and their alanine concentrations were higher than those of the AGA newborns.(2) Metabolites also had significant differences in different gestational age groups:the concentrations of alanine (t =2.423,P =0.026),proline (t =2.470,P =0.023),and 14-carbon acylcarnitine (t =-2.870,P =0.010) in premature was higher than those in full-term newborns,but the concentration of 26-carbon acylcarnitine (t =-2.189,P =0.041) was lower than full-term ones;the concentrations of alanine (t =2.354,P =0.022),glutamine (t =2.520,P =0.015),pipecolic acid (t =2.017,P =0.049),proline (t =2.204,P =0.032) in premature AGA newborns were higher than those in full-term ones,but the concentrations of homocysteine (t =-2.624,P =0.011),seven carbon acylcarnitine(t =-2.403,P =0.020),and ten carbon acylcarnitine (t =-5.739,P =0.000) were lower than those of full-term AGA newborns;the concentrations of homocysteine (t =-2.421,P =0.020),decanogl carnitine(t =-2.181,P =0.035),methyl propylene acyl carnitine (t =-2.373,P =0.022),pentyl acyl carnitine (t =-2.165,P =0.036),decyl acyl carnitine (t =-4.148,P =0.000),hydroxyl acetyl carnitine (t =-2.097,P =0.042),hydroxyl cetyl acylcarnitine (t =-2.446,P =0.019) in premature IUGR were higher than those in fullterm IUGR newborns;but the concentrations of arginine (t =2.167,P =0.036),glutamic acid (t =2.469,P =0.018),histidine (t =2.718,P =0.009),leucine/isoleucine (t =3.938,P =0.000),ornithine (t =4.264,P =0.000),serine (t =2.647,P =0.011),threonine (t =2.311,P =0.026),tryptophan (t =4.040,P =0.000),valine (t =2.700,P =0.01),7-carbon acylcarnitine (t =-2.44 1,P =0.019),18-carbon diene carnitine (t =2.449,P =0.018),capric acylcarnitine(t =-4.148,P =0.000) and hydroxyl acetyl carnitine (t =-2.097,P =0.042) were lower than those in full-term IUGR newborns.(3) For AGA newborns,metabolites had no differences between male and female (P ＞ 0.05);however,for newborns with IUGR,metabolites significantly differed between male and female,and the concentrations of aspartic acid(t=2.521,P =0.016),glutamate(t =-2.175,P =0.035) in male IUGR were lower than those in female newborns with IUGR,but the concentration of 26-carbon carnitine (t =2.231,P =0.031) was higher than that in female group.(4) Birth weight had no significant effect on free carnitine concentration or on the ratios of free carnitine and acylcarnitine to total carnitine(all P ＞ 0.05).Conclusions IUGR infants exhibit significant abnormalities in amino acid and acylcarnitine metabolism,especially those with birth weight ＜ 3rd percentile.With the increase of birth weight,amino acids and acylcarnitines showed compensatory increases or decrease,and when birth weight reached the 10th percentile,the newborns with IUGR were close to the AGA newborns.

Objective To explore the expression of heat shock protein (HSP) 90α in outside of different metastatic hepatocellular carcinoma (HCC) cell lines and its role in the cells migration and invasion.Methods The expression of HSP90α was detected by Western blot analysis in conditioned media of MHCC97L and MHCC97H with low and high metastatic HCC cell lines.A small molecule cell-impermeant HSP90 inhibitor DMAG-N-oxide was used to inhibit extracellular HSP90α.Changes of the cells migratory and invasive capability were assessed by in vitro motility and invasion assay.The endogenous matrix metalloproteinase 2 (MMP-2) was demonstrated by Zymography.The expression of extracellular co-chaperone HSP70 and MMP-2 were tested by Western blots and the association between HSP90α,HSP70 and MMP-2 was analyzed by immunoprecipitation.The effects of HSP70 knockdown by siRNA,with or without MMP-2 inhibitor Batimastat,on the level of active MMP-2 and cell migration and invasion were also evaluated.Results HSP90α can express both inside and outside of different metastatic HCC cell lines,and the level of expression was consistent with metastasis potentials.After MHCC97-H cells were treated with a special HSP90α inhibitor DMAG-N-oxide for 24 h,the average migratory cell numbers (28.11 ±3.56) had a significantly reduction,compared with those without treatment group (80.12±4.16) and empty control group (82.24±4.12),respectively (P ＜ 0.01).In vitro invasion assay showed the average invaded cell numbers in treatment group (36.54±4.12) were more fewer than without treatment group (95.12±3.48) and empty control group (101.1 1±3.36),respectively (P =0.017),and accompanying with decreasing of the extracellular MMP-2 activity.HSP70 and MMP-2 could express outside of MHCC97-H cells and interact with HSP90α.Small molecular interfere RNA (siRNA) dramatically inhibited HSP70 expression and reduced the interaction HSP90α with MMP-2 and MMP-2 activity outside MHCC97-H cells,and also suppressed MHCC97-H cells migration and invasion.In addition,combining MMP-2 inhibitor had additive inhibition effects.Conclusion Extracellular HSP90α and HSP70 form chaperone complex to assist in MMP-2 activation and increases HCC cells migration and invasion,which maybe a novel therapeutic target against metastatic HCC.