With the process of rapid mobilization,China is suffering from huge road tolls.The ethical issues related to road safety are also emerging.To provide recommendations for relevant public policies,we discussed several ethical issues in this article as follows.Human lives and health may not be traded off for the benefit of mobilization.The designers,regulators of road traffic system share responsibilities for road safety with users.The principle of equity needs to be embodied in the road traffic system.Therefore,it is necessary to increase investment in underdeveloped areas and enhance the protection of vulnerable road users.

Objective To investigate the risk factors of symptomatic vasospasm after aneurysmal subarachnoid hemorrhage and evaluate the effect of lumbar drainage of cerebrospinal fluid on vasospasm.Methods In this retrospective controlled-cohort study, 175 patients with aneurysmal subarachnoid hemorrhage met our study criteria between January 2012 and December 2013.By multi-factor regression analysis, gender, age, Hunt-Hess grade, modified Fisher grade and lumbar drainage were analyzed.The outcomes were assessed by the presence or absence of symptomatic cerebral vasospasm and vasospasm-related infarction, and the mean days of hospital stay and score of Glasgow Outcome Scale at 1-month follow-up.Results Several factors affected the prognosis of subarachnoid hemorrhage.Lumbar drainage was a protective factor of symptomatic cerebral vasospasm (OR =0.243, 95％ CI: 0.119-0.497) and vasospasm-related infarction (OR =0.305, 95％ CI: 0.154-0.604).The patients with lumbar drainage had higher score of Glasgow Outcome Scale (P ＜ 0.05).But the patients with lumbar drainage had longer hospital stay (P ＜ 0.05).Conclusions Lumbar drainage of cerebrospinal fluid after aneurysmal subarachnoid hemorrhage markedly reduced the risk of symptomatic cerebral vasospasm and improved outcome.

Objective To investigate the expression of VEGF-D and MMP-2 and explore their relationship with tumor invasion and local metastasis in pancreatic carcinoma.Methods The expression of VEGF-D and MMP-2 in 30 patients with pancreatic carcinomas and 6 cases with normal pancreatic tissues were detected by SABC immunohistochemical method.Results The positive rates of VEGF-D and MMP-2 proteins were 60%(18/30)and 66.7%(20/30)respectively,no expression of VEGF-D and MMP-2 was detected in normal pancreatie tissues.The expression of VEGF-D was significantly correlated with lymph node metastasis(P＜0.05),and the expression of MMP-2 was significantly correlated with lymph node metastasis and tumor local invasion(P＜0.05).The expression of VEGF-D protein Was positively correlated with MMP-2 protein(rs=0.54,P＜0.01).Conclusions There is a significantly positive correlation between high expression of VEGF-D and MMP-2 proteins in pancreatic carcinoma,and they may contribute to the invasive properties of pancreatic cancer.

Objective To compare and analyze gene expression patterns in rat model of nonalcoholic fatty liver disease (NAFLD).Methods Twelve male Sprague-Dawley rats were randomly given either general diet (control group) or a high-fat diet (model group) for 4 weeks.The histopathologic changes of the liver were observed and gene expression patterns were analyzed and compared by cDNA mieroarray.Results Hepatocellular steatosis and inflammatory infiltration were observed in model group after high-fat diet for 4 weeks.Fifty-one differential genes were found in model group,20 of which were up-regulated (sterol regulatory element binding factor 1,stearoyl-coenzyme A desaturase 1 and Bcl 2 modifying factor)and 31 were down-regulated (peroxisomal enoyl coenzyme A hydratase 1,heat shock 70 protein 1A and ATPase inhibitory factor 1). The up-regulating genes were involved in lipogenesis and cell apoptosis,while down-regulated genes were involved in fatty acid oxidation, protein modification and energy metabolism.Conclusions The differential expression of genes may involve in the pathogenesis of NAFLD.

Objective To investigate the clinical characteristics and surgical management of adult presacral tumors.Methods The clinical data of 24 patients with adult presacral tumors from 2007 to 2012 were retrospectively analysed.All patients were diagnosed by digital rectal examination and imaging examination before operation.Seventeen patients with via sacrococcygeal approach,4 patients with via abdominal approach,and 3 patients with via combined abdominal and sacrococcygeal approach.Results The incision of 22 patients primary healing.There were 2 patients with postoperative incision infections,after dressing change cure.No patients died during perioperative period.Twenty patients were followed up for 3-17 months,1 patient with via abdominal approach recurrenced,and was healed after a second surgical resection.Conclusions Digital rectal examination and imaging examination are the main methods for diagnosis of adult presacral tumors.Most adult presacral tumors can be resected through sacrococcygeal route.

Objective To evaluate the effect of delayed ligature of the umbilical cord on the blood volume in premature infants in early time. Methods From Oct 2007 to Jun 2010,194 premature infants with vaginal birth in department of genecology and obstetrics were randomly divided into routine ligature of the umbilical cord group (100 cases) and delayed ligature of the umbilical cord group (94 cases), comparision were made on ligature time, blood routine examination,blood pressure,oxyhemoglobin saturation and anemia incidence in 24 h,48 h,and 72 h after birth,and hemobilirubin on 1 d,2 d,3 d,and 7 d after birth. Results There were significant differences between the two groups in delayed ligature time [(100. 14 + 10. 57) s vs (22. 40 +5.02) s,P ＜0. 05)]. The hemoglobin and blood pressure in delayed ligature umbilical group were increased significantly(P ＜ 0. 05). There was 3 cases (3. 19%) of anemia in delayed ligature of the umbilical cord group, and 11 cases (11.00%) in routine ligature of the umbilical cord group, which showed significant difference (P ＜ 0. 05). And the hemobilirubin on 7 d after birth showed no significant difference between the two groups(P ＞ 0. 05). Conclusion Delayed ligature of umbilical cord has a significant influence on hemoglobin and blood pressure of premature infant. It can increase the blood volume, and reduce the incidence of anemia in early time.

Objective To study the clinic features and the mechanism of skin damage induced by high-dose methotrexate(HD-MTX).Method Children treated with HD-MTX were enrolled in a retrospective study in which the incidence and presentations of skin damage were concluded.Mechanism of the damage was studied base on skin pathology of an animal model.Result Skin damage presented in 3～9(median 5) days after HD-MTX and usually followed by bullation and exfoliation.Twelve cases,more severe than the others,accompanied with fever and symptoms of other organs especially the respiratory tract and the intestine.Skin damage was reduced when large dose rehydration used before,during and after HD-MTX.Conclusion HD-MTX may cause scald-like skin damage directly by its prolonged toxic effect on epidermal cells.Besides extended tetrahydrofolic acid rescue and supportive treatments,anti infection is the most important in dealing this condition.

Objective:To discuss treatment of complete response cases after neoadjuvant radiotherapy in rectal cancer. Methods:This retrospective study analyzed clinical data of 84 rectal cancer cases with pre-operative neoadjuvant chemoradiotherapy in our hospital from January 2010 to Augnst 2014. Results:After neoadjuvant chemoradiotherapy, 33 patients presented clinically complete response at a rate of 39.3%. After post-operative pathologic examination, among clinically complete response cases, six cases exhibited patho-logically complete responses at a rate of 18.2%. No recurrence or disease progression occurred within 12-36 months of post-operative follow up. Conclusion:Neoadjuvant chemoradiotherapy can significantly lower tumor stage and promote clinically complete remission of some patients. However, for clinically complete remission cases, further radical surgery should be provided.

AIM and METHOD: The adhesion behavior of bone marrow stromal cells(BMSC) in children with acute lymphoblastic leukemia(ALL) to bone marrow mononuclear cells(BMMC) and Raji cells were investigated by MTT method. The expression of adhesion molecules ICAM-1 and VCAM-1 were detected by flow cytometry. RESULTS: The adhesion ability of BMSC in acute period of ALL to BMMC was lower than that of control group. The adhesion ability of BMSC in long term remission period of ALL to Raji cells higher than that of control group. The expression of ICAM-1 on the surface of BMSC in acute period of ALL is much lower than that of control group. CONCLUSIONS: The adhesion of BMSC to BMMC or tumor cells in children with ALL was abnormal. The abnormal adhesion behavior might be partially due to the changed expression of adhesion molecules on BMSC.

Objective To explore the effect of Flavokawain B on the proliferation and apoptosis of acute T lymphoblastic leukemia(T -ALL)cells and its preliminary mechanism.Methods After the T -ALL cell lines CEM-C7(sensitive to glucocorticoids)and MOLT -4(resistant to glucocorticoids)cells were treated with different concentrations of Flavokawain B,the influence of Flavokawain B on the growth rate and doubling time of CEM-C7 and MOLT -4 cells was observed by 3 -(4,5 -dimethylthiazol -2 -yl)-5 -(3 -carboxymethoxyphenyl)-2 -(4 -sulfophenyl)-2H -tetrazolium(MTS)assay,and apoptosis was analyzed by using flow cytometry.Furthermore,Wes-tern blot assay was used to detect the expressions of Bim,Bcl -2 and cleaved Caspase -9.At last,the expressions of Bim and Bcl -2 in clinical T -ALL patient samples were also detected by using Western blot assay.Results MTS as-say showed that Flavokawain B significantly inhibited the cellular proliferation of T -ALL cell lines in a dose and time dependent manner(P <0.01 ).Flow cytometry findings revealed that Flavokawain B significantly induced the apoptosis of T -ALL cells in a dose -dependent manner(P <0.001 ).Western blot results indicated that Flavokawain B in-creased the expression of Bim and cleaved Caspase -9,and decreased the expression of Bcl -2 in T -ALL cell lines, which increased Bim and decreased Bcl -2 in clinical T -ALL patients samples,both in a dose -dependent manner. Conclusions Flavokawain B can inhibit the proliferation and induce the apoptosis of T -ALL cells by up -regulating the expression of Bim and down -regulating the expression of Bcl -2 and activating Caspase -9,whether resistant to glu-cocorticoids or not.