Objective To explore the expression of Survivin and MHC in non-small cell lung cancer (NSCLC), and their interaction.Methods A total of 40 patients with histologically diagnosed NSCLC were enrolled in this study.Control samples were consisted of normal lung tissues from 15 patients.Expression of Survivin and MHC were detected by flow cytometry in 40 non-small cell lung cancer tissues and 15 normal lung tissues.Results The positive rates of Survivin protein expression in NSCLC tissues classified stages Ⅰ,Ⅱ and Ⅲ were 28.57% ,30.77% and 80.00% respectively.There was a correlation between Survivin protein expres-sion and stages of NSCLC.Survivin protein expression was detected in 19 of 29 patients with lymph node metas-tasis, and 3 of 11 patients with no metastasis.There was a statistically significant difference between the two groups (P<0.030).The loss expression rates of MHC-Ⅰ in NSCLC tissues of low grade,intermediate grade and high grade were 84.62% ,42.10% and 37.50% respectively.There was a correlation in expression be-tween MHC-Ⅰ and tumor grade.The positive rates of MHC-Ⅱ expression in NSCLC tissues was related to pa-thology type (P=0.005).The expression in squamous cancer and non-squamous non-adno cancer was lower than that of adenocarcinoma (P=0.002, P=0.04).There was no obvious correlation between the expression of Survivin and MHC-Ⅰ,MHC-Ⅱ in NSCLC.Conclution The expression of Survivin and MHC could be in-volved in the pathogenesis and development of NSCLC, and the combined detection will predict the prognosis of the patients with NSCLC.

Medical care on the battlefield is the core and basis of echelons of care.This review summarizes the background and characteristics of medical care units on the battlefield from the birth and growth of mobile army surgical hospitals before being replaced by forward surgical teams and combat support hospitals, since the United States Armed Forces began to lead the world military revolution during and after the World WarⅡ.Quick adaptation to the combat envi-ronment and the combat modes is the main reason that medical care units on the battlefield are adjusted continuously.This paper may provide some ideas for the development of our medical care units on the battlefield in the future.

Objective To determine the effects of histone deacetylase inhibitor suberoylanilide hydroxamic acid(SAHA) on the cell proliferation and apoptosis of the human hepatic stellate cell line LX-2.The possible underlying mechanisms were also investigated.Methods The LX-2 cells were treated with SAHA in vitro.The morphology of LX-2 cells in different concentrations groups was observed by inverted microscope;the proliferation of LX-2 cells was measured by MTT assay;the Annexin V-FITC and PI staining was used to detect the apoptosis of LX-2 cells by flow cytometry and fluorescence microscope;the expression of α-SMA,collagen Ⅰ,acH3K9,acH3K14 and acH3K18 were detected by Western blot.Results The morphology change of LX-2 cells showed that SAHA inhibited the proliferation rate of LX-2 cells and in a dose dependent manner(P<0.05).The LX-2 cells were sensitive to SAHA along with time increasing,and in a time-dependent manner(P<0.05).Western blot showed that the expression levels of α-SMA and collagen-Ⅰ were significantly lower(P<0.05),on the contrary,the acetylation levels of acH3K9,acH3K14 and acH3K18 were significantly higher (P<0.05).Conclusions The increased acetylation of the histone acH3K9,acH3K14,acH3K18 and the lower expressed α-SMA and collagen-Ⅰ in LX-2 cells may be one of the mechanisms of SAHA.

Objective To investigate the clinical efficacy of coronary renal shunt via splenic vein for portal hypertension (PHT) after splenectomy.Methods The retrospective descriptive study was adopted.The clinical data of 5 patients with PHT who were admitted to the People's Hospital of Ningxia Autonomous Region from August 2012 to April 2015 were collected.Operative procedures:two procedures of coronary renal shunt via splenic vein (SV) were carried out after primary splenectomy.Procedure 1:the SV was freed from the residual end to the right for 5-6 cm in length and end-to-side spleno-renal shunt was carried out.The anterior wall of superior mesenteric vein (SMV) was exposed beneath the pancreatic neck and dissected behind the neck upward until the upper edge of the SV and its confluence with the left gastric vein (LGV) were exposed.The SV was ligated with clip between portal vein (PV) and LGV to let blood flow from LGV drain through the whole course of SV to left renal vein (LRV).Procedure 2:the peritoneum at the inferior border of the pancreas was incised,and the junctions of the SV and SMV and junctions of the SV and LGV were exposed.The inferior mesenteric vein (IMV) was divided between ligations.Dissection of the SV was carried out to the left for 3-4 cm in length and was divided.Its distal end was tied and proximal stump anastomosed to LRV by the end-to-side anastomosis.The SV was ligated with clip between PV and LGV.The right gastric and gastroepiploic vessels were ligated at the junction of the antrum and the body,and from this point,the hepatogastric ligment and the omentum were divided upward and downward respectively to completely separate the venous flow between the hepatointestinal area and the stomach in the two procedures.Patients took oral enteric-coated aspirin and warfarin after operation.(1) Intraoperative observation indicators included surgical procedures,operation time,volume of blood loos and free portal pressure (FPP).(2) Postoperative observation indicators included recovery of patients,time to anal exsufflation,time for diet intake,time of abdominal drainage,duration of hospital stay and occurrence of complications.(3)The follow-up using telephone interview and outpatient examination was performed to detect the changes of platelet (PLT),portal vein thrombosis (PVT),patency of spleno-renal vein anastomosis,oral anticoagulants and gastroesophageal varices up to October 2015.Measurement data with skewed distribution were analyzed by M (range).Results (1)Intraoperative observation indicators:5 patients underwent successful coronary renal shunt via splenic vein.Two patients received procedure 1 and 3 patients received procedure 2.Operation time and volume of blood loss were 226 minutes (range,195-298 minutes) and 425ml (range,235-820 mL).FPP was 3.46 kPa (range,2.69-4.61 kPa) before spleen resection,2.69 kPa (range,2.11-3.07 kPa) after spleen resection,2.98 kPa (range,2.30-3.36 kPa) after spleno-renal anastomosis,respectively.(2) Postoperative observation indicators:5 patients had good recovery,and time to anal exsufflation,time for fluid diet intake,time of abdominal drainage removal and duration of hospital stay were respectively 3 days (range,2-4 days),3 days (range,2-4 days),5 days (range,4-9 days) and 14 days (range,10-17 days).Of 5 patients,1 was complicated with pleural effusion and atelectasis and 1 with serum tumescence of incision.(3) Follow-up situations:5 patients were followed up for a median time of 18 months (range,6-36 months).The level of postoperative PLT was continuously growing,and the dose of oral warfarin was increased according to the level of growing PLT.The follow-up results of procedure 1 in 2 patients:1 patient was followed up for 36 months and complicated with splenic vein thrombosis at postoperative month 6,and underwent transcatheter hepatic arterial chemoembolization (TACE) due to primary liver cancer at postoperative month 12,and then no special treatment was conducted due to splenic vein occlusion and sever esophageal varices without red-color sign or bleeding at postoperative month 36.The other patient was followed up for 24 months,and didn't undergo special treatment due to mild hepatic encephalopathy with a level of blood ammonia of 76 μmol/L at postoperative month 3,and then was found to have mild esophageal varices at postoperative month 18 by computed tomography (CT) and gastroscopy.Three patients using procedure 2 were followed up at month 6,12,18,with increased body mass index (BMI) and without occurrence of peritoneal effusion and hepatic encephalopathy,and they were complicated with mild gastroesophageal varices by reexamination of CT angiography and gastroscopy at postoperative month 6.Conclusion Coronary renal shunt via splenic vein for PHT after splenectomy could relieve hypersplenism and reduce selectively vein decompression of gastroesophageal varices.

AIM:To study the effects of suberoylanilide hydroxamic acid (SAHA) on the apoptosis of hepatic stellate cells (HSCs) and expression of associated proteins, and to investigate the mechanisms of SAHA to induce apoptosis.METHODS:The rat HSCs were isolated by OptiPrep gradient centrifugation method.The effect of SAHA on HSC proliferation was detected by real-time cell analyzer.The morphological changes of HSCs treated with SAHA at different concentrations were observed under inverted microscope.The apoptotic rates of HSCs were analyzed by flow cytometry with Annexin V-FITC/PI staining and fluorescence microscopy.The protein expression of α-smooth muscle actin (α-SMA), collagen I, tissue inhibitor of metalloproteinase 1 (TIMP1), glucose-regulated protein 78 (GRP78) and histone deacetylase 6 (HDAC6) was detected by Western blotting.The interaction of GRP78 with HDAC6 in the HSCs was determined by co-immunoprecipitation.RESULTS:HSCs were successfully isolated and cultured for 14 d, during which the HSCs changed gradually from rest state to active state.SAHA significantly inhibited the proliferation of HSCs in a time-and dose-dependent manner (P<0.05).The results of Western blotting showed that the protein expression levels of α-SMA, TIMP1, collagen-I and HDAC6 were significantly decreased (P<0.05), while GRP78 was significantly increased (P<0.05).Compared with activated HSCs, GRP78 and total acetyl-lysine protein were significantly increased in the co-immunoprecipitated HSCs treated with SAHA, while HDAC6 protein was significantly decreased, indicting that GRP78 formed a complex with HDAC6.CONCLUSION:The anti-hepatic fibrosis effect of SAHA may be related to down-regulation of HDAC6 and up-regulation of acetylated GRP78, thus inducing endoplasmic reticulum stress of HSCs and promoting the apoptosis of HSCs.

ObjectiveTo explore the diagnosis and prognosis value of clinical pneumonic infection score (CPIS) in patients with stroke-associated pneumonia (SAP).MethodsOne hundred and fifty stroke patients were evaluated and analyzed by CPIS.SAP was regarded as gold standard,and sensitivity,specificity,diagnose accordance rate,positive predictive value and negative predictive value were calculated.Results Thirty-nine patients had SAP and 111 patients did not have SAP by CPIS,and the incidence of SAP was 22.0％ (33/150).CPIS diagnostic sensitivity was 84.8％ (28/33),specificity was 90.6％ ( 106/117 ),positive predictive value was 71.8％ (28/39),negative predictive value was 95.5％ (106/111),and diagnose accordance rate was 89.3％(134/150).The patients of SAP were divided into good prognosis (28 cases) and bad prognosis (5 cases),and the CPIS was significantly lower in patients of good prognosis 7 days after SAP than that in patients of bad prognosis[(4.21 ± 2.23) scores vs. (6.05 ±2.32) scores,P ＜0.05].ConclusionsNot only CPIS has higher diagnosis rate in SAP incidence,but also has good judgment to prognosis.It is worthy of clinical application.

Objective To observe the effect of rosuvastatin calcium on lipid,vascular endothelial growth factor (VEGF),nitric oxide (NO),tumor necrosis factor (TNF)-α and interleukin (IL)-1 in hyperlipidemia patients.Methods One hundred and twenty-seven hyperlipidemia patients were randomly divided into two groups.Patients in the study group included 72 patients which were given rosuvastatin calcium 10 mg and enteric-coated aspirin 100 mg,orally,once a day for 8 weeks.The control group included 55 patients which were only given enteric-coated aspirin 100 mg,orally,once a day for 8 weeks.The change of lipid,VEGF,NO,TNF-α and IL-1 was observed before and after treatment.Results Before treatment,the level of total cholesterol(TC),triglyceride (TG),low density lipoprotein-cholesterol (LDL-C),high density lipoprotein-cholesterol (HDL-C),VEGF,NO,TNF-α and IL-1 in two groups had no significant difference (P ＞ 0.05).After treatment,the level of TC,TG,LDL-C,TNF-α and IL-1 in study group were significantly lower than those in control group [(4.410 ± 0.688) mmol/L vs.(6.491 ± 0.744) mmol/L,(1.762 ± 0.834) mmol/L vs.(2.632 ± 0.792) mmol/L,(2.256 ± 0.347) mmol/L vs.(4.544 ± 0.493) mmol/L,(41.14 ± 5.41) ng/L vs.(71.34 ± 6.76) ng/L,(0.22 ± 0.18) μ g/L vs.(0.42 ± 0.23) μ g/L] (P ＜ 0.05).The level of HDL-C,VEGF and NO in study group were significantly higer than those in control group [(1.807 ± 0.730) mmol/L vs.(1.432 ± 0.514) mmol/L,(564.86 ± 120.02) ng/L vs.(451.23 ± 100.72) ng/L,(42.39 ± 6.71) μ mol/L vs.(33.65 ± 6.24) μ mol/L](P＜ 0.05).No adverse reaction occurred in two groups.Conclusions Rosuvastatin calcium can obviously decrease the level of lipid,elevate the expression of VEGF and NO,and reduce the expression of TNF-α and IL-1.Rosuvastatin calcium can improve vascular endothelial function obviously in hyperlipidemia patients.

Objective To observe the activities of serum peroxidase capacity,and lipid peroxidation of children from Kaschin-Beck disease (KBD) areas of Xinghai county in Qinhai province,and to explore the relationship between antioxidant capacity and KBD.Methods Sixty four KBD and forty six health subjects without KBD were chosen from KBD endemic areas,which included primary schools of Tangnaihai,Xialujuan and Qushian of Xinghai county in Qinghai province,and fifty nine age-matched healthy control subjects without KBD were from a non-KBD endemic area,Nanfan primary school of Chang'an county in Shaanxi province.Twenty patients with KBD and twenty control subjects from KBD areas and non-KBD area were extracted by simple random sampling method.2,3-DAN fluorescence technique was used to test the hair and blood selenium.The biochemical techniques were used to test the indicators of oxidative stress including malondialdehyde(MDA),antioxidant enzyme activities,total antioxidant capacity(T-AOC),serum superoxide dismutase(SOD),catalase(CAT) and glutathione peroxidase(GSHPx).ResultsAll patients with KBD had significantly lower serum GSH-Px activities[ (59.53 ± 25.23)kU/L] and selenium levels in hair[ (67.64 ± 17.28)μg/L] and blood[(36.27 ± 13.29)μg/L],respectively,than that of control subjects from KBD areas [ ( 91.88 ± 22.99 ) kU/L,( 153.32 ± 24.31 ) μg/L,( 63.06 ± 13.66) μg/L ] and nonKBD areas[ ( 122.68 ± 41.74)kU/L,(242.35 ± 38.56)μg/L,(98.93 ± 17.18)μg/L,all P ＜ 0.05].Serum MDA levels in KBD patients[ (4.64 ± 1.11 )μmol/L] were significantly higher than that in control subjects from KBD [(3.31 ± 1.22)μmol/L] and non-KBD areas[ (3.43 ± 1.29)μmol/L,all P ＜ 0.05].On the other hand,T-AOC,SOD and CAT activities were significantly higher in both KBD[(19.80 ± 6.64),(55.80 ± 8.14),(16.45 ± 5.61 ) kU/L] and control subjects[ (21.71 ± 8.82),(57.45 ± 6.96),(15.63 ± 9.18)kU/L] from KBD areas than that of control subjects from non-KBD area[ (13.56 ± 5.38),(42.79 ± 8.10),(6.05 ± 2.71 )kU/L,all P ＜ 0.05 ].Hair selenium levels,blood selenium levels and GSH-Px activity of control subjects from KBD areas were,respectively,significantly lower than that in control subjects from non-KBD area(all P ＜ 0.05).Conclusions These findings strongly confirm the evidence that KBD patients are susceptible to oxidative stress.The results also show the increase in antioxidant enzymes,which could probably be due to adaptive response to pro-oxidant in KBD state.Hence,there seems to be an imbalance between oxidant and antioxidant systems in KBD patients.

Objective:To investigate the risk factors of pancreatic fistula after radical resection of gastric cancer, and to establish a risk prediction scoring model for pancreatic fistula.Methods:The clinico-pathological data of 312 patients with gastric cancer admitted to the Fourth Hospital of Hebei Medical University from January 2019 to January 2020 were retrospectively analyzed. Multiple factor logistic regression model was used to analyze the risk factors of pancreatic fistula after radical resection of gastric cancer, and a risk prediction scoring model based on the risk factors was established. Hosmer-Lemeshow test was used to detect the goodness of fit of regression equation, and receiver operating characteristics (ROC) curve was used to evaluate the distinction degree of regression equation.Results:Among 312 patients with gastric cancer, 27 cases (8.65%) had pancreatic fistula after radical resection of gastric cancer. Multiple factor logistic regression analysis showed that male patients ( OR = 5.312, 95% CI 1.532-18.420, P = 0.008), age ≥ 60 years old ( OR = 4.928, 95% CI 1.493-16.250, P = 0.009), preoperative diabetes mellitus ( OR = 3.062, 95% CI 1.091-8.589, P = 0.034), lesion location in the gastric body-gastric antrum ( OR = 3.121, 95% CI 1.052-9.251, P = 0.040), intraoperative omental bursa resection ( OR = 6.209, 95% CI 2.084-18.478, P = 0.001), intraoperative lymph node dissection at D2+ station ( OR = 3.114, 95% CI 1.044-9.281, P = 0.042), intraoperative combined organ resection ( OR = 5.063, 95% CI 1.473-17.400, P = 0.010), preoperative TNM stage Ⅲ ( OR = 4.973, 95% CI 1.189-20.792, P = 0.028) were independent risk factors for pancreatic fistula after radical resection of gastric cancer. A risk prediction equation of pancreatic fistula after radical resection of patients with gastric cancer was established: P = -8.619+1.670X 1+1.595X 2+1.119X 3+1.138X 4+1.826X 5+1.136X 6+1.622X 7+1.604X 8; factor X was set as a binomial assignment (0 or 1); X1-X8 were listed as follows respectively: gender (the male was 1), age (≥60 years old was 1), preoperative diabetes history (yes was 1), lesion location (gastric body-gastric antrum was 1), intraoperative resection of omental bursa or not (yes was 1), intraoperative lymph node dissection at D2+ station or not (yes was 1), intraoperative combined organ resection or not (yes was 1), preoperative TNM stage (stage Ⅲ was 1). The goodness of fit of regression equation was high ( P = 0.395). The area under the curve of ROC by using risk prediction scoring model to judge pancreatic fistula was 0.916 (95% CI 0.872-0.960, P<0.01). The probability of pancreatic fistula in patients with score ≥ 5 was 40.90%, and the probability of pancreatic fistula in patients with score < 5 was 3.35%. Conclusions:The occurrence of pancreatic fistula after radical resection of gastric cancer is closely related to a variety of risk factors. By establishing a risk prediction scoring model for pancreatic fistula after radical resection of gastric cancer, it is helpful to effectively identify patients with high risk of pancreatic fistula after radical surgery during the perioperative period.

Objective To explore the method and effect of thumb and finger reconstruction and repair by emergent primary toes transplantation. Methods Three hundred and fourteen fingers of 282 cases including finger thumb defect and complex injury with hyperthena palm radid soft tissue of forearm were reconstructed and repaired by the second toes, wrap-around flap and the second third toes wrap-around flap combined with distal flap of leg or other complex tissue flap transplantation. Results Three hundred and eight reconstructed fingers survived, the survival rate was 98%. After a follow up to 6 months to 6 years, the reconstructed thumbs and fingers have accepted nip, grasp, opponent function. The result was graded as excellent in 214 fingers, good in 63, fair in 26, poor in 5. The excellent and good rate was 88%according to the upper limb functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association. Conclusion Different type of toes and combined toes transplantation can obtain preferable clinical effect on emergent primary thumb and finger defect.