Costimulatory signals have become a hot field in immunological researches. As co-inhibitory molecules, programmed death-1 ( PD-1) and its ligands (PD-1/PD-L) have been demonstrated to play an important role in autoimmune disease, organ transplant rejection, microorganism infection, tumor immune escapes etc. . In recent years,some studies about PD-1/PD-L pathway in ophthalmology have been curried out and reported. Some changes were found in PD-1/PD-L pathway, such as ocular immunologic diseases, ocular infectious diseases, ocular tumors, immune privilege in ocular tissues and so on. Through the research on PD-1/PD-L pathway,we can further understand the pathogenesis of some ocular diseases and find new methods for their prevention and treatments. This article reviewed the recent advances in PD-1/PD-L pathway in ophthalmological physiopathology.

Background Research determined that hypoxia inducible factor-1(HIF-1)is associated with the hypoxia response in normal organ,and it plays an important role during the embryon development.It is also proved that the expression of vascular endothelial growth factor(VEGF)is upregulated in embryon retina.But,whether the action of HIF-1 and VEGF is correlated is unclear. Objective The aim of this study was to investigate the dynamic change of expression of HIF-1α and VEGF in retina during embryonic development and explore the role of HIF-1α and VEGF along with retinal evolvement.Methods The different embryon ages of SD rats were obtained from 30 clean pregnant SD rats by cesarean surgery.The retinas were isolated from embryon 10一day,12一day,14-day,16-day and 20-day rats respectively.The expressions of HIF-1 α and VEGF protein in retina were semi-quantitatively and qualitatively determined by immunochemistry,and the expressions of HIF-l α and VEGF mRNA in retina with different-embryon-phase and adult rats were detected by RT-PCR. Results The hishly level of expression of HIF-1 α and VEGF protein were found in the cellular nuclei and cytoplasm of retina in embryon 10一and 12-day rats.With the increase of embryon age.the expression of HIF-1α and VEGF protein in retina lowed(F=56.70,P<0.01；F=60.78.P<0.01).Compared with the adult rats,the expressions of HIF-1α and VEGF protein in retina were higher from embryon 0-day through 20-day rats(all P<0.01).The significantly positive correlation was found in the expression level between HIF-1α and VEGF protein throughout the experimental duration(r=0.96,P=0.00).Followed the same pattern,the expression levels of HIF-1α and VEGF mRNA in retinas were also enhanced in the embryon 10- and 12-day rats.Identically,a gradually weakened trend was seen in the expressions of HIF-1 α and VEGF mRNA in retinas as the increase of gestational age of rats(F=68.84,P<0.01；F=96.49,P<0.01),and the exDressions of HIF-1 α and VEGF mRNA decreased in the adult rats compared with different embryon-phase rats,showing a statistically significant difference between them(all P<0.01). Conclusion The expressions of HIF-1 αand VEGF in retina appear a dynamic alteration from hish to low during the embryonic development of rat retina,indicating that HIF-1α/VEGF pathway might participate in the process of embryo development of rat retina.

Objective To compare volume-controlled ventilation (VCV) versus pressure-controlled ventilation (PCV) improved by PEEP during one-lung ventilation (OLV).Methods Fifty ASA physical status Ⅰ-Ⅲ patients,aged 25-64 yr,weighing 40-80 kg,undergoing elective thoracotomy,were randomly divided into 2 groups (n =25 each) using a random number table:VCV + PEEP group (group Ⅴ) and PCV + PEEP group (group P).Those in group Ⅴ underwent OLV initially with VCV for 20 min followed by 4cm H2O PEEP for 20 min and then PEEP was removed.Those in group P underwent OLV initially with PCV for 20 min followed by 4cm H2O PEEP for 20 min and then PEEP was removed.At the beginning of two-lung ventilation before chest opening (T1),at 20 min of OLV before PEEP (T2),and at 20 min of ventilation with PEEP (T3),arterial blood samples were collected for blood gas analysis and the peak airway pressure (Ppeak) and development of SpO2 ＜ 95 ％ from beginning of OLV to T3 were recorded.Results Compared with group P,Ppeak at T2,3 and PaO2 at T3 were significantly increased in group Ⅴ (P ＜ 0.05).Compared with the baseline value at T1,PaO2 was significantly decreased and Ppeak was increased at T2.3 in Ⅴ and P groups (P ＜ 0.05).The incidence of SpO2 ＜ 95％ was significantly decreased and PaO2 was increased at T3 than at T2 in Ⅴ and P groups (P ＜ 0.05).Conclusion 4 cm H2O PEEP can improve VCV and PCV during OLV and the improved efficacy is better for VCV in patients undergoing thoracotomy.

Humans ; Lung Neoplasms ; therapy ; Medicine, Chinese Traditional ; methods ; trends

Objective To study the effect of siRNA targeting bcl-2 gene on the drug-sensitivity of HL-60 cell to homoharringtonin(HT). Methods siRNA, selected by previous experiments and packaged with lipofectamine 2000, was transferred into HL-60 cells. Six hours later, the cells were cultured with homoharringtonin. The cell growth of HL-60 cells was detected by MTT methods at 24, 48, 72 hours respectively. The level of bcl-2 protein and ROS (reactive oxygen species, ROS) as well as membrane potential of mitochondrion was determined by flowcytometry. Results The siRNA could significantly increase the inhibitive effect of homoharringtonin on growth of HL-60 cells. The combination of siRNA with homoharringtonin resulted in the falling of bcl-2 protein level and rising of ROS level as well as descending of membrane potential of mitochondrion of HL-60 significantly (P

Objective:To explore the effective diagnosis method and the clinical effect of laparoscopic technique for atypical CE1 hepatic cystic echinococcosis.Methods:The clinical data of 17 patients with atypical liver cystic echinococcosis from June 2018 to June 2019 in the People's Hospital of Xinjiang Uygur Autonomous Region were analyzed retrospectively, including 11 males and 6 females, (46.0±21.6) years old, all patients with a history of exposure in animal husbandry area. Preoperative hydatid immunity test, abdominal ultrasound and abdominal CT examination were completed, and laparoscopic surgery was performed. Postoperative follow-up was conducted by outpatient review and telephone, and the follow-up period was up to June 2020. The diagnosis, operation and recurrence of hydatid disease by different examination methods were analyzed.Results:Preoperative serum immunological examination of 17 patients showed that 11 were positive and 6 were negative for hepatic echinococcosis. The results of abdominal CT showed that 17 cases were hepatic cyst. Conventional color doppler ultrasound showed that 14 patients were hepatic cyst, 3 patients showed cystic space occupying, and cystic hydatidosis was not excluded; 9 patients observed double track sign or local thickening of cystic wall at the top of hepatic cystic lesions after replacement of high-frequency probe, which was diagnosed as hepatic cystic echinococcosis(CE1) , 8 patients as hepatic cyst. All 17 patients underwent laparoscopic operation, during which they were definitely diagnosed as hepatic cystic echinococcosis (CE1). During the operation, there was no conversion to laparotomy. The operation time was (125.0±54.5) min, the intraoperative blood loss was (150.0±84.5) ml without blood transfusion, and the postoperative hospital stay was (6.5±2.5) d. There were no serious complications or deaths in the perioperative period, 2 cases had microbile leakage, and recovered by themselves 5-10 days after the operation; the patients were followed up for 6-12 months, no loss of follow-up, no recurrence of liver and abdominal hydatid.Conclusions:In the process of diagnosis and treatment of liver single cystic lesions, we should pay attention to the differential diagnosis of atypical CE1 hepatic cystic echinococcosis and simple liver cyst. The effective differential rate of abdominal spiral CT, hydatid immune experiment and abdominal ultrasound is low, which is easy to be misdiagnosed and missed. The high frequency probe of abdominal ultrasound can effectively find atypical CE1 hepatic cystic echinococcosis. Laparoscopic technique is not only an effective diagnosis method but also a treatment method. It is necessary to choose a reasonable operation method according to the patient's hydatidosis. Laparoscopic operation is safe and feasible in the treatment of hepatic cystic echinococcosis.

Outpatient care services are usually the patient's first contact between the patients and the most bas-ic health care. The provision of outpatient care contributes to immediate and large gains in health status. The pay-ment method is one of the most common incentive methods applied by purchasers to guide the performance of outpa-tient care providers. This systematic review applied cochrane review method, and searched, screened, assessed and synthesized the relevant original studies. 19 studies were finally included. It was found that existing payment methods combined with P4 P interventions could probably slightly improved the health professionals' use of some tests and treat-ments ( adjusted RR median = 1 . 095 , range 1 . 01 to 1 . 17 ) , but may have led to little or no difference in patients' utilisation of health services ( adjusted RR median = 1 . 01 , range 0 . 96 to 1 . 15 ) and may have led to little or no difference in the control of blood pressure or cholesterol ( adjusted RR = 1 . 01 , range 0 . 98 to 1 . 04 ) . Pay for per-formance involves a complex design, each detail design may contain different incentive effect, therefore policy makers intend to apply pay-for-performance to guide the behavior of health providers, the design on each components of pay for performance should be analyzed in order to find more potential intervention points.

To popularization and improvement of on-the-spot rescueability is a vital means to reduce the accidental disability rate and the mortality rate,which is also a prospective concept of health.To popularize on-the -spot rescue knowledge and to improve self and mutual medical aid is a strongly public welfare and is the manifestation of social responsibility as well as respect for life.Based onthe investigation of on-the-spot rescue ability among three higher vocational college students in Shaanxi,this paper pointed out that the popularity rate of on-the -spot rescue knowledge was low among higher vocational college students,which no longer kept pace with the demand of social development and occupational requirement.It also analyzed the importance and urgency of improving higher vocational students'on-the-spot rescue ability from the perspective of social ethics.Strengthening the propaganda and training self-rescue skills might be a possible way to enhance students' on-the-spot rescue ability.

OBJECTIVE:To observe the effects of alprostadil combined with papaverine on blood coagulation indexes and complications in uremic hemodialysis patients after initial arteriovenous fistula.METHODS:One hundred and eighteen uremic hemodialysis patients undergoing initial arteriovenous fistula in our hospital during Feb.-Jun.2015 were divided into control group and observation group according to random number table,with 59 cases in each group.Both groups received local irradiation with hemodialysis internal fistula repair instrument 30 min,tid,from 3 days before surgery to 10 days after surgery.Control group was treated with Alprostadil injection 10 μg,iv,qd,immediately after surgery.Observation group was additionally treated with Papaverine in jection 30 mg,iv,qd,on the basis of control group.Both groups received treatment for 10 d.The orificium fistulae blood flow,hemodialysis blood flow and the time of initial hemodialysis were compared between 2 group.The plasma prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinogen (Fib),platelet count (PLT) and C-reactive protein (CRP) levels were observed in 2 groups before and after surgery.The occarrence of postoperative complications was observed.RESULTS:The orificium fistulae blood flow and hemodialysis blood flow of observation group were significantly higher than those of control group,and ini tial hemodialysis time was significantly shorter than control group,with statistical significance (P＜0.05).Before surgery,there was no statistical significance in PT,APTT,Fib,PLT and CRP between 2 groups (P＞0.05).After surgery,APTT and CRP of 2 groups were increased significantly,Fib was decreased significantly;the above indexes of observation group was significantly better than that of control group,with statistical significance (P＜0.05).There was no statistical significance in PT,PLT between 2 groups (P＞0.05).There was no statistical significance in the incidence of internal fistula infection and postoperative wound bleeding volume＞ 10 mL between 2 groups (P＞0.05).The incidence of internal fistula occlusion and orificium fistulae thrombus in observation group were significantly lower than control group,with statistical significance (P＜0.05).CONCLUSIONS:The application of alprostadil combined papaverine on uremic hemodialysis patients after initial arteriovenous fistula can effectively prevent inflammation reaction,fistula thrombus formation and fistula occlusion,and improve the maturation of fistula.

Objective:Investigating the expression of HIV-1 co-receptors CXCR4,CCR5 and chemoking SDF-1 in human placentae and trophoblasts is to explore the mechanism of in-utero transmission of human immunodeficiency virus type 1(HIV-1).Methods:Using semi-quantitative reverse transcriptase-polymerase chain reaction,detected the transcripts of CXCR4,CCR5 in placenta tissues and trophoblasts.Immunocytochemistry and immunohistochemistry analysis revealed the expression of CXCR4,CCR5 in primary cultured first trimester trophoblasts and villous tissue.Also the expression of SDF-1 in villi of first trimester,and the presence of SDF-1 in the culture of isolated trophoblasts were examined by in situ hybridization,immunohistochemistry and enzyme-linked immunosorbent assay.Results:CXCR4 and CCR5 mRNA were detected in placentae of various gestational phases and in first trimester trophoblasts.However,primary cultured trophoblasts were found to be reactive only with antibodies against CXCR4.In the villous tissue sections,CXCR4 was found in trophoblasts,while CCR5 in stromal cell and/or Hofbauer cell.First trimester trophoblasts expressed SDF-1 strongly and secreted SDF-1 in vitro.Conclusion:CXCR4 and CCR5 were expressed in placentae.Hence,they maybe involved in in-utero transmission of HIV-1 as co-receptors.However,SDF-1 expressed in trophoblasts may protect fetus from being invaded by X4-HIV-1.R5-HIV-1 may infect CCR5+ stromal cells and/or Hofbauer cells through placental disruptions.