[Clinical Confusion Concerning Increased D-Dimer Value during Pregnancy].

Plasma D-dimer, a special cross-linked fibrin derivative, is produced when fibrin is degraded by plasminase. During pregnancy, D-dimer increases along with the increase of gestational age, and the reference value of plasma D-dimer (≤0.5 mg/L) traditionally used for the screening of venous thrombosis in the normal population is not applicable to the pregnant population. Due to the lack of uniform D-dimer detection methods or measurement units, there is currently no unified D-dimer reference values for pregnancy or puerperium. Each region or laboratory should establish its own pregnancy D-dimer reference value for different gestational weeks through blood coagulation function testing of large numbers of samples of different gestational periods. More and more studies have been conducted to investigate the association between D-dimer and venous thromboembolism (VTE) during pregnancy, gestational hypertensive disorders (GHD) and pregnancy outcome. We reviewed, herein, the generation and measurement of D-dimer, the reference values of D-dimer during normal pregnancy, and the association between D-dimer and some pathological pregnancies, intending to help clinicians develop a more thorough understanding of D-dimer during pregnancy.

[Preeclampsia: An Obstetrician's Perspective].

Preeclampsia-eclampsia is a common obstetric critical disease and obstetricians have studied it assiduously for hundreds of years. We have attempted to explore the etiology, pathology, prevention, intervention, and treatment of preeclampsia-eclampsia, but we still have not arrived at a thorough understanding of its causes, and it is difficult to find effective prevention and treatment methods. Although the research process has been fraught with difficulties and frustrations, we are nonetheless gradually gaining a better understanding of the disease. Perhaps, in the near future, we will be able to acquire a full understanding of the disease and find better ways to ensure the health and safety of mothers and fetuses.

[Latest Research Findings on Prediction of Preeclampsia in Pregnant Women Based on Analysis of Cell-Free RNA in Peripheral Blood].

Preeclampsia gravely threatens the health of mothers and infants. At present, treatment based on the relevant mechanisms of pathogenesis is still not available, and there is no independent reliable clinical index for early prediction of preeclampsia. According to recent studies, analysis of the cell-free RNA in the peripheral blood of pregnant women has shown that testing certain cell-free RNA levels can help predict in advance the occurrence of preeclampsia before clinical symptoms appear. In this paper, we described the status of research and progress in using maternal cell-free RNA analysis in predicting preeclampsia. In addition, we stated that cell-free RNA in peripheral blood may become a promising, real-time and non-invasive monitoring method that can be used to explore the mechanisms of pathogenesis and pathophysiology of preeclampsia and to identify different subtypes of preeclampsia.

[Development of a Predictive Model for Adverse Outcomes of Preeclampsia].

OBJECTIVE: To determine factors associated with adverse outcomes of preeclampsia and develop a predictive model. METHODS: Clinical data of 2 532 patients with preeclampsia who were admitted to our hospital from 2005 to 2014 were extracted for the study. The patients were divided into two groups, including 990 (39.1%) with adverse outcomes and 1 542 (60.9%) without adverse outcomes. Factors associated with adverse outcomes were identified through univariate analyses. The predictive model was developed through multivariate logistic regression analyses using a randomly selected sample containing 80% of the cases. The remaining 20% of cases served for the purpose of validation and the establishment of the ROC curve. RESULTS: Primiparas, educational attainments, prenatal care, multiple births, edema, chest pain, dyspnea, dizziness, headache, blurred vision, intrahepatic cholestasis of pregnancy, gestational diabetes, cardiovascular disease, blood pressure, urine protein, liver and kidney functions were found to be associated with adverse outcomes of preeclampsia. Multiple births, edema, dyspnea, blurred vision, cardiovascular disease, liver and kidney functions entered into the logistic regression model (P<0.05). The Logit(P) model had a good fitness of data and 77.1% accuracy in predicting adverse outcomes. The area under the curve (AUC) of the ROC curve was 0.804 [P<0.01, 95% confidence interval CI): 0.758 to 0.849]. The highest sensitivity was achieved when the cut-off point set risk value at 0.300, [CM(155mm]with 58.6% patients having adverse outcomes representing 83.8% true positive rate and 46.8% false positive rate. CONCLUSION: Adverse outcomes of preeclampsia can be predicted through multiple births, edema, dyspnea, blurred vision, cardiovascular disease, liver and kidney functions. Risk value ≥0.300 is recommended.

[Severe Adverse Pregnancy Outcomes in Placenta Previa and Prior Cesarean Delivery].

OBJECTIVE: To investigate the severe adverse pregnancy outcomes in pregnancies with placenta previa and prior cesarean delivery and its risk factors. METHODS: This retrospective casecontrol study reviewed all pregnancies with placenta previa and prior cesarean delivery delivered by repeat cesarean section in our institution between January 2005 and June 2015,and investigated the incidence of severe adverse pregnancy outcome. A composite of severe adverse pregnancy outcomes (including transfusion of 10 units or more red blood cells,maternal ICU admission,unanticipated injuries,repeat operation,hysterectomy,and maternal death) and other maternal and neonatal outcomes were described. Univariate and multivariable logistic regression analysis were used to quantify the effects of risk factors on severe adverse pregnancy outcomes. RESULTS: There were 478 women with placenta previa and prior cesarean delivery in our hospital over the last decade. The average age of them was 32.5±4.8 years old,most women were beyond 30 years old,the average gravidity and parity were 4 and 1,131 cases (27.4%) had severe adverse pregnancy outcomes. Transfusion of 10 units or more red blood cells happened in 75 cases (15.7%,75/478); 44 cases (9.2%,44/478) necessitated maternal ICU admission; unanticipated bladder injury occurred in 11 cases,but non ureter or bowel injury happened; All 4 repeat operations were due to delayed hemorrhage after conservative management during cesarean delivery,and an emergent hysterectomy was performed for all of the 4 cases. Hysterectomy (107 cases,22.4%) was the most common severe adverse pregnancy outcome. Among all 311 morbidly adherent placenta cases finally confirmed by pathological or surgical findings or both,only 172 (55.3%) were suspected before delivery. Multivariable logistic regression analysis showed that the risk of severe adverse pregnancy outcomes was significantly increased by pernicious placenta previa (i.e. anterior placenta overlying the prior cesarean scar),suspicion of morbidly adherent placenta before delivery and hemoglobin before delivery lower than 100 g/L,and the corresponding odds ratios and 95% confidence intervals were 2.4 (1.5-3.8),3.6 (2.3-5.6) and 2.5 (1.6-3.9),respectively. CONCLUSION: Pernicious placenta previa,suspicion of morbidly adherent placenta before delivery and hemoglobin before delivery lower than 100 g/L were associated with severe adverse pregnancy outcomes in women with placenta previa and prior cesarean delivery .

[Risk Factors for Blood Transfusion in Women with Postpartum Hemorrhage: a Case-control Study].

OBJECTIVE: To investigate the risk factors for increased red blood cells (RBCs) transfusion ratio in the women with postpartum hemorrhage (PPH). METHODS: This case-control study obtained the inpatient medical records of 112 441 pregnant women from 37 hospitals in 2011. There were 4 131 women diagnosed with PPH,record data of those patients were analyzed,including basic characteristics of patients,the level of hospital,pregnancy related complications,prenatal hemoglobin (Hb),mode of delivery,details of postpartum blood loss and blood transfusion,and maternal and neonatal outcomes. Multiple logistic regression analysis was used to identify risk factors for increased RBCs transfusion ratio. RESULTS: There were 61 339 (54.6%) out of 112 441 women received with Cesarean section and 637 (15.4%) out of 4 131 women with PPH had blood transfusion,one to four units of RBCs were sufficient for a majority of those patients. It demonstrated that level of hospital,multiple,placenta preiva,abruptio placenta,pre-eclampsia or eclampsia,pre-delivery hemoglobin,gestational age and labor method were independent risk factors for RBCs transfusion. CONCLUSION: Cesarean section and pregnant complications are important risk factors for blood transfusion in women with PPH .

Activity and distribution of plasma platelet-activating factor acetylhydrolase in women with gestational diabetes mellitus and their neonates.

BACKGROUND: Abnormal activity and distribution of plasma platelet-activating factor acetylhydrolase (PAF-AH) are associated with chronic inflammatory status. In this study, we investigate the activity and distribution of plasma PAF-AH and their association with metabolic components in mothers with gestational diabetes mellitus (GDM) and in their neonates. METHODS: Based on the International Association of Diabetes Pregnancy Study Group criteria, we performed a case-controlled study of 101 women with GDM, 98 women with uncomplicated pregnancies, 142 neonates of mothers with GDM and 121 neonates of mothers with uncomplicated pregnancies. Plasma PAF-AH, high-density lipoprotein (HDL)-associated PAF-AH (H-PAF-AH) and apolipoprotein (apo) B-containing lipoprotein-associated PAF-AH (apoB-PAF-AH) activities were measured using the trichloroacetic acid precipitation procedure with PAF C-16 as a substrate. RESULTS: The plasma PAF-AH and apoB-PAF-AH activities, triglyceride (TG) levels, atherogenic index and TG/HDL-C ratio were increased, and the H-PAF-AH proportions were decreased in the mothers with GDM compared with the control mothers (p < 0.05). Multivariate regression analyses demonstrated that the apoB and TG levels were significant predictors of plasma PAF-AH or apoB-PAF-AH activities, while the low-density lipoprotein-cholesterol levels, weight gain during pregnancy and age were associated with H-PAF-AH activities. The neonates of mothers with GDM had higher plasma insulin and glucose concentrations (p < 0.05) and tended to exhibit increased serum apoB levels (p = 0.062) compared with the neonates of mothers with uncomplicated pregnancies. CONCLUSIONS: The mothers with GDM presented with a state of chronic inflammation, and these mothers and their neonates also exhibited unfavourable metabolic profiles in terms of glucose and lipids. Copyright © 2016 John Wiley & Sons, Ltd.

[Research status of the pathogenesis of pre-eclampsia].

Pre-eclampsia is a serious obstetric complication, not only affect maternal health, but also affect the long-term prognosis of offspring generation. Even though various theories on the pathogenesis of pre-eclampsia have been proposed in recent decades, it remains unclear due to the disadvantages in these theories. Therefore, the pathogenesis of pre-eclampsia keeps attracting a lot of research efforts in the field of obstetrics. In order to find the new break through points in the study of pre-eclampsia pathogenesis (pre-eclampsia related to genetic, epigenetic and expression changes of some genes), it is necessary to illustrate and understand the research status in this field, with integrating the related resources, updating the new progress, ideas and extensive research means.

[The Ala379Val polymorphism of platelet-activating factor acetylhydrolase gene in Chinese patients with pre-eclampsia].

OBJECTIVE: To investigate the relationship between the Ala379Val polymorphism of the platelet-activating factor acetylhydrolase gene (PAF-AH) and pre-eclampsia (PE) in Chinese pregnant women. METHODS: A total of 592 subjects (210 patients with PE and 382 healthy pregnant women) in Chengdu area were included in this study. The Ala379Val polymorphism of the PAF-AH gene was determined by PCR amplification and restriction analysis. Plasma PAF-AH and high-density lipoprotein-associated PAF-AH (H-PAF-AH) activities were measured by the trichloroacetic acid precipitation method using PAF as substrate and (3 H-acetyl) PAF as tracer. Low-density lipoprotein-associated PAF-AH (L-PAF-AH) activity was obtained by subtracting H-PAF-AH activity from plasma PAF-AH activity. RESULTS: The frequencies of the A and V alleles at Ala379Val site were 0.890 and 0.110 in the patient group, and 0.865 and 0.135 in control group, respectively. No significant differences in the frequencies of the genotypes and alleles were observed between the two groups (P>0.05). However, the body mass index (BMI) and the ratio of L-PAF-AH to H-PAF-AH activities were significantly higher, and H-PAF-AH activity was significantly lower, in patients with V alleles (AV + VV genotypes) compared to patients with AA homozygotes (P<0.05). CONCLUSION: The Ala379Val polymorphism of the PAF-AH gene was not associated with PE, but the V allele variation at this site might be associated with the increased BMI and the abnormal distribution of plasma PAF-AH activities in lipoproteins in patients with PE.

[Interaction between GNB3 C825T and ACE I/D polymorphisms in pre-eclampsia].

OBJECTIVE: To verify the hypothesis if interaction between the G protein beta3 subunit (GNB3) C825T polymorphism and angiotensin-I converting enzyme (ACE) insertion/deletion (I/D) could lead to the increased risk of pre-eclampsia. METHODS: Analyses of ACE and GNB3 genotypes were performed in 188 preeclamptic patients and 273 normal pregnant controls by polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism in Chinese population, respectively. RESULTS: The distributions of alleles and genotypes for the GNB3 C825T and ACE I/D polymorphisms were not found to be significantly associathed with pre-eclamptic status. No significant interaction of the influence of GNB3 T allele and ACE genotypes on the risk of pre-eclampsia was observed (OR 0.439-1.203, all P>0.05). However, we found that in homozygous 825T genotype carriers with the ACE II genotype in controls diastolic blood pressure (DBP) levels showed highest [(77.61 +/- 1.26) mmHg (1 mmHg=0.133 kPa)] among other three genotype combinations [TT/ID, (70.94 +/- 1.64) mmHg; CT/ID, (73.15 +/- 0.89) mmHg; CT/DD, (72.57 +/- 2.14) mmHg] (all P<0.05). No significant effect on systolic blood pressure (SBP) or DBP levels in the patients were observed. CONCLUSION: Our data suggest no significant interaction of the GNB3 825T allele carriers with the ACE I/D polymorphism in pre-eclampsia in Chinese population in Chengdu area. However there is the interaction of the two genes on DBP levels in pregnancy women without pre-eclampsia in the population.

[Expression of NKG2A and NKG2C receptors and their ligand HLA-E in decidua of preeclampsia patients].

OBJECTIVE: To investigatethe expressions of NKG2A, NKG2C receptors and their ligand HLA-E in decidua of preeclampsia patients. METHODS: Decidua tissues were collected from 30 patients with mild preeclampsia, 42 patients with severe preeclampsia and 46 normal pregnancy as contrast. The expressions of NKG2A, NKG2C protein were detected by immunohistochemitry and mRNAs of NKG2A, NKG2C and HLA-E genes were detected by RT-PCR. RESULTS: The expression of HLA-E mRNA was significantly decreased in preeclampsia, especially in severe preeclampsia patients (P < 0.05); The mRNA and protein expression of NKG2A, NKG2C in severe preeclampsia group were significantly higher than that in normal pregnancy group (P < 0.05); In the severe preeclampsia group, the ratio of expression level of NKG2A and NKG2C was significantly lower than that of normal group and the mRNA and protein expression of NKG2C receptor were both significantly higher than that of NKG2A (P < 0.05); The mRNA expression level of HLA-E, NKG2A and NKG2C were closely related with clinical and biochemical indexes,such as blood pressure of late pregnancy and 24-hour proteinuria. CONCLUSION: The decreased expression of HLA-E and the unevenly increase of NKG2A and NKG2C may involve in the pathogenesis of preeclampsia.

[Comparison of operative techniques in single-incision laparoscopic cholecystectomy: suture-suspension versus three-device method].

OBJECTIVE: To compare the operative techniques of single-incision laparoscopic cholecystectomy (SILC) via suture-suspension versus three-device method. METHODS: Retrospective analysis was performed for a total of 300 patients undergoing umbilical single-incision laparoscopic cholecystectomy from June 2008 to November 2011 at our hospital. The procedures were of suture-suspension (n = 200) and three-device (n = 100). Operative duration, estimated intra-operative blood loss, exposure extent of Calot's triangle, postoperative pain score, hospital stay and complications were compared respectively between two groups. Both groups were matched for age, gender, body mass index (BMI), diagnoses and American Society of Anesthesiology (ASA) class. RESULTS: All procedures were completed by the same surgeon. Comparison between two groups showed insignificant differences in blood loss (mean: (15.6 ± 9.5) vs (16.8 ± 7.4) ml; t = 1.266, P = 0.207), postoperative complications (number of case, incision contusion:4 vs 2, P = 1.000;incision hemorrhage:2 vs 2, P = 0.603) and hospitalization duration (mean: (1.6 ± 0.5) vs (1.6 ± 0.5) d; t = 0.653, P = 0.514), but significant differences in operative duration (mean:(40.5 ± 16.0) vs (51.5 ± 18.0) min; t = 5.381, P = 0.000), postoperative pain (mean: 2.0 ± 1.7 vs 3.7 ± 1.6; t = 8.324, P = 0.000) and exposure of Calot's triangle (number of case, 197 vs 68; χ(2) = 60.178, P = 0.000). Thus the suture-suspension method was superior to the three-device counterpart. CONCLUSION: The suture-suspension method of SILC is safe, economic and easy-to-handle in clinical practice.

Maternal and fetal plasma platelet-activating factor acetylhydrolase activity and distribution in pre-eclampsia.

BACKGROUND: Distribution of platelet-activating factor acetylhydrolase (PAF-AH) in lipoproteins plays important roles in the onset of inflammation and atherosclerosis. We hypothesized that women with pre-eclampsia (PE), showing signs of inflammation and oxidative stress, and their fetuses have aberrations of PAF-AH activity and distribution. METHODS: Maternal and fetal plasma PAF-AH activity, high-density lipoprotein (HDL)-associated PAF-AH (H-PAF-AH) and low-density lipoprotein (LDL)-associated PAF-AH (L-PAF-AH) were examined in women with PE (n = 127) and in women with uncomplicated pregnancies (n = 88). RESULTS: The neonates of women with severe PE (n = 42) had significantly higher plasma PAF-AH, L-PAF-AH activities, and ratio of L-PAF-AH to H-PAF-AH activities than the neonates of women with normal pregnancies (n = 83). The mothers with severe PE (n = 106) and their neonates presented a significantly higher atherogenic index (AI) and triglyceride (TG)/HDL cholesterol (C) ratio than the control mothers and their neonates. The ratio of L-PAF-AH to H-PAF-AH activities correlated positively with TG levels, TG/HDL(C) ratio, and AI and negatively with HDL(C) levels in the neonates of women with PE. CONCLUSION: The neonates of women with severe PE presented with a chronic inflammation status, increased oxidative stress, and unfavorable lipid changes, which may potentially link to related complications responsible for oxidative stress and inflammation in later life.

Intrahepatic multicystic biliary hamartoma: A case report.

BACKGROUND: Multicystic biliary hamartoma (MCBH) is a rare hamartomatous nodule of the liver, which has recently been described as a new category of hepatic nodular cystic lesion. Most of them are benign. The imaging findings are similar to those of many other hepatic cystic lesions, but MCBH also has some notable features, such as large cysts, smooth cyst walls, and lack of communication with the hepatic duct. Due to the non-specific radiology, preoperative diagnosis is difficult, and is usually diagnosed by postoperative pathology. Complete resection is the best treatment option, and the postoperative prognosis is good. CASE SUMMARY: When the patients have MCBH, the symptoms may not very typical, and they require a combination of imaging and pathology for diagnosis. Under normal circumstances, the prognosis of MCBH is good. However, in patients with MCBH, more cases need to be observed for verification. CONCLUSION: When the patients have MCBH, the symptoms may not very typical, and they require a combination of imaging and pathology for diagnosis. Under normal circumstances, the prognosis of MCBH is good. However, in patients with MCBH, more cases need to be observed for verification.

Bloodless Laparoscopic Partial Splenectomy Assisted by Bipolar Radiofrequency Excision Hemostatic Device.

Among the lymphatic system in the human body, the spleen is the most extensive one and has hematopoietic, hemofiltration, blood storage, and immune functions. As a new method of preserving the spleen, laparoscopic partial splenectomy (LPS) has been increasingly applied in clinical practice with people's deeper insights into minimally invasive treatment and the development of technical equipment. Compared with conventional open splenectomy, LPS can preserve normal spleen tissue as much as possible, decrease the occurrence of complications after total splenectomy, and reduce postoperative hospital stay. The bipolar radiofrequency excision hemostatic device used for LPS can solidify the splenic tissue and close the small blood vessels, which reduces the hemorrhage of the spleen cross-section and clears the operative field, thus achieving the ideal effect of "bloodless partial splenectomy". Therefore, under the premise of strictly mastering the indications and fully understanding the vascular anatomy of the spleen, the application of the bipolar radiofrequency excision hemostatic device in LPS is worthy of clinical promotion.

[The expression of visfatin in placenta in women with gestational diabetes mellitus].

OBJECTIVE: To explore the relationship between the expression of visfatin in placenta and the pathological process of gestational diabetes mellitus (GDM). METHODS: The expression of visfatin mRNA in placenta was measured by RT-PCR in 50 women with GDM (GDM group) and 50 women with normal term pregnancy (control group). The clinical indexes of the pregnant women and their children were assessed by specially trained medical staff. RESULTS: The expression level of visfatin in placenta was as high as house-keeping gene---GAPDH; There was no significant difference in the expression of visfatin between the GDM group and the control group; The partial correlation analysis showed that the expression levels of visfatin mRNA in placenta negatively correlated to glucose screening test (GCT) blood glucose and neonatal body mass index, and positively correlated to body mass index, abdominal circumference and number of pregnancies of the pregnant women. CONCLUSION: Visfatin may be involved in the pathogenesis of gestational diabetes mellitus.

Case Report: One-Year Delay in the Effect of Conversion Surgery Therapy for Advanced Hepatocellular Carcinoma After Systemic Therapy.

Hepatocellular carcinoma (HCC) is the sixth most commonly diagnosed malignancy and the third leading cause of cancer-related deaths worldwide. A 58-year-old man visited his local hospital due to abdominal discomfort and was diagnosed with lung metastasis. After admission to our hospital in April 2020, he received two cycles of transcatheter arterial embolization (TAE), hepatic arterial infusion chemotherapy (HAIC-Folfox), sorafenib, and camrelizumab every 3 weeks. Due to the end of HAIC treatment, he underwent drug-eluting transcatheter arterial chemoembolization (dTACE) once, sorafenib, and camrelizumab. However, because of worsening liver function, we interrupted TACE and only gave sorafenib and camrelizumab in August 2020. Although he received systemic therapy, the tumors still rapidly progressed and we considered the possibility of tumor resistance. Subsequently, regorafenib was given. In September, the patient underwent conventional TACE (cTACE) once, regorafenib, and camrelizumab. After half a year of comprehensive treatment, the treatment effect was not satisfactory, and he returned to the local hospital to received regorafenib every day and camrelizumab once every 3 weeks. The patient found that the tumor and lung metastasis had shrunk significantly after 1 year of the initial diagnosis, then he was admitted to our hospital and received surgery treatment, and now he has survived disease-free for 6 months.

[Vasohibin and VEGF protein levels in placentae from pregnancies complicated by severe pre-eclampsia].

OBJECTIVE: To study the expression of vasohibin and vascular endothelial growth factor (VEGF) in placentae from normal pregnancies and pregnancies complicated by severe pre-eclampsia. METHODS: Placental tissues were obtained by caesarean section for 30 cases of pregnancy with severe pre-eclampsia and 30 cases of matched normal pregnancies. Protein levels of vasohibin and VEGF in placental tissue were quantified by Western blot analysis. Immunohistochemistry was used to determine the localization of the vasohibin protein in placental tissue. RESULTS: The mean value of vasohibin in normal pregnant women was 0.91 +/- 0.12, and in women with severe pre-eclampsia was 0.58 +/- 0.09. These values were statistically different between the two groups (P < 0.05). Moreover, VEGF expression was also significantly reduced in the patients compared with the controls (0.65 +/- 0.20 vs. 0.24 +/- 0.13, P < 0.05). There was a significant positive correlation between vasohibin and VEGF levels (r = 0.262, P < 0.05). Immunolocalization of vasohibin in normal term villous placenta was specifically expressed in the vascular endothelial cells, and no positive staining of other cell types such as syncytiotrophoblast cells, cytotrophoblast cells, and chorionic villi interstitial cells was found. CONCLUSION: These results suggest that reduced vasohibin and VEGF expression may be responsible, at least in part, for the impaired vascular development which occurs in the pre-eclampsia.

Associations between Huwe1 and autophagy in rat cerebral neuron oxygen­glucose deprivation and reperfusion injury.

Autophagy and the ubiquitin proteasome system (UPS) are two major protein degradation pathways involved in brain ischemia. Autophagy can compensate for UPS impairment­induced cellular dysfunction. HECT, UBA and WWE domain containing E3 ubiquitin protein ligase 1 (Huwe1), an E3 ubiquitin ligase, serves critical roles in nervous system plasticity, regeneration and disease. However, the role of Huwe1 in autophagy in brain ischemia/reperfusion (I/R) injury remains unknown. The aim of the present study was to investigate the crosstalk between autophagy and the UPS in brain ischemia. The present study established an oxygen­glucose deprivation and reperfusion (OGD/R) model in rat primary cortex neurons in vitro. Lentiviral interference was used to silence the expression of Huwe1. An autophagy promoter (rapamycin), an autophagy inhibitor (wortmannin) and a JNK pathway inhibitor (SP600125) were also used in the current study. Cellular autophagy­related proteins, including Beclin­1, autophagy related (ATG) 7, ATG5, ATG3 and microtubule associated protein 1 light chain 3 α, and apoptosis­related proteins, such as P53, cleaved caspase 3, Bax and Bcl2, were detected via western blotting and immunocytochemistry. Neuronal apoptosis was evaluated using a TUNEL assay. The results demonstrated that silencing Huwe1 increased the expression levels of autophagy­related proteins at 24 h after OGD/R. Treatment with a JNK inhibitor or cotreatment with Huwe1 shRNA significantly increased autophagy. Rapamycin increased apoptosis under OGD/R conditions. However, treatment with Huwe1 shRNA decreased the number of TUNEL­positive cells at 24 h after OGD/R. Cotreatment with Huwe1 shRNA and wortmannin alleviated neuronal apoptosis under OGD/R conditions compared with cotreatment with DMSO. Collectively, the present results suggested that silencing Huwe1 was accompanied by a compensatory induction of autophagy under OGD/R conditions. Furthermore, the JNK pathway may be a key mediator of the interaction between Huwe1 and autophagy in response to UPS impairment.