Objective:The present research aimed to explore the involvement of ERK signaling pathway in apoptosis of hepatic carcinoma induced by decitabine combined sodium valproate.Methods: HepG2 cell line was incubated with decitabine combined sodium valproate and the inhibition rate was detected by MTT method.The apoptotic related protein and ERK signal pathway proteins were assayed by Real-time PCR or Western blot.Results: The HepG2 cell line was inhibited greatly by decitabine combined sodium valproate medication with an increased expression of Caspase3,Caspase9 and Bax (P<0.05).The expression of Ras,Raf,MEK and ERK1/2 was increased dramatically after incubation with decitabine combined sodium valproate when compared with control group ( P<0.05).Conclusion:Decitabine combined sodium valproate exert a significant inhibition on the proliferation of HepG2 cell line by nor-malizing the abnormal MEK/ERK signaling pathway.

Acute appendicitis is the most common general surgical problem encountered during pregnancy, which may be associated with serious maternal and /or fetal complications such as appendiceal perforation or premature delivery.Clinical presentation and imaging remains vital in the diagnosis of appendicitis.As a general rule,the clinical suspicion of acute appendicitis during pregnancy is an indication for an urgent surgical intervention.Appendectomy is the preferred treatment.Laparoscopic appendicectomy(LA)can also be performed safely and effectively in pregnant patients without bringing additional maternal complications.

Objective:To investigate the related factors of pancreatic fistula after laparoscopic-assisted distal gastrectomy (LADG).Methods:A retrospective analysis was performed of 189 patients who underwent LADG in Beijing Friendship Hospital, Capital Medical University from June 2017 to March 2018. Twenty-seven patients with postoperative pancreatic fistula and 27 randomly selected normal patients were included in the study. The preoperative characteristics and surgical data of all patients were recorded, including body mass index, visceral fat area, past history, preoperative tumor staging, operation time and bleeding volume, etc. The related factors of postoperative pancreatic fistula were analyzed. Measurement data were expressed as mean±standard deviation ( Mean± SD), and t-test was used for comparison between groups. Chi-square test was used to compare the count data between groups. Results:The patients with high body mass index ( t=3.956, P=0.003), high visceral fat area ( t=6.161, P=0.038), long operation time ( t=2.650, P=0.024), profuse hemorrhage ( t=1.887, P=0.042), complete lymphadenectomy ( t=2.092, P=0.001) were prone to postoperative pancreatic fistula, while there was no significant difference of visceral fat area/total abdominal fat area ( χ2=1.334, P=0.324), preoperative with pulmonary diseases ( χ2=0.750, P=0.379), coronary heart disease ( χ2=0.081, P=0.500), hypertension ( χ2=0.667, P=0.239), diabetes mellitus ( χ2=2.030, P=0.127), chronic kidney disease ( χ2=0.587, P=0.352), tumor stage( χ2=1.388, P=0.500) and other factors between the two groups. Conclusions:Obesity patients and LADG patients with long operation time are more likely to have postoperative pancreatic fistula. Comprehensive preoperative assessment and prudent intraoperative operation may be one of the effective methods to avoid postoperative pancreatic fistula.

Objective To investigate the influence of Norcantharidin(NCTD)on apoptosis-related gene expression of gastric cancer cell line SGC-7901.Methods The experiment was divided into control group,5-Fu group,NCTD group and 5-Fu+NCTD group.The inhibitory rate,apoptosis rate and expression of survivin,bcl-2,and caspase-3 were detected by MTT assay,flow cytometry and SABC immunohistochemical method,respectively.Results NCTD showed that the inhibitory effect on growth of SGC-7901 cells with a dose-and time-effective dependent manner.The apoptotic rate increased from(8.30?1.49)% to(20.56? 1.32)%.The expressions of survivin decreased from(86.57?4.39)% to(26.11?2.27)% and bcl-2 from(85.35? 3.25)% to(30.26?1.83)%,while caspase-3 increased from(54.49?3.07)% to(92.78?2.47)%,5-Fu had the synergistic effects with NCTD.Conclusion NCTD can inhibit the growth of SGC-7901 cell lines.5-Fu had the synergistic effects with NCTD.The mechanism might correlate with induction of cell apoptosis via effect of the expression of apoptotic-related genes such as survivin,bcl-2 and caspase-3.

Several kinds of epidemiological methods in studies of illicit drug use were described in this article.These include case-finding,capture-recapture,privileged access interviewer,mortality multiplier method and nomination method.

Background and purpose:Chemotherapy including anthracyclin and taxanes is one of the effective regimens for patients with advanced breast cancer, but 20%-30% patients do not achieve a satisfactory curative effect .At present, there is no unified standard second-line chemotherapy regimen for these patients. We studied the efficacy and toxicity of gemcitabin plus capecitabine in the treatment of the patients with advanced breast cancer who had failed in response to the treatment of anthracyclin and taxanes chemotherapy. Methods:Gemcitabin 1 000 mg/m2 iv infusion at d1,8 and capecitabine 950 mg/m2 po tid at d1-14.The interval between the two cycles was 3 weeks. The assessment for clinical effect and side effect was conducted for the patients with completion of 2 cycles of chemotherapy at least.Results:30 female patients were enrolled in this trial ,overall response rate was 46.7%,with 6.7% complete response (2/30)and 40% partial response (12/30). Stable disease was seen in 42.3%(13/30),and disease progression in 10% (3/30).Median time to progression was 9 months, and median overall survival was 12.5 months. The main toxicities were myelosuppression and hand-foot syndrome.Conclusions:Gemcitabin plus capecitabine is effective for the patients with advanced breast cancer who failed in the treatment of anthracyclin and taxanes chemotherapy, and its side effect is tolerable.

Objective To evaluate the efficacy and safety of endoscopic sphincterotomy(EST)in treating common bile duct stone or strictive papillitis,and then analyze possible related risk factors for long-term complications after EST.Methods We made a retrospective study of 103 out of 158 patients who had EST from January 2005 to December 2006.Results In the 103 patients,there were 13 cases of long-term complications(≥3 m after EST),the incident rate being 12.6%:recurrent calculus of common bile duct in 8 cases,combined cholangitis in 6;cholangitis in 1;acute calculus cholecystitis in 2;residual calculus in 1 case;chronic pancreatitis in 1 case.Conclusion Endoscopic papillosphincterotomy is an effective and safe way to treat biliary tract obstruction.Preoperative jaundice may be the risk factor inducing long-term complications after EST.

Objective To evaluate the feasibility of 153 Sm EDTMP for multiple bone metastasis.Methods 32 patients with multiple bone metastases were treated with 153 Sm EDTMP injected into the veins,0.4～1.0 mci/kg,of which 7 cases received therapy for 2～3 times.Results 53.1%(17/32)was relieved completely,25.0%(8/32)was relieved partially and 9.4%(3/32)was relieved slightly.No effects were found in 12.5%(4/32).The overall effective rate was 78.1%.Side effects that were the decreasing of WBC and PLT were found in 15.6%(5/32),which rose to the preoperative levels within 6～8 weeks.Conclusion Internal radiotherapy with 153 Sm EDTMP is safe and effective in the treatment of multiple bone metastases.

Nurses often face ethical dilemmas in clinical practice,originating from nurses themselves,nursing measures,and nursing management as well.Only by correctly recognizing and analyzing the causes of ethical dilemmas in nursing care,can help nurses get out of the ethical dilemmas and make reasonable ethical decisions in nursing care.

Objective To seek an effective method for the treatment of grade ⅢB tibial fractures.Method From Oct. 1985 to Oct.1999, 26 cases of grade ⅢB tibial fractures were treated by early soft tissue coverage(including 12 cases of free muscle flaps and 14 cases of local muscle flaps), early fracture fixation(including 21 cases of external fixation and 5 cases of non-reamed intramedullary nail) and early bone grafting(15 cases).Results The follow up duration were from 10 to 32 months with an average of 15.5 months. The success rates of free and local muscle flaps were respectively 91.7 %(11/12) and 92.9 %(13/14)?Infection occurred in 5 cases (3 cases of local superficial infection and 2 cases of osteomyelitis). The time for bone union were from 17 to 66 weeks with an average of 42 weeks. Conclusion "San-Zao"therapy,especially early soft tissue coverage and early fracture fixation is on effective management for grade ⅢB tibial fractures with the advantages of promoting wound healing and bone union and decreasing the possibility of infection.