BACKGROUND: The morbility of rheumatoid arthritis is closely associated with cell apoptosis process. Hyperplasia of synoviocyte lies in the relatively insufficiency of synoviocyte apoptosis. Therefore, induction of synoviocyte apoptosis has clinical significance in the treatment of rheumatoid arthritis. Arteannuin and its derivatives can induce the apoptosis of various cells. OBJECTIVE: To observe the effect of artesunate on the expression of Fas/FasL and Bcl-2/Bax, which are correlated with apoptosis in synoviocyte of adjuvant arthritis. DESIGN: Randomized and controlled observation. SETTING: First College of Clinical Medical Science, Three Gorges UniversityMATERIALS: The experiment was conducted in the laboratories of Immunology and Morphology, Three Gorges University from September 2005 to November 2005. Fifty 8-week-old male Wistar rats of clean grade and (150±21) g were provided by the Animal Experimental Center of Tongji Medical College, Huazhong University of Science and Technology; Complete Freud adjuvant by SIGMA, U.S., and artesunate solution by Guilin Pharmaceutical Corporation.rabbit anti-mouse Fas (SC-716), rabbit anti-mouse FasL and Technology (No. SCXK 2004-2007).Complete Freud adjuvant (SIGMA, U.S. No. 093K8932); artesunate solution (Guilin Pharmaceutical Cor); rabbit anti-mouse Fas (SC-716), rabbit anti-mouse FasL multi-antibody (SC-834), goat anti-mouse IgG-HRP multimer, rabbit anti-mouse P53 (M3566) multi-antibody, Bcl-2 (sc-7382) multi-antibody, rabbit anti-mouse Bax (sc-7480) multi-antibody, ABC compound reagent kit and DAB coloring reagent all acquired from Santa Cruz biotechnology (Santa Cruz, USA); methotrexate (MTX) purchased from Shanghai Hualian Pharmaceutical Co., Ltd.; microscope and image analysis system obtained from Leica (Leica,Germany); microtome (Leica, Germany).METHODS: Fifty rats were randomly divided into six groups: normal group (n =8), model group (n =8), high dose artesunate group (n =8), low dose artesunate group (n =8), artesunate plus methotrexate (MTX) group (n =8), and MTX group (n =8). ①Model construction was referred to literature: Except the normal group with 0.1 mL normal saline, all rats were injected with 0.1 mL complete Freund's adjuvant into the right voix pedis to establish the models of adjuvant arthritis. Since the 13th day after modeling, high and low dose artesunate groups were intraperitoneally injected with 40 and 20 mg/kg artesunate, respectively everyday; artesunate plus MTX group was intraperitoneally injected with 20 mg/kg artesunate everyday and 0.4 mg/kg MTX every three days; MTX group with 0.4 mg/kg MTX solution every three days;model group with 1 mL normal group everyday. ②The arthrosis index (Al) of each group was evaluated before and 13 days after administration; the expressions of Fas/FasL, Bcl-2, and Bax in synovial membrane tissue were examined by immunohistochemistry.MAIN OUTCOME MEASURES : Al and the expression of Fas/FasL, Bcl-2, and Bax in synovial membrane tissue of each group.RESULTS: Fifty rats were involved in the result analysis. ①Thirteen days after administration, the Al of each experiment group (including model control) was remarkably lower than that before treating (P ＜ 0.01). The Al of eachexperiment group was significantly lower than that in model control group (P ＜ 0.01). ②The expression of Fas/FasL in high and low dose artesunate groups and artesunate plus MTX group was up-regulated significantly compared with that in model group (P ＜ 0.01). There was no statistically significant difference in the expression between MTX group and model group (P ＞ 0.05); the expression of Bcl-2 was significantly down-regulated but Bax up-regulated in two artesunate groups,artesunate plus MTX group and MTX group compared with that in model group (P ＜ 0.05).CONCLUSION: The findings suggest that artesunate could alleviate adjuvant arthritis, up-regulate the expression of Fas/FasL and Bax, but down-regulate that of Bcl-2, in which the induction of synoviocyte apoptosis may be one of the mechanisms.

OBJECTIVE:To observe the clinical efficacy and ADR of Mirabilite combined with intrapetitoneal in the treatment of elderly colorectal malignant ascites. METHODS:77 cases of patients with elderly colorectal malignant ascites were randomly di-vided into treatment group (n=40) and control group (n=37). The control group received the treatment of intraperitoneal alone, while the treatment group was based on the control group additionally received Mirabilite combined with intrapetitoneal. The clini-cal efficacy,quality of life (QOL),and ADR in 2 groups were compared and statistically analyzed. RESULTS:Compared with control group,the effective rate in treatment group was 77.5% and the disease control rate was 87.5%,with significant difference (P<0.05);the QOL score in treatment group was better than control group,with significant difference(P<0.05);the incidence of local ADR in Mirabilite for external use was low. CONCLUSIONS:Mirabilite combined with intraperitoneal has better efficacy in the elderly colorectal malignant ascites and better QOL.

OBJECTIVE: To summarize advances in clinical application of ureter stent and its biocompatibility. METHODS: A computer-based online search of CNKI (1989/2009) and Medline (1989/2009) was performed with the key words of "ureter, biocompatibility, stent, treatment, complications" in Chinese and English respectively. A total of 51 articles were collected. and 21 were included. The treatment advances and its biocompatibility of ureter stent were summarized, and clinical application advances, biocompatibility and complication prevention of ureter stent were explored. RESULTS: Ureter stent includes polymerizer, metal and degradable material stents. As the common implants in treatment of upper urinary tract diseases, ureter stent functions as stent and internal drainage, and relieve ureteral obstruction, prevent leakage of urine postoperatively and ureterostenosis. Complications following ureter stent implantation include stent shifting, urine reflux, irdtative symptoms of bladder, fouling and stone formation as well as infection. However, these complications can be relieved through positive treatment. CONCLUSION: Ureter stent is an effective approach to treat urologic disease, but the biocompatibility required improvement. Rigorous operation during stent implantation and positive treatment of complication can effectively prevent complications.

Objective: To analyze the related factors of postoperative complications after laparoscopic assisted D2 radical resection for advanced gastric cancer. Methods: From August 2015 to July 2017, 80 patients with advanced gastric cancer admitted to the First Hospital of Jiaxing were selected.All the patients were treated with laparoscopic-assisted D2 radical resection, and the risk factors related to postoperative complications were analyzed by logistic regression analysis model. Results: There were 33 cases (41.25%) with postoperative system complications, 19 cases (23.75%) with complications of level Ⅱ and above; 15 cases (18.75%) with postoperative local complications, among them 12 cases (15.00%) appeared level Ⅱ and above local complications.The number of concomitant diseases and age were related risk factors for systemic complications in patients with advanced gastric cancer after laparoscopic D2 radical resection (OR=1.982, 95%CI: 2.183-34.405, OR=6.587, 95%CI: 1.738-23.495, all P<0.05). The preoperative neoadjuvant chemotherapy, reconstruction method and age were the risk factors for local complications in patients with advanced gastric cancer after laparoscopic D2 radical resection (OR=8.273, 95%CI: 4.982-35.394, OR=12.304, 95%CI: 2.384-88.921, OR=6.365, 95%CI: 2.183-21.384, all P<0.05). Conclusion Treatment of advanced gastric cancer patients with laparoscopic D2 radical mastectomy, attention should be paid to control the patients' age, preoperative neoadjuvant chemotherapy, reconstruction mode, associated disease and other related risk factors.In order to ensure the safety of patients and to avoid postoperative complications.

Objective:To observe the correlation between the expressions profile of cytokeratin 19/glypican 3 (CK19/GPC3) and recurrence of hepatocellular carcinoma after interventional therapy.Methods:Clinical and pathological information of 251 eligible cases with hepatocellular carcinoma who underwent interventional therapy in You'an Hospital from November 2007 to May 2016 were retrospectively collected. Univariate and multivariate Cox regression analysis was used to analyze the relevant risk factors that may affect their prognosis. Kaplan-Meier survival analysis was used to draw the survival curve. Log-rank test was used to compare the difference in survival rates between the groups.Results:Kaplan-Meier univariate analysis showed that histological grade, CK19/GPC3 expression profile, alpha-fetoprotein level and Hep Parl were closely related to tumor recurrence. Multivariate Cox regression analysis showed CK19/GPC3 expression profile ( HR = 1.634, 95% CI: 1.041 ~ 2.564, P = 0.033), histological grade ( HR = 1.445, 95% CI: 1.037 ~ 2.014, P = 0.030), alpha-fetoprotein level ( HR = 1.410, 95% CI: 1.042 ~ 1.908, P = 0.026), Hep Parl ( HR = 0.570, 95% CI: 0.349 ~ 0.930, P = 0.025) were the four independent factors for prediction of recurrence after interventional therapy. Conclusion:Hepatocellular carcinoma patients with CK19 +/GPC3 + and CK19 -/GPC3 + phenotypes who meet the Milan criteria have a higher risk of recurrence after interventional therapy than CK19 -/GPC3 - phenotypes.

Objective:To investigate the clinical features and therapeutic efficacy of patients with hereditary leiomyomatosis and renal cell carcinoma(RCC) syndrome-associated RCC (HLRCC-RCC) in China.Methods:The clinical data of 119 HLRCC-RCC patients with fumarate hydratase (FH) germline mutation confirmed by genetic diagnosis from 15 medical centers nationwide from January 2008 to December 2021 were retrospectively analyzed. Among them, 73 were male and 46 were female. The median age was 38(13, 74) years. The median tumor diameter was 6.5 (1.0, 20.5) cm. There were 38 cases (31.9%) in stage Ⅰ-Ⅱand 81 cases (68.1%) in stage Ⅲ-Ⅳ. In this group, only 11 of 119 HLRCC-RCC patients presented with skin smooth muscle tumors, and 44 of 46 female HLRCC-RCC patients had a history of uterine fibroids. The pathological characteristics, treatment methods, prognosis and survival of the patients were summarized.Results:A total of 86 patients underwent surgical treatment, including 70 cases of radical nephrectomy, 5 cases of partial nephrectomy, and 11 cases of reductive nephrectomy. The other 33 patients with newly diagnosed metastasis underwent renal puncture biopsy. The results of genetic testing showed that 94 patients had FH gene point mutation, 18 had FH gene insertion/deletion mutation, 4 had FH gene splicing mutation, 2 had FH gene large fragment deletion and 1 had FH gene copy number mutation. Immunohistochemical staining showed strong 2-succinocysteine (2-SC) positive and FH negative in 113 patients. A total of 102 patients received systematic treatment, including 44 newly diagnosed patients with metastasis and 58 patients with postoperative metastasis. Among them, 33 patients were treated with tyrosine kinase inhibitor (TKI) combined with immune checkpoint inhibitor (ICI), 8 patients were treated with bevacizumab combined with erlotinib, and 61 patients were treated with TKI monotherapy. Survival analysis showed that the median progression-free survival (PFS) of TKI combined with ICI was 18 (5, 38) months, and the median overall survival (OS) was not reached. The median PFS and OS were 12 (5, 14) months and 30 (10, 32) months in the bevacizumab combined with erlotinib treatment group, respectively. The median PFS and OS were 10 (3, 64) months and 44 (10, 74) months in the TKI monotherapy group, respectively. PFS ( P=0.009) and OS ( P=0.006) in TKI combined with ICI group were better than those in bevacizumab combined with erlotinib group. The median PFS ( P=0.003) and median OS ( P=0.028) in TKI combined with ICI group were better than those in TKI monotherapy group. Conclusions:HLRCC-RCC is rare but has a high degree of malignancy, poor prognosis and familial genetic characteristics. Immunohistochemical staining with strong positive 2-SC and negative FH can provide an important basis for clinical diagnosis. Genetic detection of FH gene germ line mutation can confirm the diagnosis. The preliminary study results confirmed that TKI combined with ICI had a good clinical effect, but it needs to be confirmed by the results of a large sample multi-center randomized controlled clinical study.