Objective To investigate the effect of triptolide (TP) on the apoptosis of ovarian cancer cell line SKOV-3 and its molecular mechanism.Methods Ovarian cancer cell line SKOV-3 was cultured and treated with different doses of TP (1 × 10-6 mg/ml,1 × 10-5 mg/ml,1 × 10-4 mg/ml,1 × 10-3 mg/ml),Iscoves modification of DMEM (IMEM) medium without TP was negative control.At the 12 h,24 h and 48 h after treatment,apoptosis rate was determined by terminal dexynucleotidyl transferase (TdT) mediated dUTP nick end labeling (TUNEL) kit.At the 48 h after treatment,mRNA expression of apoptosis molecules and invasion molecules were determined by fluorescence quantitative polymerase chain reaction (PCR) kit.Results (1) At the 12 h,24 h,and 48 h after treatment with different doses of TP,at the same treatment time,the higher the TP dose was,the higher the apoptosis rate of SKOV-3 cells was;at the same treatment dose,the longer the treatment time was,the higher the apoptosis rate of SKOV-3 cells was;and TP increased the apoptosis rate on dose dependent and time dependent manner;(2) After 48 h treatment with different doses of TP,the higher the TP dose was,the higher the mRNA expression of cytochrome C (CytC),Bax,and Caspase-3 was,the lower the mRNA expression of Bcl-2,matrix metalloproteinases (MMP)2,MMP7,MMP9,N-cadherin,and vimentin was;TP increased mRNA expression of CytC,Bax,and Caspase-3 and decreased mRNA expression of Bcl-2,MMP2,MMP7,MMP9,N-cadherin,and vimentin on dose dependent manner.Conclusions TP can induce the apoptosis of ovarian cancer cells,activation of mitochondrial apoptosis pathway and inhibition of cell invasion are molecular mechanism of TP promoting apoptosis.

OBJECTIVE:To observe the clinical efficacy and safety of saxagliptin combined with metformin in the treatment of type 2 diabetes. METHODS:A total of 95 patients with type 2 diabetes were randomly divided into observation group(47 cases) and control group(48 cases). All of the patients received Metformin hydrochloride sustained-release tablets 0.5 g for continuous 4 weeks,orally,3 times a day;based on the treatment,control group was continuously given Metformin hydrochloride sustained-re-lease tablets 0.5 g for continuous 24 weeks,orally,3 times a day;observation group was given Saxagliptin tablets 5 mg continu-ous 24 weeks based on the treatment of control group,orally,once a day;the treatment course was 28 weeks. The clinic data was observed,including clinical efficacy,FPG,2 h PG,bed time glucose,HbA1c,BMI before and after treatment,incidence of hypoglyce-mia,severe hypoglycemia and adverse reactions. RESULTS:The total effective rate in observation group was higher than control group,the incidence of hypoglycemia in observation group was lower than control group(P<0.05). After treatment,the glucose in-dexes in 2 groups was significantly lower than before,and FPG and HbA1c in observation group were lower than control group(P<0.05). There were no significant differences in the BMI before and after treatment,incidence of severe hypoglycemia and adverse reactions between 2 groups(P>0.05). CONCLUSIONS:Saxagliptin combined with metformin has better efficacy and safety than metformin alone in the treatment of type 2 diabetes,and can significantly reduce the incidence of hypoglycemia.

BACKGROUND:Tumor stem cels are the root of cancer recurrence and metastasis, so clinical researches should focus on the effects of different treatments on tumor stem cels.
OBJECTIVE:To explore the effects of endocrine therapy and chemotherapy on stem cels in patients with breast cancer.
METHODS:After recovery and cultivation of estrogen receptor-positive human breast cancer cel lines MCF-7, passage 3 cels in logarithmic phase were selected and divided into three groups containing control, estradiol and estradiol with tamoxifen groups. The estradiol group was divided into three subgroups: 10-7, 10-8 and 10-9 mol/L estradiol was added into the medium, respectively; the estradiol with tamoxifen group was divided into three subgroups: 10-7, 10-8 and 10-9 mol/L estradiol with 10-6 mol/L tamoxifen were added into the medium, respectively. The same amount of absolute ethyl ethanol was added into the medium of control group. Fifteen female patients with late recurrence and metastasis of breast cancer received chemotherapy as recurrence and metastasis group. Another 15 healthy volunteers were selected as healthy control group.
RESULTS AND CONCLUSION:The proportion of CD44+CD24-/lowcel subsets in the estradiol and estradiol with tamoxifen groups was significantly higher than that of the control group (P < 0.05), and the proportion of CD44+CD24-/low cel subsets in the estradiol group was significantly higher than that of the estradiol with tamoxifen group at the same concentration (P< 0.05). The proportion of CD44+CD24-/lowcel subsets had no significant differences among groups at 10 and 20 days of culture (P < 0.05). The proportion of CD44+CD24-/low cel subsets significantly increased in MCF-7 cels after 24-hour intervention with different chemotherapy drugs. But only the proportion of CD44+CD24-/low cel subsets in the paclitaxel and doxorubicin groups was significantly higher than that of the control group after 20-day intervention (P < 0.05). Besides, the proportion of CD44+CD24-/low cel subsets in the peripheral blood of healthy volunteers was significantly lower than that of the recurrence and metastasis group (P < 0.05). Among 15 patients with late recurrence and metastatic of breast cancer, 9 had stable disease, 5 had partial remission, 1 had failed chemotherapy and cancer progression. Moreover, the proportion of CD45-CD44+CD24-/low cel subsets in the peripheral blood of patients sensitive for chemotherapy was significantly lower than that before treatment (P < 0.05). In conclusion, both endocrine therapy and chemotherapy exert a certain effect on the CD44+CD24-/low cel subsets of breast cancer positive for estrogen receptor. Given that CD44+CD24-/low cel subsets in MCF-7 cels resist chemotherapy drugs, the proportion of CD45-CD44+CD24-/low cels in the peripheral blood of patients sensitive for chemotherapy is decreased.

Objective:To evaluate the value of high-resolution magnetic resonance imaging (MRI) in the preoperative diagnosis of T and N staging of rectal cancer.Methods:Retrospective analysis of preoperative MRI and postoperative pathological data of 386 patients undergoing radical resection of rectal cancer from February 2016 to September 2018, including 246 men (63.7%), aged from 29 to 89 years old, with average (61.6±11.0) years. Two observers with experience in abdominal MR performed independent double-blind readings of MR data. T and N stages were determined according to the TNM stage system (7th Edition). The assessment of malignant lymph node probability (low, medium, high) was based on factors such as lymph node size, boundary contours, and signal strength, and ADC values of three different probability of malignant lymph nodes were compared. Statistical methods included Cohen′s kappa coefficient, Mann-Whitney′s, Kruskal-Wallis, Chi-square, Fisher′s exact test, and ROC curve.Results:MR correctly evaluated the T stage of 351 patients (90.9%; kw=0.90±0.08), and the inter-observer coefficient k=0.85±0.09. For lymph node staging, the coefficient between high-probability malignant lymph node estimation and pathology was kw=0.65±0.13. The ADC values of malignant lymph nodes were significantly different in different probability groups ( P<0.001), which were (1.27±0.24)×10 -3mm 2/s (low probability), (1.19±0.18)×10 -3mm 2/s (medium probability), (0.79±0.12)×10 -3mm 2/s (high probability). The ROC curve showed that the ADC value could distinguish high-probability malignant lymph nodes (AUC=0.872), and its diagnostic threshold was ADC≤1.0×10 -3mm 2/s. Conclusion:MR is an accurate imaging method for T stage and N stage of rectal cancer. By combining factors such as lymph node size, morphology, and signal characteristics, the prediction efficiency of high-probability malignant lymph nodes can be improved. The ability of ADC values to identify high-probability malignant lymph nodes highlights its importance in the diagnostic process.

Objective:To improve awareness about infratentorial dural arteriovenous fistula (DAVF).Methods:Three cases of DAVF in the First Affiliated Hospital of Soochow University from September 2017 to September 2019 were retrospectively analyzed in terms of clinical features, cerebrospinal fluid (CSF) analysis, brain imaging and treatment, and followed up through telephone call.Results:Case 1: A 43-year-old woman, in chronic but acute aggravated course, presented with weakness of both lower limbs and urination and defecation dysfunction. Brain magnetic resonance imaging (MRI) revealed abnormal signal in medulla. CSF analysis demonstrated aquaporin-4 antibodies positive. Misdiagnosed as neuromyelitis optica spectrum disorders, the treatment was poor. Then digital subtraction angiography (DSA) showed DAVF at the left infratentorial area, and endovascular treatment was operated. Relapse was not observed in two-year follow up. Case 2: A 57-year-old woman, in chronic progressive course, mainly manifested as memory loss, but progressed with dysphagia, fever, coma. Treatment as “central nervous infection” was poor. Then DSA showed DAVF at the bilateral transverse-sigmoid sinus area, and endovascular treatment was operated with embolized partial fistulas. The patient died from lung infection within two months. Case 3: A 52-year-old man, in subacute course, was treated in the Gastroenterology Department with clinical manifestion of stubborn nausea and vomiting. Brain MRI revealed abnormal signal in medulla, with prominent vessel flow voids nearby. Then DSA showed DAVF at the craniocervical junction, and endovascular treatment was operated. Relapse was not observed in six-month follow up.Conclusions:DAVF has a variety of clinical manifestations, and infratentorial DAVF can manifest as acute neurological dysfunction involving the brain stem, cerebellum, spinal cord, which may be easily misdiagnosed. When brain MRI showed intracranial abnormal signal, the possibility of DAVF should be considered. DSA remains the gold standard to diagnose DAVF. Endovascular embolization is the main treatment of infratentorial DAVF at present. Prognosis depends on clinical presentation and fistula classification.