The Nrf-2/ARE signaling pathway is not only affected by itself but also influenced by multiple tumor-related signals. To expand our understanding about the Nrf-2/ARE signaling pathway and lay a theoretical foundation for further research, we reviewed the effects of multiple tumor-related signals on the Nrf-2/ARE signaling pathway and studied the possible underlying mechanisms.

Objective To study the chemical constituents of transformed products by Fusarium sacchari and to find the rare ginsenosides with anti-tumor effects from the leaves of Panax notoginseng. Methods The compound isolated was separated by repeated silica gel,Sephadex LH-20,and HPLC chromatography. The structure was identified by analysis of its spectral data.Results A dammarane-type triterpene, notoginsenoside-LZ,20(S)-3?-hydroxy-12?,23-epoxy-dammar-24-ene-20-O-?-D-xylopyranosyl (1→6)-?-D-glucopyranoside,was isolated from the transformed products.Conclusion Notoginsenoside-LZ is a new compound.

Gastric duplication cyst is a very rare gastrointestinal tract malformation that accounts for 2％-4％ of alimentary tract duplications.It is a diagnostic dilemma for doctors because its clinical and radiological manifest is usually nonspecific.At the present stage,it can only rely on surgery.We should pay attention to ectopic pancreas resection and ligation of pancreatic duct during operation.There was one case of gastric duplication cyst with ectopic pancreas in adults from the Second Affdiated Hospital of Nanchang University.

Objective To evaluate the clinical effect of a novel computer-assisted navigation technique for intraoperative correction of femoral rotation deformity in diaphyseal fractures.Methods From November 2015 to November 2016,a navigation system (BrainLAB,Germany) was used in antegrade intramedullary nailing for 13 patients with femoral shaft fracture to intraoperatively restore the normal length and rotation of the fractured femur.They were 11 men and 2 women,with an average age of 38.2 years.The iujury affected the left side in 5 cases and the right side in 8.According to the Winquist Classification,there were 6 cases of type Ⅰ,3 ones of type Ⅱ,3 ones of type m,and one of type Ⅳ.This navigation system allowed the surgeons to detect and set the femoral anteversion (FAV) and length of the injured leg at the desired angle and length of the healthy contralateral femur,precisely matching the contralateral limb and restoring the normal length and rotation of the fractured femur.All the patients underwent postoperative CT scan of bilateral femora for measurement of the lengths and rotations which were conpared with the intraoperative values obtained with the navigation system.Results Additional operative time required for computerized navigation averaged 42.8 min (from 35 to 55 min).The mean length difference between the treated and untreated femora was 4.2 nnn (from 2 to 9 mm).The FAVs obtained from intraoperative navigation and postoperative CT scan were 34.0° ± 8.4° and 33.5° ± 8.3° in the healthy side and 31.2° ± 8.5° and 32.8° ± 9.0° in the injured side,showing no significant differences either between the 2 sides or between intraoperation and postoperation (P ＞ 0.05).The mean rotational difference between the 2 extremities were 4.8° ± 1.6° for the navigation and 3.8° ± 1.9° for the CT scan,showing an insignificant difference (P ＞ 0.05).All the incisions healed well with no intraoperative or postoperative complications.Conclusions This novel navigation technique may serve as a reliable tool to accurately correct the rotational malalignment of femoral shaft fractures intraoperatively,but care should be taken in every step of the navigation procedure to reduce complications.

Objective To study the triterpene saponins from Gynostemma pentaphyllum with antitumor activities.Methods The 75% EtOH extract of G.pentaphyllum was used for isolation by silica gel column chromatography and preparative HPLC.The structures of pure compounds isolated were identified by the spectral analysis and chemical evidence.Results Two compounds were isolated and identified as 23(S)-3β,20ξ,21ξ-trihydroxy-19-oxo-21,23-epoxydammar-24-ene 3-O-α-L-rhanmopyranosyl(1→2)-[β-D-xylopyranosyl(1→β)]-β-D-arabinopyranoside(1)and23(S)-21(R)-O-n-butyl-3β,20ξ-dihydroxy-21,23-epoxydammar-24-ene 3-O-α-L-rhamnopyranosyl(1→2)-[β-D-xylo-pyranosyl(1→3)]-β-D-arabinopyrannside(2).Conclusion Compound 2 is a new triterpene saponin with moderate antitumor activities against the HL-60,Colon205,and Du145 cell lines.

Objective:Whether extralevator abdominoperineal excision (ELAPE) improves survival and safety remains controversial.Systematic review of all comparative studies to define the superiority of ELAPE to conventional abdominoperineal excision (APE).Methods:Corresponding data,with case-control studies or cohorts regarding intraoperative perforation rate,the local recurrence rate and postoperative complications in the ELAPE group and the APE group,were retrieved from PubMed,Embase,the Cochrane Library,Chinese Biomedical Literature (CMB),VIP,China National Knowledge Infrastructure (CNKI),and Wanfang Database.Meta-analysis was performed by using RenMan 5.2.Results:A total of 10 articles were included.Intraperative perforation rate (MD=0.54,95％ CI 0.31 to 1.39,P=0.03),local recurrence rate (MD=0.30,95％ CI 0.21 to 0.42,P＜0.001) in the ELAPE group was significantly lower than that in the APE group.The difference in positive margin rate between the 2 groups was not statistically significant (P=0.07).Conclusion:Through gap repair of episiotomy and individualized therapy can improve ELAPE postoperative quality of life.ELAPE shows certain advantages in treating lower rectal cancer comparing to APE,but it should pay attention to individualized treatment.More studies through large sample multi-center,medium and long term randomized design are necessary to determine the effect of surgery on tumor.

Objective To evaluate the effect of left gastric venous caval shunt in the treatment of portal hypertension. Methods Eight patients suffering from portal hypertension underwent left gastric venouscaval shunt. The graft was of autogenous vein in 5 cases and artificial vein in 3 cases. Results There was no mortality and major complication nor early rebleeding. All patients were followed up from 10 mos to 10 years with an average of 5 years and 2 mos.Postoperatively,5 cases retrieved active living style. Two cases died, and one was lost during the follow-up. Conclusion Left gastric venous caval shunt decreasesthe venous pressure of the portal system within pericardiac and lower esophageal area. The shunt is a safe and effective surgical treatment presenting less alterations to splanchnic hemodynamics and with an additionaladvantage for pericardial devascularization.

Objective To explore the clinical efficacy of transanal endoscopic microsurgery (TEM) for the rectal tumor.Methods The clinical data of 35 patients with rectal tumors who were admitted to the Second Affiliated Hospital of Nanchang University between November 2012 and March 2014 were retrospectively analyzed.The preoperative endorectal ultrasonography (ERUS) was applied to patients for evaluating local invasion and lymph node metastasis,and confirming the pathological types of tumors,size and location of tumors,depth of invasion and with or without lymph node enlargement around the rectal wall,and then patients underwent TEMs.Patients were followed up by outpatient examination,telephone interview and instant messenger (WeChat) till August 2014.Results The tumors of 6 patients were located in the anterior wall of rectum,11 were in the posterior wall of rectum,9 were in the left and 9 in the right side walls of rectum.The diameter of tumor,distances between distal margin of tumor and anal verge,volume of intraoperative blood loss and operation time were (2.3 ± 0.9) cm (range,0.7-4.8 cm),(8 ±4)cm(range,4-17 cm),(32 ±19)mL (range,5-60 mL) and (79 ±35)minutes (range,31-150 minutes),respectively.Tumors with positive margin showed the negative margin after supplementary resection.All the patients didn't receive the specific analgesic therapy with the intake of liquid diets at postoperative day 1-3,and they were discharged after anal exsufflation.The duration of hospital stay was (4.2 ±1.2)days (range,2.0-9.0 days).The results of pathological examination showed that rectal adenoma were detected in 12 patients,rectal carcinoma in situ in 2 patients (Tis stage),rectal carcinoid in 2 patients,low-risk T1 stage of rectal cancer in 9 patients,high-risk T1 stage in 7 patients and T2 stage in 3 patients who received chemotherapy.Seventeen patients had postoperative complications,including 9 with perineum swelling and frequent defecation,4 with functional impairment of anal sphincter,2 with acute urinary retention and 2 with mild errhysis with the eased symptoms after symptomatic treatment.A total of 35 patients were followed up for 5-22 months with a median time of 11 months.The recurrence rate of rectal cancer was 2/19,including in the low-and high-risk T1 stage of 1/16 and in T2 stage of 1/3.Two of 12 patients without adjuvant therapy had recurrence of tumors,and other patients had no recurrence of tumors after adjuvant therapy.Conclusion TEM is safe and feasible in the treatment of rectal adenoma,carcinoma in situ,rectal carcinoid as well as rectal cancer in the low-and high-risk T1 stage.

Objective To compare the efficacy and toxicity of different cycles of neo-adjuvant chemotherapy for locally advanced breast cancer. Methods Seventy-five patients with locally advanced breast cancer were treated with epirubicin (Epi) plus paclitaxel (TAX, ET regimen). Two cycles were used in 39 patients (2 cycles group) and 4 cycles were used in 36 patients (4 cycles group). Results The overall response rate (RR) was 74% (29/39) in 2 cycles group and 94% (34/36) in 4 cycles group. One patient got clinically complete response (CR), 28 cases had partial response (PR),10 with no change (NC) in 2 cycles group, while 21 patients showed CR including 11 patients with pathologically complete response, 13 with PR, and 2 with NC in 4 cycles group. There was no progression to advanced stage in either groups. Axillary lymph nodes were palpable in all 75 patients before ET regimen, lymph nodes became non-palpable in 46% (18/39) cases in 2 cycles group and in 75% (27/36) cases in 4 cycles group. Toxicities including leukopenia, gastroenteric reactions were similar in the 2 groups, though arthralgia, myalgia, and neurotoxicity were more common in 4 cycles group than 2 cycles group. Conclusion Neo-adjuvant chemotherapy with ET regimen for 4 cycles were more effective than 2 cycles to down staging locally advanced breast cancer. Toxicities including arthralgia, myalgia, and neurotoxicity were more common in 4 cycles group than 2 cycles group.

Objective To evaluate the creditability of warning message of white differential count (WDF) and white precursor cell (WPC) channels in Sysmex XN-3000 hematology analyzer,and verify its optimal threshold and adjust the alarm threshold.Methods A total of 61 EDTA-K2 anticoagulated blood samples without abnormal warning and 521 EDTA-K2 anticoagulated blood samples with abnormal warning were simultaneously detected in WDF and WPC channels.After the smear specimens of blood sample were automatically prepared by the instrument,microscopic examinations were performed manually.The results of microscopic examination were considered as the gold standard to determine the reliability of the warning message from the instrument and verify the reasonability of initial warning threshold value provided by the manufacture.Consequently,the threshold values were adjusted based on the requirements in practical work.Results The warning messages of atypical lymphocytes and blasts/abnormal lymphocytes in WDF channel were higher sensitive (95.8％ and 100％ respectively),but lower specific (34.7％ and 23.5％ respectively) compared with microscopic examination.The warning messages of atypical lymphocyte,blasts and abnormal lymphocytes in WPC channel were lower sensitive (81.3％,66.7％,and 76.5％ respectively) but higher specific (61.9％,55.5％ and 88.3 ％ respectively) compared with microscopic examination.According to the ROC curve analysis,the prognostic values of warning message of microscopic examination were of medium level,except the warning message for abnormal lymphocytes was poor compared with WPC channel.Combining the practical retest rules,the optimal critical threshold values of atypical lymphocytes and blasts/Abn lymph in WDF channel were adjusted as 120,and they were adjusted as 140 in WPC channel.Conclusion The high sensitive WDF channel should first be used for screening,and the detectable warning message could be retested by using high specific WPC channel to shorten the turnaround time of the test results and improve the working efficiency.The initial critical warning threshold provided by the manufacture should be verified and adjusted to the optimum critical threshold in order to ensure the accuracy of test results.