Primary biliary cirrhosis (PBC)is an autoimmune disease.Ursodeoxycholic acid (UDCA)is the only safe and effective drug for the treatment of PBC,as proved by randomized controlled clinical trials,so it is advocated as first-line therapy.Alternative therapies are urgently needed for patients with poor response to UDCA.In addition to the efficacy of UDCA,the classification of alternative and adjuvant therapies for UDCA nonresponders and the latest research progress in these therapies are reviewed;the efficacy of existing drugs and treat-ment prospects are evaluated,but more long-term clinical studies are needed to confirm the efficacy of immunosuppressants such as budes-onide and etanercept and other drugs.A number of novel molecular therapies for PBC are also undergoing clinical trials.There is currently no consensus on the medical treatment for patients with poor response to UDCA.Although studies have shown that some drugs can improve liver function and liver biochemistries,there is no definitive evidence that they improve long-term outcome.

Objective: To elucidate the relationship between Notch3 expression and chemosensitivity of human colon carcinoma cell line SW620 to topotecan. Methods: Notch3 siRNA was transfected into SW620 cells, and the expression of Notch3 in SW620 cells was examined by Western blotting. After transfected with Notch3 siRNA for different time peri-ods, SW620 cells were further treated with topotecan, and the proliferation of SW620 cells was detected by MTT assay; the apoptosis of SW620 cells was detected by Hoechst 33342 staining and flow cytometry. Caspase-3 activation in SW620 cells was examined by caspase-3 activation kit. Results: Notch3 siRNA transfection remarkably inhibited Notch3 protein expression in SW620 cells. The IC_(50) of topotecan in Notch3 siRNA-transfected group was significantly decreased compared with that in the Ctrl siRNA group (P <0.05). Silence of Notch3 expression in SW620 cells by Notch3 siRNA remarkably promoted apoptosis (P < 0.05) and caspase-3 activation (P < 0.05) of SW620 cells induced by topotecan. Conclusion: Notch3 down-regulation by siRNA in SW620 cells can enhance the chemosensitivity cells to topotecan.

Objective:To construct pEGFP-C1-Smad4 expression vector and to observe the influence of Smad4 over-expression on the proliferation of human gastric cancer SGC7901 cells and its relationship with nuclear factor kappa B (NF-?B). Methods:Recombinant expression vector pEGFP-C1-Smad4 was constructed and was used to transfect human gastric cancer SGC7901 cells. EGFP expression in transfected cells was detected by fluoroscopy. Smad4 and NF-?B expression in transfectant was examined by Western blotting. Effect of Smad4 over-expression on activation of NF-?B and proliferation of transfected SGC7901 cells were examined by electrophoretic mobility shift assay (EMSA) and MTT assay,respectively. Results:Expression of EGFP in transfected SGC7901 cells was observed under fluorescence microscope. Smad4 was over-expressed in transfected SGC7901 cells,accompanied by down-regulation of NF-?B p65 expression in the tranfectants. EMSA and MTT demonstrated that Smad4 over-expression significantly inhibited the activation of NF-?B and the proliferation of SGC7901 cells (P

Objective To explore the regulatory function of over-expression of NOTCH-1 in TNF?-induced apoptosis of gastric carcinoma carcinoma BGC-823 cells.Methods BGC-823 cells were infected with retrovirus recombined with intracellular domain of NOTCH-1.The cell clones,into which objective genes had been transfected,were obtained after screening with G-418.Before and after incubation with TNF?,MTT assay,flow cytometry,Western blot and EMSA were used to detect cell growth,apoptosis,expressions of NOTCH-1,NF-?B and caspase-3 activity.Results There was stronger expression of NOTCH-1 and its target gene HES-1 in the cells transfected with NOTCH-1 gene than that of control.After TNF? treatment,the rates of killing and apoptosis in NOTCH-1-transfected cells were all lower than those in control cells.Moreover,we showed over-expression of NOTCH-1 suppressed caspase-3 activation induced by TNF?.However,TNF?-induced activation of NF-?B was not affected by over-expression of NOTCH-1.Conclusion Over-expression of NOTCH-1 significantly protects BGC-823 cells from apoptosis and growth suppression induced by TNF?.This effect is mediated,at least in part,through inhibition of caspase-3 activation independent of NF-?B.

Objective To investigate the intervention of Chinese herb Shengjiang San(SJS)for the imbal-ances of serum Th1/Th2 cells and related regulatory factors in sepsis patients. Methods Fifty-five sepsis patients were randomly divided into two groups:conventional treatment group of 27 cases and SJS group of 28 cases. Nine cases of healthy volunteers were enrolled as control group in the study. Cases of conventional group were treated with western medicine only and cases of SJS group were treated with both western medicine and Chinese herb SJS (100 mL twice one day). The therapy course of both groups was 3 days. Score of Chinese medical syndromes ,se-rum level of leukocyte count,C reactive protein(CRP)and procalcitonin(PCT),serum T-bet,GATA-3,Th1&Th2 cells in the proportion of whole CD4+Th cells and Th1/Th2 ratio were compared respectively in each group be-fore and after treatment. Results There were significant differences between SJS group and conventional group in score of Chinese medical syndromes,serum level of leukocyte count,T-bet,GATA-3,Th1&Th2 cells in the pro-portion of whole CD4+Th cells and Th1/Th2 ratio(P<0.05 or P<0.01). There were no significant differences be-tween the two groups in serum level of CRP,PCT and GATA3. Compared with control group,there were signifi-cant differences in all indicators except GATA3 of the two groups(P<0.01). Conclusion Chinese herb Shengji-ang San has an effective benefits to Chinese medical syndromes,inflammatory reaction,the imbalance of serum Th1/T2 and related regulatory factors(T-bet&GATA-3)in sepsis patients.

Objective:To analyze the clinical applicability of the sixth edition of nursing measures classification in children's general surgery, to provide a basis for standardizing clinical nursing terms and to promote the clinical use of standardized terminology of nursing measures.Methods:The research method of this study was mapping method. The electronic nursing records of the general surgery of Shanghai Children′s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine from October 1st to December 31st, 2018, including the records of care records for free entry and the records of nursing measures related to medical orders were selected. The degree of matching between electronic care records and classification of nursing measures (sixth edition of nursing measures classification) was compared with conceptual consistency. Difficulties and time-consuming analysis of the characteristics of the standardized care measures obtained by matching.Results:A total of 4 560 independent electronic care records mapped 86 treatments in seven areas. Among them, 98.84% (4 507/4 560) of the nursing records were completely matched with the nursing measures, 0.83% (38/4 560) of the nursing records were partially matched with the nursing measures, and 0.33% (15/4 560) of the nursing records did not match the nursing measures. Difficulty and time-consuming were expressed as standard deviation, which were 2.20±0.45 and 2.03±1.25 respectively.Conclusions:The classification of nursing measures can be used to describe the daily behavioral activities of the children's general surgery nurses, and can also solve the standardization problem of the nursing records in the presentation, and is suitable as a standardized nursing language for the nursing records of children's general surgery.

OBJECTIVE:To investigate the features of adverse drug reactions(ADR) occurred in the infusion room of our hospital so as to improve rational clinical drug use.METHODS:A total of 225 ADR cases reported by the infusion room of our hospital from Jan.1,2007 to Dec.31,2008 were analyzed retrospectively and statistically.RESULTS:Of the total 225 ADR cases reported,109 cases(48.44%) were children aged below 10;115 cases(51.11%) occurred within 10～30 min;ADR were induced by 29 kinds of medicines,with cephalosporin and penicillins showing the highest proportions(43.56% and 23.56%,respectively);143 cases(63.6%) manifested more often as lesions of skin and its appendage followed by ADR of digestive system(40 cases/17.8%).CONCLUSION:ADR monitoring plays an important role in medical institution.Tightening ADR monitoring in the infusion room contributes to patients' medication safety.

Objective To analyze the surgical operation and prognosis of gastric stump carcinoma in elderly patients. Methods The clinical data of 25 cases of elderly gastric stump carcinoma in our department from 1993 to 2003 were analyzed retrospectively. Results In this group of cases, TNM stages Ⅰ, Ⅱ, Ⅲ and Ⅳ was 3, 5, 8 and 7 cases, respectively. Among them, radical resection was performed in 12 cases(48.0%), palliative operation in 9 cases(36.0%), exploratory laparotomy in 2 cases, and 2 cases lost the chance of resection due to extensive tumor dissemination. Nutritional jejunostomy was performed in all the cases received resection operation. 1, 3 and 5 years survival rates in the patients who underwent radical dissection were 81.2%, 41.5% and 28.6%, respectively. Conclusion Endoscopy examination plus gastric mucosa biopsy were major means for diagnosis of gastric stump carcinoma in elderly patients. Perioperative managements should be emphasized. Radical resection was a reasonable therapeutic procedure of elderly gastric stump cancer, and was also an important factor affecting prognosis.

Objective To investigate the causes of hernia recurrence after tension free inguinal hernioplasty and its prevention and treatment Methods The clinical data of 10 hernia recurrence cases were retrospectively analyzed Results There were 6 recurrent cases after mesh plug tension free hernioplasty and 4 cases after Lichtenstein repair The causes of recurrence included too small for size of the mesh, mesh was coiled and migrated, too large holes of mesh left for spermatic cord, mesh plugs not properly fixed, internal rings too large miss matching the mesh plug, two mesh plugs not mounted together, etc Conclusion The main causes of recurrent hernia after tension free inguinal hernioplasty were related with failure in applying correct operative techniques, the recurrence needs open mesh repair, especially mesh plug tension free hernioplasty

BACKGROUND:Alpha-calcium sulfate hemiydrate/biphasic bioceramics (α-CSH/BCP) as a bone repair material has been widely used in the clinic, but there are stil some deficiencies. OBJECTIVE:To observe the effect of α-CSH/BCP on the repair of bone defects of the radius in rabbits. METHODS:The unilateral radius of 18 adult New Zealand white rabbits was selected to establish bone defect models, and then these rabbit models were randomized into three groups that were treated with α-CSH,α-CSH/BCP, BCP materials, respectively. At 4, 8, 12 weeks after implantation, bone samples were taken for gross and X-ray observations. RESULTS AND CONCLUSION: (1) Gross observation: At 12 weeks of implantation, the bone defect was completely repaired in the α-CSH/BCP group, and the defected radius recovered basicaly; in the α-CSH group, bone defects were visible; and in the BCP group, there was stil some material for filing and coverage. (2) X-ray observation: In the α-CSH group, the degradation of implanted materials was faster than new bone formation, and bone defects were visible; in the α-CSH/BCP group, bone defects were healed, cortical bone remodeling was good, and the bone marrow cavity was re-canalized; in the BCP group, the implanted materials were stil visible, and bone defects were not repaired. These findings indicate that the α-CSH/BCP bone repair material can significantly promote the repair of bone defects of rabbit radius, with a better repair effect than α-CSH or BCP alone.