Bile reflux is not only related to diseases such as gastritis,esophagitis,pharyngitis,chorditis,bronchitis and pneumonia,but also related to residual gastric ulcer,residual gastric cancer,intestinal metaplasia,dysplasia and carcinogenesis. Risk factors related to bile reflux include various operation modes, various anastomosis methods, gallbladder stone, cholecystectomy and various non-operative factors such as age, gender, allergy, mental and psychological factors,congenital factors. This article reviewed the advances in study on risk factors related to bile reflux.

During the treatment of pediatric tumor,vincristine is one of the most widely used and most effective drugs. However,the adverse reactions have limited its clinical application. In recent years,studies have found that the metabolism of vincristine are different in different races and different individuals,and co-ad-ministration with certain drugs such as imidazoles antifungal drugs may enhance its adverse reaction. Resear-ches on new drug delivery system provide a new idea for reducing the adverse reactions of vincristine and impro-ving its bioavailability.

The human sclera accounts for 95％ of the surface of the eyeball,providing ample contact area which is suitable for targeted trans-scleral ocular drug delivery.Currently there are several tans-scleral sustained-release strategies,including intra-scleral delivery,episcleral delivery,as well as tans-scleral iontophoresis.Different devices and methods have their own advantages and disadvantages,for example,intrascleral delivery is somehow invasive,and episcleral delivery device needs to be made thin to prevent erosion of conjunctiva,iontophoresis needs to be frequently repeated as of its short-term effect.With the development of bio-material engineering technology,episcleral microfilm could become an ideal drug delivery route for posterior segment ocular diseases.

Objective To discuss the clinical features and coronary artery lesions in middle-aged and young patients of coronary heart disease complicated with diabetes mellitus. Methods The clinical data of 386 middle-aged and young patients (aged from 28 to 59 years) of coronary heart disease were retrospectively analyzed. Among them, 176 cases were complicated with diabetes mellitus (diabetes group) and 210 cases didn′t have diabetes mellitus (non diabetes group). The general information, echocardiography and coronary angiography results between 2 groups were compared. Results The female ratio, incidences of hypertension and body mass index (BMI) in diabetes group were significantly higher than those in non diabetes group:28.4%(50/176) vs. 6.7%(14/210), 63.6%(112/176) vs. 43.8%(92/210) and (26.5 ± 2.5) kg/m2 vs. (23.8 ± 1.7) kg/m2, and there were statistical differences (P<0.01). There were no statistical differences in the age and the incidences of smoking history, family history of coronary heart disease and heart failure between 2 groups (P>0.05). The total cholesterol (TC) and triglyceride (TG) in diabetes group were significantly higher than those in non diabetes group:(4.96 ± 1.32) mmol/L vs. (4.67 ± 1.12) mmol/L and (2.77 ± 2.01) mmol/L vs. (2.09 ± 1.60) mmol/L, the high-density lipoprotein cholesterol (HDL-C) was significantly lower than that in non diabetes group:(0.92 ± 0.30) mmol/L vs. (1.10 ± 0.32) mmol/L, and there were statistical differences (P<0.01). There were statistical differences in the hemoglobin, platelet, total bilirubin, brain natriuretic peptide, fibrinogen (FIB) and low-density lipoprotein cholesterol (LDL-C) between 2 groups (P>0.05). There were no significant differences in the left atrial diameter, right ventricular diameter, left ventricular end diastolic diameter, ejection fraction, aortic root inside diameter and incidence of weakened ventricular wall motion between 2 groups (P>0.05). The incidence of 3 branch coronary artery lesions in diabetes group was significantly higher than that in non diabetes group:59.1%(104/176) vs. 37.6%(79/210), and there was statistical difference (P<0.01). The incidences of left main artery, circumflex artery trunk, diffuse vascular lesion and Gensini score in diabetes group were significantly higher than those in non diabetes group: 15.9% (28/176) vs. 6.2% (13/210), 79.5% (140/176) vs. 53.8% (113/210), 46.5%(82/176) vs. 23.8%(50/210) and (58.6 ± 17.9) scores vs. (49.5 ± 14.6) scores, and there were statistical differences (P<0.01). There were no statistical differences in incidences of anterior descending artery and right coronary artery between 2 groups (P>0.05). Conclusions In middle-aged and young patients of coronary heart disease complicated with diabetes mellitus, the female ratio is higher and hypertension, obesity and hyperlipidemia is more common. The lesions of coronary artery are more serious and diffuse. Three branch coronary artery lesions are the main ones, and the left main branch and the circumflex branch lesion is common.

Background and purpose:How to predict the survival length for terminally cancer patients is very important, it will help families and physicians to make decisions. This study aimed to reveal the factors related to the survival time of terminally ill cancer patients who received palliative care in our hospital. Methods:The clinical data of 271 dead patients treated in the Department of Palliative Care, Fudan University Shanghai Cancer Center from Mar. 2007 to Mar. 2012 were analyzed. The Kaplan-Meier method and the log-rank test were used to determine the corresponding factors with survival. Cox regression model was used to examine the independent prognostic factors. Different survival length of groups divided by different prognostic indexes was compared by log-rank test. Results:Seven factors were found to be related with the survival according to univariate analysis. The related factors were Karnofsky performance score (P<0.001), dyspnea (P=0.037), delirium (P=0.015), high white blood cell count (P=0.012), low lymphocyte percentage (P=0.030), high lactate dehydrogenase (P<0.001) and low serum albumin (P=0.001). The multivariate analysis selected four independent factors:Karnofsky performance score<30, high lactate dehydrogenase, low serum albumin and delirium.Conclusion:The study shows the clinical survival prognostics with Chinese characteristics. The combination of the seven factors may be useful but more studies in this area deserve further investigated.

Neuroblastoma(NB)is the most common extra -cranial malignant tumor of children.While it ac-counts for 7% of all childhood malignancies,NB accounts for 1 0% of childhood cancer mortality.According to the risk group classification systems,there is high heterogeneity malignant degree of NB.Many bio -features are associated with the prognosis of NB.As the development of the diagnosis and therapy,the relationship between some bio -features and the prognosis has been changed.In the future,target therapy of molecular biology may be a new breakthrough in the therapy area.

Objective To investigate the effects of pioglitazone pre-treating on pancreatic acinar cell (AR42J cells) apoptosis induced by caerulein.Methods AR42J cells were divided into blank control group (with normal culture),pioglitazone group (40 μmol/L),caerulein control group (1 × 10-8 mol/L),pioglitazone+ caerulein group (40 μmol/L pioglitazone + 1 × 10-8 mol/L caerulein) and pioglitazone + GW9662+caerulein group (40 μmol/L pioglitazone+ 5 μmol/L GW9662 + 1 × 10-8 mol/L caerulein).Pioglitazone and GW9662 were added 30 minutes earlier than caerulein.Cell proliferation rate of each group was determined by MTT assay at three,six,12 and 24 hour.The cell apoptosis rate was detected by flow cytometry with Annexin Ⅴ/PI staining and terminal dexynucleotidyl transferase-mediated deoxyuridine triphosphate (dUTP) nick end labeling (TUNEL) staining.The activity of Caspase 3,8 and 9 of each group was measured.Mitochondrial membrane potential (MMP) was detected by flow cytometry with JC-1 staining.Single factor analysis of variance and LSD test were performed for data analysis.Results At six,12 and 24 hour,the cell proliferation rate of pioglitazone group and pioglitazone + caerulein group was 0.19±0.02,0.22±0.02,0.36±0.02 and 0.20±0.04,0.23±0.02,0.38±0.02,respectively,which were significantly lower than those of blank control group (0.25 ±0.04,0.28 ± 0.03 and 0.46±0.02) and caerulein group (0.23±0.02,0.29±0.01 and 0.46±0.05,t lgroup=-3.16,-4.61 and-6.25,tcaerulein group =-1.58,-4.61 and-6.15,all P＜0.05).And the cell proliferation rates of pioglitazone+GW9662+caerulein group at six,12 and 24 hour (0.23±0.02,0.27±0.02 and 0.45±0.01) were significantly higher than those of pioglitazone+caerulein group (t=2.25、3.87、4.56,all P＜0.05).There was no significant difference in cell apoptosis rate detected by flow cytometry with Annexin Ⅴ/PI staining between pioglitazone group ((11.80 ± 0.47) ％,(9.62 ± 2.63) ％ and (14.92 ± 2.52) ％) and pioglitazone+caerulein group ((8.78±0.47)％,(11.89±2.80)％ and (14.25±2.67)％,all P＞0.05),but cell apoptosis of these two groups were higher than those of control group ((5.52± 0.64)％,(5.30±0.97)％ and (5.47±0.88)％) and caerulein group ((5.98±1.21)％,(7.47± 0.58) ％ and (8.11 ± 1.32) ％) respectively,and the differences were statistically significant (t l group =9.81,4.45 and 10.74,tcaerulein group =4.38,7.62 and 6.98,all P ＜0.05).There was no significant difference in apoptosis rate between pioglitazone+GW9662+caerulein group ((5.82±0.26) ％,(6.05± 0.83) ％ and (9.23±0.90)％) and caerulein group; while significantly higher when compared with those of pioglitazone+ caerulein group (t=-4.63,-10.07 and-5.70,all P＜0.05).At 12 hour,the apoptosis rate detected by TUNEL staining of pioglitazone group ((3.93 ± 0.40)％) was significantly higher than that of control group ((2.73 ±0.68) ％),the apoptosis rate of pioglitazone+ caerulein group ((8.43 ± 1.65)％) was significantly higher than that of caerulein group ((2.80 ± 0.56)％),the apoptosis rate of pioglitazone+GW9662+caerulein group ((3.87±0.35)％) was lower than that of pioglitazone+ caerulein group (t=7.93,8.92,-5.35,all P＜0.05).At 24 hour,the activity of Caspase 3,8 and 9 of pioglitazone+ caerulein group (1.28 ± 0.05,1.38 ± 0.04 and 1.53 ± 0.09) significantly increased compared with those of caerulein group (1.12±0.88,1.22±0.02 and 0.53±0.07,t=3.20,8.62 and 1.29,all P＜0.05).After treated with GW9662,part of activity of Caspase enzymes recovered.The number of cells with potential change of mitochondrial membrane in pioglitazone group and pioglitazone + caerulein group was more than that of caerulein group (28.50±0.91)％ and (28.20±2.56)％ vs (15.00±3.67)％) and part of membrane potential recovered after GW9662 added ((20.67 ± 2.20) ％).Conclusions Pioglitazone might promote AR42J cell apoptosis through the activation of caspases enzymes and changing membrane potential.And the antagonist GW9662 would partially inhibit the apoptosis induced by pioglitazone.

The interaction betweenYan-Hu-Ning (YHN) and bovine serum albumin (BSA) was investigated in order to provide further theoretical evidences on action mechanism study between YHN and proteins within the organism. Under optimal conditions, the interaction between YHN and BSA was studied by fluorescence quenching, ultraviolet absorption spectrometry and synchronous fluorescence spectroscopy. At the temperature of 283.15 K, 298.15 K and 313.15 K, quenching constant (KSV) and speed constant (Kq) were calculated by S-V curves. Static quenching constant (KLB) was obtained by L-B double reciprocal equation. Double logarithmic equation was used to calculate the binding constants (Kb) and the number of binding site (n). Thermodynamic equation was used to obtainΔH,ΔS,ΔG. Hill’s coefficients (nH) was obtained by Hill equation. The results showed that at three different temperatures, along with the increasing of YHN concentration, the fluorescence intensity of BSA decreased regularly. The value of KSV, Kq, KLB, Kb, n and nH decreased with the increasing of temperature;ΔG < 0,ΔH < 0,ΔS < 0; n was approximately equal to 1; nH > 1. It was concluded that YHN-BSA complex quenched the intrinsic fluorescence of BSA. The mechanism of fluorescence quenching was static quenching. The main binding forces were deduced as hydrogen bonds and Van der Waals forces from calculated values of thermodynamic parameters. YHN and BSA can form a binding site, which indicated certain binding interaction between YHN and BSA. YHN can be stored and transported by protein within the body. Free energy was produced to transformΔG into negative value. It showed that the process of binding between YHN and BSA was spontaneous. The nH was more than 1. It indicated that YHN had positive cooperative effect. The primary binding site was located at subdomainⅡA. The synchronous fluorescence spectra showed certain influence on the conformation of BSA by YHN. It led to the weakening of polarity within BSA and the binding site to be closer to the tyrosine.

Objective To observe the characteristics of the images of optical coherence tomography (OCT) performed on the patients with macular edema, and investigate relationship between the retinal thickness at the central fovea and the best-corrected visual acuity. Methods Fourty-seven patients (54 eyes) with macular edema diagnosed by direct and indirect ophthalmoscopy, three mirror contact lens, or fundus fluorescein angiography (FFA) underwent OCT which was also performed on 50 healthy individuals as the control. The examination focused on the horizontal and vertical planes crossing the central fovea to measure the thickness of the fovea. The correlation between retinal thickness at the central fovea and best-corrected visual acuity was analyzed, and the images of OCT in the patients with macular edema were classified according to the macular configuration. Results Significant difference of the macular configuration and best-corrected visual acuity was found between the control and macular edema group. Three characteristics were found in the images of OCT in the patients with macular edema: sponge-like retinal swelling in 20 eyes (37.1%), macular cystoid edema in 26 eyes (48.1%), and serous retinal detachment in 8 eyes (14.8%). The statistical analysis showed that there was a negative correlation between the thickness at the central fovea and best-corrected visual acuity of affected eyes (r=-0.569, P=0.000). Conclusions The images of OCT in macular edema include 3 types: sponge-like retinal swelling, macular cystoid edema, and serous retinal detachment. The retinal thickness at the central fovea of the eyes with macular edema was thicker than that of the normal ones, and the thicker the fovea is, the poorer the visual acuity will be.

Objective To investigate the effect of pioglitazone on the activation of pancreatic apoptosis in the pathogenesis of rats with acute necrotizing pancreatitis.Methods Eighty Sprague-Dawley (SD) rats were randomly divided into four groups,including acute necrotizing pancreatitis (ANP),sham operation (SO),solvent control (Solvent),pioglitazone intervention (pioglitazone) group,with 20 rats in each group.ANP model was induced by retrograde injection of 4％ sodium taurocholate (1ml/kg body weight) into the biliary-pancreatic duct.The rats in pioglitazone group were injected pioglitazone (40 mg/kg body weight) into the ANP abdominalcavity 30 min before mldel induction.The rats were sacrificed at 1 h,3 h,6 h,and 12 h after ANP model induction.The pancreatic tissues were harvested.Routine HE staining was used to evaluate pancreatic pathological damage.The apoptosis was determined by TUNEL method.The expression of PPARγ was determined by using immunohistochemistry and Western-blot methods.The activity of caspase3 in pancreatic tissues was detected by using spectrophotometry.Results The pancreatic pathological damage was attenuated in rats in pioglitazone group compared with that in rats of ANP group,and the difference between the two groups was statistically significant (P ＜ 0.05).The PPARγ expression of pioglitazone group was 1.34 ± 0.09,which was significantly higher than that in ANP group (0.75 ± 0.05),and the difference between the two groups was statistically significant (P ＜ 0.05).The apoptotic index in pioglitazone group at 3 h was 8.35 ± 0.95,which was significantly higher than that in ANP group at 3 h (4.37 ± 1.22) ; the caspase3 activity was 9.24 ± 1.78,which was significantly higher than that in ANP group (5.04 ± 0.86),and the difference between the two groups was statistically significant (P ＜0.05).Conclusions Pioglitazone intervention attenuates pancreatic inflammation,increases PPARγ expression and caspase3 activity and induces apoptosis in pancreas of rats with acute necrotizing pancreatitis.