Nuclear factor-E2 related factor 2 (Nrf2)can protect the normal cells from the damage of oxidants and electrophones,preventing tumorigenesis and metastasis.However,the abnormal activation of Nrf2 in tumor cells can lead to tumor development.Chemicals acting on Nrf2 pathway include activators and inhibi-tors,Nrf2 inhibitors can increase the chemosensitivity of the tumor,providing a new idea for the drug design of high-efficiency and low-toxicity.

Objective To evaluate the effect of probucol combined with simvastatin on blood levels of oxidied low density lipoprotein (ox-LDL) and inflammatory factors in acute stage of cerebral infarction. Methods A total of 122 patients with acute stage of cerebral infarction were randomly divided into two groups:observation group ( n = 62),and control group( n = 60). After two weeks of follow-up ,the levels of high sensitivity C-reactive protein(hsCRP) ,oxLDL ,fibrinogen ( FIB ), interleukin 6 (IL-6) and blood lipids were detected. The side effect was recorded and the difference between two groups was analyzed. At 7 d and 14 d, curative effects were evaluated by standard scale of clinical neurological deficit. Results Compared with the control group, 2weeks after the medication, low-density lipoprotein cholesterol( LDL-C), apolipoprotein B ,ox-LDL, IL-6 and hsCRP were significantly decreased in the observation group (P <0.01 ). Conclusion The treafment of probucol combined with simvastatin could reduce the levels of ox-LDL and inflammatory factors in acute stage of cerebral infarction, and prevent hemorrhagic transformation and recurrence of cerebral in farction.

Objective To investigate the feasibility of laparoscopic radical gastrectomy for gastric cancer.Methods Laparoscopic radical gastrectomy was performed in 8 cases from Febrary 2005 to April 2005,including radical distal gastrectomy in 6 cases,radical total gastrectomy in 1 case,and radical proximal gastrectomy in 1 case.Results All the 8 patients underwent laparoscopic radical gastrectomy smoothly and no conversion to open surgery was required.The operation time was 340?62 minutes in radical distal gastrectomy,was 362 minutes in radical proximal gastrectomy,and 423 minutes in radical total gastrectomy.The intraoperative blood loss was 100～250 ml(mean,140 ml) in radical distal gastrectomy,300 ml in radical total gastrectomy,and 170 ml in radical proximal gastrectomy.No blood transfusion was needed.The number of havested lymph nodes was 18～37(mean,23).No surgical-related complications occurred.The time to first flatus was 38～56 hours(mean,42.4 hours),and the time to liquid diet was 2～5 days(mean,2.5 days).All the 8 cases were followed for 12～14 months postoperatively and no recurrence or metastasis was observed.Conclusions Laparoscopic radical gastrectomy is a feasible technique for patients with gastric cancer at early stage or early progressive stage.

A fluorescence nanosensor based on an easily prepared fluorescent molecule, 1-oxo-1H-phenalene-2,3-dicarbonitrile (OPD), was developed for highly sensitive detection of glucose.Under the catalysis of horseradish peroxidase (HRP), 3,3′,5,5′-tetramethylbenzidine (TMB) was oxidized into oxidized TMB (oxTMB) by H2O2.And the fluorescence of OPD was quenched by the intense absorption of the formed oxTMB, thus realizing effective quantitative detection of H2O2.The linear range was 0.05-0.8 μmol/L and 1-10 μmol/L respectively, with limit of detection of 0.02 μmol/L.Besides, on the basis of transformation of glucose into H2O2 through the catalysis of glucose oxidase, this nanosensor could be further exploited for highly sensitive detection of glucose.The TMB-HRP-OPD sensor exhibited linear range of 0.1-3.0 μmol/L and 4.0-30 μmol/L respectively for detection of glucose, with limit of detection of 0.02 μmol/L.Furthermore, it was successfully applied to the determination of glucose in real human serum and the results were in good agreement with the clinical data.

Objective To study the risk factors for failure of INSURE strategy in very and extremely low birth weight preterm (V/ELBW) infants.Method From January 2005 to December 2014,clinical data of 149 preterm infants (gestational age less than 32 weeks) admitted to neonatal department of Tongji Hospital who received intubation-surfactant-extubation (INSURE) strategy were collected.These infants were assigned into two groups:INSURE failure group and INSURE success group,according to whether a second dose of surfactant or mechanical ventilation was needed within 72 hours after first pulmonary surfactant treatment.The clinical characteristics and outcomes between the two groups were compared.Chi square and t tests were used to define the differences between groups.Logistic regression analysis was used to identify the independent risk factors for INSURE failure.Result Among the 1 149 patients,148 received INSURE treatment,and 113 cases (76.4％) were successfully treated with the INSURE strategy.The infants in the failure group were statistically lower in birth weight,gestation age,antenatal steroids utilization rate,PaO2 and PaO2/FiO2 than those in the success group,while the age of mother,male/female ratio and PaCO2 were higher in the failure group.Logistic regression analysis showed that male (OR =7.440,95％ CI 1.846 ～29.984),BW ＜ 1 000 g (OR =9.180,95％ CI 1.716 ～49.105),PaCO2 ＞48 mmHg (OR =5.996,95％ CI 2.088 ～ 17.213),PaO2/FiO2 ＜205 (OR =3.010,95％ CI 1.033 ～8.774) were independent risk factors for INSURE failure.Conclusion INSURE strategy failure was associated with gender,birth weight,gestation age,antenatal steroids utilization,PaO2,PaCO2 and PaO2/FiO2 of the first blood gas after birth.BW ＜ 1 000 g,PaCO2 ＞ 48 mmHg and PaO2/FiO2 ＜ 205 of the first blood gas after birth were independent risk factors for INSURE strategy failure.

Objective: To investigate the diagnostic value of 64 multislice spiral CT (64-MSCT) and 1.5T MRI in nurseling with congenital vascular rings.
Methods:We retrospectively studied the diagnostic records of 64-MSCT and 1.5T MRI in 48 nurseling with congenital vascular rings. There were 42 cases received CTA, 12 received MRA and 6 received both CTA and MRA. We classiifed the types of vascular rings by Edwards sketch map of aortic arch embryonic development and trachea wrapping conditions. The diagnostic values of 64-MSCT and 1.5T MRI on vascular rings were compared.
Results: There were 25 patients with complete vascular rings including 3 of double aortic arch, 12 right aortic arch with left subclavian artery and patent ductus arteriosus (PDA), 9 combining with arterial ligament, 1 neck right aortic arch with left subclavian artery combining left PDA;and 23 patients with in-complete vascular rings including 2 pulmonary artery sling, 9 left aortic arch with right subclavian artery combining left PDA, 10 combining with arterial ligament, 1 right aortic arch with left subclavian artery combining right PDA, 1 with innominate artery compressed trachea. There were 32/48 patients combined with cardiac malformations, both 64-MSCT and 1.5T MRI may well reveal the composition and special relationship of vessel rings. The minimum intensity projection (MinIP) and air volume rendering (VR) of 64-MSCT may clearly display the morphology and development of trachea, image fusion technique could directly show the special relationships among vascular rings, trachea and esophagus. While 1.5T MRI was relatively poor to present tracheal image.
Conclusion: 64-MSCT could accurately and comprehensively display the special relationships among the vessels rings, trachea and esophagus;which was the best method for diagnosing the nurseling with vessel rings in clinical practice.

Objective To investigate the effects of H3K9ac hyperacetylation mediated by histone acetylases on the overexpression of MEF2C in the hearts of fetal mice exposed to alcohol during pregnancy,and provide new interven-tion targets for prevention and treatment of cardiac dysplasia caused by alcohol exposure.Methods C57BL/6 mice were divided into 5 groups randomly,blank control group,dimethylsulfoxide (DMSO)group,alcohol group,alcohol +anacardic acid group and anacardic acid group,and then the hearts of fetal mice were collected to be analyzed.Chroma-tin immunoprecipitation and Western blot were used in assaying the binding of histone acetylases and the level of H3K9ac to the promoter of MEF2C in the hearts of fetal mice.The mRNA expression of MEF2C was tested by adopting real -time PCR.Results The level of H3K9ac in the promoter of MEF2C in the hearts of fetal mice exposed to alcohol was higher than that in the hearts of fetal mice exposed to saline (1 .30 ±0.1 9 vs 0.45 ±0.01 ),there was statistically significant difference (P <0.05),while the binding of E1 A -binding protein (p300),p300 /cyclic adenosine mono-phosphate response element binding protein -associated factor (PCAF)and steroid receptor coactivator -1 (SRC1 )to the promoter of MEF2C were abnormally elevated in the hearts of fetal mice treated by alcohol (1 .68 ±0.08 vs 0.82 ± 0.08,1 .08 ±0.05 vs 0.42 ±0.02,1 .1 8 ±0.05 vs 0.39 ±0.08),and there were statistically significant differences (all P <0.05).The expression of MEF2C mRNA in alcohol group was higher than that in blank control group (1 .36 ± 0.1 2 vs 0.29 ±0.03),there was statistically significant difference(P <0.05).However,a pan -acetylases inhibitor, anacardic acid,could decrease significantly the binding of p300 and PCAF to the promoter of MEF2C (1 .52 ±0.05 vs 0.63 ±0.09,1 .1 3 ±0.04 vs 0.45 ±0.04),and correct abnormal hyperacetylation of H3K9ac induced by alcohol (1 .58 ±0.08 vs 0.67 ±0.05),and down -regulate the over -expression of MEF2C in the hearts of fetal mice exposed to alcohol (1 .36 ±0.1 2 vs 0.41 ±0.05 ),and there were statistically significant differences (all P <0.05 ). Conclusions Hyperacetylation of H3K9ac mediated by p300 and PCAF may be a key regulatory factor in the over -expression of cardiac nuclear transcription factor MEF2C in the hearts of fetal mice exposed to alcohol during pregnan-cy.Anacardic acid can significantly attenuate the level of H3K9ac through inhibiting the binding of p300 and PCAF to the promoter of MEF2C,and down -regulate the over -expression of cardiac nuclear transcription factor MEF2C in the hearts of fetal mice.

BACKGROUND: Many researchers at home and abroad think that interlocking intramedul ary nails may be more suitable for comminuted fractures of the tibia with severe soft tissue injury. Plate fixation is more advantageous for distal tibial fractures. OBJECTIVE: To compare the effects of multifunctional locking intramedul ary nail and locking plate in treatment of extraarticular proximal tibial fractures. METHODS: 156 patients with extraarticular proximal tibial fractures were included and divided into intramedul ary nail group (n=78) and the locking plate group (n=78) according to repair method. Curative effects and healing time were compared between the two groups. At 3 months after treatment, Johner-Wruh tibial fracture scores were used to assess the repair effect in both groups. In addition, operation time, blood loss, healing time and complications were compared between the two groups.RESULTS AND CONCLUSION: Mean healing time was 9.3 months in the locking plate group and 9.2 months in the intramedul ary nail group. At 3 months after treatment, the repair effect was significantly better in the intramedul ary nail group than in the locking plate group (P < 0.05). Blood loss and time were less in the intramedul ary nail group than in the locking plate group (P < 0.05), and surgical difficulty was high. At 3 months after treatment, the incidence rates of tibia eversion/inversion, neurovascular injury and nonunion/infection were significantly lower in the intramedul ary nail group than in the locking plate group (P < 0.05). These findings confirmed that the multifunctional locking intramedul ary nailing for extraarticular proximal tibial fractures obtained reliable efficacy, exact effect, reduced blood loss and low incidence of complications. Thus, it is better than locking plate.

Objective To investigate the clinical features ,diagnosis and treatment of cesarean scar pregnancy (CSP) .Methods We retrospectively analyzed the medical history ,clinical manifestation ,diagnoses ,treatments and outcomes of 42 patients with ec‐topic pregnancy in the cesarean scar .Results All cases got diagnosed by transvaginal ultrasound .The error rate of first diagnosis was 40 .4% (17/42) .There were 25 cases of conservative therapy ,in which 12 cases were resolved with laparoscopic surgery and 1 case resolved with open surgery ;in the first process 15 cases were carried out laparoscopic surger in which 1 case were converted to laparotomy ;abdominal surgery were underwented in 1 case and were cured .Only one case underwent abdominal total hysterectomy as of failure after uterine artery embolization .After initial conservative treatment 3 cases were hospitalized again and 2 cases under‐went reoperation .41 patients were successfully retained the uterus and normal menstrual cycle returned at two months after opera‐tion .Conclusion The early diagnosis for CSP mainly depended on ultrasound and the thickness of incision muscle layer is an impor‐tant basis for choice of treatment .Checking the thickness of incision muscle layer for CSP mainly depended on ultrasound ,and lapa‐roscopic surgery is an ideal method for diagnosis and treatment of CSP .

Objective To investigate the changes of serum bilirubin level in elderly patients with acute cerebral infarction and its significance.Methods 164 hospitalized elderly patients,who suffered from acute cerebral infarction within 1 week after onset,were divided into 2 groups according to age:group A aged over 60 years(n=85) and group B aged 40-60 years(n=79),and 66 healthy subjects aged over 40 years were collected as controls(group C).Serum bilirubin levels in all subjects were determined.The ratio of pulse pressure over mean arterial pressure(PP/MAP) in group A and B was calculated.Nerve function scores in the three groups were detected before and after 2 weeks of treatment.Meanwhile,the data of risk factors including blood glucose,blood pressure,blood lipids,smoking and drinking in group A and B were collected.Results Compared with group C,serum total,direct,indirect bilirubin levels were increased in group A and B(both P＜0.01),and the change was smaller in group A than in group B(P＜0.05).The nerve function scores was lower in group A than in group B before and after treatment [(35.2±12.6) vs.(44.3±7.9),(40.7±9.1) vs.(51.3± 4.1),t=5.58,9.73,both P＜0.01],but PP/MAP and the numbers of risk factors were higher in group A than in group B [(0.46±0.06) vs.(0.38±0.06),93.01 vs.71.20,both P＜0.01].There were no significant correlations of serum total,direct and indirect bilirubin levels with nerve function scores in group A or B(all P＞0.05).Conclusions Serum bilirubin level is increased in patients with acute cerebral infarction,but the endogenous antioxidant capacity is decreased because of aging,multiple risk factors and more serious atherosclerosis in elderly patients,and the increment of bilirubin level is relatively smaller in acute cerebral ischemia,leading to the reduced protective effect against stress.Serum bilirubin level may influence the prognosis in patients with acute cerebral infarction.