Objective To evaluate the role of Akt and nuclear factor (NF)-κB pathway in the development of chemoresistance in gastric cancer and the relation between Akt and NF-κB.Methods SGC-7901 cells were exposed to chemotherapeutic drugs (doxorubicin and etoposide ) or chemotherapeutic drugs combined with Wortmannin or MG-132.The cell growth was detected using MTT method.The apoptosis of SGC-7901 cells was measured by TUNEL and Annexin V/PI methods.The protein level of NF-κB was analyzed by immunocytochemical staining.Electrophoretic mobility shift assay (EMSA) was used to confirm the increased nuclear translocation of NF-κB/P65.chemotherapeutic drugs could obviously inhibit the growth of SGC-7901 cells in time-dose-dependent manner.Pretreatment of SGC-7901 cells with Wortmannin or MG-132 could promote this inhibitory κB in a dose-dependent manner.Wortmannin or MG-132 pretreatment could enhance the apoptosis of NF-κB was found in SGC-7901 cells stimulated with Wortmannin,but no activation of Akt was noted in those treated with MG-132.Conclusions The chemotherapeutic drugs can both induce apoptosis and activate Akt and NF-κB in SGC-7901 cells.The efficacy of chemotherapeutic drugs can be increased via inhibiting activation of Akt or NF-κB.

Objective To investigate the risk factors of pathological upgrading in gastric mucosal lesions with low-grade intraepithelial neoplasia (LGIN) after endoscopic submucosal dissection (ESD).Methods From January 2010 to December 2016,the complete clinical data of 326 patients pathologically diagnosed with gastric LGIN lesions before ESD were retrospectively analyzed.Single factor analysis of variance and multiple factor Logistic regression analysis were performed to analyze the risk factors of pathological upgrading after ESD.Results A total of 326 patients with gastric LGIN lesions diagnosed by preoperative biopsy before ESD were enrolled.Among them the postoperative pathological diagnosis of 244 cases (74.85％) were still LGIN,while the postoperative pathological diagnosis of 82 cases (25.15 ％) were upgraded,of which 61 cases (18.71％) were upgraded to high-grade intraepithelial neoplasia and 21 (6.44％) were upgraded to gastric early cancer.The results of single and multiple factor analysis indicated that lesion size≥2.0 cm,deep depressed-type,surface erythema,lesion mucosa with ulceration and lesions with spontaneous bleeding were the risk factors of pathological diagnosis upgrading after ESD (F=5.37,6.44,4.56,7.56 and 7.78,respectively;all P＜0.01),odds ratio (OR) value and 95％ confidence interval (CI) were 4.086 (2.035 to 10.786),7.435 (2.845 to 19.862),3.205 (1.535 to 8.541),8.668 (3.365 to 21.457) and 7.056 (2.732 to 18.355).The age,gender and location of the lesion were not the risk factors.Conclusions Pathological upgrading is common in gastric lesions with LGIN after ESD.The lesions with high risk factors should be alerted and treated more actively.

Objective To analyze of the effect of artificial lengthening femoral head replacement in elderly patients with stage Ⅰ of unstable femoral intertrochanteric fracture.Methods 203 patients with stage Ⅰ of unstable femoral intertrochanteric fracture were selected as the research object,and they were taken artificial lengthening femoral head replacement,among which 65caese were male,female in 138 cases.The Harris scoring,SF-36,VAS pain scores on admission,2 weeks after operation,postoperative follow-up limb were counted,and the pain of the affected limb and the hip scores were compared amond 3 time periods.Results All 203 cases of senile patients with follow-up,average operation time was 83.64 minutes,the intraoperative blood loss was 355.41mL.The curative effect was evaluated according to the Harris score,SF-36 and VAS pain scoring criteria,and the Harris scores of the affected limbs at admission,at 2 weeks after the operation and after the follow-up were (28.26 ± 5.50) points,(68.26 ±5.50) points,(93.13 ± 5.31) points,respectively,the differences were statistically significant (t =-71.27,-1 397.55,-46.07,all P ＜ 0.01);The VAS pain scores were (8.19 ± 0.48) points,(3.53 ± 0.71) points,(0.23 ± 0.42) points,respectively,the differences were statistically significant (t =88.06,324.17,60.84,all P ＜ 0.01).The sf-36 scores:physiological [(8.35 ± 1.24) points,(15.23 ± 2.17) points,(19.21 ± 2.12) points],social/family [(7.01 ±1.13) points,(14.12 ± 2.12) points,(19.85 ± 2.24) points],emotional [(4.83 ± 1.01) points,(10.12 ±1.22)points,(14.87 ± 1.32) points],function [(6.35 ± 1.21) points,(13.67 ± 1.87) points,(16.81 ±2.12) points],additional focus [(8.85 ± 1.45) points,(16.38 ± 2.12) points,(20.21 ± 2.42) points],total quality of life [(47.35 ± 4.76) points,(74.69 ± 5.87) points,(89.21 ± 6.12) points],the differences were statistically significant(-39.77,-62.92,-20.21,-44.87,-71.89,-26.79,-45.04,-89.01,-38.25,-45.79,-63.41,-15.29,-45.20,-60.39,-17.54,-52.12,-76.49,-22.58,all P＜0.O1).Conclusion Artificial lengthening femoral head replacement in elderly patients with stage Ⅰ of unstable femoral intertrochanteric fracture has good clinical effect,intraoperative high safety,less postoperative complications,postoperative limb functional recovery is good,and it is worthy of clinical promotion and application.

Objective: Comparision of the central location ability and clearance rate of ProTaper retreatment, Fengdu O-file and M3-RT three kinds of nickel-titanium instruments and hand stainless instruments K-file, H-file. Observe the form of the root canal wall. To provide experimental basis and reference for the clinical application of nickel-titanium instruments for root canal retreatment. Methods : 40 simulated resin blocks with the same specification were randomly divided into four groups (n=10). Each group was separately prepared with hand stainless instruments K-file and H-file (group A1), ProTaper retreatment (group B1), Fengdu O-file (group C1), and M3-RT (group D1). Using scanner to obtain the pre- and post-operative images and overlapping the images through Photoshop. Measuring the root canal inner and outer wall resin removal with Image J, compared the central location ability of the four group. A total of 60 mandibular single canal premolars extracted due to orthodontics were collected. The teeth were randomly divided into four groups (n=15) after filling the root canal. Use hand stainless instruments K-file,H-file(group A2), ProTaper retreatment (group B2), Fengdu O-file(group C2) , M3-RT(group D2) to remove the filling materials. The roots were longitudinally sectioned, and the image of the root surface was photographed under the 10 × magnification microscope. The software was used to trace the area of the root canal wall and residual root filling, and the root filling clearance rate of each group was calculated. Two teeth were randomly selected in each group and observed under scanning electron microscope. Results: Within 9 mm from the root tip hole, the central location ability of group B1, C1, D1 was better than that of group A1(P ＜ 0.05). At 4 mm from the root tip hole, group D1 has the best central location ability(P ＜ 0.05). There was no difference of the four instruments at a distance of 10 mm from the root tip hole（P ＞ 0.05）. There were various degree of filling material remained in the root canal after the four groups of instruments for retreatment canal preparation. There was no significant difference between group B2, C2, D2（P ＞ 0.05）, and both were higher than group A2(P ＜ 0.05). Scanning electron microscope observation results shown that the root canal wall prepared by group B2, C2, D2 was more smooth and continuous than group A2, and the residual filling material was less. Conclusion The central location ability of three kinds of nickel-titanium root canal retreatment instruments were significantly better than that of hand stainless instruments. ProTaper retreatment, Fengdu O-file and M3-RT three kinds of nickel-titanium root canal retreatment instruments showed good performance, the central location ability of M3-RT was slightly better. Nickel-titanium root canal retreatment instruments are more efficient than traditional hand stainless instruments in removing root fillings and the root canal wall after preparation is smoother and has good continuity.

Surgical position is very important in upper urinary calculi surgery.The correct surgical position can provide a good surgical field of view, shorten the operation time, reduce the incidence of complications, and ensure the safety of patients’ airway and comfort.Endoscopic surgery is the preferred treatment for kidney and ureteral stones.As the traditional position causes higher recurrence rate and more complications, more positions have been experimented.This article reviews the application and therapeutic effects of different surgical positions in percutaneous nephrolithotomy (PCNL), retrograde intrarenal flexible ureteroscopic lithotripsy (RIRS) as well as their combined use, and summarizes the advantages and disadvantages for clinical reference.

Objective To establish a blast injury experimental model using a shock tube at lateral lying position of C57BL/6 mice, investigate biomechanical responses of macrophages/microglia cells in the heart, lung and brain tissues to mechanical damage by shock wave within 24 hours. Methods Shock tube was employed to generate a shock wave to C57BL/6 mice. Firstly, the weight changes of mice were measured at different time points after the shock. Then the cardiac, pulmonary and whole brain tissue samples were dissected after anesthesia. Pathological sections were stained with HE staining to detect structural damage; the TUNEL staining method was used to mark and count the proportion of dead cells in each tissue. Microglial cells were labeled with fluorescent antibody, while responses and changes of macrophages/microglia after shock loading were analyzed. Results The shock tube exerted 179 kPa overpressure shock wave upon sideway of the mouse, and lethal rate of the mouse was 3.33%. Compared with normal control group, the mice in experimental group had a significant weight loss within 24 hours after loading shock. Pathological sections showed rupture of lung tissues after shock, accompanied by alveolar protein deposition, pulmonary bulla and other diseases. Fluorescence staining showed that lung tissue was recruited and activated in a large amount within 24 hours. The proportion of dead cells cleared rebounded to normal level within 24 hours. The heart was highly tolerant to shock, and macrophages appeared near the large blood vessels. The brain showed unilateral aggregation of microglia due to the impact posture, mainly due to prolonged inflammation and a higher proportion of dead cells at the junction of gray and white matter. Conclusions A blast shock model at lateral lying position of the mouse was established. Within 24 hours, macrophages/microglia were recruited quickly to the injury site after being impacted, which mediated strong immune stress, and might participate in the immune response to trigger a second long-term inflammatory injury. The results of the study provide experimental basis for the evaluation of primary impact injury, such as dose-effect relationship and tissue damage difference.