Obesity has rapidly become a pandemic and is associated with increased carcinogenesis, especially esophageal adeno-carcinoma (EA). Adipose tissue is considered an endocrine organ because of its capacity to secrete a variety of adipokines, such as leptin, adiponectin, and resistin. Adipokines have recently been found to be associated with different types of chronic esophageal diseas-es, including gastro-esophageal reflux diseases, Barrett esophagus, and carcinogenesis. First-hand evidence supporting the inhibitory and/or active function of adipokines has been collected on human EA. This review aims to provide important insights into the potential mechanisms of adipokines in EA progression.

Objective To incubate rat neural stem cells (NSCs) with selection-specific inhibitor ( LY294002) of PI3-K, and explore the effects of PI3-K/AKT signal transduction pathway in NSCs. Methods NSCs derived from E15-16 rats were isolated and cultured. After incubation of NSCs with different concentrations of LY294002 (0 to 40 μmol/L), cell survival ( WTS-8 assay), proliferation ( BrdU immunohistochemical identification), differentiation (β Tubulin-III immunohistochemical identification) and AKP phosphorylated protein (Western blotting) were detected. Results The effects of LY294002 on the survival, proliferation and differentiation of NSCs was concentration-dependent. The survival of the NSCs decreased significantly with a higher concentrations of LY294002 (25, 30, 35, 40 μmol/L) (P < 0. 05). The numbers of BrdU positive cells with LY294002 of 30, 35 and 40 μmol/L were significantly smaller than that of the control (LY294002 0 μmol/L) (P < 0.05). The numbers of β Tubulin-III positive cells with LY294002 of 35 and 40 μmol/L were significantly smaller than that of the control (P < 0. 05). The expression of AKT was blocked by LY294002 in a concentration-dependent manner. Conclusion PI3-K/AKT signal transduction pathway plays a vital role in the survival, proliferation and differentiation of NSCs.

To improve the clinical probation in lemology teaching,we may take the following measures:amending the teaching content,improving the teaching methods and promoting doctor-patient communications.

Objective:To investigate the effects of Dexmedetomidine for supplemental anesthesia on perioperative hemodynamics and postoperative sedation and analgesia in elderly patients receiving radical gastric cancer surgery under general anesthesia.Methods:From January 2019 to April 2020, 63 patients admitted to our hospital for radical gastric cancer surgery were included as observation objects.They all underwent general anesthesia and were divided into the Dexmedetomidine group(odd-numbered group)and the normal saline group(even-numbered group)according to the parity of serial numbers the subjects were assigned to.Changes in perioperative hemodynamic index values and the amounts of anesthetic drugs used in the two groups were monitored and recorded, and postoperative sedation and analgesia effects were evaluated by using the Ramsay sedation scale and the visual analog scale(VAS).Results:The mean artery pressure(MAP)and heart rate(HR)were lower in the Dexmedetomidine group than in the normal saline group before anesthesia induction(T1), immediately after intubation(T3)and immediately after extubation(T5)( P<0.05). The Ramsay scores were higher and the VAS scores were lower in the Dexmedetomidine group than in the normal saline group at 1 h and 4 h after surgery( P<0.05). The doses of intraoperative propofol and remifentanil were lower in the Dexmedetomidine group than in the normal saline group[(1121.5±198.5)mg vs.(1395.6±332.7)mg, (3.1±0.9)mg vs.(5.5±1.2)mg, P<0.05]. Conclusions:The use of Dexmedetomidine for supplemental anesthesia can effectively maintain the stability of the patient's intraoperative hemodynamics and enhance the sedative and analgesic effects while reducing the amount of anesthetic drugs in patients receiving radical gastric cancer surgery under general anesthesia.

Objective To study the genetic regulation mechanism of colorectal LST,polypoid adenomas and clolrectal cancer by detecting the expression of p53,c-myc and Ki-67 in these three lesions.Methods The expressions of p53,c-myc,Ki-67 were determined via two-step of immunohistochemistry method in LST,polypoid adenomas,invasive colorectal cancer and their significant difference were compared.Statistical analyses were used to analyze the correlation among Ki-67 expression and p53,c-myc expression in these three group lesions.Results Immunohistochemical staining was performed in 38 LST,62polypoid adenomas and 36 colorectal cancer.For p53 and c-myc,the positive rates in LST,polypoid adenomas and colorectal cancer were significantly different from each other.For Ki-67,the positive rates in LST and polypoid adenomas were significantly lower than that in colorectal cancer,but there was no statistical significant difference between LST and polypoid adenomas.The expression of Ki-67 did not correlate with p53and c-myc both in LST and polypoid adenomas.But in colorectal cancer,the expression of Ki-67 was strongly related to p53 and c-myc.Conclusion The expressions of p53,c-myc and Ki-67 were different in LST,polypoid adenomas and colorectal cancer,indicating that their genetic regulation mechanism might be different,and the genetic avenue for LST may be different from polypoid adenomas.

Objective To investigate the efficiency and safety of laparoscopic hepatectomy (LH) and open hepatectomy (OH) in patients with hepatocellular carcinoma (HCC). Methods A total of 45 HCC cases undergoing hepatectomy from January 2008 to December 2010 in our hospital were divided into LH group ( n =21 ) and OH group ( n =24 ).Their clinical efficiency and safety were compared and analyzed. Results The amount of intraoperative blood loss and blood transfusion in LH group were significantly higher than that of OH ( respectively x2 =3.973,x2 =4.862,all P ＜ 0.05 ).LH is associated with less postoperative complications and duration of hospital stay,compared with OH ( respectively x2 =4.746,t =-2.717,all P ＜0.05).Cumulative survival rates in both groups were not statistically significant ( x2 =0.172,P ＞ 0.05 ).However tumor-free survival rate in LH was significantly higher,superior to that of OH (x2 =4.543,P ＜ 0.05). Conclusions LH and OH are all safe and effective hepatectomy for HCC.LH has the advantage of less complication and shorter hospital stay.

BACKGROUND:Compared with traditional autogenous bone graft, composite, as the carrier of seed cells, possesses advantages of fewer traumas and no limitation of donor site in repairing bone defect.OBJECTIVE: To observe the ability of the composite of β-tricalcium phosphate artificial bone-hyaluronic acid-type I collagen (β-TCP/HA/COL-I), as induced bone marrow stromal cell (MSC) carrier, to repair rabbit radial defect, and the feasibility with the composite as bone substitute material.DESIGN: A randomized and controlled trial.SETTING: Department of Orthopaedics, Renmin HospitaL, Wuhan University.MATERIALS; The study was conducted in the Department of Orthopaedics Renmin Hospital, Wuhan University between September 2003 and July 2004. Thirty-one New Zealand big white rabbits, aged 6 months, with body mass of 1.5 to 2.0 kg were enrolled in this study. The rabbits were randomized into control group (n =4) and experimental group (n =27).METHODS : ①In vitro induction and culture of MSCs was performed on 31 white rabbits, and the alkaline phosphatase (ALP) positive ratio of induced MSCs was observed. The structure of β-TCP/HA/COL-I was observed under scanning electron microscope. ② A 2 cm radial defect was created through operation. Eight weeks later, composites of β-TCP/HA/COL-I/MSCs were implanted into one side of rabbits in the experimental group, and autogenous bone was implanted into the other side. Rabbits in the control group were untouched. ③All the animals in the experimental group were randomly sacrificed at postoperative 4,8 and 12 weeks, 6 rabbits at 4 and 8 weeks, 15 at 12 weeks; Animals in the control group were sacrificed at 12 weeks. Gross observation, X-ray photographing, haematoxylin-eosin (HE) dyeing, and assessment of inorganic ingredient were performed. Osteogenic area and biomechanical tests were performed at 12weeks. Repairing effects on bone defect in each group were compared.MAIN OUTCOME MEASURES: The ALP positive ratio of induced MSCs; The structure of composite ofβ-TCP/HA/COL-I;Gross observation; X-ray photographing; HE dyeing and assessment of inorganic ingredient; Osteogenic area and biomechanical tests.RESULTS: All the 31 rabbits entered the stage of result analysis. ① The ALP positive ratio of cells reached 75% after induction and culture. ② Scanning electron microscope observation showed that 3 kinds of materials with abundant cellular structure distributed evenly. ③ The osteogenic area at 12 weeks was (72.5±3.6)% and (76.7±6.2)% in the experimental group and autogenous group, respectively (P ＞ 0.05). ④The maximum bending moment was (521.0±61.1) and (554.3±53.3)N·mm in the experimental group and control group, respectively; The maximum displacement at point of application of force was (0.816±0.071)and (0.870±0.103)respectively, without significant difference (P ＞ 0.05). ⑤Inorganic ingredient in the composite was 75%, 57% and 42% at 4,8 and 12 weeks respectively, suggesting that the inorganic component in the material was gradually decomposed with the elongation of time. ⑥Results of gross observation,X-ray photographing, histopathological examination, biomechanical test showed that with the elongation of time, composite of β-TCP/HA/COL-I/MSCs could repair bone defect in the experimental group, while bone defect in the control group had not been repaired.CONCLUSTON: Composite of β-TCP/HA/COL-I /MSCs possesses the same effect on repairing bone defect as autogenous bone, so it may be used as autogenous bone graft substitute.

ObjectiveTo discuss the biomechanical properties of clavicle intramedullarynail in fixing middle fracture of clavicle and compare with the traditional plate and screw and single Kirschner wire,in order to provide scientific evidence for clinical application.MethodsFifteen adult cadaver were collected to make middle fracture of clavicle models.According to the clinical operation methods,the fracture models were divided into three groups with 5 specimens each:clavicle intramedullary nail group,plate and screwfixation group,and Kirschner wire internal fixation group.Biomechanical properties of three groups were tested and compared by experimental stress analysis method.ResultsIn the load 1000 N,the bending strength and bending stiffness of clavicle intramedullary nail group[ (57.41±4.72),( 2.28±0.17) N ] had no significant difference compared with those of plate and screw fixation group[(58.50 ±t4.14),(2.26 ±0.20) N ] (P ＞ 0.05),while had statistical significance compared with Kirschner wire internal fixation group [(51.14±4.32),(1.54±0.16) N] (P ＜ 0.05).The bending strength and bending stiffness had statistical significance between plate and screw fixation group and Kirschner wire internal fixation group (P＜ 0.05).In the torsional mechanical test,torque of clavicle intramedullary nail group had no significant difference compared with plate and screw fixation group (P ＞ 0.05 ),but had statistical significance compared with Kirschner wire internal fixation group (F =14.88,P ＜0.05).In compression test of the clavicle,the compression limit load of clavicle intramedullary nail grotup [ ( 1246±87) N ] had no statistical significance compared with plate and screw fixation group [ ( 1348±121 ) N ] ( P ＞ 0.05 ),and had significant difference compared with Kirschner wire internal fixation group [ ( 870±72 ) N ] (F =14.74,P ＜ 0.05 ).Conclusions Clavicle intramedullary nailing for treating middle fracture of clavicle can provide better biomechanical strength,stiffness and stability.Meanwhile as a minimally invasive operation,this operation method is feasible.Compared to other internal fixation methods,it has certain advantages.

Objective:To observe the influence of isehemia-reperfusion(I/R)on hepatoma growth and on the expression of genes associated with tumor metastasis and recurrence(VEGF and MMP-9)in the adjacent tissues of cancer in nude mice. Methods:BALB/c nude mouse model bearing Hep3B-tumor in the liver was established and the model mice were evenly randomly into 5 groups:sham group and ischemia/reperfusion 1 h,6 h,5 d,and 7 d groups(n=8).I/R models were established by blocking porta hepatic;the sham group underwent the same treatment as the I/R model group except for blocking of porta hepatic.ALT and AST were detected in I/R 1 h and 6 h groups.Real-time-PCR was employed to detect the change of VEGF and MMP-9 in the adjacent tissues of cancer and the results were compared with that of the control group(n=6). Histopathological changes of liver were studied by H-E staining and necrotic areas were calculated in I/R 5 d and 7 d groups (n=6).The remnant tumor bearing mice were sacrificed 2 weeks after I/R to measure the volume and mass of the tumors. Results:Two weeks later,the tumor volume and mass in I/R group were increased compared with those in the sham group ([209.6?25.74]mm~3 vs[330.6?32.01]mm~3,[0.214?0.036]g vs[0.374?0.045]g,P