Glycogen synthase kinase 3β (GSK3β) is a serine/threonine kinase.Several signaling pathways,such as growth factors and Wnts,inhibit the GSK3β activity,thereby it promotes cell survival At the time of cerebral ischemia,with the changes of the phosphorylated GSK3β level,its upstream and downstream phosphorylation levels also change.Ischemic preconditioning and postconditioning may induce cerebral ischemic tolerance by regulating the GSK3β signaling pathway.

Great progress has been made in the study of fatty liver with integrated traditional Chinese and western medicine in aspects of diagnosis, treatment and experimental study, etc. Most researches were designed to utilize diagnostic or model replicating method of western medicine to observe the effects or investigate the action mechanism of compound recipe, single Chinese herb or effective ingredients of Chinese herbs on fatty liver. According to the pathological mechanism of traditional Chinese medicine (TCM), fatty liver is characterized by deficiency in nature and repletion in appearance, which involves three Zang viscera such as liver, spleen and kidney and manifests as spleen Qi deficiency, liver and kidney deficiency, phlegm and dampness heaping internally, and Qi stagnation and blood stasis. This facilitates us to use specific recipe or modified recipe to treat fatty liver from the points of integrated traditional Chinese and western medicine and combining syndrome differentiation with disease differentiation. With gratifying achievement, this kind of approach has been the mainstream of the research on fatty liver and many researchers have reached an agreement on this point domestically. Spleen Fortifying and Blood Invigorating Recipe (SFBVER in brief, invented by our institute) can significantly improve the B ultrasound outcome of the liver in patients with fatty liver, with significant difference in B ultrasound scoring between pre-and post-treatment. It can alleviate the patients' symptoms, improve or regain liver function, decrease waist/buttocks ratio and the content of triglyceride and cholesterol in blood. SFBVER is superior to Dongbao Gantai Recipe in general effective rate. Experimental study also reveals that SFBVER can alleviate CCl(4) induced liver cell fatty degeneration and the inflammatory cell infiltration in rats, decrease the activities of ALT and AST, lower the content of triglyceride in liver, recover SOD activity in liver to normal level. The overall efficacy of SFBVER is superior to that of Dongbao Gantai Recipe. Further correlated study should be focused on inventing new preparation of traditional Chinese medicine and investigating its action mechanism with the guiding of the theory of TCM and referring to the latest discovery in fatty liver research in modern medicine.

Objective To investigate the safety and efficacy of transvaginal hydrolaparoscopic pelvic adhesiolysis (THLPA) treatment in the infertile women.Methods From May 2007 to Sep.2008,30 infertile patients underwent THLPA.The dye-test,hysteroscopy,and dye-test using catheterization of tubal ostium by hysteroscopy were performed at the same time.Pelvic adhesions were scored according to the revised American Fertility Society classification of endometriosis (1985).The adhesions were graded as mild (score 1-9),moderate (10-19),and severe (≥20).Twenty-four cases were in mild adhesions,5 moderate adhesions,and 1 severe adhesion.The duration of the operation and discharge,pelvic adhesions score,tubal patency,complications,and pregnancy rate were investigated.Results (1) THPLA:the majority of pelvic adhesions in all patients were successfully performed adhesiolysis.Only a little filmy adhesions of proximal peritube of 7 tubes and proper ligament of 5 ovaries and cohesive adhesions of 4 ovaries did not underwent surgical lysis.(2) Tubal patency:35 tubes were of proximal occlusion by dye-test,of which 21 (60%,21/35) were unobstructed and 4 (11%,4/35) were partly unobstructed after the dye-test using catheterization of the tubal ostium by hysteroscopy.(3) The duration of operation:the overall operative time were (32±6) minutes in mild adhesion,(52± 6) minutes in moderate adhesion,and 83 minutes in severe adhesion.Of which the time of THLPA were (11±5) minutes in mild adhesion,(35±7)minutes in moderate adhesion,and 62 minutes in severe adhesion,respectively.(4)The duration of discharge:the postoperative discharge time was 120-175 minutes.No complications occurred.(5)The rate of pregnancy:in the (15.8±4.3) months' follow-up,the rate of pregnancy was 45% (13/29),which one patient lost follow-up.Conclusions THLPA is safe,efficacious and not being hospitalized management.When compared with laparoscopy,it is simpler,more economic,and less minimally invasive approach.The appropriate indication of THLPA is to treat filmy,especially mild pelvic adhesions.It could partly avoid transabdominal operative laparoscopy for the infertile women.

Objective To explore the influence pulmonary function and inflammatory factors of symbicort combined with ambroxol hydrochloride in the treatment of acute exacerbation of chronic obstructive pulmonary disease( AECOPD) .Methods 86 patients with AECOPD were divided into control group 43 cases and treatment group 43 cases according to the computer random number table method.The control group was given intravenous injection of ambroxol hydrochloride 60 mg/time, 2 times/day, and the treatment group was given inhalation of symbicort 2 inhaling/times, 3 times/day on the basis of the control group.After 7 day treatment, the clinical efficacy and adverse reactions of two groups were observed.The percentage of forced vital capacity ( FVC%) , percentage of forced expiratory volume of 1 seconds( FEV1 %) , percentage of mid expiratory flow predicted value( MMF%) , percentage of max volume predicted value(MVV%) were measured by pulmonary function test apparatus, and the value of FEV1%/FVC% was calculated.The levels of serum tumor necrosis factor alpha(TNF-α), c-reactive protein(CRP) and interleukin 6(IL-6) were detected by ELISA.Results The total effective rate of treatment group and control group were 93.02%(40/43) and 74.42%(32/43), the difference was statistically significant(P <0.05).After treatment the FVC%(2.58 ±0.25),FEV1%(1.87 ±0.15),MMF%(70.24 ±5.86)and MVV%(72.43 ±4.35) in treatment group were higher than the control group (2.21 ±0.27),(1.68 ±0.16),(63.14 ±5.68)and 65.12 ±4.16), the difference was statistically significant(P<0.05).The levels of serum TNF-α(13.87 ±4.12)μg/mL,CRP(9.14 ±3.76)mg/mLand IL-6(76.07 ±10.14)pg/mL in treatment group were lower than the control group (16.56 ±6.48)μg/mL,(12.46 ±3.89)mg/mL and(89.55 ±11.24)pg/mL,the difference was statistically significant(P<0.05).The adverse reactions were mainly for heartburn, nausea, vomiting and skin rashes in the control group,and the adverse reactions were mainly for heart palpitations, headache, nausea, rashes, vomiting in the treatment group, the incidences of adverse reactions 23.26%(10/43) in treatment group compared to control group 18.60%(8/43) was no statistically significant difference.Conclusion The symbicort combined with ambroxol hydrochloride in the treatment of AECOPD have clinical curative effect, can improve the patient's lung function, reduce inflammation, have less adverse reactions.It was worthy of clinical popularization and application.

Objective To investigate the risk factors for postoperative anastomotic leakage in geriatric patients with esophageal carcinoma and provide new insights into clinical prevention and treatment.Method The fifty-six patients with anastomotic fistula were chosen from 636 esophageal carcinoma patients who underwent esophagectomy in Department of Thoracic Surgery from January 2011 to January 2016.In the 56 patients,the ratio of male (39 cases) to female (17 cases) was 2.3 ∶ 1.0,with the age range of 60-81 years,average of (66.4±8.6) years.The retrospective analysis was performed for obtaining the risk factors for anastomotic leakage.Results Fifty six cases who suffered from anastomotic fistula showed 10 cases (17.9％)with hormone administration,17 cases (30.4％) with preoperative chemo-radiotherapy,32 cases (57.1％) with the basic diseases,27 (48.2％) with preoperative dystrophia.In addition to the old age and tumor,the other risk factors for anastomotic leakage included the hormone use,preoperative malnutrition,and preoperative chemoradiotherapy.Conclusion High attentions have to be paid to the prevention and treatment of anastomotic fistula patients with chronic diseases,hormone use,preoperative malnutrition and preoperative chemo-radiotherapy.

The molecular weight of matrix metalloproteinase (MMP)-9 is the largest in MMP family which comes mainly from macrophage and neutrophil.MMP-9 is considered to be involved in the occurrence and metastasis of colorectal cancer.It also provides a new way for colorectal cancer in clinical prevention and treatment.

Objective:To observe the emergency treatment effect of levosimendan combined noninvasive mechanical ventilation on acute heart failure during emergency treatment period .Methods :According to random number table , 120 cases with acute heart failure were randomly and equally divided into routine treatment group and levosimendan group (levosimendan + noninvasive mechanical ventilation ) .Improvements of arterial blood gas [partial pressure of carbon dioxide and oxygen (PaCO2 ,PaO2 ) ,pH etc .] after 72h ,change of N terminal pro brain natriuretic pep-tide (NTpro-BNP ) level 4d after hospitalization and mortality rate were observed and compared between two groups .Results:After treatment ,PaO2 ,mean arterial pressure and NTpro-BNP level of the two groups significant-ly improved compared with before treatment ;compared with routine treatment group ,there was significant rise in PaO2 [ (78.2 ± 9.4) mmHg vs .(86.2 ± 10.5) mmHg] and significant reductions in mean arterial pressure [ (86.3 ± 8.2) mmHg vs .(82.2 ± 9.0) mmHg] and NTpro-BNP level [ (4340.5 ± 540.7) pg/ml vs .(4012.1 ± 426.3) pg/ml] in levosimendan group , P<0.01 all;total effective rate of levosimendan group was significantly higher than that of routine treatment group (86.7% vs .76.6% , P=0.047);after three-month follow-up ,mortality rate of le-vosimendan group was significantly lower than that of routine treatment group (11.7% vs .20.0% , P= 0.026 ) . Conclusion:Emergency treatment effect of levosimendan combined noninvasive mechanical ventilation on acute heart failure is significant ,which is worthy of further research and extension .

The single brain metastases of lung cancer is defined as limited brain metastases .Mechanism of brain metastasis from lung cancer remains to be further studied .Based on surgery ,radiotherapy ,and chemother-apy,the comprehensive treatment on limited brain metastasis of non -small cell lung cancer gets a better result , however ,the indications for combination therapy must be strictly controlled .Increasing radiation doses of local tumor area,followed by whole-brain radiotherapy,can improve tumor local control rate and prolong overall sur-vival.Prophylactic irradiation of whole brain showed no evidence on prolonging the overall survival .For patients with poor general state,targeted drugs combined with whole brain radiotherapy can be tolerated well ,as well as prolonged the overall survival to ertain extent .

Nasopharyngeal carcinoma is the commonest head and neck cancer in China and especially sensitive to both chemotherapy and radiotherapy. But radiotherapy alone has disappointing effect to local advanced cases. Nevertheless,chemoradiotherapy provides long term survival. This paper summarized the current status of the different ways of chemoradiotherapy such as induction,concurrent,adjuvant chemotherapy.