Gastric cancer is one of the most common malignancies in the digestive system.Most of the patients with gastric cancer have advanced disease at the time of diagnosis.Chemotherapy is still the mainstay of treatment for advanced gastric cancer,but efficacy of chemotherapy was modest.Molecular targeted therapies have emerged as a novel approach to the treatment of both hematological and solid tumors in recent years.The understanding of molecular biological mechanisms underlying the formation,progression and metastasis in advanced gastric cancer has enabled us to use the new approach to treat this disease in clinical practice.These therapeutic strategies include targeting EGFR signal transduction pathway,anti-angiogenesis,targeting NF-?B signal transduction pathway and cyclin-dependent kinase inhibitors.In this review,a brief introduction of the current status of the molecular targeted therapies in the treatment of gastric cancer was presented.Bevacizumab,anti-VEGF monoclonal antibody targeting the angiogenesis pathway has been approved for the treatment of colorectal cancer by FDA,has been reported to show effectiveness in metastatic gastric cancer when combined with cytotoxic agents.Inhibition of NF-?B signal transduction pathway such as PS-341(proteasome inhibitor,bortezomib) approved for the treatment of refractory or recurrent multiple myeloma by FDA has also been used to combine with chemotherapy for gastric cancer.There are also encouraging reports on the combination of standard chemotherapy with Cetuximab,Matuzumab,Gefitinib,Erlotinib and Trastuzumab which target the EGFR and HER2 signal transduction pathways.Flavopiridol is a cyclin-dependent kinase inhibitor with low molecullar weight that aims at the regulatory process of the cell cycle but this needs further clinical trial.

Multidrug resistance (MDR) is the most common cause in the failure of cancer chemotherapy. Drug transporters play an important role in multidrug resistance in cancer. Activation of drug pumps which belong to ATP-binding cassette (ABC) transporters leads to the efflux of drug via cell membrane.Three subgroups of ABC transporters are involved in the transport of cytotoxic drugs.These transporters include ABCB subgroup,ABCC subgroup and ABCG subgroup. In this review,the author discussed the recent research advances in the ABC transporters associated with MDR.

We introduced Case based learning into traditional bilingual teaching, dividing the hepatobiliary surgery teaching into four phases: preview, introduction, group discussion and estimation after class . Through the classroom organization analysis of common cases of liver and gallbladder surgery, we took students as the main body, teacher as the guide, to complete the bilingual teaching. Auxiliary case based learning used in bilingual teaching of liver and gallbladder surgery practice is beneficial to improving the quality of bilingual teaching, and helps to cultivate the students' clinical thinking. However, there are still some deficiencies of the case aided bilingual teaching, which needs continuous improvement.

Objective To explore the influence of integrated Chinese and western medicine therapy on anxiety,sugar metabolism and subjective well-being for type 2 diabetes Patients associated with anxiety.Methods Use glycated hemoglobin (HbAlc),trait anxiety inventory(TAI),and Memorial University of Newfoundland Scale of Happiness (MUNSH) to evaluate the condition of 60 patients with type 2 diabetes associated with anxiety.The patients participated in the study were randomly divided into Western medicine therapy group(control group)and integrated traditional Chinese and Western medicine therapy group (experimental group),with 30 cases in each group.The control group was treated with paroxetine while the experimental group was treated with paroxetine plus Jiawei-Xiaoyaowan.6 weeks after treatment,we tested the HbAlc level.TAI score and MUNSH score of those patients.Results After 6 weeks,the TAI score of patients in both experimental group and control group have obviously decreased (before treatment:54.07±6.41 and 56.33 ±6.01,respectively; after treatment:38.89±6.70 and 45.29±6.55,respectively) and the difference was statistically significant (P＜0.05).And the TAI score of the two groups after treatment was significantly different (P＜0.05).For both experimental and control groups,the HbA1e level were not obviously changed before and after the study with P＞0.05 (before treatment:8.14±2.69 and 8.07±2.11,respectively; after treatment:8.21±2.07 and 7.92± 1.90,respectively).Comparison between groups also showed no significant difference.MUNSH score have obviously increased in experimental group (before treatment:40.49±5.22; after treatment:44.53 ± 6.28,P＜0.05).The result of comparison between the two groups after treatment shows that MUNSH score of patients in the experimental group were obviously improved compared with patients in the control group (57.56 ±6.39),and the difference was statistically significant (P＜0.05).Conclusion The integrated traditional Chinese and western medicine therapy can obviously release anxiety and enhance subjective well-being in patients with cerebral infarction associated with anxiety.

Targeted therapy has gradually become the focus in the treatment of tumor, with the emerge of more and more targeted drugs which has brought the treatment of tumor into a new era. Imatinib, the tyrosine kinase inhibitor, is one of the important types of targeted therapy, has become the standard of care in adjuvant therapy of gastrointestinal stromal tumor(GIST) with extraordinary effects. However, the questions are still on debate incluing the optimal way to evaluate treatment results, the treatment duration, whether it can be intermitted or not, second line therapy for imatinib-intolerance or -resistance and the combination with surgery.

Objective:To explore the efficacy and safety of different surgical methods in papillary thyroid carcinoma (PTC) patients with negative cervical lymph nodes (cN0) and to provide theoretical basis for the selection of surgical procedures. Methods:A total of 225 PTC cN0 patients were selected and divided into two groups according to the operation method. Only 110 patients underwent total thy-roidectomy, whereas the 115 cases in the lobectomy group underwent ipsilateral lobectomy and isthmus resection. Al patients were treated with ipsilateral central lymph node dissection. We analyzed both groups of patients in terms of surgery, hospitalization, pathological characteristics, complications, follow-up, and recurrence. Results:(1) The length of incision, blood loss, operation time, and length of stay were not significantly different between the two groups (P>0.05). (2) In the total resection group, the number of multiple foci of the cancer cases was significantly more than that of the lobectomy patients (P<0.05). The average tumor diameter in both groups were not significantly different (P>0.05). Between the two groups, the number of central lymph node dissection and total lymph node metastasis, and the number of cases with central lymph node metastasis were not significantly different (P>0.05). Likewise, the incidence rates of mistakenly cut parathyroid, extremely low blood calcium levels, temporary larynx return nerve paralysis, and superior laryngeal nerve injury were not significantly different between the two groups (P>0.05). No permanent hypocalcemia or permanent recurrent laryngeal nerve injury occurred. (3) All patients were followed up for 2-4.5 years. No recurrent cases were reported in the total resection group. For the lobectomy group, 8 patients with adenocarcinoma had contralateral tumor metastasis and underwent contralateral lobe resection, whereas 4 patients suffered from ipsilateral neck lymph node metastasis at the side area and underwent functional lymph node clearance. Significant differences were noted in the metastasis and recurrence rates between the two groups of patients (P<0.05). No deaths were reported during the follow-up period. Conclusion:For PTC cN0 patients, total thyroidectomy with joint ipsilateral central lymph node clearance can reduce the residual tumor, metastasis, and risk of recurrence,compared with surgery limited to the affected lobe and isthmus. Postoperative complications were not significantly increased.

Objective To investigate the mechanisms of tumor necrosis factor-related apoptosis inducing ligand (TRAIL) combined with Triptolide in inducing the apoptosis of pancreatic cancer cells.Methods (1) The pancreatic cancer cells (MiaPaca-2 cells) were divided into 4 groups:blank control group (no drugs were added),TRAIL + Triptolide-group (only TRAIL was added),TRAIL-Triptolide + group (only Triptolide was added) and TRAIL+ Triptolide+ group (TRAIL and Triptolide were added).The vitality of cells in all the 4 groups was assessed by CCK-8.The expressions of poly ADP-ribose polymerase (PARP),cysteinyl aspartate specific proteinase-3 (Caspase-3) and Caspase-8 were detected by Western blot.The vitality of cells was detected by CCK-8 and the vitality of Caspase-8 was detected by Caspase-Glo assays after adding Z-IETD-FMK,a specific inhibitor of Caspase-8.The expressions of myeloid cell leukemia-1 (Mcl-1),Bcl-xL and Bcl-2 were detected by Western blot.(2) The MiaPaca-2 cells were divided into 8 groups:①TRAIL-Mcl-1 siRNA-group (no TRAIL was added and Mcl-1 siRNA cells were not transfected),TRAIL+ Mcl-1 siRNA-group (TRAIL was added and Mcl-1 siRNA cells were not transfected),TRAIL-Mcl-1 siRNA + group (TRAIL was not added and Mcl-1 siRNA cells were transfected)and TRAIL+ Mcl-1 siRNA+ group (TRAIL was added and Mcl-1 siRNA cells were transfected).②TRAIL-Bcl-xL siRNA-group (TRAIL was not added and Bcl-xL siRNA was not transfected),TRAIL+ Bcl-xL siRNA-group (TRAIL was added and Bcl-xL siRNA was not transfected),TRAIL-Bcl-xL siRNA + group (TRAIL was not added and Bcl-xL siRNA was transfected) and TRAIL+ Bcl-xL siRNA+ group (TRAIL was added and Bcl-xL siRNA was transfected).The vitality of the cells in all the groups was detected by CCK-8.The expressions of Caspase-3 and Caspase-8 protein were detected by Western blot.The measurement data with normal distribution were presented as (x) ± s.The comparison among groups was done by ANOVA,and the pairwise comparison was done by LSD-t test.Results (1) The vitalities of MiaPaca-2 cells in the blank control group,TRAIL + Triptolide-group,TRAIL-Triptolide + group and TRAIL + Triptolide + group were 100.0％ ± 1.1％,81.2％ ± 2.3％,78.6％ ± 3.6％and 40.1％ ± 2.5 ％,and the relative expressions of PARP protein were 0.510 ± 0.028,0.720 ±0.072,1.250 ±0.023 and 2.560 ± 0.220,the relative expressions of Caspase-3 were 0.080 ± 0.004,0.080 ± 0.003,0.110 ±0.005 and 2.720 ± 0.003,and the relative expressions of Caspase-8 were 0.070 ± 0.003,0.080 ± 0.005,0.120 ±0.003 and 0.990 ± 0.006,with significant differences among the 4 groups (F =203.607,1 457.785,332 421.900,35 437.218,P ＜ 0.05).The vitality of M iaPaca-2 cells in the TRAIL + Triptolide + group was significantly different from those in the blank control group,the TRAIL + Triptolide-group and the TRAIL-Triptolide + group (t =34.583,355.936,36.271,P ＜ 0.05).The relative expression of PARP protein of MiaPaca-2 cells in the TRAIL+ Triptolide + group was significantly different from those in the blank control group,TRAIL+ Triptolidegroup and TRAIL-Triptolide + group (t =591.784,63.739,2 268.987,P ＜ 0.05).The relative expression of Caspase-3 protein of the MiaPaca-2 cells in the TRAIL + Triptolide + group was significantly different from those in the blank control group,the TRAIL + Triptolide-group and theTRAIL-Triptolide + group (t =3 266.153,9 145.228,1 738.713,P ＜0.05).The relative expression of Caspase-8 protein of the MiaPaca-2 cells in the TRAIL+ Triptolide +group was significantly different from those in the blank control group,the TRAIL+ Triptolide-group and the TRAIL-Triptolide + group (t =663.953,l 432.878,327.584,P ＜ 0.05).The vitality of caspase-8 in the TRAIL+ Triptolide+ group was 711.0％ ± 5.1％ before adding Z-IETD-FMK,and then the vitality of MiaPaca-2 cells and caspase-8 changed to 70.0％ ± 4.8％ and 73.0％ ± 2.4％,with significant differences (t =17.956,55.027,P ＜ 0.05).The relative expressions of Mcl-1 protein in the blank control group,the TRAIL + Triptolidegroup,the TRAIL Triptolide + group and the TRAIL + Triptolide + group were 1.68 ± 0.22,2.08 ± 0.11,0.73 ±0.15 and 0.58 ± 0.18,the relative expressions of Bcl-xL protein were 0.65 ± 0.03,0.47 ± 0.03,0.32 ± 0.03and 0.26 ±0.05,the relative expressions of Bcl-2 protein were 0.65 ± 0.03,0.67 ± 0.03,0.62 ± 0.05 and 0.67 ± 0.03,with significant difference among the 4 groups (F =55.178,88.683,3.411,P ＜ 0.05).The relative expressions of Mcl-1 protein of the MiaPaca-2 cells in the TRAIL-Triptolide + group and the TRAIL+ Triptolide +group were significantly different from those of the blank control group (t =23.506,47.631,P ＜ 0.05) and the TRAIL + Triptolide-group (t =58.457,37.115,P ＜ 0.05).The relative expressions of Bcl-xL protein of the MiaPaca-2 cells in the TRAIL-Triptolide + group and the TRAIL + Triptolide + group were significantly different from those of the blank control group (t =38.105,42.219,P ＜ 0.05) and the TRAIL + Triptolide-group (t =32.476,15.814,P ＜ 0.05).The relative expressions of Bcl-2 protein in the TRAIL-Triptolide + group and the TRAIL+ Triptolide + group were not significantly different from those of the blank control group (t =4.724,1.732,P > 0.05) and the TRAIL + Triptolide-group (t =3.464,0.000,P ＞ 0.05).(2) The vitalities of MiaPaca-2 cells of the TRAIL-Mcl-1 siRNA-group,TRAIL + Mcl-1 siRNA-group,the TRAIL-Mcl-1 siRNA + group and the TRAIL + Mcl-1 siRNA + group were 100.0％ ± 2.2％,79.3％ ± 1.8％,71.2％ ± 3.2％ and 37.3％ ± 5.4％,the relative expressions of Caspase-8 protein were 0.100 ± 0.003,0.100 ± 0.005,0.100 ± 0.003 and 0.350 ±0.005,and the relative expressions of Caspase-3 protein were 0.020 ± 0.003,0.060 ± 0.003,0.020 ± 0.003 and 0.590 ±0.004,with significant differences among the 4 groups (F =136.681,2 717.391,44 471.429,P ＜0.05).The vitality of MiaPaca-2 cells of the TRAIL + Mcl-1 siRNA + group was significantly different from those in the TRAIL-Mcl-1 siRNA-group,the TRAIL + Mcl-1 siRNA-group and the TRAIL-Mcl-1 siRNA + group (t =33.937,20.207,26.689,P ＜ 0.05).The relative expression of Caspase-8 protein of the TRAIL + Mcl-1 siRNA +group was significantly different from those in the TRAIL-Mcl-1 siRNA-group,the TRAIL + Mcl-1 siRNA-group and the TRAIL-Mcl-1 siRNA + group (t =216.506,433.013,144.338,P ＜ 0.05).The relative expression of Caspase-3 protein of the TRAIL + Mcl-1 siRNA + group was significantly different from those in the TRAIL-Mcl-1 siRNA-group,the TRAIL + Mcl-1 siRNA-group and the TRAIL-Mcl-1 siRNA + group (t =329.09,458.993,987.269,P ＜0.05).The vitalities of MiaPaca-2 cells of the TRAIL-Bcl-xL siRNA-group,the TRAIL+ Bcl-xL siRNA-group,the TRAIL-Bcl-xL siRNA + group and the TRAIL+ Bcl-xL siRNA + group were 100.0％ ± 2.3％,87.2％ ± 4.1％,74.1 ± 3.7％ and 56.3％ ± 5.4％,and the relative expressions of Caspase-3 protein were 0.060 ±0.004,0.070 ± 0.003,0.060 ± 0.004 and 0.390 ± 0.003,with significant differences among the 4 groups (F =70.074,4 643.478,P ＜ 0.05).The vitality of MiaPaca-2 cells of the TRAIL + Bcl-xL siRNA + group was significantly different from those in the TRAIL-Bcl-xL siRNA-group,the TRAIL+ Bcl-xL siRNA-group and the TRAIL-Bcl-xL siRNA + group (t =24.416,41.170,18.136,P ＜ 0.05).The relative expression of Caspase-3 protein of the TRAIL + Bcl-xL siRNA + group was significantly different from those in the TRAIL-Mcl-1 siRNA-group,the TRAIL + Mcl-1 siRNA-group and the TRAIL-Mcl-1 siRNA + group (t =285.788,554.256,190.526,P ＜ 0.05).Conclusion Triptolide could induce the apoptosis of MiaPaca-2 cells by inhibiting the expressions of Mcl-1 and Bcl-xL,sensitizing TRAIL and activating Caspase-8 and Caspase-3.

Objective To investigate the prevalence of human immunodeficiency virus (HIV) infection and its characteristics among pregnant women in Hunan.Methods Data from information system of prevention of mother-to-child transmission of HIV management in Hunan 2011-2015 was analyzed in the study (3 + 1 mode by year statistics).Results The total HIV-positive infection rate was 0.19‰ among pregnant women from 2011 to 2015 in Hunan.The rate of HIV infection showed upward trend by years (P ＜ 0.05).The proportion of diagnosis of HIV positive cases intrapartum was 44.66％,showed declining trend by years (P ＜ 0.05).The 786 cases of HIV positive pregnant women were mainly the Han's,the age distribution of 20 to 35 years old,90.21％ of them were farmers or unemployed.A percentage (76.84％) of them had junior high school education level or lower 37.91％ of them were found in delivery or postpartum.A percentage (36.51％) of them accepted service in delivery or postpartum.A percentage (45.67％) of them was infected through sexual contact,46.82％ of them were infected by unknown ways.Conclusions The rate of HIV infection among pregnant women was increased by years in Hunan.It is suggested to strengthen health education among high-risk groups and high incidence areas,improve detection rate of early pregnant women,implement the Prevention of Mother to Child Transmission (PMTCT) measures to reduce the rate of mother to child transmission of Acquired Immune Deficiency Syndrome (AIDS).

AIM:To study the effect of Danhong Zhiganching capsules on the experimental fatty liver in rats.METHODS: Male SD rats were treated by high fat diet for 6-week after being treated by a low dose of CCl_4 to induce fatty liver model.Then,drugs were given by oral to the rats,the contents of triglyeride,total cholesterol in serum and liver tissue,the contents of superoxide dismutase and malondialdehyde in serum and the contents of free fatty acids in liver tissue acted as indexes to determine the effect of Danhong Zhiganching capsules.RESULTS: The contents of triglyeride and total cholesterol in serum and liver tissue of rats were significantly reduced by Danhong Zhiganching capsules,and so it is with the contents of free fatty acids in liver tissue(P

C and C 5457T (D1819D) were 11.1%, 5.2%, 28.2% and 31.8%, respectively. The minor allele frequency of SNPs was not same as study from Japanese or Chinese. Conclusion The distribution of SCN5A SNPs may vary between different ethnicities.