The incidence rate of nonalcoholic fatty liver disease (NAFLD) is gradually increasing in recent years, and the treatment of NAFLD is unsatisfactory due to the failure in lifestyle adjustment and a lack of effective drugs. Farnesoid X receptor (FXR), as the main bile acid receptor, may affect NAFLD by participating in glucose and fat metabolism, and intestinal FXR (iFXR) acts on the intestinal tract alone and may thus avoid the side effects of systemic release. Therefore, it may have potential value in the treatment of NAFLD, but there are also certain controversies. This article reviews the research advances in the role of iFXR in NAFLD.

Objective To compare the effects of ticagrelor and clopidogrel on platelet aggregation rate, myocardial perfusion and prognosis in patients with acute myocardial infarction. Methods One hundred and sixty-nine patients with acute ST segment elevation myocardial infarction (STEMI) and emergency percutaneous coronary intervention (PCI) were recruited and randomly divided into ticagrelor group (85 cases) and clopidogrel group (84 cases). The TIMI blood flow before and after PCI was recorded, and the ST segment fall rate of 1 h ECG after PCI was calculated. The platelet aggregation rate was measured. After 12 months' follow-up, the incidence of major adverse cardiac events (MACE) was recorded. The Logistic regression analysis was used to discover the factors of MACE. Results One hundred and sixty-nine patients with acute STEMI were recruited including 85 cases treated with ticagrelor and 84 cases in clopidogrel group. The ECG ST segment fall rate after PCI in ticagrelor group was significantly higher than that in clopidogrel group: (61.3 ± 30.7)％ vs. (47.8 ± 26.6)％, P<0.05. The platelet aggregation rate 2 h, 24 h and 7 d after PCI in ticagrelor group was significantly lower than that in clopidogrel group (P<0.05). MACE occurred in 19 cases (22.4％) in ticagrelor group and in 21 cases (25.0％) in clopidogrel group, and there was no significant difference (P > 0.05). Multiple Logistic regression analysis revealed that age and ECG ST segment fall rate were independent risk factors for MACE (P<0.05). Conclusions Compared with clopidogrel, ticagrelor can effectively reduce platelet aggregation rate and accelerate ST segment fall in STEMI patients, but their long-term prognosis is similar.

Objective: To investigate the expression and clinical significance of mismatch repair genes (MMR) MLH1, MSH2, MSH6, and PMS2 in colorectal carcinoma. Methods: Colorectal cancer tissues, collected from 607 patients enrolled in Sichuan Provincial People's Hospital from January 2015 to September 2016, were assigned into two groups based on whether the samples were positive or nega-tive for MMR expression to determine the relationship between MMR expression and clinicopathology. We then evaluated the diag-nostic value of MMR expression in the screening of Lynch syndrome and sporadic colorectal cancer. Results: The deletion rate of MMR protein was 35.58%. No statistically significant difference in age, sex, tumor size, P53, CD34, and D2-40 expression was detected be-tween the negative group with MMR protein deficiency and the positive group with normal expression (P>0.05). Differences in tumor location, differentiation, TNM stage, lymph node metastasis, and VEGF and Ki-67 expression between the two groups were statistically significant (P<0.05). The combined detection of MLH1, MSH2, PSM2, and MSH6 proteins may serve as a simple and economical meth-od for screening patients with Lynch syndrome. Conclusions: The risk of colorectal cancer can be reduced by MMR detection of surgi-cal specimens from colorectal cancer patients, screening of patients with Lynch syndrome and their family members, and assisting with proper management and intervention.

Objective To investigate the value of combined measurement of serum cystatin C (Cys C) and urinary neutrophil gelatinase-associated lipocalin (NGAL) in the diagnosis of AKI secondary to cirrhotic ascites. Methods A total of 105 patients with cirrhotic ascites who were admitted to Sichuan Provincial People's Hospital from January 2015 to June 2016 were enrolled and divided into AKI group with 56 patients and non-AKI group with 49 patients. Meanwhile, 40 healthy persons who underwent physical examination were enrolled as controls. The indices including serum Cys C, urinary NGAL, serum creatinine (Scr), and glomerular filtration rate (GFR) were observed. The 105 patients with cirrhotic ascites were divided into subgroups according to Child-Pugh class, and the changes in serum Cys C, urinary NGAL, Scr, and GFR were compared between these subgroups. The independent samples t-test was used for comparison of continuous data between two groups; a one-way analysis of variance was used for comparison between multiple groups, and the SNK-q test was used for further comparison between any two groups. The chi-square test was used for comparison of categorical data between groups, and a Pearson correlation analysis was also performed. Results There were significant differences in the levels of serum Cys C and urinary NGAL between the AKI group and the non-AKI group, as well as between the AKI group and the healthy control group (all P ＜ 0. 01) . AKI stage was determined for all AKI patients, and the AKI patients with a higher stage had significantly higher levels of serum Cys C and urinary NGAL than those with a lower stage (all P ＜ 0. 05) . Of all 56 AKI patients, 11 (19. 6％ ) died; the patients who died had significantly higher levels of serum Cys C and urinary NGAL than those who survived (t =-7. 742 and-3. 209, both P ＜ 0. 01) . The correlation analysis showed that the levels of serum Cys C and urinary NGAL were negatively correlated with GFR (r =-0. 915 and-0. 793, both P ＜ 0. 01) . The levels of serum Cys C and urinary NGAL increased significantly and GFR decreased significantly with the increase in Child-Pugh class (all P ＜0. 05) . Conclusion Combined measurement of serum Cys C and urinary NGAL can be used for the early diagnosis of AKI secondary to cirrhotic ascites and the evaluation of the severity and prognosis of AKI.

Objective To compare the efficacy of lamivudine (LAM) plus adefovir dipivoxil (ADV) de novo combination therapy to optimization monotherapy for hepatitis B virus-related compensated cirrhosis,and analyze the prediction factors of early response of antivirus treatment.Methods A total of 158 cases of patients with hepatitis B virus-related compensated cirrhosis were selected and randomly assigned to combined group (n=81) and optimized group (n =77) according to randomized digital table.The patients in the combined group accepted LAM combined ADV.The patients in the optimized group were firstly treated with LAM or ADV,then they were given optimized therapy with ADV or LAM if they had poor response or virological breakthrough at week 24.The clinical efficaeies were compared between the two groups,and the prediction factors of early response were analyzed.Results At week 12,the decline level of HBV DNA in the combined group was higher than that in the optimized group (P＜ 0.05),but no statistically significant difference was found in the negative transformation rate of HBV DNA between the two groups (P＞ 0.418).At week 24,the decline level of HBV DNA,rate of undetectable HBV DNA and rate of complete response were higher than those in the optimized group,and rate of virological breakthrough was lower than that in the optimized group (P＜0.05).At week 48,the decline level and negative transformation rate of HBV DNA,negative transformation rate and seroconversion rate of HBeAg were higher than those in the optimized group,and serum levels of hyaluronic acid and a2-macroglobulin were lower than those in the optimized group (P＜0.05).There was no statistically significant difference in the recover rate of alanine aminotransferase (ALT),rate of complete response and rate of virological breakthrough between the two groups at week 48 (P＞0.05).Logistic regression analysis showed that the complete response at week 24 was correlated with HBV DNA load,expression of HBeAg,level of ALT and initial treatment (P＜0.05).Layered evaluation showed that the rate of early complete response in the combined group was significantly higher than that in the optimized group,regardless of HBV DNA load,expression of HBeAg,and level of ALT (P＜0.05).Conclusion LAM combined with ADV can reduce resistance and improve the rate of early complete response,which has stronger antiviral activity.In addition,it can improve the liver function and partially reverse cirrhosis.

OBJECTIVE:To investigate the clinical efficacy of itopride combined with esomeprazole magnesium in the treat-ment of esophageal motility dysfunction-induced gastroesophageal reflux disease(GERD). METHODS:A total of 100 patients with esophageal motility dysfunction-induced GERD were selected from our hospital during Sept. 2015-Sept. 2016,and then divided into control group and observation group according to random number table,with 50 cases in each group. Control group was given Esomeprazole magnesium enteric-coated tablets 40 mg,po,qd. Observation group was additionally given Itopride hydrochloride tablets 50 mg,po,tid,on the basis of control group. Both groups received treatment for consecutive 6 weeks. Clinical efficacies of 2 groups were observed,and symptom scores,LES resting pressure,liquid and solid swallowing and peristaltic pressure of esopha-geal body were observed before and after treatment. The occurrence of ADR was recorded. RESULTS:Total response rate of obser-vation group was 94.0％,which was significantly higher than 78.0％ of control group,with statistical significance(P<0.05). Be-fore treatment,there was no statistical significance in symptom scores,LES resting pressure,liquid and solid swallowing or peri-staltic pressure of esophageal body between 2 groups(P>0.05). After treatment,symptom scores of 2 groups were decreased sig-nificantly,and observation group was significantly lower than control group,with statistical significance (P<0.05). Compared with before treatment,LES resting pressure of observation group was increased significantly,and significantly higher than that of control group,with statistical significance (P<0.05). Success rate of liquid swallowing increased significantly in 2 groups,and that of observation group was significantly higher than that of control group,with statistical significance(P<0.05). Success rate of solid swallowing,liquid and solid peristaltic pressure of esophageal body(near segment,middle segment and far segment)in con-trol group were higher than before treatment,without statistical significance (P>0.05). Success rate of solid swallowing, liquid and solid peristaltic pressure of esophageal body(near segment,middle segment and far segment)in observation group were signifi-cantly higher than before treatment,and significantly higher than control group at corresponding period,with statistical significance (P<0.05). No obvious ADR was found in 2 groups during treatment. CONCLUSIONS:For esophageal motility dysfunction-in-duced GERD,itopride combined with esomeprazole magnesium can significantly improve clinical symptom,effectively increase LES resting pressure,strengthen esophageal motor function,improve success rate of esophageal swallowing and enhance anti-gas-troesophageal reflux ability with good safety.

Objective To compare the clinical value of different endoscopic methods for infiltration depth of early esophageal cancer. Methods Patients with suspected esophageal cancer, examined in Sichuan Provincial People′s Hospital from August 2013 to February 2016 were enrolled to this study. The patients underwent narrow band imaging( NBI) with magnifying endoscopy( including IPCL?type and B?type methods) and endoscopic ultrasonography(EUS) to estimate infiltration depth and then underwent iodine staining and biopsy. All lesions, which included the identified moderate?severe hyperplasia, high?grade intraepithelial neoplasia and early esophageal cancer and those which were diagnosed as possible cancer by white light and NBI with the negative pathological results, were given endoscopic or surgical procedure depending on patients′ choices. A total of 54 cases were diagnosed as early esophageal cancer, with pathological results as the gold standard. The diagnostic accuracy of invasion depth of these patients was compared by the statistic kappa values. Results Type B of NBI was highly consistent with the final pathological results(Kappa=0?802). White light endoscopy and IPCL type had poorer results(Kappa=0?596, Kappa = 0?601 ) compared with the final pathological results. However, EUS had the lowest consistency with the final pathological results( Kappa=0?132) . For the mucosal layer( M1?M2) infiltration of the esophageal cancer, type B showed the highest accuracy ( 86?7%, 26/30 ) , followed by white light endoscopy(76?7%, 23/30) and IPCL type(73?3%, 22/30). And EUS showed the lowest diagnostic accuracy(30?0%, 9/30) and the highest over?diagnostic rate(70?0%,21/30). For the cancer infiltration depth( M3?SM1 ) , type B also showed slightly higher accuracy rate ( 89?5%, 17/19 ) than IPCL type (78?9%, 15/19) and white light endoscopy (73?7%, 14/19). And EUS still showed the lowest accuracy rate( 42?1%, 8/19 ) and the highest over?diagnostic rate ( 52?6%, 10/19 ) . Conclusion White light endoscopy is still valuable for the invation depth of early esophageal cancer. But B type and IPCL?type of NBI are superior to white light endoscopy. B type presents higher accuracy rate than others, and it seems much easier to operate than IPCL?type for beginners. Accuracy rate of EUS is unsatisfactory, and the over?diagnostic rate is much higher than others. Diagnosis with EUS alone is not recommended.

Objective To establish gastric bypass surgery model with SD rat and analyze the influence factors and preventive measures so as to accumulate experience and skills for further developing gastric bypass surgery model on diabetic rat( GK rat) . Methods Gastric by-pass surgery was operated on 30 SD rats. Summarized modeling experience and analyzed various factors affecting modeling success. Results 17 rats weresuccessfully survived after surgery and 13 failed, with the mortality rate 43. 3%. Three rats died during operation, including two for anesthesia and one for heart failure;one died due to anastomotic bleeding two hours after surgery. Eight died in the third day after surgery, including two for infection, two for intestinal necrosis, four for anastomotic stenosis or obstruction. One died because of anastomotic leakage caused by mistaking and satiety the fifth day after surgery. There were no other complications such as wound dehiscence occurred in this group . Conclusion Establishing models of gastric bypass surgery with SD rats which is regarded as pre-experiment of building models of gas-tric bypass surgery with GK rats is economical and feasible. Anesthesia and perioperative management, surgical techniques and infection pre-vention and control are the main factors affecting modeling. The survival rate of rat model could be increased if related factors well controlled.

Objective To investigate changes in serum levels of Th22 cell ? related cytokines and complements in patients with drug eruption before and after treatment, and to explore their possible roles in the occurrence and development of drug eruption. Methods This study included 35 patients with drug eruption, and 35 sex?and age?matched healthy controls. Five milliliters of peripheral blood samples were collected from the controls and patients before and after treatment. Enzyme?linked immunosorbent assay(ELISA)was performed to measure serum levels of interleukin 22(IL?22)and IL?13, and the cytometric bead array(CBA)system was used to determine serum levels of tumor necrosis factor?α(TNF?α) and complement components C3a, C4a and C5a. Results Before treatment, the patients with drug eruption showed significantly higher serum levels of IL?22(40.85 ± 14.56 vs. 29.09 ± 8.66 ng/L, t=5.549, P<0.05), IL?13(869.94 ± 463.39 vs. 372.92 ± 151.75 ng/L, t=6.071, P<0.05), TNF?α(1.03 ± 0.64 vs. 0.44 ± 0.31 ng/L, t=4.321, P<0.05), complement C3a(55.21 ± 32.98 vs. 42.44 ± 14.26 ng/L, t=2.832, P<0.05), C4a(285.11 ± 123.91 vs. 237.00 ± 63.57 ng/L, t=2.257, P<0.05), and C5a(279.68 ± 127.72 vs. 215.98 ± 65.38 ng/L, t=2.495, P<0.05)compared with the controls. After treatment, the serum levels of IL?22, IL?13, TNF?α, complement C3a, C4a and C5a in patients decreased to(32.72 ± 11.77)ng/L,(456.21 ± 123.22)ng/L,(0.64 ± 0.39)ng/L,(45.47 ± 21.11)ng/L,(241.86 ± 84.12)ng/L and(239.61 ± 103.51)ng/L respectively, with a significant difference between the pretreatment and posttreatment values of these proteins(t = 4.443, 5.197, 3.572, 3.213, 2.728 and 4.772, respectively, all P ≤ 0.01). Additionally, the serum levels of IL?22 and IL?13 were still significantly higher in the patients than in the controls(both P < 0.05), while there were no significant differences in the serum levels of TNF?α, complement C3a, C4a or C5a between the patients and controls after treatment(all P > 0.05). Correlation analysis showed positive correlations between complement C3a and C4a serum levels(r = 0.660, P < 0.05), between C3a and C5a serum levels(r = 0.404, P < 0.05), between C4a and C5a serum levels(r = 0.501, P < 0.05), and between IL ? 22 and TNF ? α serum levels(r = 0.573, P = 0.005), but negative correlations between IL ? 22 and complement C3a serum levels(r = -0.490, P = 0.005), in patients before treatment. Conclusion The activation of Th22 cell?related cytokines and complements may play important roles in the occurrence and development of drug eruption, and IL?22 may participate in the regulation of complements.