Objective:To explore the effect of teachers-standardized patients combined with case based learning (CBL) in clinical probation of gastrointestinal surgery.Methods:A total of 140 clinical medicine undergraduates in gastrointestinal surgery were selected as the research subjects, and were randomized into the intervention group and the control group, with 70 cases in each group. Traditional teaching method is performed in the control group, and teachers-standardized patients combined with CBL is conducted in the intervention group. Student knowledge assessment and satisfaction survey were made for teaching effect evaluation. The t test and chi-square test were performed by SPSS 24.0 for comparison between the two groups. Results:The medical records writing of the students in the intervention group and the results of the theoretical assessment [(83.20±7.94) and (82.74±7.19) points] were significantly higher than those of the control group [(79.57±9.26) and (79.49±7.86) points] ( P<0.05). Students in the intervention group have a higher level of satisfaction of this teaching mode. Conclusion:Teachers-standardized patients combined with CBL can improve teaching quality and learning enthusiasm in gastrointestinal surgery, and it is worthy of promotion and application in teaching.

Objective To explore the effect of Mucopolysaccharide Polysulfate Cream by sound conductance for prevention and cure of hand-foot syndrome (HFS) caused by oral chemotherapy in tumor patients and nursing interventions.Methods A total of 76 patients with colorectal cancer (stageⅡ/Ⅲ) in the authors′ hospital who were taking capecitabine in accordance with the requirements of NCCN guideline were selected as subjects from 1 April 2016 to 8 Octobor 2016. The medical records were coded in selected sequential order with the method of randomised controlled clinical trial. All patients (n=76) were randomly divided into control group (n=38, routine nursing care) and observation group (n=38, routine nursing care + intervention imported by Mucopolysaccharide Polysulfate Cream combined with conductivity apparatus) by random number table. The control effect of HFS caused by capecitabine was compared.Results There were 9 patients (23.7%) with HFS after intervention including 6 cases forⅠ, 3 cases forⅡ, 0 forⅢ. There were 17 patients (44.7%) with HFS after intervention including 9 cases forⅠ,7 cases forⅡ, 1 forⅢ. There was a statistically significant difference in HFS between two groups (Z=2.029,P<0.05). The result of symptom quantized integration of HFS (erythema, edema, dryness, desquamation and so on) of 9 patients with HFS in observation group was obviously better than that of 17 patients with HFS in control group with a significant difference (P<0.05). The score of KPS of 9 patients with HFS in observation group was (88.68±6.80) obviously better than that (82.99±9.51) of 17 patients with HFS in control group with a significant difference (t=2.892,P<0.05).Conclusions The prevention and cure intervention imported by Mucopolysaccharide Polysulfate Cream combined with conductivity apparatus along with nursing intervention can obviously lessen the symptoms of HFS of patients with oral chemotherapy and improve the chemotherapy tolerance.

Objective To investigate the current status of agitated behaviors among institutionalized elderly with dementia. Methods The Cohen-Mansfield Agitation Inventory (CMAI) and General Information questionnaire were used to collect information of agitated behaviors among 141 institutionalized elderly with dementia in a long-term care facility in Guangzhou. Results Nearly 90.07％(127/141) of the elderly with dementia had the symptoms of agitation. Among the four categories of the agitated behaviors, the incidence for physically non-aggressive behaviors (82.27％, 116/141) was the highest, followed by physically aggressive behaviors (78.72％ , 111/141), verbally non- aggressive behaviors (74.47％, 105/141) and verbally aggressive behaviors (64.54％, 91/141). Spitting, repetitive sentences or questions, complaining occurred frequently. Conclusions The incidence of the agitated behaviors was high and the manifestation and types of agitated behaviors were varied, which should be paid attention to by the institution. It is necessary to develop the personalized, systematic, standardized nursing intervention to provide the support for caregivers and help the elderly with dementia to cope with agitation.

Presacral recurrence, a special recurrence type in rectal cancer after surgical treatment, refers to recurrent cancer invading the presacral soft tissue or the bony structure of sacrum. It is also a major constituent of recurrent rectal cancer (15.63% to 41.67%). Reports show that presacral recurrence rate is about 2.8% to 4.8%, and it is associated with clinic staging, pathological type, surgical approach, (neo) adjuvant radiochemotherapy, tumor distance from the anus, positive circumferential margin, lymph node metastasis, and unilateral lateral lymph node dissection. CT and MRI are important for the detection of presacral recurrence. Presacral recurrence is always combined with local recurrence in other parts and distant organ metastasis. Therefore, we divide that into the following 3 types: 1) presacral recurrence with distant metastasis; 2) presacral recurrence with pelvic wall or lateral lymph node metastasis, or with recurrence of pelvic organs or anastomosis; and 3) simple presacral relapse. According to MDT evaluation. We adopt corresponding treatment scheme and surgical approach depending on the types mentioned above. When tumor recurred in the sacrum and located lower than S2/3 articular surface, then resection of recurrent tumor combined with sacrococcygeal should be the treatment of choice. For presacral recurrence with anterior invasion, combined total pelvic exenteration were available. For presacral recurrence with lateral pelvic wall invasion, internal iliac arteriovenous resection and lateral lymph node dissection and para-aortic lymph node dissection should be carried out. R0 resection may improve the 5-year overall survival rate of these patients.

Presacral recurrence, a special recurrence type in rectal cancer after surgical treatment, refers to recurrent cancer invading the presacral soft tissue or the bony structure of sacrum. It is also a major constituent of recurrent rectal cancer (15.63% to 41.67%). Reports show that presacral recurrence rate is about 2.8% to 4.8%, and it is associated with clinic staging, pathological type, surgical approach, (neo) adjuvant radiochemotherapy, tumor distance from the anus, positive circumferential margin, lymph node metastasis, and unilateral lateral lymph node dissection. CT and MRI are important for the detection of presacral recurrence. Presacral recurrence is always combined with local recurrence in other parts and distant organ metastasis. Therefore, we divide that into the following 3 types: 1) presacral recurrence with distant metastasis; 2) presacral recurrence with pelvic wall or lateral lymph node metastasis, or with recurrence of pelvic organs or anastomosis; and 3) simple presacral relapse. According to MDT evaluation. We adopt corresponding treatment scheme and surgical approach depending on the types mentioned above. When tumor recurred in the sacrum and located lower than S2/3 articular surface, then resection of recurrent tumor combined with sacrococcygeal should be the treatment of choice. For presacral recurrence with anterior invasion, combined total pelvic exenteration were available. For presacral recurrence with lateral pelvic wall invasion, internal iliac arteriovenous resection and lateral lymph node dissection and para-aortic lymph node dissection should be carried out. R0 resection may improve the 5-year overall survival rate of these patients.

Bariatric surgery has been proven to be an effective way to relieve obesity and related metabolic diseases. Complications after bariatric surgery mainly include postoperative bleeding, anastomotic leakage, gastroesophageal reflux, dumping syndrome and so on. Deep vein thrombosis is a rare complication, with low incidence in many literatures. However, deep vein thrombosis is an important cause of pulmonary embolism. Once pulmonary embolism occurs, the difficulty of treatment and mortality are both high. The authors summarize the related literature on venous thromboembolism after bariatric surgery, and briefly describe the strategies of prevention and treatment of venous thromboembolism.

Laparoscopic bariatric and metabolic surgery in China began in 2000. After 20 years of development, it has realized the transformation from nothing to existence and then to rapid development. In this paper, the number of Chinese and English literatures on weight loss and metabolism published in China in the past 20 years, the source of literature institutions, published journals, literature types, key words and other aspects are analyzed. The results show as follows: the number of published literatures is generally increasing, bariatric surgery has changed from gastric bypass and gastric banding to gastric bypass and sleeve gastrectomy, revisional surgery and intestinal flora have been the focus of research in recent years. However, the development of laparoscopic bariatric surgery in China is still in its infancy, and there is few high-level evidence-based multicenter prospective randomized controlled study. Therefore, the authors suggest that more and larger sample, multicenter, randomized controlled studies should be carried out in the future and it requires to develop guidelines suitable for Chinese population. In order to promote the further development of bariatric and metabolic surgery in China, we should establish national data and register clinical data, strergthon the combination of clinical research and basic research and conduct deeper research based on the database.

In patients with recurrent or metastatic gastrointestinal stromal tumor (GIST), imatinib is the mainstay treatment, which has significantly improved outcome. However, approximately half of patients who have initial respose to imatinib will develop secondary resistance within 2 years, leading to progressive disease. Available data suggest that cytoreductive surgery may be considered in patients with metastatic GIST who respond to imatinib and have relatively low tumor burden, particularly in whom a R0/R1 resection is anticipated. The evidence of benefit from surgery in patients with focal tumor progression on imatinib is limited, but after surgical resection of progressive lesions, shifting to second line therapy should be initiated. Patients with multifocal progression are not suitable for surgical intervention. In the meantime, surgery for patients treated with sunitinib is feasible, yet survival benefit remains controversial. Thus, surgery should be considered in patients with metastatic GIST whose disease responds to imatinib with a goal of performing R0/R1 resection. On a case-by-case basis, surgical intervention should be determined after careful multidisciplinary consultation to achieve safety, improvement of symptoms and long-term survival benefits.

In patients with recurrent or metastatic gastrointestinal stromal tumor (GIST), imatinib is the mainstay treatment, which has significantly improved outcome. However, approximately half of patients who have initial respose to imatinib will develop secondary resistance within 2 years, leading to progressive disease. Available data suggest that cytoreductive surgery may be considered in patients with metastatic GIST who respond to imatinib and have relatively low tumor burden, particularly in whom a R0/R1 resection is anticipated. The evidence of benefit from surgery in patients with focal tumor progression on imatinib is limited, but after surgical resection of progressive lesions, shifting to second line therapy should be initiated. Patients with multifocal progression are not suitable for surgical intervention. In the meantime, surgery for patients treated with sunitinib is feasible, yet survival benefit remains controversial. Thus, surgery should be considered in patients with metastatic GIST whose disease responds to imatinib with a goal of performing R0/R1 resection. On a case-by-case basis, surgical intervention should be determined after careful multidisciplinary consultation to achieve safety, improvement of symptoms and long-term survival benefits.

Objective To explore the change and clinical significance of the serum carcinoembryonic antigen (CEA)and carbohydrate antigen 724(CA724)in patients with rectal cancer before and after neoadjuvant ra-diotherapy and chemotherapy.Methods The serum levels of CEA and CA724 of 30 patients with rectal carci-noma were detected by electrochemiluminescence method and were compared with those in 30 healthy people. Results The serum levels of CEA and CA724 in rectal carcinoma patients before neoadjuvant radiotherapy and chemotherapy were significantly higher than those in the healthy people,the difference was statistically significant(P<0.05).The serum levels in complete remission and partial remission patients after eight-week neoadjuvant radiotherapy and chemotherapy were significantly lower than those before treatment,the differ-ence was statistically significant(P<0.05),and the reduction levels were obviously higher than those in the stable group,the difference was statistically significant(P< 0.05).The CEA and CA724 levels in the stable treatment patients were also lower than those of before neoadjuvant radiotherapy and chemotherapy,the difference was statistically significant(P<0.05).The serum levels in the progression group were higher than those of before treatment(P<0.05).The serum levels of CEA and CA724 before neoadjuvant radiotherapy and chemotherapy existed a positive correlation(r=0.862,P=0.000).Conclusion The serum levels of CEA and CA724 in rectal cancer are highly expressed,suggesting that both of them are closely related to the occur-rence and development of rectal carcinoma,the measurement of the serum level changes of CEA and CA724 in patients with rectal cancer before and after treatment contributes to estimate the efficacy of neoadjuvant radio-therapy and chemotherapy and tumor progression.