Targeted agents for advanced colorectal cancer mainly include inhibitors of vascular endothelial growth factor (VEGF) and epidermal growth factor receptor (EGFR).Studies show that bevacizumab and cetuximab can improve the prognosis of advanced colorectal cancer patients,but there is slight difference in the choice of chemotherapy regimens when combined with them.Bevacizumab and cetuximab can improve the overall survival of K-ras wild-type colorectal cancer patients similarly.The emergence of new targeted drugs such as aflibercept,regorafenib provides more choices for the targeted therapy of advanced colorectal cancer patients.

Objective To study the variable orderliness of vocal fold vibration caused by the voice with different frequency in chest register of various healthy subjects having several age and sex through electroglottographic examination.Methods 120 healthy subjects were respectively evaluated with electroglottography, including the old group, the adult group, the men group and the female group. Meanwhile the parameters of vocal fold vibration, such as the contact quotient, the contact index, the contact quotient perturbation and the contact index perturbation were measured and analyzed.Results With increase of the frequency, the contact quotient was decreased in all subjects, having signification difference. The contact quotient of old group and adult group ,men and female group had also signification difference. But other parameters not represented the difference in statistics.Conclusion The closer degree of vocal fold was varied with the different frequency in chest register voice from the healthy subjects who were different in age and sex ,but the symmetry and regulation of vocal fold vibration were not related to age and sex. The results were help to study physiology of vocal fold.

Objecfive To compare the clinical effectiveness of three different fixation methods for peripherally inserted central catheter(PICC).Methods Totally 120 patients requiting PICCs were randomized into suture securement group(group A),tape securement group(group B),and sutureless adhesive-hacked device (StatIock)securement group(group C),with 40 patients in each group.Patients were followed up throughout their entire catheter course,and the securement effectiveness,catheter-related complications,risk of skin injury,and patients'satisfaction were observed.Results The rate of catheter migration without function loss in group B (57.5%)was significantly higherthan in group A(12.5%,P=0.000)and in group C(7.5%,P=0.000).Catheter dislodgment rate in group B(15.0%)was also significantly higher than group A(0,P=0.034)and group C(0,JP=0.034).Phlebitis documented during their catheter course in group B(25.0%)were more than in group A(7.5%,P=0.034)and in group C(5.0%,P=0.012).In addition,the rate of cellulitis in group A was significantly higher than group C(20.0%vs.2.5%,P=0.034).The rate of skin injury in group A 0.005).Nearly half of patients in group A (52.5%)complained irritation and/or pain at the sucure site,which was significantly higher than in other two groups ( both P = 0.000 ).The patients' satisfaction rate was significantly lower in group A (12.0% ) than in the other two groups ( both P = 0.000), documented highest in group C (90.0%) (group C vs.group B, P = 0.004).Conclusions The availability of sutureless adhesive-backed de vice StatLock provides an alternative for securement of PICCs.It performs as well as suture securement in catheterfixing.Meanwhile, it can prevent catheter-related complications such as migration and dislodgment Furthermore, it avoids skin injuries during catheter fixation or securement.

OBJECTIVE: To analyze the clinical features & variation features of cervical tuberculous lymphadenitis and to discuss its effective surgical treatment. METHOD: Retrospective analysis of 27 cases of cervical tuberculous lymphadenitis patients admitted to the hospital from January 2008 to December 2013. The cervical tuberculous lymphadenitis is classified based on the enhanced CT scanning conducted before operation and the preoperative evaluation of clinical characters of patients. The lymphaden ncisional biopsy was conducted on the type I patients with cervical tuberculous lymphadenitis. The lesion resection was performed on the type II and mixed type I + II patients. The regional cervical lymph node dissection was carried on the type III, the type IV and other mixed type patients. The negative pressure drainage ball was placed after operation, and the cavity was flushed with 5% povidone iodine solution. The antituberculosis therapy was performed after wound healing. RESULT: The analysis of the clinical features for 27 patients: the incidence rate on the left side, right side, both sides and middle-line is 63.0%, 25.9%, 7.4% and 3.7% respectively. The majority of patients whose lesion involving more than one region account for 62.1%; the patients whose lesion involving one region account for 37.9%. The most common is level V involved lesion (69.0%), then level IV (62.1%), level III (51.7%), level II (34.5%), level I (10.3%) and level VI (3.4%) in order. The analysis of the CT imageology features for 27 patients: the simple type is the majority (65.5%), and the most common is type III (24.1%), then the type I (17.2%), type II (13.8%) and type IV (10.3%) in order. The mixed type is minority (34.5%), but the two mixed is often (31.0%). The three mixed is only located on one side (3.4%). The recurrence never happened on the patients with resection and standard antituberculosis therapy. CONCLUSION For the cervical tuberculous lymphadenitis, the suitable surgical treatments shall be selected according to the lesion characteristics & location and CT imaging manifestations presurgical evaluation. The effective way to treat cervical tuberculous lymphadenitis is to conduct negative pressure drainage after operation, to flush the cavity with 5% povidone iodine solution and to perform antituberculosis therapy.
Antitubercular Agents ; therapeutic use ; Drainage ; Humans ; Neck ; Neck Dissection ; Recurrence ; Retrospective Studies ; Tomography, X-Ray Computed ; Tuberculosis, Lymph Node ; classification ; drug therapy ; surgery

Facing the background of "team spirit"in constructing harmonious society and the development of relief medicine,the article analyzed the current situation of "team spirit education"and the dilemma of relief medical teaching,and put forward the suggestion of developing "team spirit education"in relief medical teaching.

Objective To evaluate the clinical effect of image guided navigation system (IGNS) and traditional methods for nasal inverted papilloma and sinus osteoma .Methods 73 cases of nasal inverted papilloma and sinus osteoma patients were divided into the navigation group and the non-navigation group ,the navigation group was given image guidance endoscopic sinus surgery ,the non-navigation group was given traditional endoscopic sinus surgery .operative time ,the anesthesia time ,amount of bleeding ,compli-cations and postoperative effects of the two groups were analyzed .Results The anesthesia time of the two groups had no significant difference(P>0 .05) ,the operative time ,blood loss had significant difference(P< 0 .05) .Ⅰ ,Ⅱ level recurrence rate of the two grups in nasal inverted papilloma had no significant difference(P>0 .05) ,while in stage Ⅲ ,Ⅳ ,the difference of recurrence rate had significant difference(P<0 .05) .In sinus osteoma ,1 case of recurrence in the non-navigation group ,the navigation group had no re-currence .In nasal inverted papilloma ,the complications of the two grouos had significant difference (P<0 .05) ,there was no signifi-cantly difference in stage Ⅰ ,Ⅱ(P>0 .05) ,while had significant different in stage Ⅲ ,Ⅳ(P<0 .05) .In the sinus osteoma ,the com-plications of the two grouos had significant difference(P<0 .05) .Conclusion For sinus osteoma and Ⅲ ,Ⅳ level of nasal inverted papilloma ,IGNS could work well with endoscopic system ,improve operation accuracy and reduce complications .IGNS is of a useful tool for endoscopy sinus surgery and would make a great important development in future .

Objective To investigate the risk factors for sensorineural hearing loss (SNHL) in patients with nasopharyngeal carcinoma (NPC) after intensity-modulated radiotherapy (IMRT).Methods From January 2012 to January 2013,29 patients with histopathologically confirmed NPC who received radiotherapy alone or concurrent chemoradiotherapy were included in this study.All patients underwent hearing tests,including pure tone audiometry and acoustic immittance measurement,before and after the IMRT.The cochlear doses for each ear were also collected for analysis.A prospective analysis was performed to investigate the relationship between cochlear dose and SNHL in patients with NPC,and the effects of other factors,including time after radiotherapy,chemotherapy,T stage,and age,were also analyzed.Results Of the 58 ears studied,6(10％) had low-frequency SNHL,and 17 (29％) had highfrequency SNHL.There were significant differences in mean cochlear doses between the patients who developed SNHL after radiotherapy and those who did not (left ears:46.1 Gy vs.35.5 Gy,P =0.006;right ears:45.0 Gy vs.35.8 Gy,P =0.009).When the mean cochlear dose was less than 44 Gy,only 15％ (6/38) of ears had high-frequency SNHL.The invasion of skull base bone was also a significant risk factor for SNHL(P =0.047),but age,chemotherapy,and time after IMRT were not significant risk factors.Conclusions The mean cochlear dose and invasion of skull base bone are significant risk factors for SNHL in patients with NPC after radiotherapy.It is recommended that the mean cochlear dose should be limited to 44 Gy to minimize the incidence of SNHL after IMRT.

Objective To explore current status of health-related productivity loss and its risk factors among nurses.Methods Stanford presenteeism scale (SPS-6) and self-designed questionnaire were used to investigate current status of health-related productivity loss and its risk factors among 1122 nurses working in a tertiary hospital in Changchun city.Results Compared with hired nurses,age and work seniority of permanent nurses were significantly higher(Z =-19.49,-19.28 ;P ＜0.05).The average score of SPS-6 of all the participants was 20.05 ± 4.37.The score of SPS-6 of married nurses was significantly lower than other nurses (Z =-3.52,P ＜ 0.05) ; and the score of SPS-6 of nurses less than 30 years old was significantly higher than those above 30 years old (Z =-2.49,P ＜ 0.05).There were no significant differences between the SPS-6 score of education degree and department.(Z =-1.37,x2 =0.58 ; P ＞0.05).The result of GLM showed that employment status and work seniority were independent risk factors of health-related productivity loss among nurses.The scores of SPS-6 of permanent nurses was significantly lower than hired nursed (x2 =4.48,P ＜ 0.05),and those who had worked for less than 3 years showed significantly higher score of SPS-6 than those who had worked longer (x2 =12.89,P ＜ 0.05).Conclusions Health-related productivity loss do exist among nurses.Improving health management may help to reduce this loss of productivity.

Objective To analyze the pathological voice ,normal voice range chart crowd voice characteristics through tests and analyze the differences between the two groups of test‐related parameters chart range between indicators ,so as to explore the value of the test range map in the polyp of vocal cord .Methods One hundred and twenty patients with vocal polyps according to in‐clusion and exclusion criteria were selected .Sixty cases of normal voice were randomly selected .Germany XION DIVAS system dia‐gram test mode range were recorded for both groups ,with the strongest voice of the bass were measured at different frequencies , first obtain low VRP intensity curve ,then get high‐intensity curve VRP .The maximum frequency of the vocal cord polyp group and normal control group ,the minimum frequency ,maximum intensity ,most quietly strong ,maximum phonation time ,fundamental fre‐quency perturbation and dysphonia index of the data were compared statistically .Results Compared with the control one ,the mean maximum frequency of vocal cord polyp group were lower (P= 0 .029 6) ,the average minimum frequency were significantly higher ( P= 0 .000 3) ,frequency range reduced(P= 0 .022 9) ;vocal cord polyp average loudest group was stronger(P= 0 .003 9) ,the whis‐pered strength values were significantly higher (P = 0 .000 0) ,significantly limited the average sound intensity range than normal voice group group (P= 0 .006 9) .Classification index based on objective voice disorders ,in terms of frequency ,mild voice disorders at the maximum frequency .There was no significant difference in the minimum frequency ,frequency range with a normal voice group ;and in severe voice disorders average maximum frequency lower than the normal voice group ,the smallest than normal voice frequency was significantly higher frequency range than the normal group was significantly limited .In terms of strength ,mild im‐pairment in the loudest voice is strong ,most quietly strong .There was no significant difference with the normal voice group intensi‐ty range ;and in severe voice disorders average maximum sound intensity ,most quietly strong values were higher than normal voice group .However ,the average sound intensity narrow range than normal voice group .Conclusion The range map test can be quanti‐fied assessment of voice ,and can distinguish normal voice ,clinical pathological voice and the severity of damage ,which is an impor‐tant means of voice feature detection to provide an objective basis .

Objective To investigate the serum levels of PGⅠ,PGⅡ,TK1,TSGF and CEA,CA724 in gastric cancer and eval-uate the application value of combined detection the above tumor markers in diagnosis of gastric cancer.Methods The serum levels of TSGF were measured in 94 patients with gastric cancer and 85 healthy control by rate method.PGⅠ,PGⅡ,TK1 and CEA,CA724 were detected by electrochemiluminescence method.Results PGⅠand PGⅠ/PGⅡwere lower than healthy control in serum of patients with gastric cancer (both P<0.05).There was no difference in PGⅡ (P>0.05),and other tumor markers were all higher than healthy control (all P<0.05).The sensitivity of PGⅠ,PGⅠ/PGⅡ were better than TK1,CEA and CA724 (all P<0.05),the specificity of PGⅠ/PGⅡ,CEA were better than TSGF (both P<0.05),the accuracy of PGⅠ,PGⅠ/PGⅡ were better than CA724 and TSGF alone (all P<0.05).When combined TSGF,TK1 and PGⅠ/PGⅡ,PGⅠ,the sensitivity was better than combined PGⅠ/PGⅡand PGⅠ alone (P<0.05).Then when added CEA, CA724,this sensitivity improved up to 82.98%.Although the combined detection would show a lower specificity,it still keep high to 84.71%.Combined detection improved the accuracy in diagnosis of gastric cancer,up to 83.80%.In this re-search,There was no difference in sensitivity,specificity and accuracy between the group of PGⅠ+PGⅠ/PGⅡ+TSGF+TK1+CEA and the group of PGⅠ+PGⅠ/PGⅡ+TSGF+TK1+CEA+CA724.Conclusion Compared with CEA and CA724 popular used in clinic,PGⅠ/PGⅡand PGⅠshowed a better application value.The group of PGⅠ+PGⅠ/PGⅡ+TSGF+TK1+CEA showed the best sensitivity.Combined detection of serum levels of PGⅠ,PGⅠ/PGⅡ,TSGF,TK1 ,CEA can significantly raise the sensitivity and accuracy in diagnosis of gastric cancer.