Precision medicine is a medical model that proposes the individual therapy,with a joint medical method of genomics,proteomics,metabolomics and clinical big data tailored to the individual patient.The diagnosis and treatment of colorectal cancer have entered the model of precision medicine with the entering the era of precision medicine.In this article,authors summarized the recent progress of diagnosis and therapy under the guidance of precision medicine,with an aim to provide some new clues for surgeons and supports for precision prevention,diagnosis and therapy.

The development of laparoscopic techniques has made surgical treatment enter into the era of minimally invasive surgery,and the application of three-dimensional (3D) high-definition laparoscopic system has brought the important innovation for laparoscopic techniques,meanwhile,it also provides stereoscopic visions and more accurate spatial orientation for surgeons.During the process of laparoscopic radical resection of lower rectal cancer,3D vision can help to identify blood vessels,nerve and tissues around the rectum,ensure accurate lymph node dissection,reduce difficulty of operation,and the learning curve of laparoscopic radical resection of lower rectal cancer for inferior surgeons might be shorten by using 3D imaging system.With the development of technology,the value on clinical application of 3D high-definition laparoscope will become more evident.

Digestive tract reconstruction after proctocolectomy is a critical step of colorectal surgery, proper reconstruction can promote the recovery of digestive tract function and improve the quality of life.At present, there are some candidate reconstruction methods after proctocolectomy, but standardized and proper one is not still established.Since there are differences of the reconstruction methods after proctocolectomy at the different parts of colorectum, the best reconstruction methords should be selected according to the condition and intraoperative situation of patients.

Objective To investigate the correlation between clinical features of breast cancer and microsatellite instability(MSI).Methods 60 samples of breast cancer were eollected and 5 microsatellite polymorphism loci were selected.MSI analysis Was made after DNA isolation,PCR amplification,electrophoresis and EB staining.Results The rate of MSI was 33.3%in breast cancer and 0%in normal breast tissues.MSI in breast cancer was associated with carcinoma differentiation degree.Conclusion MSI is an early event during breast carcinogenesis and it plays an important role in estimation of malignant degree.

Objective To research the effect of alimentary tract reconstruction after gastrectomy on the treatment of type 2 diabetes mellitus(non-insulin-dependent diabetes mellitus, NIDDM). Methods From January 2005 to January 2008, perioperative blood glucose level and insulin therapy in 24 gastric cancer or periampullary carcinoma patients with non-obesity type 2 diabetes were retrospectively analyzed. These patients underwent different alimentary tract reconstruction, including 8 patients for Billroth I, 10 for standard Whipples operation, 6 for esophageal Roux-en-Y jejunostomy after total gastrectomy. Glucose level and insulin dosage of thease patients were compared. Results In the patients underwent Billroth I operation, change of blood glucose level before and after operation was not significant(P＞0.05). The level of blood glucose in patients underwent Whipples operation and total gastrectomy were significant changed 1 and 2 months after the operation (P<0.001). In Billroth I group, 5 patients used insulin to control hyperglycemia preoperatively. After the operation, 2 patents maintained preoperative insulin dosage, 2 had to increase the use of insulin and 1 decreased the insulin dosage. In Whipples group, 6 patients used insulin preoperatively. Interestingly, 4 patents needed less insulin to control hyperglycemia and 2 were free of insulin dependance. In total gastrectomy group, there were 4 patients using insulin to control hyperglycemia. After the operation, 2 patents needed less insulin dosage and 2 stopped using insulin. Conclusions Both Whipples operation and total gastrectomy lead to decreased blood glucose level in NIDDM patients and less need of insulin.The effect of some types of alimentary tract reconstruction after gastrectomy on treatment of type 2 diabetes mellitus is assertive.

Objective To investigate the expression of β-catenin and PCNA,and its relationship with clinical parameters and prognosis.Methods Tissue microarray technology and immunohistochemical method were used to detect the expression of β-catenin and PCNA in gastric carcinoma and normal tissue collected from January 2000 to December 2006.Data were analyzed by SPSS 19.0.Results The percentage of expression of β-catenin and PCNA in gastric carcinoma is 96.7％,99.2％,respectively,and higher than the normal gastric tissue (x2 =41.082,P =0;x2 =97.692,P =0).ROC curve was used to find that PCNA was better than β-catenin to discriminate gastric carcinoma from normal gastric tissue in sensitivity,specificity,coincidence rate(84.4％,87.5％,84.6％).The expression of β-catenin is related to lymph node metastasis in gastric cancer (x2 =6.107,P =0.04).The expression of PCNA is related to pathological type (x2 =9.71,P =0.02).The expression of β-catenin and PCNA in gastric carcinoma were positively correlated (r =0.24,P =0.005).Multivariate analysis showed that TNM staging and both positive β-catenin and PCNA were independent factors impacting on the overall survival rate of patient with gastric cancer.Conclusions The expression of β-catenin and PCNA in gastric carcinoma is signifrcandy high.PCNA is more important than β-catenin in discriminating gastric carcinoma from normal gastric tissue.Combined detection of the two kinds of protein have some clinical significance in predicting the prognosis of patients with early gastric cancer.

Objective To research the effects of bosentan in on unilateral ureteral obstruction (UUO) rats. Methods Wistar rats were randomly divided into three groups. UUO group was subjected to complete ligation of left ureter, sham operation group with sham operation was used as control. Bosenten group was subjected to complete ligation of left ureter and to stomach with bosentan suspension. Three groups were killed at 5,10,15,20 d. We examined renal pathological changes and the expressions of transforming growth factor-?1 (TGF-?1) in kidney of all rats using immunohistochemistry analisis method. The plasma and ureteral obstructive kidney urinary concentration of endothelin - 1 (ET - 1) was determined by radioimmunoassay. Results In Bos and UUO groups, the urinary concentration of ET - 1 increased substantially and the expression of TGF - ?1 were much higher than those in the S group. At the same time.tubulointerstitial fibrosis was present in the kidney of rats in Bos and UUO group. But the expression of TGF- ?1 and tubu-lointerstitial fibrosis in Bos group were lower than those of UUO group. Conclusion Bosentan can effectively amelirate tubulointerstitial fibrosis in rats with UUO by ET and TGF - ?1 machanism.

Objective To determine the expression of endothelin in kidneys of rats with unilateral ureteral obstruction (UUO). Methods Rats were evenly divided into two groups. Some were subjected to complete ligation of left ureter and the others with sham operation were used as control group.Four weeks later, we examined the mRNA expressions of ET-1 in kidneys of all these rats using reverse transcription-polymerase chain reaction (RT-PCR) method.The immunohistochemistry analysis was carried out to investigate the protein level of ET-1. The urinary concentration of ET-1 was determined by radioimmunoassay.Results In UUO group, the urinary concentration of ET-1 increased substantially;both gene expression and protein level of ET-1 were much higher than those in control group. At the same time, tubulointerstitial fibrosis was present in the kidneys of rats with UUO. Conclusion ET-1 is involved in the pathogenesis of the injury of UUO.

AIM:To study the purified factors of Guanxinning for Injection(Radix et Rhizoma salviae miltiorrhizae,Rhizoma Chuanxiong,etc). METHODS: The total of salvianolic acid B、protocatchuci aldehyde and ferulic acid were used to evaluate for the study of type of macroporous adsorption resin,sample volume,the ratio of diameter to height,pH value and sample consistency etc. RESULTS: pH value Guanxinning extract was adjusted to 3.0,through D101 resin finally reached the ratio of diameter to height 1∶2,4 times of water was applied to elution and then 3 times of 70% ethanol for re-elution and collected. CONCLUSION: These factors are approprite for purifying Guanxinning for Injection.

Objective To investigate the expression of hMLH_1 in gastric cancer and its significance,Methods The expressions of hMLH_1 protein and mRNA were detected by immunohistochemistry and reverse transcription polymerase chain reaction(RT-PCR) in 68 cases of gastric cancer tissues,33 cases of para-cancer tissues and(35 cases) of normal gastric tissues.Apoptosis was assayed by terminal deoxytransferase mediated dUTP nicked labeling.Results The positive expression rates of hMLH_1 mRNA were 63.3%(43/68),100%(33/33) and 100%(35/35),and those of protein were 61.8%(42/68),93.9%(31/33),100%(35/35),respectively,in gastric cancer tissues,para-cancer tissues and normal gastric tissues.There was a correlation between the expression of hMLH_1 and clinical grade of gastric cancer(r=0.531,P