Objective This study assessed whether the best overall response rate(ORR) of cetuximab combined with oxaliplatin,leucovorin and fluorouracil/Xeloda was superior to that of this method alone as first-line treatment for metastatic colorectal cancer.The influence of KRAS mutation status was investigated.Methods Patients received cetuximab(400mg/m2 initial dose followed by 250mg/m2,wk thereafter)less than 2 times plus chemotherapy(oxaliplatin 130mg/m2 on day 1,plus leucovorin 200mg/m2 and fluorouracil as a 400mg/m2 bolus followed by a 600mg/m2 infusion during 22 hours on days 1 and 2) or chemotherapy alone.Treatment was continued until disease progression or unacceptable toxicity.KRAS mutation status was assessed in the subset of patients with assessable tumor samples.Results The confirmed ORR for cetuximab plus oxaliplatin,leucovorin and fluorouracil/Xeloda was higher than that with alone(42.86% vs 21.74%).A statistically significant increase in the odds for a response with the addition of cetuximab to oxaliplatin,leucovorin and fluorouracil/Xeloda could be established.In patients with KRAS wild-type tumors,the addition of cetuximab to oxaliplatin,leucovorin and fluorouracil/Xeloda was associated with a clinically significant increased chance of response(ORR 54.55% vs 21.74%) and a lower risk as compared with chemothrapy alone.Cetuximab plus oxaliplatin,leucovorin and fluorouracil/Xeloda was generally well tolerated.Conclusion The clinical effcacy of chemothrapy(oxaliplatin,leucovorin and fluorouracil/Xeloda) plus cetuximab is better than only chemothrapy.KRAS mutational status was shown to be a highly predictive selection criterion in the treatment decision regarding the addition of cetuximab to oxaliplatin,leucovorin and fluorouracil/Xeloda for previously untreated patients with metastatic colorectal cancer.

Objective:To provide reference for the pharmacy automation construction in outpatient pharmacy of domestic hospitals. Methods:The work process, application effect and patient satisfaction before and after the use of automatic drug dispensing machine were analyzed and compared by the data collection and questionnaire according to the operation practice of automatic drug dispensing machine in the outpatient pharmacy of our hospital. Results:After using the automatic dispensing machine, the work flow could be op-timized, the comprehensive benefit and the satisfaction of patients could be improved, and the investment return rate was promising. Conclusion:Automatic pharmacy is the direction of modern pharmacy construction, which has a good application prospect.

Objective To investigate the diagnosis and treatment of pseudomyxoma peritonei (PMP) and provide a reference for diagnosis and treatment of PMP.Methods The clinical features,laboratory examinations,treatment and outcomes of 8 PMP misdiagnosed cases were analyzed with recent relevant reference.Results Ultrasonography,CT,peritoneal cytological examination,tumor markers results are helpful for diagnosis of PMP.PMP will be confirmed and classified by pathological examination after operation.Complete cytoreductive surgery (CRS)or major debulking surgery (MDS) of the tumor combined intraperitoneal chemotherapy and systemic chemotherapy,eight patients in seven cases survived 4-71 month range,one patient died of respiratory failure of pulmonary infection after the third operation.Conclusions Ultrasonography,CT,peritoneal cytological examination,tumor markers tests help avoid misdiagnosis of PMP before operations.Intraoperative findings follow after PMP,CRS or MDS should be executed in the operation or the next time.Intraperitoneal chemotherapy and conventional chemotherapy can improve survival in patients with PMP and prolong their survival time.

Currently medical students are short in ability of doctor-patient communication and lack of professional training in doctor-patient communication.It is essential to explore ways and means of teaching clinical doctor-patient communication for medical students.Clinical doctor-patient communication training courses were carried out with internships by way of explaining the establishment of a good doctordoctor-patient communication relationship,preparation and investigation analysis of doctor-patient communication information,doctor-patient communication skills,evaluation and adjustment of doctor-doctor-patient commu-nication,doctor-doctor-patient communication in the legal and regulatory issues.Medical students were trained in the good doctor-doctor-patient communication relationship building,information collection,infor-mation giving,respect and understanding,ending doctor-patient communication skills.And after the training medical students' doctor-patient communication ability obtained a certain improvement,which means this curriculum of clinical doctor-patient communication training courses is worthy of further promotion.

Objective To compare the inhibition effects of three synthesized fragments used in small interfering RNA(siRNA) against CD133 gene in KATO-Ⅲ gastric cancer cells,and to study effects of suppressed CD133 on the proliferating ability of intervened cells.Methods Three fragments of siRNA were designed and synthesized targeted at the mRNA of CD133.Cell fluorescence counting under confocal laser scanning microscope was used to determine the transfection efficiency after transfection with the CD133FITC-siRNA.The knock-down effect of the CD133 gene was detected by RT-PCR and Western blotting.CCK-8 (cell counting kit-8 assay) was performed to measure the variation of the cell proliferative viability after the above-mentioned treatment.Results The transfection efficiency of siRNA was (85 ± 8) ％ in KATO Ⅲ Gastric cacer cell.All these three fragments of CD133 siRNA effectively inhibited the expression of CD133 gene,the inhibition rate being (11 ± 2) ％,(19 ± 2) ％,(24 ± 3) ％respectively.Compared with the control group,the cell proliferation viability was restrained (42 ± 4)％ in CD133siRNA-3 group (P ＜0.05).Conclusions CD133siRNAs were successfully transfected into KATO Ⅲ Gastric cacer cells and repressed the expression of CD133.Meanwhile,the CD133siRNA fragment 3 was screened from three CD133 siRNA,which has the best inhibition effect.The results provide preliminary evidence for the intereference of CD133+ gastric cancer cells subsequently.

Objective To investigate the biological effect of epithelial-to-mesenchymal transition (EMT) under the treatment of transforming growth factor (TGF)-β1 on the human gastric cancer cell line SGC7901 in vitro,and to observe whether the TGF-β1 can generate the tumor initiating cells ability in SGC7901 or not.Methods SGC7901 cells were cultured with TGF-β1.The morphological change was observed.The effect on proliferation of SGC7901 cells was detected by CCK-8.The invasion assay was used to investigate the motility and the invasion ability of SGC7901 cells.Immuofluorescence was used to detect the expression of E-cadherin and N-cadherin.The mRNA and protein's expression levels of EMT-related factors and CD44 were analyzed by RT-PCR and Western blotting respectively.Results TGF-β1 induced morphological alterations from epithelial to mesenchymal cells.The proliferation of SGC7901 cells was inhibited,and the ability of motility and invasion of SGC7901 cells were greatly enhanced after being treated with TGF-β1.RT-PCR and Western blotting showed that the expression of Snail (P ＜ 0.05),N-cadherin (P ＜ 0.05) and CD44 (P ＜ 0.05) were significantly increased while the expression of E-cadherin was decreased (P ＜ 0.05).Conclusions TGF-β1 can generate the EMT.The CD44 expression was up-regulated.TGF-β1 can inhibit the proliferation and promote the motility and invasion ability of SGC7901 cells.

Objective To investigate if TGF-β1 induces epithelial-mesenchymal transition (EMT) and promotes the obtaining of stemness characteristics in gastric cancer cell lines.Methods After KATO-Ⅲ cells were cultured with or without 5 ng/mL TGF-β1,the morphological change was observed and compared under phase-contrast microscopy.At the same time,the effect of TGF-β1 on the proliferation of KATO-Ⅲ cells was detected by CCK-8.On the other hand,the mRNA and protein' s expressions of EMT-related factors,ESC markers and TICs markers were analyzed by RT-PCR and Western blotting methods too.Results TGF-β1 induced morphological alterations from epithelial to mesenchymal cells.The proliferation of KATO-Ⅲ cells was inhibited after treated with TGF-β1 (P ＜ 0.05).After treated with TGF-β1,the relative mRNA expression levels of Snail (0.5219 ±0.0147) and N-cadherin(0.6640 ±0.0124) were higher than that in control group(0.2049 ±0.0214,P =0.004,0.2722 ± 0.0098,P =0.001),the relative protein expression levels of Snail (0.4769 ± 0.0234) and N-cadherin (0.5014 ± 0.0216) were higher than that in control group (0.2534 ± 0.0345,P =0.02,0.2026 ± 0.0268,P =0.009),while the relative E-cadherin mRNA and protein levels in TGF-β1 treated group (0.4701 ± 0.0215,0.1349 ± 0.0258) were lower than that in control group (0.6792 ± 0.0157,P =0.01 ; 0.6055 ± 0.0227,P =0.004),while the relative mRNA expressions of ESC markers such as Sox2,OCT4,Nanog in TGF-β1 treated group (0.594 ± 0.039、0.438 ± 0.033、0.489 ± 0.037) were higher than that in control group (0.143 ± 0.013,P =0.001,0.156 ± 0.025,P =0.001,0.325 ± 0.046,P =0.03),the relative mRNA expression levels of CD44 (0.437 ±0.037) and CD133(0.543 ±0.028) were higher than that in control group (0.247 ±0.024,P =0.000,0.139 ± 0.016,P =0.000),the relative protein expression levels of CD44 (0.429 ± 0.034) and CD133 (0.316 ±0.027) in TGF-β1 treated group were higher than that in control group (0.152 ± 0.014,P =0.000,0.110 ±0.010,P =0.000),cloning sphere-forming capacity was greatly enhanced after treated with TGF-β1 (P ＜ 0.01).Conclusion TGF-β1 can induce EMT in KATO-Ⅲ cells and promote the obtaining of stemness characteristics in gastric cancer cell lines.

Objective To investigate the clinicopathologic characters and prognostic value of epithelial mesenchymal transition (EMT) related proteins Snail and chemokine receptors 4(CXCR4) in gastric cancer.Methods The expressions of Snail and CXCR4 in the gastric tissues of 50 patients with gastric cancer were detected by Immunohistochemistry.The relation between the expressions of Snail and CXCR4 and the clinicopathologic characters were analyzed.The relative relationship between Snail expression and CXCR4 expression were identified by Spearman method.The correlation between the expressions of Snail and CXCR4 with the survival was analyzed by Kaplan-Meier method.Results The expression of Snail and CXCR4 expression were positive in 31 of 50 cases (62％) and 29 of 50 cases (58％) respectively.The expression levels of Snail and CXCR4 in the gastric cancer patients with diameter more than 5 cm,worse tissue differentiation,vascular invasion,lymphatic vessel invasion,lymph nodes metastasis,and T3 + T4 staging were significantly higher than those in the patients with diameter less than 5 cm,without vascular invasion,lymphatic vessel invasion,lymph nodes metastasis,and T1 + T2 staging (P ＜ 0.05).The Expression of Snail and CXCR4 was positively Correlated(r =0.330,P =0.014).The co-expression of Snail and CXCR4 was significantly associated with poorer prognosis and was applied as an independent prognostic factor for gastric cancer (P =0.001).Conclusions The co-expression of Snail and CXCR4 was the independent prognostic factor for gastric cancer.The combining effect of EMT and CXCR4 may promote the progressions and metastasis of gastric cancer.Therefore,it may be of an effective way for the metastasis of gastric cancer to adjust these targets of the Snail and CXCR4.

Background: Hypoalbuminemia adversely affects the clinical outcomes of various cancers. The purpose of this study was to estimate the prognostic value of hypoalbuminemia 3–5 weeks after treatment in patients with metastatic renal cell carcinoma (mRCC) who received sorafenib or sunitinib as first-line treatment. Methods: In this single-center, retrospective study, we assessed the progression-free survival (PFS) and overall sur-vival (OS) of 184 mRCC patients who received first-line sorafenib or sunitinib treatment. PFS and OS were compared between patients with post-treatment hypoalbuminemia (post-treatment albumin level <36.4 g/L) and those with normal post-treatment albumin level (albumin level ≥36.4 g/L). The Memorial Sloan Kettering Cancer Center (MSKCC)risk model stratified mRCC patients into three risk categories. Prognostic values of all patient characteristics including MSKCC risk category were determined by using univariate and multivariate Cox regression models. Prognostic value was further determined using the Harrell concordance index and receiver operating characteristic curve analysis. Results: The median PFS and OS of the 184 patients were 11 months (95% confidence interval [CI] 9–12 months) and 23 months (95% CI 19–33 months), respectively. Patients with post-treatment hypoalbuminemia had significantly shorter median PFS (6 months [95% CI 5–7 months]) and OS (11 months [95% CI 9–15 months]) than patients who had normal post-treatment albumin levels (PFS: 12 months [95% CI 11–16 months], P < 0.001; OS: 31 months [95% CI 24–42 months], P < 0.001), respectively. Multivariate analysis showed that post-treatment hypoalbuminemia was an independent predictor of PFS (hazard ratio [HR], 2.113; 95% CI 1.390–3.212; P < 0.001) and OS (HR, 2.388; 95% CI 1.591–3.585; P < 0.001). Post-treatment hypoalbuminemia could also be combined with the MSKCC risk category for better prediction about OS. The model that included post-treatment hypoalbuminemia and MSKCC risk category improved the predictive accuracy for PFS and OS (c-index: 0.68 and 0.73, respectively) compared with the basic MSKCC risk model (c-index: 0.67 and 0.70, respectively). The prognostic values for PFS and OS of the integrated MSKCC risk model involving post-treatment hypoalbuminemia were significantly more accurate than the basic MSKCC risk model using likelihood ratio analysis (both P < 0.001). Conclusions: Post-treatment hypoalbuminemia can be considered an independent prognostic factor for patients with mRCC who undergo first-line treatment with tyrosine kinase inhibitors. Additionally, integrating post-treatment serum albumin level into the basic MSKCC risk model can improve the accuracy of this model in predicting patient overall survival and progression-free survival.

Background: Sorafenib and sunitinib are widely used as first-line targeted therapy for metastatic renal cell carcinoma (mRCC) in China. This study aimed to compare the efficacy, safety, and quality of life (QoL) in Chinese mRCC patients treated with sorafenib and sunitinib as first-line therapy. Methods: Clinical data of patients with mRCC who received sorafenib (400 mg twice daily; 4 weeks) or sunitinib (50 mg twice daily; on a schedule of 4 weeks on treatment followed by 2 weeks off) were retrieved. Primary outcomes were overall survival (OS), progression-free survival (PFS), adverse events (AEs), and QoL (SF-36 scores), and secondary outcomes were associations of clinical characteristics with QoL. Results: Medical records of 184 patients (110 in the sorafenib group and 74 in the sunitinib group) were reviewed. PFS and OS were comparable between the sorafenib and sunitinib groups (bothP > 0.05). The occurrence rates of leukocytopenia, thrombocytopenia, and hypothyroidism were higher in the sunitinib group (36.5％ vs. 10.9％, P < 0.001; 40.5％ vs. 10.9％,P < 0.001; 17.6％ vs. 3.6％,P= 0.001), and that of diarrhea was higher in the sorafenib group (62.7％ vs. 35.2％,P < 0.001). There was no significant difference in SF-36 scores between the two groups. Multivariate analysis indicated that role-physical and bodily pain scores were associated with the occurrence rate of grade 3 or 4 AEs (P= 0.017 and 0.005). Conclusions: Sorafenib has comparable efficacy and lower toxicity profile than sunitinib as first-line therapy for mRCC. Both agents showed no significant impact on QoL of patients.