Metastatic colorectal cancer is a major cause of cancer-related mortality. Surgical resection of all known metastatic disease can be curative in selected patients. The majority of patients,however,require systemic chemotherapy as optimal palliative treatment for their disease. For years,effective treatment for advanced colorectal cancer was limited to fluorouracil. In the 1990s,two additional agents,irinotecan and oxaliplatin,were found to have activity against advanced colorectal cancer. Recently,new molecular targeted agents,bevacizumab and cetuximab,were for the first time demonstrated efficacy. Herein,we review recent developments in treatment for metastatic colorectal cancer and implication for optimal treatment in these patients.

Objective To evaluate the effect of dexmedetomidine on the expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) during focal cerebral ischemia-reperfusion (I/R) in rats.Methods Thirty pathogen-free male Sprague-Dawley rats,aged 12-16 months,weighing 300-360 g,were randomly divided into 3 groups (n =10 each) using a random number table:sham operation group (group Sham),focal cerebral I/R group (group I/R),and dexmedetomidine group (group D).Focal cerebral I/R was induced by occlusion of the right middle cerebral artery.In group D,dexmedetomidine was given as a loading dose of 1 μg/kg (over 10 min) starting from 1 h of ischemia,followed by an infusion of 0.05 μg · kg-1 · h-1 until 2 h of reperfusion.Neurological deficit was assessed and scored at 24 h of reperfusion,and then the rats were sacrificed.Brains were removed for determination of cerebral infarct size and expression of iNOS and COX-2 in the hippocampus (by Western blot).The percentage of cerebral infarct size was calculated.Results Compared with group Sham,the neurological deficit score,percentage of head swing to the left,percentage of cerebral infarct size,and expression of iNOS and COX-2 in the hippocampus were significantly increased in I/R and D groups (P＜0.05).Compared with group I/R,the neurological deficit score,percentage of head swing to the left,percentage of cerebral infarct size,and expression of iNOS and COX-2 in the hippocampus were significantly decreased in group D (P＜0.05).Conclusion The mechanism by which dexmedetomidine mitigates focal cerebral I/R injury may be related to inhibition of iNOS and COX-2 expression in rats.

Objective To study the incidence of venous thromboembolism (VTE) between complete and incomplete spinal cord injured patients. Methods 177 cases of acute cervical spinal cord injury were observed from April 2007 to July 2010. According to ASIA classification, 52 cases of grade A involved in observation group, while 125 cases of grades B~D involved in control group. Intervention included low molecular weight heparin and rehabilitation training. Incidence of VTE in two groups was compared. Results There was 11 cases complicated with VTE in the observation group (21.2%) while 6 cases in the control group (4.8%). There was a difference in incidence of VTE between two groups (P<0.05). Conclusion There is a higher incidence of VTE in complete than incomplete cervical spinal cord injury

Diabetic rat model was established by peritoneal injection of streptozocin.At the end of 2 weeks,oxidized low-density lipoprotein (oxLDL) level in diabetic rats was raised [ ( 2.87 ± 0.40 vs 2.27 ± 0.36 ) μg/dl,P＜0.05 ] and endothelium-dependent relaxation was sluggish compared with normal rats.At the end of 6 weeks,oxLDL level continued to increase [ 4.32 ±0.66 ) μg/dl,P＜0.01] and endothelium-dependent maximum relaxation ( Rmax ) was decreased obviously ( P ＜0.01 ).Meanwhile,the protein and mRNA expressions of lectin-like oxidized lowdensity lipoprotein receptor-1 ( LOX-1 ),NF-kB,and ICAM-1 on vessel wall of diabetic rats were higher than those in normal rats,and LOX-1 mRNA was positively correlated with the levels of oxLDL,NF-kB,and ICAM-1 mRNA,while negatively correlated with Rmax,indicating that OxLDL/LOX-1 system may cause early endothelial dysfunction in diabetes via activating NF-kB and up-regulating ICAM-1 expression.

ObjectiveTo modify the technique of whole small bowel transplantation in rats to improve the survival.MethodsOne hundred and six SD rats served as donors and recipients to establish a homogeneous and orthotopic model of small bowel transplantation without fistula.Anastomosis of aorta and vein was done with three- cuff technique,the vena mesenterica superior of recipient was done under a surgical microscope.End-to-end anastomosis was performed between donor proximal small intestine and receptor jejunum,and also between the remote and receptor ascending colon.Surviving more than 3 days after surgery was defined as the operation was successful.ResultsThe operation was successfully carried out in 48 cases with the survival rate of 90.6％ (48/53).The average warm ischemic time was 0 minute,and the average cold ischemic time was(30 ±2.48)min.The survival rate( ＞7 d) was 97.9％ (47/48).ConclusionsOn the basis of three-cuff technique,the survival of SBT was greatly improved.When the vena mesenterica superior of recipient was done under a surgical microscope,the surgical training time was shortened.

Objective To discuss the CT features and pathologic basis of hepatic alveolar echinococcosis. Methods Total 19 cases were confirmed by ELISA and IHA of antibody of echinococcosis. A part of them were confirmed by pathalogy. Results The main features of the disease were irregular,obscure contour and heterogeneous density with mainly hypodense in the liver. Almost of all accompanied with calcification. The calcification was showed some certainly signification. No contrast enhancement was observed within the lesions after administration of intravenous contrast medium. There were three type of this disease based on CT features including map type, halo type and pseudocystic type. Conclusion CT scanning has value of not only for diagnosis of hepatic alveolar echinococcosis but also useful to display each complications and metastasis.

Objective:To investigate the clinical effect and mechanisms of ceftriaxone combined with ranitidine on the acute pancreatitis.Methods:92 cases of patients with acute pancreatitis were selected and randomly divided into the control group (n=46) and experimental group (n=46),the control group was treated with ceftriaxone,and the experimental group was treated with ranitidine based on the control group,the serum levels of intedeukin-6 (IL-6),c-reactive protein(CRP),platelet activating factor (PAF),superoxide dismutase (SOD),propylene glycol (MDA),gastric secrete element,stomach,heart rate (HR),mean arterial pressure (MAP),and the relief time of clinical manifestation and the clinical efficacy were observed and compared between the two groups.Results:After treatment,the serum levels ofIL-6,CRP,PAF,MDA,gastric secrete element and HR of experimental group were significantly lower than those of the control group (P＜0.05).The serum levels of SOD,stomach motion element and MAP of experimental group were higher than those of the control group (P＜0.05).The relief time of clinical manifestation and total efficiency of experimental group were better than those of the control group (P＜0.05).Conclusions:Ceftriaxone combined with ranitidine could effectively enhance the clinical efficacy of acute pancreatitis,which might be related to the anti-oxidation and anti-inflammation.

Objective To explore the diagnostic and classified value of tuberculosis of brain with CT imaging.Methods CT scans were performed in 37 cases with tuberculosis of brain confirmed by clinic and laboratory examination of CSF.Results CT images were abnormal in 26 cases.6 cases were the type of brain substance,6 cases were meningeal type and 14 cases were mixed type.Conclusion CT examination can offer correct evidences of location and qualitalive diagnosis of tuberculosis of brain .

Objective To study X-ray and CT methods of diagnosis of unilateral dislocation of the lower cervical vertebra(C_(3～7)).Methods 15 cases of the injury of unilateral dislocation of the lower cervical vertebra were reviewed from August 2002 to June 2008,X-ray and CT findings were observed.Results Lateral projection of X-ray showed:the anterior displacement of dislocated vertebra was less than 25% in 15 cases,the distance of posterior border of lateral mass of below vertebral body to line of neural scute changed rapidly in 13 cases,sign of "bow tie" of processus articularis superior in 12 cases.Antero-posterior projection showed that spinal process was lateral deviation.Oblique projection showed that intervertebral joints were dislocation or interlocking. CT showed:the "hamburger" sign were destroyed in 7 cases,fracture of unilateral articular process in 8 cases,rotation of vertebral body of dislocation and its superior vertebral body in 13 cases, "double ring" sign in 12 cases.Conclusion The signs of X-ray and CT in combination with the mechanism of injury and clinical situation,the unilateral dislocation of the lower cervical vertebra can be diagnosed accurately.

Objective To investigate the microstructural abnormalities of cerebral white matter in patients with medication-overuse headache with diffusion tensor imaging.Methods Diffusion tensor magnetic resonance imaging (DT-MRI) was carried out in 80 migraine patients with medication-overuse headache (case group) and 80 age-and sex-matched healthy controls (control group).Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were measured and the correlation between clinical characteristics and the changes was examined.Results ① The FA values at the bilateral orbitofrontal cortex,cingulate cortex,splenium of the corpus callosum and the right anterior limb of the capsula interna were significantly lower than those in the controls(P＜0.05).② The ADC values at the right orbitofrontal cortex,left inferior frontal gyrus and anterior cingulate cortex were significantly higher than those in the controls (P＜0.05).③ There were negative correlations between FA values at the bilateral orbitofrontal cortex and right hind legs of the capsula interna and headache course as well as frequency.There was negative correlation between FA values at the left hind legs of capsula interna and headache frequency.④ There were positive correlations between ADC values at the left orbitofrontal cortex and headache course as well as frequency.There were positive correlations between ADC values at the right orbitofrontal cortex and prior cingulate cortex and headache frequency.There was positive correlation between ADC values at the posterior cingulate cortex and headache course.Conclutions There might be an integrity change of neurofibrotic microstructures in the bilateral orbitofrontal cortex and cingulate cortex in patients with medication-overuse headache,FA values are negatively associated with headache course and frequency whereas ADC values are positively associated with headache course and frequency.