Animals ; Astrocytes ; metabolism ; Brain Ischemia ; metabolism ; pathology ; Glial Fibrillary Acidic Protein ; metabolism ; Neuroprotective Agents ; pharmacology ; Propofol ; pharmacology ; Random Allocation ; Rats ; Rats, Wistar ; Reperfusion Injury ; metabolism ; prevention & control

Surgical resection has been accepted as a radical therapy for patients with colorectal cancer, but most of them will develop regional recurrence or distant metastasis. With the development and improvement of novel drugs and methods, they will bring survival hope to patients. In this article, we review the developments in chemotherapy for patients with advanced colorectal cancer.

Objective To observe the influence of preoperative regional chemotherpy on colon cancer cell cycle.Methods30 colorectal cancer patients received intraarterial chemotherapy 10 days before the radical resection.The expression of p16 and Rb protein was examined by immunohistochemistry.Result was compared with the control group.Results Labeling index (LI) of p16 protein was (35?19)% in treatment group, while in control group L1 was (16?8)%,( P

Objective To know the advantages and disadvantages of problem-based learning from students'angle. Methods Interviewed 15 students by PBL scale and face to face interview,to know their ideas about problem-based learning,and then analyzed the results. Results PBL contributed to developing problem-solving skills,self-directed learning,team collaboration and extending professional knowl-edge. But it failed to show positive effect on students'learning motivation. Conclusions PBL has two sides on the outcomes of learning. Implementing PBL appropriately could gain the optimal effects.

The major surgical managements for tibial plateau fractures are anatomical reduction, firm fixation and bone grafting. There have appeared many new techniques in recent years, such as less invasive stability system (LISS) and arthroscopy assisted treatment. But such complications as loss of reduction, infection, soft tissue lesion around the knee, nonunion, posttraumatic arthritis, and knee stiffness seem to be inevitable. This article introduces the mechanism, treatment and prevention of the complications of the tibial plateau fracture.

While the basic concept of saving life and decreasing disability h as not changed in the management of polytrauma, the timing and strategies of tre atment have been gradually modified. Damage control is one of the new strategies , and its application in orthopedic traumatology is known as damage control orth opedics. Damage control orthopedics involves formalized three stages in the mana gement of fractures of long bones and pelvis. Stage 1 consists of temporary fixa tion of the unstable fractures and hemostasis. Stage 2 comprises resuscitation, warming, oxygen delivery and administration of coagulation factors to the patien t in the intensive care unit. In Stage 3 definitive fixation is done for the fra cture. Indications of damage control orthopedics: for patients with polytrauma w hose conditions are unstable or in extremis the damage control strategy is recom mended. For the borderline patients early total care may be applied, but the sur gery should be performed with great caution. It has to be converted to the damag e control strategy if conditions of the patient deteriorate during the operation . Since damage control orthopedics is an evolving practice, further work is need ed to enhance its effectiveness and to reduce the incidence of ARDS and MOF.

Modern Chinese Orthopaedic traumatology has stemmed from the orthopaed ics of Traditional Chinese Medicine(TMC)and western orthopaedics.On the one hand,with a long history and its unique system of theory and treatment,TMC orthopaedics h as made a great con-tribution to the development of modern Chinese orthopaedic traumatology.On the other hand,the introduction and development of western medicine have dramatically pro moted the development of modern Chinese orthopaedic traumatology.Modern Chinese surgeons of orthopaedic trauma have accomplished numerous successful f irst cases in the world since 1950s an d have thus expanded their professional influence.At pr esent,the Chinese orthopaedic trau ma community has grown much stronger and established its ow n academic associations and journals.More and more de-partments of orthopaedic traumatology have been successively establis hed as an independent en-tity in large and middle-sized hospi tals in China.So far,the Chinese orthopaedic trauma com-munity,on the whole,has reached the international level,but there are q uite a lot to be improved in the aspect of treatment.To end the backwardness,in the future Chinese orthopaedic trauma community should make great efforts in education of orthopedists on comp rehensive knowledge,establishment of formal profession al training system,national standardization of orthopaedic procedures in clinical diagnosis an d treatment,active membership of re lative international aca-demic associations and increasing p rofessional exchanges with international counterparts,as well as in research and development of operative techniques and fixators.All these will be the main strategies and developmental trends in the future for Chinese orthopaed ic traumatology. [

Objective To investigate the effects of hippocampal?sparing intensity?modulated radiotherapy ( IMRT) on dose distribution of target volume and organs at risk ( OARs) in locally advanced nasopharyngeal carcinoma. Methods A retrospective dosimetric analysis was performed among 11 patients with locally advanced nasopharyngeal carcinoma. The MONACO ? v5. 10 Treatment Planning System was used to design three treatment plans:routine volumetric modulated arc therapy ( VMAT ) , hippocampal?sparing VMAT, and nine fixed?fields IMRT. The D98%, D50%, D2%, Dmean , conformity index ( CI ) , and homogeneity index (HI) of planning target volume (PTV) and PTVnx as well as dose distribution of the hippocampus and OARs were evaluated. Using single factor analysis of variance,two group comparative was LSD or paired t?test. Results For the above three plans,the D2% values of PTVnx were ,7 513,and 7 462 cGy,respectively (P=0. 016);the D98% values of PTV were 5837,5812,and 5914 cGy,respectively (P=0. 029);the average D2% values of PTV were 7 399,7 380,and 7 333 cGy,respectively ( P=0. 047);the HI values of PTV were 0. 239,0. 241,and 0. 220,respectively (P=0. 016);the V10 values of the brain stem were 97. 2%,88. 1%,and 90. 3%,respectively ( P=0. 001);the V20 values of the brain stem were 74. 2%, 62. 3%,and 67. 1%,respectively ( P=0. 032);the V30 values of the brain stem were 50. 9%,35. 8%,and 45. 5%, respectively ( P= 0. 020 );the V40 values of brain stem were 24. 4%, 14. 4%, and 23. 3%, respectively ( P=0. 018);the Dmean values of hippocampus were 1 518,899,and 896 cGy,respectively ( P=0. 000);the D40% values of hippocampus were 1 379,642,and 639 cGy,respectively ( P=0. 000);the V10 values of the hippocampus were 54. 1%,25. 1%,and 3. 8%,respectively ( P=0. 000);the V20 values of the hippocampus were 26. 2%, 12. 6%, and 12. 0%, respectively ( P=0. 001 ) . Conclusions Hippocampal?sparing VMAT and nine fixed?fields IMRT can significantly reduce the dose to the hippocampus without affecting dose distribution of target volume and OARs. VMAT may be superior to IMRT because VMAT can simultaneously reduce the dose to the brain stem.

Objective To observe the effect of hypertonic saline complex solution (hypertonic saline plus hydroxyethyl starch,HSH) on patients with severe cerebral trauma,high intracranial pressure and shock by the measurement of the changes of the mean arterial pressure (MAP),central venous pressure (CVP) and intracranial pressure (ICP),as well as GOS score changes followed up for 6 months,in order to determine the value of HSH treatment in severe cerebral trauma,intracranial hypertension and shock.Methods Sixty patients with severe brain injury and uncorrected hemorrhagic shock were selected,while the degree of coma was assessed by using GCS score,and shock severity was estimated by using the shock index (SI) score.The patients were randomly divided into HSH group (n =30) and mannitol group (MT group,n =30).Thirty minutes,60 min and 120 min after administration either solution,The changes of MAP,CVP and ICP were observed in two groups,and all patients were followed up for 6 months to observe the outcomes of patients.Results There were no statistically significant differences in age,gender,GCS score,SI scores,and other medication between two groups (P ＞ 0.05),and they were comparable between two groups.After resuscitation of patients in two groups,MAP and CVP were elevated,but the effect of HSH appeared sooner and higher within 30 minutes [MAP (63.1 ± 8.8) mmHg vs.(51.0-9.3) mmHg] (P ＜ 0.05);At the same time,ICP dropped more than 10％ lower [ICP (27.3 ± 5.9) mmHg vs.(32.8 ± 4.1) mmHg] (P ＜0.05),while the effect of MT appeared more slowly in hemodynamic improvement;at 120 min,the increase in MAP and reduction in ICP in HSH group were more significant than those in MT group [MAP (65.9 ± 13.2) mmHg vs.(60.4 ±7.2) mmHg] (P ＜0.01);the ICP [(22.2 ±4.7) mmHg vs.(28.1 ±6.1) mmHg] (P ＜ 0.01).Followed up for 6 months,good recovery rate in HSH group was higher and poor recovery rate was lower than those in MT group.Conclusions In patients with acute intracranial hypertension and uncorrected hemorrhagic shock,the employment of hypertonic saline plus hydroxyethyl starch solution can produce faster and more effective therapy for shock and reduce intracranial pressure,improving the long-term neurological function of patients.

Objective To analyze the difference of prescription dose between ICRU report 83 and Chinese recommendation in the nasopharyngeal carcinoma (NPC) for intensity modulated radiation therapy (IMRT).Methods Eighty-four NPC were treated using IMRT technology from Jan 1,2010 to Apr 1,2012.All dose volume histogram of the 84 IMRT plan were analyzed retrospectively.The target volumes of planning gross tumor volume of nasopharynx (PGTVnx) or planning clinical target volume and high risk lymphatic drainage (PCTV1) and doses of D100,D98,D95,D50,D2 and D0 were recorded.The mean,standard error,medial,range,coefficient of variation (CV) of PGTVnx,PCTV1,and D100,D98,D95,D50,D2and D0 were calculated,respectively.The homogeneity index (HI) and deviation between D95 and D50 of PGTVnx and PCTV1 were calculated,respectively.The differentiation of grouping results were analyzed with grouped t-test method.Results The HI of PGTVnx and PCTV1 were 0.118 ± 0.045 and 0.272 ± 0.037,respectively.It is the bigger target volume,the worse HI;and the advanced T stage,the worse HI.Either PGTVnx or PCTV1,D95 were less than D50.The average deviation was-5.15％ and-10.97％,and the actual difference value was (382± 180) cGy (P=0.000) and (741± 140) cGy (P=0.000).Conclusions D550,which is the recommendation prescription dose of PTV in ICRU report 83,could evaluate accurately the IMRT plan with combining D98 and D2· When D50 is used to instand of D95,the prescription dose of PGTVnx and PCTV1 should increase 5％ and 11％,respectively.