Objective To observe the safety and efficacy of FOLFOX4 regiment in elderly versus young patients with advanced colorectal cancer. Methods There were 61 patients enrolled in this study, with 28 elderly patients aged 70 years and over, 33 young patients aged less than 70 years.They suffered from advanced/recurrent colorectal cancer and received FOLFOX4 regiment (Oxaliplatin +CF+5-FU). Every 14 days were as a cycle, and the therapeutic safety and efficacy were evaluated after three cycles. Adverse events and response to treatment were compared between the elderly and young patients. Results The main adverse effects were myelosuppression, gastrointestinal disturbance and neurotoxicity. The incidence rate of diarrhea was significantly higher in elderly patients than in young patients, but the most of diarrhea were at grade Ⅰ - Ⅱ. The incidence rates of leucocyte decrease and neutrophil decrease were higher in elderly patients than in young patients (92. 8% vs. 78. 8%, 39.3% vs. 36.3%), but there were no statistically significant differences between them. The incidence rate of neurotoxicity was 46.5% in elderly patients and 36.4% in young patients (P＞0. 05). The recent efficacy rate was 25%, disease control rate was 71.4% and median time-to-progression (TTP) was 6 months in elderly patients and 24.2%, 84.8% and 7 months in young patients (all P＞0.05). Conclusions FOLFOX4 regiment is well-tolerated and effective in both young and elderly patients.

Objective: To study the effect of wortmannin (WM), a PI3K/Akt inhibitor, on the proliferation and apoptosis of leukemia cells and the possible mechanism. Methods: Human leukemia cell line K562 was treated with different concentrations of WM. The proliferation of K562 cells was examined by MTT assay. DNA damage in K562 cells was examined by single cell gel electrophoresis assay, and apoptosis of K562 cells was detected by Annexin V-FITC/PI double-staining. The expressions of total Akt, phosphorate-Akt (p-Akt), and NF-κB p65 mRNA and protein were detected by RT-PCR and Western blotting, respectively. Results: WM inhibited the proliferation of K562 cells in a dose- and time-dependent manner, with the IC((50) value of 24 h being 25 nmol/L. WM also induced apoptosis of K562 cells in a dose-dependent manner. DNA damage in K562 cells was demonstrated by appearance of comet tail after treatment with WM, with the rate of DNA tail and the tail length being significantly higher than those in the control group (P<0.01). WM dose-dependently inhibited P-Akt and NF-κB p65, but not the total Akt, mRNA and protein expressions. Conclusion: WM can inhibit proliferation and induce apoptosis of K562 cells in a dose- and time-dependent manner, probably through down-regulation of phosphorate PI3K/Akt signal pathway and NF-κB expression.

Objective:In order to provide policy-makers with basis and reference for improving the operational efficiency of county general public hospitals, this paper studies the changes in overall efficiency, technical efficiency and scale efficiency of 40 county general public hospitals in Fujian province from 2009 to 2014 , as well as how the to-tal factor productivity changes over the time. Methods: After collecting the relevant data of hospital operations from 2009 to 2014, this paper uses CCR, BBC, Malmquist model and other data envelopment analysis (DEA) methods to analyze the data. Results:The vast majority of those 40 county general public hospitals are in decreasing state. The total factor productivity of 40 hospitals from 2009 to 2014 is 1. 019. There are 21 hospitals (52. 5%) that slightly im-proved their productivity, of which 3 hospitals increased their productivity mainly due to technological progress, 3 hospitals due to efficiency increase, and the rest 15 hospitals due to the effect of both technological progress and effi-ciency increase. Conclusions:The operational efficiency of county general public hospitals in Fujian province is gen-erally insufficient, and there are significant differences between operating efficiency of different regions. The efficien-cy of hospitals in mountainous areas had increased, but the efficiency of hospitals in coastal areas had decreased. Therefore, in order to increase investment in county general public hospitals, the government should take differential policy and pay attention to the reasonable control of hospital size, as well as to strengthen the connotation building and attach importance to improving medical service technologies.

ObjectiveTo investigate mutations in exons 19, 20 and 21 of epidermal growth factor receptor (EGFR) gene in elderly patients with non-small cell lung cancer (NSCLC). MethodsEGFR gene mutations in exons 19, 20 and 21 were detected by nested PCR amplification and DNA sequencing in 46 elderly patients with non-small cell lung cancer. The relationship between mutations and clinical characteristics of these patients was analyzed. ResultsEGFR gene mutations were found in 56.5% (26/46) patients and 41.3% (19/46)were non-silent mutations. Mutation of exon 19 was detected in 6 cases (13.0%), mutation of exon 20 in 13 cases(28.2%) and that of exon 21 in 14 cases (30.4%). Seven patients among them had double mutations and the rest only had a single mutation. The incidence of EGFR gene mutations was higher in non-smokers than in smokers(P＜ 0.01). Higher EGFR mutation rate in exon 19, 20 and 21 were found in patients with clinical benefit who were treated with tyrosine kinase inhibitor(TKl)(P＜0.05). There was no difference in EGFR mutation rate between 60～69 age group and 70～85 age group. ConclusionsThe data suggest that the characteristics of EGFR gene mutations in elderly patients with NSCLC is the same as in the general NSCLC patients. The forecast informations of TKI treatment can be obtained by gene detection in elderly NSCLC patients.

To investigate AIDS-related knowledge, attitudes, beliefs and practices (KABPs) among Chinese migrant laborers in east African cities, and to examine the current status of access to AIDS-related healthcare services, we conducted a cross-sectional study in Nairobi, Kenya, and Dar es Salaam, Tanzania. Of 121 male laborer participants who spoke neither English nor Swahili, 109 (90.9%) had an education level of high school or less. The survey revealed that migrants‘ AIDS-related knowledge was poor, e.g., very few (n=4, 3.3%) were aware of the epidemiologic status of HIV in these two cities. Negative attitudes toward people living with HIV⁄AIDS (PLWHA) were widespread, and the majority (n=94, 77.7%) did not make use of AIDS-related healthcare services or education. Although the main information resources on HIV⁄AIDS in China include television (n=94, 77.7%), books and newspapers (n=78, 64.5%) and radio (n=51, 42.1%), these sources were much less common in Nairobi and Dar es Salaam (p&It;0.001 for each). One third (n=44, 36.4%) did not have any information resources in these two cities. These results indicate that Chinese migrant laborers are at risk of HIV infection in the two African cities. Appropriate education for the general population in China and for migrants in these two cities regarding HIV⁄AIDS, along with relevant information resources that are more accessible and useful for migrants in East Africa are therefore needed to minimize the risk of infection.

Objective:To investigate the characteristics of three-dimensional high resolution anorectal manometry and the effect of biological feedback therapy on the improvement of clinical symptoms in very elderly patients with chronic functional constipation.Methods:A total of 68 cases with chronic functional constipation were divided into very elderly group(≥80 years old, n=36)and the elderly group(60-79 years old, n=32)in the retrospective analysis.Patients underwent the three-dimensional high resolution anorectal manometry before and after biological feedback therapy, and the related parameters and scores of constipation symptoms before and after treatment were compared between the two groups.Results:The results of 3D high-resolution anorectal manometry showed that the anus relaxation rate in the simulated defecation test was lower and the bowel threshold in the rectal sensory threshold test was higher in the very elderly group than in the elderly group(2.44±33.81% vs.16.34±16.99%, 103.44±42.01 ml vs.77.22±41.85 ml, t=-2.047 and 2.655, P=0.049 and 0.012). In the very elderly group, the post-biological feedback therapy versus pre-biological feedback therapy showed that anal residual pressure during simulated defecation was decreased, the absolute value of negative anorectal pressure difference was reduced and the anal relaxation rate was increased [57.50±18.88 mmHg(1 mmHg=0.133 kPa) vs.64.84±25.82 mmHg, -29.64±15.98 mmHg vs.-39.47±19.45 mmHg, 10.53±29.35% vs.2.44±33.81%, t=3.342, -4.902 and -3.209, P=0.002, 0.000 and 0.003]. The scores of clinical symptom scale showed that there was no significant difference in the effective rate between the very elderly and elderly groups(66.67% or 24/36 vs.71.88% or 23/32, χ2=0.760, P=0.860). Conclusions:The elderly functional constipation patients with defecation disorder often have rectal propulsive insufficiency and dyscoordination of pelvic floor muscle contraction.The main cause of defecation disorder in very elderly patients is the decrease of anal relaxation rate during simulated defecation.Biological feedback therapy can improve the symptoms of defecation disorder in very elderly patients by reducing the anal residual pressure during simulated defecation, increasing the anal relaxation rate and reducing the absolute value of negative anorectal pressure difference.

Objective To observe the efficacy and safety of albumin bound paclitaxel in the treatment of retreatment advanced non-small-cell lung cancer (NSCLC).Methods Retreatment NSCLC patients failed from first line regimen or beyond were treated with albumin bound paclitaxel weekly by intravenous dose of 130 mg/m2 on day 1 and day 8,with a 21-day cycle.Efficacy was evaluated every two cycles and side effects were observed during each cycle.Results None of 69 patients achieved complete remission (CR),15 patients (21.7 ％) achieved partial remission (PR),and 23 patients (33.4 ％) achieved stable disease (SD).Objective response rate (ORR) was 21.7 ％,disease control rate (DCR) was 55.1％,and progress free survival (PFS) time was 3.8 months.Efficacy was not correlated with gender,age,histology and lines of previous treatment (all P ＞ 0.05).Main adverse reactions included neutropenia,alopccia and neurotoxicity,which were all tolerable.Conclusion Weekly albumin bound paclitaxel is effective and well tolerated in the treatment of retreatment advanced NSCLC,which can be considered as the second line or beyond regimen.

Purpose:To study the efficacy and safety of combination of methylprednisolone (MP) and ondansetron (OND) in the prevention of acute and delayed nausea and emesis induced by cisplatin base chemotherapy. Methods:This was a randomized, self cross over study. 47 patients receiving cisplatin based chemotherapy were randomized to enter one of the two following groups:Group 1:the combination of 80mg MP and 8 mg OND were iv injected to the patients before the first cycle of chemotherapy and then 8 mg OND was iv injected to the same patients before the second cycle of chemotherapy (23 cases); Group 2:8mg OND was iv injected to the patients before the first cycle of chemotherapy and then the combination of 80 mg MP and 8mg OND were iv injected to the same patients before the second cycle of chemotherapy (24 cases). The dosage of chemotheraputic agents and the times of anti emesis agents were the same in the two different cycles of chemotherapy for each patient.Results:The complete and partial control of the acute emesis were significantly superior in the combination of MP and OND than in the OND alone(93.6% versus 70.2%, P

Objective To investigate the morphological features of reproductive system of adult Schistosoma japonicum under an optical microscope.Methods Adult schistosomes were obtained from infected mice with cercariae shedding from Oncomelania snails.The adult worms fixed with 10% formalin,dehydrated,imbedded in paraffin,cut at 3 ?m thick,stained by HE staining and then observed under an optical microscope.Results The reproductive organs of adult Schistosoma japonicum such as testicle,ovary,fallopian tube,vitellarium,yolk duct and hystera were displayed distinctly and typically.Conclusions The morphological features of reproductive system of adult Schistosoma japonicum are distinct and typical by using routine pathological techniques preparing and HE staining,which establishes a morphological foundation for the morphological teaching of schistosomes and reproductive biology research.

Objective To investigate the expression of COX-2,MMP-2 and TIMP-2 ,the pathological fea-tures ,and their relationship in breast cancer. Methods The expressions of COX-2 ,MMP-2 and TIMP-2 were deter-mined by S-P immunohistochemical method on tissue chips,which containing 127 cases of breast carcinoma. Results The positive rates of COX-2,MMP-2 and TIMP-2 protein were 81.1 (103/127)% ,96.9(123/127)% and 60.6 (77/127) % respectively;The expression of COX-2 was positively related to auxiliary lymph node metastasis and TNM staging (P<0.01 and P<0.05, respectively), and inversely related to PR expression (P<0.05). Further-more,the expression of COX-2 was positively correlated with MMP-2 (r=0. 290 ,P<0.01). Conclusions The ex-pression of COX-2 might be closely related to the invasion and metastasis of breast cancer and has a close relation-ship with MMP-2. The levels of MMP-2 might be partly regulated by COX-2.