Objective To investigate the clinical efficacy for different treatments of stage Ⅳ right colorectal cancer and its prognostic factors.Methods The clinical data of 106 patients with stage Ⅳ right colorectal cancer who were admitted to the First People's Hospital of Chenzhou from January 2008 to December 2013 were retrospectively analyzed.Among the 106 patients,42 patients receiving palliative resection were allocated to the palliative resection group,30 patients receiving colostomy were allocated to the colostomy group,20 patients receiving bypass surgery were allocated to the bypass group and 14 patients without treatment were allocated to the non-treatment group.Fluorouracil + leucovorin (5-FU/LV) were used as postoperative chemotherapeutics,and the time of chemotherapy was 2 to 6 months.The follow-up was applied to the patients by outpatient examination and telephone interview till February 2014.The non-normal distribution data were described as median and range.The survival curve was drawn by Kaplan-Meier method,and the survival rate was analyzed using the Log-rank test.The continuous variables were cut into the categorical variables.The univariate analysis of categorical variables was done using chi-square test,and the multivariate analysis was done using the COX regression model.Results The incidences of postoperative complications in the palliative resection group,in the colostomy group and in the bypass group were 47.6％ (20/42),40.0％ (12/30) and 65.0％ (13/20),respectively,with no significant difference (x2=3.053,P ＞ 0.05).One-hundred patients were followed up for 14.0 months (range,3.0-40.0 months),with overall median survival time of 10.3 months (range,2.6-27.0 months) and the 1-,2-year survival rates of 36.8％ and 6.7％.The median survival time and 1-,2-year survival rates were 11.5 months (range,4.3-27.0 months),47.6％,16.7％ in the palliative resection group,8.5 months (range,3.5-18.0 months),20.0％,0 in the colostomy group,9.0 months (range,3.0-13.0 months),15.0％,0 in the bypass surgery and 5.0 months (range,2.6-10.0 months),0,0 in the non-treatment group,showing a significant difference in the prognosis of patients among the 4 groups (x2 =42.395,P ＜ 0.05).The prognosis of patients in the palliative resection group were significantly different from those in the other 3 groups (x2 =5.786,6.178,10.378,P ＜0.05),there was no significant difference in the prognosis of patients between the colostomy group and the bypass surgery group (x2 =0.203,P ＞ 0.05).The results of univariate analysis showed that T stage,N stage,tumor differentiation,preoperative obstruction,peritoneal implantation,methods of treatment,chemotherapy and postoperative complications were related factors affecting the prognosis of patients with stage Ⅳ right colorectal cancer (x2=37.428,48.586,32.550,22.739,33.562,42.395,21.517,11.530,P＜0.05).T4 stage,N2 stage,poor-differentiated tumors and peritoneal implantation were independent risk factors affecting the poor prognosis of patients with stage Ⅳ right colorectal cancer (RR =2.336,2.945,2.182,3.500,95％ confidence interval:1.102-4.953,1.156-7.501,1.003-4.749,1.573-7.787,P ＜0.05).The postoperative chemotherapy was an independent factor affecting the good prognosis of patients with stage Ⅳ right colorectal cancer (RR =0.495,95％ confidence interval:0.271-0.904,P ＜ 0.05).Conclusion Palliative resection can improve the prognosis of patients with stage Ⅳ right colorectal cancer.T4 stage,N2 stage,poor-differentiated tumor,and peritoneal implantation were independent risk factors affecting the poor prognosis of patients with stage Ⅳ right colorectal cancer,while postoperative chemotherapy was an independent factor affecting the good prognosis of patients with stage Ⅳ right colorectal cancer.

Objective To establish a rapid and accurate method, and to determine the density of mice and rats sperm with enzyme-labeled instrument.Methods ①The optimal wavelengths and the regression equation set up: After six Kunming mice and six Sprague-Dawley rats were sacrificed, the left epididymis was separated and fully cut up in phosphate buffer saline.With water bath, the sperm were fully dissociated.Using the enzyme-labeled instrument to detect the wavelength absorbance respectively under different wavelength and fitting absorbance curve.The best wavelength will be the most close to 1 of the correlation coefficient ( R2 ) and the standard deviation of minimum.After ten Kunming mice and ten Sprague-Dawley rats were sacrificed,the sperm suspension of different concentration gradient were got.The regression equation of the sperm density and absorbance was established by using enzyme-labeled instrument and haemocytometer.②The test of sperm absorbance stability: Mice and rats,six respectively,were used to make the sperm suspension.Samples were put in room temperature (25℃) or 37℃water bath continued,and after water bath about 0,20,30,40,50, 60 min,the change of absorbance was recorded.③The regression equation verification:The mice were administrated orally with 20% ethanol solution for 30 days to make oligospermia.In order to verify the new method, two different method were used to get the sample sperm.Results The optimal absorbancy-sperm density curve could be established at 380 nm.The means of KM mice sperm count ( x1 ) and absorbance ( y1 ) are showed to be the linear function,and the linear regression equation is y1 =2 ×10 -9 x1 +0.0648, R2 =0.9743.The means of SD rat sperm count ( x2 ) and absorbance (y2) are showed to be the linear function,and the linear regression equation is y2 =5 ×10 -9x2 +0.0621,R2 =0.9940.SD rat sperm suspension liquid after 60 min in water bath, absorbance value at 0 min significantly decreased(P<0.05), but at room temperature after 40 min significantly increased ( P<0.05); KM mice sperm suspension in the water bath and under the condition of normal temperature after 50 min, compared with the 0 min, absorbance value increased significantly(P<0.05).Compared with control group, sperm density of ethanol oligozoospermia group by enzyme standard detector and standard curve calculation were significantly decreased ( P <0.05 );compared with absorbancy-sperm density equation, determination of ethanol oligozoospermia group of sperm density by cell counting plate method had not significant difference.The results suggested absorbancy-sperm density equation could effectively detect the reduction of the mice sperm in oligospermia.Conclusion Using enzyme-labeled instrument to set up the curve of absorbancy-sperm density equation can estimate the sperm density of mice and rats rapidly and exactly.

The incidence of osteoporotic thoracolumbar vertebral fracture (OTLVF) in the elderly is gradually increasing. The kyphotic deformity caused by various factors has become an important characteristic of OTLVF and has received increasing attention. Its clinical manifestations include pain, delayed nerve damage, sagittal imbalance, etc. Currently, the definition and diagnosis of OTLVF with kyphotic deformity in the elderly are still unclear. Although there are many treatment options, they are controversial. Existing guidelines or consensuses pay little attention to this type of fracture with kyphotic deformity. To this end, the Lumbar Education Working Group of the Spine Branch of the Chinese Medicine Education Association and Editorial Committee of Chinese Journal of Trauma organized the experts in the relevant fields to jointly develop Clinical guidelines for the diagnosis and treatment of osteoporotic thoracolumbar vertebral fractures with kyphotic deformity in the elderly ( version 2024), based on evidence-based medical advancements and the principles of scientificity, practicality, and advanced nature, which provided 18 recommendations to standardize the clinical diagnosis and treatment.