Opioid-induced constipation (OIC) is the most common side effect of opioid. OIC influences the quality of life of pa-tients suffering from cancer pain. However, given that the drug is often overlooked and underappreciated, most of the time, the patients would avoid or abandon using opioid and, as a result, they continuously suffer from cancer pain. Therefore, OIC prevention and man-agement must be made before opioid use. The consensus on the diagnosis of OIC has only been reached recently. Thus, a unified defini-tion of OIC must be developed to exchange therapeutic option among departments in hospitals and compare treatment outcome. The di-agnosis of OIC is discussed, and the management of OIC, including medicinal and non-medicinal treatment, is summarized. Mean-while, the initial program for prevention and treatment of OIC is established to make OIC management more convenient for clinical physicians. Much work is still needed to establish a consensus on OIC diagnosis and a suitable program for prevention and treatment of OIC.

Objective To investigate the relationship between the expression of p53 protein and Ki-67 antigen in order to detect its clinical characters and the significance of them in them occurrence and development of appendiceal mucinous neoplasms.Methods 42 tissues of appendiceal mucinous neoplasms were selected by pathological diagnosis in the department of pathology of the PLA general hospital from May 1993 to October 2007.The 10 samples of control group were obtained from simple appendicitis after surgery.Applied PV6000 immunohistochemical method,the expressions of p53 protein and Ki-67 antigen were detected.Results The expression of p53 protein in appendiceal mucinous neoplasms was higher than that in appendicitis tissue [31.0 ％ (13/42) vs 0 (0/10),x2 =4.127,P =0.042).The positive rate of p53 protein in appendiceal mucinous adenocarcinoma was higher than that in low-grade appendiceal mucinous neoplasm tissue (40.0 ％ vs 8.3 ％,x2 =4.0218,P =0.044).The positive rate of p53 protein in appendiceal mucinous neoplasms tissue with pseudomyxoma peritonei was higher than that in tissue without PMP (45.5 ％ vs 15.0 ％,x2 =4.5464,P =0.033).The expression of Ki-67 antigen in appendiceal mucinous neoplasms was higher than that in appendicitis tissue (45.2 ％ vs 10.0 ％,x2 =4.2374,P =0.039).Considering the different factors (such as gender,age,pathological type and PMP),Ki-67 antigen expressions were still not significantly different (P ＞ 0.05).In appendiceal mucinous neoplasms,the difference of positive rates of Ki-67 between the p53 positive expression group and the p53 negative group was statistically significant (x2 =7.6299,P =0.0057).Conclusion The expression of p53 protein was correlated with the expression of Ki-67 antigen.It's valuable that both p53 protein and Ki-67 antigen are used to evaluate the biological behavior of appendiceal mucinous neoplasms and predict the malignant degree.

ObjectiveTostudytheinhibitioneffectof c-mycASODN(antisense oligodeoxynucleotide) and 5-FU (5-fluorouracil) on the expression of c-myc gene and the proliferation of human hepatomacellsHEPG-2. MethodsAfter treatedbyliposomemediatedc-mycantisense phosphorothioate oligodeoxynucleotide (APSODN) and 5-FU, the growth inhibition rate was detected by MTT assay, the expression of c-myc mRNA was detected by RT-PCR and immunohistocehemical methods HEPG-2cells. The cell cycle was analyzed by flow cytometric analysis. The morphological changes were observed by fluorescence staining and cellular genome electrophoresis. ResultsAfter sealing c-myc gene with ASODN,the growth of cells was repressed and the effect was time-dependent and dose-dependent ( P = 0. 02 ). The ability of proliferation decreased, the expression of c-myc gene was inhibited on transcription and translation levels; 5-FU can induce apoptosis of hepatoma cells HEPG-2 dramatically with the dose of 10 μ mol/L, when treated by both c-myc ASODN and 5-FU, HEPG-2 cells was induced apoptosis in a cooperative style ( P =0. 01 ).ConclusionsThe liposome mediated c-myc (APSODN) and 5-FU can inhibit the proliferation of HEPG-2 cells by inhibiting the expression of c-myc gene and can induce apoptosis of hepatoma cells HEPG-2 in a cooperative style. c-myc ( APSODN ) can increase the sensitivity of 5-FU to hepatoma cells and decrease the effective concentration of 5-FU.

To detect the expression of p16 protein and Ki-67 antigen in gastric mucosa-associated lymphoid tissue lymphoma(MALTL)and normal gastric mucosa and to investigate the clinical significance of their expression in the occurrence and development of gastric MALTL.Methods 47 samples of gastric MALTL diagnosed pathologically in the department of pathology of the PLA General Hospital from March 1993 to June 2005 were collected.By using immunohistochemial methods,the expression of p16 protein and Ki-67 antigen was detected in 20 samples of normal gastric tissue and the 47 samples of gastric MALTL.Results The positive rate of p16 protein Was 21.3%(10/47)and 90.0% in gastric MALTL and normal gastric tissue respectively.The positive rate of p16 protein in gastric MALTL was lower than that in normal gastric tissue(P<0.05).The expression of p16 was related to the degree of lymph node metastasis.The positive rate of Ki-67 labelling index(LI)in gnstric MALTL was hiigher than that in normal gastric tissue.A negative correlation was found between the expression of p16 protein and Ki-67 LI(P<0.05). Conclusions Detection p16 and Ki-67 may help to predict the possibility of lymph node metastasis and prognosis in gastric MALTL.

Objective:To investigate the application value of serum procalcitonin in patients with viral infection,bacterial infection and severe bacterial infection.Methods:Selected60 cases of patients with infection who were treated in our hospital from June 2014toDecember 2016,divided into three groupsaccording to the severity of the infection,viral infection (group A) 15 cases,general bacterial infection (group B) 22 cases,and severe bacterial infection (group C) 23 cases.Three groups of patients were treated with symptomatic treatment,and after admission,the serum procalciton in levels were detected in 1,3,5,7 d,and compared with the serum procalcitonin levels before and after treatment in the three groups.Results:The serum procalcitonin ≥ 0.5 μg/L number of B group and C group had no significant difference (P＞0.05),the serum procalcitonin ≥ 0.5 μg/L number of A group was significantly lower than that of B group and C group (P＜0.05);the survival rate of severe bacterial infection patients whose serum procalcitonin was higher than than 0.5 μg/L was significantly higher than those who with serum procalcitonin lower than 0.5 μg/L (P＜0.05).Conclusion:Serumprocalcitonin level had a good application value in the clinical diagnosis prognostic prediction of patients with severe infection.

Objective To assess efficacy and safety of enhanced rehabilitation program for patients with colorectal cancer surgery. Methods One hundred and ten consecutive patients admitted to general surgery department at Beijing Chaoyang Hospital during October 2007 to October 2009 undergone with fasttrack colorectal cancer surgery and enhanced rehabilitation were prospectively studied, with 117 patients undergone with same colorectal cancer surgery by traditional perioperative treatment during May 2005 to September 2007 as controls. Restoration of their gastrointestinal function, occurrence of complications, fatality and length of hospital stay after surgical operation were observed in the group of enhanced rehabilitation and control group. Results Demographic characteristics, stage classification of illness and surgical operation methods were comparable in both groups. The first day with air discharge from the flux was earlier in enhanced rehabilitation group than that in controls (2. 5 vs. 3. 5 day after surgery, P ＜ 0. 05 ), and the former could tolerate solid food earlier than the latter (6.0 vs. 6.7 days after surgery, P=0.028). Overall morbidity of complications was less in the group with enhanced rehabilitation than that in controls (23.6% vs. 39. 3%,P =0. 011 ) and shorter length of hospital stay was observed in the former than that in the latter (9. 0 vs. 10. 8 days after surgery, P =0. 041 ). There was no difference in mortality, incidence of anastomotic leakage, and infectious and non-infectious complications between the two groups. Conclusions Enhanced rehabilitation program is safe and effective following colorectal cancer surgery to accelerate restoration of gastrointestinal function, reduce complications and shorten hospital stay after colorectal cancer surgery.

We constructed prokaryotic recombinant expression vector of P61 gene from Nocardia brasiliensis,expressing P61 protein with biological activity in E.coli,and lay a foundation for further studies related to P61.P61 gene was synthesized and cloned into an expression vector pET-30a(+).The recombinant vector was transformed into Escherichia coli BL21 and induced with IPTG.The production was analyzed with Western blot and the catalase activity of P61 was tested with Catalase Assay Kit.The protein of P61was successfully expressed in E.coli with solubility and high catalase activity,and could be identified by anti-N.brasiliensis sera from mice.The prokaryotic expression plasmid of protein P61 was constructed successfully and can be expressed efficiently in E.coli BL21 cells with higher catalase.

Objective To report the preliminary result of cylindrical abdominoperineal resection (cylindrical APR) and pelvic reconstruction with human acellular dermal matrix (HADM). Methods Cylindrical APR was performed in 13 consecutive patients with advanced very low rectal cancer between January 2008 and April 2009. The mesorectum was not dissected off the levator muscles at abdominal part of the operation, the perineal part of the operation was done in the prone position. The levator muscles were exposed circumferentiaUy. The coccyx and part of the 5th sacrum were dissected and Waldeyer" s fascia divided. The levator muscles were divided laterally on both sides from posterior to anterior. The remaining pelvic floor muscle fibers were divided just posterior to the transverse perineal muscles and the levator muscles were resected en bloc with the anus and lower rectum. The specimen was cylindrical. The pelvic defects were reconstructed with HADM. Results There was no bowel perforation, and all specimens were proved CMR negative by pathology. Perineal wounds were healed uneventfully. After 8 months" follow-up, no patient developed perineal wound breakdown, bulge or hernia. There was 1 patient developed perineal wound infection; one patient developed seroma and three with perineal pain. Five patients with short-term urinary retention recovered within 10 days. Conclusion Clinical APR and HADM pelvic reconstruction can reduce circumferential margin positive and rectum perforation rate, and made the procedure easier and safer without increasing complications.

BACKGROUND:Bone transplantation is the only method for the repair of bone defects. However, traditional bone transplantation has some disadvantages. Bone tissue engineering, as a new treatment strategy, can achieve the desire therapeutic outcomes. OBJECTIVE:To fabricate a new tissue-engineered scaffold for improving bone repair effectively. METHODS:Hydroxyapatites (HA) with different Ca/P (1.50/1.67) ratios were synthesized by chemical precipitation method and microwave radiation method. Composite scaffolds of palygorskite (APC)/HA/polycaprolactone (PCL)/col agen (COL), APC/calcium deficiency HA (CDHA)/PCL/COL, and APC/PCL/COL (control group) were prepared by solution perfusion-solvent evaporation and ion leaching method. The material characterization, active ingredients, hydrophilic property, and mechanical properties were evaluated by scanning electron microscope, infrared spectrometer, surface contact measuring instrument and universal mechanics, respectively. The histocompatibility of the implant with the host was assessed through animal experiments. RESULTS AND CONCLUSION:By precise control of pH range, HA with different Ca/P ratios could be synthesized. The mechanical properties, air permeability, hydrophilic property of the APC/HA/PCL/COL and APC/CDHA/PCL/COL composite materials were significantly increased compared with the APC/PCL/COL composite material (P<0.05), while the porosity, water absorption expansion rate were significantly decreased (P<0.05). Results from our animal experiments showed that no immune inflammatory reaction was observed suggesting that the composite materials hold good histocompatibility. To conclude, the APC/HA (1.50/1.67)/PCL/COL composite materials are promising bone substitutes in bone tissue repair.

Objective To explore the efficacy and feasibility of additional liposome doxorubicin with DVD regimen in the treatment of multiple myeloma (MM). Methods Thirty patients with MM in Chinese PLA General Hospital from January 2012 to January 2015 were selected and divided into treatment group (DVD group,liposomal doxorubicin+vincristine+dexamethasone),control group A(VTD group,bortezomib+thalidomide+dexamethasone) and control group B (VAD group, pirarubicin+vindesine+dexamethasone) with 10 cases in each,including 18 males and 12 females,aged from 36 to 72 years old,and the mean age was 55.8 years. The treatment effect and adverse reactions among the three groups were compared. Survival analysis was evaluated through Kaplan-Meier and Log-rank tests. Results Followed up to January 31st 2016, the therapy related mortality rates in three groups were 10%(1/10), 20%(2/10) and 10%(1/10), the total efficiency rates were 80%(8/10), 100%(10/10) and 60%(6/10), the median survival time was 25.5, 25.2 and 21.6 months, the disease free survival rates were 70%(7/10), 80%(8/10) and 50%(5/10). Survival analysis showed that the difference between DVD and VTD group was not significant (P=0.098) and there were significant differences between DVD and VAD group(P=0.027),VTD and VAD group(P=0.012). The incidence of peripheral neurotoxicity in VTD group(70%,7/10)was higher than that in other two group(χ2=14.7,P=0.007), and there was no significant difference in the other adverse reactions among the three group (all P>0.05). Conclusions In the treatment of MM, the efficacy of liposomal doxorubicin enhanced DVD regimen is similar to the VTD regimen and more effective than the traditional VAD regimen. It is a safe and effective method for MM.