Colorectal cancer is one of the most common cancer.Despite the survival rate of patients with metastatic disease has been raised due to the combination therapy of chemotherapy and opetation,few longterm survivors exist.The detection of circulating tumor cells (CTC) is an evolving technology whose significance has been discussed for more than a century.The advence of modem technology has allowed for more reliable detection of CTCs,and recent studies have provided compelling evidence that CTCs can predict clinical outcome in metastatic colorectal cancer (mCRC).In this review,we will discuss the evidence for CTC significance,with particular focus on detection methods,novel markers,and clinical outcomes in CRC,and future challenges in testing them as a means to individualize the therapy of mCRC patients.

Objective To confirm the structure validity of questionnaire through a probe into latent factorial structure of the rear service personnel′s job satisfaction from polyclinics hospitals .Methods The questionnaire′s construct validity was estimated by ex‐ploratory factor analysis (EFA) and confirmatory factor analysis(CFA) .Results Exploratory factor analysis made the question‐naire including six factors which belonged to job satisfaction and occupation loyalty .Every factor had reasonable explanation and six factors remained 70 .306% information .Exploratory factor analysis of job satisfaction showed five factors ,explaining 70 .514% in‐formation .The confirmatory factor analysis model 1 and model 2 were conducted by LISREL8 .70 software .The results showed that X2 freedom degree was less than 5 .In addition to adjust the goodness of fit index was less than 0 .9 ,all other fit indices were greater than 0 .9 .At the same time ,SRMR and RMSEA were less than 0 .08 .Conclusion The results of exploratory factor analysis(EFA) and confirmatory factor analysis(CFA) both reveal that the questionnaire′s construct validity was good .

Objective To evaluate the value of pre-S1 Ag in combined detection of hepatitis B virus. Methods 288 patients' serums with chronicity type B hepatitis (CHB)were collected when they had been detected with HBV-DNA,HBVM or ALT/AST,and then ELISA assay were applied to detect pre-S1Ag. Results A total of 288 patients ,including 175 males and 113 females( their meso-age is 36.89 years old) were recruited into this study. 161 patients were pre-S1 Ag positive(68.4%), 197 patients' HBV DNA contents exceeded 5.0E + 2 copy/ml(55.9%) ,71patients were H BeAg positive (24.6%), 186 patients were HBeAg negative (64.58%). The rate of 64 patients' ALT and AST exceeded 0. 84, and their' ALT exceeded 40 u/ml ( 22. 2% ). 60 patients' AST exceeded 50 u/ml (20. 8% ). These patients were divided into pre-S1 Ag positive group and pre-S1 Ag group. In pre-S1 Ag positive group, 124 patients' HBV DNA contents exceeded 5.0E + 2 copy/ml( 62.9% ), 118 patients were HBeAg negative (59.8%). When HBV DNA content was less than 5.0E+2 copy/ml,pre-S1 Ag positive rate was 35.2% and pre-S1 Ag negative rate was 63.6%. when HBV DNA content was less than 5.0E + 3 copy/ml, pre-S1 Ag positive rate was 56.9% and pre-S1 Ag negative rate was 81.7%. When HBV DNA content exceeded 5.0E + 5 copy/ml but less than 5.0E + 8 copy/ml ,pre-S1 Ag positive rate was 33% and pre-S1 Ag negative rate was 14.3% ,so two groups had significant difference. Conclusion Pre-S1 Ag positive and HBeAg negative in the CHB patients serums signify virus replication,and it can help us decide prognosis.

50?10~9/L in MP group was 1,10,19,19 and in control group was 0,0,2,2,respectively.The ratio of the total effi- ciency was 93.7% in the treatment group and 80.6% in control group,respectively.The clinical efficacy was dif- ferent significant between groups after 2 weeks(P0.05).Conclusion High dose MP is more effective in the patients and with obvious hemorrhagic tendency than that those of the tradition- al treatment;whereas the traditional treatment is available for other severe ITP patients.

Objective To investigate the application of automatic biopsy gun in CT-guided percutaneous biopsy for the diagnosis of pulmonary sub-centimeter nodules (≤1 cm).Methods A total of 78 patients with pulmonary sub-centimeter nodules were enrolled in this study. Under CT guidance, percutaneous multi-point and multi-sampling puncture biopsy with automatic biopsy gun was carried out in all patients. The success rate of puncturing, the complications and pathological results were analyzed. Results The success rate of puncturing was 91.0% (71/78). The incidence of pneumothorax was 17.9% (14/78) and the incidence of hemorrhage was 30.8%(24/78). In all patients, no pulmonary infection, tumor tract seeding or metastasis was observed during the follow-up period. Among the 71 patients who had a successful biopsy, squamous cell carcinoma was detected in 7, adenocarcinoma in 25, small cell carcinoma in 5, metastatic lesion in 3, chronic interstitial lung inflammation in 13, granulomatous inflammation in 12, pulmonary fungus in 4, pneumoconiosis nodule in one and pulmonary hamartoma in one. Conclusion For CT-guided percutaneous puncture biopsy of pulmonary sub-centimeter nodules, the use of automatic biopsy gun is safe and reliable with higher success rate.

Object To isolate and identify the flavones from the flower of Paulownia tomentosa (Thunb.) Steud., which has been used as traditonal herb medicine in the treatment of some diseases. Methods The flavones were isolated by column chromatography and their structures were elucidated through spectroscopic analysis (NMR). Results Five flavones were isolated and identified as 5, 4′-dihydroxy-7, 3′-dimenthoxyflavanone (Ⅰ), 5-hydroxy-7, 3′, 4′-trimenthoxyflavanone (Ⅱ), diplacone (Ⅲ), mimulone (Ⅳ) and apigenin (Ⅴ). Conclusion All these compounds are obtained from the flower for the first time and the flavones should be as bioactive constituents.

Objective To explore the application value in diagnosis of chronic atrophic gastritis using the magnifying endoscopy and narrow-band imaging.Methods A total of 98 cases of chronic atrophic gastritis patients was selected,and carried out the ordinary white light endoscopy,magnifying endoscopy and narrow-band imaging(ME-NBI) and pathological examination in file,followed by comparison of the results.Results The sensitivity and specificity of chronic atrophic gastritis by magnifying endoscopy and narrowband imaging mode were 74.07％ and 82.35％,respectively;which were significantly higher than that obtained by conventional endoscopy,which were 48.15％ and 64.71％ (P ＜0.05).In magnifying endoscopy and narrow-band imaging endoscopy group,60 patients were positive,which intestinal metaplasia accounted for 35％,while in conventional endoscopy group,39 patients were positive which was only 17.95％ (P ＜ 0.05).Conclusions Magnifying endoscopy and narrow-band imaging can improve the diagnostic accuracy of chronic atrophic gastritis.

The management of emerging infectious diseases has always been given a high priority in public health. Identification of the epidemiological characteristics and transmission patterns of emerging infectious diseases is of great significance to contain the disease transmission and reduce the damages to public health and socioeconomic developments. Currently, infectious disease dynamics models are mainly established based on infectious disease surveillance data to predict the epidemiological patterns and trends of emerging infectious diseases; however, many model-based predictions fail to achieve the expected results due to the presence of multiple uncertain factors during the integrated management of infectious diseases. This review describes the basic principles and variables of common infectious disease dynamics models, including the susceptible-infected-recovered ( SIR ) model, susceptible-infected-removed-susceptible ( SIRS ) model, susceptible-exposed-infected-removed ( SEIR ) model and improved SEIR model, compares the advantages and disadvantages of these models, and summarizes the advances of the infectious disease dynamics models in the prediction of trends in incidence of emerging infectious diseases, so as to provide insights into the effective application of infectious disease dynamics models in the management of infectious diseases.

Objective To evaluate the effectiveness of applying simulation based medical education (SBME) in critical care medicine PBL teaching. Methods Totally 46 undergraduates in medical college of Shanghai JiaoTong University , who participated in critical care medicine PBL teaching in our Hospital from 2012 to 2013 were chosen as research objects. These students were divided into two groups: PBL group (2009 grade, n=24) and SBME-PBL group (2010 grade, n=22). The teaching effectiveness was evaluated by questionnaire survey, theoretical exam, direct observation of procedural skills (DOPS) and mini-clinical evaluation exercise (Mini-CEX). Data were analyzed by SPSS 17.0 software. The data of questionnaire survey were expressed as percentage and the assessment results were expressed as x±s. Chi-square and t test were used to do statistical analysis. P<0.05 signi-fies for statistically significant differences . Results ①The results of questionnaire survey showed that:there was no significant difference between two groups in study interests(P=0.665, 0.937, 0.746) and study ability(P=0.937, 0.665). But regarding collaboration ability, SBME-PBL group performed better than PBL group (P=0.019, 0.038, 0.024). ②These was no significant difference in the theo-retical knowledge exam between PBL and SBME-PBL group(P=0.743). But the DOPS scores of car-diopulmonary resuscitation (P=0.000), endotracheal intubation (P=0.023), defibrillation (P=0.002) and central venous catheterization(P=0.047) were all significantly higher in SBME-PBL group than in PBL group. ③In Mini-CEX, there was no statistical difference in physical examination skills (P=0.790) and clinic judgment(P=0.426) between the two groups. However, SBME-PBL group performed better in medical interviewing capacity(P=0.002), humanistic care (P=0.001), counseling skills(P=0.017), organization efficiency(P=0.029) and overall clinical competence(P=0.024) than PBL group. Conclusions SBME can promote the students' team work spirit, basic clinical skills and comprehen-sive clinical capacity in critical care medicine PBL teaching and can improve the teaching quality of critical care medicine.