Objective To investigate the effects of intensive insulin therapy on prognosis of patients with severe traumatic brain injury.Methods 130 patients with severe traumatic brain injury(GCS score 3-8) were randomly divided into the observation group (65 cases) and the control group (65 cases).The observation group received intensive insulin therapy,while the control group received conventional insulin therapy.The infection rate,hospital stay,in-hospital mortality and the 6-month mortality were observed.Results The infection rate of the observation group (32.4％) was significantly lower than that of the control group (46.7％) (x2 =1.946,P ＜ 0.05).The hospital stay of the observation group was significantly shorter than that of the control group (t =9.247,P ＜ 0.05).The inhospital mortality and the 6-month mortality were similar in the two groups(x2 =0.086,0.484,all P ＞ 0.05).The neurologic outcome according to Glasgow Outcome Score(GOS 4-5) at 6 months in the observation group was better than that in the control group(x2 =6.407,P ＜ 0.05).Conclusion Intensive insulin therapy can improve the prognosis of patients with severe traumatic brain injury.

Compared with patients with high-middle rectal cancer,local recurrent rate of low rectal cancer in patients is worse.The poor outcome of low rectal cancer is due to the unique anatomical features of the low rectum and the lack of clearly defined anatomical excision planes.Therefore,how to use the appropriate imaging methods,evaluate accurately preoperative cancer staging,plan feasible surgical plane and select the appropriate surgical approach,these will be very important for radical resection of rectal cancer.Therefore,the quality of life and long-term survival of the patients will be improved.

Colorectal cancer is one of the most common malignancies in human.Early diagnosis is the key points in improving the prognosis of patients with colorectal cancer.The implementation of standardized operation and comprehensive treatment for advanced and late stage cancer can improve the outcome.Based on the pattern of lymph node metastasis and the concept of complete mesocolic excision,the operation of colonic cancer has entered the era of normalization and standardization.The surgical procedure of rectal cancer (especially low rectal cancer) should be individualized based on the gold standard of total mesorectal excision (TME).For hepatic metastasis of colorectal cancer,hepatectomy is currently the standard and the only potentially curative treatment method.Therefore,how to evaluate the resectability of hepatic metastasis of colorectal cancer is particularly important.Surgeons are the most important participants in the diagnosis and treatment of colorectal cancer,and standardized diagnosis and treatment is the key to improve the prognosis of patients.

The principle of R0 resection for colorectal cancer(CRC)has been widely accepted based on the preoperative imaging evaluation.The surgeons should scientifically and strictly assess resectability of tumors and furthest reduce tumor residuals.Patients with initial unresectable CRC will give priority to conversion therapy and then undergo R0 resection if converting into resectable tumors.Palliative operation for the patients who cannot receive R0 resection according to the clinical assessment should strictly follow surgical indications and achieve wellplanned and clear surgical purposes.There is no evidence that the palliative operation or cytoreductive surgery benefits to survival of patients,and decreasing complications and improving quality of life through minimum wound are the basic principles.

Colorectal cancer (CRC) is one of the most common malignancies,and liver metastases become the leading cause of high mortality of CRC patients.Difference in the anatomy between the colon and rectum resulting in different metastatic pattern and treatment methods between the colonic cancer and the rectal cancer.Recently,molecular-based subtyping is becoming the basis of prediction of tumor response and outcomes,replacing clinical and pathological stagings.In this review,clinical characteristics,advances of molecular detection,surgery and adjuvant therapy of rectal liver metastases are summarized.

Objective To evaluate the role of transanal ileus tube decompression in the management of malignant obstruction of left-sided colon. Methods With the help of colonoscopy and radiography, 11 cases of left-sided malignant colonic obstruction were treated with transanal ileus tube insertion into the proximal obstruction site for the decompression of the dilated bowel. Curative effects were evaluated according to patient’s symptom relief, bowel sounds, abdominal circumference, intra-abdominal pressure, and plain abdominal radiography. Results Symptoms of acute intestinal obstruction were relieved in all the 11 cases after ileus tube decompression for 3~5 days. Laparoscopic or open primary colectomy was performed in 7 patients with resectable tumor. Postoperative follow-up observations for 1~18 months (median, 11 months) showed no complications like anastomotic leakage. Conclusions Transanal ileus tube decompression in the management of malignant obstruction of left-sided colon is safe and effective.

Objective To evaluate the safety of laparoscopic resection for giant abdominal benign mass.Methods Six cases of giant abdominal benign mass(8～25 in diameter)underwent laparoscopic exploration and resection under general anesthesia from July 2005 to March 2006.Results The laparoscopic resection was accomplished in all the 6 cases.The operation time was 75～220 min(mean,135 min),the intraoperative hemorrhage volume was 20～100 ml(mean,55 ml),the duration for abdominal drainage was 1～3 d(mean,2 d),and the postoperative hospital stay,2～7 d(mean,4.3 d).There was no complications such as intestinal injury,postoperative bleeding,or abdominal infection.Follow-up visits for 1～9 months(mean,6.5 months)found no recurrence.Conclusions Laparoscopic resection of giant abdominal benign mass is a feasible and safe minimally invasive technique.

Objective To explore the feasibility and safety of endoscopic thyroidectomy via axillo-breast approach and the cervical strap muscles. Methods From January to June 2007, endoscopic thyroidectomy was performed on 21 cases in our department via axillo-breast approach and the cervical strap muscles. The operation was carried out under general anesthesia, the anterior cervical muscles was preserved and dragged ahead if necessary. The pressure of CO2 at surgical space was set at 6-8 mm Hg.Results Endoscopic unilateral partial or subtotal thyroidectomy was completed in all the patients without converting to open surgery. No complication occurred in this series. The mean operation time was 70-120 min [mean,(88.3?19.5) min], and the mean blood loss was 2-100 ml [mean, (11.5?21.8) ml]. The drainage tube was removed at 36-48 hours after the operation. And the mean postoperative hospital stay was 2 days. A 3-month follow-up showed good outcomes in terms of sensation at the surgical region and cosmetic effect. Conclusion Endoscopic thyroidectomy via axillo-breast approach and the cervical strap muscles is feasible and safe for unilateral benign thyroid lesions.

Backgroud Numerous studies have confirmed the effectiveness of slowing the progression of atherosclerosis by blood pressure (Bp)control in patients with hypertension and several studies also showed the efficacy of intensive glycemic control in decreasing progression of carotid intima-media thickness (CIMT) in patients with type 1 and type 2 diabetes. However, few studies have compared the relative importance of glycemic vs. Bp control in patients with diabetes and hypertension. We aimed to investigate the association between Bp and glycemic control and subclinical carotid atherosclerosis in older patients with hypertension and type 2 diabetes. Methods In a cross-sectional study, B-mode high-resolution ultrasonography of the carotid artery was performed in 670 subjects (508 males and 162 females) aged 60 years or over who had self-reported hypertension and diabetes but no history of coronary heart disease or stroke. Subjects were categorized by their systolic blood pressure: tight control, < 130 mmHg; usual control, 130-139 mmHg; or uncontrolled, > 140 mmHg, and by their hemoglobin Alc (HbAlc) level: tight control, < 6.5%; usual control, 6.5%-7.5%; or uncontrolled, > 7.5%, respectively. Results The mean CIMT was 8.20±0.11 mm, and carotid plaque was found in 52.5% (352/670) subjects. Overall, 62.1% of the subjects had subclinical carotid atherosclerosis, defined as having either carotid plaque or elevated CIMT (≥ 1.1 mm). The mean CIMT was significantly different between Bp control categories (7.60 ± 0.09 mm, 7.90 ± 0.08 mm, and 8.60±0.12 nun, respectively, P = 0.03) but not between glycemic control categories (8.20 ± 0.10 ram, 8.1 ± 0.08 mm, and 8.40 ± 0.14 mm, respectively, P = 0.13) using ANCOVA analysis. Multivariable logistic regression adjusting for potential confounding factors showed that usual or uncontrolled Bp control were associated with having carotid plaque (OR = 1.08 and OR = 1.42, respectively), or elevated CIMT [Odd ratio (OR) = 1.17, 95% confidence interval (CI)1.04-2.24, and OR = 1.54, 95% CI 1.36-2.96, respectively compared to tight Bp control; but did not show glycemic control as independent predictor of either having carotid plaque or elevated CIMT. Conclusions In older patients with hypertension and diabetes, blood pressure control, but not glycemic control is associated with subclinical carotid atherosclerosis.

Aim In order to provide the experimental basis to investigate the pathologic mechanisms and drug treatment of pulmonary fibrosis,establish the lung slice fibrosis model induced by transforming growth factor-?_1 (TGF-?_1) . Methods Lung was isolated and inflated with 0.4 % agarose solution, then was cut into slices. The lung slice viability was assessed through lactate dehydrogenase (LDH) leakage and MTT assay after incubation of 1, 3, 5, 7, 9 days. The sub-optimal time and dose of TGF-?_1- induced lung slice fibrosis were investigated via measurement of hydroxyproline (HYP), and lung slice fibrosis was examined with HE and Masson staining. Results The lung slice was viable for up to 9 days. The sub-optimal time and dose of TGF-?_1-induced lung slice fibrosis were 7 days and 2.5 ?g?L~ -1 respectively. Meanwhile, hydrocortisone did not decrease the HYP levels in lung slices of TGF-?_1-induced fibrosis. Conclusion TGF-?_1 (2.5 ?g?L~ -1 ,?7d) induced lung slice fibrosis, and hydrocortisone did not exert advantageous effect on this process.