Targeted agents for advanced colorectal cancer mainly include inhibitors of vascular endothelial growth factor (VEGF) and epidermal growth factor receptor (EGFR).Studies show that bevacizumab and cetuximab can improve the prognosis of advanced colorectal cancer patients,but there is slight difference in the choice of chemotherapy regimens when combined with them.Bevacizumab and cetuximab can improve the overall survival of K-ras wild-type colorectal cancer patients similarly.The emergence of new targeted drugs such as aflibercept,regorafenib provides more choices for the targeted therapy of advanced colorectal cancer patients.

Objective To study the variable orderliness of vocal fold vibration caused by the voice with different frequency in chest register of various healthy subjects having several age and sex through electroglottographic examination.Methods 120 healthy subjects were respectively evaluated with electroglottography, including the old group, the adult group, the men group and the female group. Meanwhile the parameters of vocal fold vibration, such as the contact quotient, the contact index, the contact quotient perturbation and the contact index perturbation were measured and analyzed.Results With increase of the frequency, the contact quotient was decreased in all subjects, having signification difference. The contact quotient of old group and adult group ,men and female group had also signification difference. But other parameters not represented the difference in statistics.Conclusion The closer degree of vocal fold was varied with the different frequency in chest register voice from the healthy subjects who were different in age and sex ,but the symmetry and regulation of vocal fold vibration were not related to age and sex. The results were help to study physiology of vocal fold.

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Objecfive To compare the clinical effectiveness of three different fixation methods for peripherally inserted central catheter(PICC).Methods Totally 120 patients requiting PICCs were randomized into suture securement group(group A),tape securement group(group B),and sutureless adhesive-hacked device (StatIock)securement group(group C),with 40 patients in each group.Patients were followed up throughout their entire catheter course,and the securement effectiveness,catheter-related complications,risk of skin injury,and patients'satisfaction were observed.Results The rate of catheter migration without function loss in group B (57.5%)was significantly higherthan in group A(12.5%,P=0.000)and in group C(7.5%,P=0.000).Catheter dislodgment rate in group B(15.0%)was also significantly higher than group A(0,P=0.034)and group C(0,JP=0.034).Phlebitis documented during their catheter course in group B(25.0%)were more than in group A(7.5%,P=0.034)and in group C(5.0%,P=0.012).In addition,the rate of cellulitis in group A was significantly higher than group C(20.0%vs.2.5%,P=0.034).The rate of skin injury in group A 0.005).Nearly half of patients in group A (52.5%)complained irritation and/or pain at the sucure site,which was significantly higher than in other two groups ( both P = 0.000 ).The patients' satisfaction rate was significantly lower in group A (12.0% ) than in the other two groups ( both P = 0.000), documented highest in group C (90.0%) (group C vs.group B, P = 0.004).Conclusions The availability of sutureless adhesive-backed de vice StatLock provides an alternative for securement of PICCs.It performs as well as suture securement in catheterfixing.Meanwhile, it can prevent catheter-related complications such as migration and dislodgment Furthermore, it avoids skin injuries during catheter fixation or securement.

Objective To explore current status of health-related productivity loss and its risk factors among nurses.Methods Stanford presenteeism scale (SPS-6) and self-designed questionnaire were used to investigate current status of health-related productivity loss and its risk factors among 1122 nurses working in a tertiary hospital in Changchun city.Results Compared with hired nurses,age and work seniority of permanent nurses were significantly higher(Z =-19.49,-19.28 ;P ＜0.05).The average score of SPS-6 of all the participants was 20.05 ± 4.37.The score of SPS-6 of married nurses was significantly lower than other nurses (Z =-3.52,P ＜ 0.05) ; and the score of SPS-6 of nurses less than 30 years old was significantly higher than those above 30 years old (Z =-2.49,P ＜ 0.05).There were no significant differences between the SPS-6 score of education degree and department.(Z =-1.37,x2 =0.58 ; P ＞0.05).The result of GLM showed that employment status and work seniority were independent risk factors of health-related productivity loss among nurses.The scores of SPS-6 of permanent nurses was significantly lower than hired nursed (x2 =4.48,P ＜ 0.05),and those who had worked for less than 3 years showed significantly higher score of SPS-6 than those who had worked longer (x2 =12.89,P ＜ 0.05).Conclusions Health-related productivity loss do exist among nurses.Improving health management may help to reduce this loss of productivity.

Objective To investigate the risk factors for sensorineural hearing loss (SNHL) in patients with nasopharyngeal carcinoma (NPC) after intensity-modulated radiotherapy (IMRT).Methods From January 2012 to January 2013,29 patients with histopathologically confirmed NPC who received radiotherapy alone or concurrent chemoradiotherapy were included in this study.All patients underwent hearing tests,including pure tone audiometry and acoustic immittance measurement,before and after the IMRT.The cochlear doses for each ear were also collected for analysis.A prospective analysis was performed to investigate the relationship between cochlear dose and SNHL in patients with NPC,and the effects of other factors,including time after radiotherapy,chemotherapy,T stage,and age,were also analyzed.Results Of the 58 ears studied,6(10％) had low-frequency SNHL,and 17 (29％) had highfrequency SNHL.There were significant differences in mean cochlear doses between the patients who developed SNHL after radiotherapy and those who did not (left ears:46.1 Gy vs.35.5 Gy,P =0.006;right ears:45.0 Gy vs.35.8 Gy,P =0.009).When the mean cochlear dose was less than 44 Gy,only 15％ (6/38) of ears had high-frequency SNHL.The invasion of skull base bone was also a significant risk factor for SNHL(P =0.047),but age,chemotherapy,and time after IMRT were not significant risk factors.Conclusions The mean cochlear dose and invasion of skull base bone are significant risk factors for SNHL in patients with NPC after radiotherapy.It is recommended that the mean cochlear dose should be limited to 44 Gy to minimize the incidence of SNHL after IMRT.

Objective To conduct the endoscopic sinus surgery on chronic nasosinusitis by the image guided navigation system (IGNS) and to analyze the curative effect and complication compared with traditional methods .Methods 81 cases of chronic nasosi-nusitis were randomly selected and performed endoscopic sinus surgery by using IGNS ,and compared with the other 111 cases of chronic nasosinusitis by using traditional nasal endoscopic surgery in the aspects of curative effect ,complications ,etc .Results TypeⅠ and type Ⅱ nasosinusitis had no significant difference in the effective rate between the navigation group and non-navigation group;type Ⅲ nasosinusitis had significant difference in the effective rate between navigation group and non-navigation group .The total incidence rate of complications had significant difference between the navigation group and non-navigation group(P<0 .05);the incidence rate of complications in type Ⅰ and type Ⅱ nasosinusitis had no significant difference between the navigation group and the non-navigation group(P>0 .05);the incidence rate of complications in type Ⅲ nasosinusitis had significant difference be-tween the navigation group and the non-navigation group with statistical significance (P< 0 .05);the effective rates of Haller gas room and Onodi gas rooms showed no significant difference between the navigation group and the non-navigation group (P>0 .05);the total effective raates of anatomical deformity of the frontal recess or the sinus area had significant difference between the naviga-tion group and the non-navigation group(P<0 .05);the total effective rates of agger nasi cell had significant difference between the navigation group and the non-navigation group (P<0 .05) ,the total effective rates of non-agger nasi cell had no significant differ-ence between the navigation group and the non-navigation group (P>0 .05) .Conclusion For the patients with type Ⅲ chronic na-sosinusitis ,chronic frontal sinusitis ,conduct endoscopic sinus surgery by using IGNS is a reasonable choice ,can increase the opera-tive effect and accuracy ,and reduce the occurrence of complications .

Objective To evaluate the clinical effect of image guided navigation system (IGNS) and traditional methods for nasal inverted papilloma and sinus osteoma .Methods 73 cases of nasal inverted papilloma and sinus osteoma patients were divided into the navigation group and the non-navigation group ,the navigation group was given image guidance endoscopic sinus surgery ,the non-navigation group was given traditional endoscopic sinus surgery .operative time ,the anesthesia time ,amount of bleeding ,compli-cations and postoperative effects of the two groups were analyzed .Results The anesthesia time of the two groups had no significant difference(P>0 .05) ,the operative time ,blood loss had significant difference(P< 0 .05) .Ⅰ ,Ⅱ level recurrence rate of the two grups in nasal inverted papilloma had no significant difference(P>0 .05) ,while in stage Ⅲ ,Ⅳ ,the difference of recurrence rate had significant difference(P<0 .05) .In sinus osteoma ,1 case of recurrence in the non-navigation group ,the navigation group had no re-currence .In nasal inverted papilloma ,the complications of the two grouos had significant difference (P<0 .05) ,there was no signifi-cantly difference in stage Ⅰ ,Ⅱ(P>0 .05) ,while had significant different in stage Ⅲ ,Ⅳ(P<0 .05) .In the sinus osteoma ,the com-plications of the two grouos had significant difference(P<0 .05) .Conclusion For sinus osteoma and Ⅲ ,Ⅳ level of nasal inverted papilloma ,IGNS could work well with endoscopic system ,improve operation accuracy and reduce complications .IGNS is of a useful tool for endoscopy sinus surgery and would make a great important development in future .

Objective　To evaluate the effectiveness of intratracheal tube suctioning by respiratory mechanics measurement.Methods　The indexes of respiratory mechanics,including respiratory rate,expiratory tidal volume,% leak around the tube,dynamic respiratory compliance and mean airway resistance were measured just before and 20 minutes after intraendotracheal tube suction in mechanical ventilated children with respiratory failure.Results　Fifty-two measurements was carried out in 11 patie nts.The mean values of respiratory risistance was (116.73±27.12)cmH2O/L.s before suctioning and (93.38±26.64)cmH2O/L.s after suctioning,with significant differrence(P＜0.01)；The mean values of % leak around the tacheal tube dereased from(18.12±4.12)% before suctioning to (8.71±3.76)% after suctioning (P＜0.05),The mean values of expiratory tidal valume was markedly increased from(7.31±2.12)ml/kg before suctioning to(5.72±1.2)ml/kg after suctioning(P＜0.01),The total respiraory rate markedly decreased after suctioning.Conclusion　The respiratory mechanics measurement is very useful to evaluate the airway patient.The removal of secretions is crucial in respiratory managemet.

BACKGROUND: Primary progressive aphasia is a degenerative disease of nervous system clinically characterized by the progressive decrease of speech ability and the relatively reserved memory. OBJECTIVE: To investigate the characteristics of speech dysfunction and the clinical features of primary progressive aphasia we by reported onel patient with primary progressive aphasia. DESIGN: A case analysis. SETTING: Department of Neurology, Beijing Tiantan Hospital affiliated to Capital University of Medical Sciences. PARTICIPANT: One male patient of 56 years old with primary progressive aphasia was selected from the Department of Neurology, Beijing Tiantan Hospital in March 2004, he had got education in senior middle school. The patient had been unable to tell the names of daily living objects at the beginning of 2001. Not only his ability of listening comprehension had gradually declined, but his characters had gradually changed except that his memory had not been affected obviously since 2003. Although he was able in self-care now, he could not normally work. METHODS: ① The spoken fluent types of the patient were evaluated with the standards for the fluency of spoken language in Aphasia battery of Chinese. Western battery aphasia was used to assess the type of aphasia of the patient. Boston diagnostic aphasia examination severity grading standard was applied to grade the severity of aphasia. ② The cognitive psychological tests of visual character-figure matching, denomination for figures and oral reading were used to judge whether the patient had verb-noun dissociation. ③The memory of the patient was assessed with clinical memory scale. MAIN OUTCOME MEASURES: ① spoken fluency, the type and grade of aphasia; ② condition of verb-noun dissociation for the patient; ③ memory of the patient. RESULTS: ① Examination of aphasia: The patient presented the spontaneous talking that named the fluent type, there were wrong meanings in his talks so that he was diagnosed as sensory aphasia. The severity of aphasia was separated into grade 3 levels. ② Cognitive psychological test: The correct rates of verbs and nouns in the test of denomination for figures were 15% and 53% respectively, and there was obvious difference (t=0.231, P ＜ 0.05). ③ Clinical memory scale: The memory quotient was 111,and the clinical memory grade was higher than normal. CONCLUSION: The most outstanding clinical characteristics of patients with primary progressive aphasia is speech dysfunction, and there is verb specific injury.