Objective To analyze the effect of combined detection of serum tumor markers, Ki-67 and P-glycoprotein (PGP) in lymph node metastasis and postoperative recurrence of colorectal cancerpatients. Methods The clinical data of 517 colorectal cancer patients who had underwent surgicaltreatment were retrospectively analyzed. Among them, lymph node metastasis was found in 165 cases(lymph metastasis group), and 352 cases did not have lymph node metastasis (non lymphoid metastasis);postoperative recurrence was found in 224 cases (postoperative recurrence group), and 293 cases did havepostoperative recurrence (non postoperative recurrence group). The serum tumor markers levels of cancerantigen 19- 9 (CA19- 9), carcinoembryonic antigen (CEA), cancer antigen 125 (CA125) and theexpressions of Ki-67, PGP were compared. The correlation between the serum tumor markers levels andthe expressions of Ki-67, PGP was analyzed. Results The serum levels of CEA, CA19-9 and CA125 and the positive expression rates of Ki-67 and PGP in lymph metastasis group were significantly higher than those in non lymph metastasis group:(21.39 ± 3.15)μg/L vs. (10.12 ± 2.48)μg/L, (68.48 ± 5.82) U/L vs. (35.26 ± 3.51) U/L, (82.16 ± 7.53) U/L vs. (32.46 ± 6.24) U/L, 69.70% (115/165) vs. 13.64% (48/352) and 72.73%(120/165) vs. 14.77%(52/352), and there were statistical differences (P<0.01). The serum levels of CEA, CA19-9 and CA125 and the positive expression rates of Ki-67 and PGP in postoperative recurrence group were significantly higher than those in non postoperative recurrence group:(18.26 ± 2.34)μg/L vs. (9.18 ± 1.26)μg/L, (47.52 ± 4.85) U/L vs. (21.43 ± 2.18) U/L, (59.16 ± 4.25) U/L vs. (33.17 ± 3.46) U/L, 60.27% (135/224) vs. 9.56% (28/293) and 6.70% (15/224) vs. 7.51% (22/293), and there were statistical differences (P<0.01). The correlation analysis results showed that the positive expression rates of Ki-67 and PGP were positive correlated with the serum levels of CEA, CA19-9 and CA125 (P<0.05). Conclusions The levels of serum tumor markers and the positive expression rates of PGP and Ki-67 in colorectal cancer patients with lymph metastasis and postoperative recurrence are high. The levels of tumor markers are closely related to the positive expression rates of Ki-67 and PGP, which indicates that the combined detection of these indexes has a good effect on evaluating lymph metastasis and postoperative recurrence of colorectal cancer patients.

OBJECTIVE:To compare economy among sodium valproate (VPA),topiramate (TPM) and dipheninum (DPH) in the treatment of epilepsy (EP). METHODS:Retrieved from ProQuest,PubMed,Springer,CJFD,VIP,Wanfang database,re-searches about economy among VPA,TPM and DPH in the treatment of EP were collected. TreeAge Pro 2011.1.0.12.1 software was used to establish Markov model,and cost-effectiveness ratios (CER) of them were calculated to evaluate their economy. RE-SULTS:CER of DPH,VPA,TPM were 29.99,2 664.52 and 6 657.25,in ascending order of DPH

Objective To investigate the morphological and functional changes in the heart of patients with giant left ventricle after valve surgery,and to explore the relationship between the morphology of left ventricle and its function.Methods 86 patients with severely dilated left ventricle underwent echocardiographic examination before and 7-14 days after operation.Left ventricle diameters were measured(LVEDD,LVESD)and matched to the body surface area(LVEDDI,LVESDI).Left ventricular ejection fraction(EF)and fractional shortening(FS)were calculated.Results Left ventricular dimensions significantly decreased 7-14 days after operation.LVEDD was 76.48?5.21mm before operation and 62.58?12.62mm after operation(P

Objective To review the experience of surgical management of coronary artery disease associated with valvular heart disease. Methods From 1998 to 2004, fifty-seven patients with coronary artery lesion and valvular disease underwent coronary artery bypass grafting with concomitant valvular operation. The mean age of the patients was 60 years. Heart function (NYHA) was class II in 9 patients, class III in 37, class IV in 11. 37 patients had mitral valve lesion, 11 aortic valve lesion, and 9 with lesions of both valves. 26 cases had single-vessel disease, 20 with double-vessel disease,11 with triple-vessel disease, and 9 with main artery lesion. After cardiac arrest with the aid of cold cardioplegia under moderate cardiopulmonary bypass, distal anastomosis of the saphenous vein (SV) to the target vessels was first performed followed by valve replacement (49 patients) or valvular plasty (8 patients). The left mammary artery was grafted to the left anterior descending artery before aortic declamping. Proximal anastomosis of the SV to the aorta was finally finished on beating heart. The mean bypass time was 173.5 min and the mean duration of aortic cross-clamping was 112.6 min. Results Except one patient, no mortality and severe morbidity occurred during hospitalization. Heart function was improved to class I-II and no one died during follow-up period. Conclusion CABG combined with valve surgery can be safely performed with good results.

Objective To study the clinical characteristics and surgical treatment of left ventricular outflow tract obstruction (LVOTO) caused by congenital accessory mitral valve (AMV) tissue. Methods Two cases were treated in our department. Pre-operatively, case 1 was diagnosed as congenital heart disease with severe LVOTO and anterior mitral valve cleft; case 2 was diagnosed as congenital atrial septal defect combined with AMV and mild LVOTO as well as mild mitral valve regurgitation. Both patients were operated on under CPB. In case 1, LVOTO was caused by AMV which belonged to Type I (fixed type). In case 2, the AMV was type II (mobile type). Results Both AMV tissues were resected through atrial septum, and combined cardiac disorders were repaired simultaneously. The operations were successful and the patients were discharged with good results. Echocardiography revealed that the LVOTO almost disappeared. Conclusions LVOTO caused by AMV is a rare congenital heart disorder. AMV may be removed with acceptable postoperative outcome. Prophylactic removal of AMV tissue should not be attempted in patients with no or mild LVOTO and no other associated heart defects. These patients should be followed and observed periodically by Doppler echocardiography to identify any progression in LVOTO.

Objective To study the clinical manifestations of cardiac myxoma and the morbidity, mortality and recurrence rate following surgery in our institution. Methods From December 1989 to November 2004, 71 patients underwent complete excision of primary or recurrent intracardiac myxoma. Pre-operative diagnosis was established by echo-cardiography. All patients underwent operation soon after the diagnosis of myxoma was made. Combined cardiac disorder was also treated synchronously. The excised myxoma was histopathologically studied routinely. Results Myxoma most commonly occurred in the fourth decade of life. Its commonest location (92.9%) was the left atrium (LA), but 3 patients had myxoma in the right atrium (RA), one in the right ventricle (RV), and one in the left ventricle (LV). Patients with LA myxoma simulated mitral stenosis clinically, whereas patients with RA and RV myxoma presented features of right heart failure. Patients with LV myxoma had the symptoms of the left ventricular outlet tract obstruction. 6 patients had history of embolism. Combined cardiac diseases included coronary heart disease (2 cases), rheumatic mitral stenosis (2 cases), and severe mitral insufficiency (3 cases), and severe tricuspid insufficiency (4 cases). One patient had myxoma recurrence for three times after his first surgery, and died in the fourth operation. All the other patients survived the operation with the condition improved during the follow-up period. No late deaths were observed. Conclusions Echocardiography is the ideal diagnostic tool. Immediate surgical treatment is indicated in all patients. Cardiac myxoma can be excised with a low rate of mortality and morbidity. Close follow-up for detecting recurrence is necessary.

Objective To summarize the experience in diagnosis and surgical treatment of double-chambered right ventricle (DCRV). Methods From 1990 to 2001, 95 patients with DCRV received surgical correction, including 56 males and 39 females, with an age ranging from 1 to 48. 82 cases had other cardiac abnormalities, 56 of whom had ventricular septal defect (VSD). Right atrium incision was made in 8 patients, right ventricular infundibular incision in 30, and both right atriotomy and ventriculotomy in 57. Results Muscular ring was found in 61 patients, and muscular shelf in 34. No death occurred. Preoperatively, 15 patients and 3 patients were misdiagnosed by echocardiography as VSD and pulmonary stenosis, respectively. The diagnosis was corrected during operation. Conclusions DCRV was often found to be complicated with other cardiac disorders. Echocardiography was the main diagnotic method, but the misdiagnosis was not uncommon. So it was very important to make surgical exploration, especially on tricuspid valve and pulmonary valve during intraventricular operations. Right ventricular infundibular incision was convenient and dependable.

Objective To explore measures for the reform of the cooperative business operation system of township public health centers and evaluate in a comprehensive way the results of the reform. Methods A study was made by means of typical investigation of the specific measures taken by 16 township public health centers in Xianju County of Zhejiang Province in the reform of the cooperative business operation system and changes in health resources and service efficiency brought about by the reform were analyzed. Results In the reform, mixed type cooperation was adopted, with public ownership dominating; current assets were assigned in the form of stocks, with all the staff having a share; and a distribution system was established, clarifying the proportions of state, collective and personal interests. As a result, the infrastructures of the centers were enhanced, the service capabilities improved, the financial situation bettered, the value of national assets increased, the potentialities of the staff brought into full play, and social benefits maximized. Conclusion The measures taken by the centers in the reform, which were basically sound and resulted in significant first fruits, could be popularized as an effective model for deepening the reform of health care institutions in the rural areas.

Objective To investigate the expression of LOXL2 protein (lysyl oxidase like-2 protein) and epithelial-mesenchymal transition (EMT) related markers in cholangiocarcinoma tissues and its relation with the malignant features. Methods The expression of LOXL2、E-cadherin and Vimentin protein in 48 cases of cholangiocarcinoma tissues was detected by immunohistochemistry and compared with the clinicopathological data of cholangiocarcinoma. Results The positive expression rate in cholangiocarcinoma was 71% ( 34/48 ) for LOXL2 and 46% ( 22/48 ) for Vimentin, the absent expression rate was 52% (25/48) for E-cadherin. The positive expression rate of LOXL2 was significantly associated with the absent expression of epithelium markers E-cadherin ( r = 0. 394, P < 0. 05 ) and the positive expression of fibroblast markers Vimentin ( r = 0. 406, P < 0. 05 ). There was no correlation between the expression of LOXL2 and patients gender, age, and cancer differentiation, but a significant correlation with tumor metastasis was found ( P < 0. 05 ). Conclusions LOXL2 protein overexpression in cholangiocarcinoma may accelerate invasion of cholangiocarcinoma through induced EMT.

Objective To assess the diagnostic value of dynamic contrast enhanced MR imaging in predicting the efficacy of distinguishing benign from malignant soft tissue tumor Methods Dynamic contrast enhanced MR imaging was performed in 30 patients with pathologically confirmed soft tissue tumors The MR signal intensity of the ROI was plotted The slope value of the time intensity curve was analyzed Results There was significant difference between the slope value of benign and malignant lesions Based on the slope value of half minute, differentiation of benign from malignant lesions was possible with 90 9% of the sensitivity, 89 4% of the specificity, 83 3% of the positive predictive value and 94 4% of the negative predictive value Conclusion Dynamic contrast enhance MR imaging can correctly predict benignity or malignance of soft tissue tumors