Objective To investigate the clinical efficacy for different treatments of stage Ⅳ right colorectal cancer and its prognostic factors.Methods The clinical data of 106 patients with stage Ⅳ right colorectal cancer who were admitted to the First People's Hospital of Chenzhou from January 2008 to December 2013 were retrospectively analyzed.Among the 106 patients,42 patients receiving palliative resection were allocated to the palliative resection group,30 patients receiving colostomy were allocated to the colostomy group,20 patients receiving bypass surgery were allocated to the bypass group and 14 patients without treatment were allocated to the non-treatment group.Fluorouracil + leucovorin (5-FU/LV) were used as postoperative chemotherapeutics,and the time of chemotherapy was 2 to 6 months.The follow-up was applied to the patients by outpatient examination and telephone interview till February 2014.The non-normal distribution data were described as median and range.The survival curve was drawn by Kaplan-Meier method,and the survival rate was analyzed using the Log-rank test.The continuous variables were cut into the categorical variables.The univariate analysis of categorical variables was done using chi-square test,and the multivariate analysis was done using the COX regression model.Results The incidences of postoperative complications in the palliative resection group,in the colostomy group and in the bypass group were 47.6％ (20/42),40.0％ (12/30) and 65.0％ (13/20),respectively,with no significant difference (x2=3.053,P ＞ 0.05).One-hundred patients were followed up for 14.0 months (range,3.0-40.0 months),with overall median survival time of 10.3 months (range,2.6-27.0 months) and the 1-,2-year survival rates of 36.8％ and 6.7％.The median survival time and 1-,2-year survival rates were 11.5 months (range,4.3-27.0 months),47.6％,16.7％ in the palliative resection group,8.5 months (range,3.5-18.0 months),20.0％,0 in the colostomy group,9.0 months (range,3.0-13.0 months),15.0％,0 in the bypass surgery and 5.0 months (range,2.6-10.0 months),0,0 in the non-treatment group,showing a significant difference in the prognosis of patients among the 4 groups (x2 =42.395,P ＜ 0.05).The prognosis of patients in the palliative resection group were significantly different from those in the other 3 groups (x2 =5.786,6.178,10.378,P ＜0.05),there was no significant difference in the prognosis of patients between the colostomy group and the bypass surgery group (x2 =0.203,P ＞ 0.05).The results of univariate analysis showed that T stage,N stage,tumor differentiation,preoperative obstruction,peritoneal implantation,methods of treatment,chemotherapy and postoperative complications were related factors affecting the prognosis of patients with stage Ⅳ right colorectal cancer (x2=37.428,48.586,32.550,22.739,33.562,42.395,21.517,11.530,P＜0.05).T4 stage,N2 stage,poor-differentiated tumors and peritoneal implantation were independent risk factors affecting the poor prognosis of patients with stage Ⅳ right colorectal cancer (RR =2.336,2.945,2.182,3.500,95％ confidence interval:1.102-4.953,1.156-7.501,1.003-4.749,1.573-7.787,P ＜0.05).The postoperative chemotherapy was an independent factor affecting the good prognosis of patients with stage Ⅳ right colorectal cancer (RR =0.495,95％ confidence interval:0.271-0.904,P ＜ 0.05).Conclusion Palliative resection can improve the prognosis of patients with stage Ⅳ right colorectal cancer.T4 stage,N2 stage,poor-differentiated tumor,and peritoneal implantation were independent risk factors affecting the poor prognosis of patients with stage Ⅳ right colorectal cancer,while postoperative chemotherapy was an independent factor affecting the good prognosis of patients with stage Ⅳ right colorectal cancer.

Objective To explore the effects of extracellular regulated protein kinase 1/2 (ERK1/2) signal pathway on cardiomyocyte apoptosis and tumor necrosis factor-α (TNF-α) expression at different glucose-lowing rates,and the influence of glucose-lowing rate on cardiomyocyte injury and inflammatory secretion function,as well as its mechanism.Methods Cardiomyocytes of Wistar neonate rat were maintained in medium supplemented with 25 mmol/L glucose for 72 h.Then the medium was changed to different concentrations of glucose and all cells were divided into five groups.Group A was control group whose medium supplemented with 25 mmol/L glucose.Medium of group B,C,D,E was supplemented with 20,15,10,5 mmol/L glucose (glucose-lowing rate was 5,10,15,20 mmol/L) respectively.Survival rate of cardiomyocyte was measured by CCK8 kit.Cardiomyocyte apoptosis was measured by flow cytometry instrument and laser confocal microscope after Annexin V-PI.TNF-α was measured by ELISA.ERK1/2 protein and phosphorylation were measured by Western blot.Cardiomyocyte apoptosis and TNF-α levels were measured again after U0126 was added.Results At the same time point,along with the glucose-lowing rate increased,survival rate of cardiomyocyte in group A was increased and those in group C,D,E were decreased (P＜ 0.05).TNF-α concentration was increased in group B,C,D and decreased in group E.After 24 h,apoptosis rate decreased in group B and increased in group C,D,E (P＜0.05).ERK1/2 phosphorylation level increased in group B,D,and E(P＜0.05).The ERK1/2 phosphorylation level in group B was the lowest.After U0126 was added,survival rates of cardiomyocyte in all groups were increased (P＜0.01) while TNF-α concentrations were decreased (P＜0.05).In every group,survival rate of eardiomyocyte after 48 h was lower than that after 3 h and 24 h,while TNF-α concentration was higher (P＜0.05).Conclusion Influence of glucose-lowering rate for cardiomyocyte apoptosis and TNF-o is caused by ERK1/2 pathway.In the glucose-lowering course,ERK1/2 pathway promotes cardiomyocytes apoptosis and TNF-α secretion is related with not only osmotic pressure,but also ERK1/2 signal pathway activation as well.