Liver metastasis is the leading cause of death from colorectal cancer.Surgical treatment is so far the best choice for the treatment of colorectal liver metastases (CRLM).However,how to suitably select an individualized chemotherapy in perioperative period and surgical time and tool is still under controversy.Therefore,the key factors of improving the prognosis of patients with CRLM include overall evaluation of the patients and their preoperative examination outcomes,dividing patients into different groups based on different therapeutic goals,understanding different therapeutic goals of each group,selecting suitable chemotherapy and targeted therapy,ensuring surgical time (synchronous or stepwise resection) and tools (minimally invasive or open surgery) through multidisciplinary team model.

Objective To investigate the students' perception and effectiveness of the flipped class model in bilingual education in special population nutrition class.Method Two classes of Shanghai University of Traditional Chinese Medicine were exposed to either the flipped class model or the traditional class model.In the flipped class model,the students were provided a wealth of teaching resources such as short videos before class.In addition,a series of pedagogical approaches were used to develop the students' cognitive ability.The questionnaire survey and class quiz were employed to evaluate the students' perception and effectiveness of the flipped class model.Results The students in the experimental group have significant higher scores in professional vocabulary section [(23.10 ± 0.71) vs.(21.10 ± 0.67)],listening and speaking section [(21.20 ± 0.78) vs.(19.00 ± 0.74)],essay questions section [(37.80 ± 0.96) vs.(34.40 ± 1.15)],and total test scores [(82.20 ± 1.50) vs.(74.50 ± 1.52)] than did the students in the control group.In addition,the flipped class model ignites the students' learning interest,reduces the learning anxiety,and develops their learning autonomy.Conclusion The flipped class model is a highly effective means that promotes the student centered active learning.This study provides reference for implementation of the flipped class model in Chinese medical bilingual education.

Adult ; Aged ; Aged, 80 and over ; Humans ; Middle Aged ; Noninvasive Ventilation ; Nutritional Support ; Pneumoconiosis ; complications ; therapy ; Positive-Pressure Respiration ; Respiratory Insufficiency ; etiology ; therapy ; Retrospective Studies

Objective: To compare the effects of droperidol, midazolam sedation on implicit memory in patients under epidural anesthesia. Methods: Thirty- two patients with ASA I 一 II un-dergoing general surgery operations with epidural anesthesia were divided into 2 groups,group D received droperidol 2.5mg and fentanyl 0.05mg as sedative, group M received midazolam 3mg and fentanyl 0.05 mg as sedative. The explicit memory and implicit memory scores were gained by methods of process dissociation procedure, and the patients' assessment of alertness/sedation scales were graded simultaneouly. Results: The median of patient' assessment of alertness/ seda-tion scale in group D and group M were 4 and 3 respectively. Patients in group D had higher explicit memory scores and lower implicit memory scores than those in group M. But the implicit memory had not disappeared completely in group D. Respiratory depression emerged when increasing the dosage of droperidol. Conclustion: Droperidol can specifically depress the implicit memory, but it results in respiratory depression when the dosage of droperidol increased. It limits the usage of droperidol to eliminate the implicit memory completely.

Objective To investigate the alterations of SHP-2 mRNA of thymus cells of mice with ? ray-induced leukemia. Methods BALB/c mice were randomly divided into canceration group, non-canceration group, and control group. The gene mutation and content of SHP-2 mRNA in thymus cells were detected by PCR-SSCP, DNA sequencing, and real time fluorescence quantitative PCR (FQ-PCR). Results PCR-SSCP showed there was gene mutation within 700～1 096 bp of SHP-2 mRNA in thymus cells of mice in the canceration group, which was not supported by DNA sequencing. No significant difference in change of SHP-2 mRNA content was found in thymus cells in canceration, non-canceration, and control groups. Conclusion There is translational abnormality of SHP-2 mRNA in thymus cells of mice with ? ray-induced leukemia, which is presented as translational enhancement.

Objective To report a case of early rebleeding of an arterial wall wide-necked aneurysm of the internal carotid artery with stenting and coil embolization. Methods Balloon-expandable stent was deployed across the aneurismal neck through endovascular approach. Microcatheter was superselectively introduced into the aneurismal sac for coil packing. Results The procedure was technically successful with stent completely covering the neck and 90% occlusion by coil packing of the aneurysm; simultaneously keeping the patency of parent artery and adjacent perforating arteries. The patient recovered well, but died for rerupture and rebleeding of the treated aneurysm on the 16th day after the procedure. Conclusions Endovascular stenting combined with coil embolization is an alternative method for treating anterior wall wide-necked aneurysm of the internal carotid artery, but attention and recognition of the risk of early rebleeding of the treated aneurysms should always be kept on mind therefore short-term follow-up and prompt treatment are critically necessary.

Objective To observe the effect of exposure of emphysema with intermittent hypoxia on oxidative stress injury of myocardial cells in rats. Methods Sixty male Wistar rats were divided randomly into four experimental groups(each n=15). The normal control group was bred normally. The emphysema group was exposed to cigarette smoke twice a day(once 30 minutes). The intermittent hypoxia(IH)group was exposed to intermittent hypoxia circumstance 8 hours/day,and the emphysema with IH group was exposed to cigarette smoke twice a day (once 30 minutes)and intermittent hypoxia circumstance 8 hours/day. Each group was exposed for 8 weeks. At the beginning of 9 weeks,the blood gas analysis was performed in 5 rats selected randomly from each group,and the rest rats were sacrificed and their hearts and lungs were taken. Under light microscope,the lung tissues stained with hematoxylin-eosin(HE)were examined. The lung pathology and the results of blood gas analysis showed that the emphysema with IH rat model was established successfully. The levels of malonaldehyde(MDA)and superoxide dismutase(SOD)in rat myocardium were measured by enzyme-linked immunosorbent assay(ELISA),and the subunit p22phox mRNA expressions of nicotinamide adenine dinucleotide phosphate(NADPH)-oxidase were detected by real-time reverse transcription-polymerase chain reaction(RT-PCR). Results Compared with the normal group, the MDA levels and p22phox mRNA expressions were increased obviously in emphysema group, IH group and emphysema with IH group〔MDA(μmol/g):2.93±0.54, 3.58±0.63, 4.51±0.72 vs. 1.75±0.56, p22phox mRNA:0.043±0.004,0.067±0.015,0.123±0.016 vs. 0.018±0.002,all P<0.05〕,but the activities of SOD were decreased significantly(U/mg:36.07±4.79,33.51±7.12,24.29±5.36 vs. 46.08±5.12,all P<0.05). In emphysema with IH group,the increase of MDA levels and p22phox mRNA expressions and decrease of SOD levels were more remarkable compared with those in emphysema group and IH group(all P<0.05). The expression of p22phox mRNA was positively correlated with MDA level(r=0.734,P<0.001). Conclusion The myocardial tissue oxidative stress injury in rats induced by emphysema with intermittent hypoxia exposure is more serious than that induced by exposure of either emphysema or intermittent hypoxia alone,NADPH oxidase possibly being the important medium of myocardial cell response to oxidative stress.

Objective To investigate the effects of sorafenib combined with dendritic cells and cytokine induced killer (DC-CIK) cells on the growth,invasion and metastasis of hepatocellular carcinoma.Methods CIK cells and dendritic cells from healthy adults were cultured in vitro.Mice models with H22 hepatic cancer were established,and randomly divided into the normal saline group,sorafenib group,DC-CIK group and the sorafenib + DC-CIK group according to the random number table.There were 40 rats in each group.All the mice received intragastric gavage with sorafenib of 100 μg/g once a day.DC-CIK cells were intraperitoneally injected into the mice every 3 days with 1 × 107 cells each time.Twenty mice bearing tumors in each group were sacrificed after treatment for 3 weeks,and the peripheral venous blood and hepatic tumor tissues were harvested.The levels of alphafetoprotein (AFP) were detected by ELISA,and the necrotic degree of tumor tissues was evaluated by hematoxylin and eosin staining.The protein expressions of Ki-67 and CD34 in the tumor tissues were determined by immunohistochemical method.The survival time of the other 20 mice bearing the tumor in each group were detected.All data were analyzed using the analysis of variance or LSD test.Results CIK cells and dendritic cells were successfully cultured.The levels of AFP in the peripheral venous blood of the normal saline group,sorafenib group,DC-CIK group and sorafenib + DC-CIK group were (0.675 ± 0.177) rg/L,(0.379 ± 0.052) ng/L,(0.415 ± 0.028) ng/L,(0.288 ± 0.012) ng/L,with significant difference between the 4 groups (F =0.415,P ＜ 0.05).The numbers of intrahepatic and peritoneal metastasis of the normal saline group,sorafenib group,DC-CIK group and sorafenib + DC-CIK group were 21.2 ± 1.3 and 29.7 ± 7.6,16.4 ± 1.6 and 17.4 ± 1.8,20.2 ± 1.7 and 26.4 ± 1.7,15.2 ± 1.3 and 15.2 ± 1.3,with significant difference between the 4 groups (F =2.137,3.271,P ＜0.05).The tumor inhibition rate of the normal saline group,sorafenib group,DC-CIK group and sorafenib + DC-CIK group were 0,21％ ± 3％,9％ ± 3％ and 24％ ± 5％,with significant difference between the 4 groups (F =3.715,P ＜0.05).The survival time of mice in the normal saline group,sorafenib group,DC-CIK group and sorafenib ± DC-CIK group were (18.2 ± 2.5) days,(21.6 ± 2.1) days,(24.3 ± 2.8) days and (25.4 ± 1.4) days,with significant difference between the 4 groups (F =6.247,P ＜ 0.05).Conclusions Sorafenib combined with immunotherapy can significantly increase the therapeutic effects of molecular targeted drug on hepatocellular carcinoma.

Objective To study the diffusion tensor imaging (DTI)features in acute cervical spinal cord injury (CSCI)and evaluate its clinical value.Methods Eight patients with acute CSCI (within 72 hours after onset)were performed conventional MRI and fast DTI scans (112 seconds)and diffusion tensor tractography (DTT)at 3.0T Siemens Trio Tim system.Meanwhile,the fractional anisotropy (FA) values and apparent diffusion coefficient (ADC)values were calculated separately in the site of lesions,the upper and lower sections to the lesions.Then the data were analyzed by paired-samples t test analysis with SPSS 13.0 software.Results Cervical spinal cord injury occurred likely in the sites of C5-C6 (account for 4/8)and C4-C5 (account for 3/8).All MRI and DTI images were satisfied for clinical diagnosis.The FA value and ADC value of injury lesions were markedly lower than that of the normal cord.Accordingly,the injury lesions on FA map and ADC map presented low signals.There were no significant differences of FA values and ADC values between the upper and lower sections to the lesions.DTT could help in displaying the disruption of spinal fiber tract in lancination case and distortion fibers in closed cervical spinal cord injury.Conclusion Fast DTI sequence at 3.0 Tesla may obtain the qualified spinal cord images.By calculation of FA values and ADC values in CSCI patients,DTI may play an important role in detecting the changes of anisotropy and water diffusion caused by myelin sheath injury and cytotoxic edema and vasogenic edema respectively.

AIM:Chronic heart failure (CHF), caused by ischemic cardiomyopathy (ICM) and nonischemic cardiomyopathy (NICM), is among the leading causes of mortality and morbidity worldwide .Low-density lipoprotein receptor-related protein 6 (LRP6) plays a criti-cal role in regulating Wnt signaling .Dysregulated Wnt signaling contributes to high incidence of arrhythmias .Thus, there might be an association between genetic variations of LRP6 and sudden cardiac death ( SCD) .The objective of the study was to examine the associ-ation between common variants of LRP6 and prognosis of CHF patients .METHODS:From July 2005 to December 2009, patients with CHF referred from 10 hospitals and participants without structural heart disease in China were undergone a prospective study .The sin-gle-nucleotide polymorphism rs 2302684 was selected to evaluate the effect of LRP6 polymorphisms on the survival of the patients .RE-SULTS:A total of 1 887 patients (1 437 with CHF and 450 in the control group)were finally enrolled for the analysis.During a medi-an follow-up of 61 months, a total of 546 (38.00%) patients died, including 201(36.81%) cases with SCD and 345 (63.19%) ca-ses with NSCD.No end point event occurred in the control group .Patients carrying A allele of rs2302684 had increased risks of all-cause death (P<0.01) and SCD (P<0.01).After adjusted for the other risk factors , the associations remained significant in all-cause death (P<0.01) and SCD (P<0.01).In patients with CHF caused by ICM , those carrying A allele of rs2302684 also had in-creased risks of all-cause death (P<0.01) and SCD (P<0.01).After adjusted for the other risk factors , the associations remained significant in all-cause death (P<0.01) and SCD (P<0.01).However, there was no association between A allele of rs 2302684 and prognosis in patients with CHF caused by NICM .CONCLUSION:The SNP rs2302684 T>A in LRP6 is associated with an increased risk of all-cause death and SCD in patients with CHF in Chinese Han population , and the association is more prevalent in patients with CHF caused by ICM.Thus, LRP6 might be added as a novel predictor of SCD and could provide an attractive and direct therapeutic target in SCD prevention .