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 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 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 establish a curve of dosage gradient-liver signal intensity of superparamagnetic iron oxide (SPIO) in normal rats and to find an appropriate dose for enhancement. Methods: Seventy-two SD rats, 4 rats a group at random, underwent MR enhancement with 0, 2, 5, 8, 10, 12, 15, 20, 30, 40, 50, 60, 70, 80, 100, 140, 210, 280 μmol/kg SPIO respectively after plane examination. The signal-to-noise ratio of liver was measured and a curve of dosage gradient-liver signal intensity was made. Results: (1)With the increase of SPIO dose, the signal intensity of both T1 and T2 weighted images of liver declined. (2)T2 weighted images was more sensitive than T1 weighted images in small dose, the ED50 of T1 weighted was 8 μmol/kg, and the ED50 of T2 weighted was 5 μmol/kg. (3)When the dose was greater than 15 μmol/kg, the signal intensity of T1 weighted images declined more rapidly than T2 weighted, the effect of enhanced T1 weighted images resembled T2 weighted ones, and its images was with more fine resolution. (4)At the dose of 40 μmol/kg, the signal intensity of T1 weighted images approached the background noise, and at the dose of 15 μmol/kg, the signal intensity of T2 weighted images approached the background noise. Conclusion: Good effect of T1 and T2 enhanced MR imaging can be acquired at the dose of 20-10 μmol/kg SPIO respectively, the best contrast-to-noise ratio is found on T2 weighted enhanced MR image.

Objective To study the effect of brucine on the growth of a hepatocellular carcinoma cell line in vitro. Methods Brucine was added into a liver cancer cell line of SMMC-7721 in vitro, at drug concentration of brucine from 2. 5 μg/ml to 400 μg/ml. The inhibition rate of cell growth was measured by MTT technique after the cells were cultured for 72 hours. The protein and mRNA expression of PCNA,cyclin D1 and FAS were respectively assayed with Western blotting and fluorescent quantitation RT-PCR techniques at 24, 48, 72 h. Results The inhibition rate of liver cancer cell was near 100% when the brucine concentration was at 320 μg/ml. The protein and mRNA expression of FAS were of no significant difference at 24 h vs 48 h ( seperately F = 2. 547,1. 582, all P ＞ 0. 05 ), and significant difference existed at 24 h vs 72 h( seperately F = 1. 036, 1. 137, all P ＜ 0. 05 ). The protein and mRNA expression of PCNA,Cyclin D1 were of no significant difference between various time period( seperately PCNA F = 3.612,2. 174,3.029;Cyclin D1 F=2.361,2.915,1.976,all P＞0.05). Conclusions Brucine inhibits the growth of liver cancer cells, by inducing increased apoptosis of the cells probably through FAS overexpression.

Objective To preliminarily discuss the efficacy and safety of balloon protection technique in venous sinus in the embolization of lateral sinus dural arteriovenous fistula.Methods FromDecember 2012 to August 2016,7 consecutive patients with lateral sinus dural arteriovenous fistula embolized with Onyx under the protection of venous sinus balloon were enrolled retrospectively. Their clinical data,imaging data,and follow-up results were analyzed.Results In 7 patients,the fistulas of 3 cases were located in the sigmoid sinus and the fistulas of 4 cases were located in the transverse sinus. Immediately after operation, 5 patients were embolized completely and 2 were embolized mostly. All balloon protected venous sinuses maintained patency. Seven patients were followed up clinically and the follow-up time was 6-43 months. No new neurological deficits were observed. All 7 patients received whole DSA reexamination and the follow-up time was 6-11 months. It is suggested that 5 patients were completely cured,among them,the venous sinuses were patent in 4 cases,the venous sinus was occluded in 1 case;the fistula was stable and venous sinus patency in 1 case;and 1 had newly complicated venous sinus occlusion.Conclusion At the same time of embolization of the fistulas,the dural arteriovenous fistulas were embolized under the protection of venous sinus balloon. It could maintain long-term patency of venous sinus and be conductive to maintaining the stability of the embolization effect.

Objective To study the clinical and pathological characteristics of breast ductal carcinoma in situ (DCIS) and with microinvasion (DCIS-MI). Methods From June 1999 to June 2003, a total of 41 patients with DCIS and DCIS-MI patients were retrospectively studied. Results Pathology varies between DCIS type Ⅰ, type Ⅱ and DCIS-MI patients. Mammographic calcification was the only presenting symptom in 9.76% of patients with DCIS accounting for 50% of these cases. The accordance rate of mammography with final diagnosis was 80%, and 33.3% of mammography in DCIS-MI type 2 showed mass or chaos of gland construction. The initial symptom in 57% of patients was nipple discharge. For fiberoptic ductoscopy, the accordance rate was 95.65%. There were two local recurrent cases in DCIS-MI type 2. Conclusion Breast ductal carcinoma in situ and with microinvasion had their own characteristics, including different prognosis.