Colonic neoplasms is the third most commonly diagnosed cancer in men and second most commonlv diagnosed cancer in women worldwide.The morbidity of Colonic neoplasms is increasing year by year.Despite the fact that surgery is still the main treatment for patients with colon cancer,surgery alone hasn't improved the treatment effectiveness.The current management of colon cancer has come to multidisciplinary team (MDT) modality.MDT modality could offer the optimal treatment option and the internal communication.Under the pattern of MDT which integrates the surgery,chemotherapy,radiotherapy,interventional therapy,targeted therapy and immune therapy,there has been a big progress in the diagnosis and treatment of colon cancer.Patients with metastatic colon cancer should undergo a discussion by a multidisciplinary team before the initial treatment.

Objective To summarize our experiences in the long-term continuous maintenance of the peripherally inserted central catheter (PICC) in a patient with intestinal fistula.Method The systematic holistic nursing care has been provided according to the nursing practices to a patient with intestinal fistula since 2006,during which eitht PICCs were used successively.Results The eight PICCs were placed for 3-14 months.The 1 st,3rd,5th,and 7th cathers were retained for 12,13,11,and 14 months.The second catheter was retained for 6 months,and then removed due to increased body temperature (38.7℃).The 4th cather was retained for 3 months,then catheter-related bloodstream infection was suspected due to high body temperature (39℃) ; culture for fungi at the tip showed positive results.The 6th catheter was retained for 7 months,inserting from jugular vein to the superior vena cava; however,it was removed due to puncture point local purulent changes at the puncture site.The 8th catheter was applied for 8 months,but was rmoved due to tube occlusion,which responded poorly to urokinase.Conclusion The application of PICC in patients with fistula can relieve the pain and improve the quality of life.

Objective To understand the actual psychological conditions of pregnant patients with gynecologic malignancies during chemotherapy so as to instruct the nurses to provide individualized psychological care to the patients and their relatives. Method The in-depth interviews were conducted to 7 patients by implementing the phenomenological approach of qualitative study. The acquired data were analyzed. Result The patients experienced four psychological conditions: pessimism about prognosis, anxiety to know more about the chemotherapy and guilty to their family and hope for treatment effect. Conclusion Nurses should pay attention to the psychological conditions of pregnant patients with gynecologic malignancies and help them successfully live through the treatment.

Objective To explore the influence of self care interaction mode on the health behavior of the patients with thoracolumbar fracture.Methods 127 cases of thoracolumbar fracture were randomly divided into the observation group (62 cases)and the control group (65 cases)according to random digital table method.The patients of the observation group were given self nursing interactive nursing.The patients of the control group were given rou-tine nursing.The comparative study of the following indicators of the two groups of patients:(1)activities of daily liv-ing (ADL);(2)bedridden patient self -care skills of and self -care knowledge assessment;(3)satisfaction,compli-cations,the average length of days and discharged patient telephone visit the initiative.Results The discharge self nursing ability raise,health behavior change,self -care knowledge and self -care skills of the observation group were significantly better than the control group,there were statistically significant differences(P <0.05);after discharge from the hospital,bed incidence of complications (6.5%)of the observation group was significantly lower than the control group (18.1%),the difference was statistically significant (χ2 =4.16,P <0.05)and satisfaction degree (91.7 ±6.5)was higher than the control group (87.3 ±7.5),with statistically significant difference (t =3.59,P <0.05),and the average hospitalization day (16.11 ±7.61 )d was lower than that of the control group (19.95 ± 11.55)d,there was statistically significant difference (t =2.20,P <0.05).Conclusion Self care interactive mode is conducive to mining the self -care ability of patients,improve the self -care ability of patients,and has good social benefits.

Objective　To explore the effects of hypoxia on the syntheses and secretion of adrenomedullin (AM), calcitonin gene related peptide (CGRP) and c-type natriuretic peptide (CNP) and the relationship between these peptides. Methods　Rat models were established with hypoxia for 10, 20 and 30 d respectively and rats under normal altitude were served as control. Pulmonary artery pressure and the maximum increasing speed of right ventricle (RVdp/dtmax) were measured in every group. The dynamic changes of AM, CGRP and CNP concentrations in plasma were studied with radioimmunoassay. Results　During hypoxia, pulmonary artery pressure and RVdp/dtmax were enhanced. Plasma AM and CNP concentrations were increased while CGRP was decreased significantly. The plasma level of AM had positive correlation with that of CNP, but negatively correlated with that of CGRP. Conclusion　Results indicate that hypoxia may cause pulmonary artery pressure change and right ventricle has compensatory reaction to hypoxic pulmonary hypertension. Dynamic changes of plasma AM, CGRP and CNP concentrations can be regarded as indexes for condition of illness.

ABC-ELISA established by ourselves was used to detect the tiansferrin receptors (TfR) on peripheral blood mononuclear cells. It was found that the TfR quantity in the leukenie kukemk group was higher than that in the complete remission leukemia group (P0.05). We also found that the TfR quantity was higher in 6 cases of leukemia when blasts appeared in perpheral Hood than they disappeared(P

Objective To summarize experience of concomitant endovascular aneurysm aortic repair(EVAR) and coronary artery bypass grafting(CABG) for patients of severe coronary artery disease(CAD) complicated with infra-renal abdominal aortic aneurysm(AAA) or infra-renal abdominal penetrating aortic ulcer(PAU).Methods Between January 2013 and December 2016,13 patients with severe CAD and infra-renal AAA/PAU who underwent CABG and EVAR were enrolled in this study.12 patients (92.3 ％) were male and 1 patient was female (7.7 ％),the mean age of(63.7 ± 7.3) years.11 patients with CAD related symptoms,2 patients with AAA/PAU related symptoms,abdominal aortic lesions include:AAA in 3cases,PAU in 10 cases,2 patients combined with PAU of the thoracic aorta.CABG and EVAR manipulations were performed according to the routine protocol,patients who were combined with thoracic aorta PAU were treated with thoracic endovascular aortic repair (TEVAR) simultaneously.Results 7 patients received EVAR followed by CABG;6 patients received CABG followed by EVAR,TEVAR were performed in 2 patients.For all the patients,there were 11 cases of CABG were performed under the cardiopulmonary bypass(CPB) (ON-PUMP) and 2 others cases were performed without CPB(OFF-PUMP).On the average(2.5 ± 0.7)grafts were performed.The time of aortic clamp and CPB averaged were(50.7 ± 16.5)min and (58.0 ± 11.2)min respectively for the ON-PUMP CABG patients.Totally 30 thoracic aorta and abdominal aorta stent grafts were implanted in 13 patients.The duration of postoperative mechanical ventilation time was (17.8 ± 7.0) hours,Median intensive care stay was (2.7 ± 1.9) days,while hospital stay was(8.1 ± 2.4)days.All the patients was discharged.1 patient suffered wound unhealing 2 days after discharging,followed by sternal infection,he was re-admitted and received pectoralis major myocutaneous flap transfer operation,29 days after this operation,he suffered sudden cardiac arrest and eventually dead.The other 12 surviving patients was followed up for 1 ～ 36 months,The results showed that the patency of the grafts in all patients was good,no EVAR related secondary interventions were required.Conclusion For the patients with surgical indications,the procedure of one stage CABG and EVAR completed by one surgical team was safe and feasible.Comparing with the traditional one stage or staged surgical repair,this strategy showed less surgical trauma,shorter operation time,lower perioperative risks,more efficacy and more conducive to the overall management of patients.

The principal goal of opening the course of Medical Communication is to develop medical students'basic communication skills which involve three aspects:the proper use of language tools,communication and problem-solving skills in the course of general interper-sonal relationships,information communication skills between doctors and patients in the process of making a diagnosis or treatment,public communication skills on medical education and communication skills in dealing with a medical dispute or crisis between doctors and patients. This paper presents clearly the connotation of medical communication and puts forward specific programs on the organization and implementation of the course.

OBJECTIVE:To establish a method of determining the plasma concentration of capecitabine/polyethylene glycol 1000/montmorillonite (CAP/PEG1000/MMT) in rats’plasma for the study on pharmacokinetics of CAP compound in rats in vivo. METHODS:HPLC was adopted. The determination was performed on Kromasil C18 with mobile phase consisted of 0.1% glacial acetic acid-acetonitrile(73∶27),at the flow rate of 1.0 ml/min. The detection wavelength was 250 nm and column temperature was 40 ℃. The sample size was 10 μl. 18 Wistar rats were randomly divided into CAP group,CAP/MMT group(MMT as carrier)and CAP/PEG1000/MMT group(PEG1000/MMT as carrier)and ig given corresponding drugs,that equal to 200 mg/kg of CAP. Blood sample was respectively taken 15,30,60,90,120,180,240,300 and 360 min after the administration of drugs,and plasma was isolated and added with internal standard ferulic acid. The concentration of the drug in the plasma was determined by HPLC fol-lowing protein precipitation with methanol,based on which the pharmacokinetic parameters were calculated by 3p97 software. RE-SULTS:The linear range of CAP was 0.054 9-4.390 0 μg/ml (r=0.998 2) with the method recovery of 98.2%-102.1%(RSD=1.50%-3.29%, n=5) and absolute recovery of 76.2%-78.9%(RSD=2.29%-2.99%, n=5). In the above-mentioned three groups,t1/2 were(1.11±0.32),(1.57±0.32)and(1.62±0.10)h;cmax were(2.91±0.36),(0.91±0.23)and(0.91±0.14)μg/ml;AUC0-6 h were (8.70 ± 1.79),(3.76 ± 0.27) and (3.73 ± 0.25)μg·h/ml;and tmax were (0.97 ± 0.20),(1.55 ± 0.47) and (1.50 ± 0.07) h,respectively. There was no significant difference in the pharmacokinetic parameters between the CAP/MMT group and CAP/PEG1000/MMT group(P>0.05). CONCLUSIONS:The method is reliable and simple,and can be used for pharmacokinetic study of CAP/PEG1000/MMT in rats. MMT and PEG1000/MMT compound can prolong CAP acting time in the body.

OBJECTIVE:To explore the method for promoting drug circulation management of online pharmacies. METH-ODS:Hazard analysis and critical control point (HACCP) was applied to identify the critical control points (CCPs) and explore the effective method for drug circulation management of online pharmacies. RESULTS & CONCLUSIONS:According to the HAC-CP principle,four CCPs of drug circulation management of online pharmacies are supplier qualification,acceptance method,main-tenance and storage scheme and distribution system. It is suggested to adopt correct measures of drug circulation quality manage-ment of online pharmacy. Firstly,the supplier’s legal qualification should be determined and the quality of the drug should be regu-larly checked;secondly,drug retailers should improve the acceptance method of drugs and improve the sampling rate of drug;then,the three three four scientific conservation which required the medicine to be divided into three parts according to the pro-portion of 30%,30%,40% and checked monthly should be implemented to improve the storage and maintenance program;finally, the independent distribution system should be established to ensure the full process of the appearance inspection.