Targeted therapy combined with chemotherapy has achieved great success in palliative treatment for metastatic colorectal cancer.Recent studies gave more emphasis on new fields,such as maintenance treatment,adjuvant treatment and the prognostic & predictive biomarker.These advances have been gradually changing the treatment strategies for colorectal cancer.The latest advances on the targeted therapy for colorectal cancer from the 2010 Annual Meeting of American Society of Clinical Oncology are reviewed below.

Objective To investigate the value of clinical data used for conventional indications of initiating renal replacement therapy (RRT) such as serum creatinine (SCr),blood urea nitrogen (BUN) and acute renal injury (AKI) stage and in estimating the prognosis of critically ill patients with AKI.Methods A retrospective analysis of 258 AKI adult inpatients treated with continuous renal replacement therapy (CRRT) in ICU from Jan.2011 to Jan.2015.According to the outcomes,all subjects were divided into survival group (n =104)and death group (n =154).The general condition,AKI causes,results of renal function (urine output,SCr,BUN and AKI stage),homeostasis (acid-base balance and electrolyte level),severity of disease (APACHE Ⅱ score and SOFA score) and others were compared between two groups.Additionally,risk factors for the prognosis of critically ill patients with AKI were screened by the multivariate Cox's proportional hazard models and the receiver operating characteristic (ROC) curve.Results There were no significant differences in gender,age,primary disease,AKI causes,APACHE Ⅱ score,renal function (urine output,SCr,BUN and AKI stage),serum potassium level and phosphorus level between two groups before CRRT (P ＞ 0.05),but more patients in death group had severe sepsis (31.17％ vs.19.23％,P =0.033),lower pH value [(7.27 ±0.34)vs.(7.41 ±0.34),P =0.024] and higher level of lactate [(3.97 ±2.87) vs.s (2.64 ± 2.30),P =0.006].After the analysis with multivariate Coxg proportional hazard models,it was found that the levels of serum phosphorus (P =0.043) and lactate (P =0.009) were the independent risk factors for prognosis of critically ill patients with AKI,and other conventional indications for initiating RRT such as SCr,BUN,AKI stage,urine output,pH,bicarbonate level or potassium level were not closely associated with the prognosis of patients (P ＞ 0.05).Therefore,a composite of these six variables (pH,bicarbonate level,phosphorus level,potassium level,urine output and AKI stage) was analyzed.According to the analysis result of ROC curve,the diagnostic value of combined six different variables in predicting in-hospital mortality of AKI patients [area under the curve (AUC) 0.669,95％ CI:0.577-0.762] was almost as high as that of lactate (AUC:0.683,95％ CI:0.590-0.777),and significantly higher than SCr (AUC:0.460,95％ CI:0.358-0.562),BUN (AUC:0.469,95％ CI:0.366-0.571).Conclusions This composite of six different variables is more useful than any other conventional indications for initiating RRT in predicting post-AKI mortality.As a result,a composition of six different variables should be considered rather than any single variable alone for indication of initiating RRT in critically ill patients with AKI.

OBJECTIVE To investigate pathogens,drug resistance and the risk factors of ventilator-associated pneumonia(VAP) in our intensive care unit(ICU).METHODS Spetum samples collected from the low respiratory trachea of the VAP patients from July 2008 to May 2009 in ICU received bacterial culture and antibiotics sensitive test.The risk factors related to VAP were identified and evaluated with Chi-square test.RESULTS 82 strains of pathogens had been isolated by culture and most of which were Gram negative bacilli(69.51%).The other pathogens included Gram positive cocci(25.61%) and fungi(4.88%).The most common pathogens were Acinetobacter calcoaceticus-baumannii,Staphylococcus aureus and Pseudomonas aeruginosa.Most of the Gram negative bacilli were highly resistant to many kind of antibiotics,especially Acinetobacter calcoaceticus-baumannii.77.8% of S.aureus were Meticillin-resistant S.aureus(MRSA),and all sensitive to Vancomycin.The duration of mechanical ventilation≥5 days,age≥65 years,gastric acid secretion inhibitor(GASI) therapy and albumen

ObjectiveTo investigate the incidence of hypomagnesemia and the effect of serum magnesium levels on the prognosis of critically ill patients in intensive care unit (ICU).Methods A single-center prospective observation was conducted. The adult patients admitted to ICU of Zhejiang Provincial People's Hospital from January 2012 to January 2014 were enrolled, and they were expected to stay in hospital for more than 48 hours. All the patients who had been diagnosed with hypomagnesemia before ICU admission, or those who had received magnesium supplement therapy were excluded. All patients were monitored for serum magnesium levels within 24 hours after ICU admission, and they were divided into three groups: normomagnesemic group (serum magnesium levels 0.7-1.2 mmol/L), hypomagnesemic group (serum magnesium levels< 0.7 mmol/L), and hypermagnesemic group (serum magnesium levels> 1.2 mmol/L). Various parameters were recorded for every patient, including general information, disease composition, laboratory indexes, duration of mechanical ventilation, ICU stay days and final outcome. The acute physiology and chronic health evaluationⅡ (APACHEⅡ) score and sequential organ failure assessment (SOFA) score during the first 24 hours after ICU admission were calculated. The risk factors for the death in critically ill patients were postulated by logistic regression analysis.Results A total of 374 critically ill patients were enrolled, with 242 patients (64.71%) in normomagnesemic group, 102 (27.27%) in hypomagnesemic group, and 30 (8.02%) in hypermagnesemic group. As to the disease composition, although the patients in normomagnesemic group and hypomagnesemic group were mainly consisted of patients with nervous system diseases (33.06%, 31.37%) or pneumonia(25.62%, 25.49%), the proportion of patients with major abdominal and thoracic surgery (15.69% vs. 5.78%,χ2= 8.837, P= 0.003) or severe sepsis (7.84% vs. 1.65%,χ2= 9.935,P= 0.007) was significantly greater in the hypomagnesemic group compared with that of normomagnesemic group, and most hypermagnesemic patients were complicated by renal dysfunction in different degrees. Compared with the normomagnesemic group, the hypomagnesemic group was found to have higher SOFA scores (6.86±3.12 vs. 5.46±2.75,t= -2.930,P= 0.004), longer stay in ICU (days: 15.98±13.29 vs. 12.43±7.14,t= -2.318,P= 0.034) and higher mortality [54.90% (56/102) vs. 33.88% (82/242),χ2= 6.587, P= 0.010], but no statistically significant differences were found in gender composition, age, levels of other electrolytes (natrium, potassium, calcium, phosphorus), and APACHEⅡ score. As shown by the result of the logistic regression analysis, APACHEⅡ score [odds ratio (OR) = 1.129, 95% confidence interval (95%CI) = 1.064-1.197,P= 0.000] and serum magnesium level (OR= 2.163, 95%CI= 1.015-4.610,P= 0.046) were independent risk factors for death in critically ill patients.Conclusion Serum magnesium levels are closely related to mortality rate in patients in ICU, so more attention should be paid to the occurrence of hypomagnesemia in critically ill patients.

Objective:To retrospectively investigate the efficiency of Jinlong capsule combined with transarterial chemoemboli-zation for the treatment of advanced pancreatic carcinoma. Methods: Sixty advanced pancreatic carcinoma patients between January 2009 and May 2013 were randomly assigned into the experimental group (n=30, Jinlong capsule combined with transarterial chemoem-bolization) and the control group (n=30, transarterial chemoembolization). Both groups were subjected to superselective pancreas artery chemotherapy with GEMZAR at a dose of 1.0 g/m2. Results:The overall response rate (CR+PR) was 53.3%and the control rate was 70%(CR+PR+SD) (CR 0, PR 16, SD 5) in the experimental group, whereas those in the control group were 36.7%and 56.7%(CR 0, PR 11, SD 6), respectively. The short-term therapeutic efficacy was higher in the experimental group than in the control group (P<0.05). No significant difference in adverse reactions, including digestive reactions and myelosuppression, almost I-II degree, was observed be-tween the two groups (P>0.05). No significant difference in the Karnofsky performance status was observed between the two groups af-ter the treatment (P<0.05). The 24-month survival rate of the experimental group was 50.0%, whereas that of the control group was 33.3%(P<0.05). Conclusion:The application of Jinlong capsule combined with transarterial chemoembolization for the treatment of advanced pancreatic carcinoma showed good clinical effects. The patients also showed good tolerance to this treatment.

BACKGROUND:Human-mammal chimeric liver chimera has been a vital significance for the proliferation and differentiation of bone marrow mesenchymal stem cells.
OBJECTIVE:To establish an animal model of human-rhesus chimeric liver using adult bone marrow mesenchymal stem cells.
METHODS:Adult bone marrow mesenchymal stem cells were isolated, purified and cultured for the sixth generation. The number of bone marrow mesenchymal stem cells was no less than 5×108. Bone marrow mesenchymal stem cells labeled with green fluorescent protein were transplanted into the liver of the embryo rhesus with pregnancy of 10 weeks under guided by type-B ultrasound. At the 1st and 3rd months of birth, the liver tissue of the infant rhesus was taken for biopsy. After routine pathological section, histological specimens were observed under fluorescence microscope to confirm if there were adult bone marrow mesenchymal stem cells positive for green fluorescent protein and their distribution, and detected by immunohistochemical staining to identify if human albumin expressed in the liver of infant rhesus.
RESULTS AND CONCLUSION:Fluorescence microscope observation indicated that at the 1st and 3rd months after birth, there were surviving bone marrow mesenchymal stem cells derived from human with green fluorescence in the liver of infant rhesus, and these cells migrated to form more concentrated distribution. The immunohistochemical results demonstrated that functional liver cells expressing human albumin were observed in the liver of infant rhesus at the 1st and 3rd months after birth, and their distribution was in accordance with bone marrow mesenchymal stem cells with green fluorescence. Human-rhesus chimeric liver can be established using adult bone marrow mesenchymal stem cells, which can generate functional liver cells in the liver of infant rhesus.

Objective To evaluate the early diagnostic values of soluble triggering receptor expressed on myeloid cell-1 (sTREM-1) in patients with ventilator associated pneumonia (VAP).Methods A total of 112 clinical suspicion VAP ventilator-associated pneumonia (VAP) patients accepted from January 2008 through December 2010 were enrolled for prospective and observational study.Two independent intensivists without aware of the results of the sTREM-1 assay separately made diagnosis of VAP present or absent depending on the clinical symptoms and results of microbial culture.Patients were categorized into two groups:VAP group (n =74) and non-VAP group (n =38).The levels of sTREM-1 in broncho-alveolar lavage fluid (BALF) collected with Gibot method in unemployment of bronchoscope and in serum were measured by enzyme-linked immunosorbent assay (ELISA) on the first day of suspected diagnosis.Comparison of sTREM-1 level between BALF and serum was made by t-test and Receiver Operating Characteristic (ROC) curve.Results A total of 112 clinical suspicion VAP patients admitted from January 2008 through December 2010 were enrolled for prospective and observational study.Two independent intensivists without aware of the results of the sTREM-1 assay made diagnosis of VAP present or absent depending on the clinical symptoms and results of microbial culture.Patients were categorized into two groups:VAP group (n =74) and non-VAP group (n =38).The levels of sTREM-1 in broncho-alveolar lavage fluid (BALF) collected with Gibot method in unemployment of bronchoscope and in serum were measured by enzyme-linked immunosorbent assay (ELISA) on the first day of suspected diagnosis.Comparison of sTREM-1 level between BALF and serum was made by t-test and Receiver Operating Characteristic (ROC) curve.Conlclusions In suspected VAP patients,measurement of sTREM-1 levels in BALF and in serum could help identify VAP in early stage.

Objective To explore the applied value of the super-short exposure time of the DR adjustable control in radiography of infant chest.Methods 100 chest radiographic films of infant in adjustable control group and fixed control group respectively were selected randomly.The quality of all films was evaluated by 4 technicians in charge in 4 grades(A,B,C and waste)and the detective rate of the tiny parts of the images was also evaluated.Results DR adjustable control:the rate of grade A,B,C and waste was 70%,20%,10% and 0% respectively.DR fixed control:the rate of grade A,B,C and waste was 42%,41%,15% and 2% respectively.The detective rate of tiny parts was 100% and 90% in DR adjustable control group and DR fixed control group respectively.Conclusion DR adjustable control chest film in infant is better than DR fixed control in image quality.DR adjustable control system is good for radiographic diagnosis.

Objective:To evaluate the clinical application value of gastrointestinal contrast-enhanced ultrasound combined gas injection method in verifying the location of nasointestinal tube in critically ill patients.Methods:Data of 60 critically ill patients who had the indications of indwelling nasointestinal tube were collected from September 1,2015 to September 1,2016 in the Intensive Care Unit of Zhejiang Provincial People(s) Hospital.The position of nasointestinal tube in patients who underwent bedside blind insertion would be confirmed routinely through gas injection auscultation method.After tube was inserted,its route was scanned by ultrasound with gas perfusion assistance.Afterwards,rapid gas perfusion was used until suspicious tube end position was determined.Furthermore,oral ultrasound contrast agent was injected into the tube if instantaneous strong echo of gas was observed in localized lumen,and contrast agent filling meant the placement being successful.Two methods of position confirmation of nasointestinal tube in critically ill patients included gastrointestinal contrast enhanced ultrasound combined gas injection and gas injection auscultation only,and the effect of the two methods was compared and confirmed by chest and abdominal X ray examinations to verify the location of nasointestinal tube below pylorus.Results:A total of 60 patients were included in this study,58 patients(96.7％)in gastrointestinal contrast enhanced ultrasound combined gas injection group were successfully positioned.Among them,the placements of tube in 56 cases were below pylorus,while 2 cases were above pylorus.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of location of gastrointestinal contrast enhanced ultrasound combined gas injection method were 96.6％,100％,100％,50％,96.7％ and of gas injection auscultation method were 74.1％,50％,97.7％,6.3％ and 73.3％.The differences of the sensitivity,specificity,negative predictive value and accuracy between the two methods were statistically significant (P ＜ 0.05).Conclusion:Gastrointestinal contrastenhanced ultrasound combined gas injection method is a safe,simple and convenient method with high sen-sitivity,specificity,negative predictive value and accuracy in confirming the location of the nasointestinal tube.

Objective To investigate the effect of geraniin on expression of Wnt3a protein and mRNA in bone marrow stromal cell (BMSC) from osteoporotic rats. Methods The model of osteoporosis (OP) was duplicated by ovariectomy in rats. BMSCs were isolated and cultured. BMSCs from shamed rats were routinly cultured and taken as normal control, and BMSCs from OP rats were divided into model group, 1μmol/L simvastatin positive group, and geraniin group (0.01, 0.1, 1, 10, 100 μmol/L), respectively. The methods of realtime-PCR and western blot were used to assay the protein and mRNA expression of wnt3a, respectively.Results As compared with normal control group, the protein and mRNA expression of wnt3a in model group were significantly suppressed;Compared with model group, 1 μmol/L simvastatin, and 0.1, 1, 10 and 100 μmol/L geraniin significantly increased the expression of wnt3a protein and mRNA. Conclusion It is suggested that geraniin activates wnt/β-catenin pathway though increasing the expression of signaling protein wnt 3a in BMSCs from OP rats. It would be beneficial to osteogenic differentiation of BMSCs and osteogenesis.