Carcinosarcoma(CS)of the uterus is a rare class of malignant female pelvic neoplasms.The primary modality of therapy for uterine CS is surgery.Postoperative adjuvant radiation therapy may only improve loco-regional control.Standard adiuvant treatment of uterine CS has shifted from primarily loco-regional radiotherapy to chemotherapy.Potentially more effective adjuvant chemotherapy regimens will be investigated.Chemotherapy can extend life for patients with advanced,persistent,or recurrent uterine CS.However,effect of chemotherapy remains to be further enhanced.

Single-agent gemcitabine, the standard chemotherapy for pancreatic cancer, has only mod-est effect. Gemcitabine has been combined with a variety of cytotoxic agents and targeted agents. Most phase Ⅲ studies, however, have failed to show improved survival compared with gemcitabine alone. One phase Ⅲ study has shown improved survival in advanced pancreatic cancer by adding erlotinib to gemcitabine. Studies evalua-ting non-gemcitabine-based regimens have showed considerable promise.

Relapse may occur in about 75% of patients who experienced the resection of hepatic metas-tases from coloreetal cancer. Perioperative chemotherapy with 5-fluorouraeil, leucovorin and oxaliplatin (FOLFOX) can reduce the risk of disease progression in eligible and reseeted patients compared with surgery a-lone. Pre-operative chemotherapy may cause vascular changes and steatohepatitis, which has the potential to in-crease the risks of surgery. A pooled analysis shows a trend of a longer median progression-free survival dura-tion among pest-operative patients who received adjuvant chemotherapy with 5-fluorouraeil and leueovorin-based regimen. Bevaeizumab in either pre-or pest-operative chemotherapy does not increase surgical complications.How to choose the best time and duration of the ebemotherapy needs to be further studied.

Objective To investigate the value of magnetic resonance (MR) imaging in the assessment of bile duct complications after cholecystectomy. Methods Fifty patients of having bile duct complications after cholecystectomy underwent MR imaging and had some positive manifestations. The indication for cholecystectomy was symptometic cholelithiasis in all cases. MR imaging was performed with a 1.5 T clinical imager including all of the sequences of: ①T1 weighted imaging (T1WI) was performed in transverse and coronal plane before and after gadolinium enhanced. ②T2 weighted imaging (T2WI) was performed in transverse plane. ③A true fast imaging with steady state precession sequence (True fisp) was performed in coronal plane. ④MR cholangiopancreatography was also obtained. Results The bile duct complications after cholecystectomy including: 22 cases of cholelithiasis, 15 cases of chronic cholangitis with or without bile duct abscess. Bile duct strictures or abruption at the confluence of hepatic and common bile duct in 6 and 3 cases respectively. Tumors of bile duct or pancreas in 9 cases. The other complications after cholecystectomy including bile leak with choleperitonitis and/or biloma and acute pancreatitis.Conclusion MR imaging was a valuable method for the assessment of bile duct complications after cholecystectomy. MR imaging could assess the etiology of bile duct complications. If there were bile duct obstruction, MR imaging could assess the location and the severe of obstruction. For bile duct or pancreatic tumors, MR imaging could assess the areas of tumor infiltration and resection and was helpful to select treatment methods. Before lapatoscopic cholecystectomy, the overall and careful imaging assessment for bile duct and gallbladder and its adjacent hepatic tissue and pancreas so to avoid missing the relative tumors.

Objective To explore the value of intravenous low dose furosemide on visualization of upper urinary tract during CTU. Methods 39 cases of normal upper urinary samples were examined by CTU with 5 minutes delayed,19 cases underwent intravenous injection of furosemide.The upper urinary tract was divided into 5 parts for scoring of images on a 5 score scales for opacification,the average value of ureter short axis of distention,and CT value by contrast material were measured.Results were analyzed by t test using SPSS.Results (1)30/38 segments of upper urinary tract were all or almost all opacification in furosemide group,the scores of upper urinary tract were higher than that of the control group,which had significant difference except the pelvis and left proximal ureter segments. (2)The disention of the ureter was significantly higher for all segments in furosemide group.(3)CT values in furosemide group decreased significantly for all upper urinary tract.Conclusion CTU excretory phase image acquisition with intravenous low dose furosemide is helpful on visualization of upper urinary tract.

BACKGROUND: Based on previous studies, the combination of basic fibroblast growth factor (bFGF) with graft may accelerate the procedure of vascular invasion of anterior cruciate ligament (ACL) graft. The antigenicity of graft could be inhibited by the destruction of major histolocompatibility complex (MHC) through the treatment of allogenous tendon by freeze. The freeze. dried tendon showed advantages including prolonged storage time. availability for transport and possibility of commercial application. There is no experimental and clinical study on the graft substance of bFGF combined tendon in ACL reconstruction in animal model so far. OBJECTIVE: To observe histologically the effect of exogenous application or bFGF combined to freeze-dried tendon on angiogenic enhancement in early ACL reconstruction. DESIGN, TIME AND SETTING: Controlled animal study, which was performed in the Department of Orthopeadics, Xijing Hospital. Fourth Military Medical University of Chinese PLA between June 2006 and June 2007.MATERIALS: Fourteen dogs were used in the experiment. METHODS: Extensor digitorum longus tendon was harvested from the rest 2 dogs and treated by freeze-dry as graft for other experimental dogs. bFGF(100 u g/L)was combined to freeze-dried tendon and then transplanted into one side knee to substitute the original ACL. While only freeze-dried tendon was used in the transplantation at the other side as control. MAIN OUTCOME MEASURES: Twelve of them were randomly divided into 6 groups according to the 6 time points,i,e.,1,2,3,4,5,6 weeks after surgery(2 dogs in each group).The histological observation with HE staining was done under microscope to mainly observe the angiogenesis in the transplanted ACL. RESULTS: Neovascularization occurred at the 2nd to 3rd weeks and reached the peak at the 4th to 5th weeks postoperatively at the experimental sides. By contrast. The neovascularization occurred at the 4th to 5th weeks postoperatively at the control sides. Neovascularization in the combined group was longer and deeper than that in the control group. CONCLUSION: The time of neovascular formation and the depth of vascular penetration into the tendon in the group of bFGF combined to freeze-dried tendon are superior to those in the control group.

Objective To systematically review the effect of team-based learning (TBL) versus the traditional lecture-based learning (LBL) teaching model on basic medical courses in undergraduate medical education. Methods The CNKI, VIP and Wanfang medical databases were electronically searched to retrieve randomized controlled trial studies on TBL applied in undergraduate basic medi-cal courses up to June 2014. In these studies TBL teaching model was used in experiment group with LBL teaching model as control group and course grades were adopted to evaluate the effect of learn-ing. Literature screening, data extraction, and quality assessment were performed in strict accordance with the inclusion and exclusion criteria, and then data were analyzed using RevMan 5.3 software. Results This Meta-analysis examined 12 studies, all of them with low quality at C level. Meta analysis shows that the score of the course of TBL teaching is better than the traditional LBL teaching, and the difference is statistically significant [weighed mean difference (WMD): 9.33, 95%CI (5.67, 13.00), P=0.000]. Conclusion Compared with the LBL teaching, the application of TBL teaching in medical undergraduate basic medical courses has the promotion effect, but need more rigorously randomized controlled trials to verify.

Objectives The study aims were to analyze the clinical features and to explore the management of intrapancreatic pseudocysts after acute pancreatitis.Methods A retrospective study was conducted on 151 patients who received surgical treatment from Dec,2008 to Feb,2012 after acute pancreatitis.Based on CT/MRI findings and clinical data,there were 17 patients with intrapancreatic pseudocysts (11.3％).The clinical manifestations,diagnoses and treatments for these 17 patients were retrospectively analyzed,and the outcome after operations were followed.Results For the 17 patients,obstructive jaundice was present in 3 patients,pancreatic portal hypertension (PPH) in 7,pseudoaneurysm in 2.All 17 patients underwent operation.The surgical procedures included internal drainage (n=8),external drainage (n=5),distal pancreatic resection with splenectomy (n=3),and local resection (n=1).All patients recovered after the operations.Conclusions Intrapancreatic pseudocysts after acute pancreatitis had a high incidence of local complication.The diagnosis of these pseudocysts was difficult.The treatment should be performed early for those patients who had developed complications.

Objective To evaluate the predicting value of the marker of endothelial injury: plasma matrix metalloproteinase-9( MMP-9) and high sensitivity C-reactive protein( hsCRP) level on the progression of acute anterior circulating territory infarction progressing to malignant middle cerebral artery infarction (m-MCAI). Methods 90 patients with acute anterior circulating territory infarction, in which 46 patients progressed to m-MCAI, were collected and sampled consecutively. The plasma MMP-9 and hsCRP of all patients were determined by ELISA and immunotur-bidimetry,respectively,at admission. And the clinical characters and cranial CT features of the patients were analyzed. Results At admission,the plasma MMP-9 level in the patients with m-MCAI(242.0 ±58.0)ng/ml was significantly higher than that in the patients with non m-MCAI( 169.0 ± 50.0) ng/ml( P < 0. 01) ,the plasma hsCRP level in the patients with m-MCAI(6.25 ±1.2) ng/ml was significantly higher than that in the patients with non m-MCAI( 1.55 ± 0.9) mg/ml( P <0. 01).Conclusion The increased level of plasma MMP-9 and hsCRP could be predictors for the m-MCAI proceeding.

The antiEGFR monoclonal antibodies cetuximab and panitumumab have been proven to be efficient in MCRC. The degree of EGFR expression (as confirmed by immunohistochemical analysis) did not correhte with the clinical response. In this review, we describe the current status of markers that might identify patients who are likely to benefit from treatment with cetuximab or panitumumab. These molecular markers include KRAS mutations, EGFR copy number, EGFR ligands (EGF, epiregulin), cyclin DI, IgG FcγR (FCGR2A-HI31R and FCGR3A-V158F), and nuclear factor-κB, that are crucial to avoid anti-EGFR treatment toxicity and reduce treatment cost.