Objective To study the effects of acute hypervolemi c hemodilution (AHH) on the coagulation and cardiac function in elderly surgical p atients. Method Sixty surgical patients, aged 60 to70, ASA Ⅰ~ Ⅱ, were randomly divided into three groups (n=20 for each group). 6% HES 50 0~1000ml was infused in a rate of 20ml/min during vasodilation with isoflurane i nhalation (group 1), nitroglycerin (group 2), or nicardipine (group3) with the a id of an intravenous injection pump. The blood coagulation and cardiac functions were observed during hemodilution. Results No significant diff erence was found among the three groups on cardiac function and coagulation func tion during 500ml 6% HES infusion. When the volume of infusion was over 1000ml, the parameters of cardiac function increased and those of coagulation decrease d significantly (P

Background and purpose:Ever since the use of anthracycine and /or taxanes-based regimen for the adjuvant and/or neoadjuvnat chemotherapy of breast cancer,there have few sensitive agents for advanced breast cancer(ABC)when it occurs drug resistance to anthracycine and /or taxanes.The aim of this study is to evaluate the effect of gemcitabine plus cicplatin in advanced breast cancer after the failure of treatment with anthracycines and /or taxanes.Methods:From May,2005 to Jan 2007,34 ABC cases with anthracycine and/or taxanes resistance were treated with GEM(1000 mg/m2.day1,day8)and DDP(30 mg/m2,day 1 to day 3)every 3 weeks.A median of 5 cycles(2-6 cycles)of the treatment was delivered.All cases were followed up more than 6 months.Results:3 cases(8.8%)had complete response(CR),13 cases(38.2%)had partial response(PR),while 12 cases(35.3%)had stable disease(SD)and progressive disease(PD)was 6 cases(17.7%);the overall response rate was 47.0%.The median time to progression(TTP)was 6.5 months,grade 3/4 diarrhoea and thrombocytopenia were main side effects.Conclusions:GEM plus DDP are effective in the treatment of advanced breast cancer with anthracycine and/or taxanes resistance.

Hepatocellular carcinoma is one of the most common cancer with a high incidence and mortality,representing a main type of primary liver cancer.However,the molecular and cellular mechanisms of hepatocellular carcinoma pathogenesis are still poorly understood.Traditionally,the development of hepatocellular carcinoma has been viewed as a process of transforming of normal cells into malignant driven by the genetic alterations in tumor-suppressor gene deactivation and pro-oncogene activation.In recent years,with the deeper understanding of tumor,it has been found that epigenetic alterations are closely related to the occurrence and the development of hepatocellular carcinoma.DNA methylation is one of the most common epigenetic events occurring in human genome,as well as the best studied of the epigenetic changes.This review focuses on the state-of-the-art advancements of DNA methylation in hepatocellular carcinoma.

Epigenetics refers to steady phenotypic changes in gene expression without modifications in the genetic nucleotide sequence.Disorder of epigenetic mechanisms plays an important role in the occurrence and development of human malignant tumors including hepatocellular carcinoma.A large number of gene targets and pathways related to epigenetics were discovered.For instance,DNA methylation,histone modification and RNA regulator gene silencing were associated with the development of hepatocellular carcinoma.Exploring the abnormal epigenetics is of great significance for prevention and treatment of hepatocellular carcinoma.

Extracellular matrix protein-1 (ECM-1) is a secretory glycoprotein. Recent studies found that the protein may be related to the digestive tract tumor growth, invasion and metastasis. In this paper,the basic structure and function, as well as the possible mechanism in gastrointestinal cancer have been reviewed.

Objective　To investigate the effect of positive pressure ventilation on radiosensitivity of the patients suffering from primary lung cancer. Methods　Thirty cases of lung cancer were randomly divided into two groups: ① combining therapy group: patients treated with posi tive pressure ventilation using BiPAP respirator and radiotherapy;② simple radi otherapy group. The changes of PaO2, SaO2, blood white cells and the cellula r immunological function were observed before and after treatment. Resul ts　Nasal or naso-facial positive pressure ventilation with BiPAP respi rator increased PaO2 significantly with the maximum of 7.5 kPa, SaO2 was ma inteined at above 95%. No significant change for the cellular immunological func tion was found in the combining therapy group （P>0.05）and only one patient with leukopenia（6.7%）. But in the radiotherapy group, the lymphocyte transfor mation efficiency and the ratio of CD4/CD8 were obviously decreased（P<0 .01), and leukopenia was found in 5 cases（33.3%）. Conclusion　 Nasal or naso-facial positive pressure ventilation with BiPAP respirator could improve the effect of radiotherapy for lung cancers. It could also increase PaO 2 significantly and has protective rote to the marrow and cellular immunologic al function of the patients.

Continuing medical education is one of major parts in medical education system of minimal invasive surgeon. Based on the characteristics of net continuing medical education such as freedom of learning, no regional restriction and abundant resource, combined with visualized teaching of minimal invasive surgery education, the novel training model of e-learning based on internet was applied to establish minimal invasive surgery continuing education system.

Objective To evaluate the causes of postoperative complications in severe liver rupture and explore the prevention experienees.Methods The clinical data of 66 liver rupture patients who underwent surgical treatment in our hospital from January 2005 to July 2012 were retrospectively analyzed.The commou complications after surgery and the treatment measures of the complications were sludied.Results There were 9 deaths of severe liver rupture after surgery and related complications were found in 22 cases,including bile leakage (5 cases),intrahepatic abscess (3 eases),subphrenic infection (3 cases),pleural effusion (8 cases),intra-abdominal hemorrhage (2 cases),stress ulcer bleeding (2 cases).Conclusions Using damage control theory could improve the cure rate.Precise liver transection and postoperative excellent management was able to reduce the incidence of postoperative complications in severe liver rupture.

Liver transplantation is one of the most effective treatment of hepatocellular carcinoma.And rapamycin is a new class of immunosuppressors already in use after liver transplantation.Recently.more and more studies find that rapamyein not only can exert immunosuppressive effects but also has antitumor properties.Therefore,the research about rapamycin in hepatocellular carcinoma has become a focus.Herein,we review the progress of rapamycin in the treatment of hepatocelhlar carcinoma together with current results and future developments.

Based on high requirement on trainingtarget ofcultivating8-year medical students and combined with the characteristic of general surgical teaching,we applied logical thinking to strengthen students'clinical thoughts and self-analysis ability to make them become the advanced medical talents with good clinical thoughts.