Background and purpose:Colorectal carcinoma(CRC) is a major cause of cancer-related mortality. In the 1990s, several fi rst-line phase Ⅲ trails showed a signifi cant improvement in result with the addition of CPT-11(irinotecan, which is a specifi c inhibitor of topoisomerase Ⅰ) to FU-LV combination therapy(FOLFIRI).We observed the survival rate, effi cacy and adverse reaction of the combination chemotherapy of irinotecan plus folinic acid/continuous 5-? uorouracil bimonthly FOLFIRI regimen as second chemotherapy in treating advanced colorectal adenocarcinoma. Methods:Sixty patients with histologically proved advanced colorectal adenocarcinoma whose disease had progressed after treatment with first-line oxaliplatin or other chemotherapeutics agents were included to receive at least 2 cycles of chemotherapy with irinotecan 180 mg/m2 day 1 and folinic acid 200 mg/m2 iv,5-FU 400 mg/m2 iv bolus,days 1 and 2, 5-FU 600 mg/m2 iv infusion over 22 hours, days 1 and 2.Treatment was repeated every two weeks. Results:All patients were assessable for toxicity and 58 patients were evaluable for treatment response. The non-hematological toxicity was mild. Most was grade Ⅰ or Ⅱ. Only two patients experienced grade Ⅲ diarrhea and one patient experienced grade Ⅲ nausea and vomiting. There were no cases with grade Ⅳ toxicity. The most common hematological toxicity was neutropenia. Grade Ⅲ neutropenia were observed in fi ve patients. There was no case of febrile neutropenia. Based on intention to treat analysis, there were no complete responses (CR), 14(24.14%) partial response (PR), and 30 (51.72%) stable disease. the median time to disease progression was 6.09 months. The median overall survival was 9.65 months. Conclusions:Bimonthly irinotecan in combination with folinic acid and 5-fluorouracil was active with acceptable toxicities and a prolonged survival time in retreated colorectal cancer.

Objective To compare the pharmacokinetic profile of propofol administered by target-controlled infusion (TCI) during anesthesia in patients with and without obstructive jaundice. Methods Twenty-four ASAⅠorⅡpatients aged 40-65 yrs weighing 50-75 kg undergoing elective surgery under general anesthesia were divided into 3 groups (n = 8 each) : group A control (serum total bilirubin 171.1?mol?L-1) . Each group received propofol by TCI using Graseby 3500 infusion pump, based on pharmacokinetic parameter set published by Marsh. The target plasma concentration of propofol was set at 3?g?ml-1 . TCI of propofol was started from the induction of anesthesia and maintained until the end of the surgery. Arterial blood samples were taken at 0.5, 1, 2, 4, 6, 8 min after TCI of propofol was started and every 15 min during maintenance of anesthesia and at 2, 4, 6, 8, 10, 20, 30, 40, 50, 60, 90, 120, 180, 240 and 300 min after TCI was terminated. Plasma concentrations of propofol were determined by high-performance liquid chromatography (HPLC) with fluorescence detector. NONMEM was used to analyze the pharmacokinetic parameters. Results The 3 groups were comparable with respect to sex ratio, age and body weight. The pharmacokinetic profile of propofol given by TCI was best described by three-compartment open pharmacokinetic model in the majority of patients and by two-compartment open pharmacokinetic model in a few patients. There were no significant differences in the pharmacokinetic profile of propofol among the 3 groups. Conclusion Obstructive jaundice does not affect the pharmacokinetics of propofol.

Background and purpose:Pain is one of the most common symptoms in advanced cancer patients, and morphine is a representative drug in controlling moderate to severe cancer-induced pain, but some unacceptable adverse effects limited its use in part of patients.We evaluated the effect and safety of morphine sulfate controlled-release tablet (MS-CRT) combined with celecoxib for the treatment of moderate to severe cancer pain, and assessed the life quality of patients. Methods:Retrospective analysis of 125 cancer patients with moderate to severe cancer pain who were divided into two groups, one(including 67 patients) was treated by single drug of MSCRT whose initial dosage was 20 mg/12 hrs, then evaluated by verbal rating scale within 24 to 48 hrs, dosage was adjusted personally according to the state of pain (increasing rate was 50% and declining rate was 25%) until the maintenance dosage was reached; the other(including 58 patients) was treated by MS-CRT with the same initial dosage and combined with celecoxib whose dosage was 200 mg/12 hrs at first, and increased to 400 mg/12 hrs if the pain was not relieved well, then gradually increased the dosage of MS-CRT to the maintenance dosage, and analyzed the effect, dose adjustment,side effect of drug combination and improvement of quality of life for the patients. Results:The mean of maintenance dosage for MS-CRT alone was 67.3 mg/day, and for the combination of MS-CRT and celecoxib was 51.3 mg/day, the reduction rate of MS-CRT in the drug combination group compared with MS-CRT alone was 23.77% with the same analgesia effect, and the incidence of side effects such as constipation and nausea/vomiting was statistically reduced compared with the single drug group. The quality of life in both groups was improved aftertreatment. Conclusion:The combination of MS-CRT and celecoxib can effectively control moderate to severe cancer pain, , improve the quality of life in advanced cancer patients, and reduce the consumption of MS-CRT with similar side effects as morphine alone.

Objective To analyze the effect of bifrontal decompressive craniectomy on patients with refractory diffusing of brain swelling after severe traumatic brain injury.Methods The clinical data of 68 patients with refractory diffusing of brain swelling after severe traumatic brain injury were analyzed retrospectively.Thirty-five patients were performed with bifrontal decompressive craniectomy as observed group,continued intracranial pressure monitoring after surgery.Thirty-three patients were treated conservatively to reduce intracranial pressure as control group,continued intracranial pressure monitoring.The Glasgow outcome scale after discharge 6 months were assessed.The efficacy,the incidence of complications were observed in observed group.Results The admission intracranial pressure in observed group was significantly higher than that after surgery [(35.9 ±6.9) mmHg (1 mmHg =0.133 kPa) vs.(17.5 ±5.2) mmHg,P ＜0.05].The admission intracranial pressure in control group was (34.2 ± 8.6) mmHg,after admission 10.5 h was (32.0 ±4.8) mmHg (P ＜0.05),difference was no statistically significant (P＞ 0.05).The intracranial pressure after admission 10.5 h in control group was significantly higher than that in observed group after surgery (P ＜0.05).Two cases of subdural effusion,1 case of postoperative hydrocephalus in observed group.The better prognosis rate in observed group was significantly higher than that in control group [45.7％ (16/35) vs.18.2％ (6/33),P ＜ 0.05].Conclusions Bifrontal decompressive craniectomy is a suitable measure to decrease the intracranial pressure in the patients with refractory diffusing of brain swelling.If carried out early,it could provide better outcome for these patients.

ObjectiveTo compare the accelerating effect of topical recombinant human epidermal growth factor (rhEGF) and recombinant bovine basic fibroblast growth factor (rb-bFGF) on wound healing after fractional CO2 laser therapy.MethodsTwenty male guinea pigs were included in this study.After hair removal and irradiation with fractional CO2 laser,the back of each guinea pig was divided into 4 regions to be topically treated with rhEGF of 10 μg/cm2 (rhEGF group),rb-bFGF of 262.51 IU/cm2 (rb-bFGF group),the combination of rhEGF and rb-bFGF (combination group),or normal saline (control group),twice daily until the healing of wound.Skin physiology parameters including elasticity index and melanin index were detected before the irradiation,7,14 and 28 days after the irradiation,and compared between the 4 groups by analysis of variance.Tissue specimens were obtained from 4 mice at the above time points and subjected to pathological examination for the observation of collagen fibers and quantification of fibroblasts.ResultsAfter fractional CO2 laser therapy,the crusts fall off completely in growth factor-treated regions,while partly in the control regions,within 3 to 7 days; the wounds healed completely in 14 to 28 days in all the groups,with the regenerating tissue being more tender and redder compared with the surrounding unirradiated tissue.The wound surface was smaller in area and redder in color in the 3 growth factor-treated groups than in the control group.At 28 days after the irradiation,the elasticity index was 262.29 ± 62.40 in the combination group,202.00 ± 65.62 in the rhEGF group,188.86 ± 35.02 in the rb-bFGF group,167.14 ± 42.49 in the control group.Statistical difference was observed in elasticity index,but not in skin melanin index among the 4 groups.Pathological examination showed a dense and organized arrangement of collagen fibers in the combination group but a sparse and disorganized arrangement of collagen fibers in the control group.ConclusionThe combined application of rhEGF and rbbFGF can accelerate the healing of wound and increase the elasticity of regenerating tissue after fractional CO2 laser therapy.

lso.This result suggested that Th17 subset is differentiated in chronic stage of viral myocarditis.

Objective To observe the protection of human lens epithelial cells(HLEC) by different polar alkaloids extracted from Herba Dendrobii(HD).Methods We extacted the Herba Dendrobii powder with ethanol,and then treated the extract with falling-film concentration,acidification,salting out,chloroform extraction,and washing with water.Different polar alkaloids were extracted from HD after the above treatment.The protective effect of HD alkaloids was observed on HLEC,which were cultured with DMEM medium containing 10% fetal calf serum.Ten groups were set up for the experiment: normal control group,model group,high-and low-dose water-soluble alkaloids groups,high-and low-dose fat-soluble alkaloids groups,high-and low-dose low-polar alkaloids group,and high-and low-dose weak-polar alkaloids groups.The high-dose dosage of the alkaloids was 25.0 ?g/L and low-dose dosage was 12.5 ?g/L.Methyl thiazolyl tetrazolium(MTT) assay was used to evaluate the proliferation of HLEC under the different conditions of interventions.Results The single-factor experiments showed that the highest extracting rate of HD alkaloids was obtained under the conditions of extracting the powder with 80% ethanol for 3 times and for 3 hours.The results of protective experiment showed that the proliferation of HLEC in the model group was inhibited by hydrogen peroxide(H2O2),and the inhibitive rate was lower in low-dose fat-soluble alkaloids group than that in the model group(P

Objective To compare the advantages and disadvantages of three different fixation methods via muscle-splitting approach for the treatment of single segmental lumbar vertebral diseases.Methods All of 90 patients with the single segmental lumbar vertebral diseases were treated from June 2012 to June 2013,including 34 males and 56 females,at the age of 27-76 years old,averagely (53.37± 15.41) years.Twenty-seven patients were treated with unilateral pedicle screws via unilateral muscle-splitting approach (unilateral fixation group).Thirty-three patients were treated with unilateral pedicle screws and contralateral translaminar facet screw via unilateral muscle-splitting approach (combined fixation group).Thirty patients were treated with unilateral pedicle screws via bilateral muscle-splitting approach (bilateral fixation group).Observe and compare the imaging and clinical results of these three groups.Results There were no significant difference in incision length and postoperative wound drainage between these three groups.The operation time was shortest in unilateral fixation group,while longest in bilateral fixation group.In the intraoperative blood loss,the unilateral fixation group was the same as the combined fixation group,while less than the bilateral fixation group.No infection was found after operations.Seven patients experienced epidermal necrosis of the incision,including 1 patient of unilateral fixation group,4 patients of combined fixation group and 2 patients of bilateral fixation group.Three patients suffered from nerve injury,including 2 patients of combined fixation group and 1 patients of bilateral fixation group.The follow-up time was from 12 to 36 months,averagely 25.5 months.The intervertebral height of lesion segments was apparently recovered after surgery,and maintained during the follow-up in these three groups.No significant changes of area and grade of multifidus muscle were detected at 1 year after surgery compared with preoperative.Seven patients experienced endplate cutting and cage partially embedded into vertebral body,including 3 patients of unilateral fixation group,3 patients of combined fixation group and 1 patient of bilateral fixation group.There was no loosening,displacement,breakage or cage shifting.Except 5 patients (2 patients of unilateral fixation group,2 patients of combined fixation group and 1 patient of bilateral fixation group),the remaining cases had well interbody fusion.At the final follow-up time,the JOA score significantly increased compared with preoperative.Besides,unilateral fixation group and combined fixation group were superior to bilateral fixation group.Conclusion Three different fixation methods via muscle-splitting approach for the treatment of single segmental lumbar vertebral diseases had well clinical results.The unilateral fixation and combined fixation via muscle-splitting approach had more advantages.The combined fixation via muscle-splitting approach is an innovation in approach,exposure and fixation aspects.

Objective Kidney-supplementing and blood-activating method was adopted in treating senile patients with isolated systolic hypertension to observe its decompression effects and influences on microalbunminuria (Malb),retinol binding protein (RBP) level in 24 hours.Methods 90 patients with simple systolic hypertension were randomly recurited into two groups.52 cases in the treatment group were administered with kidney-supplementing and blood-activating decoction,including 1 case falling off and 51 cases entering statistical analysis; 38 cases in the control group were administered with oral placebo,among them 2 cases were fallen offand 36 cases were entered statistical analysis.Both groups were treated for 8 weeks.Results () Blood pressure:systolic blood pressure at 4 and 8 weeks after the treatment in the treatment group [(144.03±12.33)mmHg (1 mmHg=0.133kPa) and (132.27±13.15)mmHg] wassignificantlyimproved than before the treatment [(156.32±12.05)mm Hg] (P＜0.05),and also significantly better than the control group at 4,8 weeks after the treatment [(151.19± 13.83)mm Hg,(152.74± 12.03)mm Hg] (P＜0.05).②The Malb,RBP level:Malb,RBP level [(40.80±13.51)mg/L,(150.43±23.62)mg/L] after the treatment in the treatment group was reduced than before the treatment [(50.14± 15.61)mg/L,(220.04±30.20) mg/L] (P＜0.05),and was significantly different to the control group after treatment [(52.12±14.69)mg/L,(219.34±34.37)mg/L] (P＜0.05).Conclusion Kidney-supplementing and blood-activating method can improve kidney function,and thus to reduce the effect of systolic blood pressure.

ObjectiveTo evaluate the safety and efficacy of biological meshes (human aceUular dermal matrix mesh) in single-stage repair of infected or contaminated abdominal abdominal wall defects and abdominal hernias. MethodsSeventeen patients with abdominal wall defects or abdominal hernias were enrolled. The wounds of all these patients were infected or contaminated due to the existence of enterocutaneous fistula or stoma, wound infection and synchronous colonic resection. The diagnosis included enterocutaeneous fistula 8 cases, incisional hernia 6 cases, incarcerated inguinal hernia 1 case and cylindrical abdominoperineal resection for rectal cancer for 2 cases. The sizes of abdominal defects ranged from 3 cm × 2 cm to 6 cm × 17 cm, and all the cases were repaired with human acellular dermal matrix mesh(RENOV(R)). Most of the patients were repaired with intraperitoneal onlay mesh technique( IPOM, for 12 cases), and other methods included Lichtenstein operation for 1 case, inlay repair for 2 cases and sublay for 2 cases. Results All the 17 patients recovered uneventfully. For 12 patients, the wounds were sutured at operation and only one case of delayed healing occurred due to fat liquefaction. For the other 5 patients, the wounds were left open and healed after vacuum assisted closure (VAC) therapy or wet- to- dry dressing changes. On follow up for 8.3 ±4.5 months ( 1 to 15 months), no occurrence of incisional hernia or recurrence was found. laxity of abdominal wall occurred in one case. A patient complained intermittent pain of the site of suture for mesh fixing two months after operation and the pain resolved spontaneously one month later. ConclusionsThe biological mesh, acellular dermal matrix mesh, could be used in single- stage repair of infected or contaminated abdominal wall defects safely and effectively, although the long-term outcome still needs further evaluation.