Objective To examine the effect of teaching surgical nursing using a team-based (TBL) combined with case-based learning (CBL) model on higher vocational students. Methods A total of 227 nursing students were investigated, and they were divided into the experimental group (n=97) and the control group (n=130) by simple random sampling. The TBL and CBL was applied in the experi-mental group, and the traditional 1ecture-based learning (LBL) was used in the control group. After the experiment teaching, a test and questionnaire were used to compare the teaching effect of experimental group and the control group. The data was analyzed by Independent-Samples T test and Chi-square test. Results The 97 students in the experimental group achieved higher mean test scores (89.18 ± 7.808) compared with the other participants' (85.53±11.033) in the control group and the difference was statistically significant (t=2.926, P=0.004). Assessments on participants' abilities, such as indepen-dent thinking, teamwork, communication, problem solving, active learning and so on, were significantly higher in the experimental group compared with the control group students and the difference was sta-tistically significant (P=0.000). Majority of the respondents (91students, 93.82%) noted that case-based, team-based learning was a better learning strategy compared to lecture-based learning. Most of the students (90 students, 92.78%) agreed that more such instruction activity should be organized in the future. Conclusions TBL combined with CBL has enhanced the students' learning achievement and improved their abilities of independent thinking, teamwork, communication, problem solving, autonomous learning and so on, and is welcome by the teachers and students.

Mutated K-RAS is found in 15%～30% NSCLC patients, the mutations of K-RAS and EGFR are mutually exclusive,K-RAS mutations have poor sensitivity to EGFR-TKIs. The response of C-225 is not restricted to mutated K-RAS, NSCLC patients with K-RAS mutations are associated with unfavorable prognosis. A number of different approaches such as Ftase inhibitors, RAF inhibitors, MEK inhibitors aimed at abrogating K-RAS activity to improve clinical response have been explored in clinical trials.

Objective To observe the effect and mechanism of HA1077 on bone mesenchymal stem cells (BMSCs) promoting wound healing. Methods (1) In vitro study: rats' BMSCs were har-vested and divided into three groups randomly, ie, control group, induction group and HA1077 group. In control group, culture medium was DMEM with 10% fetal bovine serum. In induction group, induction medium was DMEM which consisted of 10% FBS, 8μg/ml EGF and epithelium culture condition medi-um. In HA1077 group, culture condition medium was the induction medium pins 10 μmol/L HA1077. At day 7 after replanting, CK19 expression, PCNA expression and cell cycle among three groups were clarified by flow cytometry. (2) In vivo study: rabbit's BMSCs were isolated. Six pieces of full skin loss wound were created on the back of a rabbit, with three pieces of wound on the half side of back. The wound was round and 3 cm in diameter. Eight New Zealand rabbits were randomly divided into four groups, ie, control group (Group A), EGF control group (Group B), BMSCs group (Group C) and BMSCs + HA1077 group (Group D). Wounds were treated by normal saline in Group A and by EGF (50 U/cm2) in Group B. Besides EGF,1 ml of BMSCs suspension (2 × 106/ml) was used for wound re-pair in Group C. 0.5 ml HAIO77(20 μmol/L), BMSCs and EGF were used together for wound repair in GronpD. At days3, 7and 14 after injury, wound elosuroindex (WCI) was calculated. Results In vitro study:the positive rate of CK19 in the HA1077 group was (40.31±0.82)%, higher than (11.13±2.14)% in the induction group(P < 0.01). The PCNA positive rate and the S phase, cell quantity in HA1077 group were also higher than that in the induction group. In vivo study: WCI was (86.20±1.92) % in Group D at day 14 after injury, obviously higher than that in other three groups. Conclusions HA1077 can promote BMSCs' entering into S phase, expressing PCNA and differentiating and expressing CK19. In vivo combination of HA1077 with BMSCs may facilitate wound healing.

Objective To determine the relationship between expression of topoisomerase Ⅱ α and clinicopathological factors,overall survival in colorectal caner.Methods Expression of topoisomerase Ⅱ α was measured using EnVision immunohistochemistry in 490 colorectal cancer patients.The relationship between topoisomerase Ⅱ α expression and various clinicopathological parameters was analyzed.Kaplan-Meier analyses and multivariate analyses were used to evaluate the significance of topoisomerase Ⅱ α expression in prognosis prediction.Results Overexpression of topoisomerase Ⅱ α was found to be related with lower T stage ( P =0.042 ),lower N stage ( P =0.038 ),and possibly with lower recurrence rate ( P =0.053 ).Kaplan- Meier analyses showed that overexpression of topoisomerase Ⅱ α was related with prolonged overall survival (P =0.022 ) and prolonged disease-free survival ( P =0.036).Multivariate analyses showed that elevated serum CEA ( P ＜ 0.001 ),elevated serum CA199 ( P =0.002 ),poor differentiation ( P =0.001 ),advanced Dukes stage ( P ＜ 0.001 ) and lower expression of topoisomerase Ⅱ α( P =0.017 ) were independent predictive factors for poor prognosis.Conclusions Expression of topoisomerase Ⅱ α is a favorable predictive factor for colorectal cancer,and would be useful in prognosis prediction and treatment selection for early colorectal cancer and malignant colorectal polyps,especially when it is used in combinations with serum CEA,CA199 and differentiation.

Objective To investigate methods and clinical effects of limited open reduction of ankle articular surface and locking compression plate (LCP) placement using minimally invasive plate osteosynthesis (MIPO) in managing tibial Pilon fractures.Methods Twenty-one patients with tibial Pilon fractures treated between August 2009 and August 2011 were involved in the study,including 16 males and 5 females,at age of 21-68 years (average 42.3 years).According to AO/OTA classification,12 patients were with type 43B fractures and nine with type 43C fractures.There were two patients with open fractures (both Gustilo-Anderson type Ⅰ fractures).Limited open reduction of ankle articular surface plus LCP placement using MIPO were performed.Early functional training without weight-bearing was carried out postoperatively.Results Nineteen patients were followed up for 12-24 months (average 14 months).According to Burwell-Chamley' s radiological evaluation system,17 patients obtained anatomical reduction of articular surface and two patients obtained moderate reduction,but they all had bony healing.Ankle function evaluated by Mazur' s criterion were excellent in seven patients,good in 10 and fair in two,with excellence rate of 89％.Conclusion Limited open reduction combined with LCP internal fixation can successfully construct articular anatomic relationship,decrease soft tissue dissection and attain solid fixation in treatment of Pilon fractures and further facilitate functional recovery of the affected extremity in coordination with early functional exercise.

Objective To investigate complications and mortality of primary reamed intramedullary nailing for femoral shaft fractures in patients a ssociated with thoracic injuries. Methods A retrospective a nalysis of trauma data was performed and the case selection based on the followi ng criteria: (1) patient age of 17-65 years, (2) patients with multiple injury ( ISS≥16) as well as complicated thoracic trauma (AIS≥2), (3) hospitalization stay ≥48 hours, (4)no serious pre-existing medical diseases in history, (5) as sociated femoral shaft fractures treated with reamed intramedullary nailing, ext ernal fixation, plate, cast, traction and unreamed intramedullary nailing. The s elected patients were divided into two groups according to the interval from inj ury to operation, ie, those within 24 hours as Group A and beyond 24 hours as Gr oup B. Results During the study period, 96 patients met the criteria for the investigation. There were 57 patients in the Group A and 39 pa tients in the Group B. In two groups, there was significant difference in incide nce of open femoral shaft fractures (53% in the Group A and 31% in the Group B, ? 2=4.496, P

Colonic pouch can improve fecal continence after low anterior resection in the short-term, but its superiority would disappear in the long-term (2 years after surgery), since fecal continence improves gradually with time in the non-pouch group. Furthermore, the incidence of incomplete defecation increases gradually with time, and a lot of patients would have difficulty in defecation and require long-term use of suppositories and enemas. Pouch enforcement will result in prolonged operation time and increased treatment cost. Therefore, the value of colonic pouch in low rectal anastomosis is being questioned, and its application diminishes gradually. For patients with ulcerative colitis (UC) or familial adenomatous polyposis (FAP) after total colectomy, ileal pouch anal anastomosis (IPAA) can reduce fecal frequency and improve patients' quality of life in both short-term and long-term, by increasing the volume of the neo-rectum and altering intestinal motility. For these reasons, IPAA is the first surgical choice for UC and FAP.
Anal Canal ; surgery ; Anastomosis, Surgical ; methods ; Humans ; Ileum ; surgery ; Rectum ; surgery

Objective To explore the clinicopathologic factors impacting recurrence and survival in rectal cancer patients after radical resection.Methods Clinicopathologic data of 1 166 patients with rectal cancer in Changhai Hospital,were recruited between 2005 and 2010.Kaplan-Meier analysis and the logrank test were used to evaluate the effects of the pathology on patients' survival.Cox regression model was used to assess independent factors associated with clinical prognosis.Results The 1,3,5-year overall survival rates were 94.3％,81.2％ and 76.5％,median survival time was 53 months.328 patients had recurrence and metastases,with a median recurrence time of 18 months.The independent prognostic factors for overall survival time were CEA,CA19-9,tumor distance to dentate line,surgical modality,radical operation,tumor invasion,tumor differentiation,lymph node metastasis and postoperative treatment.Surgical treatment,radical operation or not,tumor invasion and lymph node metastasis were statistically significant associated with tumor recurrence and metastases.Conclusions The important factors inffuencing the prognosis of rectal cancer patients were CEA,CA19-9,tumor distance to dentate line,surgical modality,radial operation,tumor in vasion,tumor differentiation,lymph node metastasis,and post operative treatment.

Colonic pouch can improve fecal continence after low anterior resection in the short-term, but its superiority would disappear in the long-term (2 years after surgery), since fecal continence improves gradually with time in the non-pouch group. Furthermore, the incidence of incomplete defecation increases gradually with time , and a lot of patients would have difficulty in defecation and require long-term use of suppositories and enemas. Pouch enforcement will result in prolonged operation time and increased treatment cost. Therefore, the value of colonic pouch in low rectal anastomosis is being questioned, and its application diminishes gradually. For patients with ulcerative colitis (UC) or familial adenomatous polyposis (FAP) after total colectomy, ileal pouch anal anastomosis (IPAA) can reduce fecal frequency and improve patients′ quality of life in both short-term and long-term, by increasing the volume of the neo-rectum and altering intestinal motility. For these reasons, IPAA is the first surgical choice for UC and FAP.

Colonic pouch can improve fecal continence after low anterior resection in the short-term, but its superiority would disappear in the long-term (2 years after surgery), since fecal continence improves gradually with time in the non-pouch group. Furthermore, the incidence of incomplete defecation increases gradually with time , and a lot of patients would have difficulty in defecation and require long-term use of suppositories and enemas. Pouch enforcement will result in prolonged operation time and increased treatment cost. Therefore, the value of colonic pouch in low rectal anastomosis is being questioned, and its application diminishes gradually. For patients with ulcerative colitis (UC) or familial adenomatous polyposis (FAP) after total colectomy, ileal pouch anal anastomosis (IPAA) can reduce fecal frequency and improve patients′ quality of life in both short-term and long-term, by increasing the volume of the neo-rectum and altering intestinal motility. For these reasons, IPAA is the first surgical choice for UC and FAP.