Fluorouracil,oxaliplatin and irinotecan、are generally accepted as the standard chemothera-peutic agents for metastatic colorectal cancer.In recent years,the research advances on metastatic colorectal cancer treatment focus on the combination between different active drugs,and try to search advisable combined therapy methods.Clinical trials suggest that ahemating regimen is effective and has lower toxicity which provides platform for further study of combined chemotherapy for metastatic colorectal cancer.

Basic cognition of TCM for human body includes three aspects:(1)Human body is an unify of form,Qi and sprit intrinsically;(2)Human is an unity composed of five solid organs in functions and structures;(3)Form,Qi,sprit and the Zang-and Fu-organs of human body connect together via channels and collaterals.The characteristics of TCM study methods are mainly trialistic nature of study objects,phenomenon analogy,functional leading nature of function and unify of the whole.

BACKGROUND:There are no unified methods to isolate,culture and amplify bone marrow mesenchymal stem cells(BMSCs) . Endothelial progenitor cells(EPCs) can be harvested by inducing peripheral blood or bone marrow mononuclear cells. However,the method of collecting bone marrow mononuclear cells is various,and the isolation efficiency is different. OBJECTIVE:To isolate and identify BMSCs and EPCs in vitro. DESIGN,TIME AND SETTING:The cytological in vitro study was performed at the Central Laboratory,First Affiliated Hospital,Anhui Medical University from October 2008 to February 2009. MATERIALS:Two clean healthy male Sprague Dawley rats were supplied by the Anhui Animal Center. METHODS:Rat bone marrow was extracted to harvest mononuclear cells by density gradient centrifugation. BMSCs were isolated by the differential adhesion. Following 48 hours of primary culture of BMSCs,non-adhered cells were collected and induced by EGM-2 complete medium supplemented with fetal bovine serum,vascular endothelial growth factor,fibroblast growth factor,insulin-like growth factor-1 and recombinant human epidermal growth factor. There were three groups:early adherence + common culture EPCs,twice adherence + induction culture EPCs,and rat mature aorta EPCs. Nitric oxide content was directly measured in the medium using nitrate reductase method. MAIN OUTCOME MEASURES:The following parameters were measured:in vitro culture of BMSCs and EPCs,and nitric oxide content in the medium. RESULTS:Primary culture of BMSCs was in a spindle-shape,within 24 hours the majority of cells were adherent,9-10 days up to 90% cells were confluent. Purified BMSCs were amplified and uniform,long spindle,with the passage cycle for 8 days. Flow cytometry detection showed that cells were CD34-,CD45-negative and CD105-positive. Second adherent of EPCs induced by 3 days culture showed colony formation following six days,appeared cord-like structure and microvessel-like growth at 8-10 days. At 2 weeks,the majority of cells were polygonal,colony-forming unit was interconnected,showing a typical "cobblestone"-like. At 7-10 days,cells were double stained DiI-acLDL and FITC-UEA-1. Flow cytometry showed Flk-1-positive and CD133-positive. Nitric oxide content was significantly higher in the culture medium compared with the ordinary cultured cells(P

OBJECTIVE ToevaluatetheeffectandmechanismofPaecilomyceshepialimycelium
(PHM)onexhaustedfatigueinmice.METHODS Micewereforcedtorun30minadayforconsecutive 18 d using the wheel running fatigue apparatus, and the speed was gradually increased from 10.2 m·min -1 to 12.6 m·min -1 .On d19,these animals were forced to run 60 min to establish an exhausted fatigue model.Every day,40 min before the run training,the animals were ig administered with PHM (140,280,560 mg·kg -1 )and modafinil (13 mg·kg -1 ).The number of electric shocks was recorded on d5,d9,d1 3,d1 7 and d1 9,respectively,and the body mass of each mouse was recorded daily.The levels of muscle glycogen (MG),liver glycogen (LG),serum urea nitrogen (SUN),serum lactic acid (SLA)and serum creatine kinase (CK)were detected by commercially available kits. RESULTS Duringthelastexhaustedrunningond19,thenumberofelectricshocksofthemodelgroup was markedly larger than that of the drug administration groups.When compared to the normal control group,the model group showed a significant decrease in the level of either MG or LG,but a significant increase in the level of either SUN or CK.The nu mber of electric shocks of the PHM in the moderate and high dose groups was 133 ±55 and 1 15 ±41 times,respectively,which was significantly smaller than that of the model group 240 ±89 (P<0.01 ).The levels of MG and LG of the PHM560 mg·kg -1 group were (1 .28 ±0.24)mg·g -1 and (40.9 ±1 0.2)mg·g -1 ,respectively,which were significantly higher than those of the model group〔MG:(0.91 ±0.26)mg·g -1 ,LG:(22.2 ±2.9)mg·g -1;P<0.01〕,and the levels of SUN,SLA and CK of this PHM group were (5.8 ±1 .3)mmol·L-1 ,(5.7 ±1 .7)mmol·L-1 and (0.6 ±0.2)kU·L-1 ,respectively,which were significantly lower than those of the model group 〔SUN:(7.5 ±2.1 )mmol·L-1 ,SLA:(7.1 ±1 .8)mmol·L-1 ,CK:(0.8 ±0.3)kU·L-1;P<0.05〕.The number of electric shocks of the modafinil group was also significantly smaller than that of the model group (P<0.01 ),but there were not any significant differences between the modafinil group and the model groupinthelevelsofMG,LG,SUN,SLAorCK.CONCLUSION ThisstudyshowsthatPHMcanhelp relieve fatigue,which might be associated with its abilities to increase the storeage of energy sources,to enhance the aerobic metabolis m,and to decrease the accu mulation of metabolic products.

Objective To investigate the feasibility,operation design and postoperative rehabilitation in ankylosing spondylitis patients with bilateral hips and knees bony ankylosis,who were operated on the 4 joints during one hospitalization period. Method Two operations were performed in one hospitalization period in three ankylosing spondylitis patients on the 2 hip joints and 2 knee joints respectively.One case,the left hip replacement was operated in the first operation,and the right hip and the double knees were operated in the second operation;the other two cases,unilateral hip and knee were operated in two operations respectively.Patients began to contract their lower limbs’ muscles initiatively after narcosis.The limbs were put on the CPM,the hips and knees were bent and extended repeatedly on the third day after operations.The patients began to leave bed and learned to walk 2 weeks after operations.They could walk 100 steps with aids when they leaft hospital. Result In six-month follow-up,the range of hip motion(degree)were 105?~145?(average 135?);the range of knee motion(degree)was 45?~60?(average 54?).The hip’ function score adopted Harris score system:the average of 83 and were all good;the knee’ function score adopted American Association of Knee Surgery score system in 1989:all were excellent except a good one(left knee of first case,the score was 74/75). Conclusion Performing operations on the 2 bony ankylosis hips and 2 bony ankylosis knees in the ankylosing spondylitis patients in one hospitalization period can shorten the treatment cycle,release the distress,and lighten the economic load,meanwhile it is convenient for operation and postoperative rehabilitation.It is better to do the unilateral hip and knee in a single operation.

Objective To evaluate the clinical effect of Easy Prosthesis D-10 on open preperitoneal groin tension-free hernioplasty.MethodsThe operative time,operation-correlated complications,hospital stay and recent follow-up findings of 63 patients underwent preperitoneal groin tension-free hernioplasty were analyzed from October 2006 to April 2008.ResultsNo case died in perioperative period.The average operative time was(47.6?10.5)minutes.None of incision infection and scrotal hydrocele occurred.The average hospital stay was(7.7?2.1)days.During follow-up period of 6 to 24 months,no recurrence,chronic pain and foreign body sensation were found.ConclusionThe open preperioneal groin tension-free hernioplasty by Easy Prosthesis D-10 is safe and reliable,especially for the inguinal hernia with large hernia ring or defect of transversalis fascia and recurrent hernia.

Totally, 125 elderly inpatients with aspiration pneumonia (AP) were enrolled from departments of respiratory medicine and neurology at Zhongnan Hospital, Wuhan during June 2005 to October 2009 for analysis. Results showed that listlessness was manifested in 70 cases (56%), primary neurological illness in 80 cases (64%), 57 of them (46%) complicated with respiratory failure and 26 died with case-fatality of 21%. Main pathogen for them was Gram-negative bacillus, accounting for 57% of the total. Two kinds or more of antibiotics had ever been administered in 98 cases (78%), with an average length of antibiotics use for 28 days, ranging from one day to 128 days. Nasal feeding was instituted for those with choking over their feeding and coughing, and their inspired feeding was aspirated from the trachea or bronchi and lavished with bronchoscopy, with 38 cases by tracheal intubation, 26 by tracheotomy and 42 with artificial ventilation. Their average duration of hospital stay spanned 28 days with an average cost of 25 000 RMB yuan per capita, significantly higher than that for those with common pneumonia. In conclusion, clinical features of these elderly patients with AP were not so typical, most of them manifest severe, with lots of medical cost and bad prognosis.

ObjectiveTo explore the difference of the oxytocin Levels and cortisol levels between major depression patients and normal controls,and the relationship of symptoms severity of major depression with oxytocin levels and cortisol levels.MethodsTwenty 18 ～ 45years old major depression patients and twenty six normal controls were tested by an enzyme-linked immunosorbent assay to evaluate the oxytocin levels and cortisol levels,and the Hamilton Rating Scale for Depression-17 item was used to evaluate the symptoms severity of depression in patient group.ResultsMann-Whitney test showed there were significantly differences in oxytocin level between patients and controls ( ( 213.60 ± 164.29 ) pg/ml vs ( 112.27 ± 101.21 ) pg/ml,z =- 2.306,P =0.021 ),but there were no significantly differences in cortisol level between two groups.Within the depressive sample( (0.131± 0.089) vs (0.107 ± 0.077 ) pg/ul,z =- 0.920,P =0.358 ),the severity of depressive symptom was positive correlated to the value of oxytocin ( r=0.599,P=0.005) and cortisol( r=0.691,P=0.001 ),the value of oxytocin was also positive correlated to the value of cortisol( r =0.743,P ＜ 0.01 ),Multiple liner regression analyses showed that the value of oxytocin is an impact factor of the severity of depression.( adjusted R2 =0.358,F =11.578,P =0.003 ).ConclusionThis study indicated that the value of plasma oxytocin maybe significantly differences between depression and normal controls and the plasma oxytocin level maybe a factor which influence the severity of major depression,the relationship of the cortisol value and the severity of depression can not be confirmed.

Objective To analyze the value of serum procalcitonin (PCT) in patients with community acquired pneumonia (CAP),and to evaluate the role of PCT in the therapeutic effect,severity and prognosis.Methods A retrospective analysis of data and laboratory tests of 50 patients with CAP admitted from November 15,2011 to November 15,2012 in GICU was carried out.Patients with infection of other parts of body,surgical treatment and trauma were ruled out.The level of PCT (ng/mL) before and during treatment,and the relationships between PCT and respiratory failure,mechanical ventilation,treatment results were analyzed respectively.Results According to the occurrence of sepsis,50 patients were divided into sepsis group and non-sepsis group.In the non-sepsis group,the PCT level before treatment,the highest and average PCT levels during the treatment were 0.1125 (0.078,0.269),0.1235 (0.078,0.494),and 0.1355 (0.08,0.245) respectively.Correspondingly,the PCT levels in the sepsis group were 8.92 (2.715,16.33),13.53 (6.305,25.625),and 4.26 (2.1415,8.2455),and there were statistically significant differences in three values of PCT between groups (ZIst =-4.743,PIST ＜ 0.05 ; ZMax =-5.783,PMax ＜ 0.05 ; ZMean =-5.644,PMean ＜ 0.05).According to the emergence of respiratory failure during treatment,average PCT level in the patients with respiratory failure was 1.7375 (0.224,5.092),and that in the patients without respiratory failure was 0.081 ng/mL (0.049,0.146),presenting the statistically significant difference between two groups (Z =4.472,P ＜ 0.05).In case of using mechanical ventilation (MV),the average PCT level of the patients with mechanical ventilation was 1.618 ng/mL (0.224,5.092),and that in the patients without MV was 0.086 ng/mL (0.061,0.465),producing a significant difference between the two groups (Z =-3.788,P ＜ 0.05).Grouped according to the outcome of patients,the mean value of PCT level in death group was 7.4585 ng/mL (2.392,16.25),and that in the survival group was 0.1965 ng/mL (0.885,0.618),showing statistically significant difference between two groups (Z =3.857,P ＜ 0.05).The first PCT level in the GICU within 24 h after admission was used to make the receiver operating characteristic curve (ROC),and the area under the curve (AUC) was 0.9867,cutoff point was 1.25 ng/mL.Conclusions In case of CAP,the PCT level in patients with sepsis is significantly higher than that in patients without sepsis,and PCT can distinguish sepsis from pneumonia precisely.In addition,PCT is an important biomarker to judge the severity and outcomes of CAP at early stage.

Objective To investigate the early diagnostic value of traditional scoring systems in critical acute pancreatitis.Methods From Jan 2007 to Ju12013,consecutive 184 patients with AP who were admitted to the surgical intensive care unit of the Institute of General Surgery,Nanjing Generai Hospital of Najing Militery Region within 72 h from the onset of the disease were studied.Patients were assigned to four groups,including mild,moderate,severe and critical AP according to the determinant based classification and the receiver operating characteristics(ROC) curve was used to predict the presence of critical AP,and Z test and logistic regression was applied to determine the diagnostic value of traditional scoring systems.Results The area under ROC (AUC) of Sofa,BISAP and CTSI score for early diagnosis of critical AP was 0.896,0.877 and 0.862;the best cut off value was 4.5,9.5 and 2.5.Moreover,the AUC of APACHE Ⅱ and Ranson score was 0.807 and 0.707,and the best cut off value was 8.5 and 3.5,respectively.Z test showed early diagnosis rate of Sofa,BISAP,CTSI score was significantly higher than that in Ranson score,and the difference between the two groups was statistically significant (P ＜ 0.05);though they were higher than APACHE Ⅱ score,the difference between the two groups was not statistically significant (P ＞ O.05).Logistic regression showed that high APACHE Ⅱ,Sofa,BISAP and CTSI score were independent risk factors for the development of critical AP (P ＜ 0.05).Conclusions Sofa,CTSI and BISAP score may be clinically important for early diagnosis of critical AP.