The clinical guidelines of standard chemotherapy of metastatic colorectal cancer(mCRC) were mainly from the recommendation of national comprehensive cancer network(NCCN),CNCCN and euro- pean society for medical oncology(ESMO).The key to success of mCRC is how to understand and apply these clinical guidelines correctly.Along with the appearance of evidence by newer and better evidence-based medicine,there guidelines will be revised at any time.In the clinical application,the newest guideline should be used according to the practical status of our country,in order to imorove the therapeutic effect of mCRC.

Objective To study the etiology,prophylaxis,and management of complications after transurethral prostatectomy. Methods Clinical data of 73 patients with benigh prostatic hyperplasia(BPH) undergoing transurethral resection of prostate(TURP) or transurethral vaporization of prostate(TUVP) in this hospital from August 2002 to August 2005 were reviewed.Complications occurred in 14 patients,including severe bleeding in bladder in 2 patients,postoperative urinary retention in 5 patients,urethral stricture in 2 patients,urinary incontinence in 2 patients,TURP syndrome due to the perforation of the prostatic membrane in 2 patients,and lower-extremity deep venous thrombosis in 1 patient. Results A conversion to open surgery was required in 1 patient with severe bleeding in bladder and no re-bleeding happened.In another patient with severe bleeding in bladder,a trilumen single balloon catheter was intriduced into the bladder for continuous bladder irrigation with normal saline or iced normal saline,in association with medical therapy,to obtain a full recovery of voiding function without re-bleeding.Among 5 patients with urinary retention after operation,a re-operation of TURP was conducted in 2 patients and a dilatation of the urethra in association with oral symptomatic medication was carried out in 3 patient.No recurrence of urinary retention was noted and a re-examination of the maximum flow values(Qmax) at 1~3 months after operation revealed more than 15 ml/s.The voiding function recovered well in 2 patients with urethral stricture after periodic dilatation of the urethra.Permanent cystostomy was performed in 2 patients with urinary incontinence.In 2 patients with TURP syndrome,the operation was terminated immediately and active symptomatic treatment was conducted.The two patients experienced stable vital signs and a good recovery of voiding function.The patient with lower-extremity deep venous thrombosis was cured 2 weeks later. Conclusions Urinary retention and urethral stricture are common complications following transurethral resection of prostate.Careful selection of patients,strict adherence to technique,and timely and proper management of complications are considered essential to improve results.

BACKGROUND: Bioglass is a kind of bioactive material to repair the bone defect and promote the bone growth. Many studies have focused on the underlying mechanism of promoting the proliferation of osteoblasts, but no reports concerns about the human osteoblast growth cycle. OBJECTIVE: To observe the effect of bioglass on human osteoblasts growth cycle in vitro. DESIGN, TIME AND SETTING: An observation study osteoblasts growth cycle in vitro was performed in the Haematology Research Institute of Jiangsu Province and Department of Thrombus, Haematology Research Institute of Soochow University First Affiliated Hospital between October 2005 and March 2006. MATERIALS: Nine specimens of trabecular bone were harvested from femoral head following total hip replacement and other three specimens of trabecular bone were harvested from condyles of femur following total hip replacement. Bioglass conditioned medium was produced by Gibco Company (USA) and Dulbecco’s modified eagle medium (DMEM) was produced by Hangzhou Sijiqing Biological Engineering Materials Co., Ltd (China). METHODS: The ionic products of bioglass had been introduced to a cell culture medium by dissolving bioglass particles into DMEM fluid at 37 ℃ for 24 hours. The modified DMEM with ionic products of bioglass dissolution was used as the experimental medium, while the DMEM without bioglass modification was used as the control medium. The human osteoblasts isolated from trabecular bone were treated by the mediums and the time of osteoblast growth cycle was examined. Osteoblasts were treated for 7 days with two kinds of culture media. MAIN OUTCOME MEASURES: Cell growth index as determined using MTT colourimetry. The percentages of human osteoblasts at presynthetic phase, synthesis phase, post-synthesis phase were recorded by flow cytometry every day, resulting in the cell proliferation activity index, synthesis phase fraction and proliferous index. RESULTS: The concentration of Si in the bioglass conditional medium was 26.12% of the control medium (P

The esophageal-gastric junction adenocarcinoma (AEG) is neither completely equivalent to esophageal squamous carcinoma, but also different from the distal gastric adenocarcinoma. This article begins from the concept and classification of AEG, reviews the diagnosis and treatment status of advanced AEG, and explores the molecular classification of gastric adenocarcinoma and AEG, and looks ahead the future of diagnosis and treatment of AEG according to molecular classification.

Objective To suggest the developmental direction of geriatrics based on the current status of domestic and international gerontological researches. Methods Professional literature in the gerontological field published domestically and abroad in recent 10 years were retrieved, and the current status and trend of progress in gerontology were analyzed. Results In recent 10 years, great progress was witnessed in geriatrics both in basic research and clinical diagnosis and treatment. With indept research concerining aging and anti-aging genetics, the secrets of prolonging longevity and the underlying mechanism of senescence of human being would be revealed, thus a theoretical basis for anti-aging strategy could be formalated. The research on multi-organ dysfunction, hypertension, coronary heart disease, multi-factor heart failure and senile degenerative valvular heart disease, Alzheimer disease, senile pulmonary disease and osteoporosis, and other common diseases in aged individuals might be able to reveal the clinical characteristics, improvement in their diagnostic accuracy, prevention, and control. The development of evidence-based medicine and community medicine would contribute to improve the quality of life and physical and mental health of the elderly people. Conclusions Gerontological research should focus on the causes and features of aging in the future to guide the clinical practice with the latest research findings, new medicines and prevention measures of common chronic diseases in elderly people, and also focus on community medicine to improve prevention and health care for the elderly people.

Objective To evaluate the risk factors of myasthenic crisis after thymectomy for myasthenia gravis.Methods Meta-analysis was performed to screen risk factors of myasthenic crisis after thymectomy for myasthenia gravis based on 21 associated articles published and carried out using Stata12.0.Results Twenty one studies were identified, including 3 092 patients and 698 patients developed myasthenic crisis after thymectomy.Complicated with thymoma(OR =3.93, 95％ CI 2.37-6.50, P =0.000), Ossermen classification (OR =0.12, 95 ％ CI 0.09-0.17 , P =0.000) , history of preoperative myasthenic crisis (OR =5.36, 95 ％ CI 3.82-7.51, P =0.000) , use steroid hormonea (OR =1.75,95 ％ CI 1.26-2.43, P =0.001) , postopertive lung infection(OR =4.27,95％ CI 1.63-11.18, P =0.003) , operation methods(OR =0.34,95％ CI 0.21-0.56, P =0.000) , the dose of preoperative anticholinesterase drags (OR =0.35, 95 ％ CI 0.18-0.66, P =0.000) ,pulmonary function(OR =0.18, 95％ CI 0.06-0.57, P =0.004), preoperative serum level of anti-acetylcholine receptor antibody(OR =0.06, 95％ CI0.03-0.13, P =0.000)were associated with myasthenic crisis after thymectomy.Gender, course of disease were not associated with myasthenic crisis after thymectomy.Conclusion With thymoma, Ossermen classification, history of preoperative myasthenic crisis, use steroid hormonea, operation methods, the high dose of preoperative anticholinesterase drugs, poor pulmonary function, postopertive lung infection, high preoperative serum level of anti-acetylcholine receptor antibody are risk factors affecting myasthenic crisis after thymectomy.

The etiological factors and pathogenesis of retinopathy of prematurity (ROP) are still unclear,which restricted its effective prevention and treatment.The current animal model widely used in ROP investigation is oxygen-induced retinopathy model,which is lack of specificity,and does not mimic the real pathogenesis status of human ROP patients.Thus,we should refresh our concept,seek breakthroughs in multi-disciplines,integrate more risk factors of ROP,utilize the rising technique in transgenic animal,and improve the evaluation system for improving the current models or explore new animal models of ROP.It is important for prevention and treatment of ROP.

ObjectiveTo observe the infection of continuous aspiration of subglottic secretion(CASS) for patients with ventilator associated pneumonia (VAP).MethodsOne hundred and fifty VAPpatients under mechanical ventilation whose basical information were recorded were divided into two groupsby random digits table method:control group(70 cases) and CASS group(80 cases).Conventional VAPprevention was taken in control group and CASS group,while CASS therapy was added to CASS group.ResultsSex,age,acute physiology and chronic health evaluation Ⅱ score,recent antibiotics usage,airpressure,time in ICU,hospital stay and mortality rate of two groups had no statistical significance(P ＞0.05 ).The time of ventilator treatment of CASS group was obviously shorter than that of control group [ (5.2 ±1.4) d vs.(7.8 ± 1.2) d,P =0.02 ],and VAP incidence was lower than that of control group [ 22.5％ (18/80)vs.32.9％(23/70),P =0.04 ].ConclusionCASS could reduce the incidence of VAP and short the time ofventilator treatment.

Objective　To observe the effects and explore the mechanism of orthopia by using viscoelastic substance (sodium hyaluronate)in adherent strabismus(AS).Methods　A total of 29 cases(33 eyes)of AS which were caused by various factors were performed strabotomy,in which sodium hyaluronate was poured into cap tenon space and /or around ocular muscles in which preserved after operation.Ocular movement was requested in 12～24 hours post-operation lest ocular muscles adhered to other tissues again.The main index we observed were the effectiveness of strabotomy and ocular movement.Results　All 33 eyes achieved good results:17 eyes(51.5%) were cured,26 eyes(78.8%) obtained distinct improvement(DI). The operative results have reference to the cause of adherent strabismus,period of muscular adherence and visual function post-operation.No complications were found.Conclusion　 Our observation support that sodium hyaluronate can prevent ocular muscles from re-adhering to other tissues around after strabotomy.Most of the patients can obtain better effects by this viscoelastic therapy.

Discuss the pathogenesis and treatment strategy of idiopathic thrombocytopenic purpura from the view of insidious pathogenic factors.The invasion,remission and recurrence of ITP implicated the theory model of insidious pathogenic factors,and it applied new thread for syndrome differentiation and treatment.