The liver is the most common site of colorectal cancer metastasis(CRLM). The importance of how to treat CRLM has attracted attention from doctors world wide and specific academic organization and expect consensus has been established. Relative principals of treatment of CRLM also developed in China, for example, guideline of diagnosis and treatment of colorectal cancer liver metastasis(draft) and standard for diagnosis and treatment of colorectal cancer, which were established in 2008 and 2010, respectively. However, we found that the Chinese doctors still understand these treatment policies inadequately, and easily produce deviation on the treatment progress. Based on the problems of current CRLM treatment, we have some thoughts or suggestions as follows: (1)Promoting the core conception of CRLM treatment actively: surgery is the only method to achieve possible cure of the CRLM. (2) Evaluating the status of new adjuvant chemotherapy for CRLM dialectically. (3)Paying attention to multi-disciplinary team(MDT): MDT is the scientific treatment foundation of CRLM. (4)Changing the treatment conception of primary tumor of CRLM: radical resection of primary tumor is essential for the resectable CRLM.(5)Emphasizing the surgical treatment of CRLM combined with lung metastasis. (6)Do not neglect the safety of patients, when we emphasize the surgery is the optimal treatment of CRLM. These guides of treatment of CRLM will improve the outcomes of CRLM around the world, but we still need pay attention to above mentioned points in order to insure the standardization and scientification of CRLM therapy.
China ; Colorectal Neoplasms ; pathology ; therapy ; Combined Modality Therapy ; Humans ; Liver Neoplasms ; secondary ; therapy

Objective Prepare biomimetic muitilayered scaffold which has similar structure of natural cartilage.Method By lyophilizing the scaffolds which were prefrozen at-20℃ and in liquid nitrogen successively,we prepared double-layered spongy scaffolds.By partially thawing the prefrozen samples and refreezing them in liquid nitrogen before the final liyophilization,we prepared biomimetic multilayered scaffolds with about 2mm thickness.XRD and FT-IR were used to confirm the interaction between collagen and chitosan.SEM was used to observe the morphologies of the scaffolds.The mechanical properties of pure chitosan scaffolds,pure collagen scaffolds,composite single-layered scaffolds and biomimetic multilayered scaffolds were compared both in dry and wet conditions.Results There was chemical interaction between collagen and chitosan.Composite materials will form better pore structure.The biomimetic multilayered scaffolds have upright pores,round pores and a dense layer from bottom to top of the scaffolds.The scaffolds have quite different mechanical properties between dry and wet state.Under wet state,the different layers of the biomimetic muitilayered scaffold have different mechanical properties.Results The biomimetic structure of the multilayered scaffold is very close to that of the natural articular cartilage,and the different layers of the biomimetic muitilayered scaffold had different mechanical properties under wet state.These are hopefully beneficial to help maintain the phenotypes of chondrocytes and promote the repairing effect of cartilage defects.

Objective Bioactive components were extracted from Sargassum fusiforme by using different solvents and their activities were detected in vitro in order to screen potential free radical scavenger.Methods Using the assay system of DPPH,superoxide radical,and in comparison with vitamin C,tea polyphenols and a series of extracts of sea tangle,laver.Results Different solvents had different extraction rates,and extracts by different solvents had different free radical scavenging activities.Conclusion 0.5%Na2CO3 solution had the highest extraction rate and extracts by this solution had the best scavenging ability as well.At the same time,the results obtained by DPPH detection method were more stable than those by the others.

Euphorbia lathyris (Caper spurge) is a toxic and potent Chinese materia medica (T/PCMM).This study sought a method for identifying five diterpenoids (Euphorbia factors L1-L3,L7a and L8) with the spectra of UV and mass,quantifying three diterpenoids L1,L2,and L8 in crude extracts of unprocessed and processed E.lathyris seeds by liquid chromatography/electrospray ionization mass spectrometry (LC-ESI-MS).The analysis was achieved on an Agilent Eclipse XDB-C18 column (4.6 mm × 150 mm i.d.,5 μm) with an isocratic elution with a mobile phase consisting of water and acetonitrile at a flow rate of 0.25 mL/min at column temperature of 30 ℃ and UV detection was set at 272 nm.An ESI source was used with a positive ionization mode.The calibration curve was linear in the ranges of 9.9-79 μg/mL for Euphorbia factor L1,3.8-30.5 μg/mL for Euphorbia factor L2,and 1.0-20.6 μg/mL for Euphorbia factor L8.The average recoveries (n=6) of three diterpenoids were 98.39％,91.10％ and 96.94％,respectively,with RSD of 2.5％,2.4％ and 2.1％,respectively.The contents of the three diterpenoids in processed E.lathyris seeds were 3.435,1.367 and 0.286 mg/g,respectively,which decreased more sharply than those in unprocessed E.lathyris seeds which were 4.915,1.944 and 0.425 mg/g,respectively.The method is simple,accurate,reliable and reproducible,and it can be applied to control the quality of unprocessed and processed E.lathyris seeds.

Objective To investigate the clinical features of invasive bronchial-pulmonary aspergillosis (IBPA) in critically ill patients with chronic obstructive pulmonary diseases (COPD).Methods Clinical data of 7 COPD patients complicated with IBPA from respiratory intensive care unit (RICU) in Beijing Chaoyang Hospital during April 2006 and August 2012 were retrospectively analyzed.Results All patients were treated with several kinds of broad-spectrum antibiotics and 6 patients were also treated with large dose of corticosteroids before their admission to RICU.The most frequent clinical manifestations were fever,persistent bronchospasm induced dyspnea and bilateral wheezing which were unresponsive to large doses of corticosteroids and broad-spectrum antibiotics.In 5 patients with both aspergillus tracheobronchitis (ATB) and invasive pulmonary aspergillosis (IPA),bronchoscopy showed tracheobronchial inflammation,bronchospasm,phlegm and bronchial pseudomembrane formation.All these 5 patients had a rapid progression from normal to infiltrates or consolidation in chest X-ray,and died of respiratory failure or multiple organ failure.The other 2 cases were diagnosed with ATB and received prophylactic antifungal treatments before infiltrates were shown on their chest X-ray.Both of them survived.Conclusions In COPD patients combined with IBPA,ATB may progress rapidly to IPA which affect lung parenchyma and lead a high mortality.Bronchoscopy and bronchial mucous biopsy may be helpful in early diagnosis and treatment.

Objective To investigate the value of elasticity score and elasticity strain ratio (SR) in predicting the central lymph nodes metastasis of papillary thyroid microcarcinoma (PTMC). Methods This study conducted a retrospective analysis of ultrasonography ifndings of 236 thyroid lesions from 208 patients. All of them underwent surgery in Ruijin Hospital of Shanghai Jiao Tong University from June 2012 to March 2013. Totally 82 PTMC from 82 patients were included in this study. Among them 12 patients with 12 PTMC had central lymph nodes metastasis. The elasticity score and SR were compared between metastasis and non-metastasis groups, and the receiver operating characteristic (ROC) curve of SR was calculated. Results The differences of PTMC elasticity score between two groups showed no statistical signiifcance (χ2=5.00, P=0.08). The average SR of the group with central lymph nodes metastasis is 2.44±0.61, which is higher than the group without lymph nodes metastasis whose average SR is 1.67±0.42. Differences are statistically signiifcant (t=5.5, P=0.00). The area under curve of SR-ROC curve was 0.847. Using 2.01 as cutoff of SR, the sensitivity, speciifcity, accuracy of predicting central lymph nodes metastasis was 83.3%, 81.4%, 78.6%respectively. Conclusion The SR but not elasticity score could be a meaningful indicator for predicting lymph nodes metastasis.

Euphorbia lathyris （Caper spurge） is a toxic and potent Chinese materia medica （T/PCMM）. This study sought a method for identifying five diterpenoids （Euphorbia factors LI-L3, L7a, and Ls） with the spectra of UV and mass, quantifying three diterpenoids L1, L2, and L8 in crude extracts of unprocessed and processed E. lathyris seeds by liquid chromatography/ electrospray ionization mass spectrometry （LC-ESI-MS）. The analysis was achieved on an Agilent Eclipse XDB-C18 column （4.6 mm× 150mm i.d., 5 μm） with an isocratic elution with a mobile phase consisting of water and acetonitrile at a flow rate of 0.25 mL/min at column temperature of 30 ℃ and UV detection was set at 272 nm. An ESI source was used with a positive ionization mode. The calibration curve was linear in the ranges of 9.9-79 μg/mL for Euphorbia factor Lb 3.8-30.5μg/mL for Euphorbia factor L2, and 1.0-20.6 μg/mL for Euphorbia factor LB. The average recoveries （n=6） of three diterpenoids were 98.39%, 91.10% and 96.94%, respectively, with RSD of 2.5%, 2.4% and 2.1%, respectively. The contents of the three diterpenoids in processed E. lathyris seeds were 3.435, 1.367 and 0.286 mg/g, respectively, which decreased more sharply than those in unprocessed E. lathyris seeds which were 4.915, 1.944 and 0.425 mg/g, respectively. The method is simple, accurate, reliable and reproducible, and it can be applied to control the quality of unprocessed and processed E. lathyris seeds.

Objective To investigate the efficacy of frontoparietal drill versus parietal drill in the burring hole and drainage for chronic subdural hematoma(CSDH),and provide an evidence for clinical application.Methods A total of 82 patients with CSDH from January 2013 to January 2016 in our hospital were randomly divided into observation group and control group.The observation group chose frontoparietal drill which located at the front 1/4 point at the axial view with the thickest hematoma.Control group chose parietal drill which nearby the parietal tuberodties at the axial view with the thickest hematoma.The postoperative residual hematoma volume,intracranial gas volume,recurrence rate,neurologic function and mental state between two groups were compared.Results The postoperative residual hematoma volume,intracranial gas volume,the recurrence rate and CSS were lower compared with the control group,the differences were significant(P<0.05).The MMSE score of observation group were higher that of the control group,the difference was significant(P<0.05).Conclusion The frontoparietal drill has a better effect to remove the hematoma and promotes neural functional recovery.

Objective To investigate the clinical value of 64-slice computed tomography with MinIP and MPR for imaging the bronchus related to a solitary pulmonary lesion (SPL). Methods Seventy-five subjects with solitary pulmonary lesions underwent chest 64-slice CT and their bronchi were analyzed retrospectively. All images of thin-section (0.625 mm) were reconstructed with MPR and MinIP into images of 1, 2, 3, and 5 mm thickness and 1 mm gap in two orthogonal planes along the long axis of bronchus related to the SPL. The image quality of four series of MinIP and MPR images was evaluated in the aspect of bronchus visibility and pulmonary vascular masking. One-way ANOVA with Bonferroni correction and interclass correlation coefficient were used in the statistical analysis. Results (1) The mean scores of display of the bronchi on MinIP images of four series (4.85, 4.77 and 4.84, 4.63 and 4.67, 4.25 and 4.28, in 1, 2, 3, and 5 mm thickness, respectively) and on MPR images of 1 or 2 mm thickness (4.77 and 4.76, 4.04 and 4.27, in 1 and 2 mm thickness, respectively) were good or excellent. MPR images of 1 mm thickness and MinIP images of 1-3 mm thickness showed no significant differences (t=0.318, P> 0.05 for all), but they were superior to MinIP images of 5 mm thickness (t=6.318 and 6.610, P＜0.01). MPR images of 2 mm thickness were inferior to MinIP images of 1-3 mm thickness (t=5.003-8.958, P＜0.01), but there was no significant difference between MPR images of 2 mm thickness and MinIP images of 5 mm thickness (t=1.794 and 0.3181, all P> 0.05). (2) The effect of suppression of pulmonary vascular markings on MinIP images was better with the increase of slice thickness (F=45.312 and 40.415, P＜0.01). The mean scores of MinIP images of 3 mm and 5 mm thickness (4.67 and 4.64, 5.00 and 4.97, for 3 and 5 mm thickness, respectively) were good or excellent, but MinIP images of 2 mm thickness were just acceptable. Conclusion MinIP images of 3 mm thickness may display the bronchus related to SPL more clearly.

Background Whether the wearing of bifocal lenses can delay the development of myopia in school childhood is in controversy.To assess the effect of bifocal lenses using evidence-based medicine method is of important significance.Objective Present study was to compare the effect of bifocal lenses with single vision lenses in retarding myopia progression in school-aged myopic children.Methods This was a evidence-based medicine study.The systematical literature search was performed from MEDLINE(1966 to October 2010),EMBASE(1974 to October 2010),Cochrane Library,Chinese Biomedical Database(1978 to October 2010),and Chinese Clinical Trial Registry combined with hand searching of related bibliographies of journals and books were applied to collect the randomized-controlled clinical trial about bifocal lenses.Screening,evaluation and data extraction of the retrieved literature were performed by two investigators independently.Mata-analysis was used to assess the progression of refraction and axial length among included randomized clinical trials.Results Three high-quality randomized-controlled clinical trials meeting the inclusion criterion were included in this meta-analysis.The results showed that the weighted mean difference in progression of refraction was 0.22D between bifocal lenses and single vision lenses(95% CI:-0.24-0.67),and the difference was statistical insignificance(P=0.35).The weighted mean difference in progression of refraction during the follow-up durations of 6,12,18,24 and ＞30 months were 0.15(95% CI:-0.09-0.38),0.17(95% CI:-0.05-0.39),0.42(95% CI:-0.14-0.98),0.23(95% CI:-0.21-0.66) and 0.03(95% CI:-0.40-0.46),respectively without statistical significance.The weighted mean difference in elongation of axial length between two interventions was -0.17mm(95% CI:-0.26-0.08) with a statistically significance(P=0.000).Conclusion Based on currently available studies,bifocal lenses could not significantly slow the progression of myopia in myopic school-aged children in comparison with single vision lenses.Because only few high-quality studies are currently available,this conclusion need to be supported by more large-sample-size clinical trials.