Colorectal cancer is one of the most common malignant tumors of digestive tract. In 2020， 1.93 million new cases of colorectal cancer were diagnosed globally， ranking third in the global incidence spectrum， and 930 000 new deaths were reported， ranking second in the global cause of death spectrum. Meanwhile， the medical cost of metastatic colorectal cancer is the highest among all stages. A large number of studies have demonstrated that traditional Chinese medicine（TCM） treatment can bring clinical benefits to patients with metastatic colorectal cancer with unique efficacy. In order to further standardize the TCM diagnosis and treatment for metastatic colorectal cancer and improve the level of TCM diagnosis and treatment， Xiyuan Hospital， China Academy of Chinese Medical Sciences， together with other relevant units in China， according to the guideline development process of the World Health Organization Handbook for Guideline Development and the relevant requirements of the Clinical Evidence Grading Criteria on TCM Based on Evidence Body， the Regulations for Group Standards of China Association of Chinese Medicine and others， combined with the characteristics of TCM diagnosis and treatment and the actual situation in China， the Guidelines for TCM Diagnosis and Treatment of Metastatic Colorectal Cancer was developed in accordance with the Catalogue of TCM Diagnosis and Treatment Plans for 105 Diseases in 24 Specialties issued by Department of Medical Administration of National Administration of TCM.

Objective To explore the effects and possible mechanism of Mongolian medicine Eridun ·Wurile(EW)on neuronal apoptosis in rats with acute spinal cord injury(SCI).Methods The male SD rats were randomly divided into sham-operated group(sham group),SCI group,EW low-dose group,EW medium-dose group,EW high-dose group and EW high dose+AG490 group,with 15 rats in each group,and the SCI model of rats was established by Allen's method.EW low-dose group,EW medium-dose group and EW high-dose group were given EW suspension at a dosage of 0.32,0.63 and 1.26 g/kg for gavage after surgery,respectively;the EW high-dose+AG490 group was given Janus kinase 2(JAK2)inhibitor AG490(5 mg/kg)by gavage before surgery and EW(1.26 g/kg)by ga-vage after surgery;and the sham and SCI groups were given equal volume of distilled water,twice a day for 2 weeks.The hind limb motor function of each group was assessed by BBB grading score at 1 day,3,7 and 14 days postoperatively;the rats were executed 12 h after the last administration and the spinal cord water content was examined;the histopathological changes were observed by Hematoxy-lin-Eosin(HE)staining in the spinal cord of each group;the apoptosis of spinal neurons was detec-ted by in situ notch end labeling(TUNEL).The expression of Cleaved caspase-3,B-lymphoblas-toma-2(Bcl-2),Bcl-2 associated X protein(Bax),phosphorylated(p)-JAK2,and p-signal transduction and transcriptional activator 3(STAT3)proteins in spinal cord were detected by West-ern blot.Results Compared with the sham group,the BBB scores of rats in the SCI group were significantly lower,spinal cord edema and pathological structural damage were severe,the number of apoptotic cells and the expression of Cleaved caspase-3,Bax,p-JAK2 and p-STAT3 proteins in the spinal cord were significantly increased,while the expression of Bcl-2 was decreased(P＜0.05 or P＜0.01);compared with the SCI group,the BBB scores of EW low-dose group,EW medium-dose group and EW high-dose group gradually increased,the pathological injury degree of spinal cord tissue was relieved,and the number of apoptotic cells in spinal cord tissue was reduced,Cleaved caspase-3,Bax,p-JAK2,and p-STAT3 protein expressions were gradually down-regulated,while Bcl-2 protein expression was gradually up-regulated(P＜0.05 or P＜0.01);compared with EW high-dose group,the expression of P-JAK2,p-STAT3,Bax,Cleaved caspase-3 proteins down-regulated in the spinal cord tissue of EW high dose+AG490 group,and Bcl-2 protein were up-regu-lated,and the differences were statistically significant(P＜0.01).Conclusion EW plays a neu-roprotective role via inhibiting JAK2/STAT3 signaling pathway and reducing apoptosis in acute spi-nal cord injury rats.

Objective To explore the effects and possible mechanism of Mongolian medicine Eridun ·Wurile(EW)on neuronal apoptosis in rats with acute spinal cord injury(SCI).Methods The male SD rats were randomly divided into sham-operated group(sham group),SCI group,EW low-dose group,EW medium-dose group,EW high-dose group and EW high dose+AG490 group,with 15 rats in each group,and the SCI model of rats was established by Allen's method.EW low-dose group,EW medium-dose group and EW high-dose group were given EW suspension at a dosage of 0.32,0.63 and 1.26 g/kg for gavage after surgery,respectively;the EW high-dose+AG490 group was given Janus kinase 2(JAK2)inhibitor AG490(5 mg/kg)by gavage before surgery and EW(1.26 g/kg)by ga-vage after surgery;and the sham and SCI groups were given equal volume of distilled water,twice a day for 2 weeks.The hind limb motor function of each group was assessed by BBB grading score at 1 day,3,7 and 14 days postoperatively;the rats were executed 12 h after the last administration and the spinal cord water content was examined;the histopathological changes were observed by Hematoxy-lin-Eosin(HE)staining in the spinal cord of each group;the apoptosis of spinal neurons was detec-ted by in situ notch end labeling(TUNEL).The expression of Cleaved caspase-3,B-lymphoblas-toma-2(Bcl-2),Bcl-2 associated X protein(Bax),phosphorylated(p)-JAK2,and p-signal transduction and transcriptional activator 3(STAT3)proteins in spinal cord were detected by West-ern blot.Results Compared with the sham group,the BBB scores of rats in the SCI group were significantly lower,spinal cord edema and pathological structural damage were severe,the number of apoptotic cells and the expression of Cleaved caspase-3,Bax,p-JAK2 and p-STAT3 proteins in the spinal cord were significantly increased,while the expression of Bcl-2 was decreased(P＜0.05 or P＜0.01);compared with the SCI group,the BBB scores of EW low-dose group,EW medium-dose group and EW high-dose group gradually increased,the pathological injury degree of spinal cord tissue was relieved,and the number of apoptotic cells in spinal cord tissue was reduced,Cleaved caspase-3,Bax,p-JAK2,and p-STAT3 protein expressions were gradually down-regulated,while Bcl-2 protein expression was gradually up-regulated(P＜0.05 or P＜0.01);compared with EW high-dose group,the expression of P-JAK2,p-STAT3,Bax,Cleaved caspase-3 proteins down-regulated in the spinal cord tissue of EW high dose+AG490 group,and Bcl-2 protein were up-regu-lated,and the differences were statistically significant(P＜0.01).Conclusion EW plays a neu-roprotective role via inhibiting JAK2/STAT3 signaling pathway and reducing apoptosis in acute spi-nal cord injury rats.

Objective:To explore the normal ranges of perfusion parameters between cerebral hemisphere, cerebellar hemisphere and brain anatomical subregions (56 pairs) in different gender and age groups with multiple post labeling delay time (Multi-PLD) arterial spin labeling (ASL) imaging.Methods:From November 2020 to December 2020, 42 healthy adult volunteers (Male 25, Female 17) were recruited to perform 7 PLD ASL imaging, including 21 young adults (15 males and 6 females, aged 23—35 years) and 21 seniors (10 males and 11 females, aged 36—74 years). The data was processed offline by Cereflow software to obtain arterial arrival time (ATT) and corrected cerebral blood flow (CBF) and cerebral blood volume (CBV) perfusion parameters. SimpleITK standardization function was used to standardize the calculated perfusion image according to the anatomical automatic labeling (AAL) template. Therefore, CBF, ATT, CBV perfusion values of brain subregions were obtained. Paired samples t test, Wilcoxon rank sum test, independent samples t test and Mann-Whitney U test were used to compare the differences of perfusion parameters in the cerebral hemisphere, the cerebellar hemisphere, brain subregions depending on side, gender and age. Pearson correlation analysis was used to compare the correlations of perfusion parameters with age. Results:CBF in 62.5% (35/56) subregions and CBV in 44.6% (25/56) subregions were higher in right side than those in left side. ATT in most brain anatomical subregions (16/56) were higher in left side. The CBF [(35.30±8.31) vs. (34.34±7.53) ml·100g -1·min -1, P=0.021], CBV [(0.47±0.11) vs. (0.45±0.09) ml/100g, P<0.001], ATT [(1.30±0.10) vs. (1.24±0.11) s, P<0.001] in left cerebellar hemisphere were higher than that of right side. The CBF (28/56) of cerebral hemisphere, cerebellar hemisphere and brain subregions was higher in females than that in males, while ATT in 83.9% (47/56) subregions was lower than that in males (all P<0.05). CBV in female subjects was higher only in 5 brain regions (superior occipital gyrus, middle occipital gyrus, inferior occipital gyrus, superior parietal gyrus and cerebelum_7b) (all P<0.05). In young subjects, CBF in 44.6% (25/56) subregions and CBV in 33.9% (19/56) subregions were higher than those in the senior group (all P<0.05). The ATT in most subregions in young group were lower than those in senior group, but the difference was statistically significant only in rectus gyrus ( P=0.026) and paracentral lobule ( P=0.006). The CBF ( r=-0.430, P=0.005) and CBV ( r=-0.327, P=0.035) of cerebral hemisphere were negatively correlated with age. The CBF (24/25, r range:-0.497 —-0.343, all P<0.05) and CBV (16/19, r range:-0.474 —-0.322, all P<0.05) in most subregions were negatively correlated with age, while ATT was positively correlated (gyrus rectus: r=0.311, P=0.045; paracentral lobule: r=0.392, P=0.010). Conclusions:Multi-PLD ASL imaging could be applied for quantitative analysis of brain perfusion. The perfusion parameters of anatomical subregions are different depending on side, gender, and age.

Purpose: 5-Fluorouracil (5-Fu) is used as a conventional chemotherapy drug in chemotherapy forpatients with advanced colorectal cancer, but many patients still suffer from treatment failuredue to 5-Fu resistance. Emerging observations revealed the important role of chemokine(C-X-C motif) ligand 13 (CXCL-13) in tumor microenvironment and its relationship with prognosisin patients with colorectal cancer. This study is designed to reveal the important roleof CXCL-13 in causing colorectal cancer resistance to 5-Fu. Materials and Methods: CXCL-13 levels of patient's serum or cell culture supernatants were measured separatelyby enzyme-linked immunosorbent assay. In cell assays, cell viability is detected by Cell CountingKit-8. Therefore, the recombinant human CXCL-13 was used to simulate its high expressionin cells while its antibody and siRNA were used to reduce CXCL-13 expression in cells. Results: In this study, we demonstrated that CXCL-13 is associated with 5-Fu resistance by culturemedium exchange experiments and cytokine arrays of colorectal cancer resistant and nonresistantcells. Clinical studies showed that CXCL-13 is highly expressed in the serum of5-Fu–resistant patients. High levels of serum CXCL-13 also predict a worse clinical outcome.The addition of recombinant CXCL-13 cytokine resulted in 5-Fu resistance, while its antibodyovercame 5-Fu resistance, and knockdown of CXCL-13 expression by siRNA also reduced5-Fu resistance, which can be saved by added recombination CXCL-13. Conclusion These results not only identify a CXCL-13 mediated 5-Fu resistance mechanism but alsoprovide a novel target for 5-Fu–resistant colorectal cancer in prevention and treatmentstrategies.

Objective To evaluate diagnostic method and treatment strategy for free floating thrombus in carotid artery.Methods From Ju12016 to Oct 2017,7 patients with free floating thrombus in carotid artery was diagnosed at our department.The medical history,symptoms,diagnosis,treatment strategy and prognosis of those patients were analyzed retrospectively.Results Among 7 patients,4 were symptomatic;4 patients were concomitant with severe carotid artery stenosis and 3 with mild to moderate stenosis.3 received carotid endarterectomy and patch angioplasty.4 received carotid artery stenting with distal cerebral protection divice.There was no perioperative and 30-day stroke,myocardial infarction,death or hyperperfusion syndrome occurred.The 12-month follow up showed no restenosis,no free floating thrombus recurrence and no ischemic cerebrovascular event.Conclusion Free floating filling defect in carotid artery is a typical sign for unstable plaque.Both carotid endarterectomy and carotid artery stenting can be used for the treatment of free floating thrombus.

Objective To compare the outcome of combined and staged approach on concomitant carotid and coronary severe stenosis.Methods From March 2013 to May 2015,27 patients with concomitant carotid and coronary severe stenosis were treated by carotid endarterectomy and coronary artery bypass grafting,15 cases received one-stage operation and 12 staged.The basic characteristics,details during surgery,complications,quality of life score,hospital stay and cost were compared.Results 27 patients received carotid endarterectomy and off-pump coronary artery bypass grafting under general anesthesia.Revascularization were performed on 27 carotid and 82 coronary artery.The characteristics of patients were similar between two groups,reflected with WIC,combined approach subgroup was (5.27 ± 0.88) and staged subgroup was (4.92 ± 1.24).The operation time was significantly decreased in the synchronous group [(295.33 ± 49.73)min vs (390.83 ± 73.45) min,P ＜ 0.001].Hospital stay days was also reduced [(30.20 ± 12.91) days vs(44.67 ± 6.34) days,P =0.002],the medical cost was lower in combined approach group,but no significant statistical difference.The complications including 1 case TIA,1 recurrent nerve injury in one-stage group and 1 case myocardial infarction,1 mediastinal bleeding post-operation and 1 pulmonary infection in stage group.No cerebral infarction and death.Quality of life scores(SF-36) of the two groups was 5.53 ± 1.30 and 5.75 ± 1.36 respectively,no significant difference.Conclusion The efficacy and safety of treatment for concomitant carotid and coronary severe stenosis patients with combined or staged approach was similar.But the combined approach program can reduce the hospital stay time and cost in some degree.

Objective To summarize the clinical experience of surgical treatment for complete atrioventricular septal defect in infants.Methods From December 2013 to June 2004,56 patients aged from 53 days to 12 months with complete atrioventricular septal defect were undergone operations.All patients were diagnosed by 2D-echocardiography,and 18 patients underwent cardiovascular computed angiography (CTA).Rastelli type A had 44 cases,type B 3 cases,and type C 9 cases.The single pericardium patch repair was used for 37 cases,the two-patch repair for 3 cases,and the modified single-patch repair for 16 cases.The time of mechanical ventilation was 26 to 172 hours,and the time of staying at Intensive Care Unit (ICU) was 3 to 19 days.Results There were 5 early deaths caused by severe low cardiac output in 2 cases,renal failure in 2 cases,and severe pulmonary inflammation in 1 case.One late death was due to severe mitral regurgitation with pneumonia and heart failure.The operative mortality was 10.7％.A total of 47 patients was followed-up for 3 months to 5 years after surgery and their heart function was satisfactory.Conclusions The operation should be done between 6 months and 1 year when the diagnosis of complete atrioventricular septal defect (CAVSD) is clear.Its early surgical intervention is satisfactory.The result of surgical treatment for CAVSD depends on both probing intracardiac anatomy carefully and complete correction of associated cardiac abnormalities.

Objective To observe the effect of electromyographic biofeedback combined with earlier rehabilitation on serum matrix metalloproteinase-9 (MMP-9) and its clinical efficacy for patients with cerebral infarction. Methods 90 patients with acute cerebral infarction were randomly divided into control group (n=30), rehabilitation group (n=30) and combination group (n=30). All the groups received basic medication, and the rehabilitation group combined with earlier rehabilitation, the combination group with electromyographic biofeedback and earlier rehabilitation. All patients were evaluated with Clinical Neurologic Functional Default Scoring (CNFDS) and the modified Barthel Index (MBI) before and 2 weeks after treatment. Their serum levels of MMP-9 were detected as well. Results The scores of CNFDS and MBI improved after treatment in all the groups (P<0.001), especially in the combination group (P<0.01). The levels of MMP-9 decreased more in combination group than in the rehabilitation group and the control group (P<0.001). Conclusion Electromyographic biofeedback combined with earlier rehabilitation can facilitate the recovery neural function, which may associated with the decrease of MMP-9.

Objective To evaluate the efficacy of modified arytenoid adduction in the management of patients with unilateral vocal fold paralysis(UVFP).Methods A retrospective review was performed on 22 patients who underwent modified arytenoid adduction for UVFP between February 2001 and December 2007.Pre-,and 3 months postoperative aspiration,perceptual(GRBAS),acoustic data(fundamental frequency,F_0,fundamental frequency perturbation,jitter,amplitude perturbation,shimmer,normalized noise energy,NNE)and aerodynamic(maximal phonatory time,MPT,mean airflow rate,MFR)were analyzed statistically.Results The ratings of postoperative aspiration were significantly decreased than that of the preoperation(P<0.0001).There was a significant decrease in GRBAS scales postoperatively versus preoperatively(P<0.0001).The mean values of voice acoustics parameters (F_0,jitter,shimmer,NNE)were significantly decreased,the maximum phonation time were significantly longer,and the mean airflow rate were significantly decreased after operation than that of the preoperation(P<0.001).Conclusion Modified arytenoid adduction is an effective medialization technique that can restore satisfactory speech and prevent aspiration in patients with UVFP.