Risk for colorectal cancer in ulcerative colitis:Changes,causes and management strategies

The risk of colorectal cancer for any patient with ulcer-ative colitis is known to be elevated, and is estimated to be 2% after 10 years, 8% after 20 years and 18% after 30 years of disease. Risk factors for cancer in-clude extent and duration of ulcerative colitis, primary sclerosing cholangitis, a family history of sporadic colorectal cancer, severity of histologic bowel inflam-mation, and in some studies, young age at onset of colitis. In this review, the authors discuss recent epide-miological trends and causes for the observed chang-es. Population-based studies published within the past 5 years suggest that this risk has decreased over time, despite the low frequency of colectomies. The crude annual incidence rate of colorectal cancer in ulcerative colitis ranges from approximately 0.06% to 0.16% with a relative risk of 1.0-2.75. The exact mechanism for this change is unknown; it may partly be explained by the more widespread use of maintenance therapy and surveillance colonoscopy.

Treatment strategies in obstructed defecation and fecal incontinence

Obstructed defecation （OD） and fecal incontinence （FI） are challenging clinical problems, which are commonly encountered in the practice of colorectal surgeons and gastroenterologists. These disorders sodally and psychologically distress patients and greatly impair their quality of life. The underlying anatomical and pathophysiological changes are complex, often incompletely understood and cannot always be determined. As a consequence, many medical, surgical, and behavioral approaches have been described, with no panacea. Over the past decade, advances in an understanding of these disorders together with rational and similar methods of evaluation in anorectal physiology laboratories （ARP）, radiology studies, and new surgical techniques have led to promising results. In this brief review, we discuss treatment strategies and recent updates on clinical and therapeutic aspects of obstructed defecation and fecal incontinence.

Current status of surgical treatment of colorectal liver metastases

Liver metastasis （LM） is one of the major causes of death in patients with colorectal cancer （CRC）. Approxi-mately 60% of CRC patients develop LM during the course of their illness. About 85% of these patients have unresectable disease at the time of presenta-tion. Surgical resection is currently the only curative treatment for patients with colorectal LM （CRLM）. In recent years, with the help of modern multimodality therapy including systemic chemotherapy, radiation therapy, and surgery, the outcomes of CRLM treatment have signifcantly improved. This article summarizes the current status of surgical treatment of CRLM including evaluation of resectability, treatment for resectable LM, conversion therapy and liver transplantation for unresectable cases, liver resection for recurrent CRLM and elderly patients, and surgery for concomitanthepatic and extra-hepatic metastatic disease （EHMD）. We believe that with the help of modern multimodality therapy, an aggressive oncosurgical approach should be implemented as it has the possibility of achieving a cure, even when EHMD is present in patients with CRLM.

Pregnancy after liver transplantation:Four-year follow-up of the first case in China's Mainland

The safety and feasibility of pregnancy following liver transplantation(LT) have been accredited in a series of LT center.The first case in China's Mainland is reported.The follow-up data of a 22-year-old pregnant patient with end-stage liver disease undergone orthotopic liver transplantation were analyzed retrospectively.After surgery,the patient was uneventfully recovered and became pregnant 33 mo after LT.The patient was closely monitored and treated with a standard and individualized triple-drug immunosuppressive therapy throughout her pregnancy.Caesarean section was performed in March 18,2004,and a health live-born infant was delivered.After the delivery,a 4-year follow-up period indicated that the patient was satisfactory with her condition and her baby was healthy.Our case shows that a successful pregnancy following LT is possible and safe in women with end-stage liver diseases under close monitoring.Three factors including mother,baby,and transplanted liver function must be considered for the safety of high-risk pregnancies.

Surgery for inflammatory bowel disease

Despite the new and ever expanding array of medications for the treatment of inflammatory bowel disease (IBD), there are still clear indications for operative management of IBD and its complications. We present an overview of indications, procedures, considerations, and controversies in the surgical therapy of IBD.

Characteristics and therapeutic efficacy of sulfasalazine in patients with mildly and moderately active ulcerative colitis

AIM: To investigate the characteristics and short-term efficacy of sulfasalazine (SASP) in patients with mildly and moderately active ulcerative colitis (UC).METHODS: Two hundred and twenty-eight patients with mildly and moderately active UC were recruited, 106patients in 1993-1995, and 122 patients in 2000-2002,they were assigned as the 1990s group (n = 106) and the 2000s group (n = 122), prospectively. The general characteristics, clinical manifestations, colonoscopic and histological data were compared between the two groups.The short-term efficacy and safety of SASP 3 g per d were evaluated.RESULTS: Between 2000s and 1990s groups, the gender ratio of men to women was 1:1.18 and 1:1.04, 57.4%and 50.9% of the patients were between 30 and 49 years old. The gender ratio and age of UC patients were not significantly different. The total course of 50.0% and 37.1% of UC patients was less than 1 year (P＜0.05), 10.6% and 31.2% of the cases had a duration of more than 5 years (P＜0.05) in 2000s and 1990s groups, respectively. The most common clinical type was first episode in 2000s group and chronic relapse in 1990s group. The patients showed a higher frequency of abdominal pain and tenderness in 1990s group than in 2000s group. Erosions were found in 84.4% and 67.9% of patients in 2000s and 1990s groups (P＜0.05). Rough and granular mucosa (67.9%vs43.4%, P＜0.05)and polyps (47.2% vs 32.8%, P＜0.05)were identified in 1990s group more than in 2000s group.There were no significant differences in clinical, colonoscopic and histological classifications. After SASP (1 g thrice per d) treatment for 6 wk, the clinical, colonoscopic and histological remission rates were 71.8%, 21.8% and 16.4%,respectively. In 79 patients with clinical remission, 58.2%and 67.1% remained grade 1 in colonoscopic and histological findings, respectively. The overall effects in first episode type (complete remission in 10, 18.9%, partial remission in 28, 52.8%, and improvement in 9, 17.0%) were better than in chronic relapse type (complete remission in 3,7.5%; partial remission in 16, 40.0%; and improvement in 15, 37.5%) and chronic persistent type (complete remission in 1, 5.9%; partial remission in 6, 35.3%; and improvement in 6, 35.3%) respectively (P＜0.05). In 110patients treated with SASP, 18 patients (16.4%) had adverse reactions. Except for two cases of urticaria and one case of WBC decrease, none of the patients had to stop the treatment because of severe adverse reactions.CONCLUSION: Patients with mildly and moderately active UC in 2000s group had a shorter disease course, milder clinical manifestations, more first episode type and higher frequency of acute mucosal lesions in colonoscopy than in 1990s group. The patients in 1990s group had higher proportion of chronic relapse type and chronic mucosal change in colonoscopy than in 2000s group. The shortterm efficacy of SASP could be mainly remission of clinical manifestations. But more than half of the patients still had light inflammation in colonoscopy and histology. The overall effects of SASP in first episode type were better than those in other types. SASP was a safe and effective drug to treat mildly and moderately active UC.

Peritoneal carcinomatosis of colorectal origin:Incidence,prognosis and treatment options

Peritoneal carcinomatosis (PC) is one manifestation of metastatic colorectal cancer (CRC). Tumor growth on intestinal surfaces and associated fluid accumulation eventually result in bowel obstruction and incapacitating levels of ascites, which profoundly affect the quality of life for affected patients. PC appears resistant to traditional 5-fluorouracil-based chemotherapy, and surgery was formerly reserved for palliative purposes only. In the absence of effective treatment, the histori-cal prognosis for these patients was extremely poor, with an invariably fatal outcome. These poor outcomes likely explain why PC secondary to CRC has received little attention from oncologic researchers. Thus, data are lacking regarding incidence, clinical disease course, and accurate treatment evaluation for patients with PC. Recently, population-based studies have revealed that PC occurs relatively frequently among patients withCRC. Risk factors for developing PC have been identi-fied:right-sided tumor, advanced T-stage, advanced N-stage, poor differentiation grade, and younger age at diagnosis. During the past decade, both chemother-apeutical and surgical treatments have achieved prom-ising results in these patients. A chance for long-term survival or even cure may now be offered to selected patients by combining radical surgical resection with intraperitoneal instillation of heated chemotherapy. This combined procedure has become known as hy-perthermic intraperitoneal chemotherapy. This edito-rial outlines recent advancements in the medical and surgical treatment of PC and reviews the most recent information on incidence and prognosis of this disease. Given recent progress, treatment should now be considered in every patient presenting with PC.

Magnifying endoscopy in upper gastroenterology for assessing lesions before completing endoscopic removal

Any prognosis of gastrointestinal (GI) cancer is closely related to the stage of the disease at diagnosis.Endoscopic submucosal dissection (ESD) and en bloc endoscopic mucosal resection (EMR) have been performed as curative treatments for many early-stage GI lesions in recent years.The technologies have been widely accepted in many Asian countries because they are minimally invasive and supply thorough histopathologic evaluation of the specimens.However,before engaging in endoscopic therapy,an accurate diagnosis is a precondition to effecting the complete cure of the underlying malignancy or carcinoma in situ.For the past few years,many new types of endoscopic techniques,including magnifying endoscopy with narrow-band imaging (MENBI),have emerged in many countries because these methods provide a strong indication of early lesions and are very useful in determining treatment options before ESD or EMR.However,to date,there is no comparable classification equivalent to "Kudo's Pit Pattern Classification in the colon",for the upper GI,there is still no clear internationally accepted classification system of magnifying endoscopy.Therefore,in order to help unify some viewpoints,here we will review the defining optical imaging characteristics and the current representative classifications of microvascular and microsurface patterns in the upper GI tract under ME-NBI,describe the accurate relationship between them and the pathological diagnosis,and their clinical applications prior to ESD or en bloc EMR.We will also discuss assessing the differentiation and depth of invasion,defying the lateral spread of involvement and targeting biopsy in real time.

An analysis of the national TCM master Lu Zhizheng’s academic thought

Lu Zhizheng as one of the first national TCM masters in China, has gradually formed an academic thought of his own after longterm clinical practice of TCM. Such as development of spleen and stomach theory,18-character guideline——holding central area, operating also, taking good care of emotional activities, soothing liver, moistening dryness, improving digestion, and while his conclusions have been used for clinical practice flexibly. He suggested that the key of pathogenesis may be excessive fluid together with phlegm dampness and proposed the treatment rules of diseases caused by dampness. And he attempted to expound the methods and results of the research of rheumatism diseases. If conditions of diseases change,Professor Lu Zhizheng would be agile and adjust according to the conditions. The method of herbs is principled,and King Way therapy used by TCM treatment should be promoted.

Histological Study of the Therapy in the Essential Oil of Laurusnobilis L. from the West Algerian in Rats Wistar Infected

Laurusnobilis L. is an aromatic plant, widespread in Algeria and widely used by local people as a source of spice for its medicinal properties. The essential oil of this plant native to western Algeria is the subject of the study. The extraction of the essential oil was carded by steam distillation, the yield obtained from the leaves （1.5%）, Wister rats male weight between 100 g and 80 g were infected with Salmonella then treated with anessential oil of Laurusnobilis L.. After sacrifice of the rats, histological examination of the intestines and internal organ （liver and spleen） shows the therapy of this magic plant--＂Laurusnobilis L.＂.

The apoptosis induction effect of siRNA recombinant expression vector targeting Livin gene in human colon cancer cells

Objective:To construct siRNA recombinant expression vector targeting Livin gene and observe the apoptosis induction effect of it in human colon cancer cells. Methods:SiRNA recombinant expression vector targeting Livin gene was constructed and transfected into human colon cancer cell. The effect of siRNA recombinant expression vector was detected by RT-PCR, Western blot, MTT reduction assay and flow cytometry. Results: It was confirmed by restriction endonuclease and sequence analysis that siRNA recombinant expression vector targeting Livin gene was constructed successfully. Inhibition ra-tio of Livin siRNA at mRNA and protein levels were 30.18% and 28.88%. The growth of cancer cells was inhibited significantly and the apoptotic ratio was 13.36 ± 1.45%. Conclusion: The siRNA recombinant expression vector targeting Livin gene has been constructed successfully. It not only can inhibit the expression of Livin gene but also can induce apoptosis in human colon cancer cells remarkably.

Giant hepatic hydatid cyst: A case report

Large type 1 cysts are prone to perforation. Furthermore, insufficient drainage with subsequent abscess is a frequent problem of large cysts. We report here a case of a 19-year old man who was admitted to the hospital with pain in the right upper quadrant and epigastric region. An asymmetrical right upper quadrant enlargement was detected on physical examination. UItrasonography and computerized tomography revealed a type 1 giant hydatid cyst in the right hepatic lobe, measuring 16 cm in diameter. During operation, partial cystectomy and drainage were done. The large dead space was obliterated by the ＇sandwich＇ method. Omentum and gelatin sponges were used to fill the cavity. The postoperative period was uneventful and the patient was discharged on the 5^th postoperative day.

Investigation of the relationship between DNA-dependent protein kinase and lymphatic metastasis in colorectal cancer

Objective: To investigate DNA-dependent protein kinase (DNA-PK) expression,and its relationship with lymphat-ic metastasis in colorectal cancer. Methods: Tumor tissues from 60 patients,divided into two groups according to lymphatic metastasis,were immunohistochemically stained to detect the DNA-PK expression including Ku70,Ku80 and PKcs proteins. Results: Positivity of both Ku70 and Ku80 in colorectal cancer was negatively correlated with lymphatic metastasis with an r value of -0.57 and -0.38,respectively. Similar correlation was found between Ku expression,especially Ku70,and long-term survival. PKcs,however,displayed no significant correlation. Statistical analysis failed to detect any correlation between DNA-PK expression,and clinical characteristics,such as age,sex,tumor location,tumor thickness and distant metastasis (P>0.05). Conclusion: DNA-PK expression,especially Ku70 expression,is negatively correlated with lymphatic metastasis,and the survival of patients with colorectal cancer. Ku70 expression may be a potential indicator for the preoperative evaluation,and prognosis in colorectal cancer.

Rifaximin vs conventional oral therapy for hepatic encephalopathy:A meta-analysis

AIM: To characterize the efficacy of rifaximin in the management of hepatic encephalopathy (HE) as several randomized controlled studies have shown contradictory results on its effectiveness in comparison to other oral agents. METHODS: We performed a systematic review and random effects meta-analysis of all eligible trials identifi ed through electronic and manual searches. Twelve randomized controlled trials met the inclusion criteria with a total of 565 patients. RESULTS: The clinical effectiveness of rifaximin was equivalent to disaccharides or other oral antibiotics[odds ratio (OR) 0.96; 95% CI: 0.94-4.08] but with a better safety profi le (OR 0.27; 95% CI: 0.12-0.59). At the completion of treatment protocols, patients receiving rifaximin showed lower serum ammonia levels [weighted mean difference (WMD) = -10.65; 95% CI: -23.4-2.1; P = 0.10], better mental status (WMD = -0.24; 95% CI: -0.57-0.08; P = 0.15) and less asterixis (WMD -0.1; 95% CI -0.26-0.07; P = 0.25) without reaching statistical signifi cance. On the other hand, other psychometric outcomes such as electroencephalographic response and grades of portosystemic encephalopathy were superior in patients treated with rifaximin in comparison to the control group (WMD = 0.21, 95% CI: -0.33-0.09, P = 0.0004; and WMD = -2.33, 95% CI: -2.68-1.98, P = 0.00001, respectively). Subgroup and sensitivity analysis did not show any signifi cant difference in the above fi ndings. CONCLUSION: Rifaximin appears to be at least as effective as other conventional oral agents for the treatment of HE with a better safety profi le.

Secondary hepatic resection as a therapeutic goal in advanced colorectal cancer

Surgery is the only curative option for patients with liver metastases of colorectal cancer, but few patients present with resectable hepatic lesions. Chemotherapy is increasingly used to downstage initially unresectable disease and allow for potentially curative surgery. Standard chemotherapy regimens convert 10%-20% of cases to resectable disease in unselected populations and 30%-40% of those with disease confined to the liver. One strategy to further increase the number of candidates eligible for surgery is the addition of active targeted agents such as cetuximab and bevacizumab to standard chemotherapy. Data from a phase Ⅲ trial indicate that cetuximab increases the number of patients eligible for secondary hepatic resection, as well as the rate of complete resection when combined with first-line treatment with the FOLFIRI regimen. The safety profiles of preoperative cetuximab or bevacizumab have not been thoroughly assessed, but preliminary evidence indicates that these agents do not increase surgical mortality or exacerbate chemotherapyrelated hepatotoxicity, such as steatosis （5-fluorouracil）, steatohepatitis （irinotecan）, and sinusoidal obstruction （oxaliplatin）. Secondary resection is a valid treatment goal for certain patients with initially unresectable liver metastases and an important end point for future clinical trials.

Using the Chinese-Spanish Dictionary by Video： Methodological Guidelines for the Design

The purpose of this paper is to present and analyze the methodological guidelines that directed the design, production, and use of the video program 衹要功夫深,铁棒磨成针 or How to Use the Chinese Dictionary： Beginners＇ Level, as well as expose the development phases of the program and its use by teachers in the classrooms of Chinese as a foreign language. This program is part of a series of videos about the use of dictionaries in different languages, which have been designed, produced, used, and assessed in the framework of the project ＂Diseno y produccion de material didctico en video para la ensefianza de lenguas en la UNAM＂ （Design and Production of Didactic Materials on Video for the Teaching of Languages at UNAM）, just as presented at the II Congreso Internacional de Lexicografia Hispanica （II International Congress of Hispanic Lexicography） （2006）. The topic Of this paper is the use of Chinese-Spanish bilingual dictionary. The method used was descriptive and systematic analysis methodological guidelines for creation derived from the design model proposed.

晚明徽籍印人考察

晚明的"印章热",是在文人的广泛参与、工匠艺人的不懈努力下产生的。徽籍印人是此次印章热潮中涌现出来的重要团体,人数众多,身份复杂,多活动于江南经济、文化发达地区。作为艺术史研究的一个新领域,无论是它的整体,还是印人的个体,尚存许多盲点,甚至可以说处于一种"印象"阶段。这种研究状况的主要原因是史料的相对缺乏。本文将从徽籍印人的出道问题入手,尝试解决徽籍印人研究中一个不可忽视的问题。

Cushing＇s ulcer in traumatic brain injury

Traumatic brain injury （TBI） remains a complicated and urgent disease in our modernized cities. It becomes now a public health disease. We have got more and more patients in Neurosurgery Intensive Care Unit following motor vehicle accidents and others causes. TBI brings multiple disorders, from the primary injury to secondary injury. The body received the disturbances in the brain, in the hypothalamo-pituitary-adrenocortical （HPA） axis, in the gastric mucosa, in the immune and neuroendocrine systems. The mortality of TBI is more than 50000 deaths / year, the third of the mortality of all injuries. Cushing ulcer is one ofthe severe complications of TBI and its mortality rate is more than 50%. Many studies have improved the management of TBI and the associated complications to give patients a better outcome. Furthers studies need to be done based on the similar methodology to clarify the different steps of the HPA axis and the neuroendocrine change associated. The aim of the present review is to assess the clinical and endocrinal features of hypopituitarism and stress ulcer following TBI.

Relationship between urinary nephrin and urinary albumin changes in diabetic rats and effects of Yiqiyangyinhuayutongluo Recipe

OBJECTIVE:To investigate the dynamic changes of urinary nephrin,and the relationship between it and urinary albumin excretion rate(UAER) in a diabetic rat model,as well the effects of yiqiyangyinhuayutongluo recipe.METHODS:Diabetic model was induced by high fat diet combined with low-dose Streptozotocin(STZ) in rats.Normal group(NG),model group(MG),and yiqiyangyinhuayutongluo recipe treated group(YHTG) were set.Gastrointestinal Yiqiyangyinhuayutongluo recipe was administered once daily for 32 w.At the end of the 2nd w(2w),8w,16w,and 32w,fasting blood glucose(FBG),UAER and 24h urinary nephrin(U-nephrin) were detected.RESULTS:Compared with NG,FBG in MG increased notably(P<0.05).Compared with MG,FBG of YHTG reduced slowly,and the difference was significant(P<0.05) since 16w.U-nephrin and UAER in MG increased significantly from 2w,peaked at 16w,lessened in different degree at 32w,but were still higher than NG.The correlation analysis showed that there was a significant positive correlation between U-nephrin and UAER at different time,the correlation coefficient as r>0.9,and P<0.05.Compared with MG,U-nephrin and UAER in YHTG decreased markedly(P<0.05) except for U-nephrin at 8w.CONCLUSIONS:U-nephrin and UAER in diabetic rat model have a positive linear correlation.Yiqiyangyinhuayutongluo recipe can reduce UAER markedly,and preventing the lose of nephrin in urine maybe one of the mechanisms.

Neoliberal Multiculturalism and Western Exceptionalism： The Cultural Politics of the West

The tradition of the west defines its modernity as a radical rupture with endless possibilities for egalitarian futures; yet western modernity was rooted in the genocide of indigenous populations, transatlantic racial slavery and colonialism. Moreover, as the war on terror demonstrates, racial/gender violence continues to be linked to the formation of western identity, culture and politics in the early twenty-first century. This paper examines how the histories of race and coloniality feature in the contemporary formation of the west, with a particular focus on US nationalism and Canadian multiculturalism. These nation-states are most often defined as antithetical, with the latter confirming that western society has transcended its originary racial/colonial politics. I begin with a brief discussion of the reformation of the west in the mid-twentieth century as the USA became the dominant western power. I then move to compare the contemporary national politics of the USA and Canada to highlight the divergence and convergence in their ddineation of their identity and values. My study demonstrates that although the white supremacist discourse that presently constitutes US nationalism is at variance with the multi- culturalism that shapes Canadian identity, these discourses can be defined as twin aspects of the racial/colonial politics that continue to give meaning to the idea of the west.