Objective To evaluate the feasibility and clinical significance of radical nephrectomy with en bloc resection of involved adjacent organs.Methods Totally,24 cases of renal cancer invading adjacent structures underwent radical nephrectomy with en bloc resection of involved adjacent organs.Among the 24 cases,left radical nephrectomy with en bloc resection of splenic flexure and descending colon was performed in 7,partial resection of corpus and cauda pancreatis and spleen in 5,solitary splenectomy in 3;right radical nephrectomy with en bloc resection of hepatic flexure of the colon in 4,partial hepatectomy of right lobe and end-piece in 4,duodenectomy of pars descendens in 1.Of these cases,partial resection of the psoas muscle was performed in 5,and partial resection of mesocolon in 7.Postoperatively,9 cases received immunotherapy.Results There was no intraoperative mortality or severe posuoperative complication.Follow-up of 3-240 months was available in 21 cases.The follow-up showed that 1-,3-,5-and 8-year survival rates were 90.5%(19/21),42.9%(9/21),33.3%(7/21) and 19.0%(4/21),respectively.Conclusions Radical nephrectomy remains the treatment of choice in organ-confined stage of renal carcinoma.With careful selection,radical nephrectomy with en bloc resection of adjacent structures is technically feasible.It can obtain the radical excisional effect.Based on our experience,the operation is relatively safe.Complete surgical extirpation can lead to prolonged disease-free survival.It may also offer beneficial foundation for the subsequent systematic therapy.

Objective:To explore a new technology that can protect the lungs and heart better by utilizing the dose distribution attributes of the half-field and the characteristics of the VMAT (volumetric modulated arc therapy) technology.Methods:A three-dimensional water tank was used to measure the dose of symmetrical field and half field edge and analyze them comparatively. A total of 50 patients with left breast cancer receiving the postoperative radiotherapy were selected. Among them, 25 patients were performed conserving surgery and 25 patients were performed radical mastectomy. After the operation, all the patients received the prescription dose of 50 Gy in 25 fractions. Based on the Eclipse system, the symmetrical field continuous arc VMAT technology and the semi-field segmented arc VMAT technology were used to design the plan. Besides, the dose suitability data and the treatment efficiency of target areas and organs at risk were compared and analyzed.Results:The radiation size of half-field did not increase with the increased depth in the water mode. The symmetric field gradually enlarged due to the angle of tensor factor, increased to about 2 cm at the depth of 30 cm, and the delivery dose in the half-field was lower than that in the symmetric field. The closer the field edge is, the more obvious it is. Compared with the symmetric field continuous arc plan, the half-field segmental arc VMAT plan significantly improved the delivery dose of the lungs and heart ( t=-4.11, -4.42, P=0.00), in which the mean values of V5, V30, and Dmean for the whole structure of the heart were reduced by 52.5%, 65.5%, and 47%, respectively. The left anterior descending coronary artery, which was closely related to the target area, had a decrease of more than 20%. The mean values of V5, V10, V20, and Dmean of the affected lung were reduced by 21.6%, 24.8%, 25.0%, and 23.2%, respectively. The mean values of the doses of other endangered healthy organs, and the execution time of half-field segment arc plan were also better than the continuous arc plan. Conclusions:For breast cancer radiotherapy, the combination of half-field and VMAT can give full play to the advantages of half-field and VMAT, and significantly reduce the irradiated dose of the heart, affected lung, and healthy side of the breast.

Molecular glues can specifically induce aggregation between two or more proteins to modulate biological functions. In recent years, molecular glues have been widely used as protein degraders. In addition, however, molecular glues play a variety of vital roles, such as complex stabilization, interactome modulation and transporter inhibition, enabling challenging therapeutic targets to be druggable and offering an exciting novel approach for drug discovery. Since most molecular glues are identified serendipitously, exploration of their systematic discovery and rational design are important. In this review, representative examples of molecular glues with various physiological functions are divided into those mediating homo-dimerization, homo-polymerization and hetero-dimerization according to their aggregation modes, and we attempt to elucidate their mechanisms of action. In particular, we aim to highlight some biochemical techniques typically exploited within these representative studies and classify them in terms of three stages of molecular glue development: starting point, optimization and identification.