Objective To examine the frequency and mode of distal spread of low and middle rectal cancer in the mesorectum and rectal wall. Methods Thirty-four specimens from low and middle rectal cancer were collected between August 2004 and December 2005 in Cancer Center of Sun Yat-sen University. Twenty-eight specimens of low and middle rectal cancer were collected between October 2006 and October 2007 in Shandong Provincial Hospital of Shandong University. All 62 specimens were studied using large slices stained with CK20. Logistic regression was used to analyze clinicopathologic factors related to distal spread of low and middle rectal cancer in the mesorectum and rectal wall. Results Two types of distal spread of the tumor were observed in rectal wall: submucosa invasion and muscularis propria invasion. Distal spread in rectal wall was observed in 16% (10/62) of the patients. The length of distal spread in rectal wall was found from O. 5 cm to 1.0 cm. Four types of distal spread of the tumor were observed in mesorectum: lymph node invasion, blood and lymphatic vessel invasion, perineural invasion, isolated neoplastic microfoci. Distal spread in mesorectum was observed in 24% (15/62) of the patients. The length of distal spread in mesorectum was found from 0. 5 cm to 4. 0 cm. Three more cases with microcapillary invasion in distal mesorectum was observed by immunohistochemical technique, which was difficult to identify by conventional HE staining. Univariate analysis showed that serum CEA , lymph node invasion, CMI and TNM stage were correlated with distal spread of low and middle rectal cancer in the mesorectum and rectal wall. TNM stage was shown to be independent impact factor by multivariate analysis( Wald = 9. 567, P =0. 002). Conclusion TNM stage is an independent impact factor for distal spread of low and middle rectal cancer in the mesorectum and rectal wall. Resection of 1.5 cm for distal rectal wall is necessary for a curative intention, but it must be emphasized that the clearance for distal mesorectum should be 5 cm at least.

Objective To examine the frequency and mode of distal spread of low and middle rectal cancer in the mesorectum and rectal wall to determine the optimal distal clearance in situ. Methods Thirty-four specimens with low and middle rectal cancer were collected in the pathologic study between August 2004 and December 2005 in Cancer Center of Sun Yat-sen University,Twenty-eight specimens with low and middle rectal cancer were enrolled in the pathologic study between October 2006 and October 2007 in Shandong Provincial Hospital of Shandong University.Logistic regression wag used to analyze clinicopathoiogic factors related to distal spread of low and middle rectal cancer in the mesorectum and rectal wall. Results Two types of disial spread of the tumor were identified in rectal wall:submucosa invasion and muscularis propda invasion.Distal spread in rectal wall was observed in 16%(10/62)of the patients.The length of distal spread in rectal wall was found from 0.5 cm to 1.0 cm.Four types of distal spread of the tumor were identified in mesorectum:lymph node invasion,blood and lymphatic vessel invasion,perineural invasion,isolated neoplastic microfoci.Distal spread in mesorectum was observed in 19%(12/62)of the patients.The length of distal spread in mesorectum was found from 0.5 cm to 4.0 cm.Univariate analysis showed that serum CEA,lymph node invasion.circumferential margin involvemenl and Dukes stage were correlated with distal spread of low and middle rectal cancer in the mesorectum and rectal wall.Dukes stage was shown to be independent impact factor by multivariate analysis(Wald=8.386,P=0.004).Conclusion Dukes stage is an independent impaet factor for distal spread of low and middle rectal cancer in the mesorectum and rectal wall.Resection of 1.5 cm for distal rectal wall mandatory for a curative resection,provided that the clearance for distal mesorectum is no less than 5.0 cm.

Background: The prognostic nutritional index (PNI) has been widely applied for predicting survival outcomes of patients with various malignant tumors. Although a low PNI predicts poor prognosis in patients with colorectal cancer after tumor resection, the prognostic value remains unknown in patients with stage Ⅲ colon cancer undergoing cura-tive tumor resection followed by adjuvant chemotherapy. This study aimed to investigate the prognostic value of PNI in patients with stageⅢ colon cancer. Methods: Medical records of 274 consecutive patients with stage Ⅲ colon cancer undergoing curative tumor resec-tion followed by adjuvant chemotherapy with oxaliplatin and capecitabine between December 2007 and December 2013 were reviewed. The optimal PNI cutoff value was determined using receiver operating characteristic (ROC) curve analysis. The associations of PNI with systemic inflammatory response markers, including lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP) level, and clinicopathologic characteristics were assessed using the Chi square or Fisher's exact test. Correlation analysis was performed using Spearman's correlation confficient. Disease-free survival (DFS) and overall survival (OS) stratified by PNI were analyzed using Kaplan–Meier method and log-rank test, and prognostic factors were identified by Cox regression analyses. Results: The preoperative PNI was positively correlated with LMR (r= 0.483,P < 0.001) and negatively correlated with NLR (r=? 0.441,P < 0.001), PLR (r=? 0.607,P < 0.001), and CRP level (r=? 0.333,P < 0.001). A low PNI (≤ 49.22) was significantly associated with short OS and DFS in patients with stage IIIC colon cancer but not in patients with stage IIIA/IIIB colon cancer. In addition, patients with a low PNI achieved a longer OS and DFS after being treated with 6–8 cycles of adjuvant chemotherapy than did those with < 6 cycles. Multivariate analyses revealed that PNI was inde-pendently associated with DFS (hazard ratios 2.001; 95％ confidence interval 1.157–3.462;P= 0.013). Conclusion: The present study identified preoperative PNI as a valuable predictor for survival outcomes in patients with stage Ⅲ colon cancer receiving curative tumor resection followed by adjuvant chemotherapy.

PURPOSE: To explore whether there is matching relation between the length and the tilting angle of terminal implants in the All-on-Four protocol by studying the effects of different implant configurations on stress distributions of implant, bone, and framework. MATERIALS AND METHODS: Four implants were employed to support a full-arch fixed prosthesis and five three-dimensional finite element models were established with CT images, based on the length (S and L) and distal tilt angle (0degrees, 30degrees and 45degrees) of terminal implants for an edentulous mandible, which named: Tilt0-S, Tilt30-S, Tilt30-L, Tilt45-S and Tilt45-L. An oblique 240 N was loaded at second molar. The von Mises Stresses were analyzed. The implants were consecutively named #1 to #4 from the loading point. RESULTS: 1) Tilt0-S had the greatest stress on the implants, with the other groups exhibiting variable reductions; the four implants of Tilt45-L demonstrated the greatest reduction in stress. 2) Tilt0-S had the greatest stress at bone around #1 implant neck, and Tilt45-L exhibited the least stress, which was a 36.3% reduction compared to Tilt0-S. 3) The greatest stress in the framework was found on the cantilevers distal to #1 implant. Tilt45-S exhibited the least stress. CONCLUSION: Matching different length and tilting angle of the terminal implants led to variable stress reductions on implants, bone and the superstructure. By optimizing implant configuration, the reduction of stress on implants and surrounding bone could be maximized. Under the present condition, Tilt45-L was the preferred configuration. Further clinical testings are required.
Finite Element Analysis* ; Mandible ; Molar ; Neck ; Prostheses and Implants

Objective To evaluate the efficacy and safety of 0.03% tacrolimus ointment for the treatment of atopic dermatitis (AD) in Chinese children. Methods A total of 139 children, 2 to17 years of age, with moderate to severe AD from 5 study centres were enrolled in this multicentre, randomized, double-blind, vehicle-controlled, parallel group study. Treatment with 0.03% tacrolimus ointment or vehicle was applied twice daily to the affected areas for 3 weeks. Visits were scheduled on day 1 (base line, before treatment) and 1, 2, 3 weeks after the treatment. The main therapeutic parameter was the efficacy rate at the end of the treatment. Results The efficacy rates were 84.6% and 29.0% for tacrolimus group and vehicle group, respectively (P

Objective To investigate the efficacy and toxicities of neoadjuvant chemoradiotherapy (neoCRT) in the management of unresectable locally advanced adherent colon cancer (LAACC).Methods A retrospective analysis was performed on the clinical records of 40 patients with initially diagnosed unresectable LAACC who received preoperative neoCRT in our center from October 2010 to December 2015.Results Thirty-nine patients completed the preoperative neoCRT.Thirty-four patients underwent radical resection after neoCRT, and the R0 resection rate, pathological complete response rate (pCR), tumor downstaging rate, nodal downstaging rate, and clinical downstaging rate were 91%, 24%(8/34patients), 76%(26/34patients),100%(32/32patients), and 94%(32/34patients), respectively.Among the 21 patients with bladder invasion, the full bladder was preserved in 7 patients (33%) and partial cystectomy was performed in 11 patients (52%).During the course of neoCRT, the grade 3-4 hematologic toxicity rate, grade 3 hand-foot syndrome rate, grade 3 radiodermatitis, and incomplete intestinal obstruction rate were 23%, 3%, 3%, and 5%, respectively.The 3-year sample size was 25 patients.For all the patients, the 3-year overall survival (OS) and progression-free survival (PFS) rates were 75% and 80%, respectively.Of the 34 patients who received surgical radical resection, the 3-year OS and disease-free survival (DFS) rates were 87% and 81%, respectively.In addition, local tumor recurrence was identified in 3 patients, and distant metastasis was identified in 6 patients.Conclusions NeoCRT is an effective treatment for unresectable LAACC that results in significant tumor downstaging and enhanced R0 resection rate without an increase in surgical complications.The patients treated with radical surgical resection after neoCRT show a satisfactory short-term outcome.Further studies will be required to determine the clinical value of neoCRT in treating LAACC.

Objective To evaluate the mid-to long-term survival benefits of preoperative sandwich-like neoadjuvant chemoradiotherapy (CRT) in patients with locally advanced rectal cancer (LARC).Methods A total of 45 LARC patients who underwent neoadjuvant sandwich CRT in the form of XELOX regimen prior to,concurrently with,and following volumetric modulated arc radiotherapy (VMAT) in 2012 were enrolled in this study.VMAT was given at a gross tumor volume dose of 50 Gy in 25 fractions,and a clinical target volume dose of 45-46 Gy in 25 fractions.Total mesorectal excision was performed 6 to 8 weeks after completion of VMAT.The overall survival (OS) and disease-free survival (DFS) were determined by the Kaplan-Meier method,and survival comparison and univariate prognostic analysis were performed using the log-rank test.Results The median follow-up time was 46.7 months.There was no local recurrence detected among the patients.The 3-year distant metastasis (DM) rate was 18%,and the 3-year OS and DFS were 96% and 84%,respectively.Univariate analysis indicated that perineural invasion,N1-N2 pathology (pathological stage Ⅲ),and Ca-199>35 U/ml before treatment were risk factors for DM (P=0.000,0.000,and 0.013,respectively).Conclusions The significant short-term efficacy of preoperative sandwich-like neoadjuvant CRT can be extended to a positive mid-term survival in LARC patients.However,further phase Ⅲ clinical studies will be needed to confirm this finding.

Objective: To investigate the features of literature on hand-transmitted vibration in China, 1990-2016. Methods: In September 2017, the studies on hand-transmitted vibration in China, which were published in Chinese or English during 1990-2016, with "China" and "Taiwan" as the places where author affiliations were located, were retrieved. A bibliometric analysis was performed to investigate the type of articles, publication time, the journals in which articles were published, author affiliations, author regions, and funding. Results: A total of 205 articles on hand-transmitted vibration were retrieved. There were 7.59 articles on average published annually from 1990 to 2016. In the 205 articles, 114 (55.61%) were published in the journals indexed in one or two core journal databases. In the 64 journals, 22 (34.38%) were indexed in one or two core journal databases. The first authors were from 22 provincial regions (provinces, autonomous regions, or centrally administered municipalities) in China, with 152 articles (74.15%) by the authors in the top five regions. There were a total of 876 authors, and the co-authorship degree was 4.27 (876/205). Most of the first authors (136 articles, 66.34%) were affiliated with universities or institutes for prevention and control of occupational diseases. Among the 205 articles, 103 (50.24%) were original articles or investigations, and 72 (35.12%) were funded. Conclusion The studies on hand-transmitted vibration fluctuated and increased from 1990 to 2016, with a relatively concentrated distribution in terms of sources, regions, and institutions. Interregional and international academic exchange should be strengthened.

Objective To evaluate the quality of prediction model on healthcare-associated infections in China,so as to standardize research process and reporting methods.Methods It performed a literature search for healthcare-associated infections prediction model studies published using the following databases by the end of 2022.After independently screening the literature and cross-checking the extracted data according to the inclusion and exclusion criteria,the research team applied the prediction model risk of bias assessment tool(PROBAST)to evaluate the methodological quality,and the transparent reporting of a multivariable prediction model for individual prognosis or diagnosis(TRIPOD)statement to evaluate the quality of study reporting.Results A total of 81 healthcare-associated infections prediction studies were identified.Their median PROBAST overall adherence were 58.11%±13.88%,median TRIPOD adherence were 56.11%±16.35%.The main methodological flaws involved participants defined,ignored complexities in data,and omitted missing data.The reporting flaws lay in the items of risk groups,sample size,and supplementary information.Conclusion There are methodological deficiencies and incomplete reporting of domestic hospital infection prediction modelling studies,which limit the reliability and applicability of the results and leave much room for improvement.

Objective To evaluate the quality of prediction model on healthcare-associated infections in China,so as to standardize research process and reporting methods.Methods It performed a literature search for healthcare-associated infections prediction model studies published using the following databases by the end of 2022.After independently screening the literature and cross-checking the extracted data according to the inclusion and exclusion criteria,the research team applied the prediction model risk of bias assessment tool(PROBAST)to evaluate the methodological quality,and the transparent reporting of a multivariable prediction model for individual prognosis or diagnosis(TRIPOD)statement to evaluate the quality of study reporting.Results A total of 81 healthcare-associated infections prediction studies were identified.Their median PROBAST overall adherence were 58.11%±13.88%,median TRIPOD adherence were 56.11%±16.35%.The main methodological flaws involved participants defined,ignored complexities in data,and omitted missing data.The reporting flaws lay in the items of risk groups,sample size,and supplementary information.Conclusion There are methodological deficiencies and incomplete reporting of domestic hospital infection prediction modelling studies,which limit the reliability and applicability of the results and leave much room for improvement.