Objective:To compare long-term efficacy between watch and wait (W&W) strategy and total mesorectal excision (TME) in patients who were diagnosed with locally advanced rectal cancer (LARC) and attained clinical complete response (cCR) after neoadjuvant chemoradiotherapy (nCRT).Methods:A retrospective cohort study was carried out. A total of 238 patients with stage II-III LARC exhibiting cCR after nCRT in Sun Yat-sen University Cancer Center from September 16, 2010 to January 9, 2018 were enrolled. Patients who were diagnosed with other malignant tumor within 5 years, did not receive regular follow-up in our center for more than 1 year and had no complete examination items after nCRT were excluded. Of 238 patients, 151 were male and 87 were female with a median age of 57 (27-83) years old. According to TNM stage, 61 cases were cII, 177 cases were cIII. Concurrent chemoradiotherapy (CCRT) was performed in 20 patients. CCRT plus induction/consolidated chemotherapy was performed in 218 patients. Intensity-modulated radiotherapy (IMRT) was applied to radiotherapy. The median radiation dose was 50 Gy/25 Fr for both the primary tumor and clinical target volumes, and the total dose was 45.0 to 50.6 Gy for 227 patients. In 27 patients, single-agent fluorouracil or capecitabine was used as concurrent chemotherapy. But in the other 211 patients, a combined regimen of oxaliplatin and fluorouracil or capecitabine was used. After nCRT, 59 and 179 patients received W&W (W&W group) and TME 6-12 weeks later (TME group), respectively. After the ending of treatment, patient was interviewed one time every 3 months and after 3 years, one time every six months. Overall survival (OS) rate, distant-metastasis-free survival (DMFS) rate, and local-recurrence-free survival (LRFS) rate were compared between two groups. The salvage treatment and sphincter preservation rate were analyzed. The survival curve was drawn with Kaplan-Meier method and evaluated by log-rank method.Results:In the cases treated with TME, the median interval from nCRT to surgery was 59 days. The postoperative pCR rate was 63.1%(113/179). The median follow-up time of the whole cohort was 41.8 (12.0-99.0) months. The 3-year and 5-year OS rates were 98.4% and 96.5%; the 3-year and 5-year LRFS rates were 96.5% and 96.5%; the 3- and 5-year DMFS rates were 91.0% and 87.9%, respectively. The 3-year OS rates in the W&W group and the TME group were 100% and 97.9%; the 5-year OS rates in W&W group and the TME group were 90.6% and 97.9% ( P=0.339); The 3-year local recurrence rate (LRR) in the W&W group was 12.9% (7 cases recurred within 2 years), which was significanthy higher then that in the TME group (0.6%, P=0.003). Salvage surgery was successful in 5/6 cases. After salvage surgery, LRFS rate was not significantly different between the two groups ( P=0.137). The 3-year DMFS rate in the W&W group and the TME group were 88.4% and 81.1%, whose difference was not significant ( P=0.593). Recurrence with simultaneous metastasis was seen in 3/7 cases of the W&W group. The sphincter was preserved in 89.8% (53/59) of patients in the W&W group, which was significantly higher than 73.7% (132/179) in the TME group ( P<0.001). When distance of tumor from the anal verge was ≤ 5 cm, the sphincter preservation rate (SPR) in the W&W group was 88.0% (44/50), which was significantly higher than the 54.4% (56/103) in the TME group ( P<0.001). Conclusions:W&W is safe and feasible for patients with LARC and cCR after nCRT. The results should be verified by further clinical trials.

Objective:To compare long-term efficacy between watch and wait (W&W) strategy and total mesorectal excision (TME) in patients who were diagnosed with locally advanced rectal cancer (LARC) and attained clinical complete response (cCR) after neoadjuvant chemoradiotherapy (nCRT).Methods:A retrospective cohort study was carried out. A total of 238 patients with stage II-III LARC exhibiting cCR after nCRT in Sun Yat-sen University Cancer Center from September 16, 2010 to January 9, 2018 were enrolled. Patients who were diagnosed with other malignant tumor within 5 years, did not receive regular follow-up in our center for more than 1 year and had no complete examination items after nCRT were excluded. Of 238 patients, 151 were male and 87 were female with a median age of 57 (27-83) years old. According to TNM stage, 61 cases were cII, 177 cases were cIII. Concurrent chemoradiotherapy (CCRT) was performed in 20 patients. CCRT plus induction/consolidated chemotherapy was performed in 218 patients. Intensity-modulated radiotherapy (IMRT) was applied to radiotherapy. The median radiation dose was 50 Gy/25 Fr for both the primary tumor and clinical target volumes, and the total dose was 45.0 to 50.6 Gy for 227 patients. In 27 patients, single-agent fluorouracil or capecitabine was used as concurrent chemotherapy. But in the other 211 patients, a combined regimen of oxaliplatin and fluorouracil or capecitabine was used. After nCRT, 59 and 179 patients received W&W (W&W group) and TME 6-12 weeks later (TME group), respectively. After the ending of treatment, patient was interviewed one time every 3 months and after 3 years, one time every six months. Overall survival (OS) rate, distant-metastasis-free survival (DMFS) rate, and local-recurrence-free survival (LRFS) rate were compared between two groups. The salvage treatment and sphincter preservation rate were analyzed. The survival curve was drawn with Kaplan-Meier method and evaluated by log-rank method.Results:In the cases treated with TME, the median interval from nCRT to surgery was 59 days. The postoperative pCR rate was 63.1%(113/179). The median follow-up time of the whole cohort was 41.8 (12.0-99.0) months. The 3-year and 5-year OS rates were 98.4% and 96.5%; the 3-year and 5-year LRFS rates were 96.5% and 96.5%; the 3- and 5-year DMFS rates were 91.0% and 87.9%, respectively. The 3-year OS rates in the W&W group and the TME group were 100% and 97.9%; the 5-year OS rates in W&W group and the TME group were 90.6% and 97.9% ( P=0.339); The 3-year local recurrence rate (LRR) in the W&W group was 12.9% (7 cases recurred within 2 years), which was significanthy higher then that in the TME group (0.6%, P=0.003). Salvage surgery was successful in 5/6 cases. After salvage surgery, LRFS rate was not significantly different between the two groups ( P=0.137). The 3-year DMFS rate in the W&W group and the TME group were 88.4% and 81.1%, whose difference was not significant ( P=0.593). Recurrence with simultaneous metastasis was seen in 3/7 cases of the W&W group. The sphincter was preserved in 89.8% (53/59) of patients in the W&W group, which was significantly higher than 73.7% (132/179) in the TME group ( P<0.001). When distance of tumor from the anal verge was ≤ 5 cm, the sphincter preservation rate (SPR) in the W&W group was 88.0% (44/50), which was significantly higher than the 54.4% (56/103) in the TME group ( P<0.001). Conclusions:W&W is safe and feasible for patients with LARC and cCR after nCRT. The results should be verified by further clinical trials.

Objective To explore associations between mental disorders and accidental death. Methods A case-control psychological autopsy study was conducted in Fengning county in Hebei province, Kailu county in Inner Mongolia, Meixian county in Shaanxi province, Chongzhou county in Sichuan province. One hundred and fifty-seven accidental death cases were identified, based on detailed interview and cause of death listed as"accidental death"(International Classification of Diseases 10th edition codes V01-X59),"suicide"(X60-X84) or"mental disorder"(F00-F98). We used 2008 census data for three of the four counties (Fengning county in Hebei Province stopped participating in the study in 2009), to select a multistage stratified random sample of adult community residents as the living controls. Finally, 140 living controls were randomly sampled. For each cases or controls, one family member and one associate (neighbor or friend) were interviewed separately by different interviewers. For each cases, socio-demographic data, quality of life, and psychiatric diagnosis 1 month prior to accidental death (or 1 month prior to interview for the living controls), and life events and social support 12 months prior to the death or interview (for controls) were evaluated during the interview. Axis Ⅰ mental disorders, Axis Ⅱ personality disorders were diagnosed based on Structured Clinical Interviews for DSM-Ⅳ-TR Axis Ⅰ Disorders (SCID-I) and Axis Ⅱ Personality Disorders (SCID-Ⅱ). Multivariate logistic regression was used to test the association between accidental death and mental disorders. Results The accidental death group was more likely being male (χ2=37.55, P<0.001) and unmarried (χ2=8.82, P=0.003). The prevalence of Axis Ⅰ mental disorder and of axis Ⅱpersonality disorder were higher in accidental death group than that in control group (19.7%( 31/157) vs. 3.6%(5/140), χ2=18.17, P<0.01; 11.5%(18/157) vs .3.6%(5/140), χ2=6.45, P=0.011; respectively). After adjusted for demographic variables, the adjusted OR was 1.78 (95%CI: 1.26-2.51, P=0.001) for mental disorders, and 1.48(95%CI: 1.02-2.15, P=0.040) for mental disorders other than substance use disorders. Conclusion Mental disorder is an independent risk factor for accidental death, whether or not substance use disorders were excluded.

Objective To explore associations between mental disorders and accidental death. Methods A case-control psychological autopsy study was conducted in Fengning county in Hebei province, Kailu county in Inner Mongolia, Meixian county in Shaanxi province, Chongzhou county in Sichuan province. One hundred and fifty-seven accidental death cases were identified, based on detailed interview and cause of death listed as"accidental death"(International Classification of Diseases 10th edition codes V01-X59),"suicide"(X60-X84) or"mental disorder"(F00-F98). We used 2008 census data for three of the four counties (Fengning county in Hebei Province stopped participating in the study in 2009), to select a multistage stratified random sample of adult community residents as the living controls. Finally, 140 living controls were randomly sampled. For each cases or controls, one family member and one associate (neighbor or friend) were interviewed separately by different interviewers. For each cases, socio-demographic data, quality of life, and psychiatric diagnosis 1 month prior to accidental death (or 1 month prior to interview for the living controls), and life events and social support 12 months prior to the death or interview (for controls) were evaluated during the interview. Axis Ⅰ mental disorders, Axis Ⅱ personality disorders were diagnosed based on Structured Clinical Interviews for DSM-Ⅳ-TR Axis Ⅰ Disorders (SCID-I) and Axis Ⅱ Personality Disorders (SCID-Ⅱ). Multivariate logistic regression was used to test the association between accidental death and mental disorders. Results The accidental death group was more likely being male (χ2=37.55, P<0.001) and unmarried (χ2=8.82, P=0.003). The prevalence of Axis Ⅰ mental disorder and of axis Ⅱpersonality disorder were higher in accidental death group than that in control group (19.7%( 31/157) vs. 3.6%(5/140), χ2=18.17, P<0.01; 11.5%(18/157) vs .3.6%(5/140), χ2=6.45, P=0.011; respectively). After adjusted for demographic variables, the adjusted OR was 1.78 (95%CI: 1.26-2.51, P=0.001) for mental disorders, and 1.48(95%CI: 1.02-2.15, P=0.040) for mental disorders other than substance use disorders. Conclusion Mental disorder is an independent risk factor for accidental death, whether or not substance use disorders were excluded.

Objective:Imatinib is extensively used as a first-line therapeutic agent for patients with chronic myeloid leukemia (CML) at the chronic phase (CP). Although CML patients undergoing imatinib treatment are enrolled mainly in the Glivec International Patient Assistance Program (GIPAP) in China since 2003, limited data have been reported on the long-term outcome of these patients. This study aims to compare the treatment response and prognosis of CML-CP patients who received different treatments from January 2003 to December 2013 in the First Affiliated Hospital of Nanchang University. Methods:A total of 295 patients were enrolled, includ-ing 185, 30, 50, and 30 patients for imatinib, interferon-alpha (IFN-α) plus Ara-C, hydroxycarbamide (HU), or allogeneic hematopoietic stem cell transplantation (Allo-HSCT) treatments, respectively. Results:Patients in imatinib and Allo-HSCT groups achieved excellent complete hematologic remission (CHR) (i.e., 96.7%vs. 96.7%), complete cytogenetic response (CCyR) (i.e., 89.7%vs. 93.3%), and com-plete molecular remission (CMoR) (i.e., 49.7%vs. 83.3%, P=0.001). However, significantly low rates of CHR, CCyR, McyR, and CMoR were observed in IFN-αand HU groups. Moreover, patients from imatinib group showed longer overall survival (OS) time than patients from other groups (P<0.001), even patients in Allo-HSCT group (10-year OS, 89.0%vs. 67.0%, P<0.001) because of high risk of Allo-HSCT-related complication. Multivariate analysis showed that receiving imatinib treatment (HR=5.267, 95%CI:1.054-1.940, P=0.022) and achieving CCyR (HR=9.541, 95%CI:1.692-10.513, P=0.002) were independent predictors for OS. Conclusion:Imatinib treatment may be an optimal first-line choice for Chinese patients with CML-CP who have not received any previous treatments.