Radical resection of mid-and low-rectal cancer requires not only oncologic safety but also preservation of organs and postoperative bowel function.While a 1-2 cm distal resection margin has been largely accepted,the optimal length of the proximal margin remains highly controversial.Clinically,the"10-cm rule"derived from colon cancer is often referenced,yet its applicability to rectal cancer lacks consistent supporting evidence.Previous studies have shown that an excessively long proximal margin may increase anastomotic tension and lead to anastomotic leakage,whereas insufficient resection heightens the risk of positive margins and local recurrence.In addition,the extent of lymph node metastasis,vascular perfusion of the proximal bowel,radiation-induced injury after neoadjuvant chemoradiotherapy,and postoperative bowel function-particularly low anterior resection syndrome-are all important factors influencing the selection of the proximal margin.In recent years,the application of indocyanine green fluorescence imaging has provided new evidence for intraoperative assessment of bowel perfusion;for patients receiving neoadjuvant chemoradiotherapy,radiation injury presents a gradient pattern,and resecting approximately≥20 cm proximal to the tumor may reduce the incidence of anastomosis-related complications.Based on current literature,this review provides a systematic overview of the historical evolution,influencing factors,and clinical evidence regarding proximal resection margins in rectal cancer surgery,with the aim of informing individualized margin selection and optimizing surgical strategies.

Radical resection of mid-and low-rectal cancer requires not only oncologic safety but also preservation of organs and postoperative bowel function.While a 1-2 cm distal resection margin has been largely accepted,the optimal length of the proximal margin remains highly controversial.Clinically,the"10-cm rule"derived from colon cancer is often referenced,yet its applicability to rectal cancer lacks consistent supporting evidence.Previous studies have shown that an excessively long proximal margin may increase anastomotic tension and lead to anastomotic leakage,whereas insufficient resection heightens the risk of positive margins and local recurrence.In addition,the extent of lymph node metastasis,vascular perfusion of the proximal bowel,radiation-induced injury after neoadjuvant chemoradiotherapy,and postoperative bowel function-particularly low anterior resection syndrome-are all important factors influencing the selection of the proximal margin.In recent years,the application of indocyanine green fluorescence imaging has provided new evidence for intraoperative assessment of bowel perfusion;for patients receiving neoadjuvant chemoradiotherapy,radiation injury presents a gradient pattern,and resecting approximately≥20 cm proximal to the tumor may reduce the incidence of anastomosis-related complications.Based on current literature,this review provides a systematic overview of the historical evolution,influencing factors,and clinical evidence regarding proximal resection margins in rectal cancer surgery,with the aim of informing individualized margin selection and optimizing surgical strategies.

Objective To explore the difference in inhibitory control ability between DRD2 gene subtype of heroin addicts with fMRI.Methods Thirty-seven heroin-dependent patients were divided into DRD2 Taq IA+ group (A+,22)and matched DRD2 Taq IA-group (A-,15).Functional MRI was performed in all patients while they were executing an event-related go/nogo task at 3.0T MR scanner.The differences of brain activated images and behavioral data between the two groups were analyzed with SPM8 and SPSS1 6.0 software,respectively.Results There were no significant differences in reaction time,accuracy and false alarm rates between the two groups (P>0.05).Compared with A-group,weaker activation in the medial prefrontal cortex,dorsal anterior cingulate,middle cingulate,supplementary motor area,temporal lobe,fusiform gyrus,lingual gyrus,hippocampus and parahippocampal gyrus in response inhibition condition were demonstrated in A+ group (voxel number>228,t=2.11,Alphasim correction,P<0.05).There was no corrlation between the intensity within the activated brain regions and the usage of heroin,morphine urine test positive number(P>0.05).Conclusion DRD2 Taq IA+ group exist deactivation of the brain area on memory,inhibitory control,visual spatial attention. It may be the neural basis that contribute to easy addiction and relapse for A+ carriers.

Objective: To investigate the synergistic lethal effect and mechanism of arsenic trioxide (ATO) and aclacinomycin (ACM) on human acute myeloid leukemia cell line KG-1a. Methods: Colony-forming assay was used to detect the proliferation of KG-1a cells treated with different concentration of ATO and ACM. Compusyn software was used to analyze the synergistic effect of ATO and ACM. Flow cytometry and Wright's staining were used to analyze the apoptotic rate of KG-1a cells induced by combined treatment of ATO and ACM. Western blot was used to determine the expression of proteins associated with apoptosis. Results: The cytotoxicity of arsenic trioxide or aclacinomycin alone was in a dose-dependent manner. Flow cytometry analysis showed that the apoptotic rate of KG-1a cells treated with both 0.4 μmol/L ATO and 10 nmol/L ACM was (34.5±3.1)%, significantly higher than (7.6±1.1)% of 0.4 μmol/L ATO treatment or (18.7±2.3) % of 10 nmol/L ACM treatment alone (P<0.05). The apoptotic rate of KG-1a cells treated with both 1.5 μmol/L ATO and 37.5 nmol/L ACM was (52.5±4.7)%, significantly higher than (19.1±3.2)% of 1.5 μmol/L ATO treatment or (27.7±2.2)% of 37.5 nmol/L ACM treatment alone (P<0.05). The apoptotic rate of KG-1a cells treated with both 3.0 μmol/L ATO and 75 nmol/L ACM was (61.3±4.5)%, significantly higher than (29.5±2.5)% of 3.0 μmol/L ATO treatment or (28.6±3.4) % of 75 nmol/L ACM treatment alone (P<0.05). In addition, the result of Wright's staining showed that combined treatment of ATO and ACM induced a more apparent phenotype of apoptosis when compared with single agent treatment. Compusyn software analysis showed that the combination index (CI) value of combined treatment group was less than 1, which indicated the synergistic effect of these two agents. Conclusions Combined treatment of ATO and ACM shows a synergistic lethal effect on human acute myeloid leukemia cell line KG-1a via activating the apoptotic pathway, which inhibits cell growth and induces apoptosis.

BACKGROUND:Donor selection for high-risk acute leukemia is still controversial.OBJECTIVE:To compare the therapeutic efficacy of the unrelated donor peripheral blood and matched sibling allogeneic hematopoietic stem cell transplantation for high-risk acute leukemia.METHODS:Total 65 patients with high-risk acute leukemia treated during January 2008 to January 2016 were included,in which 30 patients chose the unrelated donor peripheral blood stem cell transplantation (UD), and other 35 chose the matched sibling allogeneic hematopoietic stem cell transplantation (MS) according to the wishes of patients and their own situation. After treatment, the chi-square test, Kaplan-Meier survival analysis method, and other methods were used to compare the implanted and hematopoietic reconstitution, the occurrence of graft-versus-host disease, relapse mortality and long-term survival between the two groups.RESULTS AND CONCLUSION:The implantation rate, platelet hematopoietic reconstitution time, the incidence of acute and chronic graft-versus-host disease, and its type exhibited no significant differences between the two groups (P > 0.05).The relapse rate, total death rate, and transplant-related mortality rates were 10.0%, 50.0%, and 40.0% in the UD group and 20.0%, 48.6%, and 25.7% in the MS groups, respectively, and the intergroup difference was insignificant (P > 0.05).The expected 2-year cumulative disease-free free survival and overall survival rates were (49.4±9.2)% and (52.6±9.2)% in the UD group and (53.9±8.5)% and (53.9±8.5)% in the MS group, respectively, and the intergroup difference was also insignificant (P > 0.05). Our experimental findings show that unrelated donor peripheral blood stem cell transplantation can be used as an effective alternative in the absence of sibling donors.

Objective To investigate the epidemiological and molecular virological characteristics in HBV-infected patients with copositive HBsAg and anti-HBs.Methods HBV serological markers were analyzed in 52 070 specimens.The epidemiological characteristics of HBsAg and anti-HBs simultaneously positive patients (the experimental group) and HBsAg positive and auti-HBs negative patients (the control group) were compared.The S protein of HBV coding region was amplified by semi-nested PCR and sequenced.The statistical differences between the two groups were compared in different gene regions,genotypes and different clinical diagnosis.Results HBsAg was positive in 20.40％ (10 621/52 070) of all specimens.In the patients with positive HBsAg,2.48％ (263/10 621) was positive anti-HBs.The prevalence of co-positive HBsAg and auti-HBs was higher in aged 0 to 9 years and greater than or equal to 80 years than that in other age,and the prevalence of positive HBsAg and negative anti-HBs was completely opposite.The mutation rate of S protein in the experimental group was significantly higher than that in the control group (1.52％ vs 0.81％,P ＜0.01) with the mutation in the major hydrophilic region (MHR) (1.68％ vs 0.57％,P ＜0.01).The mutation rates of S protein of HBV carriers,chronic hepatitis B (CHB) patients and patients with liver cirrhosis (LC) in the experimental group were significantly higher than those in the control group (1.47％ vs 0.65％,1.28％ vs 0.84％,2.21％ vs 0.44％,P ＜0.05,respectively),except for the patients with hepatocellular carcinoma (HCC) (1.97％ vs 2.21％,P ＞ 0.05).Conclusion Co-positive HBsAg and anti-HBs in HBV-infected patients was more common in HBsAg positive patients aged 0 to 9 years and greater than or equal to 80 years than the others.Coexistence of HBsAg and anti-HBs in HBV-infected patients may relate to immune escape caused by mutation of S protein (mainly MHR).The mutation rates of S protein in the two groups of patients,co-positive HBsAg and anti-HBs and the positive HBsAg combined with negative anti-HBs,were associated with the stage of liver disease.

Objective To explore the effect of methadone maintenace treatment (MMT)in functional connectivity (FC)of nucleus accumbens (Nacc)on heroin addicts,and to identify the potential neuromechanism of MMT performing on heroin craving.Methods Craving scores and resting-state fMRI (rs-fMRI)were performed in 37 heroin addicts under MMT and 26 matched heroin addicts (HA) without any treatment.The rs-fMRI data preprocessing was performed by data processing assistant for rs-fMRI (DPARSF)soft-ware based on Matlab 2009a.Bilateral Naccs were set as regions of interesting (ROIs)respectively,and then the mean time series and other voxels within whole brain were analyzed by the rs-fMRI data analysis toolkit (REST).Intra-and inter-group analysis was performed with a single sample t-test and two sample t-test respectively.The partial correlation between the intensity of FC in brain regions showed abnormal FC and the duration/doses of methadone consumption was further investigated by SPSS.Craving scores were tested with two sample t-test.Results Inter-group analysis showed the FC of the right Nacc with left dorsal medial/lateral prefrontal cortex and right dorsal anterior cingulate was significantly increased in the MMT group in comparisonwith HA group,how-ever,it was decreased with right medial orbitofrontal cortex.The FC between the left Nacc and left dorsal medial/lateral prefrontal cortex,right dorsal lateral prefrontal cortex,right dorsal anterior cingulate and left insular cortex was also significantly increased in the MMT group (P <0.005,voxels>26,t=2.91).There were no regions with induced FC.The craving scores of MMT were signifi-cantly lower than those of HA (t = - 2.03,P <0.05 ).There was no significant correlation between the abnormal FC and the duration/doses of methadone consumption in MMT group.Conclusion MMT may influence the function of the nucleus accumbens through cognitive control and motivation/drive circuits,thereby reduce drug craving of heroin addicts.

BACKGROUNDBrain metastasis has become one of the most important factors of the failure of treatment of locally advanced non-small cell lung cancer (LANSCLC). There is no conclusion whether NSCLC patients should receive prophylactic cranial irradiation (PCI) or not. The aim of this study is to analyze the risk factors of brain metastasis of LANSCLC after surgery to find out the sign of PCI for LANSCLC.

METHODSA total of 223 patients with stage III NSCLC who received surgical resection were retrospectively analyzed. The risk factors of brain metastasis were determined to set up a mathematic model for brain metastasis.

RESULTSThe median survival time after surgery was 28.0 months. The 1-, 2- and 3-year survival rate was 84.3%, 56.9% and 44.8% respectively. The incidence of brain metastasis was 38.1% (85/223). Patients with extensive mediastinal lymph node metastasis, more node metastasis and non-squamous carcinoma showed significantly higher incidence of brain metastasis than those with limited mediastinal lymph node metastasis, fewer positive mediastinal lymph nodes and squamous carcinoma (P=0.000, P=0.000, P=0.013). The mathematic model of brain metastasis was: logit(P)=8.215-0.903×NPN-0.872×RT-0.714×HG-1.893×LE-0.948×HS-1.034×PC (NPN=No. of positive nodes, RT=resection type, HG=histology, LE=location and extent of mediastinal lymph node metastasis, HS=histologic stage, PC=postoperative chemotherapy). P≥0.44 meant high risk for brain metastasis.

CONCLUSIONSHigh risk factors of brain metastasis in LANSCLC patients after complete resection of the cancer include non-squamous carcinoma, extensive and more mediastinal lymph node metastasis. P≥0.44 may be considered a sign of PCI in clinical trial.

BACKGROUNDRecently, results from IALT, JBR10 and CALGB9633 showed that postoperative adjuvant chemotherapy improved survival rate of patients with non-small cell lung cancer (NSCLC) after complete resection. The aim of this study is to evaluate the effect of postoperative adjuvant chemotherapy on survival after complete resection for stage IIIA-N2 NSCLC.

METHODSFrom Jan 1999 to Dec 2003, one-hundred and fifty patients with stage IIIA-N2 NSCLC were randomly divided into two groups. The chemotherapy group received four cycles of chemotherapy with navelbine or paclitaxel plus carboplatin, while the observation group did not receive chemotherapy after operation.

RESULTSIn the chemotherapy group, 86.1% (68/79) of patients finished 4 cycles of chemotherapy, and no one died of toxic effects of chemotherapy; 25% of patients had grade III-IV leukopenia, 2% of patients had febrile leukopenia. The median survival time for the entire 150 patients was 879 days, and 1-, 2- and 3-year survival rate was 81%, 59% and 43%. There was no significant difference in median survival between the chemotherapy and observation groups (P= 0.0527), but there was significant difference in the 1- and 2-year survival rate (94.71% and 76.28% vs 88.24% and 60.13%, P < 0.05). The most common site of recurrence was the brain. Twenty-six percent (39/150) of patients recurred in the brain as their first site of failure, and 22.8% (18/79) for the chemotherapy group, 29.6% (21/71) for the observation group. The median survival time for patients who developed brain metastasis was not significantly different between the chemotherapy and observation groups (812 days vs 512 days, P=0.122), but there was significant difference in the 2-year survival rate (66.7% vs 37.6%, P < 0.01). The median survival was 190 days for the patients since brain metastasis appeared.

CONCLUSIONSPostoperative adjuvant chemotherapy dose not significantly improve median survival among patients with completely resected stage IIIA-N2 NSCLC, but significantly improves the 1- and 2-year survival rate. It also dose not decrease the incidence of brain metastasis but puts off the time of brain metastasis.

OBJECTIVE To observe xerostomia and its effect on quality of life of nasopharyngeal carcinoma patients after radiotherapy and discuss related factors that may improve the patients' quality of life. METHODS Seventy-nine nasopharyngeal carcinoma patients were given a questionnaire in clinic regarding xerostomia 1 year following radiotherapy. Its severity and effect on the quality of life were studied. RESULTS Xerostomia was found in all 79 patients. Moderate to severe xerostomia occurred in 74.7 % of the patients. Of the 79 patients, 13.9 % often drank water at night, 74.7 % needed to drink water while eating, 59.5 % felt difficulties speaking and 91.1 % thought that their daily life was effected significantly. CONCLUSION The occurrence rate of xerostomia was very high in nasopharyngeal carcinoma patients after radiotherapy. 74.7 % of the patients suffered from moderate to severe xerostomia and the daily life of the 91.1 % of patients was effected significantly.