Clinical decision-making has been perceived as a primary cognitive activity for clinicians in daily practice,which based on the process of choosing between alternatives or options for patients.A single clinical decision might affect one patient's health outcomes,while the sum of clinical decisions made by all clinicians would play a decisive role in the allocation and utilization of health resources.Several dimensions should be taken into consideration when making clinical decisions,such as scientificity,clinical experience,economical status,medical humanities and government administration.In addition,clinical decision-making behavior should be administrated and guided by government,from the following seven aspects,so as to avoid "scientism" or " commercial alienation" phenomenon:national guidelines and standards development,academic standardization,expertise offering,medical training with human factors as well as legal punishment,medical knowledge accessibility,reimbursement restriction,and application of artificial intelligence.

A proportion of patients with locally advanced rectal cancer will achieve clinical complete response (cCR) or pathologic complete response (pCR) after neoadjuvant chemoradiotherapy. With the proposal of the concept of total neoadjuvant therapy (TNT), higher complete response rates will be observed. The management of patients with cCR has long been an issue of controversy and is attractive for clinical trials. A "watch and wait" strategy for patients with cCR has been put forward by some scholars. A non-operative approach can preserve the organfunction and avoid complications after radical surgery. The safety and feasibility of a "watch and wait" strategy have been established in several non-randomized controlled studies. There is no consensus on how to make an optimal decision for patients with cCR. For example, it is only observed in partial patients that cCR is consistent with pCR and the molecular biomarkers for predicting pCR are suboptimal. Besides, cCR is inconsistently defined and surveillance recommendations varies. Furthermore, there are insufficient high-level evidence for the "watch and wait" strategy. For patients with good response after chemoradiotherapy, local excision is an attractive alternative to total mesorectal excision, however with uncertain indications and challenged oncological safety. For patients with cCR, we implement the therapeutic principles of goal-orientation, layered treatment and the whole process management.

A proportion of patients with locally advanced rectal cancer will achieve clinical complete response (cCR) or pathologic complete response (pCR) after neoadjuvant chemoradiotherapy. With the proposal of the concept of total neoadjuvant therapy (TNT), higher complete response rates will be observed. The management of patients with cCR has long been an issue of controversy and is attractive for clinical trials. A "watch and wait" strategy for patients with cCR has been put forward by some scholars. A non?operative approach can preserve the organfunction and avoid complications after radical surgery. The safety and feasibility of a "watch and wait"strategy have been established in several non?randomized controlled studies. There is no consensus on how to make an optimal decision for patients with cCR. For example, it is only observed in partial patients that cCR is consistent with pCR and the molecular biomarkers for predicting pCR are suboptimal. Besides, cCR is inconsistently defined and surveillance recommendations varies. Furthermore, there are insufficient high ? level evidence for the "watch and wait"strategy. For patients with good response after chemoradiotherapy, local excision is an attractive alternative to total mesorectal excision, however with uncertain indications and challenged oncological safety. For patients with cCR, we implement the therapeutic principles of goal?orientation, layered treatment and the whole process management.

A proportion of patients with locally advanced rectal cancer will achieve clinical complete response (cCR) or pathologic complete response (pCR) after neoadjuvant chemoradiotherapy. With the proposal of the concept of total neoadjuvant therapy (TNT), higher complete response rates will be observed. The management of patients with cCR has long been an issue of controversy and is attractive for clinical trials. A "watch and wait" strategy for patients with cCR has been put forward by some scholars. A non?operative approach can preserve the organfunction and avoid complications after radical surgery. The safety and feasibility of a "watch and wait"strategy have been established in several non?randomized controlled studies. There is no consensus on how to make an optimal decision for patients with cCR. For example, it is only observed in partial patients that cCR is consistent with pCR and the molecular biomarkers for predicting pCR are suboptimal. Besides, cCR is inconsistently defined and surveillance recommendations varies. Furthermore, there are insufficient high ? level evidence for the "watch and wait"strategy. For patients with good response after chemoradiotherapy, local excision is an attractive alternative to total mesorectal excision, however with uncertain indications and challenged oncological safety. For patients with cCR, we implement the therapeutic principles of goal?orientation, layered treatment and the whole process management.

OBJECTIVETo examine the association of preoperative carcinoembryonic antigen (CEA) level with the efficacy of neoadjuvant radiochemotherapy and postoperative metastasis and relapse in patients with rectal cancer.

METHODSBetween January 2011 and January 2014, 325 patients with local advanced rectal cancer underwent preoperative radiochemotherapy and radical operation in Department of Colorectal Cancer Surgery, Beijing University Cancer Hospital, including 194 males and 131 females. According to preoperative MRI, all the patients suffered from clinical T3-4 tumors or positive lymph nodes. Their Zubrod-ECOG-WHO score was 0-1. These patients received preoperative intensity modulated radiotherapy which consisted of 50.6 Gy in 22 fractions (IMRT GTV 50.6 Gy/CTV 41.8 Gy/22 f) with capecitabine(825 mg/m, twice per day) as radiosensitizer. According to the preoperative serum CEA level, patients were divided into high group (125 cases) and normal group (200 cases). In high group, serum CEA level decreased into normal range in 60 patients (high-normal group) after radiochemotherapy, while it was still in high level in other 65 patients (high-high group). The differences in sensitivity to radiochemotherapy and 3-year disease free survival (DFS) of these patients were both evaluated.

RESULTSIn high group and normal group, the complete response rates were 18.4% (23/125) and 17.5% (35/200) (χ=0.319, P=0.660); the percentages of tumor regression grade(TRG) 0-1 patients were 68.0%(85/125) and 67.5%(135/200)(χ=0.009, P=0.925); the T downstage rates were 63.2%(79/125) and 70.0%(140/200)(χ=1.266, P=0.274), respectively, whose differences were all not significant. The 3-year DFS rate in high group was 62.4%, which was significantly lower than 93.5% in normal group (χ=53.147, P=0.000). There were 65 patients in high-high group, accounting for 52% (65/125) of high group. Among these 65 patients, 44(67.7%) presented recurrence and metastasis within 3 years and the 3-year DFS was 32.3%, which was much lower than 95.0% of 60 patients in high-normal group(χ=182.085, P=0.000).

CONCLUSIONSPreoperative serum CEA level may not be used to predict tumor response of rectal cancer patients who receive preoperative radiochemotherapy. However, the prognosis of patients with high CEA level is worse. Recurrence and metastasis are more likely to occur in patients with high CEA level after radiochemotherapy.

Adult ; Aged ; Biomarkers, Tumor ; blood ; Carcinoembryonic Antigen ; blood ; Chemoradiotherapy ; statistics & numerical data ; Digestive System Surgical Procedures ; statistics & numerical data ; Disease-Free Survival ; Female ; Humans ; Male ; Middle Aged ; Neoadjuvant Therapy ; statistics & numerical data ; Neoplasm Metastasis ; prevention & control ; Neoplasm Recurrence, Local ; prevention & control ; Predictive Value of Tests ; Prognosis ; Rectal Neoplasms ; drug therapy ; mortality ; surgery ; Survival Rate

Objective Long-chain triacylglycerol (LCT) by three producers,each mixed with the same medium-chain triacylglycerol (MCT),were compared with the brand MCT/LCT in causing focal necrosis of hepatocytes in beagle dogs (a bioequivalence evaluation).Methods 21 beagle dogs (male,0.7-1.5 years old,10-15 kg) were used in this study.According to the sources of the LCT,the animals were divided into Group A (LCT made in China),Group B (LCT made in Japan),Group C (LCT made in Germany),and the control group (the brand 10％ MCT/LCT).Central venous port was placed via the lumber vein of the animals under general anesthesia.After 2 weeks of rehabilitation,MCT/LCT was administered through this port for 28 days at 9 g/ (kg · d) [while the routine dose used clinically was 1 g/ (kg · d)].The laboratory indexes and the pathomorphism of the liver and kidney were studied single blindly.Results Laboratory tests,including liver and kidney function,blood coagulation function and lipid metabolism,did not identify differences among emulsions with different sources of LCT.Liver biopsy at day 28 showed no focal necrosis in Group C and the control group;there was minor damage in Group B;and Group A had obvious liver necrosis.and the pathological findings of other organs are similar.No significant difference was observed in biopsies of other organs.Conclusions Emulsions with different sources of LCT varied in their damage to the liver.Generics with LCT of higher quality were equivalent to the brand MCT/LCT in terms of safety.

Objective To investigate the quality of life before and after the protective neostomy of patients with rectal cancer undergoing neoadjuvant radiotherapy.Methods A total of 81 cases with low rectal cancer were selected between March 201 2 and March 201 4 from the Colorectal Surgery Center of Beijing Cancer Hospital.Experimental group contained 40 cases of low rectal cancer with protective neostomy after neoadjuvant the rapyand control group contained 41 cases of low rectal cancer undergoing permanent colostomy.The life quality of patients in two groups were surveyed via questionnaire at 6th month after permanent colostomy,before and 6th month after protective neostomy.The differences between two groups were analyzed.Results The life-quality of the patients with low rectal cancer who received neoadjuvant therapy and protective neostomy were better than the patients with permanent colostomy (P <0.05).However,the quality of life was not significantly improved after the apotheosis of ileal stoma.Conclusions The life-quality of patients with low rectal cancer are not significantly improved by performing protective neostomy.Specific nursing measures should be carried out at these patients.

OBJECTIVETo compare the perioperative safety and efficacy between hand-assisted laparoscopic surgery(HALS) and conventional open sigmoidectomy.

METHODSA total of 291 patients with sigmoid colon cancer who underwent surgery in our hospital from January 2010 to June 2013 were seperated into (HALS) group (n=200) and conventional open surgery (COS) group (n=91) with a non-randomized method. The perioperative safety and efficacy of two groups and perioperative outcomes were compared.

RESULTSThese two groups were comparable in operative time, lymph node harvest, and postoperative complications. However, HALS group had less intraoperative bleeding [(57.9±28.3) ml vs. (82.5±47.6) ml, P=0.000], shorter time to flatus [(3.0±1.4) d vs. (3.3±0.9) d, P=0.000], and shorter hospital stay [(7.3±4.2) d vs. (8.9±4.4) d, P=0.004]. There werer no significant differences in overall survival time and disease-free survival time between the two groups during 6 months to 3 years follow-up.

CONCLUSIONSHALS results in similar outcomes of conventional open surgery for sigmoidectomy with the advantage of minimal invasiveness.

Colectomy ; Disease-Free Survival ; Hand-Assisted Laparoscopy ; Humans ; Length of Stay ; Lymph Nodes ; Operative Time ; Postoperative Complications ; Postoperative Period ; Prospective Studies ; Sigmoid Neoplasms ; Treatment Outcome

Objective To compare the perioperative safety and efficacy between hand-assisted laparoscopic surgery (HALS) and conventional open sigmoidectomy. Methods A total of 291 patients with sigmoid colon cancer who underwent surgery in our hospital from January 2010 to June 2013 were seperated into (HALS) group (n=200) and conventional open surgery (COS) group (n=91) with a non-randomized method. The perioperative safety and efficacy of two groups and perioperative outcomes were compared. Results These two groups were comparable in operative time, lymph node harvest, and postoperative complications. However, HALS group had less intraoperative bleeding [(57.9±28.3) ml vs. (82.5±47.6) ml, P=0.000], shorter time to flatus[(3.0±1.4) d vs. (3.3±0.9) d, P=0.000], and shorter hospital stay[(7.3±4.2) d vs. (8.9±4.4) d, P=0.004]. There werer no significant differences in overall survival time and disease-free survival time between the two groups during 6 months to 3 years follow-up. Conclusions HALS results in similar outcomes of conventional open surgery for sigmoidectomy with the advantage of minimal invasiveness.

Objective To compare the perioperative safety and efficacy between hand-assisted laparoscopic surgery (HALS) and conventional open sigmoidectomy. Methods A total of 291 patients with sigmoid colon cancer who underwent surgery in our hospital from January 2010 to June 2013 were seperated into (HALS) group (n=200) and conventional open surgery (COS) group (n=91) with a non-randomized method. The perioperative safety and efficacy of two groups and perioperative outcomes were compared. Results These two groups were comparable in operative time, lymph node harvest, and postoperative complications. However, HALS group had less intraoperative bleeding [(57.9±28.3) ml vs. (82.5±47.6) ml, P=0.000], shorter time to flatus[(3.0±1.4) d vs. (3.3±0.9) d, P=0.000], and shorter hospital stay[(7.3±4.2) d vs. (8.9±4.4) d, P=0.004]. There werer no significant differences in overall survival time and disease-free survival time between the two groups during 6 months to 3 years follow-up. Conclusions HALS results in similar outcomes of conventional open surgery for sigmoidectomy with the advantage of minimal invasiveness.