Lung cancer is considered as the leading cause of cancer-related mortality worldwide. Non-small cell lung cancer (NSCLC) accounts for about 85% of primary lung cancer. Owing to the improved utilization of medical technological level and the popularization of health examinations, the detection rate of early-stage NSCLC is gradually increasing. The main treatment modalities for early-stage NSCLC are surgical resection and adjuvant chemotherapy. Platinum-based chemotherapy is recommended as the standard postoperative adjuvant treatment for patients with completely resected stageⅡ-ⅢA NSCLC. However, adjuvant therapy remains a controversial option in stageⅠB NSCLC. This review focuses on postoperative adjuvant therapy such as adjuvant chemotherapy, targeted therapy, and immunotherapy for completely resected stageⅠB NSCLC. Moreover, the biomarkers and prognostic factors of high-risk patients are discussed.

Oropharyngeal cancer (OPC) is one of the head and neck cancers. According to epidemiological data, the incidence and mortality of OPC in China are increasing. In addition to tobacco and alcohol, human papillomavirus (HPV) has been proved to be one of the causes of OPC. Chinese scholars have also confirmed the correlation between HPV and OPC in China, but the proportion of HPV infection in OPC in China still needs a larger sample. Because lots of studies have shown that the efficacy and prognosis of HPV-related OPC are better, the treatment of this type of patients is the current research hotspot. Meanwhile, HPV vaccine and the screening method for HPV infection in the oropharynx or oral cavity of the population deserve further research.

Medulloblastoma (MB) is the most prevalent pediatric brain tumor. Group3 MB is the most malignant subgroup, quiet a part of which are MYC-amplified. Blocking the upstream gene sites of MYC is mainly achieved through the blockade of miR-494, DDX3, NOTCH1 pathway; BETi or ATR/Chk1 double-inhibition realizes the inhibition of duplication or transcription of MYC; as to the blockade of downstream genes of MYC, researchers mainly focus on LDHA, SETD8 and EZH2. All of these researches which target on MYC-amplified associated anti-tumor treatment mechanism present the theoretical basis for anti-MYC-associated medulloblastoma clinically.

Extranodal NK/T-cell lymphoma (ENKTL) is a rare, invasive extra nodal non-Hodgkin's lymphoma (NHL) that is commonly associated with Epstein-Barr virus (EBV). ENKTL is the commonest to men with no apparent immunodeficiency in Asia and South America. Except for EBV, no environmental or external factors are associated with tumorigenesis. The precise mechanism by which EBV infects NK or T cells and the role of the virus in the pathogenesis of ENKTL has not been fully deciphered. However, many recent discoveries have been identified, including disorders of cell signaling and mutations in tumor suppressor genes, which provide insight into the pathogenesis of ENKTL. Moreover, NK/T cell non-Hodgkin's lymphoma generally has a poor prognosis, and research on its prognostic factors is still ongoing. This article focuses on the pathogenesis and prognostic factors of ENKTL, and attempts to provide direction for improving patient outcomes.

Objective To explore the application effects of nursing team in patients with acute multiple trauma in multiple disciplinary team (MDT) model. Methods A convenient sampling method was used to select 82 patients with multiple injuries who were treated since the establishment of the trauma center in the First Affiliated Hospital of Zhengzhou University from July 2016 to June 2018. From July 2014 to June 2016, a total of 55 patients with multiple trauma before the establishment of the trauma center were seclected as the control group. The experimental group was used MDT model for rescue, and the control group was used traditional model for rescue. The doctors' arrival time, emergency examination time, emergency stay time, rescue success rate and postoperative complication rate of the specialists in the two groups were compared. Results The doctors' arrival time in the experimental group was (16.80±3.57) min, the time of emergency examination was (22.36±3.49) min, and the time of emergency stay was (38.19±8.18) min, which was shorter than those of the control group (23.27±5.76), (45.69±7.75), (55.49±13.67) min, the differences between the two groups were statistically significant (P＜0.01). The successful rescue rate of the treatment group was 96.3% (79/82), which was higher than 87.3% (48/55) of the control group. The difference between the two groups was statistically significant (P＜ 0.05). The postoperative complication rate was 3.7% (3/82) in the experimental group and 12.7% (7/55) in the control group, the difference between the two groups was statistically significant (P＜ 0.05). Conclusions Patients with multiple trauma received treatment with MDT model can effectively shorten the time of doctors' arrival, emergency examination time, emergency stay time, improve the success rate of treatment, and reduce the incidence of postoperative complications.

Currendy,the incidence of breast cancer ranks first at home and abroad of female cancer and the age of onset tends to be younger.Due to the local changes of the tumor residual cavity after the breast conserving surgery,we can't accurately delineate the irradiation range using traditional breast conserving surgery combined with external irradiation of whole breast and tumor bed plus the amount,and the course of treatment is longer.Intra-operative radiation therapy(IORT) can avoid the impact of respiratory motion and postural changes.Meanwhile,it can immediately irradiate the tumor bed during operation accurately.For patients,IORT can shorten the cycle of radiotherapy and reduce irradiation on the skin and subcutaneous tissue.So IORT is convenient,easy to be accepted,and has relatively few complications,good cosmetic results and so on.In recent years,more and more Cancer Center choose breast conserving surgery combined with IORT for treatment of early stage breast cancer and make relative researches in terms of the indications,methods,dosage,efficacy and prognosis of IORT.

OBJECTIVETo explore the factors affecting the operative difficulty of triple-port laparoscopic surgery (TLS) in anterior resection.

METHODSA retrospective case-control study was carried out. Clinical and MRI imaging data of 106 colorectal cancer cases undergoing TLS anterior resection at Department of Colorectal Surgery of Ruijin Hospital between 2013 and 2016 were retrospectively analyzed.

INCLUSION CRITERIA(1) patients receiving TLS anterior resection (Dixon operation); (2) preoperative stageI( to III( malignant tumor;(3) distance of 5-15 cm from inferior margin of tumor to anal verge; and (4) available preoperative rectal MRI.

EXCLUSION CRITERIA(1) patients receiving preoperative adjuvant therapy; (2) patients with low rectal cancer or with local advanced disease; (3) T4b tumor. Rectal MRI was introduced to measure the structure of pelvis. In sagittal view, superior margin of the first sacral vertebrae, superior margin of the third sacral vertebrae, apex of coccyx, and the line of superior margin of pubic symphysis were used to form a pentagon. The 5 lines were marked as N, O, P, Q, R, and the 5 included angles were marked as angle 1, 2, 3, 4, 5. Organs (uterus and prostate) and tumor (transverse diameter, longitudinal diameter, section area, lesion length, distance to circumference cutting edge) were also measured on MRI. The operative time was applied to be the indicator of operative difficulty and patients were divided into 2 groups according to median operative time. Baseline information (age, gender, BMI, distance from inferior margin of tumor to anal verge, operative history, length of tumor), preoperative tumor staging, and MRI measurements (pelvis, tumor, uterus, prostate), etc were compared between two groups. Factors affecting operative difficulty of TLS were analyzed with logistic regression model.

RESULTSOf 106 enrolled patients, 73 were male and 33 female with mean age of (59.8±12.2) years and mean BMI of (22.8±3.3) kg/m; 25 patients had previous abdominal surgery; distance from inferior margin of tumor to anal verge was (7.4±2.0) cm and the tumor diameter was (3.7±1.4) cm; 24, 36 and 46 patients were in stage I(, II( and III( respectively. All operations were completed successfully. The median number of harvested lymph node was 13(11-16); the median length of distal resection margin was 2.5(2.0-3.1) cm; the median operative time was 2.0(1.5-2.6) hours; the median intraoperative blood loss was 50(0-100) ml; the median time to liquid diet was 4(3-5) days; the median hospital stay was 7(6-10) days. Ten cases (9.4%) developed complications within 30 days after surgery. Patients were divided into ≤2 h group and > 2 h group according to median operative time, and both groups had 53 patients. As compared to ≤2 h group, >2 h group had shorter distance from inferior margin of tumor to anal verge [(6.8 ± 1.5) cm vs. (8.0 ± 2.4) cm, t = 3.174, P = 0.004], lower ratio of (R+N)/(O+P)(1.61±0.27 vs. 1.73±0.19, t = 2.494, P = 0.014), larger transverse distance of tumor [(3.45±0.72) cm vs. (3.05±0.89) cm, t = 0.224, P = 0.027]. Multivariate logistic regression analysis showed the distance from inferior margin of tumor to anal verge was the independent factor affecting operative difficulty(OR=0.584, 95%CI:0.429-0.796, P = 0.001).

CONCLUSIONSSurgeons may have less difficulty in performing TLS anterior resection for patients with longer distance from inferior margin of tumor to anal verge. In preoperative assessment of operative difficulty of TLS, comprehensive evaluation should be performed. Distance from inferior margin of tumor to anal verge should be regarded as the main factor, and MRI (R+N)/(O+P) and transverse diameter of tumor should be used as important reference, leading to reasonable choice of cases for TLS and smooth pass of study curve.

Aged ; Anal Canal ; Case-Control Studies ; Female ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Rectal Neoplasms ; diagnostic imaging ; surgery ; Retrospective Studies ; Treatment Outcome

Currently,the incidence of breast cancer ranks first at home and abroad of female cancer and the age of onset tends to be younger.Due to the local changes of the tumor residual cavity after the breast conserving surgery,we can't accurately delineate the irradiation range using traditional breast conserving surgery combined with external irradiation of whole breast and tumor bed plus the amount,and the course of treatment is longer.Intra-operative radiation therapy (IORT) can avoid the impact of respiratory motion and postural changes.Meanwhile,it can immediately irradiate the tumor bed intraoperative accurately.For patients,IORT can shorten the cycle of radiotherapy and reduce irradiation on the skin and subcutaneous tissue.So IORT is convenient,easy to be accepted,and it has relatively few complications,good cosmetic results and so on.In recent years,more and more Cancer Center choose breast conserving surgery combined with IORT for the treatment of early stage breast cancer and do researches to the indications,methods,dosage,efficacy and prognosis of IORT.

Objective To analyze the discrepancies between position adjustments obtained with the stereoscopic 2DKV XGS-10 system and the Varian OBI system for head-and-neck region IMRT treatments,and to compare for image acquisition and registration time.Methods CBCT images were obtained with OBI system and 2DKV images were acquired by XGS-10 system for 30 head-and-neck patients prior to Varian21EX IMRT treatment.The images were registered with planning image for localization,and position adjustments were given in LR,SI and AP directions,then the discrepancies between them were analyzed.On the comparison of the two different systems,the Pearson coefficient was used to analyzed the correlation and 95％ CI analysis to discern the consistence.Results Analysis of images acquired for the 30 patients yielded the following results:position adjustments with XGS-10 system were (-1.03 ± 2.15) mm,(0.86 ± 2.59) mm,(0.42 ± 1.66) mm in LR,SI and AP directions,whereas (0.00 ± 1.68) mm,(1.53 ± 2.12) mm,(0.10 ± 1.54) mm with CBCT in LR,SI and AP directions.The discrepancies were (-1.03 ± 1.24) mm,(-0.68 ± 1.78) mm and (0.32±1.61) mm in LR,SI and AP directions.The correlation coefficients between them were 0.817,0.731 and 0.495 in LR,SI and AP directions.95％ CI were (-1.47--0.59),(-1.32-0.04),(-0.26-0.90) mm.The average image acquisition and registration time were 10 s and ＜ 15 s in XGS-10 system,with 3 min and 8 min in OBI system.Conclusions Both of XGS-10 system and OBI system could be used to improve patient position accuracy,but XGS-10 system could cut down the total time.

Objective To evaluate the application value of domestic image‐guided radiotherapy system XGS‐10 made in Weidu medical company limited in intensity‐modulated radiotherapy for nasopharyngeal carcinoma .Methods A total of 30 nasopharyngeal carcinoma cases with intensity modulated radiatiotherapy by Varian accelerator were incorporated into the study .All patients ac‐cepted image‐guided radiotherapy system XGS‐10 of Chongqing Weidu medical company limited to obtain frontal images and CBCT to obtain CT images respectively .The images were matched with the planning images and target center ,then got the linear set‐up errors of left to right (X) ,superior to inferior (Y) ,and anterior to posterior (Z) ,and the time of acquiring and matching was recor‐ded .Results The correlation of both two instruments′setup errors in X ,Y ,Z direction is good ,the difference of setup errors was within the acceptable range ,and was not statistically significant (P>0 .05) .the time of acquiring images was (15 ± 2)s and that of matching images was (20 ± 2)s by XGS‐10 ;the time of acquiring images was (120 ± 8)s and that of matching images was (240 ± 10)s by Varian CBCT .Conclusion The setup error of XGS‐10 of intensity‐modulated radiotherapy for nasopharyngeal carcinoma was equal to CBCT ,but the time of acquiring and matching time of XGS‐10 was shorter than that of CBCT ,which could shorten the positioning time and reduce radiation dose for patient .As a result ,it is conducive to real‐time clinical radiotherapy guidance .