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Background Induction chemotherapy combined with neoadjuvant chemoradiotherapy has been recommended for patients with high-risk, locally advanced rectal cancer. However, the benefit of more intensive total neoadjuvant treatment (TNT) is unknown. This study aimed to assess the safety and efficacy of induction chemotherapy combined with chemoradiotherapy and consolidation chemotherapy for magnetic resonance imaging-stratified high-risk rectal cancer. Methods This was a single-center, single-arm, prospective Phase II trial in Peking University Cancer Hospital (Beijing, China). Patients received three cycles of induction oxaliplatin and capecitabine (CapeOX) followed by chemoradiotherapy and two cycles of consolidation CapeOX. The primary end point was adverse event rate and the second primary end points were 3-year disease-free survival rate, completion of TNT, and pathological downstaging rate. Results Between August 2017 and August 2018, 68 rectal cancer patients with at least one high risk factor (cT3c/3d/T4a/T4b, cN2, mesorectal fascia involvement, or extramural venous invasion involvement) were enrolled. The overall compliance of receiving the entire treatment was 88.2% (60/68). All 68 patients received induction chemotherapy, 65 received chemoradiotherapy, and 61 received consolidation chemotherapy. The Grade 3–4 adverse event rate was 30.8% (21/68). Nine patients achieved clinical complete response and then watch and wait. Five patients (7.4%) developed distant metastasis during TNT and received palliative chemotherapy. Fifty patients underwent surgical resection. The complete response rate was 27.9%. After a median follow-up of 49.2 months, the overall 3-year disease-free survival rate was 69.7%. Conclusions For patients with high-risk rectal cancer, this TNT regimen can achieve favorable survival and complete response rates but with high toxicity. However, it is necessary to pay attention to the possibility of distant metastasis during the long treatment period.

The role of HER2 overexpression in rectal cancer is controversial.To assess the role of HER2 overexpression in the long-term prognosis of rectal cancer.Data from patients with locally advanced rectal cancer who underwent total mesorectal excision after short-course radiotherapy at Beijing Cancer Hospital between May 2002 and October 2005 were collected. A total of 151 tissue samples of rectal cancer were obtained using rigid proctoscopy before neoadjuvant radiotherapy, followed by immunohistochemistry and fluorescenceA total of 151 patients were enrolled in this study. A total of 27 (17.9%) patients were ultimately confirmed to be HER2-positive. The follow-up duration ranged from 9 mo to 210 mo, with a median of 134 mo. Distant metastasis and local recurrence occurred in 60 (39.7%) and 24 (15.9%) patients, respectively. HER2 positivity was significantly associated with the pre-treatment lymph node stage (pre-N) (HER2 overexpression is a potential biomarker for predicting lymph node metastasis and distant metastasis, which are associated with worse long-term DFS and OS in rectal cancer patients with locally advanced disease.

BACKGROUND Human epidermal growth factor receptor 2 (HER2) is an oncogenic driver, and a well-established therapeutic target in breast and gastric cancers. While the role of HER2 as a prognostic biomarker in colorectal adenocarcinomas (CRCs) remains uncertain, its relevance as a therapeutic target has been established. We undertook the present study to evaluate the frequency of HER2 expression in CRC and to correlate it with various clinicopathological variables. AIM To correlate HER2 protein expression and HER2 gene amplification with clinicopathological features and survival in surgically resected CRC. METHODS About 1195 consecutive surgically resected CRCs were analyzed by immunohistochemical staining (IHC) to assess HER2 protein expression, and 141 selected tumors were further evaluated by fluorescence in situ hybridization (FISH) to assess HER2 gene amplification. Follow-up information was available for 1058 patients, and using this information we investigated the prevalence of HER2 protein overexpression and gene amplification in a large series of surgically resected CRCs, and evaluated the relationship between overexpression and clinicopathological parameters and prognosis. RESULTS HER2 IHC scores of 3+, 2+, 1+, and 0 were seen in 31 (2.6%), 105 (8.8%), 475 (39.7%), and 584 (48.9%) tumors, respectively. HER2 gene amplification was seen in 24/29 tumors with an IHC score of 3+ (82.8%; unreadable in 2/31), 12/102 tumors with an IHC score of 2+ (11.8%; unreadable in 2/104), and 0 tumors with IHC score of 1+ (0/10). HER2 gene amplification was seen in 36/1191 tumors (3.0%; unreadable in 4/1195). Among the tumors with HER2 IHC scores of 3+ and 2+, the mean percentage of tumor cells with positive IHC staining was 90% (median 100%, range 40%-100%) and 67% (median 75%, range 5%-95%), respectively (P < 0.05). Among tumors with IHC scores of 2+, those with HER2 gene amplification had a higher number of tumors cells with positive IHC staining (n = 12, mean 93%, median 95%, range 90%-95%) than those without (n = 90, mean 70%, median 50%, range 5%-95%) (P < 0.05). HER2 gene status was significantly associated with distant tumor metastasis and stage (P = 0.028 and 0.025). HER2 protein overexpression as measured by IHC or HER2 gene amplification as measured by FISH was not associated with overall survival (OS) or disease-specific survival for the overall group of 1058 patients. However, further stratification revealed that among patients with tubular adenocarcinomas who were 65 years old or younger (n = 601), those exhibiting HER2 gene amplification had a shorter OS than those without (mean: 47.9 mo vs 65.1 mo, P = 0.04). Among those patients with moderately to poorly differentiated tubular adenocarcinomas, those with positive HER2 tumor IHC scores (2+, 3+) had a shorter mean OS than those with negative HER2 IHC scores (0, 1+) (47.2 mo vs 64.8 mo, P = 0.033). Moreover, among patients with T2 to T4 stage tumors, those with positive HER2 IHC scores also had a shorter mean OS than those with negative HER2 IHC scores (47.1 mo vs 64.8 mo, P = 0.031). CONCLUSION HER2 protein levels are correlated with clinical outcomes, and positive HER2 expression as measured by IHC confers a worse prognosis in those patients 65 years old or younger with tubular adenocarcinomas.

To compare the effect of Nd:YAP laser and Hoshino's triple antibiotic paste on root canal disinfection in the treatment of pulp revascularization, and to provide reference for root canal disinfection in dental pulp revascularization.Forty immature permanent teeth diagnosed as acute or chronic periapical periodontitis were included. The periapical lesions and root development were recorded. The cases were divided into 2 groups: the control group and the Nd:YAP laser disinfection experimental group. Clinical examination and X-ray evaluation of each case were performed after treatment. Statistical analysis was performed using SPSS 19.0 software package.Two cases showed symptoms in control group 1 week after treatment, while 4 cases had symptoms in the experimental group. The clinical symptoms disappeared in the control group 2 weeks after treatment, while 1 case still had symptoms in the experimental group. There was no significant difference between the two groups (P0.05). Clinical evaluation at 18 months of follow-up showed that 2 and 3 cases had recurrent symptoms in the control group and the experimental group, respectively; continuous development of the root was noted in 12 and 10 cases on X-ray film in the control and experimental group, respectively, while 3 and 4 teeth had no obvious root development in the control and experimental group, respectively. There was no significant difference between the control group and the experimental group (P0.05).Nd:YAP laser can be used for effective root canal disinfection without obvious effect on the prognosis of dental pulp revascularization.

A two-dimensional finite element simulation model of longitudinal welded pipe is established by the nonlinear finite element software ABAQUS. Testing enlargement mould is used for the expanding experiments for the welded pipe under the laboratory condition. The expanding force, ovality and the shape are simulated and measured. Comparing the experimental and the simulated results, the values are fitted well.

Different vegetation patterns have difference influenced on the soil nutrients and the soil nutrient contents of different soil layers in the same vegetation patterns are also different in size. In this paper, we analyze the main soil nutrients of different soil layers in different vegetation patterns in Huanghuadianzi small watershed in Ao HanQI of Chifeng in China. The result shows that in different vegetation patterns, the secondary forest of natural bush have an obvious effect on the nutrient and concentration of organic; in the artificial forest, mingled forest has a better improving effect on soil than the pure forest and natural grassland has the smallest effect; in the same vegetation patterns, organic, total nitrogen present an overall reduction trend with the deepening of soil layer accept 40-60cm soil layers. The analysis result of this paper can provide a theoretical basis for further researching the dynamic nutrient change, tree variety optimization arrangement and regional land use planning in forest grass zone.

From a greenhouse gas policy standpoint, forests play an extremely important role in the exchange of carbon dioxide between the land and atmosphere. Because forest management has a potentially large effect on the entire forest carbon (C) cycle, and the biological and industrial systems are tightly coupled in the North region of China, simulation of varying management and forest product production scenarios are needed to explore trade-offs of managing forests for multiple objectives. Thus, an important consideration in management of forests is their present and future capacity to sequester C from the atmosphere. In this paper, C balance of the biological system was simulated under different management scenarios that were designed to test effects of plant configuration.

BACKGROUND In patients with colorectal cancer, a defunctioning ileostomy is commonly constructed to reduce anastomotic complications. However, many patients do not undergo a subsequent procedure to have their temporary stoma closed. OBJECTIVE This study investigated the incidence of nonclosure of ileostomies and identified factors associated with nonclosure. DESIGN This study is a retrospective analysis of prospectively collected data. SETTING This study was conducted at a tertiary referral cancer hospital. PATIENTS A total of 296 patients who received anterior resection with a defunctioning ileostomy with protective intention from 2006 to 2013 were included. MAIN OUTCOME MEASURES The primary outcomes measured were the incidence of nonclosure of ileostomy and associated risk factors. RESULTS Patients were followed for a median time of 29 months (range, 21-100 months). At the end of the study, 51 (17.2%) patients were left with a permanent ileostomy. The median time interval from the creation of a defunctioning ileostomy to closure was 192 days (range, 14-865 days). Multivariate analyses using a logistic regression model showed that metastatic diseases (OR, 0.179, p 1 (OR, 0.268; p < 0.01), and complications from the index surgery (OR, 0.391; p = 0.013) were significant independent risk factors for failing to close a defunctioning ileostomy. LIMITATIONS Although our study has a large patient cohort, it is limited by its retrospective nature. It is difficult to fully evaluate stoma complications after hospital discharge, and the prevalence may be underestimated. CONCLUSION One in 6 temporary ileostomies constructed during an elective anterior resection for rectal cancer was not closed. Patients should be told before the index surgery that there is a risk of nonclosure and possible complications associated with permanent ileostomy.

This research was conducted in Huanghuadianzi watershed in Aohan, Chifeng, Inner Mongolia. Geostatistic was used to study the spatial distribution of soil nitrogen and their affecting factors. The results showed that the soil nitrogen contents in all layers distributed as an island shape, and the high value areas were mainly distributed in the northwest of the watershed as an obvious fertile island shape, while the low value areas were mainly distributed in the south of the watershed. Nitrogen was mainly concentrated in the surface soil, and its content decreased with the increase of soil depth. The soil nitrogen content at first increased then decreased with the altitude, decreased with the slope, and showed the order of shady slopesemi-shady slopesemi-sunny slopesunny slope in different aspects. The average soil nitrogen contents in different land use types ranked as croplandwoodlandgrassland.

Comparative distribution characteristic of root system and the root system carbon stocks from three forest age of S. gordejevii in Aohan sanditificational. And three plots were set by using stratified segmentation mining method to test the root biomass and the carbon ratio in different soil assays and segment, and calculate root carbon reserves, analyzing distribution characteristics of forest root carbon stocks on different S. gordejevii in different forest ages. With the increase of soil depth, S. gordejevii root biomass presents the trend of increase first then decrease, mainly in soil of 0-100cm, which accounted for more than 80% of the total; with the increase of forest age, S. gordejevii root biomass presenting a growing trend. Root distribution of carbon stocks was in a fusiform, it increase with the increase of forest age. Results provide reference data for Sandy ecosystem carbon storage estimation.

To compare the safety and efficacy perioperatively between hand-assisted laparoscopic surgery (HALS) and conventional open sigmoidectomy.Prospectively collected data on 115 patients with sigmoid colon cancer between January 2009 to June 2010 were analyzed. There were 62 patients in the HALS group and 53 in the conventional sigmoidectomy group (CS). Patient characteristics, operative parameters, and perioperative outcomes were compared.HALS patients were similar to CS patients in age(60.2 yrs vs. 63.4 yrs, P=0.163), gender (53.2% vs. 60.4% male, P=0.441), tumor size (4.7 cm vs. 5.3 cm, P=0.114) and tumor stage. The two groups were comparable in operative time [(122.4±32.0) min vs.(126.7±37.4) min, P=0.510], lymph node harvest (15.1±4.6 vs. 16.8±6.4, P=0.163), free margin length [(4.1±1.8) cm vs.(4.3±1.7) cm, P=0.601], and postoperative complications. However, HALS group had less intraoperative bleeding [(62.6±35.4) ml vs. (168.9±137.1) ml, P=0.000], shorter time to flatus [(2.3±0.8) d vs. (3.3±1.1) d, P=0.000], and shorter hospital stay [(8.8±2.7) d vs.(12.6±8.0) d, P=0.001].HALS results in similar short-term outcomes compared to conventional surgery. HALS is safe and minimally invasive.

To evaluate the safety and efficacy of hand-assisted laparoscopic surgery (HALS) in colorectal tumors.Clinical data of 70 patients with colorectal tumors were retrospectively analyzed. All the patients had received HALS colectomy in the Beijing Cancer Hospital. Lapdisc was used for the hand port at the umbilicus. Two additional trocars were used.There were 38 males and 32 females. The median age was 61(29-89) years. Diagnoses included sigmoid cancer(n=48), sigmoid adenoma(n=4), descending colon cancer (n=3), ascending colon cancer (n=1), rectal cancer (n=13), total colectomy(n=1). The operative time was (126.0±22.5) minutes. The intraoperative blood loss was (75.0±18.8) ml. The mean number of lymph node dissection was(16.8±4.2). The median postoperative hospital stay was 9.4 days. There were no perioperative deaths. One patient developed anastomotic stricture and two anastomotic leak, all of which were successfully managed with conservative treatment.HALS is a safe and effective technique for colectomy.

To address the difference of pathologic and clinical characteristics of the young and the middle-aged and elderly patients with advanced rectal cancer after neoadjuvant radiotherapy.A total of 252 patients undergoing radical surgery from January 2000 to January 2005 were included in this study. The patients were divided into two groups according to the age at diagnosis:young-patient group (40 years) and old-patient group (≥ 40 years). The pathologic and clinical materials were collected and the oncologic outcome was compared between the two arms.A total of 252 patients were included in this study, included 54 patients in young-patient group and 198 patients in old-patient group, respectively. There was no significant difference in gender, clinical stage and pretreatment serum carcinoembryonic antigen (CEA) between the two groups. However, the proportion of mucinous and signet-ring cell cancer was significantly higher in young-patient group (20.4% vs. 4.0%, P0.05), and furthermore, the proportion of pathologic stage later than IIIA was also significantly higher in the young-patient group (61.1% vs. 42.9%, P0.05). There was no significant difference in local recurrence rate between the patients who received neoadjuvant radiotherapy and those who did not in the young-patient group, whereas the difference was observed significant in the old-patient group (3.3% vs. 11.2%, P0.05). There was no significant difference in both the disease free survival and overall survival between the two arms (5y-DFS: 63.3% vs. 68.5%, P0.05; 5y-OS: 73.5% vs. 72.9%, P0.05).Rectal cancer in young patients has poorer histologic differentiation and more advanced pathologic stage, but the long-term survival is similar to that in middle-aged and elderly patients. The local control effect of neoadjuvant radiotherapy on rectal cancer in young patients still need to be further investigated.

To investigate the occult lymph node metastasis in the middle and lower third rectal cancer after neoadjuvant radiotherapy.From June 2003 to December 2006, 74 rectal cancer patients received neoadjuvant radiotherapy (30 Gy/10 f/2 w, CACA-CRC-001) and underwent total mesorectal excision (TME) two weeks later. Fat clearance technique was used in all the samples. Occult lymph node metastasis was detected in the mesorectum using the anti-CK antibody.In total 1883 retrieved lymph nodes, 172 metastasis lymph nodes were harvested by HE examination with the mean diameter [(4.9+/-2.6) mm] being larger than that (2.7+/-1.4) mm of the 1711 negative nodes (P0.01). In HE negative nodes, occult metastasis was found in 40 lymph nodes (2.33%) from 24 patients. Most of these nodes were less than 5 mm (90.0%) with a mean diameter of (3.2+/-1.2)mm, smaller than those of HE-positive metastasis nodes (P0.01). Occult metastasis was found in 23.1% (9/39) of HE-negative patients. Occult metastasis incidence was higher in patients with HE-positive nodes (42.8%,P0.01). No correlation of lymph node occult metastasis with tumor differentiation, age, or surgical procedures was found. There was no significant difference in recurrence-free survival between ypN(0) patients with and without occult metastasis (P=0.157).It is not necessary to include occult lymph node metastasis in the TNM staging in patients with ypN(0) rectal cancer.

To assess the correlation between micrometastasis in mesorectum and pathological factors after total mesorectal excision(TME) in lower rectal cancer.All lymph nodes were obtained by fat clearance from 31 lower rectal cancer patients with TME. The lymph nodes which had previously been considered negative of metastasis by conventional examination were submitted to immunohistochemical examination to identify the micrometastases using anti-cytokeratin antibody. The correlation between micrometastasis and pathological factors were analyzed.One thousand and seven LNs were collected from 31 patients. One hundred and five LNs were found positive by conventional examination, and the mean diameter was (5.5 +/- 3.1) mm. The mean diameter of conventional negative LNS was (2.8 +/- 1.5) mm. The diameter differed significantly between conventional positive and negative LNS (P0.05). In 902 conventional negative LNs, 26 contained micrometastasis (209%) and the mean diameter was (3.3 +/- 1.2) mm. The diameter of LNs with micrometastasis was significantly smaller than that of conventional positive LNs (P0.05). The diameter of most of the micrometastatic LNs(88.5%) was less than 5 mm. Fourteen patients (38.7%) contained micrometastasis. The pathological stage, serum carcinoembryonic antigen level and tumor differentiation were related to micrometastasis (P0.05).With the detection of micrometastasis after fat clearance, we can estimate the LN metastasis status more accurately. It can be useful in clinical staging and individual treatment of rectal cancer.

To explore a specific diagnostic method for local recurrent rectal cancer.Immunoscintigraphy with (99m)Tc-labeled anti-CEA monoclonal antibody (MoAb) CL-58 was performed for patients suspected of having a postoperative local recurrent rectal cancer and the findings were compared with the results of conventional imaging and pathology.A total of 36 patients with a suspected local recurrent rectal cancer underwent immunoscintigraphy with (99m)Tc-conjugated CL58. Local recurrence of rectal cancer was identified in 31 patients and established in 30 during operation, endoscopy and pathological examination. No local recurrence was found in 5 patients without specific accumulation of (99m)Tc during the follow-up. Immunoscintigraphy had a positive rate of 86.11%, a specificity of 83.33%, and a sensitivity of 100%.Immunoscintigraphy has a highly specific and predictive value for detecting local recurrent rectal cancer, especially after abdominal perineal resection (APR).

In this work, a new and highly degradation efficiency Fenton-like catalyst based on Fe3O4 magnetic nanoparticles decorated with graphene oxide (GO) was successfully prepared and used to remove Rhodamine B (RhB) from aqueous solution. The Fe3O4-GO nanocomposites were characterised by X-ray diffraction (XRD), scanning electron microscopy (SEM), transmission electron microscopy (TEM) and Fourier transform infrared spectrometer (FTIR), respectively. The effects of catalyst dosage, H2O2 adding amount and pH on the degradation rate of RhB were also investigated. When 0.2 g/L of Fe3O4-GO was introduced to RhB solution (10 mg/l, 100 ml), about 95% RhB was degraded within 60 min under optimisation condition. Comparing with bare Fe3O4 nanoparticles, the degradation rate of Fe3O4-GO nanocomposites was much higher at the same reaction condition. Moreover, the Fe3O4-GO nanocomposites were demonstrated to have excellent reusability and could be easily separated from the aqueous solution by an external magnetic field. Therefore, the Fenton-like catalyst is potentially usable for degrading dyes in the field of environmental protection.