Rectal cancer classification is important to determine the preoperative chemoradiation therapy and to select appropriate surgical technique. We reviewed the Western and Japanese rectal cancer classification and we pro...Rectal cancer classification is important to determine the preoperative chemoradiation therapy and to select appropriate surgical technique. We reviewed the Western and Japanese rectal cancer classification and we propose our new classification based of Magnetic resonance imaging(MRI). We determine the relation of the tumor to fixed parameters in MRI, which areperitoneal reflection and levator ani muscle. Then, we classify the rectal cancer into four levels based on tumor distal margin and invasion to MRI parameters. We applied all three classifications to 60 retrospectively collected patients of different rectal cancer distance and we compared our classifications to the others. Based on each level we standardize our surgical approach. For stages Ⅰ-Ⅲ, We found that level Ⅰ where tumor distal margin is located above the peritoneal reflection and all of them were received low anterior resection(LAR) without chemoradiation. Level Ⅱ where tumor distal margin is located from the peritoneal reflection and above the levator ani insertion on the rectum. 90% of them were received LAR ± chemoradiation. Level Ⅲ where tumor distal margin is located at the level of levator ani insertion or invading any part of the levator ani. 60% of them had ULAR + coloanal anastomosis ± chemoradiation. Level Ⅳ where the tumor distal margin is located below the levator ani insertion; 77% were received APR ± chemoradiation. The overall kappa for all levels between surgeons and radiologist was 0.93(95%CI: 0.87-0.99), which is indicating almost perfect agreement. We concluded that the management of rectal tumors differed among each tumor level and our new MRI based classification might facilitate the prediction of surgical and chemoradiation management with better communication among a multidisciplinary team comparing to other classifications.展开更多
As is known to all, vocabulary acquisition plays an essential role in English learning. However, it was supposed very difficult to many Chinese learners. For the reason that so many kinds of approaches exists in the r...As is known to all, vocabulary acquisition plays an essential role in English learning. However, it was supposed very difficult to many Chinese learners. For the reason that so many kinds of approaches exists in the real life, English learners are always do not know which one is suitable and more effective. To solve this problem, the paper will analyze two approaches (point approach and phrase approach) for you.展开更多
The Hubei provincial governmentcommenced officially on March 18ththe trade of emission permit for keypollutants in Wuhan Optics ValleyUnited Properties Rights.The basicprices for COD and sulfur dioxide emissionpermit ...The Hubei provincial governmentcommenced officially on March 18ththe trade of emission permit for keypollutants in Wuhan Optics ValleyUnited Properties Rights.The basicprices for COD and sulfur dioxide emissionpermit were settled at RMB2 000per ton and RMB1 600 per tonrespectively.The Hubei Environmental ProtectionAdministration Bureau announcedthat the new projects approved,if展开更多
文摘Rectal cancer classification is important to determine the preoperative chemoradiation therapy and to select appropriate surgical technique. We reviewed the Western and Japanese rectal cancer classification and we propose our new classification based of Magnetic resonance imaging(MRI). We determine the relation of the tumor to fixed parameters in MRI, which areperitoneal reflection and levator ani muscle. Then, we classify the rectal cancer into four levels based on tumor distal margin and invasion to MRI parameters. We applied all three classifications to 60 retrospectively collected patients of different rectal cancer distance and we compared our classifications to the others. Based on each level we standardize our surgical approach. For stages Ⅰ-Ⅲ, We found that level Ⅰ where tumor distal margin is located above the peritoneal reflection and all of them were received low anterior resection(LAR) without chemoradiation. Level Ⅱ where tumor distal margin is located from the peritoneal reflection and above the levator ani insertion on the rectum. 90% of them were received LAR ± chemoradiation. Level Ⅲ where tumor distal margin is located at the level of levator ani insertion or invading any part of the levator ani. 60% of them had ULAR + coloanal anastomosis ± chemoradiation. Level Ⅳ where the tumor distal margin is located below the levator ani insertion; 77% were received APR ± chemoradiation. The overall kappa for all levels between surgeons and radiologist was 0.93(95%CI: 0.87-0.99), which is indicating almost perfect agreement. We concluded that the management of rectal tumors differed among each tumor level and our new MRI based classification might facilitate the prediction of surgical and chemoradiation management with better communication among a multidisciplinary team comparing to other classifications.
文摘As is known to all, vocabulary acquisition plays an essential role in English learning. However, it was supposed very difficult to many Chinese learners. For the reason that so many kinds of approaches exists in the real life, English learners are always do not know which one is suitable and more effective. To solve this problem, the paper will analyze two approaches (point approach and phrase approach) for you.
文摘The Hubei provincial governmentcommenced officially on March 18ththe trade of emission permit for keypollutants in Wuhan Optics ValleyUnited Properties Rights.The basicprices for COD and sulfur dioxide emissionpermit were settled at RMB2 000per ton and RMB1 600 per tonrespectively.The Hubei Environmental ProtectionAdministration Bureau announcedthat the new projects approved,if
