Non-operative management of rectal cancer: Highlighting the controversies

There remains much ambiguity on what non-operative management(NOM)of rectal cancer truly entails in terms of the methods to be adopted and the best algorithm to follow.This is clearly shown by the discordance between various national and international guidelines on NOM of rectal cancer.The main aim of the NOM strategy is organ preservation and avoiding unnecessary surgical in-tervention,which carries its own risk of morbidity.A highly specific and sensitive surveillance program must be devised to avoid patients undergoing unnecessary surgical interventions.In many studies,NOM,often interchangeably called the Watch and Wait strategy,has been shown as a promising treatment option when undertaken in the appropriate patient population,where a clinical complete res-ponse is achieved.However,there are no clear guidelines on patient selection for NOM along with the optimal method of surveillance.

Controversies regarding transplantation of mesenchymal stem cells

Mesenchymal stem cells(MSCs)have tantalized regenerative medicine with their therapeutic potential,yet a cloud of controversies looms over their clinical tran-splantation.This comprehensive review navigates the intricate landscape of MSC controversies,drawing upon 15 years of clinical experience and research.We delve into the fundamental properties of MSCs,exploring their unique immuno-modulatory capabilities and surface markers.The heart of our inquiry lies in the controversial applications of MSC transplantation,including the perennial debate between autologous and allogeneic sources,concerns about efficacy,and lingering safety apprehensions.Moreover,we unravel the enigmatic mechanisms surro-unding MSC transplantation,such as homing,integration,and the delicate balance between differentiation and paracrine effects.We also assess the current status of clinical trials and the ever-evolving regulatory landscape.As we peer into the future,we examine emerging trends,envisioning personalized medicine and innovative delivery methods.Our review provides a balanced and informed perspective on the controversies,offering readers a clear understanding of the complexities,challenges,and potential solutions in MSC transplantation.

Endoscopic and surgical resection of T1a/T1b esophageal neoplasms: A systematic review

AIM: To investigate potential therapeutic recommendations for endoscopic and surgical resection of T1a/ T1b esophageal neoplasms. METHODS: A thorough search of electronic databases MEDLINE, Embase, Pubmed and Cochrane Library, from 1997 up to January 2011 was performed. An analysis was carried out, pooling the effects of outcomes of 4241 patients enrolled in 80 retrospective studies. For comparisons across studies, each reporting on only one endoscopic method, we used a random effects meta-regression of the log-odds of the outcome of treatment in each study. "Neural networks" as a data mining technique was employed in order to establish a prediction model of lymph node status in superficial submucosal esophageal carcinoma. Another data mining technique, the "feature selection and root cause analysis", was used to identify the most impor-tant predictors of local recurrence and metachronous cancer development in endoscopically resected patients, and lymph node positivity in squamous carcinoma (SCC) and adenocarcinoma (ADC) separately in surgically resected patients. RESULTS: Endoscopically resected patients: Low grade dysplasia was observed in 4% of patients, high grade dysplasia in 14.6%, carcinoma in situ in 19%, mucosal cancer in 54%, and submucosal cancer in 16% of patients. There were no significant differences between endoscopic mucosal resection and endoscopic submucosal dissection (ESD) for the following parameters: complications, patients submitted to surgery, positive margins, lymph node positivity, local recurrence and metachronous cancer. With regard to piecemeal resection, ESD performed better since the number of cases was significantly less [coefficient: -7.709438, 95%CI: (-11.03803, -4.380844), P < 0.001]; hence local recurrence rates were significantly lower [coefficient: -4.033528, 95%CI: (-6.151498, -1.915559),P < 0.01]. A higher rate of esophageal stenosis was observed following ESD [coefficient: 7.322266, 95%CI: (3.810146, 10.83439), P < 0.001]. A significantly greater number of SCC patients were submitted to surgery (log-odds, ADC: -2.1206 ± 0.6249 vs SCC: 4.1356 ± 0.4038, P < 0.05). The odds for re-classification of tumor stage after endoscopic resection were 53% and 39% for ADC and SCC, respectively. Local tumor recurrence was best predicted by grade 3 differentiation and piecemeal resection, metachronous cancer development by the carcinoma in situ component, and lymph node positivity by lymphovascular invasion. With regard to surgically resected patients: Significant differences in patients with positive lymph nodes were observed between ADC and SCC [coefficient: 1.889569, 95%CI: (0.3945146, 3.384624), P<0.01). In contrast, lymphovascular and microvascular invasion and grade 3 patients between histologic types were comparable, the respective rank order of the predictors of lymph node positivity was: Grade 3, lymphovascular invasion (L+), microvascular invasion (V+), submucosal (Sm) 3 invasion, Sm2 invasion and Sm1 invasion. Histologic type (ADC/SCC) was not included in the model. The best predictors for SCC lymph node positivity were Sm3 invasion and (V+). For ADC, the most important predictor was (L+). CONCLUSION: Local tumor recurrence is predicted by grade 3, metachronous cancer by the carcinoma insitu component, and lymph node positivity by L+. T1b cancer should be treated with surgical resection.

Dong Qichang: A "Criterion" Full of Controversy

On December 6, 2018,"The Ferryman of the InkWorld: Dong Qichang's Painting and Calligraphy Art" exhibition celebrated the opening ceremony at Shanghai Museum. So far, this has been the largest Dong Qichang's painting and calligraphy art exhibition in China's Mainland, which has raised the upsurge of contemporary experts and scholars to discuss and study his art.

DFE-GCN: Dual Feature Enhanced Graph Convolutional Network for Controversy Detection

With the development of social media and the prevalence of mobile devices,an increasing number of people tend to use social media platforms to express their opinions and attitudes,leading to many online controversies.These online controversies can severely threaten social stability,making automatic detection of controversies particularly necessary.Most controversy detection methods currently focus on mining features from text semantics and propagation structures.However,these methods have two drawbacks:1)limited ability to capture structural features and failure to learn deeper structural features,and 2)neglecting the influence of topic information and ineffective utilization of topic features.In light of these phenomena,this paper proposes a social media controversy detection method called Dual Feature Enhanced Graph Convolutional Network(DFE-GCN).This method explores structural information at different scales from global and local perspectives to capture deeper structural features,enhancing the expressive power of structural features.Furthermore,to strengthen the influence of topic information,this paper utilizes attention mechanisms to enhance topic features after each graph convolutional layer,effectively using topic information.We validated our method on two different public datasets,and the experimental results demonstrate that our method achieves state-of-the-art performance compared to baseline methods.On the Weibo and Reddit datasets,the accuracy is improved by 5.92%and 3.32%,respectively,and the F1 score is improved by 1.99%and 2.17%,demonstrating the positive impact of enhanced structural features and topic features on controversy detection.

The Decline of Image of China Under the Background of Rites Controversy in Qing Dynasty

At the turn of the 18th-19th century,in the process of developing missionary business in China,there was a debate about the nature of traditional Chinese sacrificial rites among missionaries,that is,whether the traditional rites of Confucius and Christianity were consistent.With the intervention of the Vatican and the Qing Dynasty,the Chinese rites controversy evolved into the dispute over Chinese imperial power and Roman religious imperial power.The missionary career in China also experienced the transformation from the toleration order,exclusion order and the ticket receiving order to the prohibition order.The sharp opposition between Chinese imperial power and Roman religious imperial power led to the desperate situation of Christian career in China.The missionaries naturally vented their dissatisfaction with China,the good image of China gradually collapsed,and the western image of China began to decline rapidly.

Controversies and future directions in the management of gallbladder cancer

Gallbladder cancer(GBC)is a rare malignancy worldwide,with 140,000 new patients each year and more than 100,000 deaths annually.The review aims to address the controversial aspects of managing GBC.Regional differences of the study worldwide remain pending,and comparative mutational profiles will provide more information on the pathogenesis of GBC.However,certain pathologic aspects are discussed,such as the staging of early GBC,outcome differences between T2 pathologically staged patients,and the necessity of a uni-form pathologic report.The surgical management of GBC is still under debate.The extent of liver resection,type of lymphadenectomy,and selection of patients for extended resection are aspects of the disease that require revision.Laparoscopic and robotic approaches were initially slow to develop.However,with time,they have demonstrated their value in the surgical management of GBC.The OMEGA survey,performed to analyze the management practice of surgical treatment of GBC worldwide,demonstrated differences from the recom-mended guidelines.The OMEGA study,the largest cohort study,examined the outcomes of surgical intervention in 3676 patients from 133 centers.Regarding future directions,the value of collaborative efforts between centers and regions must be emphasized to better un-derstand the different aspects of the disease and globally improve therapeutic strategies for GBC.

Controversy about the Origin of the Grain Boundary Internal Friction Peak and Its Clarification

In the seventies some scientific workers from France and Italy suggested that the grain boundary internal friction peak (named the K (e) over cap peak in the literature) widely accepted as a grain boundary process, is originated from the motion of lattice dislocations. Since this problem is one of fundamental importance, this controversy has drawn much international attention. Started from 1982, the Hefei research group made a critical analysis of the large amount of literature concerning this problem and,performed a series of crucial experiments to clarify the controversy. It is concluded that the irrelevant evidence suggested by the controverters comes from the farfetched interpretation and the mis-identification of the internal friction peaks appeared under various experimental conditions and different states of the specimens.

Current Controversies and the State of the Art in Endovascular Treatment of Vascular Malformations

Vascular anomalies constitute some of the most difficult diagnostic and therapeutic enigmas that can be encountered in the practice of medicine. The clinical presentations are extremely protean and can range from an asymptomatic birthmark to fulminant。

Controversies in diagnosis and management of Kawasaki disease

Kawasaki disease(KD) is a common medium vessel systemic vasculitis that usually occurs in small children. It has a predilection for the coronary arteries, but other medium sized arteries can also be involved. The etiology of this disorder remains a mystery. Though typical presentation of KD is quite characteristic, it may also present as incomplete or atypical disease in which case the diagnosis can be very challenging. As both incomplete and atypical forms of KD can be associated with serious coronary artery complications, the pediatrician can ill afford to miss these diagnoses. The American Heart Association has enunciated consensus guidelines to facilitate the clinical diagnosis and treatment of this condition. However, there are still several issues that remain controversial. Intravenous immunoglobulin remains the cornerstone of management but several other treatment modalities, especially glucocorticoids, are increasingly finding favour. We review here some of the contemporary issues, and the controversies thereon, pertaining to management of KD.

Common controversies in management of biliary strictures

Biliary strictures are caused by a heterogeneous group of benign and malignant conditions, each requiring a specific treatment approach. Management of biliary strictures often involves endoscopy either for definite treatment, as a bridge to surgery or for palliative purposes. Endoscopic treatment of various types of biliary strictures is not standardized and there are multiple areas of controversy regarding the best treatment options. These controversies are mainly due to lack of well-designed comparative studies to support a specific therapy. This paper reviews three common areas of controversy in the endoscopic management of biliary strictures. The areas discussed in this editorial include the role of biliary drainage in resectable malignant strictures and whether such drainage should be performed routinely prior to surgery, the best endoscopic palliation for unresectable hilar strictures and whether unilateral or bilateral stenting should be attempted, and the optimal endoscopic management for dominant strictures in patients with primary sclerosing cholangitis. The goal of this editorial is twofold. The first is to review the current literature on management of the aforementioned strictures and offer recommendations based on available evidence. The second goal is to highlight the gaps in our knowledge which in turn can encourage future research on these topics.

Controversies in the diagnosis and management of early gastric cancer

Early diagnosis and treatment is the key to improving the prognosis of gastric cancer. The past decades have wimessed the rapid advances in the diagnosis and management of early gastric cancer （EGC）： endoscopy has played an increasingly important role, whereas laparoscopic techniques have also been introduced for EGC treatment. In China, the proportion of EGC is gradually increasing, and this condition will soon become a hot research topic. In this article, we will elucidate some major controversies in the diagnosis and management of EGC.

Current controversies and advances in the management of pancreatic adenocarcinoma

Pancreatic adenocarcinoma is a lethal disease with a mortality rate that has not significantly improved over decades.This is likely due to several challenges unique to pancreatic cancer.Most patients with pancreatic cancer are diagnosed at a late stage of disease due to the lack of specific symptoms prompting an early investigation.A small subset of patients who are diagnosed at an early stage have a better chance at survival with curative surgical resection,but most patients still succumb to the disease in a few years.The dismal overall prognosis is due to suspected micro-metastasis at an early stage.Due to this reason,there is a recent interest in treating all patients with pancreatic cancers with systemic therapy upfront(including the ones that are surgically resectable).This approach is still not the standard of care due to the lack of robust prospective data available.Recent advancements in treatment regimens of chemotherapy,radiation and immunotherapy have improved the overall short-term survival but the long-term survival still remains poor.Novel approaches in diagnosis and treatment have shown promise in clinical studies but long-term clinical data is lacking.The following manuscript presents an overview of the epidemiology,diagnosis,staging,recent advances,novel approaches and controversies in the management of pancreatic adenocarcinoma.

Biventricular Repair versus Uni-ventricular Repair for Pulmonary Atresia with Intact Ventrical Septum:A Systematic Review

The management of pulmonary atresia with intact ventricular septum（PA/IVS） remains controversial. The goal of separating systematic and pulmonary circulation can be achieved by biventricular or uni-ventricular（Fontan or one and a half ventricle repair） strategies. Although outcomes have been improved,these surgical procedures are still associated with high mortality and morbidity. An optimal strategy for definitive repair has yet to be defined. We searched databases for genetically randomized controlled trials（RCTs） comparing biventricular with uni-ventricular repair for patient with PA/IVS. Data extraction and quality assessment were performed following the guidelines of the Cochrane Collaboration. Primary outcome measures were overall survival,and secondary criteria included exercise function,arrhythmia-free survival and treatment-related mortality. A total number of 669 primary citations were screened for relevant studies. Detailed analysis revealed that no RCTs were found to adequately address the research question and no systematic meta-analysis would have been carried out. Nevertheless,several retrospective analyses and case series addressed the question of finding right balance between biventricular and uni-ventricular repair for patient with PA/IVS. In this review,we will discuss the currently available data.

A Review of Japanese Film Rashomon

Kurosawa's Rashomon combines two Japanese folk stories into a tale that explores,from a focal point of the ruined Rashomon temple near Kyoto,the nature of trust,of truth,and the unimpressive reality of human nature.The film reveals the most ominous aspect of human nature that is often full of unconscious prejudice,contradictory and hypocrisy.Kurosawa's distinc tive cinematography,precise close-ups,bold editing,soundtrack,multiple perspectives and long periods of silence,all of which are pivotal to his aesthetic,combine to make this film uniquely filmatic and captivating.However,Rashomon brought Kurosawa both the recognition from the West and the controversy in his native country.

Self-renewal memory of tumor-repopulating cells

Tumor-initiating cells(TICs)are a highly tumorigenic subpopulation of solid tumor cells that play a critical role in the initiation of cancer~[1].These tumorigenic cells resist conventional chemotherapeutic drug treatment and are assumed to be playing major roles in cancer relapses after chemotherapy~[2].However,the notion of TICs has been rather controversial.A report shows that a high percentage(】25%)of human melanoma cells can generate a tumor in a NOD-SCID interleukin-2 receptor gamma chain null mouse~[3],suggesting that there is no clonal development of solid tumors,refuting the idea of TICs.We recently developed a method of isolating TICs from cancer cell lines by culturing single individual cells of B16-F1(a melanoma cell line)into 3D soft fibrin gels~[4].In addition to being able to generate local tumors in a

ELECTRO-ACUPUNCTURE TREATMENT OF ACUTE STAGE PERIPHERAL FACIAL PARALYSIS

The use of electro-acupuncture in treatingperipheral facial paralysis during the acute stagehas been a controversial issue among acupunc-turists.Since 1970,100 cases of acute stage peri-pheral facial paralysis(1-10 days after onset)have been treated with electro-acupuncture witha curs rate of 84% and an effective rate of 100%,no cases showing aggravation of symptoms aftertreatment.Electro-acupuncture is therefore usefulin the treatment for acute stage peripheral facialparalysis.

Dielectric or plasmonic Mie object at air–liquid interface: The transferred and the traveling momenta of photon

Considering the inhomogeneous or heterogeneous background, we have demonstrated that if the background and the half-immersed object are both non-absorbing, the transferred photon momentum to the pulled object can be considered as the one of Minkowski exactly at the interface. In contrast, the presence of loss inside matter, either in the half-immersed object or in the background, causes optical pushing of the object. Our analysis suggests that for half-immersed plasmonic or lossy dielectric, the transferred momentum of photon can mathematically be modeled as the type of Minkowski and also of Abraham. However, according to a final critical analysis, the idea of Abraham momentum transfer has been rejected. Hence,an obvious question arises: whence the Abraham momentum? It is demonstrated that though the transferred momentum to a half-immersed Mie object(lossy or lossless) can better be considered as the Minkowski momentum, Lorentz force analysis suggests that the momentum of a photon traveling through the continuous background, however, can be modeled as the type of Abraham. Finally, as an interesting sidewalk, a machine learning based system has been developed to predict the time-averaged force within a very short time avoiding time-consuming full wave simulation.

Effects of amlodipine-based therapy on cognitive function in high-risk hypertensive patients

Objective Recent evidence has indicated that hypertension is associated with impaired cognitive function. However, the prevention of cognitive disorders with antihypertensive therapy remains controversial.The trial provided evidence to compare the efficacy on cognitive function with the combination of amlodipine with diuretics or angiotensin II receptor blocker.

Balance Equations of Electromagnetic Angular Momentum

We give theoretical foundation to torque densities proposed in the past, like the one used by Beth to study experimentally the action of circularly polarized radiation on a birefringent material, or that proposed by Mansuripur to resolve a seeming paradox concerning the Lorentz force law and relativity. Our results provide new insights into electromagnetic theory, since they provide a unified and general treatment of the balance of lineal and angular momentum that permits a better assessment of some torques. Thus in this work we extend the derivations we have made of balance equations for electromagnetic linear momentum to balance equations for electromagnetic angular momentum. These balance equations are derived from the macroscopic Maxwell equations by means of vector and tensor identities and from the different ways in which these equations are written in terms of fields E, D, B, and H, as well as polarizations P, and M. Therefore these balance equations are as sound as the macroscopic Maxwell equations, with the limitations of the constitutive relations.