Cancer of head and neck:a multidisciplinary approach

The head and neck region encompasses structures from the base of the skull to the clavicles which include nasopharynx,oropharynx,hypopharynx,larynx and oral cavity.Tobacco,alcohol,and human papilloma virus(HPV)infection are the three major risk factors for head and neck squamous cell carcinoma(HNSCC)in different countries.

Current management of liver diseases and the role of multidisciplinary approach

Liver is an organ having extremely diversified functions,ranging from metabolic and synthetic to detoxification of harmful chemicals.The multifunctionality of the liver in principle requires the multidisciplinary and pluralistic interventions for its management.Several studies have investigated liver function,dysfunction and clinic.This editorial work discusses new ideas,challenges and perspectives of current research regarding multidisciplinary and pluralistic management of liver diseases.In one hand the discussions have carried out on the involvement of extracellular vesicles,Na^(+)/H^(+) exchangers,severe acute respiratory syndrome coronavirus 2 and Epstein–Barr virus infections,Drug-induced liver injury,sepsis,pregnancy,and food supplements in hepatic disorders.In the other hand this study has discussed hepatocellular carcinoma algorithms and new bio-chemical and imaging experiments pertaining to liver diseases.Relevant articles with an impact index value">0"from reference citation analysis,which is an open multidisciplinary citation analysis database based on artificial intelligence technology,have served for the study’s argumentation.This work may be a useful tool for the clinical practice and research in managing and investigating liver disorders.

The emerging tumor microbe microenvironment: From delineation to multidisciplinary approach-based interventions

Intratumoral microbiota has become research hotspots,and emerges as a non-negligent new component of tumor microenvironments(TME),due to its powerful infuence on tumor initiation,metas-tasis,immunosurveillance and prognosis despite in low-biomass.The accumulations of microbes,and their related components and metabolites within tumor tissues,endow TME with additional pluralistic features which are distinct from the conventional one.Therefore,it's definitely necessary to comprehen-sively delineate the sophisticated landscapes of tumor microbe microenvironment,as well as their func-tions and related underlying mechanisms.Herein,in this review,we focused on the fields of tumor microbe microenvironment,including the heterogeneity of intratumor microbiota in different types of tu-mors,the controversial roles of intratumoral microbiota,the basic features of tumor microbe microenvi-ronment(i.e.,pathogen-associated molecular patterns(PAMPs),typical microbial metabolites,autophagy,infammation,multi-faceted immunomodulation and chemoresistance),as well as the multi-disciplinary approach-based intervention of tumor microbiome for cancer therapy by applying wild-type or engineered live microbes,microbiota metabolites,antibiotics,synthetic biology and rationally de-signed biomaterials.We hope our work will provide valuable insight to deeply understand the interplay of cancer-immune-microbial,and facilitate the development of microbes-based tumor-specific treatments.

Application of multidisciplinary in situ simulation training in the treatment of acute ischemic stroke: a quality improvement project

BACKGROUND:Ischemic stroke refers to a disorder in the blood supply to a local area of brain tissue for various reasons and is characterized by high morbidity,mortality,and disability.Early reperfusion of brain tissue at risk of injury is crucial for the treatment of acute ischemic stroke.The purpose of this study was to evaluate comfort levels in managing acute stroke patients with hypoxemia who required endotracheal intubation after multidisciplinary in situ simulation training and to shorten the door-to-image time.METHODS:This quality improvement project utilized a comprehensive multidisciplinary in situ simulation exercise.A total of 53 participants completed the two-day in situ simulation training.The main outcome was the self-reported comfort levels of participants in managing acute stroke patients with hypoxemia requiring endotracheal intubation before and after simulation training.A 5-point Likert scale was used to measure participant comfort.A paired-sample t-test was used to compare the mean self-reported comfort scores of participants,as well as the endotracheal intubation time and door-to-image time on the fi rst and second days of in situ simulation training.The door-to-image time before and after the training was also recorded.RESULTS:The findings indicated that in situ simulation training could enhance participant comfort when managing acute stroke patients with hypoxemia who required endotracheal intubation and shorten door-to-image time.For the emergency management of hypoxemia or tracheal intubation,the mean post-training self-reported comfort score was signifi cantly higher than the mean pre-training comfort score(hypoxemia:4.53±0.64 vs.3.62±0.69,t=-11.046,P<0.001;tracheal intubation:3.98±0.72 vs.3.43±0.72,t=-6.940,P<0.001).We also observed a decrease in the tracheal intubation and door-to-image time and a decreasing trend in the door-to-image time,which continued after the training.CONCLUSION:Our study demonstrates that the implementation of in situ simulation training in a clinical environment with a multidisciplinary approach may improve the ability and confi dence of stroke team members,optimize the fi rst-aid process,and eff ectively shorten the door-to-image time of stroke patients with emergency complications.

Airway management of a patient with linear immunoglobulin A bullous dermatosis:A case report

BACKGROUND There is limited literature on managing the airway of patients with linear immunoglobulin A(IgA)bullous dermatosis,a rare mucocutaneous disorder that leads to the development of friable bullae.Careful clinical decision making is necessary when there is a risk of bleeding into the airway,and a multidisciplinary team approach may lead to decreased patient morbidity during these high-risk scenarios,especially when confronted with an unusual cause for bleeding.CASE SUMMARY A 45-year-old African American female presented to our ambulatory surgical center for right corneal transplantation due to corneal perforation after blunt trauma in the setting of cicatricial conjunctivitis and diffuse corneal neovascularization from linear IgA bullous dermatosis.The diagnosis of IgA dermatosis was recent,and the patient had been lost to follow-up.The severity of the disease and extent of airway involvement was unknown at the time of the surgery.Significant airway bleeding was noticed upon intubation and the otorhinolaryngology team had to be called to the operating room.The patient required transfer to the intensive care unit where a multidisciplinary team was involved in her case.The patient was extubated on postoperative day 4.CONCLUSION A multidisciplinary approach to treating this disease is the best course of action before a surgical procedure.In our case,key communication between the surgery,anesthesia,and dermatology teams led to the quick and safe treatment of our patient’s disease.Ambulatory surgery should not be considered for these cases unless they are in full remission and there is no mucous membrane involvement.

Study on the Safety and Prevention Technology of Coal Mining under the River in Xingyuan Coal Mine

Coal mining-induced surface subsidence poses significant ecological and infrastructural challenges, necessitating a comprehensive study to ensure safe mining practices, particularly in underwater conditions. This project aims to address the extensive impact of coal mining on the environment, infrastructure, and overall safety, focusing on the Shigong River area above the working face. The study employs qualitative and quantitative analyses, along with on-site engineering measurements, to gather data on crucial parameters such as coal seam characteristics, roof rock lithology, thickness, water resistance, and structural damage degree. The research encompasses a multidisciplinary approach, involving mining, geology, hydrogeology, geophysical exploration, rock mechanics, mine surveying, and computational mathematics. The importance of effective safety measures and prevention techniques is emphasized, laying the foundation for research focused on the Xingyun coal mine. The brief concludes by highlighting the potential economic and social benefits of this project and its contribution to valuable experience for future subsea coal mining.

Rare combination of traumatic subarachnoid-pleural fistula and intracranial subdural hygromas:A case report

BACKGROUND Subarachnoid-pleural fistula(SPF)is a complex and rare condition characterized by a pathological shunt between the subarachnoid and pleural spaces.It can lead to the accumulation of cerebrospinal fluid(CSF)in the pleural space,pneumocephalus,and the development of central nervous system infection.Trauma or thoracic spinal surgery are common causes of SPF,with symptoms including postural headache,consciousness status changes,and dyspnea.The combination of SPF and subdural hygroma is a severe and rare condition,with little existing literature on its clinical correlation.CASE SUMMARY We report a case of an 83-year-old male patient with traumatic SPF and bilateral frontal subdural hygroma following a fall from height.The patient initially presented with severe lower back and buttock pain.During admission,the patient developed worsening lower limb weakness and pleural effusion.Further investigation revealed the presence of subdural hygromas with mass effect,requiring emergency bilateral subdural drainage.A multidisciplinary approach was undertaken to manage this complex condition,including intervention for hypovolemic CSF status and subdural hygroma management.The pleural effusion eventually resolved and the patient attained a higher level of con-sciousness after bilateral hygroma drainage surgery.We also reviewed the present literature relating to this rare combination of medical conditions.CONCLUSION Traumatic SPF with subsequent subdural hygroma is a rare but serious combination.Although the optimal treatment strategy for this complex condition remains uncertain,our literature review suggested that a multidisciplinary approach,including intervention for hypovolemic CSF and management of the subdural hygroma,is the most beneficial.

A multidisciplinary,integrated approach for the elimination of schistosomiasis:a longitudinal study in a historically hyperendemic region in the lower reaches of the Yangtze River,China from 2005 to 2014

Background:Although great success has been achieved,schistosomiasis remains a major public health concern in China,and the remaining core endemic regions are concentrated along the middle and lower reaches of the Yangtze River.In this longitudinal study,we evaluated the effectiveness of a multidisciplinary,integrated approach for schistosomiasis elimination in a historically hyper-endemic region in the lower reaches of the Yangtze River,China over the 10-year period from 2005 through 2014.Methods:A three-step roadmap for schistosomiasis elimination was designed in the study site,and multidisciplinary,integrated interventions were implemented by the health,agriculture,water resources development,land and resources,and forestry sectors from 2005 to 2014,including chemotherapy for infected individuals,health education,management of the source of Schistosoma japonicum infection,and intermediate host snail control.The annual number of schistosomiasis patients,S.japonicum infection in humans,bovines and Oncomelania hupensis snails,and water infectivity were observed to assess the effectiveness of the multidisciplinary,integrated approach for the elimination of schistosomiasis.Results:There was a tendency towards a gradual decline in both the number of schistosomiasis cases and the prevalence of S.japonicum human infection across the study period from 2005 through 2014.No S.japonicum human infection was detected since 2012,and no acute infection was seen since 2006.During the study period,no infection was found in bovines,and a 0.03%overall infection rate was observed in O.hupensis snails.Since 2009,no infected snails were identified,and the area of both snail habitats and infected snail habitats appeared a reduction over the study period.Following the 3-year multidisciplinary,integrated control,infection control was achieved,and transmission control was achieved after 6-year implementation,with all infected snails and water infectivity eliminated;in addition,the 10-year implementation resulted in interruption of schistosomiasis transmission in the study site in 2014.Conclusions:The results of the present 10-year longitudinal study demonstrate that the multidisciplinary,integrated approach is effective for the elimination of schistosomiasis as a public health problem in the lower reaches of the Yangtze River,China.

Pouch of Douglas Liposarcoma—A Rarity

Introduction: This case report is one of a fairly common tumour in an extremely uncommon anatomic location. Statistically liposarcoma is the commonest type of soft issue malignancy, but publications of such a tumour arising from the pouch of Douglas (POD) to involve the uterus, are very few and far between. Case details: A 52-year-old woman presented with a mass in the lower abdomen, post-menopausal vaginal bleeding, and lower abdominal discomfort. Investigations revealed a large pelvic tumour that was attached to the posterior wall of a bulky uterus. There was no evidence of dissemination of the tumour to distant sites, and a laparotomy was performed. A massive soft tissue tumour occupied the POD. The tumour was dissected out from the surrounding structures, and the uterus and its appendages were removed in to. The histopathological examination revealed a liposarcoma of the pleomorphic type which was arising from the pouch of Douglas (POD), and was attached to the posterior wall of the uterus. Extensive leiomyomatous changes were seen in the uterus. Immunohistochemistry confirmed the liposarcoma to be of pleomorphic type. Conclusion: This case report is being published for its rarity and to illuminate the specific issues in the treatment of this ubiquitous tumour in an unusual site. The involvement of a Multidisciplinary Team (MDT) helps to choose the optimal combination of cytoreductive surgery, chemotherapy, and radiation for a given case with a POD malignancy.

Combined and sequential treatment of oral and maxillofacial malignancies： an evolving concept and clinical protocol

Objective To introduce the concept and rational regimens and present the latest development of combined treatment of oral and maxillofacial malignancies. Data sources The related published literature was searched through the CNKI database and MEDLINE using the terms of oral cancer, oral and maxillofacial malignancies, combined and sequential therapy, multidisciplinary approach. Study selection The available related literature was read and evaluated. Studies that met the inclusion criteria were selected. Results The results show that oral and maxillofacial malignancies diagnosed at an early stages （stages Ⅰ and Ⅱ） can be well treated with surgery alone and/or radiotherapy with optimal outcome, but advanced or recurrent diseases should be treated with rational combined and sequential treatment modalities. The use of concomitant chemoradiotherapy, taxane-containing, three-drug induction regimens and Cetuximab in combination with chemotherapy or radiotherapy demonstrated favorable results in previously untreated patients with head and neck squamous cell carcinoma. Conclusions The concept of combined and sequential treatment of advanced oral and maxillofacial malignancies should be widely accepted, and the rational regimen for individual and each type of entity should be determined based on the anatomical site and the patient＇s performance status.