应重视功能性神经系统疾病诊断与治疗

功能性神经系统疾病(以下简称功能性神经疾病)是一类具有明确临床症状的自主运动或感觉系统疾病,因发病广泛和疾病负担沉重日益受到社会的高度重视。我国功能性神经疾病研究起步较晚,临床医师、患者及其家属对疾病认识不足、概念不清。本文拟对我国功能性神经疾病诊断与治疗现状进行分析,并就出台相关措施以提高我国诊断与治疗水平、加强相关研究提出建议。

Ductal adenocarcinoma of the prostate or seminal vesicle adenocarcinoma:An multi-disciplinary team(MDT)case report and literature review

We introduced a 61-year-old male with ductal adenocarcinoma of the prostate who underwent a tortuous diagnosis and treatment.Multi-disciplinary team meetings organized by our hospital have shown great value in the whole process.The patient presented with gross hematuria accompanied by frequent urination initially,and was diagnosed with ductal adenocarcinoma of the prostate involving right seminal vesicle gland and urethra by urethroscopy biopsy.The clinical stage of tumor was T3bN0M0.After 4 cycles of neoadjuvant chemotherapy,the tumor shrank significantly and the patient underwent a laparoscopic radical prostatectomy.But the patient declined to continue chemotherapy postoperatively.After 10 months,the serum prostatic specific antigen increased to 0.05 ng/mL,and multiple metastases were found in the patient's bilateral lungs.However,an unexpected diagnosis of seminal vesicle adenocarcinoma was put forward from another hospital after supplementary pathologic immunohistochemical examination.Then,after careful discussion and demonstration by our multi-disciplinary team experts,we insisted on the diagnosis of ductal adenocarcinoma of the prostate and suggested that the original regimen of chemotherapy should be continued.Up-to-date,14 months after the operation,the patient continues to survive while undergoing ongoing active treatment as recommended.

Renal tumor in developing countries:142 cases from a single institution at Shanghai,China

Background:The clinical management of children with renal tumors including Wilms'tumor,clear cell sarcoma,rhabdoid tumor and other renal tumors in our center was designed according to the National Wilms'Tumor Study Group protocols.Methods:A total of 142 consecutive patients who had been diagnosed as having renal tumors at Shanghai Children's Medical Center were reviewed retrospectively in the period of December 1998 and September 2012.Diagnosis and treatment were decided by a multi-disciplinary team including oncologists,surgeons,pathologists and sub-specialized radiologists.Results:The median age of the patients at the time of diagnosis was 27 months.The tumor stages of the patients were as follows:stage I 24.6%,stage II 23.2%,stage III 32.3%,stage IV 14.1%,and stage V 5.6%.Favorable histology was diagnosed in 80.3%,anaplasia in 4.2%,clear cell sarcoma in 9.8%,rhabdoid tumor in 4.9%,and other renal tumors in 0.7%of the patients.The event-free and overall 5-year survival rates were 80%and 83%,respectively.Tumor relapse and progress was seen in 25 patients(17.6%).The median relapse time was 6 months(range:2-37 months).Seven relapsing patients were re-treated and four of them got second complete remission(three in stage II,one in stage I).Conclusion:A multi-disciplinary team work model is feasible in developing countries,and the renal tumors protocols basically from developed countries are safe in developing countries.

Challenges and opportunities for managing pediatric central nervous system tumors in China

Central nervous system(CNS)tumors represent the most deadly cancer in pediatric age group.In China,thousands of children are diagnosed with CNS tumors every year.Despite the improving socioeconomic status and availability of medical expertise within the country,unique challenges remain for the delivery of pediatric neuro-oncology service.In this review,we discuss the existing hurdles for improving the outcome of children with CNS tumors in China.Need for precise disease burden estimation,lack of intra-and inter-hospital collaborative networks,high probability of treatment abandonment,along with financial toxicities from treatment represent the key challenges that Chinese healthcare providers encounter.The tremendous opportunities for advancing the status of pediatric neuro-oncology care in and beyond the country are explored.

Neurospinal surgery innovations

Over the past few decades, majority of neurosurgeons only specialize in spinal cord diseases. However, with the advances in spine surgery, more and more neurosurgeons focus on spine diseases. Precision minimally invasive technique in surgery of spine and spinal cord is an important branch of neurosurgery. As traditional surgery has been gradually replaced by precision surgery, open surgery has been gradually replaced by minimally invasive surgery(MIS), the diagnosis and treatment of spine diseases has been benefiting from minimally invasive techniques. With minimal surgical trauma,precise localization, MIS has become the inevitable trend of new neurosurgery. The model of multi-disciplinary team is gradually becoming universal in the world in order to make the best treatment plan for the patient with spine diseases on the basis of the comprehensive disciplinary opinion.

Survey on the current status of the diagnosis and treatment of pancreatic cancer in public tertiary hospitals in China:a cross-sectional questionnaire-based,observational study

Objective:Pancreatic cancer is one of the most aggressive digestive system malignant tumors,and its clinical diagnosis and treatment are still challenging.To further understand the current status and improve the multidisciplinary collaboration for diagnosis and treatment of pancreatic cancer in China,we conducted an online questionnaire survey on the diagnosis and treatment status of pancreatic cancer in public tertiary hospitals of China in 2021.Methods:In this cross-sectional questionnaire-based,observational study,online questionnaires with real-name authentication were used to gather data from 500 clinicians,50 pharmacists,and 1000 pancreatic cancer patients in tertiary general hospitals or cancer hospitals nationwide.Results:A total of 485 valid questionnaires were obtained from the clinicians,majority of whom were from economically better developed regions or cities of China.There were multi-disciplinary team treatment(MDT)clinics for pancreatic cancer patients in 60%of the hospitals.Minimally invasive surgeries could be performed in all the surveyed hospitals.However,open surgery was still the mainstream choice in most cases.Gemcitabine-based chemotherapy was the most popular first-line adjuvant regimen for pancreatic cancer.A total of 50 valid questionnaires were collected from pharmacists,48%of them are not satisfactory with the efficacy of the chemotherapeutic drugs,and myelosuppression,liver,and renal damage were the most concerning side effects.In total,1011 valid questionnaires were collected from the patients.Approximately,48.4%of the patients did not know about pancreatic cancer before becoming ill.Over 80%of pancreatic cancer patients reported poor to very poor health-related quality of life,and the estimated overall medical expenses were within<400,000($58823.53)in 80%of the patients.Clinicians,pharmacists,and patients believe that popularizing scientific knowledge of pancreatic cancer,constructing MDT clinics and fast-lane system,and conducting clinical research will help further improve the diagnosis and treatment of pancreatic cancer.Conclusions:The MDT clinics for pancreatic cancer have been well developed in most of the public tertiary hospitals.Minimally invasive pancreatic surgery has developed rapidly in China;however,open surgery is still the mainstream choice for pancreatic cancer.The proportion of adjuvant treatment has been significantly improved,and the gemcitabine-based regimen is the most commonly used first-line regimen.Most of the public still lacks the general knowledge of pancreatic cancer,needing further popularization.The construction of a fast-lane treatment system and conducting of high-level clinical studies are the warm expectations of the clinicians and patients.The real-world situation of the diagnosis and treatment of pancreatic cancer in the other types of hospitals of China needs further exploration.

Translation:Management of Coronavirus Disease 2019(COVID-19):Experience in Zhejiang Province,China

The current epidemic situation of coronavirus disease 2019(COVID-19)still remains severe.As the National Clinical Research Center for Infectious Diseases,The First Affiliated Hospital of the Zhejiang University School of Medicine is the primary medical care center for COVID-19 in Zhejiang Province.Based on the present expert consensus carried out by the National Health Commission and National Administration of Traditional Chinese Medicine,our team summarized and established an effective treatment strategy centered on“Four-Anti and Two-Balance”for clinical practice.The“Four-Anti and Two-Balance”strategy includes antivirus,anti-shock,antihypoxemia,and anti-secondary infection,and maintaining of water,electrolyte and acid/base balance and microecological balance.Simultaneously,an integrated multidisciplinary personalized treatment is recommended to improve therapeutic effects.The importance of early viral detection,dynamic monitoring of inflammatory indexes,and chest radiographs has been emphasized in clinical decision-making.Sputum was observed with the highest positive rate by reverse transcription-polymerase chain reaction(RTPRC).Viral nucleic acids could be detected in 10%of the patients’blood samples at the acute phase and 50%of patients had positive RT-PCR results in their feces.We also isolated live viral strains from feces,indicating potential infectiousness of feces.Dynamic cytokine detection was necessary to timely identify cytokine storms and for the application of the artificial liver blood purification system.The“Four-Anti and Two-Balance”strategy effectively increased cure rates and reduced mortality.Early antiviral treatment alleviated disease severity and prevented illness progression.We found that lopinavir/ritonavir combined with abidol showed antiviral effects against COVID-19.Shock and hypoxemia were usually caused by cytokine storms.The artificial liver blood purification system was able to rapidly remove inflammatory mediators and block the cytokine storm.Moreover,it also contributed to the balance of fluids,electrolytes,and acids/bases and thus improved treatment efficacy during critical illness.For cases of severe illness,early and also short periods of moderate glucocorticoid administration was supported.Patients with an oxygenation index below 200mmHg were transferred to the intensive care unit.Conservative oxygen therapy was preferred and noninvasive ventilation(NIV)was not recommended.Patients with mechanical ventilation were strictly supervised with cluster ventilator-associated pneumonia prevention strategies.Antimicrobial prophylaxis was prescribed rationally and was not recommended,except for patients with a long course of disease,repeated fever,and elevated procalcitonin,similarly secondary fungal infections were of concern.Some patients with COVID-19 showed intestinal microbial dysbiosis with decreased genus such as Lactobacillus and Bifidobacterium.Nutritional and gastrointestinal function should;therefore,be assessed for all patients.Nutritional support and application of prebiotics or probiotics were suggested to regulate the balance of intestinal microbiota and reduce the risk of secondary infections due to bacterial translocation.Anxiety and fear were common in patients with COVID-19.Therefore,we established a dynamic assessment and warning for psychological crises.We also integrated Chinese medicine in the treatment to promote rehabilitation.We optimized nursing processes for severe patients to promote their rehabilitation.Since viral clearance patterns after severe acute respiratory syndrome coronavirus 2 infections remained unclear,2 weeks quarantine for discharged patients was required,and a regular following-up was also needed.These Zhejiang experiences and suggestions have been implemented in our center and achieved good results.However,since COVID-19 was a newly emerging disease,more work is warranted to further improve strategies of prevention,diagnosis,and treatment for COVID-19.