Patterns of local recurrence in rectal cancer after a multidisciplinary approach

Improvements in surgery and the application of combined approaches to fight rectal cancer have succeeded in reducing the local recurrence (LR) rate and when there is LR it tends to appear later and less often in isolation. Moreover, a subtle change in the distribution of LRs with respect to the pelvis has been observed. In general terms, prior to total mesorectal excision the most common LRs were central types (perianastomotic and anterior) while lateral and posterior forms (presa-cral) have become more common since the growth in the use of combined treatments. No differences have been reported in the current pattern of LRs as a function of the type of approach used, that is, neo-adjuvant therapies (short-term or long-course radiotherapy, orchemoradiotherapy versus extended lymphadenectomy, though there is a trend towards posterior or presacral LR in patients in the Western world and lateral LR in Asia. Nevertheless, both may arise from the same mechanism. Moreover, as well as the mode of treatment, the type of LR is related to the height of the initial tumor. Nowadays most LRs are related to the advanced nature of the disease. Involvement of the circumferential radial margin and spillage of residual tumor cells from lymphatic leakage in the pelvic side wall are two plausible mechanisms for the genesis of LR. The patterns of pelvic recurrence itself (pelvic subsites) also have important implications for prognosis and are related to the potential success of salvage curative approach. The re-operability for cure and prognosis are generally better for anastomotic and anterior types than for presacral and lateral recurrences. Overall survival after LR diagnosis is lower with radio or chemoradiotherapy plus optimal surgery approaches, compared to optimal surgery alone.

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.

Enhancing perianal disease management with integrated physical and psychological approaches

This article provides a comprehensive analysis of the study by Hou et al,focusing on the complex interplay between psychological and physical factors in the postoperative recovery(POR)of patients with perianal diseases.The study sheds light on how illness perception,anxiety,and depression significantly influence recovery outcomes.Hou et al developed a predictive model that demonstrated high accuracy in identifying patients at risk of poor recovery.The article explores the critical role of pre-operative psychological assessment,highlighting the need for mental health support and personalized recovery plans in enhancing POR quality.A multidisciplinary approach,integrating mental health professionals with surgeons,anesthesiologists,and other specialists,is emphasized to ensure comprehensive care for patients.The study’s findings serve as a call to integrate psychological care into surgical practice to optimize outcomes for patients with perianal diseases.

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.

Endoscopic vacuum assisted closure therapy for esophagopericardial fistula in a 16-year-old male:A case report

BACKGROUND Esophagopericardial fistula(EPF)is a rare,life-threatening condition with limited scientific literature and no established management guidelines.This case report highlights a successful multidisciplinary approach and the innovative use of endoscopic vacuum assisted closure(endoVAC)therapy in treating this complex condition.CASE SUMMARY A 16-year-old male with a history of esophageal atresia and colon interposition presented with progressive chest pain,fever,and dyspnea.Imaging revealed an EPF with associated pleural and pericardial effusions.Initial management with an esophageal stent failed,prompting the use of an endoVAC system.The patient underwent multiple endoVAC device changes and received broad-spectrum antibiotics and nutritional support.The fistula successfully closed,and the patient recovered,demonstrating no new symptoms at a 6-month follow-up.CONCLUSION EndoVAC therapy can effectively manage EPF,providing a minimally invasive treatment option.

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.

Challenges and advancing strategies of endoscopic submucosal dissection for early gastric cancer:The puzzle of eCura C1

In this editorial,we explore the challenges of managing noncurative resections in early gastric cancer after endoscopic submucosal dissection(ESD),starting from the consideration recently made by Zhu et al.Specifically,we evaluate the management of eCura C1 lesions,where decisions regarding further interventions are pivotal yet contentious.Collaboration among endoscopists,surgeons,and pathologists is underscored to refine risk assessment and personalize therapeutic management.Recent advancements in ESD techniques and interdisciplinary collaboration offer opportunities for outcome optimization in managing eCura C1 lesions.Moreover,despite needing further clinical validation,molecular biomarkers have emerged as promising tools for enhancing prognostication.This manuscript highlights the ongoing research attempts to define treatment paradigms effectively and evaluates the potential of emerging options,ultimately aiming to improve patient care and outcomes in this complex clinical scenario.

Empowering Students with Practical ＂Working＂ Experience through Hands-on Multidisciplinary Design Projects

One of the problems that many engineering graduates face when looking for their first job is： Do you have experience？ Employers prefer graduates with relevant experience to those without. Why is experience so important to employers？ Can students accumulate ＂working＂ experience while studying in college？ This paper discusses the use of design projects inside and outside of classrooms to help students gain ＂working＂ experience and skills through hands-on design activities that simulate the actual design activities that occur in the industry. Faculty members from the Mechanical Engineering Technology and Computer Engineering Technology departments were involved in creating multidisciplinary design projects. The design projects give students new insights into what they learn in their coursework and pro.vide students the valuable experiences in analytical skills, concurrent engineering approach, people skills, and management skills needed for the students when looking for employment.

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.

Hepatic resection beyond barcelona clinic liver cancer indication:When and how

Hepatocellular carcinoma(HCC)is the main common primary tumour of the liver and it is usually associated with cirrhosis.The barcelona clinic liver cancer(BCLC)classification has been approved as guidance for HCC treatment algorithms by the European Association for the Study of Liver and the American Association for the Study of Liver Disease.According to this algorithm,hepatic resection should be performed only in patients with small single tumours of 2-3 cm without signs of portal hypertension(PHT)or hyperbilirubinemia.BCLC classification has been criticised and many studies have shown that multiple tumors and large tumors,as wide as those with macrovascular infiltration and PHT,could benefit from liver resection.Consequently,treatment guidelines should be revised and patients with intermediate/advanced stage HCC,when technically resectable,should receive the opportunity to be treated with radical surgical treatment.Nevertheless,the surgical treatment of HCC on cirrhosis is complex:The goal to be oncologically radical has always to be balanced with the necessity to minimize organ damage.The aim of this review was to analyze when and how liver resection could be indicated beyond BCLC indication.In particular,the role of multidisciplinary approach to assure a proper indication,of the intraoperative ultrasound for intraoperative restaging and resection guidance and of laparoscopy to minimize surgical trauma have been enhanced.

Surgical dilemmas in the management of colorectal liver metastases: the role of timing

Colorectal cancer(CRC) is an emerging health problem in the Western World both for its raising tendency as well as for its metastatic potential. Almost half of the patients with CRC will develop liver metastases during the course of their disease. The liver surgeon dealing with colorectal liver metastases faces several surgical dilemmas especially in the setting of the timing of operation. Synchronous resectable metastases should be treated prior or after induction chemotherapy? Furthermore in the case of synchronous colorectal liver metastases which organ should we first deal with, the liver or the colon? All these questions are set in the editorial and impulse for further investigation is put focusing on multidisciplinary approach and individualization of treatment modalities.

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.

Double Problem -Clostridium difficile and Diabetes

Considered to be the most common cause of nosocomial diarrhea, Clostridium difficile infection is a daily clinical reality, and its incidence is increasing globally. Many factors have been implicated in causing this infection, including glucose metabolism disorder. Aim： to evaluate the prevalence of diabetes among patients with C. difficile colitis and assessing the risk of disease relapse and extension of the disease, in combination with diabetes mellitus infection. Materials and methods： were included in the study 102 patients known to have diabetes type 1 or type 2 admitted to our clinic between January 2016 and June 2017, from a total of 648 patients diagnosed with C. difficile colitis. We used data from observation charts of patients. Results： 98% were suffering from type 2 diabetes, mostly female, respectively from urban areas, 29.4% being at the second hospitalization in our clinic for the same symptoms. Studying the average length of hospitalization, compared with a control group, we noticed the prolongation of hospitalization for patients with metabolic pathology associated with approximately 7 days. Conclusions： Diabetes is a risk factor for the occurrence and recurrence of C. difficile infection, an additional risk factor being the age.

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.