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 isola...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.展开更多
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)infecti...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.展开更多
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 ...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.展开更多
The rising prevalence of chronic multimorbidity poses substantial challenges to healthcare systems,necessitating the development of innovative management strategies to optimize patient care and system efficiency.The s...The rising prevalence of chronic multimorbidity poses substantial challenges to healthcare systems,necessitating the development of innovative management strategies to optimize patient care and system efficiency.The study by Fontalba-Navas et al investigates the implementation of a novel high complexity unit(HCU)specifically designed to improve the management of patients with chronic complex conditions.By adopting a multidisciplinary approach,the HCU aims to provide comprehensive,patient-centered care that enhances health outcomes and alleviates the strain on traditional hospital services.Utilizing a longitudinal analysis of data from the Basic Minimum Data Set,this study compares hospitalization metrics among the HCU,Internal Medicine,and other departments within a regional hospital throughout 2022.The findings reveal that the HCU's integrated care model significantly reduces readmission rates and boosts patient satisfaction compared to conventional care practices.The study highlights the HCU's potential as a replicable model for managing chronic multimorbidity,emphasizing its effectiveness in minimizing unnecessary hospitalizations and enhancing the overall quality of patient care.This innovative approach not only addresses the complexities associated with chronic multimorbid conditions but also offers a sustainable framework for healthcare systems confronting similar challenges.展开更多
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 pro...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.展开更多
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 disease...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.展开更多
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...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.展开更多
BACKGROUND Managing critical care emergencies in children with autism spectrum disorder(ASD)presents unique challenges due to their distinct sensory sensitivities,communication difficulties,and behavioral issues.Effec...BACKGROUND Managing critical care emergencies in children with autism spectrum disorder(ASD)presents unique challenges due to their distinct sensory sensitivities,communication difficulties,and behavioral issues.Effective strategies and protocols are essential for optimal care in these high-stress situations.AIM To systematically evaluate and synthesize current evidence on best practices for managing critical care emergencies in children with ASD.The review focuses on key areas,including sensory-friendly environments,communication strategies,behavioral management,and the role of multidisciplinary approaches.METHODS A comprehensive search was conducted across major medical databases,including PubMed,Embase,and Cochrane Library,for studies published between 2000 and 2023.Studies were selected based on their relevance to critical care management in children with ASD,encompassing randomized controlled trials,observational studies,qualitative research,and case studies.Data were extracted and analyzed to identify common themes,successful strategies,and areas for improvement.RESULTS The review identified 50 studies that met the inclusion criteria.Findings highlighted the importance of creating sensory-friendly environments,utilizing effective communication strategies,and implementing individualized behavioral management plans.These findings,derived from a comprehensive review of current evidence,provide valuable insights into the best practices for managing critical care emergencies in children with ASD.Sensory modifications,such as reduced lighting and noise,visual aids,and augmentative and alternative communication tools,enhanced patient comfort and cooperation.The involvement of multidisciplinary teams was crucial in delivering holistic care.Case studies provided practical insights and underscored the need for continuous refi-nement of protocols.CONCLUSION The review emphasizes the need for a tailored approach to managing critical care emergencies for children with ASD.Sensory-friendly adjustments,effective communication,and behavioral strategies supported by a mul-tidisciplinary team are integral to improving outcomes.Despite progress,ongoing refinement of care practices and protocols is necessary.This ongoing process addresses remaining challenges and engages healthcare professionals in continuous improvement of care for children with ASD in critical settings.展开更多
We read the article by Karim MM et al discusses the presentation of primary hyperparathyroidism as recurrent acute pancreatitis,a rare clinical condition in pediatric patients presenting to the emergency department.As...We read the article by Karim MM et al discusses the presentation of primary hyperparathyroidism as recurrent acute pancreatitis,a rare clinical condition in pediatric patients presenting to the emergency department.As emergency medicine clinicians,we frequently encounter diverse and complex cases,and such rare conditions pose significant challenges in the diagnostic process.This article will discuss the management and diagnostic approach of such cases encountered in the emergency department.展开更多
Herpes simplex virus(HSV)types 1 and 2 pose significant health risks during pregnancy,impacting both maternal and neonatal outcomes.The 2024 joint guideline from the British Association for Sexual Health and HIV(BASHH...Herpes simplex virus(HSV)types 1 and 2 pose significant health risks during pregnancy,impacting both maternal and neonatal outcomes.The 2024 joint guideline from the British Association for Sexual Health and HIV(BASHH)and the Royal College of Obstetricians and Gynaecologists(RCOG)in the United Kingdom introduces updated recommendations to reduce maternal-to-neonatal transmission.Key recommendations include initiating antiviral therapy earlier—at 32 weeks for standard pregnancies or as early as 22 weeks in high-risk cases—to minimize viral shedding.The guideline emphasizes polymerase chain reaction(PCR)testing for accurate diagnosis and advocates a multidisciplinary team(MDT)approach,involving genitourinary medicine(GUM)specialists,obstetricians,and neonatologists for delivery planning and neonatal care.However,the Chinese guidelines offer greater flexibility in the timing of antiviral treatment,tailored to regional resources and specific circumstances.PCR testing is also recommended,particularly in urban hospitals and tertiary care settings.The UK′s MDT model aligns with China′s integrative healthcare approach,presenting opportunities for mutual learning and collaboration.This comparative analysis highlights areas for cross-adaptation in clinical practices,with potential to enhance maternal and neonatal health outcomes globally.展开更多
BACKGROUND Cardiac myxoma is a benign neoplasm and one of the most common types of primary cardiac tumors.Synchronous cardiac myxoma and other malignancies are extremely rare,and only limited cases have been reported....BACKGROUND Cardiac myxoma is a benign neoplasm and one of the most common types of primary cardiac tumors.Synchronous cardiac myxoma and other malignancies are extremely rare,and only limited cases have been reported.CASE SUMMARY We describe a young patient with newly diagnosed locally advanced laryngeal cancer,with a synchronous cardiac tumor detected on staging scans.An echocar-diogram showed the typical appearance of myxoma in the left atrium.Early cardiac surgery was performed in view of its obstructive features and post cardiac surgery recovery was uneventful.The patient was scheduled for subsequent oncological treatment for the laryngeal cancer.However,due to rapid progression of the advanced laryngeal malignancy,he was placed on supportive care.CONCLUSION To our knowledge,this is the first reported case of synchronous cardiac myxoma with laryngeal malignancy.Individualized treatment strategy should be adopted to manage synchronous tumors in a multidisciplinary approach.The most life-threatening condition needs be treated first.Single resection,staged operations or simultaneous resection of both tumors have been reported with good outcomes.展开更多
The Middle to Late Jurassic,high-pressure metamorphic ophiolites of Inzecca Unit are well exposed in the Noceta-Vezzani area of Alpine Corsica.These metaophiolites were studied by using a multidisciplinary approach to...The Middle to Late Jurassic,high-pressure metamorphic ophiolites of Inzecca Unit are well exposed in the Noceta-Vezzani area of Alpine Corsica.These metaophiolites were studied by using a multidisciplinary approach to reconstruct the architecture of the oceanic sector from which they derived.The collected data indicate that this oceanic crust consists of a mantle metaperidotites and metaophicalcites,both covered by massive or pillow metabasalts with or without a layer of ophiolite-bearing metabreccias.展开更多
BACKGROUND This case highlights the importance of a multidisciplinary approach in differentiating localized infections from systemic inflammatory diseases like psoriatic arthritis.Nail psoriasis can mimic conditions l...BACKGROUND This case highlights the importance of a multidisciplinary approach in differentiating localized infections from systemic inflammatory diseases like psoriatic arthritis.Nail psoriasis can mimic conditions like paronychia,complicating diagnosis.We wrote this report to emphasize the need for clinical vigilance when interpreting imaging findings,especially in patients with a family history of psoriasis.Misdiagnosis can lead to unnecessary systemic treatments,underscoring the significance of dermatological input in achieving accurate diagnoses.CASE SUMMARY A 56-year-old woman presented with redness and swelling of multiple fingertips.Her family history of psoriasis raised suspicion of psoriatic arthritis.Two rheumatologists diagnosed psoriatic arthritis based on ultrasound findings of enthesitis with a positive Doppler signal and recommended methotrexate.However,she was reluctant to initiate therapy due to potential side effects.At our Rheumatology Center,paronychia was suspected,and laboratory tests excluded systemic inflammatory arthritis.Dermatological examination confirmed paronychia,and treatment with fluconazole and ceftriaxone was initiated to address suspected mixed bacterial and fungal infections.Imaging studies,including hand and wrist X-rays,showed no erosions or other signs of psoriatic arthritis.The patient responded well to antimicrobial therapy,with resolution of symptoms.This case highlights the need for thorough clinical evaluation,careful interpretation of imaging findings,and collaboration between rheumatologists and dermatologists to avoid misdiagnosis and inappropriate treatment.CONCLUSION This case underscores the need for thorough clinical evaluation and caution in interpreting nonspecific imaging findings,especially in patients with a family history of psoriasis.While familial predisposition may raise suspicion for psoriatic arthritis,it is essential to integrate laboratory data,imaging studies,and clinical presentation,including response to targeted antimicrobial therapy.A multidisciplinary approach,involving both rheumatologists and dermatologists,is crucial to preventing misdiagnosis,ensuring appropriate treatment,and avoiding the potential harms of unwarranted therapies.展开更多
Yu et al's study has advanced the understanding of the neural mechanisms underlying major depressive disorder(MDD)in adolescents,emphasizing the significant role of the amygdala.While traditional diagnostic method...Yu et al's study has advanced the understanding of the neural mechanisms underlying major depressive disorder(MDD)in adolescents,emphasizing the significant role of the amygdala.While traditional diagnostic methods have limitations in objectivity and accuracy,this research demonstrates a notable advancement through the integration of machine learning techniques with neuroimaging data.Utilizing resting-state functional magnetic resonance imaging(fMRI),the study investigated functional connectivity(FC)in adolescents with MDD,identifying notable reductions in regions such as the left inferior temporal gyrus and right lingual gyrus,alongside increased connectivity in Vermis-10.The application of support vector machines(SVM)to resting-state fMRI(rs-fMRI)data achieved an accuracy of 83.91%,sensitivity of 79.55%,and specificity of 88.37%,with an area under the curve of 0.6765.These results demonstrate how SVM analysis of rs-fMRI data represents a significant improvement in diagnostic precision,with reduced FC in the right lingual gyrus emerging as a particularly critical marker.These findings underscore the critical role of the amygdala in MDD pathophysiology and highlight the potential of rs-fMRI and SVM as tools for identifying reliable neuroimaging biomarkers.展开更多
BACKGROUND Epstein-Barr virus(EBV)-positive T-cell/natural killer(NK)-cell lymphoproliferative disorder is a rare but challenging condition that requires multidisciplinary teamwork,including co-management by infection...BACKGROUND Epstein-Barr virus(EBV)-positive T-cell/natural killer(NK)-cell lymphoproliferative disorder is a rare but challenging condition that requires multidisciplinary teamwork,including co-management by infection medicine,radiotherapy,rehabilitation,and psychology experts,as well as wound specialist nurses.CASE SUMMARY The patient was a 33-year-old female who presented with an erythema-like lesion on the left upper extremity that became desquamated and then blistered and eventually became a giant ulcer with exposed nerves and muscles.The left wrist had a fixed posture,and pathology tests showed cutaneous EBV-positive NK/Tcell proliferative disease.We employed a multidisciplinary collaborative treatment approach,and after 13 wound changes over 45 days,combined with radiation therapy,dietary supplementation,and psychosocial therapy,the left upper extremity wound healed.CONCLUSION Giant ulcers caused by cutaneous EBV-positive NK/T-cell proliferative disease can be treated using a multidisciplinary collaborative approach.展开更多
Cultural Interactions between Han,Tibetan,and Other Ethnic Groups from the Seventh to Thirteenth Centuries Editors-in-Chief:Xie Jisheng and Wang Ruilei.The main research objects of this book are the relics including t...Cultural Interactions between Han,Tibetan,and Other Ethnic Groups from the Seventh to Thirteenth Centuries Editors-in-Chief:Xie Jisheng and Wang Ruilei.The main research objects of this book are the relics including the inscriptions on cliffs,statues,temples and monasteries,grottoes,murals,etc.Using a multidisciplinary approach,the book dives deep into the history of inter-culture exchanges between the Han,Tibetan,and other ethnic groups from the 7th to the 13th centuries.Published by Shanghai Ancient Books Publishing House.展开更多
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 import...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.展开更多
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 clini...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.展开更多
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 ap...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.展开更多
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 proj...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.展开更多
基金Supported by CIBERehd, funded by the Carlos Ⅲ Health Institute
文摘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.
文摘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.
文摘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.
基金Supported by Basic Science Research Program through the National Research Foundation of Korea(NRF)funded by the Ministry of Education,No.NRF-RS-2023-00237287.
文摘The rising prevalence of chronic multimorbidity poses substantial challenges to healthcare systems,necessitating the development of innovative management strategies to optimize patient care and system efficiency.The study by Fontalba-Navas et al investigates the implementation of a novel high complexity unit(HCU)specifically designed to improve the management of patients with chronic complex conditions.By adopting a multidisciplinary approach,the HCU aims to provide comprehensive,patient-centered care that enhances health outcomes and alleviates the strain on traditional hospital services.Utilizing a longitudinal analysis of data from the Basic Minimum Data Set,this study compares hospitalization metrics among the HCU,Internal Medicine,and other departments within a regional hospital throughout 2022.The findings reveal that the HCU's integrated care model significantly reduces readmission rates and boosts patient satisfaction compared to conventional care practices.The study highlights the HCU's potential as a replicable model for managing chronic multimorbidity,emphasizing its effectiveness in minimizing unnecessary hospitalizations and enhancing the overall quality of patient care.This innovative approach not only addresses the complexities associated with chronic multimorbid conditions but also offers a sustainable framework for healthcare systems confronting similar challenges.
基金This work was supported by grants from National Natural Science Foundation of China(No.82204281)Natural Science Foundation of Chongqing,China(cstc2021jcyj-msxmX0544)+3 种基金Chongqing Science Fund for Distinguished Young Scholars(CSTB2023NSCQ-JQX0021,China)Key project for clinical innovation of Army Medical University(CX2019LC107,China)Innovative Research Group at Higher Educational Institutions in Chongqing(CXQT20006,China)Doctoral Through Train Scientific Research Project of Chongqing(CSTB2022BSXMJCX0004,China).
文摘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.
基金Supported by National Research Foundation of Korea,No.NRF-2021S1A5A8062526.
文摘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.
基金supported by Hangzhou Construction Fund of Key Medical Disciplines(OO20200265)Zhejiang Medical and Health Science and Technology Plan Project(2020KY687)+1 种基金Hangzhou Science and Technology Development Project(20200401B04)Hangzhou Biomedical and Health Industry Development Supporting Technology Projects(2021WJCY256).
文摘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.
文摘BACKGROUND Managing critical care emergencies in children with autism spectrum disorder(ASD)presents unique challenges due to their distinct sensory sensitivities,communication difficulties,and behavioral issues.Effective strategies and protocols are essential for optimal care in these high-stress situations.AIM To systematically evaluate and synthesize current evidence on best practices for managing critical care emergencies in children with ASD.The review focuses on key areas,including sensory-friendly environments,communication strategies,behavioral management,and the role of multidisciplinary approaches.METHODS A comprehensive search was conducted across major medical databases,including PubMed,Embase,and Cochrane Library,for studies published between 2000 and 2023.Studies were selected based on their relevance to critical care management in children with ASD,encompassing randomized controlled trials,observational studies,qualitative research,and case studies.Data were extracted and analyzed to identify common themes,successful strategies,and areas for improvement.RESULTS The review identified 50 studies that met the inclusion criteria.Findings highlighted the importance of creating sensory-friendly environments,utilizing effective communication strategies,and implementing individualized behavioral management plans.These findings,derived from a comprehensive review of current evidence,provide valuable insights into the best practices for managing critical care emergencies in children with ASD.Sensory modifications,such as reduced lighting and noise,visual aids,and augmentative and alternative communication tools,enhanced patient comfort and cooperation.The involvement of multidisciplinary teams was crucial in delivering holistic care.Case studies provided practical insights and underscored the need for continuous refi-nement of protocols.CONCLUSION The review emphasizes the need for a tailored approach to managing critical care emergencies for children with ASD.Sensory-friendly adjustments,effective communication,and behavioral strategies supported by a mul-tidisciplinary team are integral to improving outcomes.Despite progress,ongoing refinement of care practices and protocols is necessary.This ongoing process addresses remaining challenges and engages healthcare professionals in continuous improvement of care for children with ASD in critical settings.
文摘We read the article by Karim MM et al discusses the presentation of primary hyperparathyroidism as recurrent acute pancreatitis,a rare clinical condition in pediatric patients presenting to the emergency department.As emergency medicine clinicians,we frequently encounter diverse and complex cases,and such rare conditions pose significant challenges in the diagnostic process.This article will discuss the management and diagnostic approach of such cases encountered in the emergency department.
文摘Herpes simplex virus(HSV)types 1 and 2 pose significant health risks during pregnancy,impacting both maternal and neonatal outcomes.The 2024 joint guideline from the British Association for Sexual Health and HIV(BASHH)and the Royal College of Obstetricians and Gynaecologists(RCOG)in the United Kingdom introduces updated recommendations to reduce maternal-to-neonatal transmission.Key recommendations include initiating antiviral therapy earlier—at 32 weeks for standard pregnancies or as early as 22 weeks in high-risk cases—to minimize viral shedding.The guideline emphasizes polymerase chain reaction(PCR)testing for accurate diagnosis and advocates a multidisciplinary team(MDT)approach,involving genitourinary medicine(GUM)specialists,obstetricians,and neonatologists for delivery planning and neonatal care.However,the Chinese guidelines offer greater flexibility in the timing of antiviral treatment,tailored to regional resources and specific circumstances.PCR testing is also recommended,particularly in urban hospitals and tertiary care settings.The UK′s MDT model aligns with China′s integrative healthcare approach,presenting opportunities for mutual learning and collaboration.This comparative analysis highlights areas for cross-adaptation in clinical practices,with potential to enhance maternal and neonatal health outcomes globally.
文摘BACKGROUND Cardiac myxoma is a benign neoplasm and one of the most common types of primary cardiac tumors.Synchronous cardiac myxoma and other malignancies are extremely rare,and only limited cases have been reported.CASE SUMMARY We describe a young patient with newly diagnosed locally advanced laryngeal cancer,with a synchronous cardiac tumor detected on staging scans.An echocar-diogram showed the typical appearance of myxoma in the left atrium.Early cardiac surgery was performed in view of its obstructive features and post cardiac surgery recovery was uneventful.The patient was scheduled for subsequent oncological treatment for the laryngeal cancer.However,due to rapid progression of the advanced laryngeal malignancy,he was placed on supportive care.CONCLUSION To our knowledge,this is the first reported case of synchronous cardiac myxoma with laryngeal malignancy.Individualized treatment strategy should be adopted to manage synchronous tumors in a multidisciplinary approach.The most life-threatening condition needs be treated first.Single resection,staged operations or simultaneous resection of both tumors have been reported with good outcomes.
基金supported by PRIN 2020 project(Resp.Michele Marroni)Claudia D’Oriano(INGV)Matteo Masotta and Danis Filimon(Earth Science Dept)are also thanked for analytical support in the laboratoriesThis work benefited from the PRA 2022 project handled by Francesca Meneghini.
文摘The Middle to Late Jurassic,high-pressure metamorphic ophiolites of Inzecca Unit are well exposed in the Noceta-Vezzani area of Alpine Corsica.These metaophiolites were studied by using a multidisciplinary approach to reconstruct the architecture of the oceanic sector from which they derived.The collected data indicate that this oceanic crust consists of a mantle metaperidotites and metaophicalcites,both covered by massive or pillow metabasalts with or without a layer of ophiolite-bearing metabreccias.
文摘BACKGROUND This case highlights the importance of a multidisciplinary approach in differentiating localized infections from systemic inflammatory diseases like psoriatic arthritis.Nail psoriasis can mimic conditions like paronychia,complicating diagnosis.We wrote this report to emphasize the need for clinical vigilance when interpreting imaging findings,especially in patients with a family history of psoriasis.Misdiagnosis can lead to unnecessary systemic treatments,underscoring the significance of dermatological input in achieving accurate diagnoses.CASE SUMMARY A 56-year-old woman presented with redness and swelling of multiple fingertips.Her family history of psoriasis raised suspicion of psoriatic arthritis.Two rheumatologists diagnosed psoriatic arthritis based on ultrasound findings of enthesitis with a positive Doppler signal and recommended methotrexate.However,she was reluctant to initiate therapy due to potential side effects.At our Rheumatology Center,paronychia was suspected,and laboratory tests excluded systemic inflammatory arthritis.Dermatological examination confirmed paronychia,and treatment with fluconazole and ceftriaxone was initiated to address suspected mixed bacterial and fungal infections.Imaging studies,including hand and wrist X-rays,showed no erosions or other signs of psoriatic arthritis.The patient responded well to antimicrobial therapy,with resolution of symptoms.This case highlights the need for thorough clinical evaluation,careful interpretation of imaging findings,and collaboration between rheumatologists and dermatologists to avoid misdiagnosis and inappropriate treatment.CONCLUSION This case underscores the need for thorough clinical evaluation and caution in interpreting nonspecific imaging findings,especially in patients with a family history of psoriasis.While familial predisposition may raise suspicion for psoriatic arthritis,it is essential to integrate laboratory data,imaging studies,and clinical presentation,including response to targeted antimicrobial therapy.A multidisciplinary approach,involving both rheumatologists and dermatologists,is crucial to preventing misdiagnosis,ensuring appropriate treatment,and avoiding the potential harms of unwarranted therapies.
基金Supported by Basic Science Research Program through the National Research Foundation of Korea Funded by the Ministry of Education,No.NRF-RS-2023-00237287.
文摘Yu et al's study has advanced the understanding of the neural mechanisms underlying major depressive disorder(MDD)in adolescents,emphasizing the significant role of the amygdala.While traditional diagnostic methods have limitations in objectivity and accuracy,this research demonstrates a notable advancement through the integration of machine learning techniques with neuroimaging data.Utilizing resting-state functional magnetic resonance imaging(fMRI),the study investigated functional connectivity(FC)in adolescents with MDD,identifying notable reductions in regions such as the left inferior temporal gyrus and right lingual gyrus,alongside increased connectivity in Vermis-10.The application of support vector machines(SVM)to resting-state fMRI(rs-fMRI)data achieved an accuracy of 83.91%,sensitivity of 79.55%,and specificity of 88.37%,with an area under the curve of 0.6765.These results demonstrate how SVM analysis of rs-fMRI data represents a significant improvement in diagnostic precision,with reduced FC in the right lingual gyrus emerging as a particularly critical marker.These findings underscore the critical role of the amygdala in MDD pathophysiology and highlight the potential of rs-fMRI and SVM as tools for identifying reliable neuroimaging biomarkers.
文摘BACKGROUND Epstein-Barr virus(EBV)-positive T-cell/natural killer(NK)-cell lymphoproliferative disorder is a rare but challenging condition that requires multidisciplinary teamwork,including co-management by infection medicine,radiotherapy,rehabilitation,and psychology experts,as well as wound specialist nurses.CASE SUMMARY The patient was a 33-year-old female who presented with an erythema-like lesion on the left upper extremity that became desquamated and then blistered and eventually became a giant ulcer with exposed nerves and muscles.The left wrist had a fixed posture,and pathology tests showed cutaneous EBV-positive NK/Tcell proliferative disease.We employed a multidisciplinary collaborative treatment approach,and after 13 wound changes over 45 days,combined with radiation therapy,dietary supplementation,and psychosocial therapy,the left upper extremity wound healed.CONCLUSION Giant ulcers caused by cutaneous EBV-positive NK/T-cell proliferative disease can be treated using a multidisciplinary collaborative approach.
文摘Cultural Interactions between Han,Tibetan,and Other Ethnic Groups from the Seventh to Thirteenth Centuries Editors-in-Chief:Xie Jisheng and Wang Ruilei.The main research objects of this book are the relics including the inscriptions on cliffs,statues,temples and monasteries,grottoes,murals,etc.Using a multidisciplinary approach,the book dives deep into the history of inter-culture exchanges between the Han,Tibetan,and other ethnic groups from the 7th to the 13th centuries.Published by Shanghai Ancient Books Publishing House.
基金Acknowledgments The work is funded by a grant from the National Science Foundation Advanced Technology Education Division. The award number is NSF ATE No 1003712. The authors greatly appreciate the support from the NSF. In addition, the authors also would like to thank all students who are involved in this project.
文摘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.
文摘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.
文摘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.
文摘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.
