Simultaneous oncological and reconstructive plastic surgery on the mammary gland in the treatment of cancer is currently one of the important stages in the psychological rehabilitation of patients.In order to achieve ...Simultaneous oncological and reconstructive plastic surgery on the mammary gland in the treatment of cancer is currently one of the important stages in the psychological rehabilitation of patients.In order to achieve a good cosmetic result,reconstruction must be performed simultaneously with radical surgical treatment.Currently,there are a large number of methods for performing breast reconstruction.One of the most commonly used is radical subcutaneous/skin-sparing mastectomy with simultaneous reconstruction with a silicone endoprosthesis.Grand W Carlson type technique is used,with skin incisions in the form of an inverted T is usually performed in patients with large mammary gland with severe grade III ptosis,as the patients usually require reduction of excess skin.However,the most vulnerable aspects of this type of reconstruction is the impossibility of preserving the nipple-areolar complex(NAC),which is associated with a high risk of developing such complications as partial/complete necrosis of the NAC.The current study provides an overview of an original method to decrease the risk of necrosis of NAC with evaluation of blood supply of the nipple and inferior deepithelialized flap using real-time intraoperative Doppler ultrasonography and indocyanine green fluorescence system.展开更多
A thyroid storm(TS)or thyrotoxic crisis is an infrequent,life-threatening endocrinological emergency due to the worsening of the hyperthyroid state.Thyroid hormones(THs)influence almost all the body cells and tissues&...A thyroid storm(TS)or thyrotoxic crisis is an infrequent,life-threatening endocrinological emergency due to the worsening of the hyperthyroid state.Thyroid hormones(THs)influence almost all the body cells and tissues'differentiation,growth,and energy metabolism.Consequently,excess THs are expected to lead to profound organ function,regulation,and hemodynamic changes.In addition to their roles in metabolism and thermoregulation,THs play critical role in maintaining cardiovascular homeostasis through both genomic and non-genomic mechanisms.Receptors for THs are expressed in myocardial and vascular endothelial tissues,allowing fluctuations in circulating hormone levels to directly influence cardiovascular function.Excess TS induces a hyper-dynamic cardiovascular state,characterized by increased ventricular contractility and improved systolic and diastolic performance.The chronotropic and inotropic properties of THs result in dysregulation of blood pressure,heart rate,contractility,cardiac output,and systemic vascular resistance.This could lead to serious consequences such as cardiomyopathy,heart failure,and life-threatening arrhythmia,ultimately contributing to cardiocirculatory collapse and cardiac death.The management of TS necessitates a systematic approach that emphasizes the significance of resuscitation and identification of the underlying causes.It is crucial to prioritize assessing cardiac function in patients with TS.This review explores the clinical impact of TS on the heart and its clinical repercussions,emphasizing the intricate molecular and pathophysiological mechanisms and the interplay between TS and key cardiovascular parameters.This review summarizes the current knowledge of pathophysiology,pharmacological and mechanical interventions,ranging from beta-blocker use to the surgical approach.展开更多
The pancreatic development variations are relatively frequent but are often overlooked in clinical practice.This is due to the fact that they do not present with a distinct clinical picture and are usually asymptomati...The pancreatic development variations are relatively frequent but are often overlooked in clinical practice.This is due to the fact that they do not present with a distinct clinical picture and are usually asymptomatic.It also refers to the ectopic pancreatic tissue in the stomach.This anomaly can be diagnosed in any part of the digestive system,but it is mostly seen in the upper gastrointestinal tract,especially in the stomach,duodenum and jejunum.The management of this condition has evolved due to the development of minimally invasive procedures.展开更多
Ultrasound-guided fine-needle aspiration is the standard for evaluating thyroid nodules with a high safety profile and a relatively low number of non-diagnostic cytological findings.Nevertheless,this diagnostic method...Ultrasound-guided fine-needle aspiration is the standard for evaluating thyroid nodules with a high safety profile and a relatively low number of non-diagnostic cytological findings.Nevertheless,this diagnostic method traditionally has its weak points.Several diagnostic categories such as BethesdaⅠ,ⅢandⅣare not reliable for thyroid carcinoma risk assessment.Recent advancements in a core needle biopsy made it possible to use this tool as a new method for thyroid nodules evaluation.The main feature of this method is the use of thin needles(18-21G)and guns with an automatic trigger mechanism.The histological material collected with the use of a core needle biopsy is usually superior to cytological.Therefore,the core needle biopsy can be used as a complementary technique to a standard fine needle aspiration in difficult and dubious cases of thyroid neoplasia with uncertain malignant potential.展开更多
Preclinical studies have indicated that the combination of mTORC1/2 inhibitors with PD-1 antibodies exhibits synergistic effects on solid tumors.However,no clinical data supporting this combination have been reported....Preclinical studies have indicated that the combination of mTORC1/2 inhibitors with PD-1 antibodies exhibits synergistic effects on solid tumors.However,no clinical data supporting this combination have been reported.Therefore,we conducted a clinical trial(NCT 04337463)to investigate the efficacy and safety of combining onatasertib,an mTORC1/2 inhibitor,with toripalimab,a PD-1 antibody in patients with advanced solid tumors.This open-label,phase 1/2 clinical trial included dose escalation and dose expansion cohorts to evaluate safety,tolerability,objective response rate(ORR),disease control rate(DCR)and progression-free survival(PFS).A total of 46 patients were enrolled and received onatasertib at doses of 15 mg,20 mg,or 30 mg once daily(QD),combined with toripalimab 240 mg every 3 weeks(Q3W).No dose-limiting toxicities were observed,and the most common grade 3 or 4 treatment emergent adverse events were lymphopenia(23.9%)and rash(19.6%).The overall ORR was 26.1%,with a DCR of 73.9%,and a median PFS of 4.3 months.In cervical cancer patients,regardless of PD-L1 expression,the ORR was 52.4%,DCR was 90.5%and median PFS was 5.8 months.Notably,the 15 mg combination dose demonstrated a median PFS of 7.8 months.In conclusion,the safety profile of onatasertib in combination with toripalimab was manageable and showed encouraging clinical activity in advanced solid tumors,particularly among cervical cancer patients,irrespective of PD-L1 expression.The recommended phase 2 dose for the combination was determined to be onatasertib 15 mg QD and toripalimab 240 mg Q3W.展开更多
文摘Simultaneous oncological and reconstructive plastic surgery on the mammary gland in the treatment of cancer is currently one of the important stages in the psychological rehabilitation of patients.In order to achieve a good cosmetic result,reconstruction must be performed simultaneously with radical surgical treatment.Currently,there are a large number of methods for performing breast reconstruction.One of the most commonly used is radical subcutaneous/skin-sparing mastectomy with simultaneous reconstruction with a silicone endoprosthesis.Grand W Carlson type technique is used,with skin incisions in the form of an inverted T is usually performed in patients with large mammary gland with severe grade III ptosis,as the patients usually require reduction of excess skin.However,the most vulnerable aspects of this type of reconstruction is the impossibility of preserving the nipple-areolar complex(NAC),which is associated with a high risk of developing such complications as partial/complete necrosis of the NAC.The current study provides an overview of an original method to decrease the risk of necrosis of NAC with evaluation of blood supply of the nipple and inferior deepithelialized flap using real-time intraoperative Doppler ultrasonography and indocyanine green fluorescence system.
文摘A thyroid storm(TS)or thyrotoxic crisis is an infrequent,life-threatening endocrinological emergency due to the worsening of the hyperthyroid state.Thyroid hormones(THs)influence almost all the body cells and tissues'differentiation,growth,and energy metabolism.Consequently,excess THs are expected to lead to profound organ function,regulation,and hemodynamic changes.In addition to their roles in metabolism and thermoregulation,THs play critical role in maintaining cardiovascular homeostasis through both genomic and non-genomic mechanisms.Receptors for THs are expressed in myocardial and vascular endothelial tissues,allowing fluctuations in circulating hormone levels to directly influence cardiovascular function.Excess TS induces a hyper-dynamic cardiovascular state,characterized by increased ventricular contractility and improved systolic and diastolic performance.The chronotropic and inotropic properties of THs result in dysregulation of blood pressure,heart rate,contractility,cardiac output,and systemic vascular resistance.This could lead to serious consequences such as cardiomyopathy,heart failure,and life-threatening arrhythmia,ultimately contributing to cardiocirculatory collapse and cardiac death.The management of TS necessitates a systematic approach that emphasizes the significance of resuscitation and identification of the underlying causes.It is crucial to prioritize assessing cardiac function in patients with TS.This review explores the clinical impact of TS on the heart and its clinical repercussions,emphasizing the intricate molecular and pathophysiological mechanisms and the interplay between TS and key cardiovascular parameters.This review summarizes the current knowledge of pathophysiology,pharmacological and mechanical interventions,ranging from beta-blocker use to the surgical approach.
文摘The pancreatic development variations are relatively frequent but are often overlooked in clinical practice.This is due to the fact that they do not present with a distinct clinical picture and are usually asymptomatic.It also refers to the ectopic pancreatic tissue in the stomach.This anomaly can be diagnosed in any part of the digestive system,but it is mostly seen in the upper gastrointestinal tract,especially in the stomach,duodenum and jejunum.The management of this condition has evolved due to the development of minimally invasive procedures.
文摘Ultrasound-guided fine-needle aspiration is the standard for evaluating thyroid nodules with a high safety profile and a relatively low number of non-diagnostic cytological findings.Nevertheless,this diagnostic method traditionally has its weak points.Several diagnostic categories such as BethesdaⅠ,ⅢandⅣare not reliable for thyroid carcinoma risk assessment.Recent advancements in a core needle biopsy made it possible to use this tool as a new method for thyroid nodules evaluation.The main feature of this method is the use of thin needles(18-21G)and guns with an automatic trigger mechanism.The histological material collected with the use of a core needle biopsy is usually superior to cytological.Therefore,the core needle biopsy can be used as a complementary technique to a standard fine needle aspiration in difficult and dubious cases of thyroid neoplasia with uncertain malignant potential.
文摘Preclinical studies have indicated that the combination of mTORC1/2 inhibitors with PD-1 antibodies exhibits synergistic effects on solid tumors.However,no clinical data supporting this combination have been reported.Therefore,we conducted a clinical trial(NCT 04337463)to investigate the efficacy and safety of combining onatasertib,an mTORC1/2 inhibitor,with toripalimab,a PD-1 antibody in patients with advanced solid tumors.This open-label,phase 1/2 clinical trial included dose escalation and dose expansion cohorts to evaluate safety,tolerability,objective response rate(ORR),disease control rate(DCR)and progression-free survival(PFS).A total of 46 patients were enrolled and received onatasertib at doses of 15 mg,20 mg,or 30 mg once daily(QD),combined with toripalimab 240 mg every 3 weeks(Q3W).No dose-limiting toxicities were observed,and the most common grade 3 or 4 treatment emergent adverse events were lymphopenia(23.9%)and rash(19.6%).The overall ORR was 26.1%,with a DCR of 73.9%,and a median PFS of 4.3 months.In cervical cancer patients,regardless of PD-L1 expression,the ORR was 52.4%,DCR was 90.5%and median PFS was 5.8 months.Notably,the 15 mg combination dose demonstrated a median PFS of 7.8 months.In conclusion,the safety profile of onatasertib in combination with toripalimab was manageable and showed encouraging clinical activity in advanced solid tumors,particularly among cervical cancer patients,irrespective of PD-L1 expression.The recommended phase 2 dose for the combination was determined to be onatasertib 15 mg QD and toripalimab 240 mg Q3W.
