Application prospect of minimally invasive surgical techniques in the treatment of biliary tract cancer / 中华消化外科杂志

Due to the inherent disease characteristics and surgical difficulties, the develop-ment of minimally invasive surgery in biliary tract cancer has encountered more difficulties and controversies. As one of the representative fields of modern precise surgery and an important part of multidisciplinary therapy, the value and application of minimally invasive surgery in the treatment of biliary tract cancer need to be further elaborated and standardized. Minimally invasive surgical techniques should be explored and studied under reasonable norms and supervision. More higher level evidence-based evidences should be obtained under the premise of ensuring the ethical prin-ciple of maximum benefit to patients, and ultimately promote the overall progress in the field.

Metástasis cutánea metacrónica de carcinoma escamoso de canal anal / Methachronical cutaneous metastasis of squamous carcinoma of the anal canal / Metástase cutânea metacronica de carcinoma escamoso do canal anal

El tratamiento correcto de carcinoma escamoso avanzado requiere de un manejo multidisciplinar entre cirujanos, anatomopatólogos, radioterapeutas y radiólogos. Los protocolos están claros cuando nos hallamos ante una enfermedad localizada, sin embargo, cuando la enfermedad es metastática no existe evidencia científica de los pasos a seguir. Presentamos una paciente con un carcinoma escamoso del ano con una única metástasis cutánea metacrónica que fue tratada con cirugía y radioterapia posterior con buena respuesta.

The right therapy of anal cancer needs a multidisciplinary management of surgeons, pathologists, radiotherapists and radiologist. The treatment of squamous cell carcinoma of the anal canal is well-known when the patient presents a locally disease, nevertheless, there is a lack of information with the advanced anal cancer. We report a case of a 74-year-old woman with a solitary methachronical cutaneous metastasis of anal cancer which responded perfectly to surgery and radiotherapy.

A correta terapêutica do câncer anal necessita de uma gestão multidisciplinar de cirurgiões, patologistas, radio terapeutas e radiologistas.O tratamento do carcinoma espinocelular do canal anal é bem conhecido quando o paciente apresenta uma doença local, porém, há uma falta de informação sobre o câncer anal avançado. Relatamos o caso de uma mulher de 74 anos com metástase cutânea metacrônica solitária de câncer anal que respondeu perfeitamente à cirurgia e à radioterapia.

Recent advances in multidisciplinary therapy for sinonasal cancers / 中华放射肿瘤学杂志

Sinonasal cancers (SNCs) are rare and heterogeneous diseases. Most patients present with locally advanced stage due to the insidious symptoms. In the majority of cases, the treatment strategy relies on the combination of surgery and radiotherapy, supplemented with or without chemotherapy. However, postoperative organ preserving rate is low, quality of life and clinical prognosis are poor. With recent advancement of surgical techniques, radiotherapy and chemotherapy techniques, certain progress has been reached in the diagnosis and treatment of SNCs. Nevertheless, the specific treatment regimen remains controversial. In this article, advances and controversies in SNC were reviewed.

Treatment strategy for gastrointestinal tumor under the outbreak of novel coronavirus pneumonia in China / 中华胃肠外科杂志

The outbreak of the novel coronavirus pneumonia (NCP) has become a public health emergency in China. Chinese authorities and health agencies had devoted great efforts to control this disease. As surgeons specialized in the treatment of gastrointestinal tumors, we should always be aware of the prevention for NCP and incorporate this awareness into every detail of clinical practice. For the patients with gastrointestinal tumors, pre-admission screening should be done in order to rule out NCP. Real-time RT-PCR panel and chest CT scan should be conducted for patients with fever (>37.3℃), travel history to Hubei Province within 14 days, or contact history with residents from Wuhan district within 14 days. Prevention measures for both medical staffs and the screen-negative admitted patients should also be enhanced because false negative is possible. Medical instruments should be properly discarded or disinfected according to standardized procedures established by the local center for disease control and prevention (CDC). Surgical operation should be reduced at a minimal level to prevent cross infection in this special period.Surgical intervention for benign tumor should be postponed. For malignant tumor, multidisciplinary therapy (MDT) is recommended and non-surgical anti-tumor therapy should be selected with higher priority. Neoadjuvant therapy is highly recommended for gastrointestinal cancer at advanced stages that meet the indications of NCCN guideline (gastric cancer T stage ≥ 2/rectal cancer T stage ≥ 3/unresectable colon cancer). Gastric or esophagogastricjunction (EGJ) malignant tumor with obstruction can be managed with gastric tube decompression or stent placement to relieve the symptoms. Transnasal enteral feeding tube intubation/percutaneous endoscopic gastrostomy could be adopted to ensure enteral nutrition supply. For colorectal malignancy with simple intestinal obstruction, stent placement can achieve a high success rate, which not only helps avoid emergency surgery, but also creates a better condition for subsequent surgery. Transcatheter arterial embolization for hemostasis is an alternative choice for gastrointestinal tumor with bleeding. However, emergency operation still must be performed for patients with acute uncontrolled bleeding, obstruction or after other alternative treatment measures fail. All cases with suspicious or confirmed with NCP must be reported to the local CDC department. All invasive intervention must be performed in a designated isolation area. Tertiary prevention measure must be adopted for all anesthetists with additional face mask or medical goggle protection to prevent respiratory droplet transmission. Preventive enterostomy is preferable in lower digestive tract surgery. Thoroughly disinfecting the operating room after surgery is necessary. Fever after surgery must be carefully differentiated whether it's caused by post-surgery abdominal infection/inflammation or NCP. Single-room isolation and related examinations should be performed according to the standard procedures. We believe that with the unprecedentedly joint efforts of doctors and patients, we will eventually win this war against NCP.

Dental implant progress in children and adolescents / 口腔疾病防治

@#With the rapid development of implant technology, implant restoration is a conventional treatment option for adult patients with tooth loss. Severe dental lesions, trauma, tumors, abnormal development and other reasons can cause dental defects and even dentition loss in children and adolescents. There has been hesitation to perform implant therapy for growing children because of the growth period; thus, little is known about the outcomes of the osseointegration procedure in young patients. Therefore, this article reviews the current literature to discuss the use of dental implants in children and adolescents. According to current studies, orthodontic treatment or transitional restoration should be undertaken based on the characteristics of the children and adolescents. Implant surgery should be performed after the end of the peak growth period. For patients with severe dentition defects, relevant criteria should be established before implant surgery to evaluate the effect of implant therapy in children and adolescents. The patients should be treated with a multidisciplinary, staged and long-term treatment approach. Most of the recent literature consists of case reports and short-term studies. There is an urgent need for more studies in this field with long-term follow-up.

Surgical teratment for gastric cancer patients with liver metastasis / 中华肿瘤杂志

Multidisciplinary therapy is considered as an acceptable option for gastric cancer patients with liver metastases currently, while the effectiveness of surgery is still controversial. Although there was no improved survival for cytoreductive surgery, some evidences showed that some selected patients with the combination surgery of gastric cancer and liver metastases could benefit from curative resection. Compared to cytoreductive surgery for gastric cancer patients with liver metastasis, curative resection did not increase the incidence of complications or mortality. Therefore, surgery-based multidisciplinary therapy would be appropriate for some seleted gastric cancer patients with liver metastasis. In highly selected patients with neoadjuvant chemotherapy, curative resection with both primary and metastatic tumor could improve long-term survival benefits. Furthermore, the long-term survival and quality of life should be considered of equal importance in future studies.

Esophageal Cancer with Solitary Renal Metastasis Treated with Multidisciplinary Therapy: A Case Report and Mini Review of the Literature

Solitary renal metastasis of esophageal cancer is rarely encountered. Herein, we report the case of a 47-year-old man who developed a solitary renal metastasis after concurrent chemoradiotherapy followed by esophagectomy with esophagogastrostomy for esophageal squamous cell carcinoma, and treatment with nephrectomy and subsequent chemotherapy. Histopathological evaluation after operation revealed that the kidney mass was a metastatic lesion from esophageal cancer. He completed 15 cycles of palliative chemotherapy after nephrectomy and remained cancer-free for 36 months. Although lymph node metastasis occurred during regular follow-up, no evidence of lymph node metastasis was found on the imaging study after 9 cycles of chemotherapy with radiotherapy.

New updates of diagnosis and treatment of adenocarcinoma of esophagogastric junction / 中华消化外科杂志

The definition,staging and optimal treatment of adenocarcinoma of esophagogastric junction (AEG) have long been in controversy.Surgery is still the primary treatment for resectable AEG,and surgical procedures depend on its classifications.However,the efficacy of surgery alone is barely satisfactory.Neoadjuvant chemoradiotherapy and perioperative chemotherapy can improve the survival of patients.Simplified 2 cm principle is presented in the 8th edition of American Joint Committee on Cancer for TNM staging system of esophageal cancer.In addition,the new edition provides clinical staging and pathologic staging after neoadjuvant therapy,improving the clinical practicability of new staging system.

Clinical analysis of 38 patients with anorectal malignant melanoma / 肿瘤研究与临床

Objective To investigate the diagnosis and treatment of anorectal malignant melanoma,in order to regulate surgical methods and explore multi-modality treatment.Methods Clinical pathological features,diagnosis and treatment procedures of 38 patients with anorectal melanoma were reviewed,and their correlation with prognosis were analyzed.Results In 38 patients,10 of them were male and 28 were female,with the mean age of 58.7 years old (ranged 28-75 years old).28 patients underwent abdominoperineal resection,10 patients underwent wide local excision.The 1-,3-,and 5-year disease-free survival rates were 64.9 ％,18.5 ％ and 5.7 ％,respectively.The 1-,3-,and 5-year overall survival rates were 85.8 ％,24.1％ and 6.4 ％,respectively.Tumor thickness (≥ 1.51 rm) and tumor diameter (≥3 cm) were associated with lymph metastases (x2 =13.093,4.449,P =0.011,0.020),tumor thickness was also associated with distant metastases (x2 =11.965,P =0.018).According to the Kaplan-Meier method,comprehensive treatment after surgery had significant effects on disease-free survival (x2 =7.441,P =0.006).Tumor thickness,lymph metastases,and clinical staging had significant effects on overall survival (x2 =16.741,16.474,16.775,P =0.002,0.000,0.000).Cox proportional hazards model indicated that comprehensive treatment after surgery was the independent prognostic risk factors of disease-free survival (95 ％ CI 1.420-17.621,P =0.012).Tumor thickness and lymph metastases were the independent prognostic risk factors of overall survival (95 ％ CI 0.250-0.949,1.033-2.573,P =0.035,0.036).Conclusion Early detection,reasonable surgical procedure,generalized systemic focus on immunotherapy treatment are the key to improve quality of life and prolong the survival time of anorectal malignant melanoma patients.

Application and evaluation of magnetic resonance imaging in the multidisciplinary treatment of breast cancer / 中国癌症杂志

It has been shown that MR imaging of breast is superior to conventional mammography and ultrasonography on early diagnosis and cancer staging on breast cancer due to MRI’s high soft-tissue contrast and no radiation. The concept of multidisciplinary treatment of breast cancer has been increasingly accepted in clinical practice of breast cancer care. Investigation of breast MRI on cancer staging, selecting conservative therapy, detecting the primary malignant of patients presenting as axillary metastases, evaluating residual disease after neoadjuvant chemotherapy(NAC), predicting response in the early phase of treatment as well as monitoring recurrence during follow-up has been carried out along with its board clinical application. The advantages of breast MRI in mapping the disease accurately provide measures to select appropriate use of variable treatments.

Multidisciplinary Therapy on Central Pain after Spinal Cord Injury: 32 Cases Report / 中国康复理论与实践

@#Objective To observe the effects of multidisciplinary therapy on central pain of patients with spinal cord injury.Methods 32 cases of spinal cord injury with central pain were treated with accupuncture, massage and drugs, and the effects were assessed by McGill Pain Questionnaire (MPQ), Visual Analogous Score (VAS) and Barthel Index (BI).Results The scores of pain of all patients significantly decreased and the scores of BI highly increased after treatment (P<0.01).Conclusion Multidisciplinary therapy is effective on central pain in patients with spinal cord injury.

Effect of Qingre Huoxue Xiaozhong Ⅰ/Ⅱ Mixture on Knee Joint Function Disorder after Fracture / 中国康复理论与实践

@# Objective To observe the effect of Chinese medicine Qingre Huoxue Xiaozhong Ⅰ/Ⅱ mixture on the knee joint function disorder after fracture.Methods 143 patients with knee joint function disorder after fracture were randomly divided into the treatment group(n=50),control Ⅰ group(n=48),control Ⅱ group(n=45).The cases of the treatment group were treated with Qingre Huoxue Xiaozhong Ⅰ mixture 150 ml three times per day orally,Qingre Huoxue Xiaozhong Ⅱ mixture exteral washing once every day,and combined with Honghua oil and TDP instrument therapy.The cases of the control Ⅰ group were treated with the prepared medicine Shenjin Dan 6 pieces,three times a day,combined with Honghua oil and TDP instrument therapy.The cases of the control Ⅱ group were treated only with Honghua oil and TDP instrument therapy.15 days were as a treatment course,and performed 1～2 treatment courses.The patients of the three groups also took the vitamins and calcitium simultaneously.The curative effect was evaluated according to the standard of Lysholm Joint Function.Results After treatment,the total excellent rates of the treatment group,control Ⅰ group and control Ⅱ group were 78%,39.58% and 24.44%,respectively,the result of the treatment group was significantly superior to that of the control Ⅰ group and control Ⅱgroup(P<001).The total effective rates of the treatment group,control Ⅰ group and control Ⅱ group were 98%,85.42% and 75.55%,respectively.The effect of the treatment group was also significantly superior that of the control Ⅰ group(P<0.05) and control Ⅱ group( P<0.01).Conclusion The Chinese native medicine Qingre Huoxue Xiaozhong Ⅰ/Ⅱ mixture has an obvious therapeutic effect in the multidisciplinary therapies on the knee joint function disorder after fracture.

Present Situation of Multidisciplinary Therapy to Idiopathic Facial Palsy(review) / 中国康复理论与实践

@#: Idiopathic facial palsy,also called the Bell's paralysis,refers to around the single side with unclear reason and acute onset.It was one common disease caused by acute non-purulent inflammation of the stylomastoid foramen and the main characteristic was the motor function disorder of facial mimetic muscles.When the facial nerve or stylomastoid foramen had the inflammatory edema,it will oppress the facial nerve inducing mimetic muscles paralysis on sick side.In recent years domestic and foreign experts treat the idiopathic facial palsy with medicine,physical therapy,acupuncture and moxibustion,and etc.,and obtain exciting effect..