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【Objective】 To explore the clinicopathological characteristics and comprehensive treatment strategies of prostate mucosa adenocarcinoma under multidisciplinary diagnosis and treatment (MDT) mode. 【Methods】 Data of two patients with typical prostate mucosa adenocarcinoma treated in our hospital during Sep.2020 and Apr.2023 were retrospectively analyzed. 【Results】 In case 1, the clinical manifestation was macroscopic hematuria; multiparametric magnetic resonance imaging (mpMRI) indicated solid prostatic nodules, clinical stage T4N1Mx; initial prostate specific antigen (PSA) was 1.2 ng/mL; 6868Ga-prostate specific membrane antigen PET/CT (68Ga-PSMA PET/CT) suggested abnormal uptake of nuclear lesions in the prostate (SUV4.2-5.3); biopsy results indicated invasive mucinous adenocarcinoma.After prostate and pelvic field radiotherapy + androgen deprivation therapy (ADT) + antihypertensive treatment, lesions were significantly reduced, and hematuria symptoms were relieved.In case 2, the clinical manifestation was dysuria; initial PSA was 91.78 ng/mL; mpMRI suggested invasion of prostate mass into the bladder and clinical stage of T4N1M1b; 68Ga-PSMA PET/CT indicated prostate and pelvic lymph nodes, and multiple bone lesions showed increased nuclide uptake; biopsy results indicated prostate adenocarcinoma with mucinous adenocarcinoma.Initial endocrine treatment was performed.After 3 months, PSA was reduced to 0.083 ng/mL, and imaging showed the tumor was significantly reduced.Robotic-assisted laparoscopic tumor prostatectomy with extended pelvic lymph node dissection was performed, and endocrine adjuvant therapy was continued after surgery. 【Conclusion】 Prostate mucosa adenocarcinoma has different clinicopathological characteristics and prognosis from conventional acinar adenocarcinoma, and the whole-process management under MDT mode is of great value in the diagnosis and treatment of this disease.
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Autoimmune pancreatitis （AIP） is an immune⁃mediated， special type of chronic pancreatitis， which can involve multiple organs. The clinical manifestation of AIP is complex and varied， making the diagnosis and treatment challenging. With reference to the latest guidelines and studies from both domestic and international sources， this guideline comprises 20 recommendations regarding the diagnosis， treatment， follow⁃up， and prognosis of AIP. The aim of this guideline is to promote the care capability and improve the outcome of patients with AIP in China.
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In the past decade,thyroid surgery in China has developed rapidly.With the improvement of thyroid diagnosis technology,the standardization of thyroid surgery,the clinical application of systematic therapy,and the progress in fundamental research,thyroid surgery has achieved all-round development.Patients with thyroid disease have benefited significantly from safer,more standardized,more effective,and more diverse treatments,which results in the remarkable increase in the 5-year survival rate.Moreover,Chinese experts have published a number of guidelines and expert consensus related to thyroid surgery,which promotes the standardization of the diagnosis and treatment of thyroid disease.Additionally,the specialized multidisciplinary teams in cancer centers allow patients to receive more standardized diagnosis and treatment of complex thyroid diseases.In the present article,we summarize the important developments of China's thyroid surgery in the past decade,including preoperative diagnosis technology,surgical methods,operation safety,application of minimally invasive techniques,diagnosis and treatment of special thyroid cancers,multidisciplinary diagnosis and treatment models,and standardized postoperative managements.We expect to popularize the concept of standardized diagnosis and treatment of thyroid diseases,and improve the level of standardized diagnosis and treatment in thyroid surgery.
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@#Pediatric malocclusion is common in dentistry. Some children with malocclusion combined with obstructive sleep apnea-hypopnea syndrome (OSAHS) often fail to receive appropriate treatment due to a lack of multidisciplinary diagnosis and treatment. It can cause abnormal ventilation during sleep, affecting the central nervous system and cardiovascular development and even causing neurological and behavioral problems. Pediatric OSAHS is caused by the narrowing of the upper respiratory tract, characterized by specific facial bone characteristics and neuromuscular factors and correlated with malocclusion. Due to its diverse clinical manifestations and etiology, the diagnosis and treatment of pediatric OSAHS require an interdisciplinary, personalized, and specialized approach. Questionnaires and physical examinations can be used for preliminary screening. Moreover, children's stomatology and otorhinolaryngology examinations are the basis for disease diagnosis. Polysomnography (PSG) is currently the direct diagnostic method. There are various treatment methods for OSAHS in children, and for OSAHS caused by adenoid tonsil hypertrophy, adenoidectomy and tonsillectomy are the main treatments. Othodontic treatment including mandibular advancement and rapid maxillary expansion et al is also effective for OSAHS in children with malocclusion. Currently, there is limited research on the correlation between childhood malocclusion and OSAHS, and multidisciplinary combination therapy may improve the cure rate, but there is a lack of sufficient evidence. In the future, the pathogenesis of OSAHS should be further elucidated, and research on multidisciplinary combination therapy should be promoted to achieve early intervention and treatment for potential and existing patients.
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Objective To understand the effectiveness evaluation research of tumor MDT,and analyze the development status and differences of evaluation tools at home and abroad,to provide reference for the subsequent summary evaluation and continuous improvement of tumor MDT,and the strengthening of MDT supervision.Methods Four literature databases at home and abroad were searched to obtain relevant literatures,and literature screening and systematic review were conducted.Results A total of 87 literatures were included,including 26 literatures in Chinese and 61 literatures in English;the most published years were 2020;the main countries of the first authors were the UK.Foreign evaluation tools focus on the key elements of structure and process,while evaluation systems in China focus on the index content at the result level.Conclusion In China,the scientific and comprehensive selection of tumor MDT evaluation indicators needs to be improved,the analysis of influencing factors on the structure and process of MDT needs to be strengthened,and the extrapolation of the existing evaluation systems need to be verified.It is suggested to strengthen the evidence support of evaluation index selection,attach importance to the evaluation of process links,promote the in-depth study of the influencing factors of tumor MDT,and further encourage the empirical application of the existing evaluation system.
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As a part of the multidisciplinary diagnosis and treatment model of malignant tumors， traditional Chinese medicine （TCM） plays a unique role in increasing efficiency， reducing toxicity， and preventing recurrence and metastasis. It has been gradually recognized that integrated TCM and western medicine should be used in diagnosis and treatment of tumors. Western medicine such as surgery， radiotherapy， chemotherapy， endocrine therapy， targeted therapy， and immunotherapy may act as the main factors that change the syndromes， as they can induce the changes of the tongue and pulse manifestations and symptoms after acting on the body. It is therefore advised to differentiate and analyze the attributes of yin-yang and cold-heat of western medicine as well as its impact on TCM syndromes， and use Chinese herbal medicinals precisely so as to increase efficiency and reduce toxicity. Moreover， it is better to grasp the syndrome evolution trend of modern medicine and predict the disease tendency， so as to improve the accuracy of syndrome differentiation and treatment in TCM under multi-disciplinary diagnosis and treatment model， and promote the maximization of the benefits of integrated TCM and western medicine in treating tumors.
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Objective:To explore the application effect of the multidisciplinary diagnosis and treatment nursing in improving postoperative anxiety and depression and quality of life in patients with lateral skull base tumor, so as to provide a constructive template for the multidisciplinary diagnosis and treatment nursing.Methods:This was a prospective cohort study design. A total of 100 patients who underwent lateral skull base tumor surgery in Shandong Second Provincial General Hospital from January 2021 to April 2022 were selected as the research objects. The patients were divided into observation group and control group by random digits table method with 50 cases in each group. The control group was given routine nursing care after operation of lateral skull base tumor and routine follow-up management. The observation group received the multidisciplinary diagnosis and treatment nursing on the basis of the control group. The intervention time was 3 months. The psychological state and quality of life of the two groups before and after intervention were evaluated by Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Short Form Health Questionnaire (SF-36).Results:There was no significant difference in SAS, SDS, and SF-36 scores before intervention between the two groups ( P>0.05). The scores of SAS, SDS and SF-36 after the intervention were (44.58 ± 5.61), (41.66 ± 8.48), (75.66 ± 13.65) points in the observation group, and (50.86 ± 4.91), (45.80 ± 9.32), (68.43 ± 14.34) points in the control group, there were statistically significant differences between the two groups( t values were -5.95, -2.32, 2.58, all P<0.05). Conclusions:The multidisciplinary diagnosis and treatment nursing can significantly improve anxiety, depression and quality of life of patients with lateral skull base tumor after surgery.
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Colorectal cancer is one of the most common malignant tumors in the world, with a high mortality, but with the continuous improvement of diagnosis and treatment technology and treatment concept in recent years, many patients can get timely and effective treatment. From the aspects of distant metastasis of colorectal cancer and the progress of diagnosis and treatment under multidisciplinary diagnosis and treatment mode, focusing on the significance of multidisciplinary diagnosis and treatment mode for metastatic colorectal cancer, and exploring a more accurate and effective treatment system, so as to provide some reference for the comprehensive treatment of metastatic colorectal cancer.
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We retrospectively analyzed the clinical characteristic of one patient with metastatic prostate cancer and the relative literatures were reviewed. A 40-year-old man was admitted and diagnosed as prostate cancer on March 20, 2018(T 4N 1M 1a) with prostate-specific antigen (PSA) at 47.99 ng/ml. The first 68Ga-PSMA PET/CT showed multiple nodular lesions in the bilateral peripheral bands of the prostate, multiple nodular lesions in the right apex, abnormal uptake of nuclides in multiple lymph nodes in the abdominal aortic wandering zone, the abdominal aortic bifurcation zone, and the bilateral iliac artery wandering zone at the level of the lumbar 2-5 vertebral body, and metastasis was considered. The patient was treated with six cycles of drug castration combined with antiandrogenic treatment and pre-operative system chemotherapy(docetaxel). Six months later, the PSA decreased to 0.225ng/ml. Robot-assisted laparoscopic prostatectomy and expanded pelvic lymph node dissection was performed. Postoperative total androgen blocking therapy was maintained, and PSA slowly increased. Ten months after operation, salvage radiotherapy for enlarged lymph nodes was performed in pelvic extension field, prostate tumor bed area and pelvic cavity. PSA remained stable for 7 months postradiotherapy, and then increased. The patient developed castration-resistant prostate cancer and was treated with triptorelin combined with abiraterone. PSA was decreased, and local radiotherapy was performed for new lymph node metastases in the neck. 68Ga-PSMA PET/CT could provide a decision-making basis for accurate clinical staging, therapeutic effect evaluation and distant metastatic lesions location with guiding value for the formulation of individualized treatment plans.
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Bone is a common metastatic site of renal cell carcinoma (RCC), with about 30% of metastatic RCC patients are suffering from bone metastasis. More than 70% of RCC patients with bone metastasis may experience skeletal related events (SREs), which may severely impair patients' quality of life and even shorten their survival time. Therefore, SREs prevention has become one of the treatment objectives of RCC bone metastasis. Bone-modifying agents are the basic treatment of bone metastases in addition to anti-tumor therapy. The treatment of RCC bone metastasis also requires multi-disciplinary team and individualized comprehensive treatment strategies. To standardize the diagnosis and treatment of RCC bone metastasis in China, the expert group of Genitourinary Oncology Committee, Chinese Anti-cancer Association has formulated the expert consensus for the reference of clinical practice, to improve the general therapeutic level of RCC with bone metastasis and benefit more patients.
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Humans , Bone Neoplasms/drug therapy , Carcinoma, Renal Cell/drug therapy , Consensus , Kidney Neoplasms , Quality of LifeABSTRACT
Radiation therapy plays a significant role in the integrated treatment for patients with pelvic malignancies, but may lead to radiation-induced rectal injury in some patients, which may affect their physical health and quality of life negatively. Patients with radiation-induced rectal injury are often complicated with pelvic multi-organ injury. Collaborative, multidisciplinary evaluation of pelvic injuries should be highlighted in clinical practices, including clinical, endoscopic, radiological and histopathologic evaluation. To determine the overall treatment strategy and develop individualized treatment strategy, it is necessary to assess the oncologic prognosis, severity and stage of radiation-induced rectal injury and clinical classification using different rating scales. Considering that the disease is self-limiting, non-surgical treatment should be performed for patients with early lesions, while surgical interventions should be performed as soon as possible for patients with severe complications. In terms of prevention of radiation-induced rectal injury, prevention should be targeted for patients at high risk of radiation-induced rectal injury through technique improvement, physical protection and drug prevention. This consensus aims to provide guidance for the clinical practice of radiation-induced rectal injury in China.
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Humans , China , Consensus , Quality of Life , Radiation Injuries/therapy , RectumABSTRACT
The diagnosis and treatment of thyroid cancer during pregnancy is one of the hot spots and difficult problems in the diagnosis and treatment of thyroid diseases.The detection of thyroid cancer during pregnancy has been a great challenge for both clinicians and pregnant women.It should be diagnosed as soon as possible through multidisciplinary collaboration. Comprehensive and reasonable assessment of the status of pregnant women and fetuses,selection of the most appropriate treatment and follow-up methods are needed to avoid iatrogenic side effects on pregnant women and fetuses,maintain normal pregnancy and obtain the best therapeutic effect.
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Heart specialists team has become one of the core concepts of diagnosis and treatment mode for cardiovascular diseases.Multidisciplinary collaboration has proved its beneficial effects on the diagnosis and treatment strategies, patient selection, follow-up and management of some cardiovascular diseases.At present,it is chiefly seen in the diagnosis and treatment of coronary artery revascularization and transcatheter aortic valve replacement.During implementation there still exist such problems as lack of awareness,attention and effective operation of the medical staff,and lack of an incentive mechanism, thus incurring controversies over such a model.Therefore further follow-up and improvements are expected in combination with the characteristics of China′s medical institutions.
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Through several years of exploration in Shanghai Chongming region, the team from Chongming Branch of Xinhua Hospital has established the initial multidisciplinary diagnosis and treatment model of cancer pain, which includes the department of oncology, anesthesiology, pain, rehabilitation, psychology and so forth. By means of medical informationization, they take cancer pain management as the starting point and have initially real-ized a new model of the real-time assessment and treatment of cancer pain, which has helped patients effectively reduce the physical and psychological suffering, improved the quality of life, developed a healthy self-manage-ment of patients, and has reference significance to palliative care.