Multiple Disciplinary Team Research Articles

Consensus guidelines on the diagnosis and treatment of pancreatic pseudocyst and walled-off necrosis from a Chinese multiple disciplinary team expert panel.

To prepare a set of practice guidelines to standardize the entire process, from diagnosis to treatment and follow-up, for pancreatic pseudocysts and walled-off necrosis. Thirty-six experts in the fields of digestive endoscopy, pancreatic surgery, interventional radiology, and others presented their opinions via discussions in online conferences by referring to the patient, intervention, comparison, and outcomes principles and then reviewed the evidence and statements using the Delphi method to reach a consensus. The consensus of >80% was finally achieved for the items. The experts discussed and reached a consensus on 29 statements including 10 categories: (1) definition and classification, (2) imaging and endoscopic diagnosis, (3) therapeutic implications, (4) surgical therapy, (5) percutaneous catheter drainage, (6) endoscopic retrograde cholangiopancreatography, (7) EUS-guided drainage, (8) stent selection for EUS-guided drainage, (9) complication related to stents for cyst drainage, and (10) drug treatment and follow-up. This consensus based on the clinical experience of experts in various fields and international evidence-based medicine further standardizes the multidisciplinary diagnosis and treatment processes for pancreatic pseudocysts and walled-off necrosis.

Laparoscopic necrosectomy for acute necrotizing pancreatitis: mesocolon-preserving approach and outcomes.

The surgical treatment of acute necrotizing pancreatitis has significantly evolved in recent years with the advent of enhanced imaging techniques and minimally invasive surgery. Various minimally invasive techniques, such as video-assisted retroperitoneal debridement (VARD) and endoscopic transmural necrosectomy (ETN), have been employed in the management of acute necrotizing pancreatitis and are often part of step-up approaches. However, almost all reported step-up approaches only employ a fixed minimally invasive technique prior to open surgery. In contrast, we implemented different minimally invasive techniques during the treatment of acute pancreatitis based on the extent of pancreatic necrosis. For acute necrotizing pancreatitis of the pancreatic bed with or without extension into the left retroperitoneum, we performed mesocolon-preserving laparoscopic necrosectomy for debridment. The quantitative indication for pancreatic debridment in our institute has been described previously. For acute necrotizing pancreatitis of the pancreatic bed with or without extension into the left retroperitoneum, mesocolon-preserving laparoscopic necrosectomy was performed for debridment. To safeguard the mesocolon, the pancreatic bed was entered via the gastrocolic ligament, and the left retroperitoneum was accessed via the lateral peritoneal attachments of the descending colon. Of the 77 patients requiring pancreatic debridment, 41 patients were deemed suitable for mesocolon-preserving laparoscopic necrosectomy by multiple disciplinary team and informed consent was acquired. Of these 41 patients, 27 underwent percutaneous drainage, 10 underwent transluminal drainage, and 2 underwent transluminal necrosectomy prior to laparoscopic necrosectomy. Two patients (4.88%) died of sepsis, three patients (7.32%) required further laparotomic necrosectomy, and five patients (12.20%) required additional percutaneous drainage for residual infection. Three patients (7.32%) experienced duodenal fistula, all of which were cured through non-surgical treatments. Nineteen patients (46.34%) developed pancreatic fistula that persisted for over 3weeks, with 17 being successfully treated non-surgically. The remaining two patients had pancreatic fistulas that lasted over 3months; an internal drainage procedure has been planned for them. No patient developed colonic fistula. Mesocolon-preserving laparoscopic necrosectomy proved to be safe and effective in selected patients. It can serve as a supplementary procedure for step-up approaches or as an alternative to other debridment procedures such as VARD, ETN, and laparotomic necrosectomy.

Pulmonary tuberculoma, to resect or not to resect: a systematic review

Introduction: Pulmonary tuberculomas usually present as a solitary pulmonary nodule. Pulmonary tuberculoma is difficult to differentiate from lung cancer. The treatment should follow the multiple disciplinary teams. Method: This systematic review aims to summarize the effectiveness of pulmonary tuberculoma treatment, including the response to anti-tuberculosis treatment or surgical resection. PubMed, Wiley, Cochrane, ProQuest, and ScienceDirect were searched for any design study that showed the cure rate of pulmonary tuberculoma treatment, with surgical resection or the used of anti-tuberculosis treatment. Result: Four studies were identified and analyzed from 288 initial articles. Data were then extracted from the studies and summarized descriptively. Two hundred eighty-eight articles were screened, and four studies were identified and eventually selected. The cure rate of pulmonary tuberculoma increased in patients with surgical procedures compared with medical treatment (only anti-tuberculosis treatment). Pulmonary tuberculoma responds poorly to anti-tuberculosis treatment and often requires long-term treatment. Conclusion: The treatment of tuberculoma with surgical resection works effectively, with better short- and long-term effects for tuberculoma. Surgical resection was effective in increasing the cure rate of pulmonary tuberculoma. Pulmonary resection in combination with post-operative anti-tuberculosis treatment results in excellent cure rate.

High Frequency of Genetic Variants Influencing Diagnosis and Bleeding Pattern in Patients with Presumed Primary Immune Mediated Thrombocytopenia (ITP)

Introduction Immune mediated thrombocytopenia (ITP) is a platelet disorder in which the immune system attacks and destroys the body's own platelets. Mechanisms leading to low platelet count in ITP are multifactorial, involving both increased peripheral platelet destruction and decreased platelet production. This is caused by autoantibodies targeting megakaryocytes and platelet-specific glycoproteins, as well as cytotoxic T cells directly acting on platelets. Although antibodies in some cases can be found in patients with ITP, there is no well-established diagnostic test and the diagnosis is thus, one of exclusion. While most cases of ITP resolve within 3 months with or without treatment, some patients do not respond to conventional treatment and develop a refractory ITP. It is likely that in the group of patients diagnosed with refractory ITP, some does not have an immune mediated thrombocytopenia, but other causes of low counts (PLC)s. With the development of high throughput sequencing and the increasing knowledge of inherited bleeding disorders, the possibility to identify the underlying cause of disease in these patients is steadily growing. In ITP, there is a high degree of interindividual differences in bleeding rates, where some patients have no bleeding symptoms despite of unmeasurable PLC, whereas other patients show severe bleeding symptoms at PLC > 30 x10 9 /L. The underlying etiology of these discrepancies is currently unknown and complicates the clinical care of these patients. We hypothesize that genetic defects influence the bleeding pattern in true ITP patients as well as being one of the underlying causes of thrombocytopenia in patients misdiagnosed with “refractory ITP”. The aim of this pilot study was to investigate whether upfront genetic screening of patients suspected of ITP could be a valuable diagnostic tool to determine presence of inherited thrombocytopenia, secondary thrombocytopenia and genetic variants that might affect bleeding pattern. Method Patients were included after informed consent following the declaration of Helsinki. We performed whole genome sequencing (WGS) in patients diagnosed with presumed ITP at the Skåne University Hospital, Sweden. Whole genome sequencing was performed at the Center for Genomic Medicine at Rigshospitalet, Copenhagen. An in-silico gene panel consisting of 113 genes known to be associated with bleeding disorders as well as 86 genes associated with ITP (Using the VarSeq gene prioritisation algorithm phorank) was analysed and pathogenicity was classified according to the ACMG/AMP guidelines. Patients' medical records were examined, laboratory work up was performed and clinical data regarding demographics and information regarding bleeding was collected. A final evaluation of susceptible variants took place at multiple disciplinary team conferences. Results Twenty-one patients were enrolled (9 women, 12 men, 17 were adults and 4 children). Mean age of adult patients was 50,5 years and mean age of paediatric patients was 11,5 years. Out of 21 patients, 7 were shown to have genetic variants with relevance to their disease. All variants were found in adult patients. Two patients had variants related to inherited thrombocytopenia (X-linked thrombocytopenia(WAS) and monoallelic Bernard-Soulier Syndrome(GP1BB)), 4 had variants in genes related to secondary ITP (3 with variants associated with common variable immunodeficiency (NFKB1, TNFRSF13B) and 1 with systemic lupus erythematosus (TREX1)) and 1 had a variant associated with platelet dysfunction (platelet delta storage pool deficiency (UNC13D)). Only the variant associated with X-linked thrombocytopenia was previously described (class 5) whereas the remaining 6 variants were initially classified as variants of unknown significance (VUS). Functional work-up and co-segregation studies indicated them as probably pathogenic (class 4) but confirming studies are still pending. Conclusion In this pilot study, 33% of patients with presumed primary ITP had variants with relevance to their clinical phenotype, and we were able to diagnose 1 patient with an inherited bleeding disorder (X-linked thrombocytopenia). Whole genome sequencing seems to be a useful diagnostic tool in the work up of patients with thrombocytopenia where ITP is suspected to ensure the diagnosis and could also add important information when assessing bleeding risk in individual patients.

The general trend of surgical treatment of nasal skull base tumors is to construct a multiple disciplinary team including rhinologist and neurosurgeon

The general trend of surgical treatment of nasal skull base tumors is to construct a multiple disciplinary team including rhinologist and neurosurgeon

Clinical diagnosis and treatment of multiple pulmonary nodules

CT screening has markedly reduced the lung cancer mortality in high-risk population and increased the detection of early-stage pulmonary neoplasms, including multiple pulmonary nodules, especially those with a ground-glass appearance on CT. Multiple primary lung cancer (MPLC) constitutes a specific subtype of lung cancer with indolent biological behaviors, which is predominantly early-stage adenocarcinoma. Although MPLC progresses slowly with rare lymphatic metastasis, existence of synchronous lesions and distributed location of these nodules still pose difficulty for the management of such patients. One single operation is usually insufficient to eradicate all neoplastic lesions, whereas repeated surgical procedures bring about another dilemma: whether clinical benefits of surgical treatment outweigh loss of pulmonary function following multiple operations. Therefore, despite the anxiety for treatment among MPLC patients, whether and how to treat the patient should be assessed meticulously. Currently there is a heated discussion upon the timing of clinical intervention, operation mode and the application of local therapy in MPLC. Based on clinical experience of our multiple disciplinary team, we have summarized and commented on the evaluation, surgical treatment, non-surgical local treatment, targeted therapy and immunotherapy of MPLC in this article to provide further insight into this field.

Multiple disciplinary team for Pompe disease

庞贝病是由于编码溶酶体内酸性α-葡糖苷酶（acid α-glucosidase，GAA）的基因缺陷所致的常染色体隐性遗传病。早期诊断和治疗干预可有效改善患者预后。由于庞贝病多系统受累，临床表现多样，故需要进行多学科综合管理贯穿患者的筛查诊断及治疗管理全程。现系统性总结庞贝病多学科综合管理的最新研究进展，为临床医师提供参考。.

Neoadjuvant chemotherapy in the treatment of locally advanced olfactory neuroblastoma in 25 cases

Objective: To evaluate the efficacy of neoadjuvant chemotherapy (NACT) in the treatment of locally advanced olfactory neuroblastoma (ONB), and to explore the factors related to the efficacy of NACT. Methods: A total of 25 patients with ONB who underwent NACT in Beijing TongRen Hospital from April 2017 to July 2022 were retrospectively analyzed. There were 16 males and 9 females, with an average age of 44.9 years (ranged 26-72 years). There were 22 cases of Kadish stage C and 3 cases of stage D. After multiple disciplinary team(MDT) discussion, all patients were treated sequentially with NACT-surgery-radiotherapy. Among them, 17 cases were treated with taxol, cis-platinum and etoposide (TEP), 4 cases with taxol, nedaplatin and ifosfamide (TPI), 3 cases with TP, while 1 case with EP. SPSS 25.0 software was used for statistical analysis, and survival analyses were calculated based on the Kaplan-Meier method. Results: The overall response rate of NACT was 32% (8/25). Subsequently, 21 patients underwent extended endoscopic surgery and 4 patients underwent combined cranial-nasal approach. Three patients with stage D disease underwent cervical lymph node dissection. All patients received postoperative radiotherapy. The mean follow-up time was 44.2 months (ranged 6-67 months). The 5-year overall survival rate was 100.0%, and the 5-year disease-free survival rates was 94.4%. Before NACT, Ki-67 index was 60% (50%, 90%), while Ki-67 index was 20% (3%, 30%) after chemotherapy [M (Q1, Q3)]. The change of Ki-67 before and after NACT was statistically significant (Z=-24.24, P<0.05). The effects of age, gender, history of surgery, Hyams grade, Ki-67 index and chemotherapy regimen to NACT were analyzed. Ki-67 index≥25% and high Hyams grade were related to the efficacy of NACT (all P<0.05). Conclusions: NACT could reduce Ki-67 index in ONBs. High Ki-67 index and Hyams grade are clinical indicators sensitive to the efficacy of NACT. NACT-surgery-radiotherapy is effective for patients with locally advanced ONB.

Expert consensus on treatment for stage III non‐small cell lung cancer

AbstractStage III non‐small cell lung cancer (NSCLC) encompasses a group of diseases with high heterogeneity. Such patients should actively receive comprehensive treatments. It is imperative for all stage III NSCLC patients to receive consultation with a multiple disciplinary team, which allows the development of a proposal for clinical diagnosis and treatment. In this consensus, stage III NSCLC is divided into two types (operable and inoperable) according to different clinical conditions. Resectable NSCLC is further subdivided into two conditions (with or without driver genes). For each clinical scenario, this consensus emphasizes that the foundation of any medical decisions regarding the optimal diagnostic or therapy procedure is scientific evidence from clinical research. Finally, based on the level of evidence and strength of recommendations, this consensus provides recommendations for the management of stage III NSCLC from six perspectives. The objective of this consensus is to help clinicians choose the best treatment and promote the standardization of stage III NSCLC diagnosis and treatment in China.

Effect of multiple disciplinary team led by pain specialist nurses on postoperative analgesia in patients undergoing mastectomy

This study aims to analyze the effect of multiple disciplinary team (MDT) led by pain specialist nurses on postoperative analgesia in patients undergoing mastectomy. 140 patients with breast cancer admitted to our hospital were treated with mastectomy and randomly divided into the control group and the intervention group. Routine pain care was applied in the control group, while pain care of MDT led by pain specialist nurses was applied in the intervention group based on the control group. The degree of pain, total postoperative analgesic dose, the first ambulation time, the time for recovery of surgical wound and hospital stay were compared between both groups. The psychological status, stress response-related indicators before and after intervention were compared between both groups, and the incidence of postoperative complications and analgesic satisfaction were counted. In contrast to the control group, the numerical rating scale (NRS) score of the intervention group was lower (p &lt; 0.05); total postoperative analgesic dose, the first off-bed activity time, the time for surgical wound recovery, the drainage tube placement time and the hospital stay of the intervention group were reduced (p &lt; 0.05); after intervention, self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores of the intervention group were diminished (p &lt; 0.05); after intervention, decreased noradrenaline (NE), adrenocorticotropic hormone (ACTH) and Cor indexes were presented in the intervention group (p &lt; 0.05); the incidence of postoperative complications of the intervention group was 7.14%, lower than 18.57%of the control group (p &lt; 0.05); the analgesic satisfaction of the intervention group was 95.71%, higher than 84.29% of the control group (p &lt; 0.05). Therefore, we conclude that MDT led by pain specialist nurses is worthy of clinical application.

Study protocol for a prospective, open-label, single-arm, phase II study on the combination of tislelizumab, nab-paclitaxel, gemcitabine, and concurrent radiotherapy as the induction therapy for patients with locally advanced and borderline resectable pancreatic cancer.

Pancreatic ductaladenocarcinoma (PDAC) is a fatal malignancy with a low resection rate. Chemotherapy and radiotherapy (RT) are the main treatment approaches for patients with advanced pancreatic cancer, and neoadjuvant chemoradiotherapy is considered a promising strategy to increase the resection rate. Recently, immune checkpoint inhibitor (ICI) therapy has shown remarkable efficacy in several cancers. Therefore, the combination of ICI, chemotherapy, and concurrent radiotherapy is promising for patients with potentially resectable pancreatic cancer, mainly referring to locally advanced (LAPC) and borderline resectable pancreatic cancer (BRPC), to increase the chances of conversion to surgical resectability and prolong survival. This study aims to introduce the design of a clinical trial. This is an open-label, single-arm, and single-center phase II trial. Patients with pathologically and radiographically confirmed LAPC or BRPC without prior anti-cancer treatment or severe morbidities will be enrolled. All patients will receive induction therapy and will be further evaluated by the Multiple Disciplinary Team (MDT) for the possibility of surgery. The induction therapy consists of up to four cycles of gemcitabine 1,000 mg/m2 and nab-paclitaxel 125 mg/m2 via intravenous (IV) infusion on days 1 and 8, along with tislelizumab (a PD-1 monoclonal antibody) 200 mg administered through IV infusion on day 1 every 3 weeks, concurrently with stereotactic body radiation therapy (SBRT) during the third cycle of treatment. After surgery, patients without progression will receive another two to four cycles of adjuvant therapy with gemcitabine, nab-paclitaxel, and tislelizumab. The primary objectives are objective response rate (ORR) and the R0 resection rate. The secondary objectives are median overall survival (mOS), median progression free survival (mPFS), disease control rate (DCR), pathological grade of tumor tissue after therapy, and adverse reactions. Besides, we expect to explore the value of circulating tumor DNA (ctDNA) in predicting tumor response to induction therapy and survival outcome of patients. This is a protocol for a clinical trial that attempts to evaluate the safety and efficacy of the combination of anti-PD-1 antibody plus chemotherapy and radiotherapy as the induction therapy for LAPC and BRPC. The results of this phase II study will provide evidence for the clinical practice of this modality. http://www.chictr.org.cn/edit.aspx?pid=53720&htm=4, identifier ChiCTR2000032955.

Bouveret syndrome: A challenging case of impacted gallstone within the fourth part of the duodenum.

Introduction and importanceBouveret syndrome is a rare condition characterised by gastric outlet obstruction secondary to a gallstone fistulating into the proximal duodenum or pylorus. Although rare, this condition carries a high mortality rate and no current standardised guidelines for management.Case presentationWe present a case of a patient in their 60s with recurrent small bowel obstruction secondary to a cholecysto-duodenal fistula and large gallstone which became impacted in the fourth part of the duodenum. The patient had a P-POSSUM Score of 14% mortality and 60% morbidity risk, had multiple co-morbidities, was bedbound, BMI 59 and had been deemed high risk for general anaesthetic at oncology centre for a 10 × 10 cm likely gynaecological malignancy a month prior to this admission.Clinical discussionIn contrast to existing literature, endoscopic lithotripsy was considered but not attempted due to unavailability of this service locally. Surgical intervention was decided based on radiological features of impending duodenal perforation on CT imaging and multiple disciplinary team discussion. The patient was managed with open enterolithotomy at the duodeno-jejunal (DJ) flexure and discharged 3 weeks post-operatively at her pre-operative baseline.ConclusionThis is the first report to our knowledge to describe successful surgical management of a gallstone impacted in the fourth part of the duodenum. In cases where anatomical location of impaction precludes retrieval via simple gastrostomy, we suggest using high pressure flush to mobilise the stone to more favourable location distally. We emphasise that stone size should be considered when planning surgical management.

Outcome of Sigmoid Colectomy in patients with recurrent Sigmoid Volvulus. A single center experience from a Rural Hospital

Objective: To assess the outcomes of definitive surgical management (sigmoid colectomy) in recurrent sigmoid volvulus. Study Design: Retrospective analytic study. Place and Duration: Department of Surgery at Balfour Hospital, Orkney, Scotland from 1st September 2014 to 1st September 2021. Methodology: Data of patients admitted with recurrent volvulus for three or more times and selected for surgery by a multiple disciplinary team retrieved. The median follow up of 32 (5-60) months was analyzed. The demographic features of the patient, symptoms, and complications after surgery, number of admissions before and after surgery and patient quality of life before and after surgery were analyzed. Results: A total of 33 patients were analyzed with an age ranges from 35 to 76 years with a median age of 55.5 years, M:F ratio of 12:2 and with duration of symptomatic volvulus 12 to 36 (median 24) months. Of the patients in the study, 24 patients had three previous admissions and 9 had more than three admissions with sigmoid volvulus that was managed conservatively. Complications experienced included post-operative ileus in 33.3%, wound infection 6%, and readmission with volvulus was 3.03% however 57.5% reported no complications. Conclusion: Our study concluded an excellent intermediate term outcome with very low clinical recurrence in patients who were offered definitive management following multiple admissions. Keywords: Sigmoid volvulus, Recurrent, Co-morbidities, Colectomy, Complications, Outcome

The Chinese guidelines for neoadjuvant therapy of pancreatic cancer (2020)

Abstract Aiming to keep pace with the renewal of international guidelines and refine the domestic treatment system of pancreatic cancer, the Chinese Pancreatic Surgery Association, Chinese Medical Association and Pancreatic Disease Committee of China Research Hospital Association launched this Chinese guidelines for neoadjuvant therapy of pancreatic cancer (2020 edition). Based on the Grading of Recommendations Assessment, Development, and Evaluation system, the guidelines have conducted a discussion on the indication, regimen selection, therapeutic effect evaluation, pathological diagnosis, surgery strategy, etc. The guidelines have quantified the evidence level of the current clinical researches and provided recommendations for the clinical practice in neoadjuvant therapy of pancreatic cancer. The guidelines have highlighted the role of multiple disciplinary team and represented the conversion of treatment concepts in pancreatic cancer. Neoadjuvant therapy has prolonged the survival of part of pancreatic cancer patients. However, more high-quality clinical researches are in urgent need to improve the level of evidence, optimize the clinical practice, and improve the survival of patients.

Lung Cancer Screening Study in Macao Smoking Individuals

背景与目的中国澳门肺癌发病率逐年上升，吸烟人群是肺癌的高发人群，本研究旨在了解中国澳门长期吸烟人群的肺癌发病情况及胸部低剂量计算机断层扫描(low-dose computed tomography, LDCT)肺结节特点。方法通过澳门中华医学会会员私家医生推荐及宣传招募中国澳门无症状长期吸烟人士，行胸部LDCT检查，分析肺癌、肺部结节检出率及影像学特点。结果符合纳入条件者291例，检出肺癌10例，检出率3.44%(95%CI: 2.78%-4.01%)，其中，肺腺癌5例，鳞癌、小细胞肺癌各2例，腺鳞癌1例。早期肺癌4例，占40%。212例检出肺结节，肺结节总检出率72.9%(95%CI: 67.8%-78.0%); 疑似肺癌结节44例，检出率15.1%(95%CI: 11.0%-19.2%)。单发结节51例，无肺癌检出; 多发结节161例，检出肺癌9例，两组肺癌检出率无统计学差异(P > 0.05)。 < 6 mm实性结节与 < 5 mm非实性结节组168例，未检出肺癌; ≥6 mm实性结节与≥5 mm非实性结节组44例，检出肺癌9例，两组比较有统计学差异(P < 0.05)。结论长期吸烟人群中肺癌检出率高，类型以腺癌为主，肺部结节发生率高，当实性结节≥6 mm或非实性结节≥5 mm时，肺癌检出率增高。建议在符合高危因素的男性吸烟人群中推行胸部LDCT筛查肺癌，女性肺癌筛查，应重新界定高危因素。

A RARE CASE OF SARCOIDOSIS CAUSING OSTEOLYTIC LESIONS IN BOTH JAWS AND SKULL

<h3>Background</h3> A 65-year-old woman presented to the oral maxillofacial department with a nonhealing oral antral fistula. Radiographic examination revealed opacification of the left maxillary antrum and an ill-defined radiolucency in the maxilla. The patient continued to develop further osteolytic lesions in the skull and mandible, leading to anesthesia of the third division of the trigeminal nerve. <h3>Objective</h3> To discuss the clinicopathological correlation, differential diagnosis, and pathway to achieving a definitive diagnosis in this challenging case. <h3>Results</h3> Clinical symptoms included a history of fatigue, painful joints, and chest pain. Multiple biopsies taken from the osteolytic lesions of the mandible, maxilla, and a supraclavicular lymph node revealed naked noncaseating granulomas. Computed tomography (CT) of the head and neck revealed an irregular, diffuse, mottled appearance of the bone in the left maxillary alveolus, right mandible, and left temporal bone. Angiotensin-converting enzyme and serum calcium levels were normal. CT scans showed hilar lymphadenopathy, which was not visible on plain film radiography. Exclusion of other causes of granulomatous inflammation eventually led to a diagnosis of sarcoidosis. The patient has been discussed at a multiple disciplinary team meeting and referred to a specialist team. <h3>Conclusions</h3> Sarcoidosis is a chronic multisystem granulomatous disease characterized histologically by naked noncaseating granulomas. It has an unknown etiology and no pathognomonic diagnostic test, making definitive diagnosis difficult. This patient presented with rare and aggressive features appearing initially to be from the maxillary antrum, eventually affecting the jaws and skull with only subtle symptoms of the more cardinal features of the disease.

Multiple Disciplinary Team (MDT) Treatment Could Help Convert Unresectable HCC of Late Stage to Resectable

Multiple Disciplinary Team (MDT) Treatment Could Help Convert Unresectable HCC of Late Stage to Resectable

E-athletes’ lifestyle behaviors, physical activity habits, and overall health and wellbeing: a systematic review

Background E-sports is becoming increasingly popular; however, participation is not without risks. Certain lifestyle factors associated with gaming may have negative effects on the wellbeing of the players. Objective This systematic review of current studies of e-athletes’ health and wellbeing, primarily focused on athletes level of physical activity. This review also aimed to gain insight on potential health promotion and management strategies for e-gamers and e-athletes. Method Four online databases (Medline, SCOPUS, Web of Science, and EBSCO) were searched for full-text English articles published between 2010 and April 2020. A total of six articles met the inclusion criteria and were included for review. Results From the six studies, five themes were identified: (1) demographics of e-sports; (2) e-athletes’ level of physical activity, compared to World Health Organization (WHO) guidelines; (3) reasons to engage in physical activity; (4) physical training as a part of e-sport training; and (5) degree of sedentary time. Other findings included e-sports injuries reported by participants, broader aspects of health behaviors, along with proposals for multiple disciplinary team approaches to e-athlete management. Conclusion Despite the level of sedentary behavior and e-sports related injuries from the reviewed studies, the majority of e-athletes in the studies included met WHO physical activity guidelines with health promotion as primary motivation. Other health behaviors (sleep and diet) are particularly relevant to e-athletes. More research is needed to better understand this population's health-related behavior and habits to better establish their wellbeing and health risks.

The progress in management of esophagogastric variceal bleeding in cirrhotic portal hypertension

Esophagogastric variceal bleeding (EVB) is the most dangerous complication of cirrhotic portal hypertension.With the continuous emergence of research findings on EVB, multiple disciplinary team, including internal medicine department, surgery department, intervention therapy department, radiology department, has become a new mode for the prevention and treatment of EVB. This article first reviewed the classification of esophageal varices and gastric varices, and then reviewed the recent research findings of EVB from three aspects: primary prophylaxis, active variceal bleeding treatment, and secondary prophylaxis.The aim was to provide new ideas for the individualized prevention and treatment of EVB.

The guideline for neoadjuvant therapy of pancreatic cancer in China (2020 edition)

In order to improve the overall treatment level of pancreatic cancer in China, Study Group of Pancreatic Surgery in China Society of Surgery of Chinese Medical Association and Pancreatic Disease Committee of China Research Hospital Association have formulated the guideline for neoadjuvant therapy of pancreatic cancer in China (2020 edition). Based on the GRADE system, the guideline has conducted a discussion on the indication, regimen selection, therapeutic effect evaluation, pathological diagnosis and surgery strategy, etc. This guideline has quantified the evidence level of the current clinical researches and provided recommendations for the clinical practice in the neoadjuvant therapy of pancreatic cancer. The guideline has highlighted the role of multiple disciplinary team and represented the conversion of treatment concept in pancreatic cancer. Neoadjuvant therapy has prolonged the survival of the part of pancreatic cancer patients. However, more high-quality clinical researches are in urgent need to improve the level of evidence, optimize the clinical practice and improve the survival of patients.