Cáncer Gástrico Bifocal con Linfonodos Negativos en un Paciente con Cirrosis Hepática / Bifocal Gastric Cancer with Negative Lymph Nodes in a Hepatic Cirrhosis Patient

El cáncer gástrico (CG), es la primera causa de muerte por cáncer, en hombres, y la tercera en mujeres, en Chile. No obstante ello, el CG bifocal (CGB) es una situación poco frecuente. El objetivo de este manuscrito fue reportar un caso de CGB, con linfonodos negativos en un paciente con cirrosis hepática, que fue intervenido quirúrgicamente; y revisar la evidencia existente respecto de sus características morfológicas, terapéuticas y pronósticas. Caso clínico: Hombre de 74 años diabético, hipertenso, insuficiente cardíaco y cirrótico; portador de CGB (subcardial y antro-pilórico), diagnosticado por endoscopia y con confirmación histológica de ambas lesiones; operado en Clínica RedSalud Mayor Temuco en septiembre de 2023. En el intraoperatorio se verificó además la coexistencia de una lesión de aspecto metastásico en el segmento III del hígado, y adhesión de la región antro-pilórica a la vesícula biliar. Se realizó gastrectomía total, linfadenectomía D2, esófago-yeyuno anastomosis término-lateral, resección segmentaria hepática (segmento III) y colecistectomía. El paciente permaneció 6 días en la UCI debido a que desarrolló insuficiencia hepática (encefalopatía leve y ascitis). Se alimentó vía enteral por sonda naso-yeyunal. Posteriormente inició alimentación oral progresiva, la que fue bien tolerada. Completó 11 días de hospitalización en servicio médico-quirúrgico, donde mejoró actividad neurológica, hasta su alta domiciliaria. Actualmente, lleva dos meses desde su operación, se encuentra en buenas condiciones generales, y el Comité Oncológico decidió no dar quimioterapia adyuvante. Se presenta un caso inusual de CG de tipo bifocal, respecto de lo cual hay escasa información disponible. Se logró realizar cirugía con intención curativa en un paciente de alto riesgo, con un resultado exitoso.

SUMMARY: Gastric cancer (GC) is the first cause of death from cancer in men, and the third one in women, in Chile. However, a bifocal GC (BGC) is uncommon. The aim of this study was to report a case of CGB, with negative-lymph nodes in a patient with liver cirrhosis, who underwent surgery; and review the existing evidence regarding its morphological, therapeutic and prognostic characteristics. Clinical case: A 74-year-old male patient with a medical history of diabetes, hypertension, congestive heart failure, and cirrhosis underwent surgical intervention for GC located in subcardial and antro- pyloric regions. The diagnosis was established via endoscopy and confirmed histologically. Surgery was performed at the RedSalud Mayor Temuco Clinic in September 2023. During intraoperative assessment, the coexistence of a lesion with metastatic-like characteristics in segment III of the liver was also verified, along with adhesions between the antro-pyloric region and the gallbladder. Surgical approach encompassed total gastrectomy, D2 lymphadenectomy, esophago-jejunostomy, segmental hepatic resection, and cholecystectomy. Subsequently, the patient required a six-day stay in ICU due to the development of hepatic insufficiency, characterized by mild encephalopathy and ascites. Enteral nutrition was administered via a naso-jejunal tube, followed by a gradual transition to oral feeding, which was well-tolerated. The patient completed an 11-day hospitalization period in the medical-surgical ward, during which his neurological function improved significantly, resulting in his discharge. At present, 2 months post-surgery, the patient remains in satisfactory general health, and the Oncology Committee decided not to proceed with adjuvant chemotherapy. This case represents a rare instance of bifocal GC, for which there is limited available literature. Surgical intervention with curative intent was successfully carried out in a high-risk patient, yielding a positive outcome.

Effect of spousal synchronous exercise and diet intervention on maternal and neonatal outcomes in overweight pregnant women with gestational diabetes mellitus / 中国医科大学学报

Objective To analyze the effect of spousal synchronous exercise and diet intervention on maternal and neonatal outcomes in overweight pregnant women with gestational diabetes mellitus(GDM).Methods We divided 120 overweight pregnant women with GDM into intervention and control groups(n= 60 per group),who received spousal synchronous and routine exercise and diet interventions,respectively.The age,body mass index(BMI),and levels of fasting blood glucose(FPG),2-hour postprandial blood glucose(2 h-PG),and glycosylated hemoglobin(HbA1c)at the first prenatal examination were recorded.The levels of FPG,2 h-PG,and HbA1c at the diagnosis of GDM and gestational week 28,delivery mode,and incidence of complications during the delivery were compared between the groups.The self-rating depression scale and self-rating anxiety scale were used to evaluate the women's mental status after delivery.The body weight,blood glucose level,Apgar score,and incidence of complications including macrosomia,hypoglycemia,and asphyxia in the new-borns were compared between the groups.Results The groups did not differ significantly in term of age,BMI,FPG,2 h-FPG,or HbA1c at GDM diagnosis(P>0.05).At gestational week 28,the FPG,2 h-FPG,and HbA1c levels were significantly lower than those before the intervention in both groups,and were also significantly lower in the intervention group than in the control group(P<0.05).Com-pared with the control group,the proportion of natural delivery was significantly higher and the incidence of complications was sig-nificantly lower in the intervention group(P<0.05).The anxiety and depression status were significantly better in the intervention group than in the control group(P<0.05).Compared with the control group,the frequency of macrosomia and blood glucose levels were significantly lower and the Apgar scores were significantly higher in the intervention group(P<0.05).Conclusion Spousal synchronous exercise and diet intervention may effectively decrease the blood glucose and HbA1c levels in overweight pregnant women with GDM,decrease the incidence of maternal and neonatal complications,and improve pregnant women's mental status.

Synchronous primary head and neck tumors: Follicular thyroid carcinoma and squamous cell carcinoma of the tonsil

@#Simultaneously occurring malignancies may be detected in different organs or tissues at any given time. Patients diagnosed with a tumor may be found to have another tumor or second primary cancer. Second primary cancers (SPCs) may be further classified as synchronous or metachronous. Synchronous SPCs are lesions detected simultaneously or within 6 months after the diagnosis of the primary tumor while metachronous SPCs are tumors diagnosed 6 months after primary tumor diagnosis.1There is an increased risk of having second primary cancer in Head and Neck Squamous Cell Carcinoma (HNSCC) patients.1 In a study by Strojan et al. in 2013, among 2,106 head and neck cancer patients, 2.4% developed synchronous second primary cancers.2 A systematic review by Coco-Pelaz et al. in 2020, showed that second primary tumors most frequently occur in the head and neck area followed by the lungs and esophagus.3We present a case of follicular thyroid carcinoma with an incidental finding of cervical lymph-node metastatic squamous cell carcinoma from the tonsil and discuss the clinical presentation, ancillary procedures and management.

Segmentation Clock Networks in Vertebrate Somitogenesis / 生物化学与生物物理进展

In vertebrate embryonic development, the segmentation clock controls the cyclic formation of somites through presomitic mesoderm (PSM) cells. Somites are paired segmented structures along the anterior-posterior axis that eventually develop into vertebrae and ribs. Disruptions in the segmentation clock leads to defects in somitogenesis, resulting in congenital spinal diseases. The major patterning modules that are involved in segmentation clock is the clock and wavefront, which primarily relies on signaling gradients and cyclic oscillation. Mesodermal differentiation is regulated by combinatorial gradient system that involves the activity of the fibroblast growth factor (FGF), the Wnt/β-catenin, and the retinoic acid (RA) signaling pathways. The antagonistic gradients of these signals set a position of the determination front. In the tail bud and posterior mesoderm, FGF and Wnt signaling prevent cell maturation and the molecular oscillators start to express. The molecular oscillators rely on negative feedback loops to maintain their oscillatory expression patterns. As the cells move anteriorly, FGF signaling gradually decays and RA signaling began to strengthen. Meanwhile, the molecular oscillators propagate anteriorly with wave pattern. At the determination front, low levels of FGF signaling and high levels of RA signaling eliminate differentiation inhibition and initiate molecular oscillators to activate cyclic genes, such as Mesp2, leading to the formation of repetitive structures in somites. Advancements in live reporter and 2D culture systems have revealed that coupling delays in cell communication can maintain the synchronous segmentation clock between adjacent cells. Studies have shown that these coupling delays are controlled by Lfng gene, it can adjust coupling delays to fit in-phase oscillations by increasing the time required for intercellular DLL1-Notch signaling. To sum up, the dual homeostasis of opposing signaling gradients determines the segment boundaries, the distance traveled by a molecular oscillator in one oscillation cycle determines the somite size, and the delayed coupling in intercellular signaling regulates the synchronization of clock oscillations. These three factors interact with each other to form a segmentation clock network coordinating somitogenesis. Recent studies have revealed that the intercellular coupling delay mechanism is a major factor influencing the maintenance of oscillation synchronization. Intercellular coupling delay errors, such as increased or decreased delay time, can desynchronizing intercellular oscillations and resulting in somite fusion. However, the mechanisms governing how intercellular communication becomes involved in oscillation synchronization remains unclear. Congenital scoliosis (CS) is a result of anomalous development of the vertebrate which associate with somitogenesis malformation. We observed that deficiency or overdose of vitamin A intake in gestation may lead to CS. While the deep mechanism of how RA signaling regulates oscillation synchronization still need to be detected. With the rapid development of 3D culture systems, researchers have successfully recapitulated the formation of somite-like structures with antero-posterior identity and indicated that the rate of metabolism is directly proportional to that of development. In summary, deconstructing the segmentation clock in vitro facilitates the dissection of regulation networks of the segmentation clock and offers an excellent proxy for studying the metabolic regulation of somitogenesis speed across species and the mechanisms underlying the formation of bilateral symmetry. It also creates a platform for exploring dysregulation mechanisms involved in the development of pathological somite defects.

Clinical Outcomes of the Liver-First Approach in the Management of Synchronous Colorectal Liver Metastases: A Retrospective Study

Abstract Introduction Almost 25% of colorectal cancer (CRC) patients have synchronous colorectal liver metastasis (SCLM) coinciding with the disease diagnosis. Liver-first approach for the treatment of SCLM involves neoadjuvant chemotherapy, subsequent liver resection, and then primary tumor resection. This strategy is adopted as the prognosis of the disease depends mainly on the metastases, not the primary tumor. This study aims to evaluate the feasibility of the liver-first approach and clinical prognosis in managing SCLM. Materials and Methods This retrospective study included 25 patients with SCLM from July 2015 to July 2020. All patients were subjected to a liver-first approach with an "intention-to-treat" approach. Follow-up was planned for at least 3 years. Data were collected from the hospital records and included survival rates and univariate analyses of the prognostic factors, such as gender, age, and number of chemotherapy cycles to evaluate their effect on the survival probability. Results Nineteen patients completed the treatment paradigm. Long-term outcomes reported a median overall survival (OS) of 32 months. One-year and 3-year survival probabilities were 89.5% and 42.1%, respectively. The median disease-free survival was 13 months. The number of metastatic lesions, unilobar versus bilobar disease, and the frequency of administered chemotherapy cycles significantly affected survival (p < 0.05). Seven patients (36.84%) remained disease free (no recurrence) while 2 patients (10.53%) survived with recurrence. The overall mortality included 10 deaths (52.63%) due to recurrence. Conclusion Synchronous colorectal liver metastasis treated with the liver-first approach achieved a notable overall advantage. However, the recurrence rate remained relatively high.

La escritura como intervención en salud mental y salud pública: revisión a 25 años del abordaje phaedrus para el autismo / Writing as an intervention in Mental Health and Public Health: revision 25 years after the Phaedrus Approach to autism

RESUMEN INTRODUCCIÓN: El tratamiento del autismo resultó un desafío desde su descripción, sobre todo en personas sin habla (SH) o con habla mínima (HM), generalmente relegadas de la literatura científica y de alto costo sanitario. En 2022 se cumplieron 25 años de un abordaje para el autismo SH/HM rediseñado en Argentina, realizado a través de la escritura tipeada sincrónica (Abordaje Phaedrus). El objetivo fue revisar y describir por primera vez los cambios clínicos (CC) tras esta intervención. MÉTODOS: Se realizó una revisión sistemática descriptiva de los reportes de los CC mencionados en una serie de casos que fueron abordados con la intervención en estudio. RESULTADOS: Se describieron los reportes de los 10 CC más frecuentes de la muestra, que se presentaron en promedio a los 13,8 meses de tratamiento. Cada caso presentó 7,5 CC, con resultados similares entre diagnósticos previos al tratamiento y con alguna diferencia en favor del género femenino, de menores de 10 años al inicio del tratamiento y de personas SH. El 100% accedió a la escritura tipeada independiente y, luego de ello, el 71% logró o mejoró el habla. DISCUSIÓN: Los 7 CC más frecuentes representan aspectos claves del tratamiento del autismo. Aunque se requieren más estudios, los resultados son muy auspiciosos y representan un aporte sustancial a la evidencia científica. Este abordaje podría resultar costo-efectivo para el trastorno del espectro autista SH/HM y ser de interés para otras problemáticas en la intersección entre salud mental y salud pública.

ABSTRACT INTRODUCTION: The treatment of autism was a challenge since its description, especially in non-speaking (NS) or minimally speaking (MS) people, who receive little attention from scientific literature and represent a high health care cost. The year 2022 marked the 25th anniversary of an approach to NS/MS autism redesigned in Argentina and carried out through synchronous typewriting (Phaedrus Approach). The objective of this work was to review and describe for the first time the clinical changes (CC) after intervention. METHODS: A systematic descriptive review of the CC reports was carried out, based on a series of cases addressed with the intervention under study. RESULTS: The reports of the 10 most frequent CC in the sample were described, which appeared on average after 13.8 months of treatment. Each case presented 7.5 CC, with similar results between diagnoses prior to treatment and with some differences in favor of female gender, those under 10 years of age at the start of treatment, and NS people. While 100% acceded to independent typewriting, 71% achieved or improved speech afterwards. DISCUSSION: The 7 most frequent CC represent key aspects of autism treatment. Although more studies are required, the results are very promising and represent a substantial contribution to the scientific evidence. This approach could be cost-effective for NS/MS autism spectrum disorder and could be of interest for other problems at the intersection of mental health and public health.

Effectiveness of synchronous vs asynchronous faculty aid in learning how to diagnose, plan and perform a 44C ankle fracture osteosynthesis in a synthetic bone model / Eficacia de la ayuda docente sincrónica frente a la asincrónica en el aprendizaje del diagnóstico, la planificación y el desempeño de una osteosíntesis de fractura de tobillo 44C en un modelo de hueso sintético

Abstract: Introduction: COVID-19 pandemic has disrupted educational activities since 2020. AO Trauma Latin American courses took place in a blended modality during 2021 and participant's feedback was positive. In this study, we aim to identify if there was any difference in learning, planning, and executing an osteosynthesis on a bone model with synchronous or asynchronous faculty support during an online asynchronous learning program. Material and methods: we designed an online asynchronous course designed for teaching about trimalleolar ankle fractures. We randomized twenty participants into two groups: the control group had synchronous faculty support and the intervention group had asynchronous faculty support. Participants were evaluated with initial and final quizzes, preoperative planning, and execution of an osteosynthesis on a bone model. Comparisons of scores between CG and IG were performed using the Mann-Whitney U test for non-parametric variables. A two-tailed p < 0.05 was considered statistically significant. Results: we did not find a significant difference between synchronous or asynchronous faculty support during our asynchronous learning program in quiz results, preoperative planning, global rating scale or the result of the osteosynthesis as compared to the preoperative plan. Conclusion: there appears to be no difference in participant learning with synchronous or asynchronous faculty support during an online, asynchronous course. Asynchronous activities appear to be effective teaching methods and should be considered in continuous medical education in orthopedics. Larger studies are needed to identify differences in participant learning outcomes between synchronous and asynchronous faculty support models.

Resumen: Introducción: la pandemia de COVID-19 ha interrumpido las actividades educativas desde 2020. Los cursos de AO Trauma Latinoamérica se realizaron en modalidad semipresencial durante 2021 y la retroalimentación de los participantes fue positiva. En este estudio, nuestro objetivo es identificar si hubo alguna diferencia en el aprendizaje, la planificación y la ejecución de una osteosíntesis en un modelo óseo con el apoyo sincrónico o asincrónico de la facultad durante un programa de aprendizaje asincrónico en línea. Material y métodos: diseñamos un curso asíncrono en línea para la enseñanza de las fracturas trimaleolares de tobillo. Se distribuyó aleatoriamente a 20 participantes en dos grupos: el grupo de control tuvo apoyo docente sincrónico y el grupo de intervención tuvo apoyo docente asincrónico. Se evaluó a los participantes con cuestionarios iniciales y finales, planificación preoperatoria y ejecución de una osteosíntesis en un modelo óseo. Las comparaciones de las puntuaciones entre GC e GI se realizaron mediante la prueba U de Mann-Whitney para variables no paramétricas. Una p de dos colas < 0.05 se consideró estadísticamente significativa. Resultados: no encontramos diferencia significativa entre el apoyo del profesorado síncrono o asíncrono durante nuestro programa de aprendizaje asíncrono en los resultados de los cuestionarios, la planificación preoperatoria, la escala de valoración global o el resultado de la osteosíntesis en comparación con el plan preoperatorio. Conclusión: no parece haber diferencias en el aprendizaje de los participantes con el apoyo sincrónico o asincrónico del profesorado durante un curso en línea asincrónico. Las actividades asíncronas parecen ser métodos de enseñanza eficaces y deberían tenerse en cuenta en la formación médica continua en ortopedia. Se necesitan estudios más amplios para identificar las diferencias en los resultados de aprendizaje de los participantes entre los modelos de apoyo docente síncrono y asíncrono.

Acceptability of teleconsultation in a public service specialized in the prevention and care of HIV infection and other sexually transmitted infections / Aceitabilidade da teleconsulta em um serviço público especializado na prevenção e cuidado da infecção pelo HIV e outras infecções sexualmente transmissíveis

Introduction: Telemedicine was leveraged for its contribution to mitigate the impact of COVID-19 in Brazil and worldwide. Objective: We aim to evaluate the acceptability of incorporating teleconsultation through synchronized videoconference by users and professionals in a service specialized in the prevention and treatment of the human immunodeficiency virus and other sexually transmitted infections, and to identify associated factors. Methods: This is a cross-sectional study with 410 users and 57 professionals who answered a category-standardized questionnaire. Predictors of acceptability were assessed using logistic regression model. Results: A total of 364 (88.8%) users said they would accept the modality. The factors positively associated with the odds of acceptance were the self-assessment of having favorable conditions to participate in a teleconsultation (aOR 54.8; 95%CI 12.4­242.1; p<0.001), the perception of saving money (aOR 5.2; 95%CI 1.9­14.0; p=0.001), and perceived convenience of the modality (aOR 6.7; 95%CI 2.9­15.9; p<0.001). Factors associated with reduced odds of acceptance were the fear of not being evaluated well (aOR 0.2; 95%CI 0.1­0.4; p<0.001), or remaining long without seeing the professional (aOR 0.2; 95%CI 0.1­0.5; p<0.001). The acceptance of the modality among professionals was 75.4% and the perception of its convenience (aOR 16.8; 95%CI 2.6­108.4; p=0.003) and that the institution has appropriated conditions (aOR 7.7; 95%CI 1.5­40.6; p=0.016) were associated with increased odds of accepting its incorporation in their routine. Conclusion: Governance should invest in infrastructure and support, secure protocols, digital literacy, and training of its users and employees for video teleconsultation. (AU)

Introdução: A telemedicina foi alavancada por sua contribuição para mitigar o impacto da COVID-19 no Brasil e no mundo. Objetivo: Pretendemos avaliar a aceitabilidade da incorporação da teleconsulta por videoconferência síncrona por usuários e profissionais de um serviço especializado na prevenção e tratamento da infecção pelo vírus da imunodeficiência humana (HIV) e outras infecções sexualmente transmissíveis, bem como identificar fatores associados. Métodos: Estudo transversal com 410 usuários e 57 profissionais, que responderam a um questionário padronizado por categoria. Os preditores de aceitabilidade foram avaliados utilizando-se um modelo de regressão logística. Resultados: O total de 364 (88,8%) usuários disseram que aceitariam a modalidade. Os fatores positivamente associados à probabilidade de aceitação foram a autoavaliação quanto a ter condições favoráveis para participar de uma teleconsulta (razão de chances ajustada ­ aOR 54,8; intervalo de confiança de 95% ­ IC95% 12,4­242,1; p<0,001), a percepção de poupar dinheiro (aOR 5,2; IC95% 1,9­14,0; p=0,001) e a percepção de conveniência da modalidade (aOR 6,7; IC95% 2,9­15,9; p<0,001). As menores probabilidades de aceitação foram o medo de não ser bem avaliado (aOR 0,2; IC95% 0,1­0,4; p<0,001) e de permanecer muito tempo sem ver o profissional (aOR 0,2; IC95% 0,1­0,5; p<0,001). A aceitação da modalidade pelos profissionais foi de 75,4% e a percepção de sua conveniência (aOR 16,8; IC95% 2,6­108,4; p=0,003) e a de que a instituição possui condições favoráveis (aOR 7,7; IC95% 1,5­40,6; p=0,016) foram associadas com a maior probabilidade de aceitar a incorporação da modalidade em sua rotina. Conclusão: A governança deve investir em infraestrutura e apoio, protocolos seguros, literacia digital e treinamento de seus usuários e funcionários para a videoconsulta. (AU)

A comparative study on the efficacy and adverse reactions of nituzumab and bevacizumab combined with synchronous ra-diotherapy and chemotherapy in the treatment of locally advanced cervical cancer / 实用肿瘤学杂志

Objective The objective of this study was to compare the short-term efficacy and adverse reactions of nituzum-ab combined with synchronous radiotherapy and chemotherapy and bevacizumab combined with synchronous radiotherapy and chemo-therapy in the treatment of locally advanced cervical cancer.Methods A total of 100 locally advanced cervical cancer patients with pathological type of squamous cell carcinoma were collected from 1 September 2020 to 31 December 2021.They were divided into a control group(synchronous radiotherapy and chemotherapy group),a nituzumab group(nituzumab combined synchronous radiotherapy group)and a bevacizumab group(bevacizumab combined synchronous radiotherapy and chemotherapy group).The total effective rate of short-term treatment,changes in tumor volume before and after treatment,serum squamous cell carcinoma antigen(SCC)levels be-fore and after treatment,and adverse reactions after treatment were compared among patients of the three groups.Results The short-term total effective rates of the Nitro group,Bevar group and control group were 90.3％,87.2％and 60.0％,respectively.The total effective rates of the Nitro and Bevar groups were significantly higher than those of the control group,and the differences were statisti-cally significant(P＜0.001).There was no statistically significant difference in the total effective rates of the Nitro and Bevar groups(P＞0.05);The degree of tumor volume reduction and SCC reduction in the Nituo group and Bevac group after treatment was higher than those in the control group(P＜0.05),and there was no statistically significant difference between the two groups(P＞0.05).The incidence of hypertension in the Bevar group was 33.4％,significantly higher than that in the control group(10.0％)and the Ni-tro group(12.9％)(P＜0.05).There was no statistically significant difference in the incidence of hypertension between the Nito group and the control group(P＞0.05);There was no statistically significant difference in the incidence of adverse reactions among the three groups except hypertension(P＞0.05).Conclusion Nituzumab combined with synchronous radiotherapy and chemothera-py,as well as bevacizumab combined with synchronous radiotherapy and chemotherapy,can improve the short-term efficacy of locally advanced cervical cancer,effectively reduce tumor volume and inhibit the expression of tumor markers,both of which are superior to synchronous radiotherapy and chemotherapy alone.Compared to bevacizumab,nituzumab has fewer adverse reactions.For patients with locally advanced cervical cancer,the combination of nituzumab and concurrent radiotherapy and chemotherapy is more reliable in terms of safety.

Exploration on training model of general practitioners in county medical community with the outreaching of medical consortium / 中华全科医师杂志

In recent years, a number of policies have been implemented to strengthen the cultivation of general practitioners in China. However, the development of community-level health professionals is still lagging behind, the development is uneven among regions, the overall number of general practitioners is insufficient, and the quality of medical services needs to be improved. Based on the Shanhai (Mountain and Sea) promotion project, with the close cooperation between the Second Affiliated Hospital and the medical consortium unit Suichang County People′s Hospital, a " Joint Cultivation by Dual-Teachers " model has been applied in training general practitioners for Suichang county community since March 2021. In this article we discuss the optimization and integration of medical and health resources through the outreaching assistance of high-quality personnel, management and system of medical service, to comprehensively upgrade the primary care and the quality of grass-roots general practitioners in remote mountainous areas.

Colonoscopy follow-up in patients with simultaneous multiple primary colorectal cancer and patients with sporadic colorectal cancer: a matched-pair study / 中华消化杂志

Objective:To investigate the incidences of metachronous advanced adenoma (MAA) in patients with simultaneous multiple primary colorectal cancer (CRC) and patients with sporadic CRC.Methods:From January 1, 2008 to September 30, 2022, at Beijing Shijitan Hospital, Capital Medical University, CRC patients who underwent surgery and 3 years follow-up with endoscopy were enrolled. The patients completed colonoscopy at least 2 times during follow-up in 6 to 36 months after surgery, and the interval between the 2 times colonoscopies was over 6 months. Clinical data including age, gender, and tumor location, stage, pathological features, combined underlying diseases, preoperative carcinoembryonic antigen, hemoglobin and other laboratory results, baseline colonoscopy results, and detection of MAA were collected. According to age (±2 years old), gender, location of primary lesion and stage of tumor, patients with simultaneous CRC or sporadic CRC were matched at 1∶1 ratio by propensity score matching. The cumulative risks of MAA in patients with simultaneous multiple primary CRC and patients with sporadic CRC were calculated. Cox proportional hazard regression was used to analyze the influencing factors in the occurrence of MAA.Results:A total of 814 CRC patients were enrolled and matched. After paired matching, there were 36 cases of simultaneous multiple primary CRC (78 lesions) and 78 cases of sporadic CRC (78 lesions). The cumulative incidences of MAA at 1, 2 and 3 years of simultaneous CRC group were 11.1%(4/36), 22.2%(8/36) and 33.3%(12/36), respectively. The cumulative incidences of MAA at 1-, 2- and 3-year of sporadic CRC group were 3.8%(3/78), 12.8%(10/78) and 20.5%(16/78), respectively.Simultaneous CRC was correlated with an increase in the 3-year cumulative incidence of MAA ( HR=4.163, 95% confidence interval(95% CI) 1.032 to 4.721, P=0.047). Especially in left-sided CRC, the risk of MAA in simultaneous CRC increased ( HR=7.186, 95% CI 1.602 to 20.787, P=0.010). The results of multivariate cox-regression analysis indicated that detection of simultaneous advanced adenoma at baseline endoscopy was an independent risk factor of MAA ( HR=3.175, 95% CI 1.411 to 7.142, P=0.005). Conclusion:Colouoscopy follow-up should be strengthened in patients with simultaneous multiple primary CRC and simultaneous advanced adenomas.

Experiences and challenges in telemedicine of physicians from the National Capital Region during the COVID-19 pandemic: A qualitative study / The Health Sciences Journal

Introduction@#The COVID-19 pandemic caused a shift to delivering health services through telemedicine. This study recognized the perceptions, experiences, and challenges of physicians who practice synchronous teleconsultation in the Philippines.@*Methods@#A qualitative descriptive research design using purposive sampling, eight physicians from NCR were interviewed. Data collected were subjected to thematic analysis for common themes and integrated into an analytic narrative.@*Results@#Eight physicians were included as participants. Different measures taken to remedy the gap included upskilling of physicians, adjustment of clerical work, ensuring data privacy, and creating a conducive workplace. Remote consultations posed limitations on physical examination and emphasized the reliance on diagnostics. Digital platforms used depended on the physician’s preference, type of practice, and patient’s accessibility. This led to an increased dependency on good internet and network service connections to ensure smooth teleconsultations. A lack of respect for the physician’s personal boundaries and work-life balance was cited as a major challenge. @*Conclusion@#Telemedicine proved to be an option to provide healthcare despite its limitations, but the shift to its practice exposed many challenges as it is not a replacement for physical consultations.

Synchronous Primary Parosteal Osteosarcoma and Primary Mediastinal Germ Cell Tumour with Atypical Mycobacterial Infection – A Rare Phenomenon: A Case Report

@#Mediastinal germ cell tumours are a rare group of extragonadal germ cell tumours with less than 5% prevalence of all germ cell tumours. Primary mediastinal germ cell tumours themselves account for 16-36% of the extragonadal germ cell tumours. Along the spectrum of osteosarcoma, parosteal osteosarcoma is a welldifferentiated surface osteosarcoma with a prevalence of 4% of all osteosarcoma. As such synchronous primary parosteal osteosarcoma and primary mediastinal germ cell tumour are exceedingly rare. This leads to complexity in determining the most appropriate chemotherapy for two different types of tumours and its potential side effects of reduced immunity leading to potential secondary infection. Here we report a case of a 16-year-old boy who presented with synchronous primary osteosarcoma and primary mediastinal germ cell tumour, complicated with atypical mycobacterial infection post-operatively. Additionally, we discuss our choice of chemotherapy and the management of the atypical mycobacterial infection.

A case of Constitutional Mismatch Repair Deficiency (CMMRD)

@#Constitutionalmismatch repair deficiency(CMMRD) is a hereditary predisposition of malignancy evident in childhood leukemias, lymphomas, and malignant tumors of the brain, GI tract. It is a very rare condition that affects 1 per 1 million patients. Patients with CMMRD syndrome may also manifest with Neurofibromatosis Type 1 (NF1) phenotypic features, and benign masses, particularly in the gastrointestinal tract. This is a case of a 12-year old male who presented with phenotypic features of NF1, developed Acute Lymphoblastic Leukemia at 7 years old and went into remission. He subsequently developed synchronous Glioblastoma and Poorly differentiated Adenocarcinoma of the rectum.This report aims to raise awareness regarding the possibility of a CMMRD syndrome in pediatric patients who present with phenotypic features of NF1, and in those patients who present with two or more malignancies in their lifetime.

Primary carcinoma esophagus with unusual synchronous second malignancies: A case series

Multiple primary cancer is no longer a rarity. As life expectancy has increased, more individuals are living long enough to develop not only one but also two or more cancers. Herein, we report on three cases of synchronous malignancies associated with the primary esophagus cancer. All three patients posed a challenge for the treatment. These patients carry a dismal prognosis so early diagnosis of subsequent cancer at a curable stage by regular follow-up is encouraged. The early investigation of new symptoms and signs may help to diagnose, initiate early treatment, and reduce the number of deaths from subsequent primary cancers in patients.

Fóruns de accountability síncrona: a dinâmica interna das audiências públicas orçamentárias / Foros sincrónicos de accountability: la dinámica interna de las audiencias públicas presupuestarias / Synchronous accountability forums: the internal dynamics of budget public hearings

Resumo As audiências públicas orçamentárias são espaços de transparência e participação social. Esses espaços podem ser considerados fóruns de accountability síncrona, em que a prestação de contas e a responsabilização podem ocorrer no mesmo momento, o que gera preocupação para o prestador de contas quanto às possíveis formas de responsabilização. Esta pesquisa teve como objetivo analisar como ocorre a dinâmica das audiências públicas orçamentárias organizadas pelas prefeituras municipais. Foi realizada uma pesquisa qualitativa interpretativista, por meio de entrevistas semiestruturadas com gestores públicos como principal fonte de coleta. Os resultados indicam que os responsáveis pelas audiências públicas adotam estratégias para minimizar os riscos reputacionais e de responsabilização. As estratégias ocorrem em diferentes momentos: (i) na etapa de preparação, com a definição das regras de participação e o uso de filtro informacional; (ii) durante a sua realização, na forma de apresentação das informações e no direcionamento de atenção do público; e (iii) na etapa pós-audiência, por meio de baixa transparência e até manipulação de documentos. A pesquisa contribui para o entendimento das audiências como fóruns de accountability esperada, em que a expectativa do prestador de contas pode direcionar a dinâmica das audiências públicas, transformando-as em um teatro. Os resultados trazem implicações para os Tribunais de Contas e o Poder Legislativo, que poderiam exercer maior controle e fiscalização das audiências; para a sociedade, que poderia atuar de forma mais ativa e organizada; e, ainda, para a legislação em vigor, que poderia estabelecer diretrizes claras para a realização das audiências.

Resumen Las audiencias públicas presupuestarias son espacios de transparencia y participación social. Estos espacios pueden considerarse como foros de accountability sincrónicos, en los que la rendición de cuentas y la responsabilización pueden ocurrir al mismo tiempo, lo que genera preocupaciones para el rendidor de cuentas sobre las posibles formas de responsabilización. Esta investigación tuvo como objetivo analizar cómo ocurre la dinámica de las audiencias públicas de presupuesto organizadas por los municipios. Se realizó una investigación cualitativa e interpretativa, utilizando como principal fuente de recolección de datos entrevistas semiestructuradas a gestores públicos. Los resultados indican que los responsables de las audiencias públicas adoptan estrategias, minimizando los riesgos reputacionales y de responsabilización. Las estrategias ocurren en diferentes momentos: (i) en la etapa de preparación, con la definición de las reglas de participación y el uso del filtro informativo; (ii) durante su ejecución, en la forma de presentar la información y dirigir la atención del público; y, (iii) en la etapa posterior a la audiencia, a través de la baja transparencia e incluso manipulación de documentos. La investigación contribuye a la comprensión de las audiencias como foros de esperada rendición de cuentas, en los que la expectativa del rendidor de cuentas puede orientar la dinámica de las audiencias públicas, transformándolas en un teatro. Los resultados tienen implicaciones para los Tribunales de Cuentas y el Poder Legislativo, que podrían ejercer un mayor control e inspección de las audiencias; para la sociedad, que podría actuar de forma más activa y organizada; y también para la legislación vigente, que podría establecer lineamientos claros para la celebración de audiencias.

Abstract Budget public hearings are spaces for transparency and social participation. These spaces can be considered synchronous accountability forums, where the rendering of accounts and the attribution of responsibilities can co-occur, raising concerns for the responsible parties about possible accountability models. This qualitative and interpretative research analyzed the dynamics of public budget hearings organized by Brazilian municipalities using semi-structured interviews with public managers. The results indicate that those responsible for public hearings adopt strategies minimizing reputational and accountability risks at different times: (i) in the preparation stage, with the definition of participation rules and the use of an informational filter; (ii) during execution, in the form of the presentation of information and in directing the public's attention; and, (iii) in the post-hearing stage, through low transparency and document manipulation. The research contributes to understanding hearings as forums of expected accountability, in which the expectation of the authorities can direct the dynamics of public hearings, transforming them into a theater performance. The results have implications for the courts of accounts and the legislative branch, which could exercise greater control and inspection of the hearings; for society, which could act in a more active and organized way; and also for the legislation in force, which could establish clear guidelines for holding hearings.

Synchronous uterine serous carcinoma and ovarian sex cord stromal tumor (thecoma)–A rare first case report

Synchronous endometrial and ovarian carcinoma is a rare instance and it accounts for 50 to 70% of all synchronous female genital tract tumors. However, it is very rare to find synchronous endometrial carcinoma and ovarian sex cord–stromal tumor (thecoma). The present case is a 75-year-old woman with a complaint of post-menopausal vaginal bleeding. Radiologically, the magnetic resonance imaging (MRI) pelvis revealed altered signal intensity mass in the uterus. Frozen section and routine histopathological examination were done on radical hysterectomy. Microscopically, serous carcinoma involving uterine corpus and left Fallopian tube was identified along with the unusual finding of contralateral ovarian sex cord–stromal tumor (thecoma), which was confirmed on immunohistochemical examination. It is a very rare association and is first reported in the present study after a thorough search of the published literature. Their relationship based on a high level of estrogen produced by the hyperactive ovary is controversial as serous carcinomas are less hormone-dependent.

Surgical roles in the management of metachronus para-aortic lymph node recurrence and synchronous para-aortic lymph node metastasis in colorectal cancer patients

Background: The relative rarity of synchronous para-aortic lymph node (PALN) metastasis (SPM) and metachronous PALN recurrence (MPR) in colorectal carcinoma (CRC) patients leads to a limited number of studies on patient management, and no treatment guidelines have been established to date. Objective: To assess the prognostic, predictive roles, and long-term outcomes of different management strategies for isolated MPR and SPM in CRC patients to establish the best one. Materials and Methods: We included 35 CRC patients with isolated MPR and 25 patients with isolated SPM who underwent curative R0 resection. We performed PALN dissection (PALND) in 15 cases in MPR group and in 10 cases in the SPM group; all remaining patients in both groups underwent chemoradiotherapy (CRT) without further surgical intervention. During the study period of about 5 years, we compared the patients who underwent PALND and those who underwent CRT. Results: The overall survival and recurrence-free survival rates were significantly longer in patients who underwent PALND (p = 0.049 and 0.036 respectively). (AU)

Bleeding per rectum during induction chemotherapy: Looking beyond the leukaemia – 2 case reports and review of literature

Synchronous malignancies involving acute leukemia and a solid organ are rare. Bleeding per rectum is a common manifestation of acute leukemia during induction chemotherapy and might mask the presence of synchronous colorectal adenocarcinoma (CRC). Here we present two rare cases of acute leukemia with synchronous CRC. We also review previously reported synchronous malignancies to investigate demographics, diagnosis, and treatment modalities. Management of these cases requires a multispecialty approach

Oncologic Panendoscopy: Description of an Optimized Procedure Based on Our Experience

Abstract Introduction All patients with a new head and neck squamous cell carcinoma (HNSCC) undergo diagnostic panendoscopy as part of the screening for synchronous second primary tumors. It includes a pharyngolaryngoscopy (PLS), a tracheobronchoscopy and esophagoscopy, and a stomatoscopy. Rigid techniques are risky, with long learning curves. Objective We propose a precise description of the panendoscopy protocol. We include an optimization of the PLS technique that completes the flexible esophagoscopy when rigid esophagoscopy isn't performed. Methods The present retrospective observational study includes 122 consecutive patients with a new primary HNSCC who underwent traditional panendoscopy and the new PLS technique between January 2014 and December 2016. A two-step procedure using a Macintosh laryngoscope and a 30° telescope first exposes panoramically the larynx, the upper trachea, and the oropharynx; then, in a second step, the hypopharynx is exposed down to the upper esophageal sphincter. Broncho-esophagoscopy is performed with a rigid and flexible scope. Results In total, 6 (5%) patients presented synchronous tumors (3 in the esophagus, 2 in the oral cavity, and 1 in the larynx 1). Rigid endoscopy was complicated by 2 (1,6%) dental lesions, and had to be completed with a flexible scope in 38 (33%) cases for exposition reasons. The two-step PLS offered a wide-angle view of the larynx, upper trachea, and oroand hypopharynx down to the sphincter of the upper esophagus. The procedure was easy, reliable, safe, repeatable, and effectively completed the flexible endoscopies. Conclusion Rigid esophagoscopy remains a difficult procedure. Two-step PLS combined with flexible broncho-esophagoscopy offers good optical control.