Referral patterns and outcomes of a highly specialised pelvic exenteration multidisciplinary team meeting: A retrospective cohort study

IntroductionThe purpose of this study was to review recommendations made from a specialist pelvic exenteration (PE) multidisciplinary team (MDT) and to provide insights as to the impact of the MDT on patient selection and clinical decision making.Materials & methodsA retrospective review was conducted at Royal Prince Alfred Hospital's PE MDT between June 2014 and December 2015. Data was collected from the recorded minutes of MDT meetings. Referral information and clinical data was extracted from individual patient files. Additional data including operative dates and surgical resection margins were collected from electronic medical records.ResultsOf the 183 patients considered for PE during the MDT meeting, 104 (57%) were recommended for surgery. Factors that influenced the recommendation in favour of surgery were referral by a surgeon (P = 0.004), referral from a rural location (P = 0.05) and having locally advanced primary cancer (P < 0.001). Patients who were seen by the unit's surgeon prior to the MDT did not impact on the MDT recommendation nor the decision for or against surgery (P = 0.771). The most common reason for recommendation against PE was unresectable distant metastatic disease (43%).ConclusionsThe PE MDT meeting is a critical step in the patient care pathway and facilitates critical decision making. Anatomically-based contraindications to surgery (i.e. involvement of adjacent organs, bone and neurovascular structures) do not appear to influence MDT decision making regarding resectability.     

骶四针疗法配合盆底肌锻炼对产后压力性尿失禁患者盆底功能及性生活质量的影响

目的探讨骶四针疗法配合盆底肌锻炼对产后压力性尿失禁患者盆底功能及性生活质量的影响。方法选取2017年5月至2020年5月新疆医科大学第一附属医院收治的98例产后压力性尿失禁患者作为研究对象。采用随机数字表法分为研究组和对照组,各49例。两组均接受常规护理,对照组在常规护理的基础上给予盆底肌锻炼,研究组在对照组的基础上给予骶四针疗法,比较两组的临床疗效?1 h漏尿量?盆底肌力恢复情况及性生活情况。结果治疗后,研究组总有效率为91.84%,明显高于对照组的69.39%,差异具有统计学意义(P<0.05);与治疗前比较,治疗后两组1 h漏尿量减少,且研究组1 h漏尿量少于对照组,差异具有统计学意义(P<0.05);治疗后,两组盆底肌力分级均升高,且研究组盆底肌力分级高于对照组,差异具有统计学意义(P<0.05);治疗后,研究组性生活质量高水平比率为38.78%,高于对照组的20.41%,差异具有统计学意义(P<0.05)。结论骶四针疗法配合盆底肌锻炼用于产后压力性尿失禁患者,能改善患者的漏尿情况,提高其盆底肌力及性生活质量,临床疗效较好。     

低位直肠癌保功能手术的相关问题

外科手术是治疗直肠癌的基础,尤其是对于低位直肠癌,在追求远期肿瘤学疗效的同时,如何更好地兼顾患者术后生命质量,保留正常生理功能,一直是业界关注的重要问题。近年来,随着对直肠癌病理学与分子病理学理解的深入、多学科综合诊断与治疗策略的优化与发展、全直肠系膜切除术和保留盆腔自主神经等手术技术和治疗理念的引入,以及技术设备与外科手术方式的持续创新,低位直肠癌保功能手术得到不断完善与持续发展。直肠癌外科领域未来的发展方向无疑将更多地体现在功能的保留与保护等方面。对于低位直肠癌患者,在保证肿瘤根治前提下如何最大限度地保留功能,有赖于精准选择以循证医学证据为基础的治疗策略和精细地施行个体化的保肛手术。     

Comparative neuroanatomy of ctenophores: Neural and muscular systems in Euplokamis dunlapae and related species

Ctenophora is an early-branching basal metazoan lineage, which may have evolved neurons and muscles independently from other animals. However, despite the profound diversity among ctenophores, basal neuroanatomical data are limited to representatives of two genera. Here, we describe the organization of neuromuscular systems in eight ctenophore species focusing on Euplokamis dunlapae—the representative of the lineage sister to all other ctenophores. Cydippids (Hormiphora hormiphora and Dryodora glandiformis) and lobates (Bolinopsis infundibulum and Mnemiopsis leidyi) were used as reference platforms to cover both morphological and ecological diversity within the phylum. We show that even with substantial environmental differences, the basal organization of neural systems is conserved among ctenophores. In all species, we detected two distributed neuronal subsystems: the subepithelial polygonal network and the mesogleal elements. Nevertheless, each species developed specific innovations in neural, muscular, and receptor systems. Most notable Euplokamis-specific features are the following: (a) Comb nerves with giant axons. These nerves directly coordinate the rapid escape response bypassing the central integrative structure known as the aboral sensory organ. (b) Neural processes in tentacles along the rows of “boxes” providing structural support and located under striated muscles. (c) Radial muscles that cross the mesoglea and connect the outer wall to the aboral canal. (d) Flat muscles, encircling each meridional canal. Also, we detected a structurally different rectangular neural network in the feeding lobes of Lobata (Mnemiopsis/Bolinopsis) but not in other species. The described lineage-specific innovations can be used for future single-cell atlases of ctenophores and analyses of neuronal evolution in basal metazoans.     

Split liver transplantation is utilized infrequently and concentrated at few transplant centers in the United States

Split liver transplantation (SLT) is 1 strategy for maximizing the number of deceased donor liver transplants. Recent reports suggest that utilization of SLT in the United States remains low. We examined deceased donor offers that were ultimately split between 2010 and 2014. SLTs were categorized as “primary” and “secondary” transplants. We analyzed allocation patterns and used logistic regression to evaluate factors associated with secondary split discard. Four hundred eighteen livers were split: 54% from adult, 46% from pediatric donors. Of the 227 adult donor livers split, 61% met United Network for Organ Sharing “optimal” split criteria. A total of 770 recipients (418 primary and 352 secondary) were transplanted, indicating 16% discard. Ninety‐two percent of the 418 primary recipients were children, and 47% were accepted on the first offer. Eighty‐seven percent of the 352 secondary recipients were adults, and 7% were accepted on the first offer. Of the 352 pairs, 99% were transplanted in the same region, 36% at the same center. In logistic regression, shorter donor height was associated with secondary discard (odds ratio 0.97 per cm, 95% CI 0.94‐1.00, P = .02). SLT volume by center was not predictive of secondary discard. Current policy proposals that incentivize SLT in the United States could increase the number of transplants to children and adults.