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| 1 | Constructal multidisciplinary optimization of electromagnet based on entransy dissipation minimization显示文摘Based on entransy dissipation, the mean temperature difference of solenoid (electromagnet) with high thermal conductivity material inserted is deduced, which can be taken as the fundament for heat transfer optimization using the extremum principle of entransy dissipation. Then, the electromagnet working at steady state (constant magnetic field, constant heat generating rate per unit volume) is optimized for entransy dissipation minimization (i.e. mean temperature difference minimization) with and without volume constraint. Besides, the effect of high thermal conductivity material on the magnetic field is analyzed, and the minimum mean temperature versus volume and magnetic induction characteristic are also studied. | WEI ShuHuan CHEN LinGen SUN FengRui | 2009 | Science China(Technological Sciences)2009，52，10： | 29 |
| 2 | Multisciplinary management of patients with liver metastasis from colorectal cancer显示文摘Colorectal cancer(CRC) is one of the leading causes of cancer-related death. Surgery, radiotherapy and chemotherapy have been till now the main therapeutic strategies for disease control and improvement of the overall survival. Twenty-five per cent(25%) of CRC patients have clinically detectable liver metastases at the initial diagnosis and approximately 50% develop liver metastases during their disease course. Twentythirty per cent(20%-30%) are CRC patients with metastases confined to the liver. Some years ago various studies showed a curative potential for liver metastases resection. For this reason some authors proposed the conversion of unresectable liver metastases to resectable to achieve cure. Since those results were published, a lot of regimens have been studied for resectability potential. Better results could be obtained by the combination of chemotherapy with targeted drugs, such as anti-VEGF and antiEGFR monoclonal antibodies. However an accurate selection for patients to treat with these regimens and to operate for liver metastases is mandatory to reduce the risk of complications. A multidisciplinary team approach represents the best way for a proper patient management. The team needs to include surgeons, oncologists, diagnostic and interventional radiologists with expertise in hepatobiliary disease, molecular pathologists, and clinical nurse specialists. This review summarizes the most important findings on surgery and systemic treatment of CRC-related liver metastases. | Kathleen De Greef Christian Rolfo Antonio Russo Thiery Chapelle Giuseppe Bronte Francesco Passiglia Andreia Coelho Konstantinos Papadimitriou Marc Peeters | 2016 | World Journal of Gastroenterology2016，22，32： | 22 |
| 3 | Colorectal liver metastases:An update on multidisciplinary approach显示文摘Liver metastasis is the commonest form of distant metastasis in colorectal cancer.Selection criteria for surgery and liver-directed therapies have recently been extended.However,resectability remains poorly defined.Tumour biology is increasingly recognized as an important prognostic factor;hence molecular profiling has a growing role in risk stratification and management planning.Surgical resection is the only treatment modality for curative intent.The most appropriate surgical approach is yet to be established.The primary cancer and the hepatic metastasis can be removed simultaneously or in a two-step approach;these two strategies have comparable long-term outcomes.For patients with a limited future liver remnant,portal vein embolization,combined ablation and resection,and associating liver partition and portal vein ligation for staged hepatectomy have been advocated,and each has their pros and cons.The role of neoadjuvant and adjuvant chemotherapy is still debated.Targeted biological agents and loco-regional therapies(thermal ablation,intra-arterial chemo-or radio-embolization,and stereotactic radiotherapy) further improve the already favourable results.The recent debate about offering liver transplantation to highly selected patients needs validation from large clinical trials.Evidencebased protocols are missing,and therefore optimal management of hepatic metastasis should be personalized and determined by a multi-disciplinary team. | Felix Che-Lok Chow Kenneth Siu-Ho Chok | 2019 | World Journal of Hepatology2019，11，2： | 20 |
| 4 | Treatment and outcomes of 1041 pediatric patients with neuroblastoma who received multidisciplinary care in China显示文摘Importance:Neuroblastoma is the most common extracranial malignant solid tumor in children.Multidisciplinary care is critical to improving the survival of pediatric patients with neuroblastoma.Objective:To systematically summarize the clinical characteristics of children with neuroblastoma and evaluate their prognosis with multidisciplinary care provided in a single center.Methods:This retrospective study analyzed the clinical data of 1041 patients with neuroblastoma who were diagnosed,treated,and followed-up in the Hematology-Oncology Center of Beijing Children’s Hospital from 2007 to 2019.Results:The median age at diagnosis was 34 months;80.8%of the patients were younger than 5 years of age.Notably,243 patients(23.3%)were classified as low-risk,249 patients(23.9%)were classified as intermediate-risk,and 549(52.7%)were classified as high-risk.Furthermore,956 patients underwent surgical resections;986(94.7%)patients received chemotherapy;and 176 patients with high-risk neuroblastoma received hematopoietic stem cell transplantation.The 5-year event-free survival(EFS)rate was 91.3%and 5-year overall survival(OS)rate was 97.5%in low-risk group;in the intermediate-risk group,these rates were 85.1%and 96.7%,respectively,while they were 37.7%and 48.9%in the high-risk group(P<0.001 for both).The 5-year EFS and OS rates were significantly higher in patients diagnosed between 2015 and 2019 than in patients diagnosed between 2007 and 2014(P<0.001).In total,278 patients(26.7%)exhibited tumor relapse or progression;the median interval until relapse or progression was 14 months.Of the 233 patients who died,83%died of relapse or progression of neuroblastoma and 4.3%died of therapy-related complications.Interpretation:The 5-year OS rate was low in high-risk patients,compared with low-and intermediate-risk patients.Multidisciplinary care is critical for improvement of survival in pediatric patients with neuroblastoma.Additional treatment strategies should be sought to improve the prognosis of patients with high-risk neuroblastoma. | Yan Su Hong Qin Chenghao Chen Shengcai Wang Shihan Zhang Dawei Zhang Mei Jin Yun Peng Lejian He Xiaoman Wang Suyun Qian Maoquan Qin Ming Ge Fuquan Zhang Qi Zeng Huanmin Wang Xiaoli Ma Xin Ni | 2020 | Pediatric Investigation2020，4，3： | 16 |
| 5 | Overview of China's Antarctic research progress 1984–2016显示文摘It is more than 30 years since the first Chinese National Antarctic Research Expedition(CHINARE) landed in Antarctica in 1984, representing China's initiation in polar research. This review briefly summarizes the Chinese Antarctic scientific research and output accomplished over the past 30 years. The developments and progress in Antarctic research and the enhancement of international scientific cooperation achieved through the implementation of the CHINARE program have been remarkable. Since the 1980 s, four permanent Chinese Antarctic research stations have been established successively and 33 CHINAREs have been completed. The research results have been derived from a series of spatiotemporal observations in association with various projects and multidisciplinary studies in the fields of oceanography, glaciology, geology, geophysics, geochemistry, atmospheric science, upper atmospheric physics, Antarctic astronomy, biology and ecology, human medicine, polar environment observation, and polar engineering. | CHEN Liqi LIU Xiaohan BIAN Lingen CHEN Bo HUANG Hongliang HU Hongqiao LUO Wei SHI Guitao SHI Jiuxin XU Chengli YANG Guang ZHAO Yue ZHANG Shaohua | 2017 | Advances in Polar Science2017，28，3： | 9 |
| 6 | The anatomy of reliability: a must read for future human brain mapping显示文摘Human brain mapping (HBM)is increasingly becoming a multidisciplinary field where some scientific issues are fundamental for all scientists and applications of using the technology to investigate individual differences.Reliability represents a significant issue for all scientific fields and has particularly been overlooked for decades by the HBM field [1].Meanwhile,recent advances in open science have offered the field big data for developing novel methodological frameworks as well as performing largescale investigations of the brain-mind associations based upon the individual differences assessed with HBM [2].A systematic investigation of reliability seems still far behind these HBM developments. It is critical that reliability is evaluated ahead of these applications, motivating the current commentary on delineation of the anatomy of reliability for future HBM. | Xiu-Xia Xing Xi-Nian Zuo | 2018 | Science Bulletin2018，63，24： | 8 |
| 7 | One hundred and seventy-eight consecutive pancreatoduodenectomies without mortality:role of the multidisciplinary approach显示文摘BACKGROUND:Pancreatoduodenectomy offers the only chance of cure for patients with periampullary cancers.This,however,is a major undertaking in most patients and is associated with a significant morbidity and mortality.A multidisciplinary approach to the workup and follow-up of patients undergoing pancreatoduodenectomy was initiated at our institution to improve the diagnosis,resection rate,mortality and morbidity.We undertook the study to assess the effect of this approach on diagnosis,resection rates and short-term outcomes such as morbidity and mortality.METHODS:A prospective database of patients presenting with periampullary cancers to a single surgeon between April 2004 and April 2010 was reviewed.All cases were discussed at a multidisciplinary meeting comprising surgeons,gastroenterologists,radiologists,oncologists,radiation oncologists,pathologists and nursing staff.A standardized investigation and management algorithm was followed.Complications were graded according to the Clavien-Dindo classification.RESULTS:A total of 295 patients with a periampullary lesion were discussed and 178 underwent pancreatoduodenectomy (resection rate 60%).Sixty-one patients (34%) required either a vascular or an additional organ resection.Eighty-nine patients experienced complications,of which the commonest was blood transfusion (12%).Thirty-four patients (19%) had major complications,i.e.grade 3 or above.There was no in-hospital,30-day or 60-day mortality.CONCLUSIONS:Pancreatoduodenectomy can safely be performed in high-volume centers with very low mortality.The surgeon's role should be careful patient selection,intensive preoperative investigations,use of a team approach,and an unbiased discussion at a multidisciplinary meeting to optimize the outcome in these patients. | Jaswinder S Samra Raul Alvarado Bachmann Julian Choi Anthony Gill Michael Neale Vikram Puttaswamy Cameron Bell Ian Norton Sarah Cho Steven Blome Ritchie Maher Sivakumar Gananadha Thomas J Hugh | 2011 | Hepatobiliary & Pancreatic Diseases International2011，10，4： | 8 |
| 8 | Reliability-based multidisciplinary design optimization using incremental shifting vector strategy and its application in electronic product design显示文摘Use of multidisciplinary analysis in reliabilitybased design optimization(RBDO) results in the emergence of the important method of reliability-based multidisciplinary design optimization(RBMDO). To enhance the efficiency and convergence of the overall solution process,a decoupling algorithm for RBMDO is proposed herein.Firstly, to decouple the multidisciplinary analysis using the individual disciplinary feasible(IDF) approach, the RBMDO is converted into a conventional form of RBDO. Secondly,the incremental shifting vector(ISV) strategy is adopted to decouple the nested optimization of RBDO into a sequential iteration process composed of design optimization and reliability analysis, thereby improving the efficiency significantly. Finally, the proposed RBMDO method is applied to the design of two actual electronic products: an aerial camera and a car pad. For these two applications, two RBMDO models are created, each containing several finite element models(FEMs) and relatively strong coupling between the involved disciplines. The computational results demonstrate the effectiveness of the proposed method. | Z.L.Huang Y.S.Zhou C.Jiang J.Zheng X.Han | 2018 | Acta Mechanica Sinica2018，34，2： | 8 |
| 9 | Neo-adjuvant radiotherapy in rectal cancer显示文摘In rectal cancer treatment,attention has focused on the local primary tumour and the regional tumour cell deposits to diminish the risk of a loco-regional recurrence.Several large randomized trials have also shown that combinations of surgery,radiotherapy and chemotherapy have markedly reduced the risk of a locoregional recurrence,but this has not yet had any major influence on overall survival.The best results have been achieved when the radiotherapy has been given preoperatively.Preoperative radiotherapy improves loco-regional control even when surgery has been optimized to improve lateral clearance,i.e.,when a total mesorectal excision has been performed.The relative reduction is then 50%-70%.The value of radiotherapy has not been tested in combination with more extensive surgery including lateral lymph node clearance,as practised in some Asian countries.Many details about how the radiotherapy is performed are still open for discussion,and practice varies between countries.A highly fractionated radiation schedule(5 Gy×5),proven efficacious in many trials,has gained much popularity in some countries,whereas a conventionally fractionated regimen(1.8-2.0 Gy×25-28),often combined with chemotherapy,is used in other countries.The additional therapy adds morbidity to the morbidity that surgery causes,and should therefore be administered only when the risk of loco-regional recurrence is sufficiently high.The best integration of the weakest modality,to date the drugs(conventional cytotoxics and biologicals)is not known.A new generation of trials exploring the best sequence of treatments is required.Furthermore,there is a great need to develop predictors of response,so that treatment can be further individualized and not solely based upon clinical factors and anatomic imaging. | Bengt Glimelius | 2013 | World Journal of Gastroenterology2013，19，46： | 7 |
| 10 | Multidisciplinary management of nonfunctional neuroendocrine tumor of the pancreas显示文摘Pancreatic neuroendocrine tumors(PNETs) are a rare and diverse group of tumors; nonfunctional(NF) PNETs account for the majority of cases. Most patients with NF-PNETs have metastatic disease at the time of presentation. A variety of treatment modalities exist, including medical, liver directed, and surgical treatments. Aggressive surgical management is associated with prolonged survival, however available data are limited by selection bias and the frequent combination of PNETs with carcinoid tumors. Although few patients with metastatic disease will be cured, application of currently available therapies in a multidisciplinary setting can lead to excellent outcomes with prolonged patient survival. | Ian W Folkert Paul Hernandez Robert E Roses | 2016 | World Journal of Gastroenterology2016，22，11： | 6 |
| 11 | Role of D2 gastrectomy in gastric cancer with clinical para-aortic lymph node metastasis显示文摘BACKGROUND Owing to the technical difficulty of pathological diagnosis, imaging is still the most commonly used method for clinical diagnosis of para-aortic lymph node metastasis(PALM) and evaluation of therapeutic effects in gastric cancer, which leads to inevitable false-positive findings in imaging. Patients with clinical PALM may have entirely different pathological stages(stage IV or not), which require completely different treatment strategies. There is no consensus on whether surgical intervention should be implemented for this group of patients. In particular, the value of D2 gastrectomy in a multidisciplinary treatment(MDT)approach for advanced gastric cancer with clinical PALM remains unknown.AIM To investigate the value of D2 gastrectomy in a MDT approach for gastric cancer patients with clinical PALM.METHODS In this real-world study, clinico-pathological data of all gastric cancer patients treated at the Cancer Hospital, Chinese Academy of Medical Sciences between 2011 and 2016 were reviewed to identify those with clinically enlarged PALM. All the clinico-pathological data were prospectively documented in the patient medical record. For all the gastric cancer patients with advanced stage disease,especially those with suspicious distant metastasis, the treatment methods were determined by a multidisciplinary team.RESULTS In total, 48 of 7077 primary gastric cancer patients were diagnosed as having clinical PALM without other distant metastases. All 48 patients received chemotherapy as the initial treatment. Complete or partial response was observed in 39.6%(19/48) of patients in overall and 52.1%(25/48) of patients in the primary tumor. Complete response of PALM was observed in 50.0%(24/48)of patients. After chemotherapy, 45.8%(22/48) of patients received D2 gastrectomy, and 12.5%(6/48) of patients received additional radiotherapy. The postoperative major complication rate and mortality were 27.3%(6/22) and 4.5%(1/22), respectively. The median overall survival and progression-free survival of all the patients were 18.9 and 12.1 mo, respectively. The median overall survival of patients who underwent surgical resection or not was 50.7 and 12.8 mo,respectively. The 3-year and 5-year survival rates were 56.8% and 47.3%,respectively, for patients who underwent D2 resection. Limited PALM and complete response of PALM after chemotherapy were identified as favorable factors for D2 gastrectomy.CONCLUSION For gastric cancer patients with radiologically suspicious PALM that responds well to chemotherapy, D2 gastrectomy could be a safe and effective treatment and should be adopted in a MDT approach for gastric cancer with clinical PALM. | Xiao-Hao Zheng Wen Zhang Lin Yang Chun-Xia Du Ning Li Gu-Sheng Xing Yan-Tao Tian Yi-Bin Xie | 2019 | World Journal of Gastroenterology2019，25，19： | 6 |
| 12 | Multidisciplinary design optimization of adaptive wing leading edge显示文摘Adaptive wing can significantly enhance aircraft aerodynamic performance, which refers to aerodynamic and structural opti-mization designs. This paper introduces a two-step approach to solve the interrelated problems of the adaptive leading edge. In the first step, the procedure of airfoil optimization is carried out with an initial configuration of NACA 0006. On the basis of the combination of design of experiment (DOE), response surface method (RSM) and genetic algorithm (GA), an adaptive air-foil can be obtained whose lift-to-drag ratio is larger than the baseline airfoil's at the given angle of attack and subsonic speed.The next step is to design a compliant structure to achieve the target airfoil shape, which is the optimization result of the previous step. In order to minimize the deviation of the deformed shape from the target shape, the load path representation topology method is presented. This method is developed by way of GA, with size and shape optimization incorporated in it simul-taneously. Finally, a comparison study with the Solid Isotropic Material with Penalization (SIMP) method in Altair OptiStruct is conducted, and the results demonstrate the validity and effectiveness of the proposed approach. | SUN RuJie CHEN GuoPing ZHOU Chen ZHOU LanWei JIANG JinHui | 2013 | Science China(Technological Sciences)2013，56，7： | 5 |
| 13 | Multidisciplinary integrated design of long-range ballistic missile using PSO algorithm显示文摘In the case of the given design variables and constraint functions, this paper is concerned with the rapid overall parameters design of trajectory, propulsion and aerodynamics for long-range ballistic missiles based on the index of the minimum take-off mass.In contrast to the traditional subsystem independent design, this paper adopts the research idea of the combination of the subsystem independent design and the multisystem integration design.Firstly, the trajectory, propulsion and aerodynamics of the subsystem are separately designed by the engineering design, including the design of the minimum energy trajectory, the computation of propulsion system parameters, and the calculation of aerodynamic coefficient and dynamic derivative of the missile by employing the software of missile DATCOM. Then, the uniform design method is used to simplify the constraint conditions and the design variables through the integration design, and the accurate design of the optimized variables would be accomplished by adopting the uniform particle swarm optimization(PSO) algorithm. Finally, the automation design software is written for the three-stage solid ballistic missile. The take-off mass of 29 850 kg is derived by the subsystem independent design, and 20 constraints are reduced by employing the uniform design on the basis of 29 design variables and 32 constraints, and the take-off mass is dropped by 1 850 kg by applying the combination of the uniform design and PSO. The simulation results demonstrate the effectiveness and feasibility of the proposed hybrid optimization technique. | ZHENG Xu GAO Yejun JINGWuxing WANG Yongsheng | 2020 | Journal of Systems Engineering and Electronics2020，31，2： | 5 |
| 14 | Gradient-based Kriging approximate model and its application research to optimization design显示文摘In the process of multidisciplinary design optimization, there exits the calculation complexity problem due to frequently calling high fidelity system analysis models. The high fidelity system analysis models can be surrogated by approximate models. The sensitivity analysis and numerical noise filtering can be done easily by coupling approximate models to optimization. Approximate models can reduce the number of executions of the problem's simulation code during optimization, so the solution efficiency of the multidisciplinary design optimization problem can be improved. Most optimization methods are based on gradient. The gradients of the objective and constrain functions are gained easily. The gra- dient-based Kriging (GBK) approximate model can be constructed by using system response value and its gradients. The gradients can greatly improve prediction precision of system response. The hybrid optimization method is constructed by coupling GBK approximate models to gradient-based optimiza- tion methods. An aircraft aerodynamics shape optimization design example indicates that the methods of this paper can achieve good feasibility and validity. | XUAN Ying XIANG JunHua ZHANG WeiHua ZHANG YuLin | 2009 | Science China(Technological Sciences)2009，52，4： | 4 |
| 15 | Practical strategies for increasing efficiency and effectiveness in critical care education显示文摘Technological advances and evolving demands inmedical care have led to challenges in ensuring adequate training for providers of critical care. Reliance on the traditional experience-based training model alone is insufficient for ensuring quality and safety in patient care. This article provides a brief overview of the existing educational practice within the critical care environment. Challenges to education within common daily activities of critical care practice are reviewed. Some practical evidence-based educational approaches are then described which can be incorporated into the daily practice of critical care without disrupting workflow or compromising the quality of patient care. It is hoped that such approaches for improving the efficiency and efficacy of critical care education will be integrated into training programs. | Maurice F Joyce Sheri Berg Edward A Bittner | 2017 | World Journal of Critical Care Medicine2017，6，1： | 4 |
| 16 | Does in-house availability of multidisciplinary teams increase survival in upper gastrointestinal-cancer?显示文摘AIM: To investigate the effect of the establishment of in-house multidisciplinary team (MDT) availability (iMDTa) on survival in upper gastrointestinal cancer (UGI) patients. METHODS: In 2001, a cancer centre with irradiation and chemotherapy facilities was established in the Norwegian county of West Agder with a change of iMDTa (WA/MDT-Change). 'iMDTa'-status was defined according to the availability of the necessary specialists within one institution on one campus, serving the population of one county. We compared survival rates during 2000-2008 for UGI patients living in counties with (MDT-Yes), without (MDT-No), with a mix (MDT-Mix) and WA/MDT-Change. Survival was calculated with Kaplan-Meier method. Cox model was used to uncover differences between counties with different MDT status when adjusted for age, sex and stage. RESULTS: We analyzed 395 patients from WA/MDT-Change and compared their survival to 12 135 UGIpatients from four other Norwegian regions. Median overall survival for UGI patients in WA/MDT-Change increased from 129 to 300 d from 2000-2008, P = 0.001. The regions with the highest level of iMDTa achieved the largest decrease in risk of death for UGI cancers (compared to the county with MDT-Mix: MDT-Yes 11%, P <0.05 and WA/MDT-Change 15%, P < 0.05). Analyzing the different tumour entities separately, patients living in the WA/MDT-Change county reached a statisti-cally significant reduction in the risk of death [hazard ratios (HR)] compared to patients in the county with MDT-Mix for oesophageal and gastric, but not for pan-creatic cancer. HR for the study period 2000-2004 are given first and then for the period 2005-2008: The HR for oesophageal cancers was reduced from [HR = 1.12; 95%CI: 0.75-1.68 to HR = 0.60, 95%CI: 0.38-0.95] and for gastric cancers from [HR = 0.87, 95%CI: 0.66-1.15 to HR = 0.63, 95%CI: 0.43-0.93], but not for pancreatic cancer [HR = 1.04-, 95%CI: 0.83-1.3 for 2000-2004 and HR = 1.01, 95%CI: 0.78-1.3 for 2005-2008]. UGI patients treated during the second study period in the county of WA/MDT-Change had a higher probability of receiving chemotherapy. In the first study period, only one out of 43 patients (2.4%, 95%CI: 0-6.9) received chemotherapy, compared to 18 of 42 patients diagnosed during 2005-2008 (42.9%, 95%CI: 28.0-57.8). CONCLUSION: Introduction of iMDTa led to a two-fold increase of UGI patients, whereas no increase in survival was found in the MDT-No or MDT-Mix counties. | Christian Kersten Milada Cvancarova Svein Mjland Odd Mjland | 2013 | World Journal of Gastrointestinal Oncology2013，5，3： | 3 |
| 17 | Aircraft robust multidisciplinary design optimization methodology based on fuzzy preference function显示文摘This paper presents a Fuzzy Preference Function-based Robust Multidisciplinary Design Optimization(FPF-RMDO) methodology. This method is an effective approach to multidisciplinary systems, which can be used to designer experiences during the design optimization process by fuzzy preference functions. In this study, two optimizations are done for Predator MQ-1 Unmanned Aerial Vehicle(UAV):(A) deterministic optimization and(B) robust optimization. In both problems, minimization of takeoff weight and drag is considered as objective functions, which have been optimized using Non-dominated Sorting Genetic Algorithm(NSGA). In the robust design optimization, cruise altitude and velocity are considered as uncertainties that are modeled by the Monte Carlo Simulation(MCS) method. Aerodynamics, stability and control, mass properties, performance, and center of gravity are used for multidisciplinary analysis. Robust design optimization results show 46% and 42% robustness improvement for takeoff weight and cruise drag relative to optimal design respectively. | Ali Reza BABAEI Mohammad Reza SETAYANDEH Hamid FARROKHFAL | 2018 | Chinese Journal of Aeronautics2018，31，12： | 3 |
| 18 | Anal carcinoma in giant anal condyloma, multidisciplinary approach necessary for optimal outcome:Two case reports and review of literature显示文摘BACKGROUND Anal cancers are caused by human papilloma virus(HPV). Buschke-Lowenstein tumor also known as giant anal condyloma(GCA) is a variant of giant neglected anal tumors arising from warts caused by HPV infection. HPV are a family of double-stranded DNA viruses and primarily cause sexually transmitted disease of the genitalia and oropharyngeal mucosa. These tumors are slow growing;locally destructive large verrucous masses.CASE SUMMARY We present a series of two cases with large anal tumors harboring invasive cancers and highlight their presentation and management. Tumors with high risk HPV subtypes(HPV 16, 18, 31, 33) may progress into invasive squamous cell carcinoma(SCC). Untreated GCA can attain enormous size and extend into the pelvic organs and bony structures. Some tumors show malignant degeneration into SCC and are often difficult to diagnose given the large size of the tumors.Complete surgical excision with negative margins is the treatment of choice and necessary to prevent recurrence. This is often not feasible and leaves large surgical wounds with tissue defects with delay in healing and increases postoperative morbidity. Pelvic reconstructive techniques including muscle flaps and grafts are often necessary to close the defects. Human immunodeficiency virus and immunocompromised patients generally do poorly with standard treatments.CONCLUSION A multidisciplinary team of colorectal and plastic surgeons, medical and radiation oncologists along with combination treatment modalities are necessary when malignant transformation occurs in GCA, for optimal outcomes. | Santosh Shenoy Murali Nittala Yazen Assaf | 2019 | World Journal of Gastrointestinal Oncology2019，11，2： | 2 |
| 19 | Propofol pump controls nonconvulsive status epilepticus in a hepatic encephalopathy patient: A case report显示文摘BACKGROUND Status epilepticus is an emergent and critical condition which needs management without hesitation. Nonconvulsive status epilepticus (NCSE) tends to be less recognized, and its diagnosis is delayed in comparison with overt status epilepticus because of the absence of specific clinical signs. It is often difficult to make a diagnosis, particularly in patients with hepatic encephalopathy. CASE SUMMARY A 38-year-old man with a history of alcoholic liver cirrhosis presented with altered mental status;the initial diagnosis was hepatic encephalopathy. Although optimal treatment for hepatic encephalopathy was administered, the patient's mental status did not improve. A final diagnosis of NCSE was made by continuous electroencephalogram (EEG) monitoring. Treatment with levetiracetam and propofol pump was immediately started. The patient’s consciousness gradually improved after discontinuation of propofol therapy, and no further epileptic discharge was observed by EEG monitoring. After 1 wk, the patient returned to full consciousness, and he was able to walk in the hospital ward without assistance. He was discharged with minimal sequela of bilateral conjunctivitis. CONCLUSION In cases of persistent altered mental status without reasonable diagnosis, NCSE should be considered in hepatic encephalopathy patients with persistently altered levels of consciousness, and EEG monitoring is very important. We also recommend propofol as a safe and efficient therapy for NCSE in liver cirrhosis patients. | Shao Hor Chih-Yu Chen Sheng-Ta Tsai | 2019 | World Journal of Clinical Cases2019，7，18： | 2 |
| 20 | Multidisciplinary approach for multifocal, bilobar hepatocellular carcinoma: A case report and literature review显示文摘BACKGROUND Hepatocellular carcinoma(HCC) is the second most lethal malignancy worldwide. There has been virtually no change in the survivability of HCC in spite of improvement in therapies. Surgery is considered the ideal first, curative intervention, however most patients present in advanced stages with unresectable disease. Therefore, systemic and liver-directed non-operative therapies are initially offered to downstage the disease. To ensure optimal management, a multidisciplinary team approach is often warranted. Our case highlights the benefits of a multidisciplinary approach in a young woman with multifocal, bilobar HCC.CASE SUMMARY A 36-year-old Chinese woman with untreated hepatitis B was found to have large bilobar HCC during work up for abdominal pain. Her initial serum alphafetoprotein was significantly elevated to 311136 ng/mL. Computed tomography scan demonstrated bulky bilobar liver masses, consistent with intermediate stage HCC, Barcelona Clinic Liver Cancer Stage B. Her case was discussed and a personalized care plan was developed at the Multidisciplinary Center for Advanced Minimally Invasive Liver Oncologic Therapies at the University of Washington. She initially underwent bilobar transarterial chemoembolization with partial response of the left lobar tumor. Salvage hypofractionated proton beam radiation therapy was delivered to the right lobe followed by two additional transarterial chemoembolizations to the left lobe with good response.Finally, to remove left lobar residual disease, she was taken to the operating roomfor a left hepatectomy eleven months after her initial presentation. She continues to be without evidence of disease.CONCLUSION Coordinating the multiple HCC treatment modalities is complex and our case highlights the benefits of a multidisciplinary approach. | Kevin P Labadie Stephanie K Schaub Derek Khorsand Guy Johnson Smith Apisarnthanarax James O Park | 2019 | World Journal of Hepatology2019，11，1： | 2 |
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