Objective: The mandible is the most common fractured craniofacial bone of all craniofacial fractures in the Philippines, with the mandibular body as the most involved segment of all mandibular fractures. To the best of our knowledge, there are no existing guidelines for the diagnosis and management of mandibular body fractures in particular. General guidelines include the American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAOHNSF) Resident Manual of Trauma to the Face, Head, and Neck chapter on Mandibular Trauma, the American Association of Oral and Maxillofacial Surgeons (AAOMS) Clinical Practice Guidelines for Oral and Maxillofacial Surgery section on the Mandibular Angle, Body, and Ramus, and a 2013 Cochrane Systematic Review on interventions for the management of mandibular fractures. On the other hand, a very specific Clinical Practice Guideline on the Management of Unilateral Condylar Fracture of the Mandible was published by the Ministry of Health Malaysia in 2005. Addressing the prevalence of mandibular body fractures, and dearth of specific guidelines for its diagnosis and management, this clinical practice guideline focuses on the management of isolated mandibular body fractures in adults. Purpose: This guideline is meant for all clinicians (otolaryngologists – head and neck surgeons, as well as primary care and specialist physicians, nurses and nurse practitioners, midwives and community health workers, dentists, and emergency first-responders) who may provide care to adults aged 18 years and above that may present with an acute history and physical and/or laboratory examination findings that may lead to a diagnosis of isolated mandibular body fracture and its subsequent medical and surgical management, including health promotion and disease prevention. It is applicable in any setting (including urban and rural primary-care, community centers, treatment units, hospital emergency rooms, operating rooms) in which adults with isolated mandibular body fractures would be identified, diagnosed, or managed. Outcomes are functional resolution of isolated mandibular body fractures; achieving premorbid form; avoiding use of context-inappropriate diagnostics and therapeutics; minimizing use of ineffective interventions; avoiding co-morbid infections, conditions, complications and adverse events; minimizing cost; maximizing health-related quality of life of individuals with isolated mandibular body fracture; increasing patient satisfaction; and preventing recurrence in patients and occurrence in others. Action Statements The guideline development group made strong recommendationsfor the following key action statements: (6) pain management- clinicians should routinely evaluate pain in patients with isolated mandibular body fractures using a numerical rating scale (NRS) or visual analog scale (VAS); analgesics should be routinely offered to patients with a numerical rating pain scale score or VAS of at least 4/10 (paracetamol and a mild opioid with or without an adjuvant analgesic) until the numerical rating pain scale score or VAS is 3/10 at most; (7) antibiotics- prophylactic antibiotics should be given to adult patients with isolated mandibular body fractures with concomitant mucosal or skin opening with or without direct visualization of bone fragments; penicillin is the drug of choice while clindamycin may be used as an alternative; and (14) prevention- clinicians should advocate for compliance with road traffic safety laws (speed limit, anti-drunk driving, seatbelt and helmet use) for the prevention of motor vehicle, cycling and pedestrian accidents and maxillofacial injuries.The guideline development group made recommendations for the following key action statements: (1) history, clinical presentation, and diagnosis - clinicians should consider a presumptive diagnosis of mandibular fracture in adults presenting with a history of traumatic injury to the jaw plus a positive tongue blade test, and any of the following: malocclusion, trismus, tenderness on jaw closure and broken tooth; (2) panoramic x-ray - clinicians may request for panoramic x-ray as the initial imaging tool in evaluating patients with a presumptive clinical diagnosis; (3) radiographs - where panoramic radiography is not available, clinicians may recommend plain mandibular radiography; (4) computed tomography - if available, non-contrast facial CT Scan may be obtained; (5) immobilization - fractures should be temporarily immobilized/splinted with a figure-of-eight bandage until definitive surgical management can be performed or while initiating transport during emergency situations; (8) anesthesia - nasotracheal intubation is the preferred route of anesthesia; in the presence of contraindications, submental intubation or tracheostomy may be performed; (9) observation - with a soft diet may serve as management for favorable isolated nondisplaced and nonmobile mandibular body fractures with unchanged pre - traumatic occlusion; (10) closed reduction - with immobilization by maxillomandibular fixation for 4-6 weeks may be considered for minimally displaced favorable isolated mandibular body fractures with stable dentition, good nutrition and willingness to comply with post-procedure care that may affect oral hygiene, diet modifications, appearance, oral health and functional concerns (eating, swallowing and speech); (11) open reduction with transosseous wiring - with MMF is an option for isolated displaced unfavorable and unstable mandibular body fracture patients who cannot afford or avail of titanium plates; (12) open reduction with titanium plates - ORIF using titanium plates and screws should be performed in isolated displaced unfavorable and unstable mandibular body fracture; (13) maxillomandibular fixation - intraoperative MMF may not be routinely needed prior to reduction and internal fixation; and (15) promotion - clinicians should play a positive role in the prevention of interpersonal and collective violence as well as the settings in which violence occurs in order to avoid injuries in general and mandibular fractures in particular.
Mandibular Fractures ; Jaw Fractures ; Classification ; History ; Diagnosis ; Diagnostic Imaging ; Therapeutics ; Diet Therapy ; Drug Therapy ; Rehabilitation ; General Surgery

Based on the four major classic studies of perioperative treatment of locally advanced gastric cancer (LAGC), the North American Intergroup-0116 trial, the European MRC MAGIC trial, the Japan ACTS-GC trial and Korea-China CLASSIC trial, the perioperative therapy of LAGC was divided into three major patterns in the world, namely, postoperative adjuvant chemoradiotherapy in the North America, perioperative chemotherapy in the Europe and postoperative adjuvant chemotherapy in the East Asia. In recent years, scholars around the world have done many researches on the perioperative treatment of gastric cancer. For instance the German FLOT4-AIO trial pushed the perioperative chemotherapy of gastric cancer to a high point, so the NCCN guide changed perioperative chemotherapy to the preferred recommendation, and rewrote the perioperative chemotherapy regimen. The ARTIST trial in Korea showed that the addition of radiotherapy to the adjuvant chemotherapy after D2 radical resection of gastric cancer could not improve the overall survival rate, and further defined adjuvant chemotherapy as the standard treatment in D2 resection of gastric cancer. Asian scholars are actively exploring the application of perioperative chemotherapy in LAGC. For Bulky N cases, neoadjuvant chemotherapy has been recommended as the standard treatment in the Japanese guidelines. The JOCG1509,the RESOLVE and other studies will provide more effective evidence-based recommendations for the best perioperative therapy options of LAGC in Asian countries. At present, it is not clear whether perioperative chemotherapy or postoperative adjuvant chemotherapy is better. In this article, the development course of the three patterns of perioperative therapy of gastric cancer, the research progress in the perioperative period of gastric cancer in recent years, and the changes of guidelines are reviewed in order to provide reference for clinical practice.
Combined Modality Therapy ; history ; methods ; Gastrectomy ; History, 20th Century ; History, 21st Century ; Humans ; Perioperative Care ; history ; methods ; Stomach Neoplasms ; history ; pathology ; surgery ; therapy

China ; History, 21st Century ; Societies, Medical ; history ; Thoracic Surgery ; history

Chemotherapy in prostate cancer (PCa) has undergone dramatic landscape changes. While earlier studies utilized varying chemotherapy regimens which were found to be largely palliative in nature and hardly resulted in durable or meaningful responses, docetaxel resulted in the first chemotherapy agent that showed improvement in overall survival in metastatic castration-resistant prostate cancer (mCRPC). However, combination chemotherapy or any agents added to docetaxel have failed to yield incremental benefits. The improvement in overall survival as well as secondary endpoints of prostate-specific antigen (PSA) and time to recurrence when using docetaxel in the metastatic hormone-sensitive state has changed the standard of care for treatment of newly diagnosed de novo metastatic PCa. There are also promising results in locally advanced PCa and high-risk PCa in both the neoadjuvant and adjuvant settings. This review summarizes the historical as well as the more contemporary use of chemotherapeutic agents in PCa in varying states and phases of disease.
Antineoplastic Agents/therapeutic use* ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Chemotherapy, Adjuvant ; Docetaxel/therapeutic use* ; History, 20th Century ; History, 21st Century ; Humans ; Male ; Neoadjuvant Therapy ; Prostatic Neoplasms/surgery* ; Taxoids/therapeutic use*

Ophthalmic plastic and reconstructive surgery combines the precision of ophthalmic microsurgery with plastic and reconstructive surgical principles, allowing for subspecialized care of the eyelid, orbital, and lacrimal system. A foundation in ophthalmology allows the oculoplastic surgeon's knowledge and skills to safely and successfully protect the globe while achieving good functional and aesthetic results. Oculoplasty emerged following World War II, in which a high rate of ophthalmic and oculoplastic trauma occurred. Following this, more structured and specialized studies dedicated to clinical and surgical management led to the development of a highly specific and rapidly growing sub-specialty dedicated to eyelid, lacrimal, and orbital care. Stem cell treatments in oculoplasty has been spanned a wide array of subfields, ranging from reconstruction of the eyelid to the generation of artificial lacrimal glands and oncological therapeutics. Tissue engineering represents the future of regenerative and reconstructive medicine, with significant potential applications in ophthalmic plastic surgery. Difficulty remains in disease modeling for various disorders, owing to genetic and functional variation across patients as well as the complexity of several diseases. Progressive advances in the understanding of the immunopathogenesis of diseases such as thyroid eye disease and lacrimal gland carcinoma continue to spur clinical trials utilizing targeted therapies to enhance treatment outcomes. Continued investigation of the molecular mechanisms of disease will expand potential treatments. In the future, public awareness and interest in the field of oculoplasty will further grow, and personalized and optimized treatment will become a cornerstone of modern medicine.
Eye Diseases ; Eyelids ; Graves Ophthalmopathy ; History, Modern 1601- ; Humans ; Lacrimal Apparatus ; Microsurgery ; Ophthalmology ; Orbit ; Plastics ; Stem Cells ; Surgery, Plastic ; Thyroid Gland ; Tissue Engineering ; World War II

BACKGROUND: Innovation has molded the current landscape of plastic surgery. However, documentation of this process only exists scattered throughout the literature as individual articles. The few attempts made to profile innovation in plastic surgery have been narrative, and therefore qualitative and inherently biased. Through the implementation of a novel innovation metric, this work aims to identify and characterise the most prevalent innovations in plastic surgery over the last 50 years. METHODS: Patents and publications related to plastic surgery (1960 to 2010) were retrieved from patent and MEDLINE databases, respectively. The most active patent codes were identified and grouped into technology areas, which were subsequently plotted graphically against publication data. Expert-derived technologies outside of the top performing patents areas were additionally explored. RESULTS: Between 1960 and 2010, 4,651 patents and 43,118 publications related to plastic surgery were identified. The most active patent codes were grouped under reconstructive prostheses, implants, instruments, non-invasive techniques, and tissue engineering. Of these areas and other expert-derived technologies, those currently undergoing growth include surgical instruments, implants, non-invasive practices, transplantation and breast surgery. Innovations related to microvascular surgery, liposuction, tissue engineering, lasers and prostheses have all plateaued. CONCLUSIONS: The application of a novel metric for evaluating innovation quantitatively outlines the natural history of technologies fundamental to the evolution of plastic surgery. Analysis of current innovation trends provides some insight into which technology domains are the most active.
Bias (Epidemiology) ; Breast ; Diffusion of Innovation ; Fungi ; Lipectomy ; Natural History ; Plastics* ; Prostheses and Implants ; Publications ; Surgery, Plastic* ; Surgical Instruments ; Tissue Engineering

Altruism ; Canada ; China ; Communism ; General Surgery ; history ; History, 20th Century ; Humans ; Philately ; Politics ; Surgeons

France ; History, 19th Century ; History, 20th Century ; Humans ; Philately ; history ; Specialties, Surgical ; history ; Vascular Diseases ; history ; surgery ; Vascular Surgical Procedures ; history

China ; History, 20th Century ; History, 21st Century ; Reconstructive Surgical Procedures ; history ; Surgery, Plastic ; history

Severe acute pancreatitis (SAP) is hard to treat for the abrupt onset, critical condition and complicated pathophysiology. Historically, the treatment strategy of SAP hovered between surgical intervention and conservative treatment. At the turn of the 20(th) century, SAP was reported to be cured by surgical intervention in a series cases, which lead to the dominance of surgical intervention in SAP treatment. Subsequently, SAP was documented to respond to nonoperative therapy. A wave of conservatism emerged, and surgical intervention for SAP was rarely practiced for the next 3 decades. However, surgeons refined the indications and considered new approaches for surgical treatment in 1960s because of the poor outcomes of conservation, and surgical interventions was mainly performed at early stage of SAP. However, a series of prospective studies showed that conservative treatment of patients with sterile pancreatic necrosis is superior to surgical intervention, and that delayed intervention provide improved outcomes in 1990s, which changed the treatment concept of SAP again. The modern treatment concept formed during the progression: organ supportive care dominates in the early stage of the disease, and surgical intervention should be performed at late stage with proper indications. Despite the advances in treatment, the morbidity of SAP is still 5%-20%, which suggests the pancreatic surgeons' exploration in the future.
Disease Progression ; History, 20th Century ; Humans ; Pancreatectomy ; history ; Pancreatitis ; surgery