BACKGROUND Cholangiocarcinoma(CCA)comprises heterogeneous malignancies arising at different anatomical locations:Intrahepatic cholangiocarcinoma(IHCC),perihilar cholangiocarcinoma(PHCC),and distal cholangiocarcinoma(D...BACKGROUND Cholangiocarcinoma(CCA)comprises heterogeneous malignancies arising at different anatomical locations:Intrahepatic cholangiocarcinoma(IHCC),perihilar cholangiocarcinoma(PHCC),and distal cholangiocarcinoma(DCC).These subtypes exhibit distinct clinical behaviors,treatment approaches,and outcomes.Despite advances in surgical and adjuvant therapies,the prognostic implications of tumor location remain unclear and inconsistently reported.Understanding these variations is essential for personalized management and staging refinement.We hypothesized that the anatomical subtype of CCA significantly influences prognostic outcomes and pathological features.AIM To compare prognostic outcomes and clinicopathological characteristics among IHCC,PHCC,and DCC based on current evidence.METHODS A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines.PubMed,EMBASE,and the Cochrane Library were searched,yielding 11 eligible retrospective comparative studies involving 14484 patients(IHCC:6260;PHCC:6895;DCC:1329).Outcomes assessed included overall survival(OS),lymph node metastasis,neural invasion,and vascular invasion.Statistical analyses were performed using RevMan 5.3 and Stata 13.0.RESULTS DCC demonstrated the most favorable prognosis among all subtypes.Despite the highest lymph node metastasis rate(DCC:56.9%),it was associated with better OS than PHCC and IHCC.Vascular invasion was more prevalent in IHCC(OR=1.66,95%CI:1.22-2.28,P=0.001).OS comparisons showed no significant difference between PHCC and IHCC(HR=1.02,P=0.88),while DCC showed consistent trends toward better survival against both.CONCLUSION Anatomical subtype is a significant prognostic factor in CCA.DCC patients experience superior outcomes despite aggressive lymphatic spread,suggesting better resectability and surgical outcomes.These insights underscore the need for subtype-specific management strategies and future prospective validation.展开更多
BACKGROUND In pediatric age group patients(<18 years old)treated operatively for distal radius/both bone fractures extending imaging beyond the initial postoperative period-particularly in uncomplicated cases-appea...BACKGROUND In pediatric age group patients(<18 years old)treated operatively for distal radius/both bone fractures extending imaging beyond the initial postoperative period-particularly in uncomplicated cases-appears to provide limited additional benefit.AIM To determine the necessary number of follow-up X-rays to use resources efficiently.METHODS Participants included in this study are pediatric age group patients who were treated operatively for distal radius/both bone fractures and were identified from a prospected collected data from the operating room database between the years 2009 and 2017.The data in the study included patients who had distal radius fractures and underwent fixation surgery(n=88).RESULTS When assessing the difference in the odds of conducting 1 or less X-ray compared to 2 or more X-rays in regard to the type of fixation,the only significant difference is the closed reduction fixation method.Patients who underwent closed reduction method procedure have significantly lower odds of having 2 more X-rays compared to those who didn’t have closed reduction method.Open reduction,internal fixation,and other fixation methods(close reduction and internal fixation,debridement,or epiphysiodesis)have higher odds of having two or more X-rays compared to patients who did not receive these methods;however,these odds are not statistically significant.CONCLUSION The findings of this study reveal notable absence of a statistically significant association between the frequency of postoperative X-rays and the outcome of children with distal radius fractures.展开更多
Background and Objectives: The distal radius fracture (DRF) is a major public health problem in northern countries. Its frequency is constantly increasing. The locked anterior plate with its well-established biomechan...Background and Objectives: The distal radius fracture (DRF) is a major public health problem in northern countries. Its frequency is constantly increasing. The locked anterior plate with its well-established biomechanical properties, offers a reliable alternative. The aim of this study was to evaluate the radiological, the functional results and to determine the factors of poor postoperative prognosis of DRF treated with Newclip radial plates®. Methodology: This prospective cohort study evaluates the radiological and functional outcames of displaced radius fractures (DRFs) in patients ≥50 years old treated with Newclip® (locked anterior plates) at the Basse-Terre Hospital in Guadeloupe from 2022 to 2024. The patients were categorized into those with epiphyseal involvement (E1 - E4) and without epiphyseal involvement (E0) based on Laulan’s MEU classification. Radiological parameters (distal radio-ulnar index (DRUI), radial inclination frant view (IRF), radial inclination sagittal view (IRS) were assessed pre and post-operatively. Functional recovery was evaluated at 12 months using the QuickDash questionnaire. Results: Falls were the most common cause of fracture. Post-operatively, SRI was the least restored parameter. Poor prognostic factor for SRI improvement included posterior commimution and unstable fractures. Factors associated with higher QuickDash scores included unstable factures, unrestored DRUI, low plate position, metaphyseal features, and ulnar features. Conclusion: The anterior locking plate osteosynthesis is reliable treatment option with excellent functional outcomes.展开更多
BACKGROUND Clavicle fractures are a common type of fracture that often occurs after high-energy trauma.The treatment methods for clavicle fractures remain controversial.Both locking compression and hook plates are rec...BACKGROUND Clavicle fractures are a common type of fracture that often occurs after high-energy trauma.The treatment methods for clavicle fractures remain controversial.Both locking compression and hook plates are recommended.CASE SUMMARY A 44-year-old male suffered an injury during skiing.Radiography revealed a right-sided distal clavicular fracture.The fracture was treated using a hook plate due to its small size.During the surgical procedure,Kirschner wires were used to drill holes in the acromion.The end of the hook plate was inserted into the hole rather than below the edge of the acromion.CONCLUSION One year later,imaging revealed complete healing of the fracture,and the hook plate was removed.The patient was satisfied with the course and treatment results.Additionally,a new classification system was proposed based on the degree of injury to the distal clavicle joint surface.The incidence of postoperative complications associated with the use of hook plates for clavicular fracture treatment is relatively high.Complications can be reduced by changing the hook plate placement.展开更多
Objective:Medical expulsive therapy(MET)is a suitable option for facilitating stone expulsion in patients with distal ureteral stones.This meta-analysis was conducted to compare efficacy and safety of monotherapy and ...Objective:Medical expulsive therapy(MET)is a suitable option for facilitating stone expulsion in patients with distal ureteral stones.This meta-analysis was conducted to compare efficacy and safety of monotherapy and combination therapy with tamsulosin,silodosin,and tadalafil on stone expulsion rate(SER)and stone expulsion time(SET),as well as their comparative safety,numbers of colic pain episodes,and need for analgesics.Methods:Randomized controlled trials were retrieved by searching PubMed,Scopus,and Web of Science up to November 27,2023.Hand-searching was also conducted in Google Scholar to find additional records.Papers in English that compared the safety and efficacy of at least two of the above agents in adults with distal ureteral stones≤10 mm were included.Results:In total,27 studies were identified(six studies through database searches and 21 through checking reference lists and hand-searching in Google Scholar).More than half of them(n=15,56%)were conducted in India.The SER significantly improved with silodosin compared with tamsulosin(odds ratio[OR]2.24,p<0.001),whereas the difference in SET was non-significant.Tadalafil achieved a significantly higher SER compared with tamsulosin(OR 1.42,p=0.042)without any difference in SET.Subgroup analysis of 5-and 10-mg doses of tadalafil showed no significant difference in SER or SET.We found no significant difference in need for analgesics(mean difference(MD−53.73,p=0.2)or the mean number of colic episodes(MD−0.42,p=0.060)between tadalafil and tamsulosin.SER or SET was not significantly different between silodosin and tadalafil.Tadalafil plus tamsulosin led to a significantly higher SER(OR 1.87,p<0.001)and SET(MD−2.99,p=0.002)compared with tamsulosin,without any significant difference in adverse effects.Conclusion:Compared with tamsulosin,SER significantly improved with silodosin,tadalafil,and the combination of tadalafil plus tamsulosin.Meanwhile,the difference in SET was only significant between tadalafil plus tamsulosin versus tamsulosin.It appears that tadalafil and silodosin have similar efficacy in SET and SER.All medical expulsive therapies had comparable safety.展开更多
Routine postoperative radiographs after surgical fixation of pediatric distal-radius fractures have long been part of standard care.Yet growing evidence shows that these images rarely change management in stable cases...Routine postoperative radiographs after surgical fixation of pediatric distal-radius fractures have long been part of standard care.Yet growing evidence shows that these images rarely change management in stable cases,adding unnecessary cost,radiation exposure,and clinical burden.A recent study highlights this issue and questions whether routine imaging truly benefits patient outcomes.As orthopedic care shifts toward more patient-centered and value-driven models,there is increasing support for the judicious use of radiographs,reserving imaging for cases where clinical examination or patient symptoms suggest a potential problem.This shift would reflect a broader movement within orthopedic practice:Aligning tradition with necessity,and optimizing care based on evidence rather than habit.展开更多
BACKGROUND Distal small bowel resection with preservation of the terminal ileum(DBRPI)significantly improves glucose metabolism in rats.AIM To explore the underlying mechanisms of DBRPI in improving glucose metabolism...BACKGROUND Distal small bowel resection with preservation of the terminal ileum(DBRPI)significantly improves glucose metabolism in rats.AIM To explore the underlying mechanisms of DBRPI in improving glucose metabolism.METHODS Following 8 weeks of a high-fat diet,the rats were randomly divided into the DBRPI group and the sham operation group.After surgery,body weight and glucose tolerance were monitored.At 6 weeks post-surgery,the composition of intestinal microbiota,bile acid levels,and the expression of farnesoid X receptor(FXR),Takeda G protein-coupled receptor 5,and glucagon-like peptide-1(GLP-1)in the ileum were examined.Additionally,the gene expression of key enzymes involved in gluconeogenesis in the liver was evaluated.RESULTS DBRPI reduced body weight and improved glucose tolerance.At 6 weeks postsurgery,the abundance of Prevotellaceae_NK3B31_group and the level of 7-ketolithocholic acid(7-KLCA)were significantly increased,while the abundance of Desulfovibrio fairfieldensis and the level ofα-muricholic acid were significantly decreased.The expression of FXR and GLP-1 in the terminal ileum was significantly upregulated.Furthermore,the expression of key gluconeogenic enzyme genes,glucose-6-phosphatase(G6PC)and phosphoenolpyruvate carboxykinase 1(PCK1),was significantly downregulated.Correlation analysis showed that the Prevotellaceae_NK3B31_group was positively correlated with 7-KLCA and FXR,and negatively correlated with glucose tolerance,α-muricholic acid,G6PC,and PCK1.CONCLUSION DBRPI inhibits hepatic gluconeogenesis and improves glucose metabolism.The mechanism may be related to activation of the 7-KLCA-FXR signaling pathway mediated by the Prevotellaceae_NK3B31_group.展开更多
BACKGROUND Pancreatic cancer involving the pancreas neck and body often invades the retroperitoneal vessels,making its radical resection challenging.Multimodal treatment strategies,including neoadjuvant therapy,surger...BACKGROUND Pancreatic cancer involving the pancreas neck and body often invades the retroperitoneal vessels,making its radical resection challenging.Multimodal treatment strategies,including neoadjuvant therapy,surgery,and postoperative adjuvant therapy,are contributing to a paradigm shift in the treatment of pancreatic cancer.This strategy is also promising in the treatment of pancreatic neckbody cancer.AIM To evaluate the feasibility and effectiveness of a multimodal strategy for the treatment of borderline/locally advanced pancreatic neck-body cancer.METHODS From January 2019 to December 2021,we reviewed the demographic characteristics,neoadjuvant and adjuvant treatment data,intraoperative and postoperative variables,and follow-up outcomes of patients who underwent multimodal treatment for pancreatic neck-body cancer in a prospectively collected database of our hospital.This investigation was reported in line with the Preferred Reporting of Case Series in Surgery criteria.RESULTS A total of 11 patients with pancreatic neck-body cancer were included in this study,of whom 6 patients were borderline resectable and 5 were locally advanced.Through multidisciplinary team discussion,all patients received neoadjuvant therapy,of whom 8(73%)patients achieved a partial response and 3 patients maintained stable disease.After multidisciplinary team reassessment,all patients underwent laparoscopic subtotal distal pancreatectomy and portal vein reconstruction and achieved R0 resection.Postoperatively,two patients(18%)developed ascites,and two patients(18%)developed pancreatic fistulae.The median length of stay of the patients was 11 days(range:10-15 days).All patients received postoperative adjuvant therapy.During the follow-up,three patients experienced tumor recurrence,with a median disease-free survival time of 13.3 months and a median overall survival time of 20.5 months.CONCLUSION A multimodal treatment strategy combining neoadjuvant therapy,laparoscopic subtotal distal pancreatectomy,and adjuvant therapy is safe and feasible in patients with pancreatic neck-body cancer.展开更多
Reconstruction of a traumatic distal femur defect remains a therapeutic challenge.Bone defect implants have been proposed to substitute the bone defect,and their biomechanical performances can be analyzed via a numeri...Reconstruction of a traumatic distal femur defect remains a therapeutic challenge.Bone defect implants have been proposed to substitute the bone defect,and their biomechanical performances can be analyzed via a numerical approach.However,the material assumptions for past computational human femur simulations were mainly homogeneous.Thus,this study aimed to design and analyze scaffolds for reconstructing the distal femur defect using a patient-specific finite element modeling technique.A three-dimensional finite element model of the human femur with accurate geometry and material distribution was developed using the finite element method and material mapping technique.An intact femur and a distal femur defect model treated with nine microstructure scaffolds and two solid scaffolds were investigated and compared under a single-leg stance loading.The results showed that the metal solid scaffold design could provide the most stable fixation for reconstructing the distal femur defect.However,the fixation stability was affected by various microstructure designs and pillar diameters.A microstructure scaffold can be designed to satisfy all the biomechanical indexes,opening up future possibilities for more stable reconstructions.A three-dimensional finite element model of the femur with real bone geometry and bone material distribution can be developed,and this patient-specific femur model can be used for studying other femoral fractures or injuries,paving the way for more comprehensive research in the field.Besides,this patient-specific finite element modeling technique can also be applied to developing other human or animal bone models,expanding the scope of biomechanical research.展开更多
BACKGROUND The volar approach with plate fixation is the gold standard for treating distal radius fractures,often requiring incision of the pronator quadratus(PQ)muscle.Preserving the PQ during surgery may facilitate ...BACKGROUND The volar approach with plate fixation is the gold standard for treating distal radius fractures,often requiring incision of the pronator quadratus(PQ)muscle.Preserving the PQ during surgery may facilitate early postoperative recovery.However,conventional minimally invasive plate osteosynthesis(MIPO)techniques frequently necessitate multiple(3-4)intraoperative fluoroscopic adjustments to achieve optimal plate positioning,which can inadvertently damage the PQ muscle.Based on our clinical observations,we developed a novel 3-point positioning technique to minimize PQ injury while ensuring accurate plate placement.Preliminary results demonstrate promising early clinical outcomes.AIM To retrospectively analyze distal radius fractures treated using the 3-point positioning-assisted MIPO technique with preservation of the PQ.METHODS The 3-point positioning technique was applied:The Kirschner wire was inserted after fluoroscopy and was correctly adjusted the position of the plate above the PQ.With the aid of Kirschner wires positioning the PQ stripping was performed only once,and the plate then placed in a correct and satisfactory position.Operation time,incision length,wrist pain score,upper extremity function disabilities of the arm,shoulder and hand(DASH)score,wrist Gartland-Werley score,wrist grip strength,and range of motion were among the quantitative variables recorded.Qualitative variables including AO fracture classification,intraoperative and postoperative complications were evaluated.RESULTS At a mean follow-up of 6.9±0.8 months,the mean scar length was 25.4±1.5 mm,the pain score was 0.7±0.6,the DASH score for the upper limb was 4.7±1.3,and the Gartland-Werley score for wrist function was 4.1±1.1 at the last follow-up.Mean flexion was 97.3%,extension was 97.0%,pronation was 98.9%,supination was 98.9%,and grip strength was 86.6%compared to contralateral values.No unfavorable intraoperative or postoperative complications occurred.CONCLUSION The 3-point positioning technique may reduce the damage to the PQ muscle and is a safe and effective method for MIPO for distal radius fractures.展开更多
Colorectal cancer has a high incidence and mortality rate in China, with the majority of cases being middle and low rectal cancer. Surgical intervention is currently the main treatment modality for locally advanced re...Colorectal cancer has a high incidence and mortality rate in China, with the majority of cases being middle and low rectal cancer. Surgical intervention is currently the main treatment modality for locally advanced rectal cancer, with the common goal of improving oncological outcomes while preserving function. The controversy regarding the circumferential resection margin distance in rectal cancer surgery has been resolved. With the promotion of neoadjuvant therapy concepts and advancements in technology, treatment strategies have become more diverse.Following tumor downstaging, there is an increasing trend towards extending the safe distance of distal rectal margin. This provides more opportunities for patients with low rectal cancer to preserve their anal function.However, there is currently no consensus on the specific distance of distal resection margin.展开更多
Objective:To compare the efficacy of using“distal acupoints only”vs.“local acupoints mainly combined with distal acupoints”in cases of acute low back pain(ALBP).Methods: A total of 102 eligible patients aged 18–6...Objective:To compare the efficacy of using“distal acupoints only”vs.“local acupoints mainly combined with distal acupoints”in cases of acute low back pain(ALBP).Methods: A total of 102 eligible patients aged 18–65 years with ALBP lasting less than 6 weeks will be randomized in a 1:1 ratio to the distal acupoints only group(DPOG)and the local acupoints mainly combined with the distal acupoints group(LPMG).During a 4-week treatment period,patients in the DPOG will receive acupuncture at distal acupoints only(Houxi[SI 3]and Yaotongxue[EX-UE 7])twice a week,while those in the LPMG group will receive acupuncture at local acupoints(mainly Shenshu[BL 23]and Dachangshu[BL 25])combined with distal points(Weizhong[BL 40]).The patients in both groups will be evaluated at every session of treatment,and the follow-up will be performed for 3 months.The primary outcome measure will be the change in ALBP intensity,assessed using visual analogue scale scores before and after treatment.The secondary outcome measure will be the evaluation of functional disability using the Oswestry Disability Index.Discussion: This study compares the DPOG and LPMG to explore the feasibility of the DPOG in the treatment of ALBP.展开更多
BACKGROUND Elderly patients maintaining functional independence can now be candidates for primary wrist hemiarthroplasty to manage acute irreparable distal radius fractures(DRFs).However,further investigation with lon...BACKGROUND Elderly patients maintaining functional independence can now be candidates for primary wrist hemiarthroplasty to manage acute irreparable distal radius fractures(DRFs).However,further investigation with long-term follow-up is required to validate these initial findings.AIM To review the literature on the outcomes of distal radius hemiarthroplasty with available implants to assess its viability as a treatment option.METHODS A comprehensive review of the literature was conducted using electronic databases,including PubMed,Medline,and Scopus.The search terms employed were"distal radius fracture","hemiarthroplasty","wrist arthroplasty",and related terminology.The search was restricted to articles published in English from 1980 until June 2023.Inclusion criteria encompassed cases or case series of DRF treated with hemiarthroplasty,providing clinical or radiographic outcomes,and published in peer-reviewed journals.RESULTS A total of 2508 articles from PubMed and 883 from Scopus were identified initially.Following screening and removal of duplicates,13 articles met the inclusion criteria.These articles,predominantly clinical retrospective studies,provided insights into hemiarthroplasty outcomes,including functional improvements and complications.Hemiarthroplasty was a treatment option for complex DRF,particularly those cases with severe comminution,intraarticular involvement,or severe osteoporosis.Functional outcomes demonstrated improvements in pain relief,wrist mobility,and grip strength,with variability across studies.Complications included implant loosening,infection,nerve injury,and stiffness,with varying incidence rates influenced by surgical techniques and implant choice.Long-term outcomes were inadequately documented,warranting further research.CONCLUSION Hemiarthroplasty is a promising treatment for irreparable DRF in the elderly.Long-term outcomes and complications require further study.展开更多
BACKGROUND The relationship between preoperative inflammation status and tumorigenesis as well as tumor progression is widely acknowledged.AIM To assess the prognostic significance of preoperative inflammatory biomark...BACKGROUND The relationship between preoperative inflammation status and tumorigenesis as well as tumor progression is widely acknowledged.AIM To assess the prognostic significance of preoperative inflammatory biomarkers in patients with distal cholangiocarcinoma(dCCA)who underwent pancreat-oduodenectomy(PD).METHODS This single-center study included 216 patients with dCCA after PD between January 1,2011,and December 31,2022.The individuals were categorized into two sets based on their systemic inflammatory response index(SIRI)levels:A low SIRI group(SIRI<1.5,n=123)and a high SIRI group(SIRI≥1.5,n=93).Inflam-matory biomarkers were evaluated for predictive accuracy using receiver operating characteristic curves.Both univariate and multivariate Cox proportional hazards analyses were performed to estimate SIRI for overall survival(OS)and recurrence-free survival(RFS).RESULTS The study included a total of 216 patients,with 58.3%being male and a mean age of 65.6±9.6 years.123 patients were in the low SIRI group and 93 were in the high SIRI group after PD for dCCA.SIRI had an area under the curve value of 0.674 for diagnosing dCCA,showing better performance than other inflammatory biomarkers.Multivariate analysis indicated that having a SIRI greater than 1.5 independently increased the risk of dCCA following PD,leading to lower OS[hazard ratios(HR)=1.868,P=0.006]and RFS(HR=0.949,P<0.001).Additionally,survival analysis indicated a significantly better prognosis for patients in the low SIRI group(P<0.001).CONCLUSION It is determined that a high SIRI before surgery is a significant risk factor for dCCA after PD.展开更多
BACKGROUND Peroral endoscopic myotomy(POEM)has been widely performed as a standard treatment for achalasia;however,its efficacy and safety for treating distal esophageal segmental spasms induced by cancer metastasis r...BACKGROUND Peroral endoscopic myotomy(POEM)has been widely performed as a standard treatment for achalasia;however,its efficacy and safety for treating distal esophageal segmental spasms induced by cancer metastasis remain unknown.CASE SUMMARY A 72-year-old male was referred to our hospital and complained of progressive dysphagia for two years.Endoscopy revealed a 2 cm long segment esophageal stenosis with intact mucosa and normal cardia.Computed tomography showed a right upper lung mass,and pathology of the right pleural effusion confirmed the diagnosis of right upper lung adenocarcinoma with multiple rib and mediastinal lymph node metastases and right malignant pleural effusion.Individualized POEM was performed first to alleviate dysphagia,and the final diagnosis was changed to esophageal muscle metastasis arising from lung adenocarcinoma.After treatment,the patient could eat soft solid food and received multiple rounds of pembrolizumab-combination chemotherapy.The patient’s progression-free survival was approximately 16 months.Long stable disease was obtained during the 24-month follow-up.CONCLUSION The incidence of distal esophageal segmental spasms induced by muscular metastasis arising from lung adenocarcinoma is extremely low.Individualized POEM can effectively improve a patient’s nutritional status before subsequent chemotherapy can be combined with immune checkpoint inhibitors.展开更多
Background: Despite the conservative treatment of tibio-femoral osteoarthritis through realignment osteotomies, the rate of total knee replacements following an osteotomy is increasing. The aim of this study was to id...Background: Despite the conservative treatment of tibio-femoral osteoarthritis through realignment osteotomies, the rate of total knee replacements following an osteotomy is increasing. The aim of this study was to identify the factors associated with the progression of knee osteoarthritis after a medial closing-wedge distal femoral osteotomy. Methods: Hospital-based observational study on 20 patients who underwent a medial closing-wedge distal femoral osteotomy evaluating the progression of osteoarthritis using the Kellgren and Laurence classification. The Wilcoxon test was used to compare the variation in the progressive stage of the Kellgren and Laurence classification of knee osteoarthritis preoperatively and at the final follow up. Univariate analysis made it possible to determine the factors associated with progression. The final significance threshold for statistical tests was set at 5% (p Results: Overall, the mean follow-up of 46 months ± 6.6 months, with a mean age of 43 years (range: 27 - 69 years) and a female predominance (M: F = 3/7). The progression of tibiofemoral osteoarthritis following a medial closing-wedge distal femoral osteotomy is associated with valgus or varum malalignment been a moderate valgus (OR 6.2 [1.5 - 42.7] at 95% CI;p-value = 0.02), a correction of the mechanical deviation angle with a valgus alignment (OR 2.7 [0.9 - 8.3] at 95% CI), and loss of correction (OR 3.8 [1.3 - 11.6] at 95% CI;p -value) for the lateral compartment while varus alignment (OR 1.7 [0.9 - 8.3] 95% CI, p-value = 0.05) and with rupture of the lateral cortex (OR 2.8 [1.7 - 11.5] 95% CI, p-value = 0.02) were those of the medial compartment. Conclusion: Distal femur closing wedge osteotomy does not definitively interrupt the progression of valgus knee osteoarthritis. The factors associated with the progression of this pathology are modifiable. Taking them into account when performing this surgical technique could improve the osteotomy survival curve.展开更多
Introduction: Fractures of the distal end of the humerus are becoming increasingly frequent in young subjects because of the increase in road traffic accidents, and in elderly subjects because of osteoporosis related ...Introduction: Fractures of the distal end of the humerus are becoming increasingly frequent in young subjects because of the increase in road traffic accidents, and in elderly subjects because of osteoporosis related to aging populations. Materials and Methods: It was a prospective, monocentric study from January 2018 to December 2020 involving 14 patients who received and were treated surgically for distal humeral fractures and followed up. Results: We collected 14 patients, including 11 men (78.57%) and 3 women (21.43%), with a sex ratio of 3.7. The mean age was 36.41 years. The circumstances of onset were dominated by road traffic accidents, with 12 cases (85.71%). The dominant side was right-handed, with 11 cases (78.57%). Standard elbow radiography revealed 8 cases of type A fractures (57.14%), 4 cases of type B and 2 cases of type C fractures of the AO. We performed Lecestre plate osteosynthesis in 12 patients and external fixator in 2 others, using the trans-olecranial and transtricipital approaches. Elbow stiffness was the most frequent complication, with 6 cases (42.86%). After six months’ follow-up, our results were excellent and good in 78.57% of cases (MEPS). Conclusion: Surgical treatment with posterior approaches enabled us to achieve restitution of the articular surfaces, solid restraint and early mobilization of the elbow with satisfactory functional results.展开更多
Background Distal radial artery access(DRA)has emerged as an alternative to conventional transradial access(TRA)for percutaneous coronary interventions(PCI).This study aims to compare the efficacy and safety of DRA ve...Background Distal radial artery access(DRA)has emerged as an alternative to conventional transradial access(TRA)for percutaneous coronary interventions(PCI).This study aims to compare the efficacy and safety of DRA versus TRA.Methods A total of 873 participants were enrolled,divided into the DRA group(n=236)and the TRA group(n=637).The primary endpoint was the success rate of access puncture.Secondary endpoints included procedural efficiency,patient comfort,and complication rates.Baseline characteristics,procedural data,and outcomes were analyzed and compared between the two groups.Results The success rates for access puncture showed no significant statistical difference between the DRA and TRA groups.However,the DRA group required more puncture attempts.DRA showed significant advantages,including shorter hemostasis times,reduced access puncture and postprocedural pain,and lower incidences of radial artery occlusion(2.1%vs.6.1%,P=0.043)and hematoma(1.7%vs.5.2%,P=0.037).Conclusions DRA is a viable alternative to TRA for performing PCI,offering comparable success rates and procedural efficiency with improved patient comfort and reduced complications.展开更多
Background: When applied to trabecular bone X-ray images, the anisotropic properties of trabeculae located at ultra-distal radius were investigated by using the trabecular bone scores (TBS) calculated along directions...Background: When applied to trabecular bone X-ray images, the anisotropic properties of trabeculae located at ultra-distal radius were investigated by using the trabecular bone scores (TBS) calculated along directions parallel and perpendicular to the forearm. Methodology: Data from more than two hundred subjects were studied retrospectively. A DXA (GE Lunar Prodigy) scan of the forearm was performed on each subject to measure the bone mineral density (BMD) value at the location of ultra-distal radius, and an X-ray digital image of the same forearm was taken on the same day. The values of trabecular bone score along the direction perpendicular to the forearm, TBS<sub>x</sub>, and along the direction parallel to the forearm, TBS<sub>y</sub>, were calculated respectively. The statistics of TBS<sub>x</sub> and TBS<sub>y</sub> were calculated, and the anisotropy of the trabecular bone, which was defined as the ratio of TBS<sub>y</sub> to TBS<sub>x</sub> and changed with subjects’ BMD and age, was reported and analyzed. Results: The results show that the correlation coefficient between TBS<sub>x</sub> and TBS<sub>y</sub> was 0.72 (p BMD and age was reported. The results showed that decreased trabecular bone anisotropy was associated with deceased BMD and increased age in the subject group. Conclusions: This study shows that decreased trabecular bone anisotropy was associated with decreased BMD and increased age.展开更多
Background:Although transradial access(TRA)has become the main vascular access for coronary intervention,its high radial artery occlusion rate limits its application in some patients.Studies have shown that compared w...Background:Although transradial access(TRA)has become the main vascular access for coronary intervention,its high radial artery occlusion rate limits its application in some patients.Studies have shown that compared with TRA,distal transradial access(dTRA)with the snuffbox area or the Hegu acupoint area as the puncture point significantly decreases the incidence of radial artery occlusion.However,no randomized controlled study has confirmed the safety and efficacy of coronary artery intervention via dTRA in China.Methods and analyses:This single-center,prospective,randomized controlled,superiority open-label study will enroll 428 consecutive patients with coronary heart disease undergoing percutaneous coronary intervention as the study population.After preoperative evaluation,the participants will be randomly divided into a study group(dTRA)and control group(TRA)in a 1:1 ratio.The primary endpoint(radial artery occlusion at 24 hours after operation)and secondary endpoint events will be evaluated and recorded.Study registration:This study has been registered in the Chinese Clinical Trial Registry(registration number:ChiCTR2300073902).展开更多
文摘BACKGROUND Cholangiocarcinoma(CCA)comprises heterogeneous malignancies arising at different anatomical locations:Intrahepatic cholangiocarcinoma(IHCC),perihilar cholangiocarcinoma(PHCC),and distal cholangiocarcinoma(DCC).These subtypes exhibit distinct clinical behaviors,treatment approaches,and outcomes.Despite advances in surgical and adjuvant therapies,the prognostic implications of tumor location remain unclear and inconsistently reported.Understanding these variations is essential for personalized management and staging refinement.We hypothesized that the anatomical subtype of CCA significantly influences prognostic outcomes and pathological features.AIM To compare prognostic outcomes and clinicopathological characteristics among IHCC,PHCC,and DCC based on current evidence.METHODS A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines.PubMed,EMBASE,and the Cochrane Library were searched,yielding 11 eligible retrospective comparative studies involving 14484 patients(IHCC:6260;PHCC:6895;DCC:1329).Outcomes assessed included overall survival(OS),lymph node metastasis,neural invasion,and vascular invasion.Statistical analyses were performed using RevMan 5.3 and Stata 13.0.RESULTS DCC demonstrated the most favorable prognosis among all subtypes.Despite the highest lymph node metastasis rate(DCC:56.9%),it was associated with better OS than PHCC and IHCC.Vascular invasion was more prevalent in IHCC(OR=1.66,95%CI:1.22-2.28,P=0.001).OS comparisons showed no significant difference between PHCC and IHCC(HR=1.02,P=0.88),while DCC showed consistent trends toward better survival against both.CONCLUSION Anatomical subtype is a significant prognostic factor in CCA.DCC patients experience superior outcomes despite aggressive lymphatic spread,suggesting better resectability and surgical outcomes.These insights underscore the need for subtype-specific management strategies and future prospective validation.
文摘BACKGROUND In pediatric age group patients(<18 years old)treated operatively for distal radius/both bone fractures extending imaging beyond the initial postoperative period-particularly in uncomplicated cases-appears to provide limited additional benefit.AIM To determine the necessary number of follow-up X-rays to use resources efficiently.METHODS Participants included in this study are pediatric age group patients who were treated operatively for distal radius/both bone fractures and were identified from a prospected collected data from the operating room database between the years 2009 and 2017.The data in the study included patients who had distal radius fractures and underwent fixation surgery(n=88).RESULTS When assessing the difference in the odds of conducting 1 or less X-ray compared to 2 or more X-rays in regard to the type of fixation,the only significant difference is the closed reduction fixation method.Patients who underwent closed reduction method procedure have significantly lower odds of having 2 more X-rays compared to those who didn’t have closed reduction method.Open reduction,internal fixation,and other fixation methods(close reduction and internal fixation,debridement,or epiphysiodesis)have higher odds of having two or more X-rays compared to patients who did not receive these methods;however,these odds are not statistically significant.CONCLUSION The findings of this study reveal notable absence of a statistically significant association between the frequency of postoperative X-rays and the outcome of children with distal radius fractures.
文摘Background and Objectives: The distal radius fracture (DRF) is a major public health problem in northern countries. Its frequency is constantly increasing. The locked anterior plate with its well-established biomechanical properties, offers a reliable alternative. The aim of this study was to evaluate the radiological, the functional results and to determine the factors of poor postoperative prognosis of DRF treated with Newclip radial plates®. Methodology: This prospective cohort study evaluates the radiological and functional outcames of displaced radius fractures (DRFs) in patients ≥50 years old treated with Newclip® (locked anterior plates) at the Basse-Terre Hospital in Guadeloupe from 2022 to 2024. The patients were categorized into those with epiphyseal involvement (E1 - E4) and without epiphyseal involvement (E0) based on Laulan’s MEU classification. Radiological parameters (distal radio-ulnar index (DRUI), radial inclination frant view (IRF), radial inclination sagittal view (IRS) were assessed pre and post-operatively. Functional recovery was evaluated at 12 months using the QuickDash questionnaire. Results: Falls were the most common cause of fracture. Post-operatively, SRI was the least restored parameter. Poor prognostic factor for SRI improvement included posterior commimution and unstable fractures. Factors associated with higher QuickDash scores included unstable factures, unrestored DRUI, low plate position, metaphyseal features, and ulnar features. Conclusion: The anterior locking plate osteosynthesis is reliable treatment option with excellent functional outcomes.
文摘BACKGROUND Clavicle fractures are a common type of fracture that often occurs after high-energy trauma.The treatment methods for clavicle fractures remain controversial.Both locking compression and hook plates are recommended.CASE SUMMARY A 44-year-old male suffered an injury during skiing.Radiography revealed a right-sided distal clavicular fracture.The fracture was treated using a hook plate due to its small size.During the surgical procedure,Kirschner wires were used to drill holes in the acromion.The end of the hook plate was inserted into the hole rather than below the edge of the acromion.CONCLUSION One year later,imaging revealed complete healing of the fracture,and the hook plate was removed.The patient was satisfied with the course and treatment results.Additionally,a new classification system was proposed based on the degree of injury to the distal clavicle joint surface.The incidence of postoperative complications associated with the use of hook plates for clavicular fracture treatment is relatively high.Complications can be reduced by changing the hook plate placement.
文摘Objective:Medical expulsive therapy(MET)is a suitable option for facilitating stone expulsion in patients with distal ureteral stones.This meta-analysis was conducted to compare efficacy and safety of monotherapy and combination therapy with tamsulosin,silodosin,and tadalafil on stone expulsion rate(SER)and stone expulsion time(SET),as well as their comparative safety,numbers of colic pain episodes,and need for analgesics.Methods:Randomized controlled trials were retrieved by searching PubMed,Scopus,and Web of Science up to November 27,2023.Hand-searching was also conducted in Google Scholar to find additional records.Papers in English that compared the safety and efficacy of at least two of the above agents in adults with distal ureteral stones≤10 mm were included.Results:In total,27 studies were identified(six studies through database searches and 21 through checking reference lists and hand-searching in Google Scholar).More than half of them(n=15,56%)were conducted in India.The SER significantly improved with silodosin compared with tamsulosin(odds ratio[OR]2.24,p<0.001),whereas the difference in SET was non-significant.Tadalafil achieved a significantly higher SER compared with tamsulosin(OR 1.42,p=0.042)without any difference in SET.Subgroup analysis of 5-and 10-mg doses of tadalafil showed no significant difference in SER or SET.We found no significant difference in need for analgesics(mean difference(MD−53.73,p=0.2)or the mean number of colic episodes(MD−0.42,p=0.060)between tadalafil and tamsulosin.SER or SET was not significantly different between silodosin and tadalafil.Tadalafil plus tamsulosin led to a significantly higher SER(OR 1.87,p<0.001)and SET(MD−2.99,p=0.002)compared with tamsulosin,without any significant difference in adverse effects.Conclusion:Compared with tamsulosin,SER significantly improved with silodosin,tadalafil,and the combination of tadalafil plus tamsulosin.Meanwhile,the difference in SET was only significant between tadalafil plus tamsulosin versus tamsulosin.It appears that tadalafil and silodosin have similar efficacy in SET and SER.All medical expulsive therapies had comparable safety.
文摘Routine postoperative radiographs after surgical fixation of pediatric distal-radius fractures have long been part of standard care.Yet growing evidence shows that these images rarely change management in stable cases,adding unnecessary cost,radiation exposure,and clinical burden.A recent study highlights this issue and questions whether routine imaging truly benefits patient outcomes.As orthopedic care shifts toward more patient-centered and value-driven models,there is increasing support for the judicious use of radiographs,reserving imaging for cases where clinical examination or patient symptoms suggest a potential problem.This shift would reflect a broader movement within orthopedic practice:Aligning tradition with necessity,and optimizing care based on evidence rather than habit.
基金Supported by National Natural Science Foundation of China,No.82360168 and No.81960154Natural Science Foundation of Jiangxi Province,No.20212BAB206020the Foundation of Health Commission of Jiangxi Province,No.202310024.
文摘BACKGROUND Distal small bowel resection with preservation of the terminal ileum(DBRPI)significantly improves glucose metabolism in rats.AIM To explore the underlying mechanisms of DBRPI in improving glucose metabolism.METHODS Following 8 weeks of a high-fat diet,the rats were randomly divided into the DBRPI group and the sham operation group.After surgery,body weight and glucose tolerance were monitored.At 6 weeks post-surgery,the composition of intestinal microbiota,bile acid levels,and the expression of farnesoid X receptor(FXR),Takeda G protein-coupled receptor 5,and glucagon-like peptide-1(GLP-1)in the ileum were examined.Additionally,the gene expression of key enzymes involved in gluconeogenesis in the liver was evaluated.RESULTS DBRPI reduced body weight and improved glucose tolerance.At 6 weeks postsurgery,the abundance of Prevotellaceae_NK3B31_group and the level of 7-ketolithocholic acid(7-KLCA)were significantly increased,while the abundance of Desulfovibrio fairfieldensis and the level ofα-muricholic acid were significantly decreased.The expression of FXR and GLP-1 in the terminal ileum was significantly upregulated.Furthermore,the expression of key gluconeogenic enzyme genes,glucose-6-phosphatase(G6PC)and phosphoenolpyruvate carboxykinase 1(PCK1),was significantly downregulated.Correlation analysis showed that the Prevotellaceae_NK3B31_group was positively correlated with 7-KLCA and FXR,and negatively correlated with glucose tolerance,α-muricholic acid,G6PC,and PCK1.CONCLUSION DBRPI inhibits hepatic gluconeogenesis and improves glucose metabolism.The mechanism may be related to activation of the 7-KLCA-FXR signaling pathway mediated by the Prevotellaceae_NK3B31_group.
基金Supported by the Hunan Province Clinical Medical Technology Innovation Guidance Project,No.2020SK50912Annual Scientific Research Plan Project of Hunan Provincial Health Commission,No.C2019057Hunan Provincial Natural Science Foundation of China,No.2023JJ40381.
文摘BACKGROUND Pancreatic cancer involving the pancreas neck and body often invades the retroperitoneal vessels,making its radical resection challenging.Multimodal treatment strategies,including neoadjuvant therapy,surgery,and postoperative adjuvant therapy,are contributing to a paradigm shift in the treatment of pancreatic cancer.This strategy is also promising in the treatment of pancreatic neckbody cancer.AIM To evaluate the feasibility and effectiveness of a multimodal strategy for the treatment of borderline/locally advanced pancreatic neck-body cancer.METHODS From January 2019 to December 2021,we reviewed the demographic characteristics,neoadjuvant and adjuvant treatment data,intraoperative and postoperative variables,and follow-up outcomes of patients who underwent multimodal treatment for pancreatic neck-body cancer in a prospectively collected database of our hospital.This investigation was reported in line with the Preferred Reporting of Case Series in Surgery criteria.RESULTS A total of 11 patients with pancreatic neck-body cancer were included in this study,of whom 6 patients were borderline resectable and 5 were locally advanced.Through multidisciplinary team discussion,all patients received neoadjuvant therapy,of whom 8(73%)patients achieved a partial response and 3 patients maintained stable disease.After multidisciplinary team reassessment,all patients underwent laparoscopic subtotal distal pancreatectomy and portal vein reconstruction and achieved R0 resection.Postoperatively,two patients(18%)developed ascites,and two patients(18%)developed pancreatic fistulae.The median length of stay of the patients was 11 days(range:10-15 days).All patients received postoperative adjuvant therapy.During the follow-up,three patients experienced tumor recurrence,with a median disease-free survival time of 13.3 months and a median overall survival time of 20.5 months.CONCLUSION A multimodal treatment strategy combining neoadjuvant therapy,laparoscopic subtotal distal pancreatectomy,and adjuvant therapy is safe and feasible in patients with pancreatic neck-body cancer.
基金funded by the TaipeiMedical University-National Taiwan University of Science and Technology joint research program under Grant No.TMU-NTUST-109-09.
文摘Reconstruction of a traumatic distal femur defect remains a therapeutic challenge.Bone defect implants have been proposed to substitute the bone defect,and their biomechanical performances can be analyzed via a numerical approach.However,the material assumptions for past computational human femur simulations were mainly homogeneous.Thus,this study aimed to design and analyze scaffolds for reconstructing the distal femur defect using a patient-specific finite element modeling technique.A three-dimensional finite element model of the human femur with accurate geometry and material distribution was developed using the finite element method and material mapping technique.An intact femur and a distal femur defect model treated with nine microstructure scaffolds and two solid scaffolds were investigated and compared under a single-leg stance loading.The results showed that the metal solid scaffold design could provide the most stable fixation for reconstructing the distal femur defect.However,the fixation stability was affected by various microstructure designs and pillar diameters.A microstructure scaffold can be designed to satisfy all the biomechanical indexes,opening up future possibilities for more stable reconstructions.A three-dimensional finite element model of the femur with real bone geometry and bone material distribution can be developed,and this patient-specific femur model can be used for studying other femoral fractures or injuries,paving the way for more comprehensive research in the field.Besides,this patient-specific finite element modeling technique can also be applied to developing other human or animal bone models,expanding the scope of biomechanical research.
基金Supported by Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma,No.2020Y2014Fuzhou Health Technology Innovation Platform Construction Project,No.2019-S-wp2.
文摘BACKGROUND The volar approach with plate fixation is the gold standard for treating distal radius fractures,often requiring incision of the pronator quadratus(PQ)muscle.Preserving the PQ during surgery may facilitate early postoperative recovery.However,conventional minimally invasive plate osteosynthesis(MIPO)techniques frequently necessitate multiple(3-4)intraoperative fluoroscopic adjustments to achieve optimal plate positioning,which can inadvertently damage the PQ muscle.Based on our clinical observations,we developed a novel 3-point positioning technique to minimize PQ injury while ensuring accurate plate placement.Preliminary results demonstrate promising early clinical outcomes.AIM To retrospectively analyze distal radius fractures treated using the 3-point positioning-assisted MIPO technique with preservation of the PQ.METHODS The 3-point positioning technique was applied:The Kirschner wire was inserted after fluoroscopy and was correctly adjusted the position of the plate above the PQ.With the aid of Kirschner wires positioning the PQ stripping was performed only once,and the plate then placed in a correct and satisfactory position.Operation time,incision length,wrist pain score,upper extremity function disabilities of the arm,shoulder and hand(DASH)score,wrist Gartland-Werley score,wrist grip strength,and range of motion were among the quantitative variables recorded.Qualitative variables including AO fracture classification,intraoperative and postoperative complications were evaluated.RESULTS At a mean follow-up of 6.9±0.8 months,the mean scar length was 25.4±1.5 mm,the pain score was 0.7±0.6,the DASH score for the upper limb was 4.7±1.3,and the Gartland-Werley score for wrist function was 4.1±1.1 at the last follow-up.Mean flexion was 97.3%,extension was 97.0%,pronation was 98.9%,supination was 98.9%,and grip strength was 86.6%compared to contralateral values.No unfavorable intraoperative or postoperative complications occurred.CONCLUSION The 3-point positioning technique may reduce the damage to the PQ muscle and is a safe and effective method for MIPO for distal radius fractures.
基金supported by “San Ming” Project of Shenzhen, China (No. SZSM201612051)National Natural Science Foundation of China (No. 81972240)。
文摘Colorectal cancer has a high incidence and mortality rate in China, with the majority of cases being middle and low rectal cancer. Surgical intervention is currently the main treatment modality for locally advanced rectal cancer, with the common goal of improving oncological outcomes while preserving function. The controversy regarding the circumferential resection margin distance in rectal cancer surgery has been resolved. With the promotion of neoadjuvant therapy concepts and advancements in technology, treatment strategies have become more diverse.Following tumor downstaging, there is an increasing trend towards extending the safe distance of distal rectal margin. This provides more opportunities for patients with low rectal cancer to preserve their anal function.However, there is currently no consensus on the specific distance of distal resection margin.
基金funded by Chinese Medicine Research Practical Training Program of Hong Kong Hospital Authority Chinese Medicine Department(Hong Kong,China),fourth batch.
文摘Objective:To compare the efficacy of using“distal acupoints only”vs.“local acupoints mainly combined with distal acupoints”in cases of acute low back pain(ALBP).Methods: A total of 102 eligible patients aged 18–65 years with ALBP lasting less than 6 weeks will be randomized in a 1:1 ratio to the distal acupoints only group(DPOG)and the local acupoints mainly combined with the distal acupoints group(LPMG).During a 4-week treatment period,patients in the DPOG will receive acupuncture at distal acupoints only(Houxi[SI 3]and Yaotongxue[EX-UE 7])twice a week,while those in the LPMG group will receive acupuncture at local acupoints(mainly Shenshu[BL 23]and Dachangshu[BL 25])combined with distal points(Weizhong[BL 40]).The patients in both groups will be evaluated at every session of treatment,and the follow-up will be performed for 3 months.The primary outcome measure will be the change in ALBP intensity,assessed using visual analogue scale scores before and after treatment.The secondary outcome measure will be the evaluation of functional disability using the Oswestry Disability Index.Discussion: This study compares the DPOG and LPMG to explore the feasibility of the DPOG in the treatment of ALBP.
文摘BACKGROUND Elderly patients maintaining functional independence can now be candidates for primary wrist hemiarthroplasty to manage acute irreparable distal radius fractures(DRFs).However,further investigation with long-term follow-up is required to validate these initial findings.AIM To review the literature on the outcomes of distal radius hemiarthroplasty with available implants to assess its viability as a treatment option.METHODS A comprehensive review of the literature was conducted using electronic databases,including PubMed,Medline,and Scopus.The search terms employed were"distal radius fracture","hemiarthroplasty","wrist arthroplasty",and related terminology.The search was restricted to articles published in English from 1980 until June 2023.Inclusion criteria encompassed cases or case series of DRF treated with hemiarthroplasty,providing clinical or radiographic outcomes,and published in peer-reviewed journals.RESULTS A total of 2508 articles from PubMed and 883 from Scopus were identified initially.Following screening and removal of duplicates,13 articles met the inclusion criteria.These articles,predominantly clinical retrospective studies,provided insights into hemiarthroplasty outcomes,including functional improvements and complications.Hemiarthroplasty was a treatment option for complex DRF,particularly those cases with severe comminution,intraarticular involvement,or severe osteoporosis.Functional outcomes demonstrated improvements in pain relief,wrist mobility,and grip strength,with variability across studies.Complications included implant loosening,infection,nerve injury,and stiffness,with varying incidence rates influenced by surgical techniques and implant choice.Long-term outcomes were inadequately documented,warranting further research.CONCLUSION Hemiarthroplasty is a promising treatment for irreparable DRF in the elderly.Long-term outcomes and complications require further study.
文摘BACKGROUND The relationship between preoperative inflammation status and tumorigenesis as well as tumor progression is widely acknowledged.AIM To assess the prognostic significance of preoperative inflammatory biomarkers in patients with distal cholangiocarcinoma(dCCA)who underwent pancreat-oduodenectomy(PD).METHODS This single-center study included 216 patients with dCCA after PD between January 1,2011,and December 31,2022.The individuals were categorized into two sets based on their systemic inflammatory response index(SIRI)levels:A low SIRI group(SIRI<1.5,n=123)and a high SIRI group(SIRI≥1.5,n=93).Inflam-matory biomarkers were evaluated for predictive accuracy using receiver operating characteristic curves.Both univariate and multivariate Cox proportional hazards analyses were performed to estimate SIRI for overall survival(OS)and recurrence-free survival(RFS).RESULTS The study included a total of 216 patients,with 58.3%being male and a mean age of 65.6±9.6 years.123 patients were in the low SIRI group and 93 were in the high SIRI group after PD for dCCA.SIRI had an area under the curve value of 0.674 for diagnosing dCCA,showing better performance than other inflammatory biomarkers.Multivariate analysis indicated that having a SIRI greater than 1.5 independently increased the risk of dCCA following PD,leading to lower OS[hazard ratios(HR)=1.868,P=0.006]and RFS(HR=0.949,P<0.001).Additionally,survival analysis indicated a significantly better prognosis for patients in the low SIRI group(P<0.001).CONCLUSION It is determined that a high SIRI before surgery is a significant risk factor for dCCA after PD.
基金Supported by The Young and Middle-aged Mainstay Talent Training Program of Fujian Provincial Health System,China,No.2017-ZQN-16The Science and Technology Project of Fujian Province,China,No.2020Y0068The Joint Funds for the Innovation of Science and Technology of Fujian Province,China,No.2023Y9414.
文摘BACKGROUND Peroral endoscopic myotomy(POEM)has been widely performed as a standard treatment for achalasia;however,its efficacy and safety for treating distal esophageal segmental spasms induced by cancer metastasis remain unknown.CASE SUMMARY A 72-year-old male was referred to our hospital and complained of progressive dysphagia for two years.Endoscopy revealed a 2 cm long segment esophageal stenosis with intact mucosa and normal cardia.Computed tomography showed a right upper lung mass,and pathology of the right pleural effusion confirmed the diagnosis of right upper lung adenocarcinoma with multiple rib and mediastinal lymph node metastases and right malignant pleural effusion.Individualized POEM was performed first to alleviate dysphagia,and the final diagnosis was changed to esophageal muscle metastasis arising from lung adenocarcinoma.After treatment,the patient could eat soft solid food and received multiple rounds of pembrolizumab-combination chemotherapy.The patient’s progression-free survival was approximately 16 months.Long stable disease was obtained during the 24-month follow-up.CONCLUSION The incidence of distal esophageal segmental spasms induced by muscular metastasis arising from lung adenocarcinoma is extremely low.Individualized POEM can effectively improve a patient’s nutritional status before subsequent chemotherapy can be combined with immune checkpoint inhibitors.
文摘Background: Despite the conservative treatment of tibio-femoral osteoarthritis through realignment osteotomies, the rate of total knee replacements following an osteotomy is increasing. The aim of this study was to identify the factors associated with the progression of knee osteoarthritis after a medial closing-wedge distal femoral osteotomy. Methods: Hospital-based observational study on 20 patients who underwent a medial closing-wedge distal femoral osteotomy evaluating the progression of osteoarthritis using the Kellgren and Laurence classification. The Wilcoxon test was used to compare the variation in the progressive stage of the Kellgren and Laurence classification of knee osteoarthritis preoperatively and at the final follow up. Univariate analysis made it possible to determine the factors associated with progression. The final significance threshold for statistical tests was set at 5% (p Results: Overall, the mean follow-up of 46 months ± 6.6 months, with a mean age of 43 years (range: 27 - 69 years) and a female predominance (M: F = 3/7). The progression of tibiofemoral osteoarthritis following a medial closing-wedge distal femoral osteotomy is associated with valgus or varum malalignment been a moderate valgus (OR 6.2 [1.5 - 42.7] at 95% CI;p-value = 0.02), a correction of the mechanical deviation angle with a valgus alignment (OR 2.7 [0.9 - 8.3] at 95% CI), and loss of correction (OR 3.8 [1.3 - 11.6] at 95% CI;p -value) for the lateral compartment while varus alignment (OR 1.7 [0.9 - 8.3] 95% CI, p-value = 0.05) and with rupture of the lateral cortex (OR 2.8 [1.7 - 11.5] 95% CI, p-value = 0.02) were those of the medial compartment. Conclusion: Distal femur closing wedge osteotomy does not definitively interrupt the progression of valgus knee osteoarthritis. The factors associated with the progression of this pathology are modifiable. Taking them into account when performing this surgical technique could improve the osteotomy survival curve.
文摘Introduction: Fractures of the distal end of the humerus are becoming increasingly frequent in young subjects because of the increase in road traffic accidents, and in elderly subjects because of osteoporosis related to aging populations. Materials and Methods: It was a prospective, monocentric study from January 2018 to December 2020 involving 14 patients who received and were treated surgically for distal humeral fractures and followed up. Results: We collected 14 patients, including 11 men (78.57%) and 3 women (21.43%), with a sex ratio of 3.7. The mean age was 36.41 years. The circumstances of onset were dominated by road traffic accidents, with 12 cases (85.71%). The dominant side was right-handed, with 11 cases (78.57%). Standard elbow radiography revealed 8 cases of type A fractures (57.14%), 4 cases of type B and 2 cases of type C fractures of the AO. We performed Lecestre plate osteosynthesis in 12 patients and external fixator in 2 others, using the trans-olecranial and transtricipital approaches. Elbow stiffness was the most frequent complication, with 6 cases (42.86%). After six months’ follow-up, our results were excellent and good in 78.57% of cases (MEPS). Conclusion: Surgical treatment with posterior approaches enabled us to achieve restitution of the articular surfaces, solid restraint and early mobilization of the elbow with satisfactory functional results.
基金supported by the Wuzhou Science and Technology Project(No.202102094)。
文摘Background Distal radial artery access(DRA)has emerged as an alternative to conventional transradial access(TRA)for percutaneous coronary interventions(PCI).This study aims to compare the efficacy and safety of DRA versus TRA.Methods A total of 873 participants were enrolled,divided into the DRA group(n=236)and the TRA group(n=637).The primary endpoint was the success rate of access puncture.Secondary endpoints included procedural efficiency,patient comfort,and complication rates.Baseline characteristics,procedural data,and outcomes were analyzed and compared between the two groups.Results The success rates for access puncture showed no significant statistical difference between the DRA and TRA groups.However,the DRA group required more puncture attempts.DRA showed significant advantages,including shorter hemostasis times,reduced access puncture and postprocedural pain,and lower incidences of radial artery occlusion(2.1%vs.6.1%,P=0.043)and hematoma(1.7%vs.5.2%,P=0.037).Conclusions DRA is a viable alternative to TRA for performing PCI,offering comparable success rates and procedural efficiency with improved patient comfort and reduced complications.
文摘Background: When applied to trabecular bone X-ray images, the anisotropic properties of trabeculae located at ultra-distal radius were investigated by using the trabecular bone scores (TBS) calculated along directions parallel and perpendicular to the forearm. Methodology: Data from more than two hundred subjects were studied retrospectively. A DXA (GE Lunar Prodigy) scan of the forearm was performed on each subject to measure the bone mineral density (BMD) value at the location of ultra-distal radius, and an X-ray digital image of the same forearm was taken on the same day. The values of trabecular bone score along the direction perpendicular to the forearm, TBS<sub>x</sub>, and along the direction parallel to the forearm, TBS<sub>y</sub>, were calculated respectively. The statistics of TBS<sub>x</sub> and TBS<sub>y</sub> were calculated, and the anisotropy of the trabecular bone, which was defined as the ratio of TBS<sub>y</sub> to TBS<sub>x</sub> and changed with subjects’ BMD and age, was reported and analyzed. Results: The results show that the correlation coefficient between TBS<sub>x</sub> and TBS<sub>y</sub> was 0.72 (p BMD and age was reported. The results showed that decreased trabecular bone anisotropy was associated with deceased BMD and increased age in the subject group. Conclusions: This study shows that decreased trabecular bone anisotropy was associated with decreased BMD and increased age.
基金funded by the CAMS Innovation Fund for Medical Sciences(CIFMS,No.2022-I2M-C&T-B-048).
文摘Background:Although transradial access(TRA)has become the main vascular access for coronary intervention,its high radial artery occlusion rate limits its application in some patients.Studies have shown that compared with TRA,distal transradial access(dTRA)with the snuffbox area or the Hegu acupoint area as the puncture point significantly decreases the incidence of radial artery occlusion.However,no randomized controlled study has confirmed the safety and efficacy of coronary artery intervention via dTRA in China.Methods and analyses:This single-center,prospective,randomized controlled,superiority open-label study will enroll 428 consecutive patients with coronary heart disease undergoing percutaneous coronary intervention as the study population.After preoperative evaluation,the participants will be randomly divided into a study group(dTRA)and control group(TRA)in a 1:1 ratio.The primary endpoint(radial artery occlusion at 24 hours after operation)and secondary endpoint events will be evaluated and recorded.Study registration:This study has been registered in the Chinese Clinical Trial Registry(registration number:ChiCTR2300073902).
