BACKGROUND Laparoscopic distal pancreatectomy(LDP)has emerged as the preferred approach for both benign and malignant lesions located in the pancreatic body and tail.Nevertheless,a notable deficiency persists in the a...BACKGROUND Laparoscopic distal pancreatectomy(LDP)has emerged as the preferred approach for both benign and malignant lesions located in the pancreatic body and tail.Nevertheless,a notable deficiency persists in the absence of a standardized,procedure-specific metric for evaluating and comparing surgical quality.A composite measure termed“textbook outcome(TO)”,which encompasses key short-term endpoints,has been validated in laparoscopic pancreatoduodenectomy but has not yet been established in dedicated LDP cohorts.The definition and prediction of TO in this context could aid in facilitating cross-institutional benchmarking and fostering advancements in quality improvement.AIM To establish procedure-specific criteria for TO and identify independent predictors of TO failure in patients undergoing LDP.METHODS Consecutive patients who underwent LDP at a single high-volume pancreatic center between January 2015 and August 2022 were retrospectively analyzed.TO was defined as the absence of clinically relevant postoperative pancreatic fistula(grade B/C),post-pancreatectomy hemorrhage(grade B/C),severe complications(Clavien-Dindo≥III),readmission within 30 days,and in-hospital or 30-day mortality.Multivariable logistic regression was employed to identify independent predictors of TO failure,and a nomogram was constructed and internally validated.RESULTS Among 405 eligible patients,286(70.6%)attained TO.Multivariable analysis revealed that female sex[odds ratio(OR)=0.62,95%confidence interval(CI):0.39-0.99]conferred a protective effect,while preoperative endoscopic ultrasound-guided fine-needle aspiration(OR=2.66,95%CI:1.05-6.73),pancreatic portal hypertension(OR=2.81,95%CI:1.06-7.45),and cystic-solid(OR=2.51,95%CI:1.34-4.69)or solid lesions(OR=1.91,95%CI:1.06-3.44)were independently associated with TO failure(all P<0.05).The derived nomogram exhibited modest discrimination and calibration when assessed in both the training and validation datasets.CONCLUSION The proposed LDP-specific definition of TO is feasible and discriminative,and the developed nomogram provides an objective tool for individualized risk assessment.展开更多
Robotic distal pancreatectomy(RDP)is being increasingly used in centres with access to the robot and offers technological improvements over conventional laparoscopy.Some studies have also shown superior outcomes compa...Robotic distal pancreatectomy(RDP)is being increasingly used in centres with access to the robot and offers technological improvements over conventional laparoscopy.Some studies have also shown superior outcomes compared with laparoscopic and open approaches.However,robotic technology is not widely available currently.This review aims to compare RDP with open and laparoscopic distal pancreatectomy,covering the basics of the RDP technique and highlighting the current nuances of the evidence pertaining to RDP with respect to clinical effectiveness and cost‒benefit analysis.展开更多
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
Tumors grow in chronically stressed microenvironments characterized by hypoxia,acidosis,nutrient limitation,immune surveillance,and therapy-induced stress.To survive and expand in such adversity,cancer cells have evol...Tumors grow in chronically stressed microenvironments characterized by hypoxia,acidosis,nutrient limitation,immune surveillance,and therapy-induced stress.To survive and expand in such adversity,cancer cells have evolved diverse adaptations and often activate stress-response pathways that can accelerate disease progression.1 Glucose is the principal carbon and energy source supporting biosynthesis and proliferation.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
Spleen-preserving distal pancreatectomy(SPDP)has gained increasing attention as a safe and effective alternative to distal pancreatectomy with splenectomy,particularly for benign and low-grade malignant lesions of the...Spleen-preserving distal pancreatectomy(SPDP)has gained increasing attention as a safe and effective alternative to distal pancreatectomy with splenectomy,particularly for benign and low-grade malignant lesions of the pancreatic body and tail.This narrative review evaluates the current evidence,technical considerations,and disease-specific indications for SPDP.Literature was reviewed using up to date scientific evidence and most recent national and international guidelines.Studies addressing SPDP outcomes,splenectomy complications,and disease-specific oncologic principles were included.Spleen preservation has been associated with reduced rates of postoperative infections,thromboembolic events,and longterm immunologic compromise,without compromising oncologic outcomes in selected patients.Indications favoring SPDP include pancreatic neuroendocrine tumors,intraductal papillary mucinous neoplasms,and solid pseudopapillary neoplasms.Although current guidelines generally recommend splenectomy for pancreatic ductal adenocarcinoma,emerging data suggest that spleen preservation may be feasible in highly selected cases.Technical approaches—primarily the Kimura and Warshaw techniques—enable safe dissection and splenic vessel management,particularly with the support of minimally invasive platforms.In conclusion,SPDP should be considered in appropriately selected patients to reduce morbidity while preserving long-term immune function.Future randomized studies are warranted to define oncologic safety and refine indications across tumor types.展开更多
BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is increasingly recognized for its role in the pathogenesis of various cancers.However,its impact on gastric cancer(GC)outcomes,particularly in patients undergoing la...BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is increasingly recognized for its role in the pathogenesis of various cancers.However,its impact on gastric cancer(GC)outcomes,particularly in patients undergoing laparoscopic distal gastrectomy(LDG),remains unclear.AIM To investigate the clinical and prognostic impacts of NAFLD on GC patients undergoing LDG.METHODS In this retrospective cohort study,we collected clinical data from 1122 GC patients who underwent LDG at the Gastric Cancer Center of the First Affiliated Hospital of Nanjing Medical University between January 2020 and December 2022.Propensity score-matching(PSM)was used to mitigate the bias to compare the oncological and surgical outcomes between the two groups.Survival analysis was also performed to evaluate NAFLD as a prognostic factor.RESULTS PSM yielded a balanced cohort of 260 patients(52 with NAFLD and 208 controls)from the original cohort.No differences in clinicopathological characteristics,including surgery time,complications,T stage,N stage,p-tumornode-metastasis stage,neural invasion,vascular invasion,total number of retrieved lymph nodes,positive retrieved lymph nodes and positive lymph nodes rate,were observed between the two groups.Overall survival was comparable between two groups(Log-rank P=0.49),whereas progression-free survival(PFS)in the NAFLD group was inferior to that in the control group(Log-rank P=0.016).Univariable Cox regression analysis further confirmed that NAFLD was an unfavorable prognostic factor for PFS.CONCLUSION GC patients with NAFLD exhibited inferior PFS,suggesting that addressing NAFLD-related metabolic alterations may enhance clinical outcomes.Future investigations should explore the mechanistic links between NAFLD and GC progression and consider integrated therapeutic strategies.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
BACKGROUND Accurate surgical fixation of intra-articular distal humerus fractures require olecranon osteotomy.Repair of osteotomy is achieved with a variety of techniques but no consensus has been achieved regarding t...BACKGROUND Accurate surgical fixation of intra-articular distal humerus fractures require olecranon osteotomy.Repair of osteotomy is achieved with a variety of techniques but no consensus has been achieved regarding the optimum technique for fixing the olecranon osteotomy.In this retrospective study,we compared the functional and radiological outcome of the two commonly used techniques of fixing olecranon osteotomy after fixing distal humerus intra-articular fractures.We hypothesized that olecranon osteotomy fixed with 6.5 mm cancellous intramedullary screw alone yielded better radiological and functional outcome than fixation with cerclage wire over cancellous screw applied in figure of eight as tension band wiring(TBW).AIM To determine the radiological and functional outcome of olecranon osteotomy fixation with cancellous screw alone vs cancellous screw combined with cerclage wiring applied as TBW.METHODS This retrospective study was conducted in Lady Reading Hospital Peshawar Pakistan.Intra-articular distal humerus fractures fulfilling the inclusion criteria and operated during 2023 to 2025 were included.Olecranon osteotomy fixation with 6.5 mm cancellous screw alone was labelled as group A while cerclage wire over cancellous screw in figure of eight as TBW were labelled as group B.The demographics,radiological and functional outcome in both groups were compared at one year using Mayo Elbow Performance Score and Quick Disabilities of the Arm,Shoulder,and Hand Score.RESULTS We included 32 patients in this study.The mean age of group A patients was 34±5.5 years while group B had a mean age of 34±6.2 years.Radiological union of olecranon osteotomy was achieved in all cases in both groups.Functional outcome however was significantly better in group A than in group B(P<0.05).The Mayo Elbow Performance Score was excellent in 14(87.5%)and good in 2(12.5%)patients in group A while 7(43.47%)patients had excellent outcome,5(31.25%)good and 4(25%)had fair outcome in group B.The mean Quick Disabilities of the Arm,Shoulder,and Hand Score was 24.5±2.1 and 78.1±12.1 in group A and B respectively(P<0.05).CONCLUSION Similar radiological union was achieved in all patients of olecranon osteotomy treated with intramedullary screw alone and intramedullary screw with TBW.Functional outcome however was significantly better in intramedullary screw alone than in intramedullary screw with TBW.展开更多
文摘BACKGROUND Laparoscopic distal pancreatectomy(LDP)has emerged as the preferred approach for both benign and malignant lesions located in the pancreatic body and tail.Nevertheless,a notable deficiency persists in the absence of a standardized,procedure-specific metric for evaluating and comparing surgical quality.A composite measure termed“textbook outcome(TO)”,which encompasses key short-term endpoints,has been validated in laparoscopic pancreatoduodenectomy but has not yet been established in dedicated LDP cohorts.The definition and prediction of TO in this context could aid in facilitating cross-institutional benchmarking and fostering advancements in quality improvement.AIM To establish procedure-specific criteria for TO and identify independent predictors of TO failure in patients undergoing LDP.METHODS Consecutive patients who underwent LDP at a single high-volume pancreatic center between January 2015 and August 2022 were retrospectively analyzed.TO was defined as the absence of clinically relevant postoperative pancreatic fistula(grade B/C),post-pancreatectomy hemorrhage(grade B/C),severe complications(Clavien-Dindo≥III),readmission within 30 days,and in-hospital or 30-day mortality.Multivariable logistic regression was employed to identify independent predictors of TO failure,and a nomogram was constructed and internally validated.RESULTS Among 405 eligible patients,286(70.6%)attained TO.Multivariable analysis revealed that female sex[odds ratio(OR)=0.62,95%confidence interval(CI):0.39-0.99]conferred a protective effect,while preoperative endoscopic ultrasound-guided fine-needle aspiration(OR=2.66,95%CI:1.05-6.73),pancreatic portal hypertension(OR=2.81,95%CI:1.06-7.45),and cystic-solid(OR=2.51,95%CI:1.34-4.69)or solid lesions(OR=1.91,95%CI:1.06-3.44)were independently associated with TO failure(all P<0.05).The derived nomogram exhibited modest discrimination and calibration when assessed in both the training and validation datasets.CONCLUSION The proposed LDP-specific definition of TO is feasible and discriminative,and the developed nomogram provides an objective tool for individualized risk assessment.
文摘Robotic distal pancreatectomy(RDP)is being increasingly used in centres with access to the robot and offers technological improvements over conventional laparoscopy.Some studies have also shown superior outcomes compared with laparoscopic and open approaches.However,robotic technology is not widely available currently.This review aims to compare RDP with open and laparoscopic distal pancreatectomy,covering the basics of the RDP technique and highlighting the current nuances of the evidence pertaining to RDP with respect to clinical effectiveness and cost‒benefit analysis.
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Tumors grow in chronically stressed microenvironments characterized by hypoxia,acidosis,nutrient limitation,immune surveillance,and therapy-induced stress.To survive and expand in such adversity,cancer cells have evolved diverse adaptations and often activate stress-response pathways that can accelerate disease progression.1 Glucose is the principal carbon and energy source supporting biosynthesis and proliferation.
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Spleen-preserving distal pancreatectomy(SPDP)has gained increasing attention as a safe and effective alternative to distal pancreatectomy with splenectomy,particularly for benign and low-grade malignant lesions of the pancreatic body and tail.This narrative review evaluates the current evidence,technical considerations,and disease-specific indications for SPDP.Literature was reviewed using up to date scientific evidence and most recent national and international guidelines.Studies addressing SPDP outcomes,splenectomy complications,and disease-specific oncologic principles were included.Spleen preservation has been associated with reduced rates of postoperative infections,thromboembolic events,and longterm immunologic compromise,without compromising oncologic outcomes in selected patients.Indications favoring SPDP include pancreatic neuroendocrine tumors,intraductal papillary mucinous neoplasms,and solid pseudopapillary neoplasms.Although current guidelines generally recommend splenectomy for pancreatic ductal adenocarcinoma,emerging data suggest that spleen preservation may be feasible in highly selected cases.Technical approaches—primarily the Kimura and Warshaw techniques—enable safe dissection and splenic vessel management,particularly with the support of minimally invasive platforms.In conclusion,SPDP should be considered in appropriately selected patients to reduce morbidity while preserving long-term immune function.Future randomized studies are warranted to define oncologic safety and refine indications across tumor types.
基金Supported by China Postdoctoral Science Foundation,No.2021TQ0132The Youth Fund Program for National Natural Science Foundation of China from the First Affiliated Hospital of Nanjing Medical University,No.PY2021032。
文摘BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is increasingly recognized for its role in the pathogenesis of various cancers.However,its impact on gastric cancer(GC)outcomes,particularly in patients undergoing laparoscopic distal gastrectomy(LDG),remains unclear.AIM To investigate the clinical and prognostic impacts of NAFLD on GC patients undergoing LDG.METHODS In this retrospective cohort study,we collected clinical data from 1122 GC patients who underwent LDG at the Gastric Cancer Center of the First Affiliated Hospital of Nanjing Medical University between January 2020 and December 2022.Propensity score-matching(PSM)was used to mitigate the bias to compare the oncological and surgical outcomes between the two groups.Survival analysis was also performed to evaluate NAFLD as a prognostic factor.RESULTS PSM yielded a balanced cohort of 260 patients(52 with NAFLD and 208 controls)from the original cohort.No differences in clinicopathological characteristics,including surgery time,complications,T stage,N stage,p-tumornode-metastasis stage,neural invasion,vascular invasion,total number of retrieved lymph nodes,positive retrieved lymph nodes and positive lymph nodes rate,were observed between the two groups.Overall survival was comparable between two groups(Log-rank P=0.49),whereas progression-free survival(PFS)in the NAFLD group was inferior to that in the control group(Log-rank P=0.016).Univariable Cox regression analysis further confirmed that NAFLD was an unfavorable prognostic factor for PFS.CONCLUSION GC patients with NAFLD exhibited inferior PFS,suggesting that addressing NAFLD-related metabolic alterations may enhance clinical outcomes.Future investigations should explore the mechanistic links between NAFLD and GC progression and consider integrated therapeutic strategies.
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.
文摘BACKGROUND Accurate surgical fixation of intra-articular distal humerus fractures require olecranon osteotomy.Repair of osteotomy is achieved with a variety of techniques but no consensus has been achieved regarding the optimum technique for fixing the olecranon osteotomy.In this retrospective study,we compared the functional and radiological outcome of the two commonly used techniques of fixing olecranon osteotomy after fixing distal humerus intra-articular fractures.We hypothesized that olecranon osteotomy fixed with 6.5 mm cancellous intramedullary screw alone yielded better radiological and functional outcome than fixation with cerclage wire over cancellous screw applied in figure of eight as tension band wiring(TBW).AIM To determine the radiological and functional outcome of olecranon osteotomy fixation with cancellous screw alone vs cancellous screw combined with cerclage wiring applied as TBW.METHODS This retrospective study was conducted in Lady Reading Hospital Peshawar Pakistan.Intra-articular distal humerus fractures fulfilling the inclusion criteria and operated during 2023 to 2025 were included.Olecranon osteotomy fixation with 6.5 mm cancellous screw alone was labelled as group A while cerclage wire over cancellous screw in figure of eight as TBW were labelled as group B.The demographics,radiological and functional outcome in both groups were compared at one year using Mayo Elbow Performance Score and Quick Disabilities of the Arm,Shoulder,and Hand Score.RESULTS We included 32 patients in this study.The mean age of group A patients was 34±5.5 years while group B had a mean age of 34±6.2 years.Radiological union of olecranon osteotomy was achieved in all cases in both groups.Functional outcome however was significantly better in group A than in group B(P<0.05).The Mayo Elbow Performance Score was excellent in 14(87.5%)and good in 2(12.5%)patients in group A while 7(43.47%)patients had excellent outcome,5(31.25%)good and 4(25%)had fair outcome in group B.The mean Quick Disabilities of the Arm,Shoulder,and Hand Score was 24.5±2.1 and 78.1±12.1 in group A and B respectively(P<0.05).CONCLUSION Similar radiological union was achieved in all patients of olecranon osteotomy treated with intramedullary screw alone and intramedullary screw with TBW.Functional outcome however was significantly better in intramedullary screw alone than in intramedullary screw with TBW.
