The Kirschner wires (K-wires) are stiff and straight wires made of smooth stainless steel. These are used in surgery to aid in repairing the process of a fractured bone. In forefoot elective surgeries, these pins are ...The Kirschner wires (K-wires) are stiff and straight wires made of smooth stainless steel. These are used in surgery to aid in repairing the process of a fractured bone. In forefoot elective surgeries, these pins are mostly used for fixation of the phalangeal or metatarsal area. These wires are usually either buried or exposed, The exposed wires do not require another operation to remove them and are generally preferred. In using the forefoot surgery history of a single surgeon which was taken for 3 years<span>.</span><span> The purpose of this study is to evaluate the occurrence of infections following elective surgeries of the forefoot that were fixed using k-pins and to indicate an effective treatment option for resolving the infection. The inclusion criteria set for this study was to remove any patient having any disease except for diabetes. Moreover, the age limit was set to be 18</span><span> </span><span>-</span><span> </span><span>44, making a final sample of 50 people, prescribed prophylactic antibiotics or early removal of k-pins, where necessary. The researcher recorded demographic and biological data from the patients such as age, BMI, and smoking status were recorded. The researcher conducted a Univariate analysis via a Chi-square test. 50</span><b><span> </span></b><span>Patients (82 K-wires) were analyzed. Results showed that surgery type, BMI, and smoking were three variables that affect the infection growth significantly while diabetes and type of cleaning disinfectant had marginal effects. Further study is required to clarify the best treatments in this area, as the treatment option antibiotics have nearly similar results.</span>展开更多
Objective To analyze the surgical treatment options and its results for thoracic and thoracolumbar disc herniation.Methods From June 2004 to December 2009,thirty-one patients of thoracic and thoracolumbar disc herniat...Objective To analyze the surgical treatment options and its results for thoracic and thoracolumbar disc herniation.Methods From June 2004 to December 2009,thirty-one patients of thoracic and thoracolumbar disc herniation with展开更多
Objective: Capmatinib and tepotinib, two recently FDA-approved and highly specific small-molecule inhibitors of c-MET exon 14 skipping mutations are new and important therapeutic options for the treatment of NSCLC pat...Objective: Capmatinib and tepotinib, two recently FDA-approved and highly specific small-molecule inhibitors of c-MET exon 14 skipping mutations are new and important therapeutic options for the treatment of NSCLC patients harbouring c-MET alterations. However, the precise role of these molecules as a new treatment option is still not fully defined. Methods: In an attempt to further evaluate the contributions of c-MET inhibitors to the armamentarium of treatment options for advanced and metastatic NSCLCs, relevant phase II and III studies were retrospectively analyzed in terms of ORR and mPFS (mOS numbers are still not available for current c-MET trials and therefore not considered for statistical purposes). Results: Treatment of advanced and metastatic NSCLC patients harbouring c-MET exon 14 skipping mutations with the novel and highly selective c-MET inhibitors is significantly superior (p Conclusion: The novel and highly selective c-MET inhibitors capmatinib and tepotinib are promising novel treatment options for patients with c-MET-dysregulated NSCLC primarily in the first-line setting, albeit a clear mOS benefit has not yet been established. Since immunotherapy did not appear to be particularly effective in NSCLC patients harbouring c-MET alterations, the vast majority of these patients are treated with immunotherapy plus chemotherapy. C-Met inhibitors appear to be equally effective and thereby sparing patients from the toxic effects of the chemotherapy. The routine testing of c-MET exon 14 skipping mutations should be performed as the GEOMETRY mono-1 data clearly showed higher response rates with capmatinib in treatment-naive than in pretreated patients, indicating that c-MET exon 14 skipping mutations should preferably be molecularly assessed at baseline. C-MET exon 14 skipping mutations are, therefore, clear biomarkers of response to c-MET inhibitors.展开更多
Since existing selection methods of surgical treatment schemes of renal cancer patients mainly depend on physicians’clinical experience and judgments,the surgical treatment options of renal cancer patients lack their...Since existing selection methods of surgical treatment schemes of renal cancer patients mainly depend on physicians’clinical experience and judgments,the surgical treatment options of renal cancer patients lack their scientifical and reasonable information expression and group decision-making model for renal cancer patients.Fuzzy multi-sets(FMSs)have a number of properties,which make them suitable for expressing the uncertain information of medical diagnoses and treatments in group decision-making(GDM)problems.To choose the most appropriate surgical treatment scheme for a patient with localized renal cell carcinoma(RCC)(T1 stage kidney tumor),this article needs to develop an effective GDM model based on the fuzzy multivalued evaluation information of the renal cancer patients.First,we propose a conversionmethod of transforming FMSs into entropy fuzzy sets(EFSs)based on the mean and Shannon entropy of a fuzzy sequence in FMS to reasonably simplify the information expression and operations of FMSs and define the score function of an entropy fuzzy element(EFE)for ranking EFEs.Second,we present the Aczel-Alsina t-norm and t-conorm operations of EFEs and the EFE Aczel-Alsina weighted arithmetic averaging(EFEAAWAA)and EFE Aczel-Alsina weighted geometric averaging(EFEAAWGA)operators.Third,we develop a multicriteria GDM model of renal cancer surgery options in the setting of FMSs.Finally,the proposed GDM model is applied to two clinical cases of renal cancer patients to choose the best surgical treatment scheme for a renal cancer patient in the setting of FMSs.The selected results of two clinical cases verify the efficiency and rationality of the proposed GDM model in the setting of FMSs.展开更多
BACKGROUND Isolated dislocations of the scaphoid are extremely rare types of injuries,commonly associated with severe ligament disruptions,and are occasionally misdiagnosed.Treatment options for dislocations of the sc...BACKGROUND Isolated dislocations of the scaphoid are extremely rare types of injuries,commonly associated with severe ligament disruptions,and are occasionally misdiagnosed.Treatment options for dislocations of the scaphoid mainly include closed reduction,with or without internal fixation,and open reduction with ligament repair.CASE SUMMARY A 59-year-old male worker sustained a twisting trauma of his right wrist,caused by a moving belt while he was operating a machine.When he presented at our emergency department,the patient complained of swelling,tenderness,and restriction of movement of the right wrist.Radiographs confirmed a primary complex partial radial dislocation of the scaphoid and some chip fractures of the capitate and hamate.Closed reduction with K-wire internal fixation was performed with the assistance of arthroscopy,and an excellent prognosis was achieved.CONCLUSION Arthroscopy-assisted reduction is a minimally invasive method to reduce the dislocated scaphoid and maintain the blood supply.展开更多
Over the past 20 years,the incidence and prevalence of type 2 diabetes mellitus(T2DM)in children and adolescents have increased,particularly in racial and ethnic minorities.Despite the rise in T2DM in children and ado...Over the past 20 years,the incidence and prevalence of type 2 diabetes mellitus(T2DM)in children and adolescents have increased,particularly in racial and ethnic minorities.Despite the rise in T2DM in children and adolescents,the pathophysiology and progression of disease in this population are not clearly understood.Youth-onset T2DM has a more adverse clinical course than is seen in those who develop T2DM in adulthood or those with T1DM.Furthermore,the available therapeutic options are more limited for children and adolescents with T2DM compared to adult patients,mostly due to the challenges of implementing clinical trials.A better understanding of the mechanisms underlying the development and aggressive disease phenotype of T2DM in youth is important to finding effective prevention and management strategies.This review highlights the key evidence about T2DM in children and adolescents and its current burden and challenges both in clinical care and research activities.展开更多
Transdermal medications are an useful yet underutilized tool in the field of psychiatry.Despite numerous advantages of using this route of medication delivery,transdermal medications remain less popular compared to ot...Transdermal medications are an useful yet underutilized tool in the field of psychiatry.Despite numerous advantages of using this route of medication delivery,transdermal medications remain less popular compared to other routes of medication administration such as oral and intramuscular routes in the management of various psychiatric conditions.In this editorial,we examine the advantages of transdermal medications with a brief overview of transdermal being used in psychiatry and other medical specialties.We discuss the factors that play a role in their limited usage in psychiatry.We highlight certain patient categories who can specifically benefit from them and discuss potential solutions that can broaden the perspective of treating clinicians making this an intriguing avenue in the field of psychiatry.展开更多
Waldenstrom macroglobulinemia(WM)is a type of incurable,indolent B-cell lymphoma that is prone to relapse.Over time,treatment strategies have progressed from cytotoxic drugs to rituximab(R)-or bortezomib(V)-based regi...Waldenstrom macroglobulinemia(WM)is a type of incurable,indolent B-cell lymphoma that is prone to relapse.Over time,treatment strategies have progressed from cytotoxic drugs to rituximab(R)-or bortezomib(V)-based regimens,and have now entered into an era of Bruton tyrosine kinase inhibitor(BTKi)-based regimens.However,the optimal treatment for the relapsed patients is still unclear.Herein,we analyzed the outcomes of the first-and second-line therapies in 377 patients with WM to illustrate the optimal choices for second-line therapy.After a median follow-up of 45.4 months,89 patients received second-line therapy,and 53 patients were evaluated for response.The major response rates(MRR)of first-and second-line treatment were 65.1%and 67.9%(P=0.678).The median progression-free survival(PFS)for the second-line therapy(PFS2)was shorter than that for the first-line therapy(PFS1)(56.3 vs 40.7 months,P=0.03).However,PFS2 in targeted drugs group(R-/V-/BTKi-based regimens)was comparable to PFS1(60.7 months vs 44.7 months,respectively,P=0.21).Regarding second-line therapy,patients who underwent sequential treatment escalation—such as transitioning from cytotoxic drugs to R-/V-/BTKi-based regimens or from R-/V-based to BTKi-based regimens(escalation group)—had higher MRR(80.6%vs 47.1%,respectively,P=0.023)and longer PFS2(50.4 vs 23.5 months,respectively,P<0.001)compared to the non-escalation group.Patients in the escalation group also had longer post-relapse overall survival compared with the non-escalation group(median,not reached vs 50.7 months,respectively,P=0.039).Our findings indicate that sequential treatment escalation may improve the survival of patients with WM.展开更多
Heel pain is a very common foot disease. Varieties of names such as plantar fasciitis, jogger＇s heel, tennis heal, policeman＇s heel are used to describe it. Mechanical factors are the most common etiology of heel pa...Heel pain is a very common foot disease. Varieties of names such as plantar fasciitis, jogger＇s heel, tennis heal, policeman＇s heel are used to describe it. Mechanical factors are the most common etiology of heel pain. Common causes of hell pain includes： Plantar Fasciitis, Heel Spur, Sever＇s Disease, Heel bump, Achilles Tendinopathy, Heel neuritis, Heel bursitis. The diagnosis is mostly based on clinical examination. Normally, the location of the pain and the absence of associated symptoms indicating a systemic disease strongly suggest the diagnosis. Several therapies exist including rest, physical therapy, stretching, and change in footwear, arch supports, orthotics, night splints, anti-inflammatory agents, and surgery. Almost all patients respond to conservative nonsurgical therapy. Surgery is the last treatment option if all other treatments had failed. Rest, ice, massage, the use of correct exercise and complying with a doctor＇s advice all play important part in helping to recover from this hell pain condition, but getting good quality, suitable shoes with the appropriate amount of support for the whole foot is the most important.展开更多
In the absence of gallstones or any other form of mechanical obstruction,hypoperfusion to the gallbladder can lead to inflammation,ischaemia and perforation.This constellation of findings has historically been simply ...In the absence of gallstones or any other form of mechanical obstruction,hypoperfusion to the gallbladder can lead to inflammation,ischaemia and perforation.This constellation of findings has historically been simply referred to as‘acalculous cholecystitis’.However,this term makes no distinction between inflammation due to critical illness and poor perfusion,or what we will refer to as ischaemic cholecystitis,versus other non-obstructive aetiologies.Ischaemic cholecystitis presents diagnostic as well as treatment challenges that are unique to patients in the critical care setting.More importantly,the morbidity and mortality of this proposed subcategory of acute gallbladder inflammation is much higher compared with other forms of acute cholecystitis.In the present manuscript,we introduce the concept of ischaemic cholecystitis and the importance of differentiating this clinical diagnosis from other forms of acalculous cholecystitis.Additionally,we elaborate on the most recent diagnostic modalities and treatment options specific to this vulnerable patient population.展开更多
文摘The Kirschner wires (K-wires) are stiff and straight wires made of smooth stainless steel. These are used in surgery to aid in repairing the process of a fractured bone. In forefoot elective surgeries, these pins are mostly used for fixation of the phalangeal or metatarsal area. These wires are usually either buried or exposed, The exposed wires do not require another operation to remove them and are generally preferred. In using the forefoot surgery history of a single surgeon which was taken for 3 years<span>.</span><span> The purpose of this study is to evaluate the occurrence of infections following elective surgeries of the forefoot that were fixed using k-pins and to indicate an effective treatment option for resolving the infection. The inclusion criteria set for this study was to remove any patient having any disease except for diabetes. Moreover, the age limit was set to be 18</span><span> </span><span>-</span><span> </span><span>44, making a final sample of 50 people, prescribed prophylactic antibiotics or early removal of k-pins, where necessary. The researcher recorded demographic and biological data from the patients such as age, BMI, and smoking status were recorded. The researcher conducted a Univariate analysis via a Chi-square test. 50</span><b><span> </span></b><span>Patients (82 K-wires) were analyzed. Results showed that surgery type, BMI, and smoking were three variables that affect the infection growth significantly while diabetes and type of cleaning disinfectant had marginal effects. Further study is required to clarify the best treatments in this area, as the treatment option antibiotics have nearly similar results.</span>
文摘Objective To analyze the surgical treatment options and its results for thoracic and thoracolumbar disc herniation.Methods From June 2004 to December 2009,thirty-one patients of thoracic and thoracolumbar disc herniation with
文摘Objective: Capmatinib and tepotinib, two recently FDA-approved and highly specific small-molecule inhibitors of c-MET exon 14 skipping mutations are new and important therapeutic options for the treatment of NSCLC patients harbouring c-MET alterations. However, the precise role of these molecules as a new treatment option is still not fully defined. Methods: In an attempt to further evaluate the contributions of c-MET inhibitors to the armamentarium of treatment options for advanced and metastatic NSCLCs, relevant phase II and III studies were retrospectively analyzed in terms of ORR and mPFS (mOS numbers are still not available for current c-MET trials and therefore not considered for statistical purposes). Results: Treatment of advanced and metastatic NSCLC patients harbouring c-MET exon 14 skipping mutations with the novel and highly selective c-MET inhibitors is significantly superior (p Conclusion: The novel and highly selective c-MET inhibitors capmatinib and tepotinib are promising novel treatment options for patients with c-MET-dysregulated NSCLC primarily in the first-line setting, albeit a clear mOS benefit has not yet been established. Since immunotherapy did not appear to be particularly effective in NSCLC patients harbouring c-MET alterations, the vast majority of these patients are treated with immunotherapy plus chemotherapy. C-Met inhibitors appear to be equally effective and thereby sparing patients from the toxic effects of the chemotherapy. The routine testing of c-MET exon 14 skipping mutations should be performed as the GEOMETRY mono-1 data clearly showed higher response rates with capmatinib in treatment-naive than in pretreated patients, indicating that c-MET exon 14 skipping mutations should preferably be molecularly assessed at baseline. C-MET exon 14 skipping mutations are, therefore, clear biomarkers of response to c-MET inhibitors.
基金This study has received funding by the Science and Technology Plan Project of Keqiao District(No.2020KZ58).
文摘Since existing selection methods of surgical treatment schemes of renal cancer patients mainly depend on physicians’clinical experience and judgments,the surgical treatment options of renal cancer patients lack their scientifical and reasonable information expression and group decision-making model for renal cancer patients.Fuzzy multi-sets(FMSs)have a number of properties,which make them suitable for expressing the uncertain information of medical diagnoses and treatments in group decision-making(GDM)problems.To choose the most appropriate surgical treatment scheme for a patient with localized renal cell carcinoma(RCC)(T1 stage kidney tumor),this article needs to develop an effective GDM model based on the fuzzy multivalued evaluation information of the renal cancer patients.First,we propose a conversionmethod of transforming FMSs into entropy fuzzy sets(EFSs)based on the mean and Shannon entropy of a fuzzy sequence in FMS to reasonably simplify the information expression and operations of FMSs and define the score function of an entropy fuzzy element(EFE)for ranking EFEs.Second,we present the Aczel-Alsina t-norm and t-conorm operations of EFEs and the EFE Aczel-Alsina weighted arithmetic averaging(EFEAAWAA)and EFE Aczel-Alsina weighted geometric averaging(EFEAAWGA)operators.Third,we develop a multicriteria GDM model of renal cancer surgery options in the setting of FMSs.Finally,the proposed GDM model is applied to two clinical cases of renal cancer patients to choose the best surgical treatment scheme for a renal cancer patient in the setting of FMSs.The selected results of two clinical cases verify the efficiency and rationality of the proposed GDM model in the setting of FMSs.
文摘BACKGROUND Isolated dislocations of the scaphoid are extremely rare types of injuries,commonly associated with severe ligament disruptions,and are occasionally misdiagnosed.Treatment options for dislocations of the scaphoid mainly include closed reduction,with or without internal fixation,and open reduction with ligament repair.CASE SUMMARY A 59-year-old male worker sustained a twisting trauma of his right wrist,caused by a moving belt while he was operating a machine.When he presented at our emergency department,the patient complained of swelling,tenderness,and restriction of movement of the right wrist.Radiographs confirmed a primary complex partial radial dislocation of the scaphoid and some chip fractures of the capitate and hamate.Closed reduction with K-wire internal fixation was performed with the assistance of arthroscopy,and an excellent prognosis was achieved.CONCLUSION Arthroscopy-assisted reduction is a minimally invasive method to reduce the dislocated scaphoid and maintain the blood supply.
文摘Over the past 20 years,the incidence and prevalence of type 2 diabetes mellitus(T2DM)in children and adolescents have increased,particularly in racial and ethnic minorities.Despite the rise in T2DM in children and adolescents,the pathophysiology and progression of disease in this population are not clearly understood.Youth-onset T2DM has a more adverse clinical course than is seen in those who develop T2DM in adulthood or those with T1DM.Furthermore,the available therapeutic options are more limited for children and adolescents with T2DM compared to adult patients,mostly due to the challenges of implementing clinical trials.A better understanding of the mechanisms underlying the development and aggressive disease phenotype of T2DM in youth is important to finding effective prevention and management strategies.This review highlights the key evidence about T2DM in children and adolescents and its current burden and challenges both in clinical care and research activities.
文摘Transdermal medications are an useful yet underutilized tool in the field of psychiatry.Despite numerous advantages of using this route of medication delivery,transdermal medications remain less popular compared to other routes of medication administration such as oral and intramuscular routes in the management of various psychiatric conditions.In this editorial,we examine the advantages of transdermal medications with a brief overview of transdermal being used in psychiatry and other medical specialties.We discuss the factors that play a role in their limited usage in psychiatry.We highlight certain patient categories who can specifically benefit from them and discuss potential solutions that can broaden the perspective of treating clinicians making this an intriguing avenue in the field of psychiatry.
基金supported by grants from the National Nature Science Foundation of China(81970187,82170193,81920108006,and 81900203)the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(2022-I2M-1-022,2021-I2M-C,and T-B-081).
文摘Waldenstrom macroglobulinemia(WM)is a type of incurable,indolent B-cell lymphoma that is prone to relapse.Over time,treatment strategies have progressed from cytotoxic drugs to rituximab(R)-or bortezomib(V)-based regimens,and have now entered into an era of Bruton tyrosine kinase inhibitor(BTKi)-based regimens.However,the optimal treatment for the relapsed patients is still unclear.Herein,we analyzed the outcomes of the first-and second-line therapies in 377 patients with WM to illustrate the optimal choices for second-line therapy.After a median follow-up of 45.4 months,89 patients received second-line therapy,and 53 patients were evaluated for response.The major response rates(MRR)of first-and second-line treatment were 65.1%and 67.9%(P=0.678).The median progression-free survival(PFS)for the second-line therapy(PFS2)was shorter than that for the first-line therapy(PFS1)(56.3 vs 40.7 months,P=0.03).However,PFS2 in targeted drugs group(R-/V-/BTKi-based regimens)was comparable to PFS1(60.7 months vs 44.7 months,respectively,P=0.21).Regarding second-line therapy,patients who underwent sequential treatment escalation—such as transitioning from cytotoxic drugs to R-/V-/BTKi-based regimens or from R-/V-based to BTKi-based regimens(escalation group)—had higher MRR(80.6%vs 47.1%,respectively,P=0.023)and longer PFS2(50.4 vs 23.5 months,respectively,P<0.001)compared to the non-escalation group.Patients in the escalation group also had longer post-relapse overall survival compared with the non-escalation group(median,not reached vs 50.7 months,respectively,P=0.039).Our findings indicate that sequential treatment escalation may improve the survival of patients with WM.
文摘Heel pain is a very common foot disease. Varieties of names such as plantar fasciitis, jogger＇s heel, tennis heal, policeman＇s heel are used to describe it. Mechanical factors are the most common etiology of heel pain. Common causes of hell pain includes： Plantar Fasciitis, Heel Spur, Sever＇s Disease, Heel bump, Achilles Tendinopathy, Heel neuritis, Heel bursitis. The diagnosis is mostly based on clinical examination. Normally, the location of the pain and the absence of associated symptoms indicating a systemic disease strongly suggest the diagnosis. Several therapies exist including rest, physical therapy, stretching, and change in footwear, arch supports, orthotics, night splints, anti-inflammatory agents, and surgery. Almost all patients respond to conservative nonsurgical therapy. Surgery is the last treatment option if all other treatments had failed. Rest, ice, massage, the use of correct exercise and complying with a doctor＇s advice all play important part in helping to recover from this hell pain condition, but getting good quality, suitable shoes with the appropriate amount of support for the whole foot is the most important.
文摘In the absence of gallstones or any other form of mechanical obstruction,hypoperfusion to the gallbladder can lead to inflammation,ischaemia and perforation.This constellation of findings has historically been simply referred to as‘acalculous cholecystitis’.However,this term makes no distinction between inflammation due to critical illness and poor perfusion,or what we will refer to as ischaemic cholecystitis,versus other non-obstructive aetiologies.Ischaemic cholecystitis presents diagnostic as well as treatment challenges that are unique to patients in the critical care setting.More importantly,the morbidity and mortality of this proposed subcategory of acute gallbladder inflammation is much higher compared with other forms of acute cholecystitis.In the present manuscript,we introduce the concept of ischaemic cholecystitis and the importance of differentiating this clinical diagnosis from other forms of acalculous cholecystitis.Additionally,we elaborate on the most recent diagnostic modalities and treatment options specific to this vulnerable patient population.
