Objective To discuss the relationship between recovery of anatomical integrity and functional outcome in elderly patients with distal radius fractures by comparing the effects of open reduction and closed reduction. Methods The cl inical data were retrospectively analyzed from 78 elderly patients with distal radius fractures treating with nonoperation andoperation from February 2005 to March 2009. Thirty-seven patients underwent closed reduction and spl intlet fixation or cast appl ication (non-operation group), and forty-one patients underwent open reduction and internal fixation (operation group). In non-operation group, there were 15 males and 22 females with an average age of 73 years (60-83 years). According to the AO classification system for fracture, there were 8 cases of type A2, 7 cases of type A3, 7 cases of type B1, 4 cases of type B2, 2 cases of type B3, 4 cases of type C1, 2 cases of type C2, and 3 cases of type C3. The time from injury to admission was between 30 minutes and 3 days with a mean time of 1 day. In operation group, there were 18 males and 23 females with an average age of 71 years (62-80 years). According to the AO classification system for fracture, there were 5 cases of type A2, 7 cases of type A3, 7 cases of type B1, 6 cases of type B2, 3 cases of type B3, 4 cases of type C1, 5 cases of type C2, and 4 cases of type C3. The time from injury to admission was between 30 minutes and 7 days with a mean time of 1 day. There were no significant differences (P gt; 0.05) in sex, age, disease course and fracture classification between two groups. Results All incisions obtained heal ing by first intention after operation in operation group. All patients were followed up for 9-36 months (20 months on average). Fracture heal ing was achieved within 8 to 15 weeks, with an average of 11 weeks. There were no significant differences (P gt; 0.05) in fracture heal ing time between non-operation group [(10.8 ± 2.0) weeks] and operation group [(11.7 ± 2.5) weeks]. At last follow-up, thepalmar tilt angle was (5.6 ± 2.0)° and (8.6 ± 3.0)°, the radial incl ination angle was (19.1 ± 4.9)° and (21.8 ± 2.0)°, and the radial length was (8.3 ± 1.3) mm and (10.4 ± 1.4) mm in non-operation group and operation group, respectively; showing significant differences (P lt; 0.05) between two groups. According to the Gartland-Werley score, the results were excellent in 9 cases, good in 21 cases, fair in 5 cases, and poor in 2 cases in non-operation group, the excellent and good rate was 81.1%; in operation group, the results were excellent in 13 cases, good in 25 cases, fair in 2 cases, and poor in 1 case, the excellent and good rate was 92.7%, showing no significant difference (P gt; 0.05) between two groups. There were no significant differences (P gt; 0.05) in flexion and extension activity of wrist, radioulnar partial activity, pronation-supination activity, grip and pinch strength between two groups. Conclusion Open reduction and closed reduction can achieve satisfactory functional outcomes, but closed reduction was inferior to open reduction in anatomic reduction for treating distal radius fractures in elderly patients.
Due to the lack of head to head direct comparison evidence, applying indirect comparison (ITC) as well as network meta-analysis to compare multiple interventions becomes a new popular and powerful statistical technique. However, its theoretical system still needs improvement. In this article, we briefly introduce and summarize its progress concerning basic concepts, method assumptions, influencing factors of effectiveness, and software for analysis, so as to help researchers better understand the method and promote its application in evidence production.
Objective To systematically analyze and compare the research literature of thoracic surgery simulation-based medical education (SBME) at home and abroad, and provide ideas for the future development of thoracic surgery SBME in China. Methods Using word frequency analysis and cluster analysis as analysis methods, CiteSpace visualization software and Excel statistical software as tools, the domestic and foreign SBME literature retrieved from PubMed and CNKI databases were visualized and statistically analyzed respectively. Results A total of 2 491 domestic and foreign literature on SBME in thoracic surgery were included. The annual number of foreign publications showed an increasing trend. The top three countries in terms of number of publications were the USA (n=581), Canada (n=105) and Germany (n=57); "cardiac surgery", "medical knowledge medical knowledge" and "medical education" are the hotspots of research in the direction of thoracic surgery simulation, while "lung cancer", "surgical training" and "3D printing" were still in the process of explosion. The core research themes were endoscope simulation trainer, scenario-based simulation teaching methods, standardized patients and virtual reality models. Conclusion Domestic SBME in thoracic surgery should learn from foreign development experience, keep up with the frontier and integrate cutting-edge technology, innovate the curriculum and offer non-technical skills teaching, and improve the system and focus on software construction.
To compare the effectiveness of dressing by a combination of traditional Chinese medicine (TCM)-Western medicine (WM) after TCM bath and by the silver sulfadiazine cream (SD-Ag) in treating residual deep burn wound. Methods A total of 128 cases of residual deep burn wound between July 2003 and December 2009 were randomly divided into the TCM-WM treatment group (70 cases) and the WM control group (58 cases). In the treatment group, there were 45 males and 25 females with an average age of 38.6 years (range, 18-60 years), including 34 cases of flame burns, 28 cases of molten steel burns, and 8 cases of chemical burns with an average burn area of 57.6% total body surface area (TBSA) and an average residual wound of 7.4% TBSA. In the control group, there were 50 males and 8 females with an average of 37.9 years (range, 20-59 years), including 26 cases of flame burns, 12 cases of hot water burns, 16 cases of molten steel burns, and 4 cases of chemical burns with an average burn area of 56.5% TBSA and an average residual wound of 6.9%TBSA. There was no significant difference in general data between 2 groups (P gt; 0.05), so the cl inical data of 2 groups had comparabil ity. In the treatment group, the patients had a bath with TCM, and then the wounds were treated with dressing change of combined TCM-WM. In the control group, the wounds were treated with SD-Ag after cleaning the wounds with chlorhexidine solution. The pain, wound heal ing time, and the rate of scar formation were observed in 2 groups after treatment. Results According to wound pain classification after medication, the results were excellent in 23 cases, good in 30 cases, fair in 17 cases in the treatment group; were excellent in 17 cases, good in 20 cases, fair in 13 cases, poor in 5 cases, and fairly poor in 3 cases in the control group. The wound heal ing time of the treatment group (13.45 ± 4.74) days was significantly shorter than that of the control group [(23.87 ± 14.45) days, P lt; 0.05)]. After 2 weeks of treatment, scar occurred in 15 patients (21.4%) of the treatment group and 35 patients (60.3%) of the control group, showing significant difference (P lt; 0.05). Conclusion Based on TCM bath, a combination of TCM-WM for the residual burn wounds is obviously superior to SD-Ag. It has the advantages of rapid heal ing, l ight pain, no obvious scar, and short hospital ization time.
ObjectiveTo compare the effectiveness between the method of simple posterior debridement combined with bone grafting and fusion and internal fixation and the method of one-stage anterior radical debridement combined with bone grafting and fusion and posterior internal fixation in the treatment of thoracolumbar brucella spondylitis so as to provide the reference for the clinical treatment. MethodsA retrospective analysis was made on the clinical data of 148 cases of thoracolumbar brucella spondylitis between January 2002 and January 2012. Simple posterior debridement combined with bone grafting and fusion and internal fixation was used in 78 cases (group A), and one-stage anterior radical debridement combined with bone grafting and fusion and posterior internal fixation in 70 cases (group B). There was no significant difference in gender, age, disease duration, involved vertebral segments, erythrocyte sedimentation rate (ESR), visual analogue scale (VAS) score, neural function grade of America Spinal Injury Association (ASIA), and kyphosis Cobb angle before operation between 2 groups (P > 0.05). The peri operation period indexes (hospitalization time, operation time, and intraoperative blood loss) and the clinical effectiveness indexes (VAS score, ASIA grade, Cobb angle, and ESR) were compared; the bone fusion and the internal fixation were observed. ResultsIncision infection and paravertebral and/or psoas abscess occurred in 2 and 3 cases of group A respectively. All incisions healed by first intention and 2 cases had pneumothorax in group B. The operation time and the hospitalization time of group A were significantly shorter than those of group B (P < 0.05), and the intraoperative blood lossof group A was significantly lower than that of group B (P < 0.05). All of the cases in 2 groups were followed up 14-38 months, 25 months on average. The VAS, ESR, and Cobb angle were significantly decreased at each time point after operation when compared with preoperative ones in 2 groups (P < 0.05), but no significant difference was found between 2 groups (P > 0.05). The neurological function was significantly improved at 3 months after operation; there were 1 case of ASIA grade C, 14 cases of grade D, and 63 cases of grade E in group A, and there were 1 case of grade C, 11 cases of grade D, and 58 cases of grade E in group B; and difference was not significant (Z=0.168, P=0.682). The grafting bone fusion was observed in both groups. The fusion time was (8.7±0.3) months in group A and (8.6±0.4) months in group B, showing no significant difference (t=0.591, P=0.601) was found. At last follow-up, no loosening or fracture of internal fixation was found. ConclusionBased on regular medicine therapy, the effectiveness of the two methods is satisfactory in the treatment of thoracolumbar brucella spondylitis as long as the operation indications should be controlled strictly.
ObjectiveTo analyze and compare the incidence, mortality, temporal trends, and cancer spectrum differences between China and the United States (US), providing theoretical support for cancer prevention and control in China. MethodsAge standardized incidence rate (ASIR), age standardized mortality rate (ASMR), and cancer site composition were extracted from GLOBOCAN, Cancer Statistics 2025, the China Cancer Registry Annual Report, and other epidemiological sources. Spatial (urban-rural, sex specific) and temporal distributions were described, and average annual growth rate (AAGR) were calculated. ResultsFrom 2005 onward, China exhibited a modest rise in ASIR, whereas the US showed a decline (AAGR: 0.58 vs –0.42); nevertheless, China’s overall incidence remained lower (2022 ASIR = 201.61/100 000) than that of the US (303.60/100 000). Both countries experienced decreasing ASMR (AAGR: –1.03 vs –1.72). In both nations, male ASIR and ASMR were higher than female. Since 2005, the top three US cancers had remained prostate (men) or breast (women), lung and colorectal cancer. In China, incidences of lung, colorectal, female breast and thyroid cancers had continued to rise, while stomach and liver cancer incidences had declined yet still rank high among men. Urban ASIR in China exceeded rural rates, whereas rural ASMR was higher than urban counterparts. ConclusionsAccelerating population ageing and lifestyle transitions have driven an upward incidence trend in China, accompanied by a shift towards a mixed pattern of traditional and emerging cancer risks. Drawing on US experience, China should intensify tobacco control measures, expand organized screening and early detection programs, implement comprehensive interventions for priority cancers, strengthen primary level capacity and improve treatment access in rural areas, thereby establishing a more effective national cancer prevention and control system.
Objective?To compare the double dorsal phalangeal flap (DDPF) with the combination of digital neurovascular island flap (NVIF) and first dorsal metacarpal artery flap (FDMA) in terms of repairing digit degloving injury.?Methods?From October 2005 to March 2008, DDPF was used to repair 9 patients (9 fingers) with degloving injury of the thumb and index finger and completely amputated thumb and index finger (group A). From August 1996 to June 2007, NVIF and FDMA were used to repair 13 patients (13 fingers) with the thumb degloving injury and completely amputated or necrotic thumb (group B). In group A, there were 7 males and 2 females aged 19-48 years old, there were 4 cases of thumb and index finger degloving injury repair and 5 cases of completely amputated thumb and index finger reconstruction, the skin defect ranged from 6.0 cm × 3.5 cm to 7.0 cm × 4.5 cm, and the interval between injury and operation was 3-10 hours. The size of DDPF harvested during operation was 4.0 cm × 3.5 cm-5.0 cm × 4.0 cm. In group B, there were 10 males and 3 females aged 18-50 years old, there were 5 cases of thumb degloving injury repair and 8 cases of completely amputated or necrotic thumb reconstruction, the skin defect ranged from 6.0 cm × 3.0 cm to 7.0 cm × 4.5 cm, and the interval between injury and operation was 3 hours-5 days, and the size of NVIF and FDMA harvested during operation was 3.5 cm × 3.0 cm-5.0 cm × 4.0 cm. The donor site was repaired with the full-thickness skin graft.?Results?All the flaps survived uneventfully except for 1 case in group A suffering from venous crisis 1 day after operation and 2 cases in group B suffering from FDMA artery crisis 4-12 hours after operation. Those flaps survived after symptomatic treatment. All the wounds healed by first intention. All patients in two groups were followed up for 1-12 years (average 3.2 years). All the donor sites were normal except for 3 cases in group B suffering from flexion contracture deformity of the proximal interphalangeal joint due to the scar contracture in the margin of NVIF donor site. According to Allen test, the skin temperature and color of the donor fingers in two groups were normal under room temperature; 1 case of group A and 6 NVIF donor fingers of group B were pale and cold under ice water. According to sensory recovery evaluation system, 16 fingers in group A were graded as S4, 1 as S3+, and 1 as S2; while in group B, 3 NVIF fingers were graded as S3, 6 NVIF fingers as S2, 4 NVIF fingers as S1, and 13 FDMA fingers as S4. The appearance of the recipient flap was satisfactory and the color was similar to the surrounding skin. The skin temperature and color of the flaps in two groups were normal under room temperature; 2 cases of group A and 4 recipient fingers of group B were pale and cold under ice water. In group A, all the palmar flap of the recipient finger achieved the reorientation of the recipient flap sensation; while in group B, 8 cases achieved the reorientation of the recipient flap sensation, and 5 cases had double sensation. For the two-point discrimination of the flap, group B was superior to that of group A in terms of the palmar aspect (P lt; 0.05), no significant difference was evident between two groups in terms of the dorsal aspect (P gt; 0.05), and the palmar aspect of each group was superior to the dorsal flap (P lt; 0.05).?Conclusion?DDPF is less invasive to donor finger, easy to be operated, able to partially restore the sensory of the injured finger, and suitable for the repair of the degloving injury of the thumb and the index finger. Combination of NVIF and FDMA can restore the fine sensory of recipient palmar flap better and is applicable for those patients suffering from digital nerve defects from the proximal phalanx and with high demand for the recovery of thumb sensory.
ObjectivesTo assess the accuracy of different types and magnetic field intensity of cardiac magnetic resonance for coronary artery disease.MethodsPubMed, The Cochrane Library, EMbase, WanFang Data, CNKI and CBM databases were searched to collect the studies on different types and magnetic field intensity of cardiac magnetic resonance for coronary artery disease from inception to May 15th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, data were synthesized by using MetaDisc 1.4, RevMan 5.3 and Stata 12.0 softwares. The pooled sensitivity (Sen), pooled specificity (Spe), pooled positive likelihood ratio (+LR), pooled negative likelihood ratio (–LR), pooled diagnostic odds ratio (DOR) and the area under curve (AUC) of the summary receiver-operating characteristic curve (SROC) were used to assess the diagnostic value of different types and magnetic field intensity of cardiac magnetic resonance.ResultsTwenty diagnostic studies were included, which involved 1 357 patients. The results of meta-analysis showed that (1) based on patient: compared with the gold standard, the pooled Sen, Spe, +LR, –LR, DOR and the AUC of SROC, pre-test probability, post-test probability were (0.87, 95%CI 0.82 to 0.90), (0.88, 95%CI 0.82 to 0.92), (7.33, 95%CI 4.74 to 11.32), (0.15, 95%CI 0.11 to 0.20), (49.53, 95%CI 27.46 to 89.36), (0.93, 95%CI 0.91 to 0.95), 20.00% and 65.00%, respectively. (2) Based on blood vessels: the pooled Sen, Spe, +LR, –LR, DOR and the AUC of SROC, pre-test probability, post-test probability were (0.81, 95%CI 0.76 to 0.85), (0.87, 95%CI 0.81 to 0.91), (6.37, 95%CI 4.37 to 9.30), (0.22, 95%CI 0.17 to 0.27), (29.58, 95%CI 18.53 to 47.22), (0.89, 95%CI 0.86 to 0.92), 20.00% and 61.00%, respectively. (3) Subgroup analysis showed that there was no difference in AUROC of different types of cardiac magnetic resonance, but significant difference was found in AUROC of 1.5T and 3.0T magnetic field intensity.ConclusionsCurrent evidence shows that, compared with gold standard, cardiac magnetic resonance can be regarded as an effective and feasible method for preoperative staging of breast cancer.
Objective To provide methodological guidance for the application of matching-adjusted indirect comparison (MAIC). Methods The methodology literature on MAIC was examined to clarify key steps and methodological points, and MAIC application literature in the non-small cell lung cancer field published after January 2016 was systematically reviewed to compare and analyze the current status and problems of MAIC. Results MAIC consisted of five key steps: data source and sample selection, matching variable screening, individual weight calculation, matching validity evaluation, and relative efficacy calculation. The systematic review revealed that studies primarily employed literature reviews to screen data sources, used statistical analysis and other scientific methods to screen matching variables, employed software for individual weight calculation, evaluated matching validity by reporting effective sample size (ESS), calculated relative efficacy using Cox, logistic, and other models, conducted sensitivity analyses to evaluate the uncertainty caused by different data sources and matching variable combinations, and the studies demonstrated good overall reporting standardization but significant differences in particular aspects. Concerning the connection between MAIC and pharmacoeconomic research, studies included mainly used target drugs as the reference group of survival data extrapolation, and proportional hazards (PH) assumptions were considered when utilizing hazard ratios (HR) in extrapolation. Conclusion There are some deficiencies in the method application and reporting standards of MAIC research, such as lack of explanation of data source selection criteria and matching variable screening criteria, insufficient reporting of weight distribution, and inadequate consideration of PH assumptions. It is recommended that future MAIC research systematically screen data sources and report covariate distribution evaluation, covariate status evaluation, weight distribution, uncertainty measurement, etc. Additionally, considering PH assumptions after calculating HR is suggested.
To compare the effectiveness between open reduction combined with internal fixation and artificial radial head replacement in treating Mason type-III comminuted fracture of radial head, to provide the evidence for available treatment methods. Methods Between January 2004 and June 2008, 65 cases of Mason type-III comminuted fractures were treated with open reduction, AO mini plate and screw system or a combination of Kirschner treatment (internal fixation group, n=35) and with artificial radial head replacement (replacement group, n=30). In internal fixation group, there were 21 males and 14 females with an age range of 21 to 35 years (mean, 30.7 years); the causes of injury were traffic accidentin 12 cases, fall ing from height in 8 cases, and a fall in 15 cases; the locations were left side in 23 cases and right side in 12 cases; and the time between injury and surgery was 1-7 days (mean, 3 days). In replacement group, there were 19 males and 11 females with an age range of 23 to 67 years (mean, 32.5 years); the causes of injury were traffic accident in 7 cases, fall ing from height in 8 cases, and a fall in 15 cases; the locations were left side in 17 cases and right side in 13 cases; and the time between injury and surgery was 1-6 days (mean, 1.5 days). There was no significant difference in gender, age, disease cause, disease duration, or other general information between 2 groups (P gt; 0.05), so that 2 series of patients had comparabil ity. Results Incisions healed primarily in 2 groups. All patients were followed up 1 to 4 years with an average of 2.5 years. There were significant differences in elbow flexion angle, extension angle, and forearm rotation angle between 2 groups (P lt; 0.05), but no significant difference in elbow pronation or supination weakness (P gt; 0.05). In internal fixation group, primary union occurred in 29 cases, delayed union in 2 cases, nonunion with ectopic ossification in 2 cases, and internal fixation failure in 2 cases. In replacement group, elbow flexion angle lost beyond 30º in 1 case after 1 year, elbow stiffness occurred in 1 case because prosthesis was too long. According to Broberg and Morrey elbow scores system, the scores were 69.51 ± 10.23 in internal fixation group and 81.55 ± 12.06 in replacement group, showing significant difference (P lt; 0.05). The results were excellent in 15 cases, good in 5 cases, fair in 11 cases, and poor in 4 cases with an excellent and good rate of 57.1% in internal fixation group; the results were excellent in17 cases, good in 5 cases, fair in 6 cases, and poor in 2 cases with an excellent and good rate of 73.3%. Conclusion Artificial radial head replacement can achieve better joint function compared with open reduction combined with internal fixation in treating Mason type-III comminuted fractures of radial head.