ObjectiveTo review the advancement made in the understanding of valgus impacted proximal humeral fracture (PHF). MethodsThe domestic and foreign literature about the valgus impacted PHF was extensively reviewed and the definition, classification, pathological features, and treatment of valgus impacted PHFs were summarized. Results PHF with a neck shaft angle ≥160° is recognized as a valgus impacted PHF characterized by the preservation of the medial epiphyseal region of the humeral head, which contributes to maintenance of the medial periosteum’s integrity after fracture and reduces the occurrence of avascular necrosis. Therefore, the valgus impacted PHF has a better prognosis when compared to other complex PHFs. The Neer classification designates it as a three- or four-part fracture, while the AO/Association for the Study of Internal Fixation (AO/ASIF) categorizes it as type C (C1.1). In the management of the valgus impacted PHF, the selection between conservative and surgical approaches is contingent upon the patient’s age and the extent of fracture displacement. While conservative treatment offers the advantage of being non-invasive, it is accompanied by limitations such as the inability to achieve anatomical reduction and the potential for multiple complications. Surgical treatment includes open reduction combined with steel wire or locking plate and/or non-absorbable suture, transosseous suture technology, and shoulder replacement. Surgeons must adopt personalized treatment strategies for each patient with a valgus impacted PHF. Minimally invasive surgery helps to preserve blood supply to the humeral head, mitigate the likelihood of avascular necrosis, and reduce postoperative complications of bone and soft tissue. For elderly patients with severe comminuted and displaced fractures, osteoporosis, and unsuitable internal fixation, shoulder joint replacement is the best treatment option. ConclusionCurrently, there has been some advancement in the classification, vascular supply, and management of valgus impacted PHF. Nevertheless, further research is imperative to assess the clinical safety, biomechanical stability, and indication of minimally invasive technology.
Through summarizing the definition, concept, and development of patient registry, and also retrieving ClinicalTrials.gov, we introduce its application areas, application range, disease, research number. Based on the application situation, we present the challenges faced now and future development of direction.
Bias in clinical trials or systematic reviews may result in overestimation or underestimation of the benefits or harms of the interventions, and conclusions may be false. Meta-epidemiological study is an important tool to identify and quantify the impact of potential bias characteristics, and it can provide empirical evidence for controlling the bias. This paper summarized the origin, development and definition of the meta-epidemiology study, and discussed the challenges and development trends, so as to provide references for carrying out the meta-epidemiological studies.
ObjectiveTo systematically review the current status of doctor-patient conflicts in China.MethodsWe searched CNKI and CSSCI databases to collect literatures about the doctor-patient conflicts from inception to April 23rd, 2017. The literatures were categorized by the published time, the high-frequency vocabulary, the citation frequency, the researching discipline, the researching facility, the quality of literature, the theme of literature and so on. The current research status of the doctor-patient conflicts was analyzed.ResultsA total of 226 literatures were included, in which 72 defined and classified the doctor-patient conflicts, 122 analyzed the causing reasons of doctor-patient conflicts, and 160 analyzed the governance paths of doctor-patient conflicts. The research disciplinary vision was limited to the policies, regulations and the medical education and so on, and the researches in psychology or economics disciplinary vision were insufficient. The medical and comprehensive universities were the main research units of the studies of the doctor-patient conflicts. The frequency and quality of the researches about doctor-patient conflicts were low.ConclusionThe classified studies of doctor-patient conflicts are insufficient, so the scientific and manageable classified criterions are needed in the further studies. Systematic studies in influential factors of doctor-patient conflicts are insufficient, so the occurring mechanisms of conflicts are needed to be done by systematical researches on patient-centered way. The studies of governance paths of doctor-patient conflicts are insufficient, so the strategies of classified and systematical management which according to the different conflicting forms and entire process of the conflict occurrence should be put forward.
Lifestyle medicine is an emerging medical specialty of 20-year-history. It is more cost effective and environmentally friendlier in managing chronic health conditions of individuals and populations than the conventional allopathic medicine. By summarizing the development, implementation and prospects of lifestyle medicine in America, this paper aims to contribute to the advancement of lifestyle medicine in China.
ObjectiveTo summarize the terms and definitions related to neurofibromatosis type 1 (NF1) with a view to standardizing and unifying the existing terminology system. Methods To review the research literature related to NF1 at home and abroad, and to summarize the expressions of the disease and related terms. Results There are still some limitations in the current knowledge of NF1, especially in the expression of the terminology, and there are discrepancies in the description and naming of NF1-related features in different medical literatures and clinical guides. There are differences in the description and naming of NF1-related features in different medical literature and clinical guidelines. Through a systematic review of the literature, this paper provides a detailed compendium and summary of the terms and definitions of NF1-related clinical manifestations, pathological features, and genetic types, and further standardizes and unifies existing diagnostic criteria and terminology systems. ConclusionThe terms and definitions of NF1-related clinical manifestations are summarized to enhance the knowledge of clinicians and researchers related to NF1.
Objective To further comprehend the definition， molecular mechanism， and clinical significance of perineural invasion （PNI） so as to explore new therapy for the tumors. Methods The literatures about the definition， molecular mechanism， and clinical study of PNI were reviewed and analyzed. Results At present， widely accepted definition of PNI was that at least 33% of the circumference of the nerve should be surrounded by tumor cells or tumor cells within any of three layers of the nerve sheath. The newest theory on molecular mechanism of PNI was that PNI was more like infiltration， invasion， not just diffusion. “Path of low-resistance” and “Reciprocal signaling interactions” were the main theories. More recently， the studies had demonstrated that “Reciprocal signaling interactions” could more clearly explain the mechanism of PNI. Stromal elements， including fibroblasts， seemed to play a key role in the complex signaling interactions driving PNI. Neurotrophins and axonal guidance molecules had been implicated in promoting the progress of PNI. PNI was a prognosis index in the cancers of the head and neck， stomach， pancreas， colon and rectum， and prostate， which was positive indicated that the patients would have a poor prognosis and a low 5-year survival rate. Conclusions The mechanism of PNI is very complex， and its clear mechanism is still undefined. Keeping on researching the mechanism of PNI could provide theoretical foundation to disclose the mechanism and the therapy of PNI.
目的 评估国际抗癫痫联盟（ILAE）耐药癫痫定义专家共识在发展中国家、发展中地区应用的可行性及应用中存在的问题。 方法 2010年12月9日－2011年2月18日，连续登记癫痫专科门诊患者409例。共纳入183例患者，根据ILAE耐药癫痫新定义对每位纳入患者癫痫分类进行评估。 结果 耐药癫痫患者18例（8.7%），临床治愈患者29例（14.1%），不能判断为159例（77.2%）。入组患者共涉及癫痫药物治疗方案321项。根据ILAE定义步骤一分类为不确定的治疗方案共有199项（62.00%），其中数量最多的为服药剂量＜50% WHO限定日剂量有157例（78.89%）。 结论 由于治疗剂量未能够达到国际统一标准，大量患者分类不明确，使得该共识应用面临巨大挑战，但目前为止该共识对于发展中地区耐药癫痫治疗有很强的指导促进意义，对未来耐药癫痫的早期识别有非常大的应用潜力。