Objective To investigate the mid- and long-term effectiveness of external fixator distraction arthroplasty in the treatment of moderate to severe ankle arthritis. Methods The clinical data of 23 patients with moderate to severe ankle arthritis treated with external fixation distraction arthroplasty who met the selection criteria between January 2007 and November 2019 were retrospectively analyzed. There were 20 males and 3 females; the age ranged from 21 to 65 years, with an average age of 43.7 years. Etiology included 8 cases of primary ankle arthritis, in which 5 cases combined with varus deformity; 15 cases of traumatic ankle arthritis, the cause of injury was 5 cases after ankle fracture surgery, 3 cases after Pilon fracture surgery, 5 cases of chronic ankle instability and repeated sprain, and 2 cases of other causes. According to Takakura staging system, there were 4 cases of stage ⅢA, 12 cases of stage ⅢB, and 7 cases of stage Ⅳ; according to Giannini staging system, there were 5 cases of stage Ⅱ and 18 cases of stage Ⅲ; according to Cheng staging system, 16 cases were in stage Ⅲ, and 7 cases stage Ⅳ. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analogue scale (VAS) score were used to evaluate the improvement of ankle pain and function before operation and at last follow-up, and the data were analyzed according to different etiological groups. At last follow-up, the surgical results were evaluated subjectively and objectively. The changes of ankle joint space before operation and at last follow-up were compared. The patients were divided into two groups according to their age: ≤45 years old group [young group, 10 cases, aged (35.62±7.41) years old] and >45 years old group [middle-aged and elderly group, 13 cases, aged (54.20±6.20) years old]. The AOFAS ankle-hindfoot score and VAS score were compared before and after operation between the two groups, and the influence of age on distraction arthroplasty was analyzed. ResultsThe external fixator was removed after 3 months of continuous distraction,12 patients got infection around the wire tunnels. All the 23 patients were followed up 13-143 months, with an average of 56.9 months; the follow-up time was (43.46±32.77) months and (69.80±37.79) months in the young group and middle-aged and elderly group, respectively. At last follow-up, the AOFAS ankle-hindfoot score and VAS score significantly improved when compared with those before operation (P<0.05). According to etiological analysis, there was no significant difference in AOFAS ankle-hindfoot score and VAS score before and after operation (P>0.05) in Pilon fracture patients, while the significant difference was found in remaining patients (P<0.05). There was significant difference in AOFAS ankle-hindfoot score before operation between the young group and the middle-aged and elderly group (t=2.110, P=0.040), but no significant difference in preoperative VAS score and the differences in VAS score and AOFAS ankle-hindfoot score before and after operation between the two groups (P>0.05). The subjective and objective results of pain evaluation at last follow-up showed that 4 patients had no pain, 12 patients had moderate pain relief, 5 patients had mild pain relief, and 2 patients had no significant pain relief; among the 10 patients who were followed up more than 5 years, there were 2, 5, 2, and 1 patient, respectively; 2 patients who were followed up more than 10 years had moderate pain relief. At last follow-up, the ankle joint space was (3.7±0.4) mm, which significantly increased when compared with before operation [(1.5±0.2) mm] (t=1.791, P=0.002). The ankle joint space was (2.9±0.5) mm in 10 patients who were followed up more than 5 years, and 3.3 mm and 3.0 mm in 2 patients who were followed up more than 10 years. Conclusion Distraction arthroplasty of the ankle joint can achieve satisfactory results in patients with moderate to severe ankle arthritis (except for arthritis caused by Pilon fracture), and age has no significant effect on distraction arthroplasty.
Objective To investigate the key risk factors for low anterior resection syndrome (LARS) within 6 months after rectal cancer surgery and to construct a risk prediction model based on the random forest algorithm, providing a reference for early clinical intervention. Methods A retrospective study was conducted on patients who underwent rectal cancer surgery at West China Hospital of Sichuan University between January 2020 and August 2021. A total of 394 patients were included. A prediction model for the occurrence of LARS within 6 months after rectal cancer surgery was constructed using the random forest algorithm. The dataset was divided into a training set and a test set in an 8:2 ratio. Model performance was evaluated by accuracy, sensitivity, specificity, area under the receiver operating characteristic curve (AUC), Brier score, and decision curve analysis (DCA). The SHAP (Shapley Additive Explanations) method was used to interpret the contribution of each variable. Results Among the 394 patients, 106 developed LARS within 6 months after surgery, with an incidence rate of 26.9%. According to the importance ranking in the random forest algorithm, the key predictors were: distance from the inferior tumor margin to the dentate line, body mass index (BMI), tumor size, time to postoperative flatus, operation time, age, neoadjuvant therapy, and TNM stage. The prediction model built using these key factors achieved an accuracy of 73.4%, sensitivity of 75.0%, specificity of 72.7%, AUC (95% confidence interval) of 0.801 (0.685, 0.916), and a Brier score of 0.198. DCA showed that the model provided favorable clinical benefit when the threshold probability was between 25% and 64%. Conclusion The results of this study suggest that patients with a shorter distance from the tumor to the dentate line, higher BMI, larger tumor size, and those receiving neoadjuvant therapy are at higher risk of developing LARS. The risk prediction model constructed in this study demonstrated good predictive performance and may provide a useful reference for early identification of high-risk patients after rectal cancer surgery.
Objective To investigate the effect of problem-based learning (PBL) used in the course of evidencebasedmedicine.Methods Totally eight classes were randomly assigned to the lecture based learning (LBL) group(n=4) and PBL group (n=4). The examination scores, questionnaire, and seminars were used to evaluate the teaching effectiveness. SPSS 11.5 software was used for statistical analysis. Results More than 50% of students in each group believed that the teaching method of PBL could activate learning enthusiasm and interest, improve problem analysis and independent study abilities. There were significant differences between the two groups in terms of comprehensive analysis, learning efficiency, digesting the contents of study and strengthening the teacher-student communication, and whether or not to perform PBL teaching. Apart from single choice questions, other types of examination questions and total scores have significant differences. Conclusions The PBL teaching model can effectively train undergraduateclinical thinking, cultivate the abilities of deconstructing problem, comprehensive analysis, literature retrieval, language expression, exploration innovation; and overall improve the teaching quality of evidence based medicine.
This is the third paper in the evidence-based medicine glossary series. We count terms and phrases having the words"evidence-based" in the title using bibliometrics. We then analyze the frequency of emergence, publication period, languages, and journal of the glossaries published. Finally, we focus on the link between the title and the glossary, and explore the development of trends in EBM.
ObjectiveTo summarize the injury characteristics and therapeutic strategy of patients injured in " 8·8” Jiuzhaigou earthquake.MethodsThe clinical data of 48 patients injured in " 8·8” Jiuzhaigou earthquake who were admitted to Mianyang Central Hospital were analyzed retrospectively. There were 25 males and 23 females with an average age of 36 years (range, 5-87 years). The average interval from injury to admission was 30 hours (range, 3-53 hours). The patients from Sichuan province accounted for 45.8% (22 cases), from other province for 52.1% (25 cases), and from abroad for 2.1% (1 case). Patients were primarily hurted by collapsing houses and flying stones. Thirty-seven patients (77.1%) had single injury, mainly involving 36 patients (75.0%) in limbs, and the other 11 patients (22.9%) had multiple injuries. Ten patients (20.8%) had open fractures, including 1 case rated as typeⅠ, 2 as typeⅡ, 3 as type Ⅲa, 2 as type Ⅲb, and 2 as type Ⅲc according to Gustilo classification criteria. The abbreviated injury scale (AIS) score was 2-3 in 37 patients of single injury, and the injury severity score (ISS) was 8-22 (mean, 13.2) in 11 patients of multiple injuries. Sixteen patients (33.3%) were diagnosed as mental disorders by Hamilton rating scale for anxiety (HAMA), including 8 cases had their anxiety scores≥29, 4 cases of 21-28, 3 cases of 14-20, and 1 case of 7-13. Of the 16 patients, 2 showed suicidal tendency.ResultsExcept 2 referrals, 30 patients received operation［28 patients (93.3%) for orthopaedic surgeries］and 16 patients received conservative treatment. The procedures included internal fixation, soft tissue debridement, external fixation, bipolar femoral head replacement, embolization of carotid cavernous sinus arteriovenous fistula, and amputation. Among the 46 patients treated in this hospital, 21 discharged from hospital at 2-12 days (mean, 6.7 days) after admission, the others received further rehabilitation in this hospital or local hospital. No undesirable consequence occurred in 16 patients with mental disorders. Five cases of infection occurred out of hospital were cured after debridement. No dead and nosocomial infection case reported.ConclusionIntensive treatment, specialist management, multidisciplinary team, and early intervention of nosocomial infection and deep venous thrombosis are the key to improve the general level of successful earthquake medical rescue.
