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.
Objective To compare the cl inical results of two plating osteosynthesis techniques, open reduction and plating ostosynthesis (ORPO) and minimal invasive plating osteosynthesis (MIPO), in surgical treatment of mid-distal humeralshaft fractures. Methods From March 2004 to October 2006, 40 cases of closed unilateral mid-distal humeral shaft fractures were surgically treated with MIPO or ORPO. In the MIPO treated group (n=19), there were 14 males and 5 females, with a mean age of 39.05 years. Fractures involved in middle humeral shaft in 10 cases and distal fragment in 9 cases. According to OTA classification, there were 3 cases of type A, 13 cases of type B and 3 cases of type C. Four cases compl icated by radial nerve palsies. In the ORPO treated group (n=21), there were 13 males and 8 females with a mean age of 39.05 years, including 14 cases of type A and 7 cases of type B fractures according to OTA classification. The fractures involved in middle humeral shaft in 13 cases and distal fragment in 8 cases. Five cases compl icated by radial nerve palsies. The time from injury to operation in both groups were 2 to 14 days. For patients in the MIPO group, fractures were closely reduced and fixated with an anterior placed plate inserted through two small incisions made at the anterior side of arm, away from fracture sites. The radial nerves were not exposed. For patients in the ORPO group, fractures were exposed, reduced, and fixated with an anterolateral or a posterior positioned plate after careful dissection and protection of radial nerve through an anterolateral or a posterior approach. The operation time, the occurrence of iatrogenic radial nerve palsy and the bone heal ing time were recorded. The functions of the affected shouldersand elbows were evaluated with UCLA end-result score and Mayo elbow perform index (MEPI), respectively. Results All the wounds in both groups healed primarily. There was no iatrogenic radial nerve palsies in the MIPO group after surgery; however, 5 cases of transient iatrogenic radial nerve palsies were identified in the ORPO group after surgery, and the function of radial nerve recovered in these cases at the last follow-up. Eighteen cases were followed up 14-44 months (mean 25.44 months) in MIPO group, and 19 cases were followed up 13-48 months (mean 32.11 months) in ORPO group. The mean bone heal ing time was 17.06 (12-32) weeks in MIPO group and 16.11 (8-58) weeks in ORPO group, showing no significant difference between two groups (P gt; 0.05). There was no nonunion and hardware failure in both groups. The mean forward flexion of the shoulder was 166.94° (150-170°) in MIPO group and 164.74° (130-170°) in ORPO group. The mean UCLA shoulder score was 34.78 (33-35) points in MIPO group and 34.42 (30-35) points in ORPO group. The mean range of motion of the elbow in MIPO and ORPO groups was 133.33° (120-140°) and 136.7° (120-140°), respectively. The MEPI in these two groups was 99.44 (90-100) and 99.74 (95-100) points, respectively. There was no statistically significant difference between two groups in all indexes mentioned above. Conclusion The good results could be obtained when ORPO and MIPO technique are appl ied to treat mid-distal humeral shaft fractures. MIPO technique has advantages to not expose the radial nerve and to decrease the occurrence of iatrogenic radial nerve palsies.
ObjectiveTo summarize the current comparison of the efficacy of different treatments for recurrent hepatocellular carcinoma.MethodTo search the literatures about the comparative studies on the efficacy of different treatments for recurrent hepatocellular carcinoma in recent years and analyze them.ResultsIn the treatment of recurrent hepatocellular carcinoma, percutaneous arterial chemoembolization combined with radiofrequency ablation could improve the survival rate and tumor-free survival rate to some extent, compared with the single use of percutaneous arterial chemoembolization. In the short term, there was no difference in efficacy between radiofrequency ablation and surgical resection, but the local recurrence rate of radiofrequency ablation was higher than that of surgical resection group. Salvage liver transplantation offered potential opportunity to reduce the risk of recurrence and tended to improve long-term survival outcomes, but liver sources were scarce and costly. ConclusionsAt present, there is no systematic staging scheme and treatment system for recurrent hepatocellular carcinoma. At the same time, most studies are retrospective, and more prospective studies are needed to further explore the treatment of recurrent hepatocellular carcinoma.
Objective To compare the clinical effects of treating prolapse of the cervical intervertebral disc by the Solis cage fusion, the titanium cage fusion or the autogenous iliac crest graft combined with the titanium plate fixation. Methods Sixty-four patients with prolapse of the cervical intervertebral discadmitted to hospital from February 2002 to May 2005 were retrospectively analyzed. In Group A, 20 patients (15 males and 5 females, aged 38.76 years, 30 intervertebral spaces) were treated with the Solis cage fusion, and the preoperative JOAscores were 9-16, averaged 11.4; in Group B, 21 patients (15 males and 6 females,aged 37-78 years, 23 intervertebral spaces) were treated with the titanium cagefusion, and the preoperative JOA scores were 8-13, averaged 10.1; in Group C, 23 patients (18 males and 5 females, aged 32-76 years, 28 intervertebral spaces)were treated with the autogenous iliac crest graft combined with the titanium plate fixation, and the preoperative JOA scores were 9-14, averaged 10.6. The comparative analysis was made among the 3 groups in the following aspects: X-ray exposure time, time working on the iliac bone, operation time, hemorrhage amount，complication incidence after operation, cervical vertebral fusion rate, symptom relief rate, and recovery rate of the JOA score. Results According to the follow-upfor 2-15 months averaged 12 months, the time working on the iliac bone was longer in Group C than in Groups A and B (11.5±2.4 vs 4.1±1.7 minand 4.2±1.9 min, P＜0.05); the operation time was longer in Group C than in Groups A and B (98.3±14.7 min vs 55.5±10.3 min and 56.8±12.6 min, P＜0.05); and the X-ray exposure time was longer in Group C than in Groups A and B (7.8±1.8 min vs 4.3±1.2 min and 4.2±1.3 min, P＜0.05). Also, the hemorrhage amount in Group C was much greater than in Groups A and B (145.8±19.3 ml vs 65.8±10.2 ml and 67.2±12.3 ml,P＜0.05). The postoperative complication rate was lower in Groups A and Bthan in Group C (P＜0.05). There was a significant difference in the complication rate in the cervical region between Group A (5.0%±1.8%) and Group B (14.3%±2.6%,Plt;0.05）. The fusion rate in Groups A and B was 100% 3-4 monthsafteroperation, and there was no difference when compared with that in Group C. The recovery rates of the JOA scores in the three groups were 81.9%±3.2%，78.9%±7.3%, and 76.3%±9.4%, respectively, and there was no significant difference among the three groups. Conclusion The Solis cage fusion has a better therapeutic effect in treating prolapse of the cervical intervertebral disc than the titanium cage fusion and the autogenous iliac crest graft combined with the titanium plate fixation. The Solis cage fusion also makes the operation easier, with a more rapid recovery rate and fewer postoperative complications in the patient.
In 2025, the American Cancer Society published "Cancer statistics, 2025", which projected cancer data for the upcoming year based on incidence data collected by central cancer registries (through 2021) and mortality data obtained from the National Center for Health Statistics (through 2022). Similarly, the National Cancer Center of China released "Cancer incidence and mortality in China, 2022" in December 2024, analyzing data from 22 cancer registries across the country. This study provides a comparative analysis of cancer incidence and mortality trends in China and the United States during the same period, with a focus on sex- and age-specific distributions and long-term changes in cancer patterns. Long-term trends indicate that lung and liver cancer mortality rates in China have declined, primarily due to tobacco control measures and hepatitis B vaccination programs. However, the burden of gastric and esophageal cancers remains substantial. In the United States, mortality rates for colorectal and lung cancers have continued to decline, largely attributed to widespread screening programs and advances in immunotherapy. As economic growth and social development, China’s cancer profile is gradually shifting towards patterns observed in countries with high human development index. However, the prevention and control of upper gastrointestinal cancers remains a critical public health challenge that requires further attention.
Objective To summarize the description about the pure noninvasive breast carcinoman in guidelines. Methods The related guidelines and literatures about the pure noninvasive breast carcinoma were collected to make a review. Results Through reviewing the guidelines of breast carcinoma, including Chinese Anti Cancer Association (CACA), National Comprehensive Cancer Network (NCCN), St.Gallen, European Society for Medical Oncology Clinical Practice Guidelines for Diagnosis, Treatment and Follow-up, as well as Japanese Breast Cancer Society Clinical Practice Guideline, we find that, the main treatment of noninvasive breast carcinoma is operation and the surgery for axillary is not recommended by most guidelines. The sentinel lymph node biopsy (SLNB) should be performed only when the invasive ductal carcinoma (IDC) is suspected or location of lesion would decrease the success of SLNB in the future. The radiotherapy should be advised to patients following conservation surgery. The patients with estrogen receptor (ER)-positive should undergo endocrine therapy. However, the using of endocrine therapy should be discussed with patient. Conclusions Although the prognosis of pure noninvasive breast carcinoma is better than invasive cancer, the research about it is still less, and the treatments recommended by guidelines are different. The more attention should be paid to the research about the pure noninvasive carcinoma.
With the increase in the number of single-arm clinical trials and lack of head-to-head clinical studies, the application of unadjusted indirect comparisons and network meta-analysis methods has been limited. Matching-adjusted indirect comparison (MAIC) is an alternative method to fully utilize individual patient data from one study and balance potential bias caused by baseline characteristics differences in different trials through propensity score matching with aggregated data reported in other studies, and complete the comparison of the efficacy between target interventions. This study introduced the concept and principles of MAIC. In addition, we demonstrated how to use the anchored MAIC method based on R language for survival data, which has been widely used in anti-cancer drug evaluation. This study aimed to provide an alternative method to inform evidence-based decisions.
Objective To compare the long-term results between theMckay procedure and the musclestrength balancing procedure in treatment of congenital clubfoot (CCF).Methods Thirty-seven children with 54 clubfeet were treated by the muscle-strength balancing procedure (31 feet) or the Mckay procedure (23 feet).There were 27 males (38 feet) and 10 females (16 feet). The average age at the time of surgery was 1.2 years (range, 5 months to 3.5 years). The deformity occurred on the left side in 7 patients, on the right side in 13, and on both sides in 17. During the musclestrength balancing procedure, the anterior tibial tendonwas transplanted to the middle or the lateral cuneiform, and the Achilles tendon was lengthened. During the Mckay procedure, the complete releasing of the softtissues and the lengthening of the tendons were performed routinely; in addition, the abductor hallucis was also excised. The clinical outcomes were evaluated with the Diméglio classification method. According to the Diméglio scoring system, 3 clubfeet were at Grade Ⅱ (score, 6-10); 26 clubfeet at Grade Ⅲ (score, 11-15); 25 clubfeet at Grade Ⅳ (score, 16-20). Based on the Diméglio grading system, all the patients were divided into two groups before operation. Group Aconsisted of 29 feet at Grade Ⅱ or Ⅲ (score, 12.55±1.84); Group B consistedof 25 feet at Grade Ⅳ (score, 17.20±1.08). The score in the group undergoingthe musclestrength balancing procedure was 14.16±2.83, and the score in the group undergoing the Mckay procedure was 15.43±2.63. Results All the patients were followed up for an average of 8.2 years (range, 5.0-10.5 years). According to the Diméglio grading system, 32 patients were at Grade Ⅰand 22 patients at Grade Ⅱ, and none of the patients at Grade Ⅲ or Ⅳ. Two patients undergoing the Mckay procedure developed the postoperative incision infection, but the incision wound healed after the dressing changes. The Diméglio score was 4.07±1.25 in Group A and 6.52±1.74 in Group B after operation, with a significant difference when compared with before operation (Plt;0.05). In Group A the two procedureshad no significant difference in effectiveness (Pgt;0.05); however, in Group B they had a significant difference (Plt;0.05). Judging by the correction degrees for the deformity on the different planes, the two procedures had no significant difference for correcting the equinus of hind foot (Pgt;0.05); however, in the correction degrees for the cross-foot and supination or adduction of the anterior foot, the Mckay procedure was significantly finer than the muscle-strength balancing procedure. It has a good biocompatibility. The mechanical test has showed that the Mckay procedure had the best result in the correction of the forefoot adduction. Conclusion For treatment of congenital clubfoot at Grades Ⅰ-Ⅲ, the musclestrength balancing procedure can achieve an excellent correction result; for treatment of congenital clubfoot at Grade Ⅳ, the Mckay procedure should be performed. No matter whichprocedure, the abductor hallucis excision is recommended to prevent poor correction for the anterior foot adduction.
ObjectiveTo investigate the status of research and development methods of Cochrane overviews. MethodsThe Cochrane Library and PubMed were searched up to March 2014 to identify Cochrane overviews. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed and analyzed search strategy, quality assessment method, data analysis, and study results. ResultsA total of 18 Cochrane overviews were included. Among them, 4 (22.2%) overviews included formal statistical indirect comparison; 8 (44.4%) included only results from direct comparison; 6 (33.4%) only systematically analyzed current studies without data pooling; 12 (66.7%) only searched The Cochrane Library, while 6 (33.3%) expanded search to other databases; 14 (77.8%) applied the AMSTAR tool to assess methodological quality of included literature; 12 (66.7%) applied the GRADE system to assess the quality of evidence; and 9 (50%) yielded new outcomes. ConclusionCurrently, the development and reporting standards of Cochrane overviews are still immature. Investigators should choose proper methods based on research objectives when developing Cochrane overviews.
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.