Objective To compare the effectiveness of simultaneous and delayed repair of combined full-thickness rotator cuff rupture in proximal humerus fracture. Methods Between January 2015 and January 2017, 44 patients with proximal humerus fractures complicated with full-thickness rotator cuff injuries were included. Twenty-four patients underwent open reduction and internal fixation (ORIF) and rotator cuff repair simultaneously (simultaneous operation group), and 20 patients underwent delayed arthroscopic rotator cuff repair more than 90 days after ORIF (delayed operation group). There was no significant difference in gender, age, cause of injury, and side of injury between the two groups (P>0.05). The fracture healing was observed by X-ray films. The shoulder function was assessed at 3, 6, and 12 months after operation by using the University of California at Los Angeles (UCLA) score. Results All incisions healed by first intention. All patients were followed up 12-24 months (mean, 17 months). Fractures all healed at 3 months after operation in simultaneous operation group. According to UCLA score, the patients had achieved significantly better outcomes in function, active forward flexion, strength of forward flexion, and subjective satisfaction in simultaneous operation group than in delayed operation group at 3, 6, and 12 months after operation (P<0.05). However, there was no significant difference in pain between the two groups (P>0.05). Conclusion For patients with proximal humerus fracture complicated with full-thickness rotator cuff rupture, performing ORIF and simultaneous repair of rotator cuff can improve shoulder function and achieve better effectiveness when compared with delayed repair of rotator cuff.
Current guidelines recommend follow-up observation for moderate aortic stenosis (MAS), but clinical evidence shows that its prognosis is poor, especially when combined with left ventricular systolic dysfunction, the risk of death and hospitalization for heart failure is significantly increased. With the technical maturity and device development of transcatheter aortic valve replacement (TAVR), its therapeutic potential in MAS has attracted attention. This paper systematically reviewes the risk stratification indicators of MAS and the clinical research results of early TAVR intervention, and analyzes the key clinical issues such as patient selection and operation timing. It points out that early TAVR may improve the prognosis and quality of life of some high-risk MAS patients, but its wide clinical application still needs more evidence-based medical evidence support.
Objective To compare the effectiveness of early versus delayed closed reduction and percutaneous Kirschner wire fixation in the treatment of pediatric supracondylar humerus fractures. Methods A retrospective analysis was conducted on 468 children with supracondylar humerus fractures, who were admitted between January 2020 and December 2023 and met the inclusion criteria. Among them, 187 children were treated during 12 hours after injury (early operation group) and 281 were treated after 12 hours (delayed operation group). There was no significant difference between the two groups (P>0.05) in the gender, age, injury mechanism, fracture side and type, while there was significant difference in interval from injury to operation (P<0.05). The operative outcomes, including the operation time, intraoperative blood loss, the length of hospital stay, fracture healing time, elbow function assessed by Flynn criteria at 3 months after operation, and complications, were compared. Results Compared to the delayed operation group, the early operation group demonstrated significantly shorter operation time and less intraoperative blood loss (P<0.05). There was no significant difference in the length of hospital stay between the two groups (P>0.05). All children were followed up 3-12 months. The follow-up time was (6.7±2.9) months in the early operation group and (6.9±2.8) months in the delayed operation group, showing no significant difference between the two groups (P>0.05). There was no significant difference in the fracture healing time between the two groups (P>0.05). At 3 months after operation, the early operation group exhibited superior Flynn elbow functional outcomes to the delayed operation group (P<0.05). In the early operation group, there was 1 case of fracture non-union and 3 cases of cubital varus deformity after operation. In the delayed operation group, there was 1 case of nerve injury, 7 cases of fracture non-union, and 12 cases of cubital varus deformity after operation. There was significant difference in the incidence of complications between the two groups (P<0.05). One case of the early operation group and 10 cases of the delayed operation group underwent secondary operation, showing no significant difference in the incidence of secondary operation between the two groups (P>0.05). ConclusionFor pediatric supracondylar humerus fractures, early closed reduction and percutaneous Kirschner wire fixation can reduce operation time, minimize intraoperative blood loss and postoperative complications, and improve the functional recovery compared to delayed operation.
Intracranial hemorrhage (ICH) represents a severe complication of infective endocarditis (IE) and stands as a significant contributor to the poor prognosis associated with IE. Current guidelines suggested a delay of 4 weeks for cardiac surgery in patients with ICH, but these recommendations were based on insufficient clinical evidence, and recent studies have yielded different opinions. In this paper, we thoroughly reviewed relevant guidelines and their references in conjunction with 3 typical cases with IE and ICH, discussed the recommendations with controversy, and proposed a process for the management of IE with ICH.
ObjectiveTo evaluate optimal surgical timing of high ligation and ambulatory phlebectomy in treatment of primary great saphenous varicose vein. MethodsThe patients who met the inclusion criteria were divided into simple varicose vein (C2) group and soft tissue complications (C3-C4) group.All the patients were received high ligation and ambulatory phlebectomy.The surgery-related indexes,hospital costs,improvement of quality of life,postoperative recurrence rate were observed. ResultsAll the operations were successful.The operative time,the number of operative incision,and the hospital costs in the C2 group were significantly less than those in the C3-C4 group (P<0.05).The total postoperative complications rate in the C2 group was significantly lower than that in the C3-C4 group (P<0.05).The postoperative AVVQ score on month 3 in the C2 group was significantly lower than that in the C3-C4 group (P<0.05).The postoperative recurrence rate on month 3 had no statistical significance between these two groups (P>0.05). ConclusionsEarly stage (C2) is the optimal surgical timing of primary great saphenous varicose vein,benefits of surgery and health economics in early stage are significantly better than those in mid-advanced stage (C3-C4).It is suggested that surgery should be underwent at early stage in patients with primary great saphenous varicose vein.
Integrated TOF-PET/MR is a multimodal imaging system which can acquire high-quality magnetic resonance (MR) and positron emission tomography (PET) images at the same time, and it has time of flight (TOF) function. The TOF-PET system usually features better image quality compared to traditional PET because it is capable of localizing the lesion on the line of response where annihilation takes place. TOF technology measures the time difference between the detectors on which the two 180-degrees-seperated photons generated from positron annihilation are received. Since every individual crystal might be prone to its timing bias, timing calibration is needed for a TOF-PET system to work properly. Three approaches of timing calibration are introduced in this article. The first one named as fan-beam method is an iterative method that measures the bias of the Gaussian distribution of timing offset created from a fan-beam area constructed using geometric techniques. The second one is to find solutions of the overdetermination equations set using L1 norm minimization and is called L1-norm method. The last one called L2-norm method is to build histogram of the TOF and find the peak, and uses L2 norm minimization to get the result. This article focuses on the comparison of the amount of the data and the calculation time needed by each of the three methods. To avoid location error of the cylinder radioactive source during data collection, we developed a location calibration algorithm which could calculate accurate position of the source and reduce image artifacts. The experiment results indicate that the three approaches introduced in this article could enhance the qualities of PET images and standardized uptake values of cancer regions, so the timing calibration of integrated TOF-PET/MR system was realized. The fan-beam method has the best image quality, especially in small lesions. In integrated TOF-PET/MR timing calibration, we recommend using fan-beam method.
Acute kidney injury is a common complication in the critically ill patients with high morbidity and mortality. Continuous renal replacement therapy (CRRT) is one of the most important treatments for the disease. The timing of starting and stopping of CRRT is often a matter of choice for clinicians. Early stopping of CRRT may lead to inadequate treatment, recurrent disease and poor prognosis, while excessive treatment of CRRT may prolong the hospital stay, increase medical costs and increase the risk of CRRT-related complications. In order to illustrate the proper stopping time of CRRT, this paper summarizes the research progress of the clinical indicators and biomarkers by reviewing relevant domestic and foreign data.
Tricuspid regurgitation (TR) is a common cardiac valve disease in clinic. Traditional medical treatment can only relieve symptoms, while surgical operations, due to their large trauma and high risks, are difficult to cover high-risk patients who are elderly and with multiple comorbidities. Transcatheter tricuspid valve intervention (TTVI), as a new treatment strategy, provides a new choice for this group. In recent years, various devices for TTVI have emerged. This paper elaborates the characteristics of TR, the design characteristics of existing TTVI devices, relevant clinical research, and the comprehensive evaluation means of device selection, and points out the existing shortcomings and future development direction.
Recently, an editorial in Cell Research illuminated the concept of the curative time window for lung adenocarcinoma. Within this window, patients could achieve 100.0% 5-year or 10-year post-operative recurrence-free survival. Adenocarcinoma in situ and minimally invasive adenocarcinoma in pathology, as well as pure ground-glass opacity in radiology could be regarded as the curative time window. However, not all the patients can catch this time window. A precise understanding of this concept helps elevate the curative rate for lung cancer patients and mitigate the risks of overdiagnosis and overtreatment. This article delves into the accurate comprehension of the surgical curative time window for lung adenocarcinoma, proposed a clinical strategy for early-stage lung adenocarcinoma, and introduced clinical procedures comprising of this time window. It offers fresh insights into the timing of surgical interventions for lung adenocarcinoma.
Abstract: Ventricular septal rupture is a rare complication of acute myocardial infarction, but it can easily lead to such complications as acute heart failure and cardiac shock with sinister prognosis. Surgical treatment is a fundamental measure to improve the prognosis, and the selection of operation time is a key factor. The basic guiding principles of operation timing are as follows. Those patients who have acute heart failure and/or cardiac shock soon after the onset of ventricular septal rupture, and can not be controlled by nonsurgery therapy and are also unable to tolerate surgery, will die soon. For them, surgery treatment cannot be implemented because they have missed the optimal operation time. For those whose perforation was so small that they can be stably controlled by nonsurgery therapy, surgery treatment can be postponed for 1 to 4 weeks. However, emergency operation should be performed in time once the condition of the patients becomes unstable. For others, no matter in what state they are, surgical treatment should be implemented immediately.