Objective To compare the clinical efficacy of external fixator and locking plate internal fixation via middle volar minimally invasive approach in the treatment of distal radius fractures.Methods A retrospective case-control study was conducted on the clinical data of 51 patients with distal radius fractures admitted from October 2014 to August 2016.There were 21 males and 30 females,aged 41-78 years (mean,57 years).According to the random number table method,the patients were divided into minimally invasive plate group (25 cases) which adopted locking plate internal fixation via middle volar minimally invasive approach and external fixator group (26 cases) with closed reduction of external fixator.The AO classification of the fractures in minimally invasive plate group was as follows:A2 in four cases,A3 in five cases,B1 in four cases,B2 in two cases,B3 in seven cases,and C1 in three cases.The AO classification of the fractures in external fixator group was as follows:A2 in three cases,A3 in six cases,B1 in five cases,B2 in three cases,B3 in seven cases,and C1 in two cases.The total incision length,operation time,intraoperative blood loss,preoperative and postoperative radial height,palmar inclination angle,ulnar deviation angle,pain visual analogue score (VAS),wrist active motion range (palmar flexion,dorsal extension,pronation,supination,radial deviation,and ulnar deviation),relative contralateral grip force,and wrist function Mayo score were compared between the two groups.Results There were no significant differences in the total length of incision,operation time,intraoperative blood loss,VAS 3 d after operation,radius height,ulnar deviation,and radius height,palm inclination and ulnar deviation at 14 months after operation between the two groups (P ＞ 0.05).The palmar inclination was (9.6-± 0.6) ° in the minimally invasive plate group and (7.9 ± 0.6) ° in the external fixator group (P ＜ 0.05).The wrist active motion range (palmar flexion,dorsal extension,pronation,supination,radial deviation,and ulnar deviation) and relative contralateral grip strength 3 months after operation in the minimally invasive plate group were significantly better than those in the external fixator group (P ＜ 0.05).However,the Mayo score of wrist function at 14 months after operation was (88.7 ± 12.7)points in the minimally invasive plate group and (88.7 ± 13.1)points in the external fixator group (P ＞ 0.05).Minimally invasive plate group showed median nerve stimulation in one case.External fixator group showed redness around the nail,increased temperature,and increase secretion of the infection in one case,and joint stiffness in one case after external fixation removal.But all symptoms were improved or resolved after treatment.Conclusion Both locking plate via minimally invasive approach and external fixator can achieve good results in the treatment of distal radius fractures,but the former method has better effects on early functional recovery than the latter one.

Objective:To establish a predictive model of moderate to severe pain in patients with hepatocellular carcinoma (HCC) undergoing transcatheter arterial chemoembolization (TACE).Methods:264 patients with HCC who underwent TACE operation in Southern Medical University from January 2017 to April 2018 were selected as the modeling set. The pain was assessed by numeric rating scales. The patients were divided into pain group ( n=96) and non-pain group ( n=168) according to whether moderate to severe pain occurred within 24 hours after the operation. Binary Logistic regression analysis were performed for variables that were statistically significant in the univariate analyses. The predictive nomogram was constructed and the internal validation was performed. In addition, 87 patients with HCC who underwent TACE operation from January 2020 to June 2020 were selected as the validation set for external validation. Results:In the modeling set, 96 patients (36.36%) had moderate to severe pain within 24 hours after TACE operation in 264 patients with HCC, and the dosage of morphine intramuscularly injected within 24 hours was 1015 mg, with an average of 10.57 mg per patient. Multivariate Logistic regression analysis showed that preoperative pain, the distance between the tumor and capsule ≤2 cm, high prothrombin activity, dosage of lipiodol>10 ml, and several thromboembolic tumors were independent risk factors for moderate to severe pain after TACE ( P<0.05). Age>50 was the protective factor of moderate to severe pain after TACE ( P<0.05). The area under ROC curve was 0.799 (95% CI: 0.745-0.853) in the modeling set. The area under Roc curve for internal validation and external validation were 0.780 and 0.788, respectively. The calibration curves showed satisfactory agreements between the model predicted probability and the actually observed probability. Conclusion:The predictive model of moderate to severe pain after TACE was established in this study has good differentiation and accuracy, it has certain guiding significance for predicting the high-risk group of moderate to severe pain after TACE operation and formulating the targeted prevention strategy.

Tuochuang Shengji therapy (the therapy of supporting sores and generating muscle) belongs to the "tonic method" of internal treatment of TCM surgical sores and ulcers. Its meaning is to strengthen the healthy qi and discharge purulent, remove the rot and promote the growth of the muscle. The representative prescriptions include Tuoli Xiaodu Powder, Huangqi Decoction, Painong Neituo Powder, Shengong Neituo Powder, etc., mostly with Astragali Radix, Ginseng Radix et Rhizoma, Atractylodis Macrocephalae Rhizoma, Angelicae Sinensis Radix and other tonic drugs, supplemented by Gleditsiae Spina, Lonicerae Japonicae Flos and other anti-pathogenic factor drugs to strengthen the the healthy qi and discharge purulent. The main mechanism of Tuochuang Shengji method in the treatment of refractory wounds include anticoagulation in the hemostasis stage, anti-inflammation and bacteriostasis in the inflammation stage, promoting angiogenesis in the proliferation stage, and promoting granulation tissue growth and re-epithelialization in the remodeling stage. The existing research on the understanding of Tuochuang Shengji therapy is mostly the method of tonifying qi and supporting sores, and there is few related literature on the remaining treatment methods. In the future, the integrity and systematicness of TCM should be paid attention to, the multi-component analysis of Tuochuang Shengji compound and the continuous research on the upstream and downstream of signaling pathways should be strengthened, the quality of research should be improved.

Objective:To discuss the clinical features and prognostic factors of adrenal metastases.Methods:The clinical data of 37 patients with adrenal metastases admitted to the First Affiliated Hospital of Guangxi Medical University from May 2015 to August 2022 were retrospectively analyzed. There were 30 males and 7 females. The median age was 54 (43, 62) years old, including 13 cases aged ≥60 years old and 24 cases aged < 60 years old. There were 22 cases of right metastasis, 12 cases of left metastasis and 3 cases of bilateral metastasis. The maximum diameter of metastatic carcinoma was <3 cm in 10 cases, 3-6 cm in 18 cases, and >6 cm in 9 cases. There were 20 cases of synchronous metastasis (diagnosed with adrenal metastasis at the same time as the primary tumor) and 17 cases of metachronous metastasis (found after the diagnosis of primary tumor). There were 20 cases of adrenal metastasis alone and 17 cases of adrenal metastasis combined with other distant metastasis. 16 cases underwent adrenalectomy, 15 cases underwent adrenalectomy combined with other organ resection, and 6 cases underwent ultrasound-guided needle biopsy. 18 patients were treated with surgery alone, and 19 patients were treated with combined treatment (surgery, chemotherapy, radiotherapy, immunotherapy, targeted therapy, interventional therapy and seed implantation). There were 12 cases of hepatocellular carcinoma, 8 cases of renal clear cell carcinoma, 5 cases of lung adenocarcinoma, 2 cases of colon adenocarcinoma, 2 cases of neuroblastoma, 1 case of renal pelvis carcinoma, 1 case of gastric adenocarcinoma, 1 case of cholangiocarcinoma, 1 case of renal papillary cell carcinoma, 1 case of colon adenosquamous carcinoma, 1 case of thymic small cell carcinoma, 1 case of endometrial carcinoma, and 1 case of diffuse large B-cell lymphoma. The Kaplan-Meier method was used to draw the survival curve, the log-rank test was used to analyze the relationship between the clinical characteristics of patients and overall survival (OS) and progression-free survival (PFS), and the Cox proportional hazards regression model was used to analyze the factors affecting OS.Results:The median follow-up time of the 37 patients was 10 (4, 18.5) months.The overall survival rates at 6 months, 1 year and 2 years were 59.5% (22/37), 43.2% (16/37) and 32.4% (12/37), respectively. The 6-month, 1-year and 2-year overall survival rates of 18 patients who underwent surgery alone were 66.7% (12/18), 44.4% (8/18) and 27.8% (5/18), respectively. The 6 months, 1 year and 2 years overall survival rates of 19 patients with comprehensive treatment were 52.6% (10/19), 42.1% (8/19) and 36.8% (7/19), respectively. There was no significant difference in overall survival rate between the two groups ( P=0.773). Kaplan-Meier survival curve analysis showed that the side of metastatic cancer was a risk factor for OS ( P=0.012) and PFS ( P=0.013), and the time of diagnosis of metastatic cancer was a risk factor for OS ( P=0.021). Univariate Cox regression analysis showed that, time to diagnosis of metastases ( HR=2.5, 95% CI 1.1-5.4, P=0.021), side of metastases ( HR=3.6, 95% CI 1.5-8.5, P=0.004), pulmonary metastases ( HR=3.6, 95% CI 1.1-11.0, P=0.032) and adenocarcinoma of the primary tumor ( HR=3.2, 95% CI 1.2-8.8, P=0.025) were risk factors for OS. Multivariate Cox regression analysis showed that simultaneous presence of metastases ( HR=2.6, 95% CI 1.1-6.2, P=0.033) and metastases located on the left side ( HR=3.6, 95% CI 1.5-8.6, P=0.005) were independent risk factors for OS. Conclusions:Hepatocellular carcinoma is the most common pathological type of adrenal metastases in this study. Patients may benefit from combined therapy based on surgery. The time of diagnosis, side, tumor origin and pathological type of primary tumor are the prognostic factors of adrenal metastases. Simultaneous presence of metastases and left-sided metastases are independent risk factors for OS in patients with adrenal metastases.