Severe open tibiofibular fractures account for approximately 28.1% of all open fractures. Among them, Gustilo-Anderson type IIIB/C fractures present significant clinical challenges due to associated bone and soft tissue defects, high infection rates, and risk of amputation. Inadequate preoperative assessment may lead to suboptimal emergency surgical planning or intraoperative complications. Historically, external fixation was often preferred, but this approach has been associated with limitations such as restricted joint mobility, delayed bone union, joint stiffness, and disuse osteoporosis, resulting in poor functional recovery. With advancements of debridement techniques, standardization of antibiotic use, and popularization of early soft tissue coverage, early internal fixation has gained broader acceptance. Nevertheless, controversies persist regarding the choice of fixation method, timing of definitive fixation, use of reamed versus unreamed intramedullary nailing, and necessity of fibular fixation. To standardize the diagnosis and early management of severe open tibiofibular fractures, reduce complication rates, and improve functional recovery, the Society of Microsurgery of the Chinese Medical Association organized a panel of domestic experts to develop the Evidence-based guideline for the diagnosis and early fixation of severe open tibiofibular fractures ( version 2025), using evidence-based methodology. The guidelines provided 12 recommendations covering diagnostic and early fixation strategies of severe open tibiofibular fractures, aiming to provide clinicians with scientifically grounded and standardized guidance.

Objective:To clarify the prognostic significance of 1q21 amplification in multiple myeloma(MM),and explore the efficacy and prognosis of ixazomib in the treatment of MM patients with 1q21 amplification.Methods:A retrospective analysis of clinical data was conducted on 77 patients with newly diagnosed MM who were hospitalized in Zhongshan Hospital,Xiamen University from January 2010 to December 2022.To analyze the clinical features of MM patients with 1q21 amplification,evaluate the mitigation rate and survival treated with ixazomib-based regimens.Results:Among the 77 newly diagnosed MM patients,40 patients had 1q21 amplification,while 37 didn't.Multivariate Cox regression analysis revealed that 1q21 amplification was an independent risk factor affecting the prognosis of MM patients(P＜0.05).Compared to patients without 1q21 amplification,those with 1q21 amplification had poorer progression-free survival(PFS)and overall survival(OS)(both P＜0.05).When the 1q21 amplification ratio exceeded 66.7％,both PFS and OS were worse(P＜0.05).There were no statistical differences in the deep remission rate(≥VGPR),overall response rate and PFS between the 1 q21 amplification positive and negative groups treated with ixazomib-based regimens(P＞0.05),but OS showed a significant difference(P＜0.05).Among the patients who switched to ixazomib treatment from bortezomib,there was a statistically significant difference in the complete response rate(P＜0.05).Compared to other treatment regimens,ixazomib-based regimens resulted in a significant reduction in adverse reactions such as peripheral neuropathy(P＜0.05).Conclusion:Ixazomib-based chemotherapy regimens can overcome the poor prognosis associated with 1q21 amplification and improve mitigation rates and PFS in patients.Ixazomib has low incidence of adverse reactions,good safety profile and prolonged duration of therapy.

Objective To analyze the risk factors of tracheal reintubation after total aortic arch replace-ment and to provide evidence for the prevention of tracheal reintubation after total aortic arch replacement.Methods From January 1,2019 to June 31,2020,162 patients who underwent total aortic arch replacement in the Department of Cardiac Surgery of a tertiary grade-A hospital in Guangdong Province were randomly selected and divided into reintubation group(n=27)and control group(n=135)based on the occurrence of tracheal reintubation.The risk factors were analyzed by univariate and multivariate logistic regression.Results Among the 162 patients,27 cases(16.7%)had tracheal reintubation.Compared with those in the control group,the length of ICU stay and hospitalization cost in the reintubation group were significantly increased(P<0.001).Univariate analysis indicated that there were significant differences in terms of age,glomerular filtration rate,diabetes mellitus,venti-lator time,pulmonary infection,liver insufficiency,hypoxemia,delirium and cerebrovascular accident(P<0.05).Multivariate analysis showed age(OR=1.069,P=0.038),pulmonary infection(OR=5.227,P=0.047),delirium(OR=7.079,P=0.011),and ventilator use time(OR=1.006,P=0.001)were independent risk factors for tracheal reintubation after total arch replacement.A regression equation was established as follows:[Logit(P)=-8.885+0.066×age+1.654×pulmonary infection+1.957×delirium+0.006×time]of first ventilator use.The area under the ROC curve of the subjects in this model was 0.931(95%CI:0.884～0.979),P<0.001;The results of Hosmer-Lemeshow test(χ2=4.76 and P=0.782)indicated that the model had high accuracy.Conclusion Age,pulmonary infection,delirium and ventilator use time are independent risk factors for tracheal reintubation after total aortic arch replacement.

OBJECTIVE: Investigating the clinical efficacy of treating dorsally displaced distal radial double-column Die-punch fractures using a dorsal approach external fixator combined with Kirschner wires. METHODS: Retrospectively analyzed the clinical data of 15 patients with distal radial double-column Die-punch fractures treated with an external fixator combined with Kirschner wire between July 2020 and January 2023. There were 10 males and 5 females;6 cases on the left side and 9 on the right;age ranged from 22 to 76 years old. Recorded the preoperative and the final follow-up Cooney wrist function scores for the patients. The fracture healing time, and occurrence of complications were recorded. RESULTS: All 15 patients were followed up ranged from 12 to 16 months post-operation. All fractures achieved bony union, healing time ranging form 8 to 16 weeks. Not a single patient exhibited complications such as surgical site infection, fracture redislocation, or tendon injury. All individuals had their Kirschner wires and external fixation devices removed six weeks post-operatively and commenced rehabilitative therapy for wrist articulation. The Cooney wrist function scores at preoperative and ranged from 5 to 45 scores, at the latest follow-up ranged from 65 to 100 scores. At the final follow-up, the results were assessed as excellent in 10 patients, good in 4 patients, and fair in 1 patient. CONCLUSION The clinical efficacy of treating distal radial double-column Die-punch fractures using a dorsal approach external fixator combined with Kirschner wires is satisfactory.
Humans ; Male ; Female ; Middle Aged ; Adult ; External Fixators ; Bone Wires ; Aged ; Retrospective Studies ; Radius Fractures/physiopathology* ; Young Adult ; Fracture Fixation/methods*

Objective To analyze the risk factors of tracheal reintubation after total aortic arch replace-ment and to provide evidence for the prevention of tracheal reintubation after total aortic arch replacement.Methods From January 1,2019 to June 31,2020,162 patients who underwent total aortic arch replacement in the Department of Cardiac Surgery of a tertiary grade-A hospital in Guangdong Province were randomly selected and divided into reintubation group(n=27)and control group(n=135)based on the occurrence of tracheal reintubation.The risk factors were analyzed by univariate and multivariate logistic regression.Results Among the 162 patients,27 cases(16.7%)had tracheal reintubation.Compared with those in the control group,the length of ICU stay and hospitalization cost in the reintubation group were significantly increased(P<0.001).Univariate analysis indicated that there were significant differences in terms of age,glomerular filtration rate,diabetes mellitus,venti-lator time,pulmonary infection,liver insufficiency,hypoxemia,delirium and cerebrovascular accident(P<0.05).Multivariate analysis showed age(OR=1.069,P=0.038),pulmonary infection(OR=5.227,P=0.047),delirium(OR=7.079,P=0.011),and ventilator use time(OR=1.006,P=0.001)were independent risk factors for tracheal reintubation after total arch replacement.A regression equation was established as follows:[Logit(P)=-8.885+0.066×age+1.654×pulmonary infection+1.957×delirium+0.006×time]of first ventilator use.The area under the ROC curve of the subjects in this model was 0.931(95%CI:0.884～0.979),P<0.001;The results of Hosmer-Lemeshow test(χ2=4.76 and P=0.782)indicated that the model had high accuracy.Conclusion Age,pulmonary infection,delirium and ventilator use time are independent risk factors for tracheal reintubation after total aortic arch replacement.

Objective:To clarify the prognostic significance of 1q21 amplification in multiple myeloma(MM),and explore the efficacy and prognosis of ixazomib in the treatment of MM patients with 1q21 amplification.Methods:A retrospective analysis of clinical data was conducted on 77 patients with newly diagnosed MM who were hospitalized in Zhongshan Hospital,Xiamen University from January 2010 to December 2022.To analyze the clinical features of MM patients with 1q21 amplification,evaluate the mitigation rate and survival treated with ixazomib-based regimens.Results:Among the 77 newly diagnosed MM patients,40 patients had 1q21 amplification,while 37 didn't.Multivariate Cox regression analysis revealed that 1q21 amplification was an independent risk factor affecting the prognosis of MM patients(P＜0.05).Compared to patients without 1q21 amplification,those with 1q21 amplification had poorer progression-free survival(PFS)and overall survival(OS)(both P＜0.05).When the 1q21 amplification ratio exceeded 66.7％,both PFS and OS were worse(P＜0.05).There were no statistical differences in the deep remission rate(≥VGPR),overall response rate and PFS between the 1 q21 amplification positive and negative groups treated with ixazomib-based regimens(P＞0.05),but OS showed a significant difference(P＜0.05).Among the patients who switched to ixazomib treatment from bortezomib,there was a statistically significant difference in the complete response rate(P＜0.05).Compared to other treatment regimens,ixazomib-based regimens resulted in a significant reduction in adverse reactions such as peripheral neuropathy(P＜0.05).Conclusion:Ixazomib-based chemotherapy regimens can overcome the poor prognosis associated with 1q21 amplification and improve mitigation rates and PFS in patients.Ixazomib has low incidence of adverse reactions,good safety profile and prolonged duration of therapy.

Severe open tibiofibular fractures account for approximately 28.1% of all open fractures. Among them, Gustilo-Anderson type IIIB/C fractures present significant clinical challenges due to associated bone and soft tissue defects, high infection rates, and risk of amputation. Inadequate preoperative assessment may lead to suboptimal emergency surgical planning or intraoperative complications. Historically, external fixation was often preferred, but this approach has been associated with limitations such as restricted joint mobility, delayed bone union, joint stiffness, and disuse osteoporosis, resulting in poor functional recovery. With advancements of debridement techniques, standardization of antibiotic use, and popularization of early soft tissue coverage, early internal fixation has gained broader acceptance. Nevertheless, controversies persist regarding the choice of fixation method, timing of definitive fixation, use of reamed versus unreamed intramedullary nailing, and necessity of fibular fixation. To standardize the diagnosis and early management of severe open tibiofibular fractures, reduce complication rates, and improve functional recovery, the Society of Microsurgery of the Chinese Medical Association organized a panel of domestic experts to develop the Evidence-based guideline for the diagnosis and early fixation of severe open tibiofibular fractures ( version 2025), using evidence-based methodology. The guidelines provided 12 recommendations covering diagnostic and early fixation strategies of severe open tibiofibular fractures, aiming to provide clinicians with scientifically grounded and standardized guidance.

Objective To comprehensively excavate and analyze the research status,research hotspots and future trends of the literature related to the field of acupoint catgut embedding therapy for pain treatment in the CNKI database.Methods We searched the CNKI database from its establishment to June 2022,and scientifically analyzed the authors,keywords,and institutions of the included literature of acupoint catgut embedding therapy for pain treatment through specific algorithms of Citespace to generate a visual knowledge map.Results A total of 319 documents were included for statistical analysis,the number of publications in the field of acupoint catgut embedding therapy for the treatment of pain was generally on the rise,the number of publications by various authors was on the low side,and there was a lack of co-operation between the research teams,with the main institutions being the Guang'anmen Hospital,Chinese Academy of Chinese Medical Sciences,Affiliated Hospital of Youjiang Medical Universities of Nationalities and the Guangzhou University of Chinese Medicine,forming a 10-keyword clustering,and the hotspots of diseases under study were mainly mixed haemorrhoids,postoperative pain,low back and leg pain and dysmenorrhoea,etc..The main interventions were pure acupoint catgut embedding therapy and the combination of acupoint catgut embedding therapy and other acupuncture therapies,and the main research method was clinical research.Conclusion Acupoint catgut embedding therapy for the treatment of pain has a good development prospect,the future needs to deepen the clinical research,strengthen the mechanism research,pay attention to the joint use of acupoint catgut embedding therapy and other traditional Chinese medicine methods,and pay attention to the research of different thread materials.

Humans ; Retrospective Studies ; Tetanus/epidemiology* ; China/epidemiology*

OBJECTIVE: To investigate the efficacy of posterior axillary approach internal fixation for Ideberg Ⅰa andⅡ glenoid fractures. METHODS: From December 2018 to September 2021, 9 patients with lower part of glenoid fractures were treated by posterior axillary approach, including 3 males and 6 females, aged from 50 to 78 years old. All the fractures were closed fractures. According to Ideberg type of scapular glenoid fracture was type Ⅰa in 6 cases and type Ⅱ in 3 cases. AP and lateral X-ray films of scapula were taken at 6, 12 weeks and 6 and 12 months postoperatively. Constant-Murley and disabilities of the arm shoulder and hand (DASH), and other complications were recorded at the latest follow-up. RESULTS: Nine patients were followed up, ranged from 6 to 15 months. And bone healing was achieved in all 9 patients at the final follow-up, the healing time 3 to 6 months, Constant-Murley score at the final follow-up ranged from 55 to 96, and DASH score ranged from 3.33 to 33.33. Both of them were better than preoperative. CONCLUSION The posterior axillary approach internal fixation for Ideberg Ⅰa and Ideberg Ⅱ Glenoid fractures scapular fracture is satisfactory and worthy of clinical application.
Male ; Female ; Humans ; Middle Aged ; Aged ; Fractures, Bone/surgery* ; Fracture Fixation, Internal ; Shoulder/surgery* ; Scapula/surgery* ; Shoulder Fractures ; Fractures, Closed ; Treatment Outcome ; Retrospective Studies