Objective:To compare the clinical efficacy of anchor repair versus screw fixation in the treatment of posterior malleolar fracture with distal tibiofibular syndesmosis injury.Methods:PubMed, Medline, Web of Science, ScienceDirect, CNKI, Wanfang, and Chinese Medical Journal Full-text Database were searched for articles on anchor repair versus screw fixation in the treatment of posterior malleolar fracture with distal tibiofibular syndesmosis injury. The search time was from the establishment of each database to April 2023. Literature screening, data extraction and literature quality assessment were performed independently by two researchers according to the inclusion and exclusion criteria, and meta-analysis of the included literature was performed.Results:A total of 7 articles were included in the meta-analysis, including 3 randomized controlled trials and 4 case-control studies. There were 280 cases treated with anchor repair and 312 cases treated with screw fixation. The results of meta-analysis showed that the number of fluoroscopy [ MD=-5.08, 95% CI (-9.20, -0.96), P=0.020], postoperative anterior inferior tibiofibular space [ MD=-0.93, 95% CI (-1.06, -0.81), P<0.001] and incidence of malposition [ OR=0.21, 95% CI (0.10, 0.46), P<0.001] in the anchor repair group were smaller than that in the screw fixation group, while postoperative recovery time were earlier than that in the screw fixation group [ MD=-2.22, 95% CI (-2.68, -1.75), P<0.001], postoperative ankle plantarflexion angle [ MD=2.77, 95% CI (0.28, 5.25), P=0.030], and postoperative 6 months of American Orthopedic Foot and Ankle Society score [ MD=5.85, 95% CI (2.05, 9.64), P=0.003] were greater than those of the screw fixation group. The operation time [ MD=-10.45, 95% CI (-24.25, 3.35), P=0.140], the American Orthopaedic Foot and Ankle Society score at 6 months after operation [ MD=0.09, 95% CI (-0.94, 1.11), P=0.860] and the postoperative ankle dorsiflexion angle [ MD=0.66, 95% CI (-0.75, 2.88), P=0.360] were not statistically different. Conclusion:Compared with screw fixation, fixation of anterior inferior tibiofibular ligament with anchor fixation has the advantages of less fluoroscopy, faster recovery time, better reduction quality, and higher ankle function score.

Background and aim:Real-world data on the effectiveness and safety of treatment with the direct-acting antiviral agent-based regimen are limited on the Chinese mainland.The aim of this study was to conduct a multicenter,prospective,real-world study of ombitasvir/paritaprevir/ritonavir(OBT/PTV/r)combined with dasabuvir(DSV)in hepatitis C virus(HCV)genotype 1b-infected non-cirrhotic or compensated cirrhotic Chinese adult patients. Materials and methods:Genotype 1b-infected patients were enrolled at eight sites in China.Patients received 25/150/100 mg of OBT/PTV/r once daily combined with 250 mg of DSV twice daily for 8 weeks or 12 weeks.Sustained virological response at 12 weeks post-treatment(SVR12)and the incidence of adverse events were assessed.We have also evaluated the effect of intensive questioning of patients who were overdue for SVR12 testing.Intention-to-treat(1TT)and modified 1TT(mITT)populations were used in the analysis. Results:One hundred forty patients were included,among whom 90.0％(126/140)were newly diag-nosed,9.3％(13/140)had compensated cirrhosis,92.9％(130/140)received 12 weeks of treatment,and 7.1％(10/140)received 8 weeks of treatment.In the mITT population,the virological response rate at week 4 was 96.4％(108/112),and at the end of treatment was 100％(102/102).Among these patients,139 patients completed 12 weeks of treatment,and 73 patients were followed-up.All followed-up patients achieved SVR12.There was no adverse event-related discontinuation.Serious adverse events during treatment were reported in two(1.4％)patients,and none were considered to be drug-related.Sixty-six(47.1％)patients did not return to receive the HCV RNA test at 12 weeks post-treatment. Conclusions:The rate of SVR12 was consistent with Phase Ⅲ clinical studies.OBT/PTV/r combined with DSV showed effectiveness in Chinese adult patients,and both tolerability and safety profile were favorable.However,patient compliance should be further improved in the real world.

Regardless of the cause of the chest wall defect, especially the extensive chest wall defect, if it cannot be effectively repaired and reconstructed, it may cause physiological and pathological changes such as chest wall softening, respiratory abnormalities and mediastinal oscillations. The main factors affecting the repair and reconstruction of the chest wall are the choice of reconstruction methods and materials. With the increasing understanding of chest wall defects, advances in reconstructive surgery techniques and the development of reconstructed materials, it has become possible to reconstruct many extensive chest wall defects that were previously impossible to complete. This article reviews the characteristics of chest wall defects, methods of repair, and current status and progress of reconstructed materials.

Esophageal cancer (EC) is the eighth dangerous cancer in the world. As the global population ages, the management of elderly patients with EC poses a challenge as they have many aging-associated diseases and physiological changes. In addition, the data on the tolerability of cancer treatment and the use of combined therapies in the patients to guide their treatment are limited. In this paper, we reviewed the literatures and discussed the effect of surgical resection and the potential complications of elderly patients. We reviewed the basic principles of combined therapy and the potential benefits of chemotherapy or chemoradiotherapy for patients and focused on the management of elderly patients with EC as well as the role of comprehensive assessment for aging to provide treatment options for elderly patients.

Thymoma; myasthenia gravis; thoracoscopy combined with mediastinoscopy; thymectomy Objective     To compare the different surgical treatment methods of thymoma combined with myasthenia gravis (MG), and to discuss the clinical effectiveness of thoracoscopic combined mediastinoscopic extended thymectomy. Methods     We retrospectively analyzed the clinical data of 58 patients of thymoma combined with myasthenia gravis in Northern Jiangsu People's Hospital between 2011 and 2016 year. According to the operation method, the patients were divided into three groups including a group A for thoracoscopic thymectomy (n=32), a group B for thoracoscopic combined mediastinoscopic thymectomy (n=15), and a group C for transsternal thymectomy (n=11). The clinical effects were observed and compared. Results     In the group A and the group B, the bleeding volume, postoperative hospital stay and other complications were significantly lower than those in the group C with statistical differences (P<0.05). The incidence of myasthenic crisis in the group B (6.7%) was less than that in the group C (36.4 %), but the difference was not statistically different (P=0.058). The operation time of the three groups was 122.0 ± 39.4 min, 130.3 ± 42.5 min, and 142.3 ± 40.8 min respectively with no statistical difference between the two groups (P>0.05). The rate of dissection grade in the group B (grade 1, 12 patients, 80%) was significantly greater than that in the group A (grade 1, 14 patients, 43.8%, P<0.05). The effective rate of the group A, the group B, the group C was 84.4%, 93.3% and 90.9%, respectively with no statistical difference between groups (P>0.05). Conclusion     The thoracoscopy combined mediastinoscopic thymectomy not only has the advantages of less trauma, quicker recovery and fewer complications, but also can more thoroughly clean the thymus and adipose tissue, which can achieve the same therapeutic effect as the transsternal thymectomy.

Objective To explore clinical implications of pleural effusion in thoracic endovascular aorta repair (TEVAR) of type B aortic dissection.Methods Clinical data of 28 patients (23 males,5 females) hospitalized from Jan 2015 to Dec 2016 were analyzed retrospectively.There were ruptured aortic dissection (RAD) (n =7) and the contained aortic dissection (CAD) (n =21).26 patients underwent TEVAR,and two patients received conservative treatment.Results 26 patients received TEVAR and operations were successful.2 patients treated conservatively died.Six patients had bilateral pleural effusion,while 20 had left pleural effusion and two had right pleural effusion.The distribution of pleural effusion was significantly different between CAD and RAD group (x2 =10.4,P ＜ 0.05),and the rupture risk was the highest in right sided pleural effusion.The median volume of pleural effusion on right side in RAD group are higher than that in CAD group (Z =-3.293,P =0.001).One patient died of sudden death on post-op 9th day.Pleural effusion disappeared in all 24 patients who were followed-up for more than 3 months.There were no ensuing pleural thickening,pulmonary atelectasis,and lung consolidation.Conclusious Pleural effusion on left side are common in type B aortic dissection,while bulk right pleural effusion may indicate impending rupture.Endovascular therapy is a feasible,safe and effective therapy for aortic dissection with pleural effusion.

Objective To explore the influence of multidimensional social support system on quality of life and psychological state for myasthenia gravis patients underwent VATS.Methods Phenomenological research design and in-depth interviews were conducted for 12 patients with myasthenia gravis in cardiothoracic surgery department in our hospital.And countermeasures were implemented.Results There were four themes drew from MG including the pressure and pains of patients,the difficulties in treatment period and daily life,social support was a great help for patients,adapting and adjusting to MG.Conclusion The quality of life for MG patients is generally lower than healthy people,and the generalized is worse than the ocular after VATS.Increasing the multi-dimensions social support,especially family and peer support is the key factor for the patient's postoperative quality of life.

Objective To explore the influence of multidimensional social support system on quality of life and psychological state for myasthenia gravis patients underwent VATS.Methods Phenomenological research design and in-depth interviews were conducted for 12 patients with myasthenia gravis in cardiothoracic surgery department in our hospital.And countermeasures were implemented.Results There were four themes drew from MG including the pressure and pains of patients,the difficulties in treatment period and daily life,social support was a great help for patients,adapting and adjusting to MG.Conclusion The quality of life for MG patients is generally lower than healthy people,and the generalized is worse than the ocular after VATS.Increasing the multi-dimensions social support,especially family and peer support is the key factor for the patient's postoperative quality of life.

Standard endovascular repair of iliac/aortoiliac pathologies can lead to complications, such as buttock claudication, colon ischemia and erectile dysfunction. Branch grafts have been developed but require at least 6 weeks for customization and are not currently available in China; they are also quite expensive. To our knowledge, modified fenestrated stent grafts (MFSGs) are a safe and effective alternative for treating patients with juxtarenal aneurysms. Most MFSGs are used for the preservation of renal and left subclavian arteries. Few cases of MFSGs have been reported in the treatment of iliac pathologies. The use of an MFSG is decided on a case-by-case basis. This report presents our first clinical use of an MFSG for preservation of the internal iliac artery.
Aneurysm ; Blood Vessel Prosthesis* ; Buttocks ; China ; Colon ; Erectile Dysfunction ; Humans ; Iliac Artery* ; Ischemia ; Male ; Pathology ; Stents* ; Subclavian Artery ; Transplants

Objective To investigate the continuous ambulatory peritoneal dialysis ( CAPD) and daytime ambulatory perito-neal dialysis ( DAPD) on sleep quality. Methods This is a multi-center cross-sectional survey, we used the Pittsburgh Sleep Index Scale ( PSQI) ,the unified investigating time, the organized trained peritoneal dialysis nurses qualified to conduct research full-time. Survey content includes general information, sleep index, laboratory tests, dialysis adequacy and other indicators, and the results were pooled analysis. Results A total of eight hospitals of 325 patients undergoing peritoneal dialysis were included in this study,which CAPD patients and DAPD Pittsburgh Sleep Quality Index Scale scores were 6.88 ±2.43,6.71 ±2.69, the difference was not statisti-cally significant (P>0.01).DAPD patients had a lower sleep efficiency than CAPD patients, but it had no difference between subjec-tive feeling, CAPD patients were more likely to have more nocturnal cough, snoring and other symptoms and lower quality of life in mental status scores than DAPD patients(P<0.01). Conclusion Sleep quality of peritoneal dialysis patients scored lower than the norm.Dialysis modes have an impact on sleep quality of patients, health care workers should fully assess the physical and mental state of the patients in order to select the appropriate mode of dialysis.