Osteoporotic proximal humeral fracture (OPHF) is one of the common osteoporotic fractures in the aged, with an incidence only lower than vertebral compression fracture, hip fracture, and distal radius fracture. OPHF, secondary to osteoporosis and characterized by poor bone quality, comminuted fracture pattern, slow healing, and severely impaired shoulder joint function, poses a big challenge to the current clinical diagnosis and treatment. In the field of diagnosis, treatment, and rehabilitation of OPHF, traditional Chinese and Western medicine have accumulated rich experience and evidence from evidence-based medicine and achieved favorable outcomes. However, there is still a lack of guidance from a relevant consensus as to how to integrate the advantages of the two medical systems and achieve the integrated diagnosis and treatment. To promote the diagnosis and treatment of OPHF with integrated traditional Chinese and Western medicine, relevant experts from Orthopedic Expert Committee of Geriatric Branch of Chinese Association of Gerontology and Geriatrics, Youth Osteoporosis Group of Orthopedic Branch of Chinese Medical Association, Osteoporosis Group of Orthopedic Surgeon Branch of Chinese Medical Doctor Association, and Osteoporosis Committee of Shanghai Association of Integrated Traditional Chinese and Western Medicine have been organized to formulate Expert consensus on the diagnosis and treatment of osteoporotic proximal humeral fracture with integrated traditional Chinese and Western medicine ( version 2024) by searching related literatures and based on the evidences from evidence-based medicine. This consensus consists of 13 recommendations about the diagnosis, treatment and rehabilitation of OPHF with integrated traditional Chinese medicine and Western medicine, aimed at standardizing, systematizing, and personalizing the diagnosis and treatment of OPHF with integrated traditional Chinse and Western medicine to improve the patients ′ function.

The incidence of osteoporotic thoracolumbar vertebral fracture (OTLVF) in the elderly is gradually increasing. The kyphotic deformity caused by various factors has become an important characteristic of OTLVF and has received increasing attention. Its clinical manifestations include pain, delayed nerve damage, sagittal imbalance, etc. Currently, the definition and diagnosis of OTLVF with kyphotic deformity in the elderly are still unclear. Although there are many treatment options, they are controversial. Existing guidelines or consensuses pay little attention to this type of fracture with kyphotic deformity. To this end, the Lumbar Education Working Group of the Spine Branch of the Chinese Medicine Education Association and Editorial Committee of Chinese Journal of Trauma organized the experts in the relevant fields to jointly develop Clinical guidelines for the diagnosis and treatment of osteoporotic thoracolumbar vertebral fractures with kyphotic deformity in the elderly ( version 2024), based on evidence-based medical advancements and the principles of scientificity, practicality, and advanced nature, which provided 18 recommendations to standardize the clinical diagnosis and treatment.

Metabolic-dysfunction associated fatty liver disease (MAFLD) is a common concomitant disease of breast cancer. It is one of the main causes of liver damage during chemotherapy and also an important cause of liver damage during endocrine therapy or follow-up, which seriously affects the quality of life and prognosis of breast cancer patients. Nonalcoholic fatty liver disease was renamed as MAFLD, which changed the original "exclusive diagnosis" to "inclusive diagnosis" and the non-negligible role of metabolic factors in the occurrence and development of fatty liver disease was recognized, but the clinical attention is not enough at present. More attention should be paid to the diagnosis and treatment of MAFLD in breast cancer patients because the proportion and risk of metabolic disorders are higher than that in general people. In this article, we will focus on the clinical significance, prevention and treatment of the new definition of MAFLD in the comprehensive management of concomitant diseases of breast cancer, so as to further improve the quality of life and prognosis of breast cancer patients.

Humans ; Female ; Prevalence ; Breast Neoplasms ; Cancer Survivors ; Non-alcoholic Fatty Liver Disease ; Liver

Objective:To investigate the clinical efficacy of laparoscopic adrenalectomy and traditional open adrenalectomy for adrenal tumors in children.Methods:In Department of Pediatric Surgery, Fujian Provincial Maternity and Children′s Hospital from June 2008 to June 2016, the clinical data of 31 pediatric adrenal tumors was retrospectively analyzed.According to different surgical methods, they were divided into traditional open adrenalectomy group and laparoscopic adrenalectomy group.Bleeding loss, operation duration, incision length, abdominal drainage time, postoperative hospital stay, postoperative complications and recurrence were compared between the 2 groups.Results:There was no significant difference in age, sex, weight, and tumor size between the 2 groups (all P>0.05). The intraoperative bleeding loss was (18.06±4.86) mL for open adrenalectomy group and (15.20±4.48) mL for laparoscopic adrenalectomy group, and there existed no significant difference in the amount of bleeding between the 2 groups( T=-1.702, P>0.05). The operation duration was (137.44±19.32) min for open adrenalectomy group versus (134.80±6.21) min for laparoscopic adrenalectomy group, and there was no significant difference in operation duration between the 2 groups ( T=-0.504, P>0.05). The length of incision was (7.94±1.34) cm for open adrenalectomy group versus (3.44±0.21) cm for laparoscopic adrenalectomy group, the length of incision in laparoscopic group was shorter than that in open adrenalectomy group.There was significant difference in the length of incision between the 2 groups ( T=-12.843, P<0.001). The hospitalization time was (9.63±2.55) d for open adrenalectomy group versus (7.20±1.37) d for laparoscopic adrenalectomy group, the hospitalization time in laparoscopic group was shorter than those in open adrenalectomy group.The difference of operation time between the 2 groups was statistically significant ( T=-3.261, P=0.003). The average indwelling time of abdominal drainage tube was(5.94±1.53) d for open adrenalectomy group versus (4.80±1.74) d for laparoscopic adrenalectomy group, with no significant difference in postoperative abdominal drainage time between the 2 groups( T=-1.938, P>0.05). There was 1 case of retroperitoneal hematoma in laparoscopic adrenalectomy group and 2 cases of complications in open adrenalectomy group.There was no significant difference in the incidence of complications between the 2 groups ( P=1.000). There were 3 cases of distant metastasis and 1 case of recurrence in laparoscopic group, and 2 cases of distant metastasis and 1 case of recurrence in open adrenalectomy group.There was no significant difference in recurrence between the 2 groups ( P=1.000). Conclusions:Compared with open adrenalectomy surgery, laparoscopic adrenalectomy in children has various advantages, including beautiful incision, less trauma and fast recovery.However, it is necessary to select the appropriate cases.

Chronic pelvic pain with pelvis pain as its main manifestation often occurs in the process of the occurrence, development and treatment of gynecologic pelvic tumors which mainly include ovarian cancer, cervical cancer and endometrial cancer. It seriously affects the physical health, mental health and quality of life of female pelvic cancer patients. At present, there are few relevant studies on chronic pelvic pain caused by gynecological pelvic tumors and lack of research on TCM syndromes. There is no targeted diagnosis and therapy until now. This paper discusses the related concepts of chronic pelvic pain, the characteristics of chronic pelvic pain caused by different pelvic tumors and the current status of diagnosis and therapy of chronic pelvic pain, to provide a reference for further research on the symptoms and clinical diagnosis and treatment of chronic pelvic pain caused by gynecological pelvic tumor.

During the occurrence, development and treatment of gynecological tumors, mainly including cervical cancer, endometrial cancer and ovarian cancer, patients are prone to sleep disorders which seriously affect the quality of life. At present, there are few relevant studies on gynecological tumors associated with sleep disorders, and there is a lack of research on TCM syndromes, so there is no targeted treatment plan. This article mainly introduces the present situation of diagnosis and treatment of sleep disorders caused by gynecological tumors in Chinese and western medicine, to provide reference for further study.

Objective To investigate the relationship between subgroups of central lymph node metastasis (sCLNM) and lateral lymph node metastasis (LNM) of unilatal papillary thyroid carcinoma (uPTC) with cervical lymph node negative(cN0).Methods The clinical and pathological data of 161 patients with cN0-uPTC who underwent total thyroidectomy+central lymph node dissection+lateral lymph node dissection from Jan.2016 to Dec.2016 were retrospectively analyzed.The relationship between the lymph node metastasis of each subarea in the central area of the affected side and the lymph node metastasis of the affected side was investigated.Results Binary logistic regression analysis of cN0-uPTC subregions in the affected central region showed:pre-laryngeal lymph node metastasis,pre-tracheal lymph node metastasis and paratracheal lymph node metastasis were independent risk factors for lymph node metastasis in the affected lateral region(P=0.008,0.016,0.035,respectively).Prelaryngeal lymph node metastasis was an independent risk factor for lymph node metastasis in the affected area Ⅱ (P=0.015).Pre-tracheal lymph node metastasis was an independent risk factor for lymph node metastasis in affected area Ⅲ (P=0.004).Pre-tracheal and para-tracheal lymph node metastasis were independent risk factors for lymph node metastasis in the affected Ⅳ area (P=0.035,0.011,respectively).Conclusions The lymph node metastasis pathway of thyroid cancer had certain regularity.The pre-laryngeal lymph node metastasis has the prediction value for the lymph node metastasis of the affected area Ⅱ.The pre-tracheal lymph node metastasis has the prediction value for the lymph node metastasis of the affected area Ⅲ.The pre-tracheal and paratracheal lymph node metastasis have the prediction value for lymph node metastasis of the affected area Ⅳ.Lymph node dissection in affected areas Ⅲ and Ⅳ needs to be considered in patients with pre-tracheal or paratracheal lymph node metastases.On this basis,lymph node dissection on the affected areas Ⅱ,Ⅲ,and Ⅳ might be considered if there is pre-laryngeal lymph node metastasis at the same time.

We report one case of unilateral breast cancer treated with contralateral prophylactic mastectomy simultaneously and confirmed pathologically as synchronous bilateral primary breast carcinoma.The clinical characterization and diagnosis of bilateral primary breast cancer combined with a review of literature were discussed to serve as a reference for early diagnosis and treatment of the disease.

Objective:To retrospectively analyze the regularity and risk factors of skip metastasis (central lymph node negative and lat-eral lymph node positive) in papillary thyroid carcinoma (PTC). Methods:A total of 521 PTC patients underwent total thyroidectomy and central plus lateral lymph node dissection at The First Affiliated Hospital of Chongqing Medical University from January 2013 to De-cember 2016. Clinicopathological characteristics of the patients were collected and analyzed. Results:Skip metastasis rate of PTC was 8.3％(43/521). Tumors in the upper lobe (OR=3.401, 95％CI:1.770-6.536;P=0.001) and in the lateral part (OR=3.424, 95％CI:1.182-9.920;P=0.023) of the thyroid, as well as age above 45 (OR=2.856, 95％CI:1.488-5.482;P=0.002), were independent risk factors for skip metastases for this disease. Clinically node-negative (cN0) PTC patients with tumors in the upper lobe had higher possibility of skip metastases than those with clinically involved lateral neck nodes(cN1b) (P=0.022). Conclusion:Skip metastasis of PTC is not un-common. Thus, preoperative clinical assessment and imaging examination for lateral lymph node is necessary, especially for PTC pa-tients who are above 45 years old and with tumors in the upper lobe and/or unilateral area of thyroid. The lateral lymph node dissec-tion should be performed when necessary.