Objective To analyze the progress of evaluation indexes for enhanced recovery after surgery (ERAS) model at home and abroad, and to propose suggestions for constructing systematic evaluation model of ERAS. Methods Atfirst checked the Chinese and English databases, including Medline, Embase, Sciencedirect, ACP Journal Club, BioMed Central, the Cochrane Central Register of Controlled Trials (CENTRAL), Science Citation Index Expanded, Cochrane Library, NHS Economic Evaluation Database, CNKI, VIP, and Wanfang databases (retrieval time was from January 1997 to December 2017), and then filtered the literatures, excluded duplicate documents, a total of 1 020 English literatures and 786 Chinese literatures were enrolled eventually to make an review. Results The literatures showed that, at present, there was no comprehensive and systematic evaluation index system about ERAS at home and abroad. The existing evaluation indexes mainly included the following deficiencies: localization and fragmentation of evaluation indicators, lack of evaluation indicators of ERAS organizational framework and process management, as well as lack of standardized operational definition of evaluation indicators. Conclusions The evaluation indexes of ERAS at home and abroad do not constitute a systematic evaluation index system according to scientific principles, which will restrict the standardization of accelerated surgical rehabilitation in our country. To establish a multidimensional and comprehensive quality evaluation index system based on multi-evaluation of hospital, patient, social, and medical management institutions, which covers ERAS organizational structure, process management, and clinical outcomes, is a necessary condition for the development of ERAS model.
Pelvic fractures are often caused by high-energy trauma. The condition of patients is complex and requires active therapy. The treatment of pelvic fractures includes conservative and surgical treatment. Surgical treatment is suitable for patients with unstable pelvic fractures. In recent years,the anterior subcutaneous internal fixator (INFIX) for the treatment of unstable pelvic fractures has been popularized and achieved extraordinary outcomes. INFIX is a relatively novel technology for the treatment of anterior pelvic ring fractures. It has excellent biomechanical properties, a wide range of indications, and has the advantages of minimally invasive, convenient care, fewer complications, and better clinical outcomes. If patients with anterior pelvic ring fractures have the indications for INFIX after careful evaluation, INFIX is recommended. This article summarizes the research progress of INFIX in the treatment of anterior pelvic ring fractures, and summarizes its surgical methods, biomechanical properties, indications, advantages, complications and clinical outcomes.
Transcatheter aortic valves implantation have been widely used in patients with high risk of non-surgical or surgical procedures since the first implantation in 2002, and have achieved good therapeutic results. However, as one of the main complications after transcatheter aortic valve implantation, paravalvular regurgitation seriously affects the outcome of patients. This article reviews recent researches on transcatheter aortic valve paravalvular regurgitation, and summarizes the influencing factors of paravalvular regurgitation after transcatheter aortic valve implantation and the corresponding countermeasures. This review can provide guidance and reference for clinical application and research of transcatheter aortic valves.
Although the incidence of gastrointestinal hemorrhage after cardiac surgery is low, the mortality rate is high. Early detection and diagnosis of gastrointestinal hemorrhage are difficult. The high risk phases including preoperation, intraoperation and postoperation. Preoperative high risk comorbidities include gastrointestinal ulcer, hypertension, coronary heart disease and chronic renal failure. Intraoperative high risk factors include decreased gastrointestinal blood perfusion due to cardiopulmonary bypass, inflammatory factors releasing, coagulation disorders, and thrombosis. Postoperative high risk factors include hypotension, low cardiac output, prolonged mechanical ventilation, etc. This article retrospectively summarized high-risk factors and pathogenesis of gastrointestinal hemorrhage after cardiac surgery, in order to improve prevention and treatment of gastrointestinal hemorrhage.
Objective To review the research progress of Sch?ttle’s method in medial patellofemoral ligament reconstruction (MPFLR), and provide the latest knowledge and suggestions for surgical treatment. Methods The studies on Sch?ttle’s method at home and abroad in recent years were extensively collected, then summarized the problems affecting the accuracy of Sch?ttle’s method and the new ideas to improve the accuracy of localization. Results It’s vital to accurately locate the femoral tunnel during MPFLR. Malposition of the femoral tunnel is the main cause of postoperative complications and surgical failure. Sch?ttle’s method is the most well studied and most reproducible method for femoral tunnel localization, which is widely used as the “gold standard”. However, there are still problems that affect the accuracy of Sch?ttle’s method, including the impact of the internal/external rotation and varus/valgus of the knee on localization accuracy, unclear requirements for X-ray imaging and anatomical landmark reference line drawing standards, no suitable for patients with anatomical variations, and lack of further research on pediatric patients. In recent years, some new ideas are proposed to improve the Sch?ttle’s method to improve the localization accuracy. ConclusionFuture research should combine new technologies such as three-dimensional (3D) printing and intraoperative navigation to develop personalized and intelligent Sch?ttle’s method, further improving their localization accuracy.
Artificial bone repair material is the best substitute for autologous bone transplantation. Bone repair materials are constantly being replaced and upgraded, which can be roughly divided into three generations: bioinert materials, bioactive materials, and smart materials. Research and development of bone repair materials with multiple biological activities, in vivo degradation property that perfectly fit for new bone formation, and ability of complete reconstruction of bone tissue in physiological state are the focus of future research.
ObjectiveTo review the research progress of the surgical treatment for lateral malleolus defect.MethodsThe related literature about surgical treatment and effectiveness of lateral malleolus defect at home and abroad was reviewed, summarized, and analysed.ResultsLateral malleolus defects are often caused by severe trauma or wide resection of fibular neoplasms. Although the incidence is not high, the defects are difficult to handle. These bony defects should be reconstructed to prevent an abnormal gait induced by ankle instability and avoid the occurrence of traumatic arthritis. Various repair methods have been developed, including bone transplantation, fibula lengthening, and ankle arthrodesis.ConclusionThere are various surgical methods to repair the defect of lateral malleolus, but each has its own advantages and disadvantages. In order to achieve the best results, the surgeon should choose the appropriate operation according to his own level, the patient’s specific injury, and age.
Objective To summarize the research progress on augmentation repair of anterior talofibular ligament (ATFL) under arthroscopy. Methods The domestic and international studies from the past decade on augmentation repair techniques for the ATFL. The advantages and limitations of each approach were summarized and the outcomes of these augmentation repair techniques when applied to ATFL repair were evaluated. Results Mechanical augmentation technique (suture tape or internal brace technique, double anchor enhancement technique) can increase the strength after ATFL repair, but it will increase the economic burden of the patients; bioenhanced repair technology (inferior extensor retinaculum enhancement, anterior tibiofibular ligament’s distal fascicle transfer augmentation) can also increase the strength after ATFL repair, but it will damage the anatomical structure in the ankle cavity to a certain extent, and the surgery is difficult, and the operation time will prolong and also increase the incidence of perioperative complications. Regardless of the augmentation repair techniques used, the benefits are higher for patients with high exercise needs, and active postoperative rehabilitation is required to maximize the surgical effect. Conclusion Although augmentation repair of ATFL offers several advantages, its use—whether augmentation should be employed and, if so, which technique is preferable—requires further study across patient subgroups owing to increased costs, potential disruption of ankle anatomy, and longer operation time.
ObjectiveTo summarize the papers about the molecular mechanisms of liver metastasis from colorectal cancer in recent years and in order to provide assistance for the diagnosis and treatment of liver metastases from colorectal cancer.MethodThe relevant literatures at home and abroad in recent years about the molecular mechanisms of liver metastasis from colorectal cancer were reviewed.ResultsThe molecular mechanism of liver metastasis from colorectal cancer is complicated. For example, microRNA-192 could inhibit liver metastasis from colorectal cancer through multiple targets, however microRNA-181a could promote liver metastasis from colorectal cancer. TGF-β inhibits liver metastasis from colorectal cancer by inhibiting cell proliferation and Smad-dependent signaling to induce apoptosis. Elevated CEA level not only help in the diagnosis of colorectal cancer, but also as a prognostic indicator for colorectal cancer patients. CEA could promote liver metastasis by affecting the survival of colorectal cancer cells in vessels, changeing the liver microenvironment, and affecting the adhesion and survival of circulating tumor cells in the liver.ConclusionsThe molecular mechanism of liver metastasis of colorectal cancer has not been fully elucidated. Through in-depth study of the mechanism of liver metastasis of colorectal cancer, it can provide molecular targets for targeted therapy in patients with liver metastases from colorectal cancer, such as bevacizumab, cetuximab, panitumab and so on. Detecting the change of serological markers in patients with colorectal cancer can help diagnose, judge recurrence, prognosis and metastasis.
Tuberculosis poses a significant challenge to global public health, characterized by high incidence rates, high drug resistance rates, high mortality rates, and lengthy treatment cycles. Patients with tuberculosis often experience stigma, which can adversely affect their treatment adherence, psychological state, and quality of life. Despite numerous reported interventions both domestically and internationally, there remains a lack of systematic research on personalized intervention strategies tailored to diverse ethnic groups. This article aims to review the domestic and international status of stigma among tuberculosis patients, assessment tools, influencing factors, and intervention strategies, with the goal of providing references for developing effective management strategies for stigma in multicultural tuberculosis patient populations.