Functional outcomes and complications after treatment of distal radius fracture in patients sixty years and over: A systematic review and network meta-analysis

AimThis network meta-analysis aims to compare functional outcomes and complications between conservative treatment and surgery for distal radius fractures in patients aged 60 years and over.MethodsWe searched the PubMed, EMBASE, and Web of Science databases for randomized controlled trials (RCTs) assessing the effect of conservative treatment and surgery for distal radius fractures in patients aged 60 years and over. Primary outcomes included grip strength and overall complications. Secondary outcomes included Disabilities of the Arm, Shoulder, and Hand (DASH) scores, Patient-Rated Wrist Evaluation (PRWE) scores, wrist range of motion and forearm rotation, and radiographic assessment. All continuous outcomes were assessed using standardized mean differences (SMDs) with 95% confidence intervals (CIs), and binary outcomes were assessed using odds ratio (OR) with 95% CIs. The surface under the cumulative ranking curve (SUCRA) was used to determine a hierarchy of treatments. Cluster analysis was performed for grouping treatments based on the SUCRA values of primary outcomes.ResultsFourteen RCTs were included to compare conservative treatment, volar lockedplate (VLP), K-wires fixation, and external-fixation. VLP outperformed conservative treatment for 1-year and minimum 2-year grip strength (SMD; 0.28 [0.07 to 0.48] and 0.27 [0.02 to 0.53], respectively). VLP yielded the optimal grip strength at 1-year and minimum 2-year follow-up (SUCRA; 89.8% and 86.7%, respectively). In a subgroup analysis of patients aged 60 to 80 years old, VLP outperformed conservative treatment in DASH and PRWE scores (SMD, 0.33 [0.10, 0.56] and 0.23 [0.01, 0.45], respectively). In addition, VLP had the fewest complications (SUCRA = 84.3%). Cluster analysis suggested that VLP and K-wire fixation were more effective treatment groups.ConclusionEvidence to date demonstrates that VLP provides measurable benefits in grip strength and fewer complications to those 60 years of age and over, and that benefit is not reflected in current practice guidelines. There is a subgroup of patients where K-wire fixation outcomes are similar to those of VLP; defining this subgroup may yield substantial societal benefits.     

血清miR-210与新生儿呼吸窘迫综合征严重程度和预后的关系

目的 探讨血清微小RNA-210（mircoRNA-210，miR-210）与新生儿呼吸窘迫综合征（neonatalrespiratory distress syndrome，NRDS）严重程度和预后的关系。 方法 收集NRDS患儿104例，根据预后分为生存组与死亡组。所有新生儿根据首次胸部X线片结果与病情严重程度分为轻度组（Ⅰ级、Ⅱ级）与重度组（Ⅲ级、Ⅳ级）。比较死亡组与生存组患儿一般资料，轻度组与重度组血清miR-210水平与新生儿急性生理学评分围生期补充Ⅱ（perinatal supplement of acute physiological score for neonates Ⅱ，SNAPPE-Ⅱ）评分。绘制ROC曲线分析血清miR-210水平对NRDS患儿死亡的预测价值。采用Spearman相关性分析NRDS发生与血清miR-210的相关性。 结果 根据预后分组，104例患儿中预后较好81例（77.88%），死亡23例（22.12%）。生存组miR-210水平、SNAPPE-Ⅱ评分低于死亡组（P＜0.05）；2组性别、胎龄、出生体重、母亲年龄、病因、剖宫产、双胎、羊水异常差异无统计学意义（P＞0.05）。按照胸部X线片表现分组，104例患儿轻度患儿73例，重度患儿31例。轻度组miR-210水平、SNAPPE-Ⅱ评分低于重度组（P＜0.05）。NRDS发生与血清miR-210水平呈正相关（r=0.638，P＜0.001）。血清miR-210与SNAPPE-Ⅱ评分呈正相关（r=0.513，P＜0.05）。血清miR-210的最佳分界值为16.71 ng/L时，曲线下面积为0.763，OR=0.846，95%CI：0.892~1.064，敏感度为82.61%，特异度为86.42%。结论 血清miR-210水平升高与NRDS病情严重程度以及预后密切相关，血清miR-210水平与NRDS病情程度呈正相关性，当血清miR-210临界值为16.71 ng/L时对评估NRDS患儿预后具有较高价值。     

A Case of Refractory Childhood Glaucoma Secondary to Weill-Marchesani Syndrome: Management with Combined CO2 Laser-Assisted Sclerectomy Surgery and Trabeculectomy

A 2-year-old girl was diagnosed as Weill-Marchesani syndrome with typical systemic features of short stature, short and stubby hands and feet, language disorders and mental retardation. He developed bilateral angle closure glaucoma, ectopia lentis and suffered visual loss from the ocular features of Weill-Marchesani syndrome. The child was successfully treated by combined CO₂ laser-assisted sclerectomy surgery and trabeculectomy.     

Psychological immune competency predicts burnout syndrome among the high-risk healthcare staff: A cross-sectional study

BackgroundBurnout and psychological immune competency have not been investigated together among employees of high-risk specializations such as emergency medicine, intensive care or surgery.AimIn this study we aim to examine the prevalence of burnout among high-risk clinical staff and explore whether the strength of psychological immune competency predict burnout.DesignA cross-sectional design utilizing a self-administrated questionnaire was used to collect data from the participants (n = 216). Nurses (n = 145) and physicians (n = 71) from emergency medicine, intensive care and surgery departments participated in the study.MethodBurnout syndrome was measured using the Maslach Burnout Inventory, while psychological immune competency was measured using the Psychological Immune Competency Questionnaire. The data collection started in June of 2018 and was finished in March of 2019.ResultsParticipants with higher psychological immune competency reported lower levels of burnout: emotional exhaustion (r = −0.478; p < 0.001), depersonalization (r = −0.459; p < 0.001) and personal accomplishment (r = 0.543; p < 0.001). Multiple linear stepwise regression analysis revealed the psychological immune competency to be a stable predictor of burnout on all three scales.ConclusionPsychological immune competency shows a strong relationship with scales of burnout syndrome and as such should be further examined due to development of successful intervention and prevention programs.     

导引功法结合腹部按摩预防亚健康人群向慢性疲劳综合征转化的临床研究

摘要：目的 观察导引功法结合腹部按摩预防亚健康人群向慢性疲劳综合征转归的临床疗效。方法 将纳入研究的144例患者随机分成观察组（n=72）和对照组（n=72），两组患者均给予标准化的健康教育干预，在此基础上观察组运用导引功法结合腹部按摩干预，2组疗程均为12周，分别在干预前、干预后采用疲劳评定量表（FSS）、中医症候积分量表及生活质量量表（SF-36）进行评价。结果 两组各随机选完成研究的36例进行组内比较：两组均较干预前显著改善，有统计学意义（P＜0.05）；组间比较：干预后，观察组疲劳评定总分和中医症候积分显著低于对照组，生活质量评分高于对照组，均有统计学意义（P＜0.05）。结论 导引功法结合腹部按摩预防亚健康人群向慢性疲劳综合征转归效果明显，能有效摆脱疲劳状态，提高生活质量，值得临床推广应用。