Comprehensive comparison between conservative therapy and surgical management for completely displaced and comminuted mid-shaft clavicle fractures.

PURPOSE: It is still controversial whether complete displaced mid-shaft clavicle fractures should be treated with internal fixation or conservative therapy. This retrospective study aims to compare clinical outcomes of two treatment protocols. MATERIALS AND METHODS: 105 patients with displaced and comminuted mid-shaft clavicle fractures were included in this study, among which 55 patients were treated conservatively and 50 patients accepted surgical fixation and were followed up for over 20 months on average. Rate of union, malunion, time taken for union, functional outcome, self-reported satisfaction and complications were compared. RESULTS: Union rate of operative group (n=49, 98.0%) was higher than the non-operative group (n=48, 87.3%). Time taken for union in operative group (2.37±1.06 months) was shorter than the non-operative group (3.69±1.01 months). Malunion and asymmetric were only seen in the conservative group. Numbness of the shoulder was only reported in the operative group (n=23, 46.0%). Most of patients in the operative group (n=45, 90%) accepted a second operation to remove the implant. No statistically difference was found in self-reported satisfaction, Quick-DASH and Constant-Murley score. The operative group returned to work faster (1.47±0.89 to 3.34±1.37 months), regained full range of motion earlier (1.66±0.78 to 3.83±1.24 months) and regained strength faster (3.86±2.45 to 8.03±2.78 months) than the non-operative group. CONCLUSION: Complete displaced and comminuted mid-shaft clavicle fractures treated surgically have more reliable union and faster recovery when compared to conservatively treated fractures.

The diagnosis and treatment of Criss-Cross injury of the forearm: A retrospective analysis.

BACKGROUND: Due to the paucity of 'Criss-Cross' injury, the pathological changes and injury patterns have not been clearly described; as well as the treatment and prognosis. This retrospective study aimed to investigate the treatment and clinical outcomes of 'Criss-Cross' injury of the forearm. METHODS: All patients diagnosed with Criss-Cross injury meeting the inclusion and exclusion criteria in our Level 3 hospital (most advanced level) from 2010 to 2022, were enrolled in the study. A total of 12 patients were enrolled in our retrospective analysis. Closed reduction was successful in 3 patients, open reduction performed in the remaining patients. 6 patients associated with a fracture, while 2 cases had a concomitant convergent elbow dislocation. The follow-up time in conservative patients was 23.0 months on average (3-51 months), while 38.4 months in surgery group on average (3-108 months). The forearm function was evaluated with the Anderson's forearm function score. The range of motion (ROM) of the elbow and wrist and forearm rotation including any complications was also documented during the follow-up. RESULTS: On final follow-up, ROM of the elbow, wrist, and forearm rotation significantly improved after conservative treatment (50.0 ± 24.5° to 128.3 ± 2.9°, 55.0 ± 7.1° to 166.7 ± 5.8°, 83.3 ± 20.8° to 165.0 ± 15.0°, respectively, p < 0.001) and surgical treatment (41.7 ± 22.4° to 102.8 ± 21.1°, 42.2 ± 16.4° to 125.6 ± 25.1°, 34.4 ± 26.5° to 138.3 ± 22.6°, respectively, p < 0.001). However, compared with the contralateral side, there were still significant difference regarding the ROM of the elbow (102.8 ± 21.1° to 143.9 ± 4.9°), wrist (125.6 ± 25.1° to 167.8 ± 5.1°), and forearm rotation (138.3 ± 22.6° to 163.3 ± 3.5°) after surgical treatment (P < 0.01). Anderson's Forearm Function Score was excellent in all conservative cases and 2 of 9 patients treated with operation. 2 patients complained about occasional elbow locking, wrist pain and reduced power after conservative treatment. 2 patients reported ulnar neuritis after the operation, one of which was treated with anterior transposition of the ulnar nerve. CONCLUSION: The Criss-Cross injury could be associated with different fractures and/or simultaneous convergent elbow dislocation. The basic principle of treatment is to reduce both PRUJ and DRUJ by closed reduction or surgery, with early rehabilitation. Most of the patients regained good forearm function after receiving either conservative or surgical treatment.

Severe/critical COVID-19 early warning system based on machine learning algorithms using novel imaging scores.

BACKGROUND: Early identification of severe/critical coronavirus disease 2019 (COVID-19) is crucial for timely treatment and intervention. Chest computed tomography (CT) score has been shown to be a significant factor in the diagnosis and treatment of pneumonia, however, there is currently a lack of effective early warning systems for severe/critical COVID-19 based on dynamic CT evolution. AIM: To develop a severe/critical COVID-19 prediction model using a combination of imaging scores, clinical features, and biomarker levels. METHODS: This study used an improved scoring system to extract and describe the chest CT characteristics of COVID-19 patients. The study also took into consideration the general clinical indicators such as dyspnea, oxygen saturation, alternative lengthening of telomeres (ALT), and androgen suppression treatment (AST), which are commonly associated with severe/critical COVID-19 cases. The study employed lasso regression to evaluate and rank the significance of different disease characteristics. RESULTS: The results showed that blood oxygen saturation, ALT, IL-6/IL-10, combined score, ground glass opacity score, age, crazy paving mode score, qsofa, AST, and overall lung involvement score were key factors in predicting severe/critical COVID-19 cases. The study established a COVID-19 severe/critical early warning system using various machine learning algorithms, including XGBClassifier, Logistic Regression, MLPClassifier, RandomForestClassifier, and AdaBoost Classifier. The study concluded that the prediction model based on the improved CT score and machine learning algorithms is a feasible method for early detection of severe/critical COVID-19 evolution. CONCLUSION: The findings of this study suggest that a prediction model based on improved CT scores and machine learning algorithms is effective in detecting the early warning signals of severe/critical COVID-19.

Single-cell RNA sequencing reveals the role of cell heterogeneity in the sex difference in primary hyperparathyroidism.

Objective: To explore the difference in parathyroid tissue-derived cells between male and female PHPT patients. Methods: Resected parathyroid tissues were collected from PHPT patients of both sexes. Single cells were isolated and sequenced for RNA expression profiles. The cell sequencing data were annotated by cell type, followed by population analysis, functional analysis, pathway analysis, cell communication analysis, differential gene expression analysis, and pseudotime trajectory analysis. The subcluster analyses were also performed in the parathyroid cells. Results: No substantial difference in the cell population, function, or communication is found between the two sexes. The interferon-a response, oxidative phosphorylation, and reactive oxygen species pathways are up-regulated in females than in male patients, mainly contributed by fibroblast cells, endothelial cells, parathyroid cells, and myeloid cells, which also have significantly more up-regulated pathways and cellular interactions than the other three cell types. The subcluster analysis of parathyroid cells identified five subpopulations: SPARCL1-OC and ISG15-OC are predominant in females, while more S100A13-PCC and PTHLH-OC are found in males. The cellular functions are also elevated in females compared with males. Cells from female patients show a higher expression level of parathyroid hormone (PTH) but a lower expression level of parathyroid hormone-like hormone (PTHLH). The cell pseudotime trajectory and pathway analyses show that the oxyphil cells may be more mature and functionally active than the chief cells in both sexes. Conclusion: These findings suggest that the sex difference in PHPT may be caused by the differentially expressed genes and activated pathways in different cell types in the parathyroid tissue. The heterogeneity of parathyroid cell subpopulations, especially in oxyphil cells, may be associated with the sex differences in PHPT pathogenesis.