In Taiwan, cancer is the top cause of death, and the mortality rate of lung cancer is the highest of all cancers. Some studies have demonstrated that multidisciplinary team (MDT) care can improve survival rates of non-small cell lung cancer (NSCLC) patients. However, no study has discussed the effect of MDT care on different stages of NSCLC. The target population for this study consisted of patients with NSCLC newly diagnosed in the 2005–2010 Cancer Registry. The data was linked with the 2002–2011 National Health Insurance Research Database and the 2005–2011 Cause of Death Statistics Database. The multivariate Cox proportional hazards model was used to explore whether the involvement of MDT care had an effect on survival. This study applied the propensity score as a control variable to reduce selection bias between patients with and without involvement of MDT care. The adjusted hazard ratio (HR) of death of MDT participants with stage III & IV NSCLC was significantly lower than that of MDT non-participants (adjusted HR = 0.87, 95% confidence interval = 0.84-0.90). This study revealed that MDT care are significantly associated with higher survival rate of patients with stage III and IV NSCLC, and thus MDT care should be used in the treatment of these patients.

The findings of this study can serve as a reference to help orthopaedic surgeons select clavicle hook plates.

For compression fracture, vertebral body height loss (VBHL) and kyphotic angle (KA) are two important imaging parameters for determining the prognosis and appropriate treatment. This study used previous measurement methods to assess the degree of VBHL and KA, compare and examine differences between various measurement methods, and examine the correlation between relevant measurement parameters and intravertebral cleft (IVC) in the vertebral body. The radiographic images (lateral view of the T-L spine) of 18 patients with a single-level vertebral compression fracture were reviewed. We measured 9 characteristic lengths and angles on plain radiographs, including anterior vertebral height (AVH) and AVH of the adjacent upper and lower levels, middle vertebral height (MVH) and MVH of the adjacent upper and lower levels, posterior vertebral height (PVH), and vertebral body width, and assessed 6 parameters, including vertebral compression ratio (VBCR), percentage of anterior height compression (PAHC), percentage of middle height compression (PMHC), kyphotic angle (KA), calculated kyphotic angle (CKA), and IVC. The results showed that VBCR is a simple and rapid method of VBHL assessment, but it may result in an underestimation of the degree of VBHL compared to PAHC. When PMHC<40% or kyphotic angle>15°, the probability of IVC occurring on the vertebral body was higher which means the higher risk of vertebral body instability. The results of this study could provide a reference for surgeons when using imaging modalities to assess the degree of vertebral body collapse.

There are three methods for evaluation of dislocation of the distal radioulnar joint using computed tomography: the radioulnar line method, the epicenter method, and the congruity method. However, some patients who are clinically symptom-free have abnormal findings from computed tomography of the distal radioulnar joint according to the aforementioned criteria. In addition, these methods are qualitative, not quantitative definitions. Forty patients were included in this study. Computed tomography scans of the wrists were done. The variation of displacement of the distal radioulnar joint was measured. By the epicenter method, the 95% confidence interval (mean +/- 1.96 standard error) was from 0.0026 to 0.1114 in supination and from -0.1171 to 0.0446 in pronation. By the radioulnar line method, the 95% confidence interval was from 0.0026 to 0.0479 in supination and from -0.0065 to 0.0745 in pronation. By the modified radioulnar line method, the 95% confidence interval was from 0.1778 to 0.2752 in supination and from 0.0990 to 0.2310 in pronation. There was a wide range of the displacement of the distal radioulnar joint in patients with clinically normal wrists. The results can be regarded as reference points for normal variation of the distal radioulnar joint. This can help to differentiate the causes of internal derangement of the wrist.

Robot-assisted pedicle screw placement for spine surgery has become popular in recent years. This study compares clinical, radiographic outcomes and the screw loosening rate between robot-assisted and fluoroscopy-guided pedicle screw placement in patients who underwent transforaminal lumbar interbody fusion (TLIF). We retrospectively examined 108 patients with the degenerative lumbar disease who underwent TLIF. According to whether the robotic system was used, patients were assigned to either the robot-assisted (Ro TLIF, n = 29) or fluoroscopy-guided TLIF (FG TLIF, n = 79) group. Radiographic parameters and patient-reported outcomes, including leg and back pain visual analog scale (VAS) and Oswestry Disability Index (ODI), were assessed. Loosening signs were noted in 48 out of 552 pedicle screws. The screw loosening rate was higher in the FG TLIF (10.2%) than Ro TLIF group (4.3%). A significant correlation was found between screw loosening and age, the number of level(s) fused, and the ratio of the average distance from the pedicle screw to the upper endplate to vertebral body height. VAS-leg, VAS-back, and ODI showed significant improvements in both groups postoperatively (all p < 0.05). These results indicated that robot-assisted pedicle screw placement in TLIF had a lower screw loosening rate and similar patient-reported outcomes compared with the fluoroscopy-guided technique.

BackgroundCephalomedullary nails are frequently used in unstable intertrochanteric fractures. The implant position is an important factor for surgical success. Thus, in the present study, finite element analysis methods were used to investigate the biomechanical behavior of five different cephalomedullary nail positions in unstable intertrochanteric fractures.MethodsFive different cephalomedullary nail implant positions were investigated. The observed indicators were the maximum displacement of the lag screw, the stress on the intertrochanteric fracture with involvement of the posteromedial cortex, and the tip–apex distance.ResultsThe smallest lag screw displacement was achieved when the implant was closer to the inferior femoral head. Lower stress was placed on the posteromedial cortex when the implant was positioned closer to the inferior femoral head. However, the tip–apex distance increased when the lag screw was positioned more inferiorly.ConclusionsThe results of this study suggest that positioning the lag screw closer to the inferior aspect of the femoral head can reduce stress on the posteromedial cortex and deformation of the implant in unstable intertrochanteric fractures. These findings provide a biomechanical basis for selection of the cephalomedullary nail implantation site.Level of evidenceIII.

No abstract

Cortical bone trajectory (CBT) is increasingly used in spinal surgery. Although there are many biomechanical studies, the biomechanical effect of CBT in combination with traditional pedicle screws is not detailed. Therefore, the purpose of this study was to investigate the effects of the traditional pedicle screw and CBT screw implantation on the lumbar spine using finite element methods. Based on the combination of the traditional pedicle screw and the CBT system implanted into the lumbar spine, four finite element spinal lumbar models were established. The models were given four different load conditions (flexion, extension, lateral bending, and axial rotation), and the deformation and stress distribution on the finite element model were observed. The results show that there was no significant difference in the structural stability of the lumbar spine model between the traditional pedicle screw system and the CBT system. In addition, CBT may reduce stress on the endplate. Different movements performed by the model may have significant biomechanical effects on the spine and screw system. Clinical spinal surgeons may also consider using the CBT system in revision spinal surgery, which may contribute to smaller wounds.