Onset time of complications in patients with severe acute pancreatitis receiving nonoperative therapy

Objective: To retrospectively analyze 85 hospitalizednonoperative patients with severe acute pancreatitis(SAP) and to find out the stages of the disease.Methods: We statistically calculated the time of onsetof complications in these patients from 1987 to 1999.Results: The 95% confidence interval of total averagefor the complications of acute respiratory distress syn-drome (ARDS), shock and kidney failure was between2 to 4 days, and for encephalopathy, hemorrhage ofthe digestive tract, bacterial infection, fungous infec-tion and abscess between 3 to 6 days, 3 to 5 days, 13to 16 days, 13 to 16 days, and 14 to 23 days respec-tively. The 95% confidence interval of total averagein 18 deaths (21%) was between 5 to 6 days. ARDS,kidney failure, and shock occurred within 4 days, en-cephalopathy within 6 days (average 4.8±0.9 days),abscesses after 14 days, systemic bacterial infectionand fungous infection within half a month (average14.6±1.1days, 14.8±0.9days respectively), and deathwithin 6 days.Conclusion: According to the time of the occurrence ofcomplications, we divide the courses of the disease intothree stages: early phase(first 4 days) with ARDS,kidney failure, shock, encephalopathy and hemorrhageof the digestive tract; middle phase (5-15 days) withbacterial infection and fungous infection; late phase(15 days after the onset) with abscess.

Clinical effect of operative vs nonoperative treatment on humeral shaft fractures:Systematic review and meta-analysis of clinical trials

BACKGROUND Whether operation is superior to non-operation for humeral shaft fracture remains debatable.We hypothesized that operation could decrease the nonunion and reintervention rates and increase the functional outcomes.AIM To compare the clinical efficacy between operative and nonoperative approaches for humeral shaft fractures.METHODS We searched the PubMed,Web of Science,ScienceDirect,and Cochrane databases from 1990 to December 2023 for clinical trials and cohort studies comparing the effects of operative and conservative methods on humeral shaft fractures.Two investigators independently extracted data from the eligible studies,and the other two assessed the methodological quality of each study.The quality of the included studies was assessed using the Cochrane risk bias or Newcastle-Ottawa Scale.The nonunion,reintervention and the overall complications and functional scores were pooled and analyzed using Review Manager software(version 5.3).RESULTS A total of four randomized control trials and 13 cohort studies were included,with 1285 and 1346 patients in the operative and nonoperative groups,respectively.Patients in the operative group were treated with a plate or nail,whereas those in the conservative group were managed with splint or functional bracing.Four studies were assessed as having a high risk of bias,and the other 13 were of a low risk of bias according to the Newcastle-Ottawa Scale or Cochrane risk bias tool.The operative group had a significantly decreased rate of nonunion[odds ratio(OR)0.30;95%CI:0.23 to 0.40,reintervention(OR:0.33;95%CI:0.24 to 0.47),and overall complications(OR:0.62;95%CI:0.49 to 0.78)].The pooled effect of the Disabilities of Arm,Shoulder,and Hand score showed a significant difference at 3[mean difference(MD)-8.26;95%CI:-13.60 to-2.92],6(MD:-6.72;95%CI:-11.34 to-2.10),and 12 months(MD:-2.55;95%CI:-4.36 to-0.74).The pooled effect of Visual Analog Scale scores and the Constant-Murley score did not significantly differ between the two groups.CONCLUSION This systematic review and meta-analysis revealed a trend of rapid functional recovery and decreased rates of nonunion and reintervention after operation for humeral shaft fracture compared to conservative treatment.