UNASSIGNED: The prevalence of papillary thyroid cancer is gradually increasing and the trend of youthfulness is obvious. Some patients may not be able to undergo surgery, which is the mainstay of treatment, due to physical or financial reasons. Therefore, the prediction of cancer-specific survival (CSS) in patients with non-operated papillary thyroid cancer is necessary.
UNASSIGNED: Patients\' demographic and clinical information was extracted from the Surveillance, Epidemiology, and End Results database. SPSS software was used to perform Cox regression analyses as well as propensity score matching analyses. R software was used to construct and validate the nomogram. X-tile software was used to select the best cutoff point for patient risk stratification.
UNASSIGNED: A total of 1319 patients were included in this retrospective study. After Cox regression analysis, age, grade, T stage, M stage, radiotherapy, and chemotherapy were used to construct the nomogram. C-index, calibration curves, and receiver operating characteristic curves all verified the high predictive accuracy of the nomogram. The decision curve analysis demonstrated that patients could gain clinical benefit from this predictive model. Survival curve analysis after propensity score matching demonstrated the positive effects of radiotherapy on CSS in non-operated patients.
UNASSIGNED: Our retrospective study successfully established a nomogram that accurately predicts CSS in patients with non-operated papillary thyroid cancer and demonstrated that radiotherapy for operated patients can still help improve prognosis. These findings can help clinicians make better choices.

UNASSIGNED: Non-operative management for pediatric blunt splenic injury is well established in high-income countries, leading to a low splenectomy rate in hemodynamically stable children. Splenectomy rate became a quality indicator for Trauma Center verification utilized by the American College of Surgeons Committee on Trauma. However, data on splenectomy rate in children from countries with different income levels, such as Brazil, remain limited. This study aimed to assess the post-traumatic splenectomy rate among Brazilian children over the past decade and the relation with local resources.
UNASSIGNED: Data on pediatric splenic injuries and splenectomies from 2008 to 2019, including patient age and admitting service (adult or pediatric), were obtained from FioCruz database, a public, free, cloud-based platform that offers extensive national health data. The regional numbers of pediatric surgeons, pediatric intensive care unit (PICU) beds, and computed tomography scanners were obtained from Brazilian national databases. A national analysis of splenectomy rate by year and service of admission and an analysis of splenectomy rate by the level of regional resources, the number of pediatric surgeons, PICU beds, and computed tomography scanners was performed.
UNASSIGNED: 4061 children were hospitalized with a splenic injury, and 2287 (51.8%) of them underwent splenectomy, unchanged over time. 76.8% were male and 23.1% female patients with splenic injury. Mean age was 11.61 years old. The odds of splenectomy was 14.77 times higher for pediatric patients admitted under adult surgical service compared to pediatric service (OR = 14.77, 95% CI 11.75-18.56, p < 0.0001). The overall increase in pediatric surgeons, PICU beds, and CT scanner availability did not correspond with changes in splenectomy rate.
UNASSIGNED: The post-traumatic splenectomy rate among Brazilian children is high, far exceeding that of high-income countries. Increased regional pediatric resources did not correspond to a decrease in splenectomy rate. Further research is essential to understand Brazil\'s barriers to adopting non-operative management for pediatric splenic injuries.
UNASSIGNED: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Metacarpal fractures produce significant hand disability, and non-operative management of these fractures can produce satisfactory functional outcomes with few complications. However, most studies assessing non-operative outcomes of metacarpal fractures revolves around metacarpals I and V, which possess different anatomy. Therefore, further investigation into outcomes after non-operative treatment of metacarpals II-IV is required to inform management decisions and allow modification of the rehabilitation protocols to specific fracture patterns. All records for 76 non-operative patients presenting with fractures of metacarpals II-IV to our tertiary centre in the year 2019 were retrospectively reviewed. Patients were treated with thermoplastic splinting or fibreglass casting with a rehabilitative exercise programme. Range of motion (ROM) of the Metacarpophalangeal (MCPJ), Proximal Interphalangeal (PIPJ), and Distal Interphalangeal joints (DIPJ), return to work time, and complications were assessed at 12 weeks post-treatment. Mean return to work time was 5.4 weeks, and patients did not report any serious adverse events; the main complication reported was tenderness on palpation (20%). The MCPJ exhibited the poorest ROM (9° flexion reduction relative to the healthy hand). Metacarpal II fractures were associated with significantly worse MCPJ flexion than metacarpal III (p = 0.022) and metacarpal IV (p = 0.049) fractures. Fractures of the metacarpal base were associated with superior MCPJ flexion (p = 0.004) but longer return to work time (p = 0.042) than head fractures. Spiral fractures were associated with shorter return to work time (p = 0.043) and superior ROM results (p = 0.041). In conclusion, outcomes of the non-operative treatment of metacarpal II-IV fractures are highly dependent on the location and pattern of the fracture, and this should be considered during clinical decision making.

UNASSIGNED: A minority of geriatric hip fracture patients pursue non-operative treatment. Compared with surgical patients, non-operative patients have higher mortality rates. However, patient satisfaction following non-operative vs operative treatment has not been investigated extensively. The purpose of this study was to compare satisfaction among non-operatively vs operatively treated hip fracture patients.
UNASSIGNED: We identified patients aged 60+ years with proximal femur fractures treated over a 10-year period. Excluded were patients with isolated greater/lesser trochanteric fractures. Patients or relatives were asked to complete a 6-question survey about their treatment satisfaction.
UNASSIGNED: Survey responses from 56 operative and 28 non-operative patients were recorded. Overall, 91.1% of operative and 82.1% of non-operative patients were satisfied with their treatment course (P = 0.260). However, only 71.4% of non-operative patients were satisfied with treatment option explanations vs 83.9% of operative patients (P = 0.014). While only 64.3% of non-operative respondents were satisfied with the ultimate treatment outcome (vs 85.7% of operative patients, P = 0.025), 89.3% of patients in each cohort would choose the same treatment plan again.
UNASSIGNED: Our findings highlight the complexity of defining patient satisfaction, particularly in a geriatric hip fracture population. Unlike previous studies, we chose a direct approach to quantifying patient satisfaction by asking participants specifically about satisfaction with treatment outcome and the overall treatment course. Additional survey questions were then included to assess factors considered important in treatment satisfaction, such as health care provider treatment explanations, post-treatment mobility, and palliative care service involvement.
UNASSIGNED: We identified significant differences between non-operatively and operatively treated geriatric hip fracture patients regarding satisfaction with the explanation of treatment options, and ultimate treatment outcomes. There was no significant difference in overall satisfaction with the treatment course or likelihood of choosing the same treatment again. Further research investigating patient satisfaction following geriatric hip fracture treatment is warranted.

BACKGROUND: Over recent decades, splenic angioembolization (SAE) as an adjunct to non-operative management (NOM) has emerged as a prominent intervention for patients with blunt splenic injuries (BSI). SAE improves patient outcomes, salvages the spleen, and averts complications associated with splenectomy. This systematic review aimed to evaluate the failure rate and complications related to SAE in patients with BSI.
METHODS: A systematic literature search (PubMed, SCOPUS, and Cochrane Library) focused on studies detailing splenic angioembolization in blunt trauma cases. Articles that fulfilled the predetermined inclusion criteria were included. This review examined the indications, outcomes, failure rate, and complications of SAE.
RESULTS: Among 599 identified articles, 33 met the inclusion criteria. These comprised 29 retrospective studies, three prospective studies, and one randomized control trial. The analysis encompassed 25,521 patients admitted with BSI and 3,835 patients who underwent SAE. The overall failure rate of SAE was 5.3 %. Major complications predominantly were rebleeding (4.8 %), infarction (4.6 %), and abscess formation (4 %). Minor complications were fever (18.4 %), pleural effusion (13.1 %), and coil migration (3.9 %). Other complications included splenic atrophy, splenic cyst, hematoma, and access site complications such as splenic/femoral dissection. Overall, post embolization mortality was 0.08 %.
CONCLUSIONS: SAE is a valuable adjunct in managing BSI, with a low failure rate. However, this treatment modality is not without the risk of potentially serious complications.

UNASSIGNED: Meniscus tears are a common cause of knee pain encountered in orthopedics and sports medicine. There are numerous management strategies, from physical therapy and oral medications to surgery. Recent evidence is more favorable for conservative management, as operative treatment has limited clinical benefits and is associated with an accelerated progression toward osteoarthritis. Injections with orthobiologic therapies, such as platelet-rich plasma (PRP), are emerging as an alternative therapeutic tool for degenerative tears. This study aims to evaluate the latest evidence regarding the efficacy of PRP injections for the nonoperative management of degenerative meniscal pathology.
UNASSIGNED: Articles were obtained from Embase, PubMed, World of Science, Cochrane, and Galileo databases after searching \"Platelet-rich plasma\" AND \"Meniscus.\" Inclusion criteria consisted of original, human studies evaluating the use of platelet-rich plasma for nonoperative management of meniscus tears.
UNASSIGNED: A total of 384 articles were screened, with ten studies selected for final inclusion. The pooled study population comprised 686 patients, with an average age ranging from 33 to 53 years, and a 38% female population. Three different injection approaches were utilized, categorized as intra-articular alone (IA), intra-meniscal alone (IM), or a combination of both. Most studies demonstrated improved pain and functionality by 3 months that persisted for at least one year. Within the IA and IM groups, the majority of patients were either radiographically stable (30-70%) or demonstrated interval healing (40-60%). Several studies within IM and combined treatment groups evaluated rates and time to arthroscopy, and found lower failure rates and greater arthroscopy-free survival time than control comparison groups.
UNASSIGNED: PRP appears to be a safe and efficacious treatment strategy for degenerative meniscal pathology. However, due to diverse periprocedural techniques, PRP injectate characteristics, and a lack of high-quality studies, additional trials are needed to provide greater a degree of confidence in PRP\'s clinical impact on patients with meniscus tears.
UNASSIGNED: Systematic Review.

There remains much ambiguity on what non-operative management (NOM) of rectal cancer truly entails in terms of the methods to be adopted and the best algorithm to follow. This is clearly shown by the discordance between various national and international guidelines on NOM of rectal cancer. The main aim of the NOM strategy is organ preservation and avoiding unnecessary surgical intervention, which carries its own risk of morbidity. A highly specific and sensitive surveillance program must be devised to avoid patients undergoing unnecessary surgical interventions. In many studies, NOM, often interchangeably called the Watch and Wait strategy, has been shown as a promising treatment option when undertaken in the appropriate patient population, where a clinical complete response is achieved. However, there are no clear guidelines on patient selection for NOM along with the optimal method of surveillance.

BACKGROUND: The majority of all proximal humeral fractures (PHFs) are treated non-surgically. Due to the risk of early secondary fracture displacement patients with non-surgically treated PHFs routinely undergo serial clinical and radiological evaluations. However, the value of these routine follow-up visits is unclear. This study aimed to examine the rate of early conversion to surgery in non-surgically treated PHFs. Moreover, the associations between patient and fracture characteristics and the risk of conversion to surgery were explored in order to assess the need for routine follow-ups.
METHODS: Data on all patients aged ≥18 years with a non-surgically treated PHF registered between 2013 and 2021 were extracted from the Swedish Fracture Register. Early change of treatment from non-surgical to surgical is an optional treatment modality in the SFR. The rate of early conversion to surgery within 60 days from injury was analyzed in relation to age and sex of the patient, energy level at injury and fracture morphology according to the AO/OTA classification.
RESULTS: A total of 31,761 primarily non-surgically treated PHFs (mean age 70 years: 76 % female) were included in the study. The overall rate of early conversion to surgery was 3.7 %. Younger age and increasing fracture severity were associated with a higher conversion rate to surgery. Patients ≥80 years and those with the three most common fracture types (A1, A2, and B1) had <2 % early conversion to surgery. In contrast, patients with C-type fractures, unstable/displaced fractures (A3, B2, and C2), or fracture dislocations (A1.3, B3, and C3) had a substantially higher risk (5.0-20 %) of early conversion.
CONCLUSIONS: The overall risk of early conversion to surgery in non-surgically treated PHFs is low and can be further predicted based on patient age and fracture morphology. These results could have implications regarding which patients are in need of routine follow-ups.
METHODS: Level II; Retrospective design; Prognosis study.

UNASSIGNED: Platelet-rich plasma (PRP) has shown promising results for adhesive shoulder capsulitis (AC) in pre-clinical models. The aim of this review is to investigate the clinical outcomes of using PRP in AC.
UNASSIGNED: We conducted a systematic scoping review of the literature using bibliographic databases from inception until the 9th of January 2022 [PubMed, Web of Science, Scopus, and CENTRAL]. Randomized studies were included if they investigated the use of PRP in human patients with a diagnosis of AC. Authors performed individual study quality assessments using the RoB 2 tool.
UNASSIGNED: We screened a total of 470 results and 6 were included in the final synthesis. Studies included data of 578 patients with 263 patients receiving PRP (45.5%). All studies used PRP as part of non-operative treatment. PRP was compared to another intervention in all six studies. Four of these studies found PRP to be more effective. No major adverse effects were reported in any study.
UNASSIGNED: PRP is a safe treatment option that can be added to the investigative treatment arsenal of AC. Despite showing some favorable results, several limitations and patient-centered questions remain to be addressed by future studies.
UNASSIGNED: IV.

UNASSIGNED: There is substantial evidence that operative treatment reduces the risk of nonunion but offers no long-term functional gains compared with nonoperative treatment. Despite some studies citing quicker recovery with surgery, the promise of accelerated functional recovery remains under-investigated. The aim of this meta-analysis of randomized controlled trials was to investigate the possible early functional gains (≤6 months) after operative treatment of displaced midshaft clavicular fractures compared with nonsurgical treatment.
UNASSIGNED: A systematic search was performed to identify randomized controlled trials comparing plate osteosynthesis with nonoperative treatment. We evaluated shoulder function outcomes measured by Constant Score or Disability of the Arm, Shoulder, and Hand (DASH) questionnaire. Other outcomes of interest were sick leave and return to previous activity (work, leisure).
UNASSIGNED: Ten studies including 1333 patients were included. The mean difference in DASH score after 6 weeks was 9.4 points (95% confidence interval [CI] 13.7-5.1) in favor of operative treatment. At 3 months, the difference was 3.6 points (95% CI 6.9-0.4), and at 6 months, the difference was 3.2 points (95% CI 5.2-1.1), both in favor of operative treatment. Results for Constant Score were similar to that of DASH score.
UNASSIGNED: This meta-analysis shows that there is an early functional gain at six weeks following plate fixation of midshaft clavicular fractures compared with nonoperative treatment. At three and six months, the functional gain is lesser and not clinically relevant.