Background: Currently, virtual reality (VR) simulators are of increasing interest for surgical training, but there is no systematic review exploring the advantages and disadvantages of VR in orthopedic education. Objective: This paper aims to explore the relationship between VR education and traditional education. Methods: We searched PubMed, Embase, Web of Science, Cochrane library, Scopus, Chongqing VIP Database (VIP), Chinese National Knowledge Infrastructure (CNKI), and Wan Fang Database up to July 2024 for relevant studies. A total of 2 investigators independently conducted literature screening, data extraction, and risk of bias assessment for included studies in accordance with the PICOS framework (Population, Intervention, Comparison, Outcomes, and Study Design), followed by statistical synthesis of outcomes using RevMan 5.3 software (Cochrane Collaboration). The risk of bias evaluation adhered to the Cochrane Risk of Bias Tool (RoB 2.0) for randomized controlled trials, ensuring systematic appraisal of sequence generation, allocation concealment, blinding, incomplete outcome data, and selective reporting. Results: A total of 23 randomized controlled trials included 1091 participants in this meta-analysis. The majority of studies focused on the undergraduates (n=3) and trainees (n=8), resident doctors (n=10), and postgraduate doctors (n=2). A total of 3 studies were missing the age of participants, and 5 studies were also missing the duration data. The main outcome included knowledge scores, clinical operation scores, surgical design scores, and so on. The secondary outcomes were included course participation, learning efficiency, enhance clinical ability, and so on. Compared to traditional teaching, VR interventions resulted in significantly higher knowledge scores (standardized mean difference [SMD]=1.08, 95% CI 0.71-1.46; P <.001). Furthermore, VR-based education yielded superior clinical operation scores (SMD=1.44, 95% CI 1.07-1.81; P <.001) and surgical design scores (SMD=1.75, 95% CI 1.05-2.44; P <.001). In addition, VR teaching enhanced clinical understanding (SMD=1.05, 95% CI 0.62-1.48; P <.001) and clinical thinking ability (SMD=1.17, 95% CI 0.66-1.68; P <.001) compared to traditional methods. Furthermore, VR teaching was associated with higher levels of teaching interest (odds ratio [OR]=4.17, 95% CI 2.16-8.04; P <.001) and teaching satisfaction (OR 4.13, 95% CI 1.96-8.69; P <.001) than traditional approaches. Finally, VR significantly enhanced the initiation of learning among students when compared with traditional teaching methods (SMD=1.15, 95% CI 0.91-1.39; P <.001). Conclusions: This meta-analysis emphasizes VR as an excellent orthopedic educational tool. It significantly enhances both theoretical knowledge and practical skills, while also markedly increasing student engagement and satisfaction. Therefore, adopting VR technology in medical education holds promise for improving orthopedic surgical competence. However, the quality of this meta-analysis was limited by the notable heterogeneity in terms of VR platforms these findings and further validation through multicenter, double-blind, and large-sample randomized controlled trials is required.

Introduction: We carried out a systematic review and meta-analysis to assess the safety and effectiveness of uterine artery embolization (UAE) compared with conventional hysterectomy on refractory postpartum hemorrhage (PPH). Methods: We searched PubMed, Embase, Chinese National Knowledge Infrastructure database (CNKI), Cochrane Library, and Wanfang database through October 2017 for randomized controlled trials (RCTs) and observational studies assessing the safety and effectiveness of UAE compared with hysterectomy on refractory PPH. The main outcome measures included the blood loss, operating time, hemostatic effective rate, and length of stay. Results: Six RCTs and nine observational studies were included in the meta-analysis, which involved 1142 women with refractory PPH. The results demonstrated that UAE was more beneficial on refractory PPH compared with hysterectomy using four scales: blood loss (WMD 893.39 mL; 95% CI: –1205.65, –581.13; p < .001); operating time (WMD −37.19 minutes; 95% CI: –44.42, –29.96; p < .001); length of stay (WMD −5.36 days; 95% CI: –5.76, –4.97; p < .001), hemostatic effective rate (OR 1.58, 95% CI: 0.80, 3.12, p = .184) . Conclusions: In the present meta-analysis, the positive findings suggest UAE has beneficial effects on refractory PPH. UAE significantly reduced blood loss, shortened the operating time, and length of stay compared with hysterectomy. And there is no difference between the UAE group and hysterectomy group in hemostatic effective rate. However, those findings should be treated with caution because of heterogeneity and potential biases.

Aim: We carried out a systematic review and meta-analysis to evaluate the safety and efficacy of electroacupuncture for patients with carpal tunnel syndrome.Methods: We searched PubMed, Embase, Cochrane Library, Scopus, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Chongqing VIP Database (VIP), and Wan Fang Database up to May 2022 for relevant studies. Relevant studies were identified by using specific eligibility criteria and data were extracted.Results: A total of 26 randomized controlled trials (RCTs) with 1,698 patients were included. Compared with routine treatment, electroacupuncture treatment had lower visual analog scale (VAS) score [mean difference = −0.79, 95% confidence interval (CI): −1.11 to −0.47, P < 0.00001], and the symptom severity scale and function status scale in electroacupuncture group were significantly lower than the control group (P = 0.0001 and P = 0.006). Moreover, the electrophysiological parameters in the electroacupuncture group were better than the control group. The electroacupuncture group had higher total effective rate than the control group (odds ratio = 4.94, 95% CI: 3.44–7.08, P < 0.00001).Conclusion: Our meta-analysis indicated that electroacupuncture had lower VAS score, higher total effective rate, a lower the scores of symptoms and function and electroacupuncture had better electrophysiological parameters. However, these findings needed to be verified further by multicenter, double-blind, and large-sample RCTs.

Rupture of HCC (rHCC) is a life-threatening complication of hepatocellular carcinoma (HCC), and rHCC may lead to a high rate of peritoneal dissemination and affect survival negatively. Treatment for rHCC mainly includes emergency surgery, interventional therapies, and palliative treatment. However, the management of rHCC should be carefully evaluated. For patients with severe bleeding, who are not tolerant to open surgery, quick hemostatic methods such as rupture tissue ablation and TAE/TACE can be performed. We described clinical presentation, prognosis, complication, interventional management, and current evidence of rHCC from the perspective of interventional radiologists. Overall, our review summarized that interventional therapies are necessary for most patients with rHCC to achieve hemostasis, even in some patients with Child–Pugh C. Moreover, TAE/TACE followed by staged hepatectomy is a beneficial treatment for rHCC according to current clinical evidence. TAE/TACE is the first choice for most patients with rHCC, and appropriate interventional treatment may provide staged surgery opportunities for those who are not tolerant to emergency surgery to reach an ideal prognosis.

Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. With the development of systemic therapies, several studies are currently underway, especially those related to the use of programmed death-1/programmed cell death-ligand 1 (PD-1/PD-L1) immunotherapy. Moreover, studies on transarterial chemoembolization (TACE) and PD-1/PD-L1 immunotherapy have demonstrated some interesting outcomes. This article reviewed the current clinical evidence on the combination of TACE and PD-1/PD-L1 immunotherapy. Overall, our review summarized that a favorable survival time could be achieved using this combination in most patients. However, complications such as hyperprogression should be taken seriously, and the underlying mechanisms need to be explored.