1.Surviving the year: Predictors of mortality in conservative kidney management.
Swee Ping TEH ; Boon Cheok LAI ; Ivan Wei Zhen LEE ; Shashidhar BAIKUNJE ; Sye Nee TAN ; Lee Ying YEOH
Annals of the Academy of Medicine, Singapore 2025;54(9):524-530
INTRODUCTION:
Conservative kidney management (CKM) is a recognised treatment option for selected patients with chronic kidney disease stage 5 (CKD G5), but prognostic indicators for mortality and optimal timing for palliative care transition remain uncertain.
METHOD:
This is a single-centre, prospective cohort study of CKD G5 patients who opted for CKM, conducted between April 2021 and September 2024, with longitudinal monitoring of Edmonton Symptom Assessment System Revised: Renal; Palliative Perfor-mance Scale (PPS); Resources Utilisation Group.Activities of Daily Living (RUG-ADL) scale; Clinical Frailty Score; Karnofsky Performance Score; and clinical and laboratory data. Primary outcomes included identifying baseline mortality predictors and validating the PPS for survival estimation. Cox proportional hazards models were used to identify independent predictors of mortality.
RESULTS:
Among 109 patients (mean age 79.8±7.3 years, 64.2% female), 62 (56.9%) died during follow-up. Multivariate analysis identified baseline estimated glomerular filtration rate (eGFR) (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.08.1.68, P<0.01) and serum albumin (HR 1.24, 95% CI 1.08.1.43, P<0.01) as predictors of 1-year mortality. Median survival varied by eGFR: 3.0 months (95% CI 0.6.2) for eGFR .5 mL/min/1.73 m2, 13.0 months (95% CI 9.1.16.9) for eGFR 6.10 mL/ min/1.73 m2, and 20.0 months (95% CI 16.5.23.5) for eGFR >10 mL/min/1.73 m2 (P<0.01). Subsequent PPS correlated strongly with survival, with median survival of 1.8 months for PPS <50, 5.3 months for PPS 50.60, and 7.9 months for PPS 70.80 (P=0.03).
CONCLUSION
Baseline eGFR and serum albumin predict 1-year mortality in CKM patients. PPS offers a practical tool for identifying patients requiring palliative care transition, supporting personalised care pathways and timely integration of palliative care.
Humans
;
Female
;
Male
;
Aged
;
Prospective Studies
;
Glomerular Filtration Rate
;
Palliative Care/methods*
;
Conservative Treatment/methods*
;
Aged, 80 and over
;
Prognosis
;
Serum Albumin/analysis*
;
Proportional Hazards Models
;
Activities of Daily Living
;
Singapore/epidemiology*
2.Mediation analysis of plasma phosphorylated tau217 in the association between periodontitis and mild cognitive impairment.
Yanbiao ZHANG ; Meirong WEI ; Xuejuan ZHAO ; Xiaolei QI ; Shanshan ZUO ; Shumei MAO ; Jun WANG ; Gang DING
West China Journal of Stomatology 2025;43(6):845-859
OBJECTIVES:
This study aimed to investigate the potential mediating role of plasma phosphorylated tau217 (p-tau217) in the association between periodontitis and mild cognitive impairment (MCI).
METHODS:
In this case-control study, patients diagnosed with MCI in the Neurology Department of the First Affiliated Hospital of Shandong Second Medical University from November 2023 to May 2024 were selected as the case group (MCI group). Cognitively normal (CN) volunteers, matched for age and education level and recruited from the physical examination center during the same period, served as the control group (CN group). The general demographic data of the study participants were collected. The Beijing versions of the Montreal Cognitive Assessment (MoCA), clinical dementia rating (CDR), and activities of daily living scale (ADL) were used to assess neuropsychological functions. Clinical periodontal examinations were conducted, the periodontal inflamed surface area (PISA) was calculated, and the periodontitis stage was determined in accordance with the 2018 classification. Fasting elbow venous blood samples were collected in the morning, and blood biochemical indicators were measured. Plasma p-tau217 levels were detected using enzyme-linked immunosorbent assay (ELISA). Statistical analyses were performed using t-test, Mann-Whitney U test, chi-square test, partial correlation analysis, multivariate Logistic regression analysis, multiple linear regression analysis, restricted cubic spline (RCS) regression analysis, and mediation effect analysis.
RESULTS:
Among the 192 participants, 96 belong to the MCI group and 96 to the CN group. The prevalence of periodontitis was 63.5% in the MCI group and 43.8% in the CN group, with a statistically significant difference (χ²=7.561, P=0.006). The plasma p-tau217 levels in the MCI group were significantly higher than those in the CN group [7.00 (4.27-9.65) ng/mL versus 2.02 (0.80-3.81) ng/mL, Z=-8.108, P<0.001]. Partial correlation analysis revealed that plasma p-tau217 levels were positively correlated with all the clinical periodontal indices (all P<0.001). After adjustments for baseline covariates, multivariate Logistic regression indicated that periodontitis was an independent risk factor for MCI. Patients with periodontitis had a 1.977-fold higher MCI risk than those without periodontitis (OR=1.977, 95%CI: 1.088-3.594, P=0.025). Moreover, the MCI risk for stage Ⅰ/Ⅱ periodontitis and stage Ⅲ/Ⅳ periodontitis was 1.878 times (OR=1.878, 95%CI: 1.029-3.425, P=0.040) and 2.625 times (OR=2.625, 95%CI: 1.073-6.246, P=0.035) higher than that for patients without periodontitis, respectively. Trend test showed that the MCI risk increased with periodontitis severity (Ptrend=0.016). After adjustments for baseline covariates, multiple linear regression analysis showed that periodontitis was an independent risk factor for increased plasma p-tau217 levels (β=3.309, 95%CI: 2.363-4.254, P<0.001). Compared with patients without periodontitis, those with stage Ⅰ/Ⅱ periodontitis (β=1.838, 95%CI: 0.869-2.806, P<0.001) and stage Ⅲ/Ⅳ periodontitis (β=5.539, 95%CI: 4.442-6.636, P<0.001) had significantly higher plasma p-tau217 levels. In addition, trend test indicated that plasma p-tau217 levels increased with periodontitis severity (Ptrend<0.001). After adjustments for baseline covariates, RCS regression analysis further revealed that PISA had a positive linear dose-response relationship with MCI risk (Poverall=0.002, Pnonlinear=0.344) and plasma p-tau217 levels (Poverall<0.001, Pnonlinear=0.140). After adjustments for baseline covariates, mediation analysis showed that plasma p-tau217 mediated the association between periodontitis and MCI, with a mediation proportion of 13.99% (95% Bootstrap CI: 0.38%-49.39%, P=0.038).
CONCLUSIONS
Periodontitis was independently positively associated with MCI risk, and plasma p-tau217 plays a mediating role in this association.
Humans
;
Cognitive Dysfunction/complications*
;
tau Proteins/blood*
;
Periodontitis/complications*
;
Case-Control Studies
;
Male
;
Female
;
Phosphorylation
;
Aged
;
Middle Aged
;
Activities of Daily Living
3.Functional outcome after clinical recovery from moderate to critical COVID-19 among patients admitted to the Philippine General Hospital: A prospective cohort study
Micah G. Catalan ; Sharon D. Ignacio
Acta Medica Philippina 2024;58(20):35-46
BACKGROUND AND OBJECTIVE
COVID-19 is a novel disease primarily affecting the respiratory system. Of those infected, approximately 20% require management in a hospital-setting which may lead to deconditioning. Measures implemented to control spread of the virus also restricted mobility both in the hospital and community setting. The goal of this study was to describe the patient characteristics (age, sex, comorbidities), hospitalization (length of hospital stay, ICU stay, referral to Rehabilitation Medicine), and long-term functional outcome of patients who have clinically recovered from moderate to critical COVID-19 in terms of participation in activities of daily living.
METHODSThis was a descriptive prospective cohort study conducted at a tertiary government hospital with participant recruitment from September 2020 to February 2021 consisting of clinically recovered adult patients managed as COVID-19 Confirmed via rRT-PCR with moderate, severe, or critical risk status. Descriptive statistics were obtained and multiple regression analysis was done to determine associations between patient demographics and their Barthel Index Scores on follow-up at discharge, one month post-discharge, and six months post-discharge.
RESULTSA total of 63 patients were recruited to our study with an average age of 52.4 years. More recovered patients had fulfilled the criteria of moderate illness (46%), with the most common comorbidity being chronic lung disease (42.1%) and diabetes (42.1%). Almost all had total independence pre-morbidly with better baseline functional scores for the COVID-19 severe population. Majority of the patients (63.5%) were not referred for Rehabilitation services. Across all patients, Barthel Index Score at discharge indicated a significant decline from slight dependence to moderate dependence in performing activities of daily living with the pre-morbid status significantly predicting scores at discharge (β = 0.621, p = 0.001) on multiple regression analysis. Patient demographics, hospitalization and ICU stay and outcome, and referral to Rehabilitation Medicine were not found to be significant factors. In the course of follow up, a high dropout rate was observed across the population and by the end of the study, 57.1% of the participants were alive while among those lost to follow up, 20.6% had expired and the remaining 22.2% had an unknown status.
CONCLUSIONCOVID-19 significantly affects the functional outcome of patients in terms of activities of daily living as measured by the Barthel Index. Preliminary data gathered from our study and the high dropout rate supports the need for better follow-up and selecting a tool that is better able to describe the non-demographic factors affecting functionality and participation in activities of daily living.
Covid-19 ; Patient-relevant Outcome ; Treatment Outcome ; Activities Of Daily Living ; Rehabilitation ; Cohort Studies
4.Effects of acupuncture on hemorrhagic transformation and motor function in stroke patients after intravenous thrombolysis with rt-PA: a prospective cohort study.
Chen-Xi LIANG ; Ling-Yong XIAO ; Jing-Ying GAN ; Xiao-Xiao SHI ; Xiao-Xuan WANG ; Yi LIU ; Chun-Lei TIAN ; Xiao-Yu DAI
Chinese Acupuncture & Moxibustion 2023;43(7):733-738
OBJECTIVE:
To observe the effects of the Xingnao Kaiqiao (regaining consciousness and opening orifices) acupuncture on hemorrhagic transformation and limb motor function after intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in stroke patients.
METHODS:
A total of 130 stroke patients after rt-PA thrombolytic were divided into an acupuncture group (58 cases, 1 case dropped off) and a non-acupuncture group (72 cases, 7 cases dropped off) according to whether they received acupuncture treatment. Propensity score matching (PSM) was used to match each group, with 38 patients in each group. The patients in the non-acupuncture group received rt-PA thrombolytic therapy and western medical basic treatment. In addition to the basic treatment, the patients in the acupuncture group received Xingnao Kaiqiao acupuncture at Shuigou (GV 26), bilateral Neiguan (PC 6), and ipsilateral Sanyinjiao (SP 6), Chize (LU 5), once a day for 14 days. The incidence of hemorrhagic transformation within 30 days after onset was compared between the two groups. The Fugl-Meyer assessment (FMA) score and activities of daily living (ADL) score were observed at baseline and 30 days, 6 months, 1 year after onset in the two groups. The disability rate at 6 months and 1 year after onset was recorded, and safety was evaluated in both groups.
RESULTS:
The incidence of hemorrhagic transformation in the acupuncture group was 5.3% (2/38), which was lower than 21.1% (8/38) in the non-acupuncture group (P<0.05). At 30 days, 6 month, and 1 year after onset, the FMA and ADL scores of both groups were higher than those at baseline (P<0.01), and the scores in the acupuncture group were higher than those in the non-acupuncture group (P<0.01). The disability rate in the acupuncture group at 1 year after onset was 10.5% (4/38), which was lower than 28.9% (11/38) in the non-acupuncture group (P<0.05). There was no significant difference in the incidence of adverse events between the two groups (P>0.05).
CONCLUSION
The Xingnao Kaiqiao acupuncture method could reduce the incidence of hemorrhagic transformation in stroke patients after intravenous thrombolysis with rt-PA, improve their motor function and daily living ability, and reduce the long-term disability rate.
Humans
;
Tissue Plasminogen Activator/adverse effects*
;
Activities of Daily Living
;
Prospective Studies
;
Stroke
;
Acupuncture Therapy
;
Thrombolytic Therapy/adverse effects*
5.Design and Research of Wearable Fall Protection Device for the Elderly.
Jie WANG ; Yeke SUN ; Zhenglong CHEN ; Yongchun JIN ; Yunhua XU
Chinese Journal of Medical Instrumentation 2023;47(3):278-283
A protective device was designed that can be worn on the elderly, which consists of protective airbag, control box and protective mechanism. The combined acceleration, combined angular velocity and human posture angle are selected as the parameters to determine the fall, and the threshold algorithm and SVM algorithm are used to detect the fall. The protective mechanism is an inflatable device based on CO2 compressed air cylinder, and the equal-width cam structure is applied to its transmission part to improve the puncture efficiency of the compressed gas cylinder. A fall experiment was designed to obtain the combined acceleration and angular velocity eigenvalues of fall actions (forward fall, backward fall and lateral fall) and daily activities (sitting-standing, walking, jogging and walking up and down stairs), showing that the specificity and sensitivity of the protection module reached 92.1% and 84.4% respectively, which verified the feasibility of the fall protection device.
Humans
;
Aged
;
Monitoring, Ambulatory
;
Activities of Daily Living
;
Wearable Electronic Devices
;
Walking
;
Acceleration
;
Algorithms
6.Comparison of Effects of Liuzijue Exercise and Conventional Respiratory Training on Patients after Cardiac Surgery: A Randomized Controlled Trial.
Qiao-Li ZHANG ; Min GE ; Cheng CHEN ; Fu-Dong FAN ; Yan JIN ; Ning ZHANG ; Lei WANG
Chinese journal of integrative medicine 2023;29(7):579-589
OBJECTIVE:
To evaluate the feasibility and safety of Liuzijue exercise (LE) for the clinical effect in patients after cardiac surgery.
METHODS:
Totally 120 patients who underwent cardiac surgery and were admitted to the Cardiothoracic Intensive Care Unit of Nanjing Drum Tower Hospital between July and Oclober, 2022 were allocated to the LE group, the conventional respiratory training (CRT) group, and the control group by a random number table at a ratio of 1:1:1; 40 patients in each group. All patients received routine treatment and cardiac rehabilitation. LE group and CRT group respectively performed LE and CRT once a day for 30 min for 7 days. Control group did not receive specialized respiratory training. The forced vital capacity, forced expiratory volume in 1 s, peak inspiratory flow rate, peak expiratory flow rate, maximum inspiratory pressure, maximum expiratory pressure, modified Barthel index (MBI), and Hamilton Rating Scale for Anxiety (HAM-A) were evaluated before, after 3 and 7 days of intervention. In addition, the postoperative length of hospital stay (LOS) and the adverse events that occurred during the intervention period were compared.
RESULTS:
A total of 107 patients completed the study, 120 patients were included in the analysis. After 3 days of intervention, the pulmonary function, respiratory muscle strength, MBI and HAM-A of all 3 groups improved compared with that before the intervention (P<0.05 or P<0.01). Compared with the control group, pulmonary function and respiratory muscle strength were significantly improved in the CRT and LE groups (P<0.05 or P<0.01). MBI and HAM-A were significantly improved in the LE group compared with the control and CRT groups (P<0.05 or P<0.01). On the 7th day after intervention, the difference was still statistically significant (P<0.01), and was significantly different from that on the 3rd day (P<0.05 or P<0.01). In addition, on the 7th day of intervention, the pulmonary function and respiratory muscle strength in the LE group were significantly improved compared with those in the CRT group (P<0.01). MBI and HAM-A were significantly improved in the CRT group compared with the control group (P<0.01). There were no significant differences in postoperative LOS among the 3 groups (P>0.05). No training-related adverse events occurred during the intervention period.
CONCLUSIONS
LE is safe and feasible for improving pulmonary function, respiratory muscle strength, the ability to complete activities of daily living and for relieving anxiety of patients after cardiac surgery (Registration No. ChiCTR2200062964).
Humans
;
Activities of Daily Living
;
Breathing Exercises
;
Cardiac Surgical Procedures/adverse effects*
;
Respiratory Muscles
;
Muscle Strength/physiology*
7.Comparison of Functional Status Between Diabetic Patients With and Without Nephropathy Based on the International Classification of Functioning,Disability and Health Rehabilitation Set.
Jun-Zhi ZHU ; Wei-Yan LU ; Ying-Fen LIU ; Dan-Dan TANG ; Li-Shi DU ; Hao-Xiang WANG
Acta Academiae Medicinae Sinicae 2023;45(5):752-759
Objective To compare the functional status of diabetic patients with and without nephropathy and identify the items that diabetic patients with nephropathy are more likely to develop dysfunction than diabetic patients without nephropathy based on the international classification of functioning,disability and health rehabilitation set(ICF-RS).Methods A cross-sectional study was conducted.A total of 320 diabetic patients hospitalized in Guangdong Provincial Hospital of Chinese Medicine from August 2021 to February 2022 were selected and assigned into a group with nephropathy and a group without nephropathy.The general characteristics,clinical examination,and laboratory findings were compared by the t test,rank sum test,and Chi-squared test.The functional status of the patients was compared between the two groups by the t test based on the ICF-RS.Logistic regression was employed to control interferential factors between the two groups and identify the association between nephropathy and ICF-RS problematic items among diabetic patients.Results The diabetic patients with nephropathy had more problematic items in ICF-RS(P<0.001),the body function dimension(P=0.003),the activity dimension(P<0.001),and the participation dimension(P<0.001)than those without nephropathy.Moreover,the diabetic patients with nephropathy experienced severer problems in 5 body function items(energy and drive functions,sleep functions,sexual functions,exercise tolerance functions,and muscle power functions),10 activity items(transferring oneself,walking,moving around using equipment,moving around,washing oneself,caring for body parts,toileting,dressing,doing housework,and looking after one's health),and 4 participation items(using transportation,assisting others,basic interpersonal interactions,and recreation and leisure)(all P<0.05).The Logistic regression results showed that compared with the diabetic patients without nephropathy,the diabetic patients with nephropathy were more likely to develop problems in energy and drive functions(aOR=4.35,95%CI=1.28-14.79,P=0.019),emotional functions(aOR=1.88,95%CI=1.06-3.34,P=0.031),sexual functions(aOR=3.39,95%CI=1.82-6.34,P<0.001),moving around(aOR=3.11,95%CI=1.76-5.52,P<0.001),doing housework(aOR=17.48,95%CI=3.57-85.60,P<0.001),looking after one's health(aOR=1.97,95%CI=1.13-3.43,P=0.017),using transportation(aOR=2.59,95%CI=1.38-4.88,P=0.003),and recreation and leisure(aOR=2.52,95%CI=1.46-4.35,P<0.001).Conclusion Compared with the diabetic patients without nephropathy,the patients with nephropathy suffer more ICF-RS problematic items and are more likely to develop dysfunction in certain items in all the three dimensions.
Humans
;
Disability Evaluation
;
Cross-Sectional Studies
;
Functional Status
;
Disabled Persons/rehabilitation*
;
Kidney Diseases
;
Diabetes Mellitus
;
Activities of Daily Living
8.Return to sports WeChat applet for evaluating the rehabilitation effects after anterior cruciate ligament reconstruction.
Zhengliang SHI ; Yanlin LI ; Yang YU ; Kai LI ; Wenting TANG ; Ziwen NING ; Renjie HE ; Kun WANG ; Guoliang WANG
Chinese Journal of Reparative and Reconstructive Surgery 2023;37(9):1086-1093
OBJECTIVE:
To clarify the intervention guidance of return to sports WeChat applet and evaluate the rehabilitation effectiveness after anterior cruciate ligament (ACL) reconstruction.
METHODS:
Between September 2020 and September 2022, 80 patients who met the selection criteria and underwent ACL anatomical single bundle reconstruction were selected as the research objects. According to the double-blind random method, they were divided into the applet group and the regular group, with 40 cases in each group. Patients in the applet group were rehabilitated under the guidance of the return to sports WeChat applet, and the patients were asked to perform the test once a month after operation, including patients' subjective scores [Tegner score, knee injury and osteoarthritis outcome score (KOOS), International Knee Documentation Committee (IKDC) score, American Hospital for Special Surgery (HSS) score], psychological assessment [ACL recovery sports injury scale (ACL-RSI) score], jumping test, balance test, bending angle test. Patients in the regular group were followed up by doctors and nurses regularly by telephone every month. All the patients were reexamined at 3, 6, 9, and 12 months after operation, and the range of motion of the knee joint with 6 degrees of freedom (flexion and extension angle, varus and valgus angle, internal and external rotation angle, anteroposterior displacement, superior and inferior displacement, and internal and external displacement) recorded by Opti_Knee three-dimensional knee joint motion measurement gait analysis system was observed. The anterior tibial translation difference (ATTD) was measured by Ligs knee measuring instrument when a forward thrust of 120 N was applied to the posterior part of the proximal tibia. Tegner score, IKDC score, KOOS score (including KOOS-Pain score, KOOS-Symptoms score, KOOS-Activities of daily living score, KOOS-Sport score, and KOOS-Quality of life score), HSS score, ACL-RSI score, jumping ability, balance ability, patients' satisfaction with the rehabilitation process, and ACL healing grading according to ACL continuity and signal intensity shown by MRI.
RESULTS:
There were significant differences in various indicators between different time points after operation in the two groups ( P<0.05). At 3 months after operation, except that the ACL-RSI score of the applet group was significantly higher than that of the regular group ( P<0.05), there was no significant difference in the other indicators between the two groups ( P>0.05). At 6 months after operation, the ACL-RSI score, IKDC score, Tegner score, KOOS scores of different items, HSS score, balance and jumping ability of the applet group were significantly higher than those of the regular group ( P<0.05), and there was no significant difference in the other indicators between the two groups ( P>0.05). At 9 months after operation, there was no significant difference in all indicators between the two groups ( P>0.05). At 12 months after operation, 27 cases (67.5%) in the applet group and 21 cases (52.5%) in the regular group returned to sport, with a significant difference of the return to sports incidence between the two groups [ RR(95% CI)=1.50 (1.00, 2.25), P=0.049]. In the applet group, 27 cases were very satisfied with the rehabilitation process, 10 cases were satisfied, 2 cases were basically satisfied, and 1 case was not satisfied, while 19, 13, 5, and 3 cases in the regular group, respectively. The satisfaction degree of the applet group was significantly better than that of the regular group ( P=0.049). MRI examination of the two groups showed that the ACL was continuous without secondary rupture or necrosis. The ACL healing grade of the applet group was 31 cases of grade 1 and 9 cases of grade 2, and that of the regular group was 28 cases of grade 1 and 12 cases of grade 2, there was no significant difference in ACL healing grade between the two groups ( P=0.449).
CONCLUSION
The application of return to sports WeChat applet in the rehabilitation of patients after ACL reconstruction can significantly reduce the fear of return to sports and improve the rate of return to sports. The return to sports WeChat applet is convenient to operate, with high utilization rate and high patient compliance, which significantly improves the satisfaction.
Humans
;
Activities of Daily Living
;
Quality of Life
;
Return to Sport
;
Knee Joint/surgery*
;
Anterior Cruciate Ligament Injuries/surgery*
;
Anterior Cruciate Ligament Reconstruction
9.Risk factors and prognosis of acute cerebrovascular events at 1 year after hip fracture in elderly patients.
Hong-Tao LUO ; Wei YAN ; Qing-Yang YAO ; Li-Tong ZHENG ; Peng-Xiang MEN ; Jin-Qiang WANG
China Journal of Orthopaedics and Traumatology 2023;36(12):1119-1124
OBJECTIVE:
To investigate risk factors of acute cerebrovascular events and effects on the prognosis within 1 year after hip fracture surgery.
METHODS:
A retrospective analysis was performed on 320 elderly patients with hip fracture treated from July 2017 to December 2020, including 111 males and 209 females, aged from 60 to 101 years old with an average of (79.05±8.48) years old. According to whether acute cerebrovascular events occurred within 1 year after surgery, patients were divided into cerebrovascular events and non-cerebrovascular events group. Clinical data of patients were collected, including age, sex, comorbidities, fracture type, white blood cell count, hemoglobin, albumin, activities of daily living (ADL) score, walking ability, type of anesthesia, type of surgery, and length of hospital stay, Univariate analysis and multivariate Logistic regression were used to analyze the independent risk factors of acute cerebrovascular events within 1 year after hip fracture in elderly patients. ADL, walking ability and mortality were compared between the two groups 1 year after surgery.
RESULTS:
Acute cerebrovascular events occurred in 38 patients (11.9%) within 1 year after surgery. In the cerebrovascular events group, there were 20 males and 18 females, aged (82.53±7.91) years. In the non-cerebrovascular event group, there were 91 males and 191 females, aged with an average of (78.59±8.46) years old . Univariate analysis showed that acute cerebrovascular events were associated with age (t=2.712, P=0.007), male (χ2=6.129, P=0.013), hypertension (χ2=8.449, P=0.004), arrhythmia (χ2=6.360, P=0.012), stroke history (χ2=34.887, P=0.000), diabetes mellitus (χ2=4.574, P=0.032) and length of hospital stay (t=2.249, P=0.025) were closely related. Multivariate Logistic regression analysis showed age (OR=1.068, P=0.018), male (OR=2.875, P=0.008), arrhythmia (OR=2.722, P=0.017) and stroke history (OR=7.382, P=0.000) was an independent risk factor for acute cerebrovascular events 1 year after surgery. The patients with cerebrovascular events died at 1 year after surgery (11 cases) compared with those without cerebrovascular events (41 cases), and the difference was statistically significant(χ2=5.108, P=0.024). ADL scores of patients with cerebrovascular events at 1 year after operation were (58.70±14.45) points compared with those without cerebrovascular events (67.83±10.45) points, and the difference was statistically significant(t=4.122, P=0.000). Independent walking, assisted walking and bed rest were 3, 17 and 7 cases in cerebrovascular event group, and 54, 174 and 13 cases in non-cerebrovascular event group, respectively;and the difference was statistically significant(χ2=11.030, P=0.003).
CONCLUSION
Acute cerebrovascular events were common in elderly patients 1 year after hip fracture. Age, male, arrhythmia and stroke history were independent risk factors for acute stroke. The patients in the cerebrovascular event group had higher mortality and worse self-care ability and walking ability one year after operation.
Female
;
Humans
;
Male
;
Aged
;
Middle Aged
;
Aged, 80 and over
;
Retrospective Studies
;
Activities of Daily Living
;
Hip Fractures
;
Risk Factors
;
Prognosis
;
Stroke
;
Arrhythmias, Cardiac
10.A new method of anterior talofibular ligament reconstruction: Arthroscopically artificial ligament reconstruction with tensional remnant-repair.
Qiu HUANG ; Xiao-Xi JI ; Wen-Hui ZHU ; Ye-Hua CAI ; Lie-Hu CAO ; Yong-Cai WANG
Chinese Journal of Traumatology 2023;26(6):317-322
PURPOSE:
To investigate the clinical effects of arthroscopically artificial ligament reconstruction with tensional remnant-repair in patients who are obese, and/or with demand for highly intensive sports, and/or with poor-quality ligament remnants.
METHODS:
A retrospective case series study was performed on patients treated by arthroscopically anterior talofibular ligament (ATFL) reconstruction with tensional remnant repair technique from January 2019 to August 2021. General data, including demographics, surgical time, and postoperative adverse events, were recorded. The American Orthopaedic Foot and Ankle Society score (AOFAS), foot and ankle ability measure (FAAM), visual analog scale (VAS), and anterior talar translation were measured preoperatively and at 6 weeks, 3 months, and 2 years postoperatively. Ultrasonography examination was performed preoperatively and 2 years postoperatively to evaluate the ATFL. Data were analyzed using SPSS 19.0. F test was used to analyze the pre- and postoperative VAS, FAAM, and AOFAS scores. The significance was set at p < 0.05.
RESULTS:
There were 20 males and 10 females among the patients with a mean age of (30.71 ± 5.81) years. The average surgical time was (40.21 ± 8.59) min. No adverse events were observed after surgery. At 2 years postoperatively, the anterior talar translation test showed grade 0 laxity in all patients. VAS score significantly decreased from preoperatively to 6 weeks, 3 months, and 2 years postoperatively (p < 0.001). Improvement of FAAM score and the AOFAS score from preoperatively to 6 weeks, 3 months, and 2 years postoperatively was statistically significant (p < 0.001). At 3 months postoperatively, most patients (23/30) could return to their pre-injured activities of daily living status. At 2 years postoperatively, all patients were able to return to their pre-injured activities of daily living status, and almost every patient (18/19) who expected highly intensive sports returned to sports with only 1 obese patient failing to achieve the goal. The ultrasonography examination at 2 years postoperatively showed that there was a linear band structure of soft tissue on the tension-rich fiber tape image from the fibular to the talar attachment sits of ATFL.
CONCLUSION
The novel arthroscopically artificial ligament reconstruction with tensional remnant-repair technique for ATFL achieved satisfactory clinical outcomes in the short and medium term after operation, and allowed early return to pre-injured activities, which could be a reliable option for patients with chronic lateral ankle instability.
Male
;
Female
;
Humans
;
Young Adult
;
Adult
;
Ankle Joint/surgery*
;
Retrospective Studies
;
Activities of Daily Living
;
Ankle Injuries/surgery*
;
Lateral Ligament, Ankle/surgery*
;
Joint Instability/surgery*
;
Ligaments
;
Obesity
;
Arthroscopy/methods*


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