BACKGROUND:Fast track surgery, also cal ed enhanced recovery after surgery, is a series of optimal measures adopted during the perioperative period on the basis of evidence-based medicine, to reduce the physical and mental trauma brought to the patient and accelerate their recovery. It has become the research focus of orthopedic clinic as the surgery and anesthesia skil s are improved a lot in recent years, especial y the articular surgery, which has been widely used in clinics. OBJECTIVE:To summarize the clinical study of the application of optimal measures in joint replacement surgery both at home and abroad in recent years. METHODS:The first author searched related articles in PubMed and Chinese Journal Ful-text Database from January 1997 to September 2016. The key words were“joint replacement, enhanced recovery after surgery, multi-mode analgesia, diet management, steroid hormones”. 81 articles were found at last and one monograph was included. RESULTS AND CONCLUSION:(1) We found that the recovery plan reduced the hospital stays of the patients from 4-12 days to 1-3 days, including pre-operative health education, shortening fasting and water-depriving duration before surgery, super-anesthesia before surgery and do not place catheter;adopting general anesthesia and appropriate adductor canal to relieve the pain, and stopping bleeding using tranexamic acid during operation;multi-mode analgesia, faster function exercise after anesthesia recovery, and drinking water in early phase after surgery during the perioperative period of joint replacement surgery conducted by the cooperation of surgeon, anesthetist, nurse and nutritionist. There were no significant improvements of postoperative complications rate and rehospitalization rate. (2) The research found that, enhanced recovery after surgery is suitable for most of the patients receiving joint replacement surgery, including those in advanced age, combined heart and lung disease before surgery, type 2 diabetes and smoking and drinking before surgery.

Objective: To systematically evaluate the influencing factors for autism spectrum disorder (ASD) in Chinese children, so as to provide the evidence for risk prediction and intervention of ASD. Methods: The publications pertaining to the influencing factors for ASD in Chinese children were retrieved from CNKI, Wanfang Data, VIP, PubMed and Embase database from inception to August 2024. A meta-analysis was performed using R package version 4.4.1. Sensitivity analysis was performed using the "leave-one-out" evaluation procedure. Publication bias was assessed using Egger regression test. Results: A total of 38 high-quality articles out of 9 015 articles were finally included, covering 149 607 individuals, with 5 974 cases of ASD. The meta-analysis showed that demographic factors including family history of related diseases (OR=14.958), maternal age of ≥35 years (OR=2.287) and parental history of hazardous occupations (OR=3.511); pregnancy-related factors including history of abortion (OR=5.832), no folate supplementation before and during pregnancy (OR=4.566), tobacco exposure before and during pregnancy (OR=2.596), history of other adverse exposures before and during pregnancy (OR=3.533), history of infectious diseases during pregnancy (OR=3.753), history of non-infectious diseases during pregnancy (OR=2.563), psychological problems during pregnancy (OR=3.864), history of medication during pregnancy (OR=6.651), adverse environmental exposures during pregnancy (OR=3.754), severe pregnancy reactions (OR=5.082), abnormal perinatal period (OR=2.987), cesarean delivery (OR=1.659), other perinatal adverse factors (OR=3.856), history of neonatal asphyxia (OR=2.792) and neonatal jaundice (OR=3.687); parenting factors including non-exclusive breastfeeding (OR=2.510), early/excessive screen exposure (OR=3.589) and feeding problems (OR=3.113); and individual factors including being male (OR=3.333) and history of convulsions/epilepsy (OR=7.035) were influencing factors for ASD in Chinese children. Conclusions The prevalence of ASD in Chinese children is primarily associated with 23 influencing factors, including family history of related diseases, history of abortion, no folate supplementation before and during pregnancy, medication during pregnancy, early/excessive screen exposure and history of convulsions/epilepsy.

Panax notoginseng (PN) is one of the commonly used clinical medicines for cardiovascular diseases and possesses a variety of pharmacological effects. P. notoginseng saponins (PNS) are the most important bioactive components in PN. The purpose of this study was to explain the mechanism of PNS on molecular network level. 18 targets of the main medicinal ingredients of PNS were gained by virtual screening based on pharmacophores and data mining. A protein interaction network of PNS was constructed with 189 nodes and 721 interactions. By a graph theoretic clustering algorithm Molecular Complex Detection (MCODE), 14 modules were detected. Gene ontology (GO) enrichment analysis of the modules demonstrated that the roles of PNS played in cardiovascular disease related to multiple biological processes, which could represent the characteristics of traditional Chinese medicine (TCM) as a whole to regulate the disease. The results showed that the blood circulation and hemostasis efficacy of PN related with the biological processes such as positive regulation of cAMP metabolic and biosynthetic process, platelet activation and regulation of blood vessel size, regulation of T cell proliferation and differentiation and so on. Therefore, the module-based network analysis will be an effective method for better understanding TCM.
Drugs, Chinese Herbal ; chemistry ; Humans ; Panax notoginseng ; chemistry ; Protein Interaction Maps ; drug effects ; Proteins ; chemistry ; Saponins ; chemistry

Objective To investigate the image changes of proton magnetic resonance spectroscopy (1H-MRS) in children with epilepsy and their clinical significance. Methods Sixty-four patients with epilepsy,admitted to our hospital from March 2008 to March 2011,and 10 healthy children as control group were chosen in our study; the patients were divided into MR normal group and MR abnormal group according to the results of MR imaging. All of them received 1H-MRS examination on the hippocampal area.The ratio of NAA/Cho+Cr was compared between each 2 groups. Results No significant differences on the ratio of NAA/Cho+Cr were noted between the fight and left sides in all the groups (P＞0.05).The ratio of NAA/Cho+Cr was significantly different:MR normal group and control group enjoyed obvious difference as compared with MR abnormal group (P＜0.05); however,MR normal group and MR abnormal group existed no statistically significant differences (P＞0.05). Conclusion 1H-MRS is more sensitivity than MRI in children with epilepsy,therefore,1H-MRS can find the lesions earlier than MR imaging.

Objective To explore the protective effects of diazoxide on injury of human renal tubular cell(HK-2)induced by serum obtained from neonates with asphyxia.Methods HK-2 cells was used as the target cel1.The attacking concentration of serum obtained from neonates with asphyxia was 200 mL/L.The experiment was designed as 3 groups.HK-2 cells were divided into control group,asphyxia group,and diazoxide group.Control group:joined nutrient fluid including 100 mL/L embryo cow blood serum.Asphyxia group:joined nutrient fluid including the isometric 200 mL/L serum obtained from neonates with asphyxia.Diazoxide group:the diazoxide was joined nutrient including the isometric 200 mL/L serum obtained from neonates with asphyxia fluid.The diazoxide density finally was 100 ?mol/L.Then the change of morphology was observed and photographed under inverted microscope,and the cell viability was measured by methyl thiazolyl tetrazolium method,and the leakage rate oflactate dehydrogenase(LDH)was determined by biochemical methods.Results Under inverted microscopy,HK-2 cells in control group pastes the wall to be good,assumes the paving stone type,into flat polygon,fission many,the cell arrangement was close,connection large expanse,quantity were many.Compared with control group,the HK-2 cell to suffer injury obviously,the shape changed,become the anomalous circular or the ellipse by the model flat polygonal cell,the intercellular space crevice enlarged,the connection was loose,intercellular space obviously many cell fragmented.Living cell quantity reduced obviously,the cell vigor dropped,and the leakage rate of LDH increased significantly in asphyxia group(P

Animals ; China ; epidemiology ; Disease Models, Animal ; Humans ; Polymorphism, Genetic ; Venous Thromboembolism ; diagnosis ; epidemiology ; genetics

BACKGROUND: The perioperative hemorrhage of knee surgeries is a difficulty in clinic, and the efficacy of tranexamic acid to reduce postoperative bleeding has attracted more attention, but choosing which administrations remains controversial. OBJECTIVE: To investigate the efficacy of tranexamic acid by intravenous injection or articular injection for reducing the perioperative hemorrhage of total knee arthroplasty. METHODS: Sixty patients undergoing unilateral total knee replacement were enrolled, and were then randomized into three groups (n=20 per group): no tranexamic acid administration (group A); intravenous dropping of 15 mg/kg tranexamic acid before tourniquet application plus 10 mg/kg tranexamic acid at 3 hours postoperatively (group B); articular injection of 50 mL saline diluted with 1 g tranexamic acid through a drainage tube (group C). Two-hour closure of drainage tube was performed in all patients. The postoperative dominant and hidden blood loss, blood transfusion rate, pulmonary embolism as well as lower extremity deep venous thrombosis were recorded. RESULTS AND CONCLUSION: (1) The dominant and hidden blood loss in the groups B and C were significantly less than those in the group A (P < 0.05); the dominant blood loss showed no significant difference between groups B and C (P > 0.05); the group B exhibited a significantly less hidden blood loss compared with group C (P < 0.05). (2) The blood transfusion rate in the groups B and C was significantly lower than that in the group A (P < 0.05). (3) No pulmonary embolism or lower extremity deep venous embolism occurred during 3-month follow-up. (4) That is to say, tranexamic acid can obviously reduce perioperative blood loss and blood transfusion rate without pulmonary embolism or lower extremity deep venous thrombosis, and intravenous administration exerts better clinical effectiveness.

Background::Acute pulmonary embolism (APE) is a fatal cardiovascular disease, yet missed diagnosis and misdiagnosis often occur due to non-specific symptoms and signs. A simple, objective technique will help clinicians make a quick and precise diagnosis. In population studies, machine learning (ML) plays a critical role in characterizing cardiovascular risks, predicting outcomes, and identifying biomarkers. This work sought to develop an ML model for helping APE diagnosis and compare it against current clinical probability assessment models.Methods::This is a single-center retrospective study. Patients with suspected APE were continuously enrolled and randomly divided into two groups including training and testing sets. A total of 8 ML models, including random forest (RF), Na?ve Bayes, decision tree, K-nearest neighbors, logistic regression, multi-layer perceptron, support vector machine, and gradient boosting decision tree were developed based on the training set to diagnose APE. Thereafter, the model with the best diagnostic performance was selected and evaluated against the current clinical assessment strategies, including the Wells score, revised Geneva score, and Years algorithm. Eventually, the ML model was internally validated to assess the diagnostic performance using receiver operating characteristic (ROC) analysis.Results::The ML models were constructed using eight clinical features, including D-dimer, cardiac troponin T (cTNT), arterial oxygen saturation, heart rate, chest pain, lower limb pain, hemoptysis, and chronic heart failure. Among eight ML models, the RF model achieved the best performance with the highest area under the curve (AUC) (AUC = 0.774). Compared to the current clinical assessment strategies, the RF model outperformed the Wells score ( P = 0.030) and was not inferior to any other clinical probability assessment strategy. The AUC of the RF model for diagnosing APE onset in internal validation set was 0.726. Conclusions::Based on RF algorithm, a novel prediction model was finally constructed for APE diagnosis. When compared to the current clinical assessment strategies, the RF model achieved better diagnostic efficacy and accuracy. Therefore, the ML algorithm can be a useful tool in assisting with the diagnosis of APE.

Objective To explore the role of multi-department cooperation in the prevention and control of nosocomial infection of multi-drug-resistant bacteria(MDRO). Methods Theretrospective analysis was conducted on 1 478 inpatients before the implementation of multi-department cooperative management (January 2019 to December 2019). The implementation of multi-department cooperative management began in January 2020, including :(1) the establishment of multi-department cooperative management organization system; (2) Establish a three-level MANAGEMENT network of MDRO; (3) Multidisciplinary joint training; (4) Clinical departments shall be equipped with clinical pharmacists; (5) The hospital infection monitoring system was used to conduct real-time monitoring on the submission of microbial samples, the detection rate of MDRO, the changes of drug-resistant bacteria and the use of antibiotics; (6) Led by the department of hospital pathology and medical Service, regular joint ward rounds should be conducted in the departments and key departments with high DETECTION rate of MDRO; (7) PDCA cycle mode was adopted for quality control of all links of nosocomial infection prevention and control measures; After the implementation of multi-department cooperative management (January 2020 to December 2020), all the hospitalized patients in 1849 cases were detected and counted, and the incidence of nosocomial infection, the detection rate of MDRO, the compliance rate of hand hygiene, the implementation rate of contact isolation, and the specimen inspection rate of therapeutic use of antibiotics and the reasonable utilization rate of antibiotics were compared before and after the implementation. Results The incidence of nosocomial infection and the detection rate of MDRO were significantly lower after the implementation of multi-department cooperative management than before (χ²=46.611, χ²=16.814, P < 0.05). The hand hygiene compliance rate and contact isolation implementation rate were significantly higher after the implementation of multi-department cooperative management than before (χ² = 25.357, χ²=29.227, P<0.05). After the implementation of multi-department cooperative management, the sample test rate of therapeutic use of antibiotics was significantly higher than that before the implementation of multi-department cooperative management (χ²=25.576, χ²=33.624, P<0.05). Conclusion The practice of multi-department cooperative management brings into full play the advantages of interdisciplinary complementarity, improves the ability of medical staff to implement the prevention and control measures for MDRO, and can effectively reduce the incidence of nosocomial infection in MDRO.

OBJECTIVETo evaluate the efficacy of hepatitis B viruse (HBV) vaccination and its influencing factors among children in rural area of Jiangsu province.

METHODSTwenty-five hundred and twenty-two children born after 1998 in rural area were selected as the study population using multistage cluster sampling method. HBsAg and anti-HBs were detected by enzyme linked immunoassay (ELISA) and radio-immunoassay (RIA), respectively. Anti-HBs negative children were boosted using different hepatitis B vaccines and the efficacy was compared. Factors causing HBV infection in HBsAg positive children were also investigated.

RESULTSHBsAg positive rates in 1-7 year olds were 0.28%-1.28%, and the anti-HBs positive rates decreased from 76.7% to 45.5%. The HBsAg positive rate in children not timely vaccinated was significantly higher than those with HBV vaccine injection within 24 hours after birth (1.4% vs. 0.5%, P = 0.031). More than 90% of the anti-HBs negative children had protective level of anti-HBs after boosted with HBV vaccine.

CONCLUSIONHBsAg positive rate in children born after 1998 in rural area of Jiangsu province decreased significantly, with an average of 0.8%. The reason for HBsAg carriage in children might be attributed to mother-to-infant transmission or not timely HBV vaccination.

Adult ; Child ; Child, Preschool ; China ; epidemiology ; Female ; Hepatitis B ; epidemiology ; immunology ; prevention & control ; transmission ; Hepatitis B Surface Antigens ; blood ; Hepatitis B Vaccines ; administration & dosage ; immunology ; Humans ; Infant ; Infectious Disease Transmission, Vertical ; Pregnancy ; Rural Population