Objective To investigate the diagnostic value of knee skin temperature and serum soluble intercellular adhesion molecule-1 (sICAM-1) level in peri-prosthetic infection after total knee arthroplasty (TKA).Methods Thirty patients (11 males and 19 females,aged 59.3±9.5 years old) underwent primary TKA during November 2012 and October 2015.Ten patients with peri-prosthetic infection (3 males and 7 females,aged 60.9±8.2 years old) underwent two-stage revision TKA from November 2012 to October 2015.The interleukin-6 (IL-6),C-reactive protein (CRP),erythrocyte sedimentation rate (ESR),sICAM-1 in serum and the skin temperature in knee joint were recorded preoperatively (revision patients on diagnosis),at days 1,7 and at 1,3,6,12 months post-operatively.Results All of the 40 patients were followed up for 12 months.The serum CRP,IL-6 and ESR levels in the primary TKA group were normal preoperatively and increased after operation,reaching their peaks at 1-7 days postoperatively.These indexes then returned slowly to the normal levels within 3 months.The serum sICAM-1 level in the primary TKA group did not change significantly during the follow up.The serum levels of CRP,IL-6,ESR,and sICAM-1 in the revision group were significantly higher than that in the primary TKA group preoperatively (P＜0.05),IL-6,CRP,ESR returned slowly to the normal levels within 3 months after the second-stage revision,while the level of sICAM-1 returned to normal within 3 months after the first-stage revision.During whole follow-up after the second-stage revision,the level of sICAM-1 didn't change significantly.The preoperative mean differential temperature (MDT) in the primary TKA group was 0.73±0.62 ℃ preoperatively and elevated to 4.37±1.06 ℃ at 7 days postoperatively,which returned to the baseline within 6 months after primary TKA.The preoperative MDT in the revision group was 5.03±0.81 ℃,which was significantly higher than that in the primary TKA group (P＜0.05).The MDT returned to the normal level within 6 months after the second-stage revision TKA.Conclusion The change of MDT is in accordance with serum CRP,IL-6,and ESR,which together may predict the occurrence of infection.Serum sICAM-1 level may also be valuable in the diagnosis of peri-prosthetic infection.

Objective To evaluate the early stage effects of partial two?stage exchange (PTE) for infection after total hip arthroplasty (THA) in order to improve surgical treatment outcomes. Methods Twelve patients (7 males and 5 females) of infect?ed THA treated by PTE between September 2000 and February 2016 were included with an average of 59 years old (range, 40-74 years old). The femoral stem prosthesis was preserved when we ensured that it was not infected and with well fixation during opera?tion. The acetabular prosthesis was totally replaced. Furthermore, the secondary surgery was performed on patients who were free from infection for at least 3 months. At the follow?up duration, the pelvic X?ray was examined to access the presence of loosening of the prosthesis. The inflammatory index was recorded. Hip function was assessed by the Harris hip score, and the visual analogue score (VAS) and patient's subjective satisfaction were recorded by the questionnaire. Results All of the 12 patients were fol?lowed up for a mean of 33.3 months (range, 24-48 months). We achieved a 92% (11/12) success rate. One patient resuffered infec?tion, which was controlled after the second debridement. The preoperative Harris score of 12 patients was 23-57, with an average of 40.83±10.62. All patients had significant improvement in hip function after PTE. The Harris score reached 59.58±4.34 at one month after surgery, and reached 64.58±9.08 after three months and 86.75±4.58 at the last follow?up. There was significantly dif?ferent when compared with the preoperative Harris score. At the last follow?up, the length difference between the lower limbs was less than 1cm in all patients. Two patients did not complain of pain, while other 10 patients got a VAS score of less than 2 points. The patient's subjective satisfaction rating was 100%. Conclusion PTE could be a valuable alternative treatment for infection af?ter THA. The infection control rate and clinical outcomes are comparable to those of two?stage exchange.

Objective To make a comprehensive analysis of the index of benefit and medical service ability of disease,and provide references for the operation management of public hospital based on disease.Methods TOPSIS was used to compre-hensively evaluate the income contribution,income structure,daily income,the proportion of operation/grade 4 operation,DRG-CMI and other indexes.According to the Boston matrix,two-dimensional quadrant analysis was carried out to determine the dominant diseases in the operation management.Results Twelve main diseases in a hospital specialty were analyzed,and the comprehensive scores of two dimensions of benefit and medical service ability were formed.According to the scores,a two-dimen-sional quadrant map was drawn,and the characteristics of diseases in each quadrant were summarized to identify the dominant diseases that contribute greatly to the economic operation and technical difficulty evaluation of the specialty.Conclusion The combined application of TOPSIS and Boston matrix in specialty operation analysis can help public hospital to realize the classifica-tion management of disease balancing benefit and difficulty,so as to optimize the disease structure and improve the utilization rate of medical resources.

Objective:To conduct a scoping review on symptom cluster of hematopoietic stem cell transplantation (HSCT) patients, aiming to provide reference for improving postoperative symptom management in HSCT patients.Methods:The study on postoperative symptom clusters in HSCT patients was searched in PubMed, Web of Science, CINAHL, Embase, Cochrane Library, China National Knowledge Infrastructure, Chinese Biomedical Database, VIP, and WanFang Data. The search period was from database establishment to July 17, 2023.Results:A total of 10 articles were included, and 9 symptom clusters were extracted. The top three symptom clusters in terms of frequency were fatigue related, gastrointestinal related, and psychological symptom clusters. The influencing factors of symptom cluster mainly included chronic graft-versus-host disease, transplant type, conditioning regimen, gender, depression level and so on. The heterogeneity of HSCT patient symptom cluster assessment tools was relatively high.Conclusions:The dynamic changes of postoperative symptom clusters in HSCT patients are influenced by multiple factors, and specific assessment tools still need to be developed.