Objective To evaluate the prognostic value of plasma D dimer level in cancer thrombosis and vascular invasion assessment and to analyze the correlation between plasma D dimer level and the Pittsburgh modified TNM staging in patients with hepatocellular carcinoma for orthotopic liver transplantation. Methods The plasma D dimer level was quantitated using Golden method in 120 patients with hepatocellular carcinoma for orthotopic liver transplantation. Cancer thrombosis in trunk vein and microvascular invasion was diagnosed by pathology. The relationship between plasma D dimer level in different Child pugh’s classification patients and vascular invasion as well as the Pittsburgh modified TNM staging was analyzed with ? 2 test, factorial analysis of variance and q test by microsoft SPSS 9.0.Results In Child Pugh’s A, B and C patients, the difference of plasma D dimer level between patients with trunk vein cancer thrombosis and patients without vascular invasion was significant ( P 0.05). The differences of plasma D dimer level between patients with the Pittsburgh modified TNM Ⅰand Ⅱ tumor and patients with TNM Ⅲ tumor, and between patients with the Pittsburgh modified TNM Ⅰand Ⅱ tumor and patients with TNM Ⅳ tumor were significant ( P 0.05). Conclusion Plasma D dimer level, which increasing as upgrade of the Pittsburgh TNM staging, is useful in the vascular invasion and cancer thrombosis assessment in patients with hepatocellular carcinoma for liver transplantation, and the correlation was more significant as progression of vascular invasion and upgrade of Child pugh’s classification.

There has still been controversy on selection of approapreate treatments for elderly patients with acetabular fracture who are rapidly increasing in number. Although the treatment principle for them is anatomical reduction, effective fixation and early mobilization, choice of a proper treatment has turned to be a new hot spot for clinical research because the physical status, bone quality and fracture type of the elderly population are special. With unceasing achievements in medicine, surgical techniques and implants, the management ideas and strategies for elderly acetabular fractures have become gradually mature and diversified. The current major protocols include conserverative treatment, open reduction and internal fixation and total hip arthroplasty. In order to enhance the surgeons'knowledge of elderly acetabular fractures and summarize the cilinical experiences in management of them, we present this review to illustrate the current achievements and new development trends.

Objective To observe the development of endotoxemia and its treatment during swine orthotopic liver transplantation (OLT). Methods Blood perfusion was carried out in 12 swine OLT cases during anhepatic period. Results It was 0 18 EU/ml in anhepatic period and 0 48 EU/ml in reperfusion period in control group compared to 0 13 EU/ml and 0 13 EU/ml,respectively in activated charcoal perfusion group( P

Objective:To investigate the safety of early hip fracture surgery for elderly patients on clopidogrel.Methods:This retrospective study included 242 consecutive elderly patients (≥65 years) with acute hip fracture who had undergone surgery at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital between November 2016 and April 2017. Of them, 20 were assigned into the study group who had taken clopidogrel before injury but discontinued its use within 4 days before surgery. They were 6 males and 14 females, with a median age of 80 years (77, 81). Their operation procedures for hip fracture included internal fixation with cannulated screws for femoral neck fracture in 2 cases, hemiarthroplasty for displaced femoral neck fracture in 11 cases, and internal fixation for intertrochanteric fracture in 7 cases. The control group included 222 patients who had undergone the same operative procedures but not taken any antiplatelet or anticoagulant drugs. The 2 groups were compared in terms of time between admission and operation, operation duration, intraoperative blood loss, perioperative transfusion and complications related to bleeding to analyze the safety of early surgery.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). There was no significant difference between the 2 groups in the time between admission and operation [42.5 (36.3, 48.0) h for the study group versus 43.0 (28.0, 61.0) h for the control group] ( P=0.870). The median time between the last use of clopidogrel and operation was 55.0 (30.5, 71.0) h. There were no significant differences between the 2 groups in preoperative hemoglobin, operation duration, intraoperative blood loss, rate or amount of perioperative blood transfusion, or rate or amount of wound drainage ( P>0.05). The rate of general anesthesia was significantly higher for the study group (45.0%, 9/20) than for the control group (18.5%,41/222) ( P=0.012). No complications related to spinal hematoma occurred in the patients receiving spinal anesthesia from the study group. Wound hematoma and subsequent infection occurred in 2 patients from the control group. Conclusion:Early hip fracture surgery is safe for elderly patients on clopidogrel.

Objective:To investigate the current situation of perioperative fasting management in patients with orthopaedic trauma waiting for elective surgery (those combined with diabetes mellitus included) and the surgeons' awareness in China.Methods:From November 1st to December 31st, 2021, the questionnaire forms were distributed through WeChat in the exchange group of National Enhanced Recovery Surgery (ERAS) and the exchange group of national training orthopaedists in Beijing Jishuitan Hospital. The survey contents included: time for preoperative water deprivation and for postoperative recovery of drinking in patients without diabetes mellitus, the rationales for orthopaedists to choose perioperative dietary management, the orthopaedists＇understanding of the existing guidelines, time for preoperative water deprivation and postoperative recovery of drinking and diabetes-related issues in patients with diabetes mellitus, and the time for postoperative recovery in all the patients (For the postoperative recovery of eating, there is no difference between patients with and without diabetes mellitus). The relationships were analyzed between some professional data of the orthopaedists and their rationales for choice of management strategies and their understanding of the guidelines.Results:A total of 565 valid questionnaires were collected. 12.92% (73/565) of orthopaedists required their patients without diabetes mellitus not to drink for at least 2 hours. In fact, the proportion of water prohibition from 0 o'clock on the day of operation was still the highest [24.07% (136/565)]. Respectively, 22.83% (129/565) and 42.12% (238/565) of the orthopaedists chose "water intake is allowed once awakened" and "water intake after at least 6 hours after operation" for their patients without diabetes mellitus. 33.98% (192/565) of the orthopaedists required all the patients fasted for at least 6 hours before surgery, and 44.25% (250/565) of the orthopaedists chose "eating can be resumed if there is no discomfort for 2 hours after water intake" .21.06% (119/565) of the orthopaedists demonstrated that they were quite familiar with the guidelines and carried out perioperative dietary management according to the guidelines. The management of water deprivation was more inconsistent for patients with diabetes mellitus, and more hospitals followed the traditional principles for water deprivation. The proportions of water deprivation starting at 0 o'clock on the day of operation, 8 hours before operation, 6 hours before operation and 4 hours before operation accounted respectively for 22.83% (129/565), 19.12% (108/565), 21.95% (124/565), and 18.94%% (107/565). The level of an orthopaedist's hospital and the professional rank of an orthopaedist were the factors related to the orthopaedist's understanding of the guidelines ( P<0.05). Conclusions:The current perioperative dietary management guidelines are not widely implemented or well known in Chinese faculties of orthopaedic trauma. The process of perioperative dietary management needs to be optimized for the patients combined with diabetes mellitus.

Hip fractures,with an increasing morbidity in the elderly patients,pose a serious threat to the health of the aged.At the moment,surgery is the preferred treatment for the vast majority of these patients.Early surgical intervention is strongly recommended by most guidelines and articles.It is still controversial,however,whether surgery should be postponed or performed and whether medication therapy should be withdrawn or continued in some of the elderly patients with hip fracture who are taking anticoagulant or antithrombotic drugs before they are injured.Clopidogrel is one of the anti-platelet drugs commonly used clinically.This article reviews the literature regarding the impact of clopidogrel on surgical timing for hip fractures in the aged,hoping to provide useful clues to the clinical study and practice.

Opioid-free anesthesia(OFA)is a multimodal analgesic strategy that combines multiple non-opioid drugs and/or techniques to obtain high-quality anesthesia.With the popularization of the concept of enhanced recovery after surgery(ERAS),OFA has become a common concern hot spot for perioperative phy-sicians.OFA is in line with the ERAS concept,and under multimodal anesthesia and pain management,it can reduce surgical stress,inflammation reaction and postoperative complications,significantly improve the prog-nosis of patients,promote postoperative rapid recovery and reduce the burden of medical and health resources.This article reviews the adverse reactions of opioids,OFA concept and indications,the clinical application of OFA in recent years,the existing controversies and problems to be solved.

Objective:To evaluate the effectiveness of perioperative fasting abbreviation in traumatic patients with orthopaedic trauma and diabetes mellitus undergoing selective surgery.Methods:The patients were selected for this prospective nonrandomized controlled study who had undergone selective surgery from June 2019 to June 2021 at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital. They were divided into an intervention group and a control group according to the wards where they stayed. The intervention group was fasted for solids from 0 o'clock on the surgery day and received oral solution with 6.25% maltodextrin which had been prepared by the nutritional department 3 hours prior to surgery. The control group was fasted for either liquids or solids from the midnight before surgery. All patients were evaluated according to the wake-up score and defensive reflex score after surgery. Once they were awakened, they were allowed slag-free drinks. Normal food was allowed if there was no discomfort after 2 hours. The 2 groups were compared in terms of basic information, actual preoperative fasting time, total amount of preoperative drinking, and postoperative time for initial drinking and eating. The perioperative subjective feelings (anxiety, thirst, hunger, nausea, fatigue, dizziness, sweating, stomach discomfort, etc.), grip strength and blood glucose were observed and compared between the 2 groups. Adverse reactions in the 2 groups were also observed.Results:A total of 135 patients were included, including 52 in the intervention group and 83 in the control group. The intervention group consisted of 22 males and 30 females aged from 30 to 84 years; the control group consisted of 39 males and 44 females aged from 29 to 81 years. There was no significant difference in the basic information between the 2 groups, showing comparability ( P>0.05). The intervention group had significantly shorter preoperative fasting time [3.5 (2.5, 6.3) h versus 12.0 (9.0, 16.0) h], significantly higher water intake before surgery [300 (200, 300) mL versus 100 (100, 200) mL], significantly shorter postoperative fasting time [0.08 (0, 1.25) h versus 2.00(0, 6.00) h], and significantly reduced time to return to normal diet [2.0 (2.0, 2.3) h versus 3.0(2.0, 6.0) h] than the control group (all P<0.05). The symptoms of anxiety, fatigue, sweating, and stomach discomfort in the intervention group were significantly fewer than those in the control group throughout the evaluation period. The thirst in the intervention group was significantly alleviated than that in the control group immediately after returning to the ward after surgery, and the dizziness and hunger were significantly alleviated than those in the control group when the patients left the ward to the operation room before surgery and immediately after returning to the ward. The symptom of nausea after returning to normal diet in the intervention group was significantly relieved compared with the control group. All the comparisons above showed statistically significant differences ( P<0.05). The blood glucose in the intervention group 2 hours after taking slag-free drinks was significantly higher than that in the control group ( Z=-2.108, P=0.035). There was no significant difference in the blood glucose between the 2 groups during other measurement periods ( P>0.05). There were no serious adverse reactions in either of the 2 groups. Conclusion:The protocol of perioperative fasting abbreviation may be safe and feasible for the patients with orthopaedic trauma and diabetes mellitus undergoing selective surgery, because it shows benefits of improving the patients' subjective feelings and stabilizing the blood glucose perioperatively.

Acute kidney injury (AKI) is a complication with high morbidity and mortality after cardiac surgery. In order to predict the incidence of AKI after cardiac surgery, many risk prediction models have been established worldwide. We made a detailed introduction to the composing features, clinical application and predictive capability of 14 commonly used models. Among the 14 risk prediction models, age, congestive heart failure, hypertension, left ventricular ejection fraction, diabetes, cardiac valve surgery, coronary artery bypass grafting (CABG) combined with cardiac valve surgery, emergency surgery, preoperative creatinine, preoperative estimated glomerular filtration rate (eGFR), preoperative New York Heart Association (NYHA) score>Ⅱ, previous cardiac surgery, cadiopulmonary bypass (CPB) time and low cardiac output syndrome (LCOS) are included in many risks prediction models (>3 times). In comparison to Mehta and SRI models, Cleveland risk prediction model shows the best discrimination for the prediction of renal replacement therapy (RRT)-AKI and AKI in the European. However, in Chinese population, the predictive ability of the above three risk prediction models for RRT-AKI and AKI is poor.

Objective:To compare the long-term clinical outcomes between cannulated screw internal fixation for stable femoral neck fractures and arthroplasty for unstable ones in the elderly patients.Methods:A retrospective study was conducted to analyze the 542 patients with femoral neck fracture who had been admitted to Department of Orthopedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University from May 2015 to April 2017. The 542 patients were divided into 2 groups based on fracture stability and treatment method. In the stable group (Garden type Ⅰ, type Ⅱ, and abduction compression type) of 121 cases who underwent cannulated screw internal fixation, there were 28 males and 93 females with a mean age of (77.6±8.1) years, and 20 cases of type Ⅰ, 101 cases of type Ⅱ, and 34 cases of abduction compression type by the Garden classification. In the unstable group (Garden type Ⅲ, type Ⅳ, and type Ⅱ with a posterior tilt angle >20°) of 421 cases who underwent arthroplasty, there were 130 males and 291 females with a mean age of (78.7 ± 6.9) years, and 14 cases of type Ⅱ, 403 cases of type Ⅲ, and 4 cases of type Ⅳ by the Garden classification. The postoperative mortality, reoperation rate, and mobility at the last follow-up were compared between the 2 groups.Results:There were no statistically significant differences in the baseline characteristics, except for serum albumin concentration and peripheral white blood cell count at admission, between the 2 groups, indicating comparability ( P>0.05). The hospital stay in the stable group [5.0 (4.0, 6.0)d] was significantly shorter than that in the unstable group [6.0 (5.0, 8.0)d], and the follow-up time for the stable group [54.4 (49.3, 58.7) months] significantly longer than that for the unstable group [52.2 (46.0, 59.3) months] ( P<0.05). A total of 158 patients (45 cases in the stable group and 113 cases in the unstable group) were lost to the last follow-up. At the last follow-up, the mortality in the stable group (18.4%, 14/76) was significantly lower than that in the unstable group (31.5%, 97/308), the reoperation rate in the former (15.8%, 12/76) significantly higher than that in the latter (3.6%, 11/308), and the capability of daily activities in the former (by the fracture mobility scoring: level 1 in 35 cases, level 2 in 13 cases, level 3 in 3 cases, level 4 in 2 cases, and level 5 in 1 case) significantly better than that in the latter (level 1 in 99 cases, level 2 in 47 cases, level 3 in 24 cases, level 4 in 22 cases, and level 5 in 5 cases) (all P<0.05). Conclusion:Compared with the arthroplasty for unstable femoral neck fractures, cannulated screw internal fixation for stable femoral neck fractures leads to a lower long-term mortality and a better capability of daily activities, but a significantly higher reoperation rate.