30 kg/m2 served as obesity group.Using Gross formula,the true total blood loss was calculated depending on the height,body mass and pre-and post-operative Hct,and hidden blood loss was gotten by subtracting the visible blood loss from total loss.③The correlation between visible and hidden blood loss was observed.RESULTS:All 41 patients undergoing THA and 37 TKA were involved in the result analysis.①Following THA,the mean total loss was 1 520 mL and the hidden blood loss 482 mL(32%).Following TKA,the mean total loss was 1 508 mL and the hidden blood loss was 776 mL(52%).The hidden blood loss between THA and TKA was significantly different(P 0.05).CONCLUSION:①The hidden blood loss in TKA is far higher than THA.It is very important to supplement the blood volume during TKA for the insufficiency to regain general circulation although using blood re-infusion.②It may improve clinical evaluation capabilities to estimate hidden blood loss and thus result in better patient care after joint arthroplasty.

Objective To evaluate the clinical efficacy and safety of akatinol memantine in the treatment of Alzheimer's disease (AD).Methods Two hundred and forty-one patients with AD were randomly assigned to receive 10 mg of donepezil daily or 20 mg of memantine daily for 24 weeks.The primary efficacy variables were the Clinician' s Interview-Based Impression of Change Plus (CIBIC-Plus),the Alzheimer Disease Assessment Scale-cognition (ADAS-cog) and the Activities of Daily Living (ADL).The secondary efficacy variables were the Neuropsychiatric Inventory (NPI) and the Mini-Mental Status Examination (MMSE).Results Two hundred and seven patients completed the study and were evaluated at week 24.Both memantine and donepezil had significant efficacies at the end point, according to the ADAS-cog, the ADL, the NPI and the MMSE.Patients receiving memantine had a similar outcome as those receiving donepezil, according to the results of all the variables changes (CIBIC-Plus: memantine 3.4±0.8vs donepezil 3.5±0.8; ADAS-cog: memantine-4.7±5.8 vs donepezil-4.6±6.5; ADL: memantine -2.4±6.7 vs donepezil-2.2±5.3 ; NP1: memantine-5.8±9.0 vs donepezil-3.1±8.5 ; MMSE:memantine 1.7±3.1 vs donepezil 1.8±2.8, all P >0.05).The adverse events were as following: donepezil group 41.88% and memanintine group 30.58%.Conclusion The memantine as a new drug for AD, has the similar efficacy as donepezil, and it is safe.

Objective:To assess the predictive values of bioelectrical impedance analysis(BIA)-measured body fat indices to abnormal lipid profiles, and to preliminary propose optimal cut-off values of body fat in children and adolescents.Methods:Children and adolescents, aged 6-16 years, were selected from 30 schools (8 primary schools, 21 middle schools and one 12-year education school) in Dongcheng, Tongzhou, Fangshan and Miyun districts of Beijing by adopting a stratified cluster sampling method from November 2017 to January 2018.Questionnaire survey, body mass index(BMI), body fat mass index (FMI), fat mass percentage (FMP) and four lipid profiles were conducted.Results:A total of 14 309 participants, aged (11.0±3.3) years, were enrolled in the analysis, with 49.9% boys.In boys and girls, the percentile values ( P60- P95) fitted by FMI and FMP with K-median-coefficient of variation(LMS) method were taken as the cutting points, and P75 values were selected as the cut-off points of excessive body fat for their better sensitivity, specificity, predictive value and area under curve (AUC) for identification of abnormal lipid profiles.Boys with FMI above P75 accounted for 28% of the total population, and controlling boys with FMI below P75 could prevent dyslipidemia of 8%-57%.FMI in girl population occupied about 26% of the above, and controlling FMI in girl population below this cut-off point may prevent dyslipidemia from 8%-42%.FMP observed similar results to FMI.Assessed by FMI or FMP with P75 cut-off values, adiposity performed better than BMI for recognizing abnormal lipid profiles in boys (AUC: 52.4%-69.6% vs.50.2%-67.1%, P<0.05) rather than in girls ( P>0.05). In addition, when FMI or FMP beyond P90, the specificity of each abnormal lipid profiles was around 90%. Conclusions:The recommend cut-off points for body fat may be to assess children′s adiposity, and can be applied in preventive activities.

Objective:To investigate the association between vitamin D nutritional status and the body muscle mass in children.Methods:Data were obtained from School-based Cardiovascular and Bone Health Promotion Program. In 2017, a total of 15 391 children aged 6-16 years in Beijing were selected through stratified cluster sampling in baseline survey. A follow-up investigation was conducted in 2019. The questionnaire survey and the detection of serum 25-hydroxyvitamin D [25(OH)D] level were conducted. The bioelectrical impedance analysis (BIA) apparatus was used to measure body muscle mass, and muscle mass index (MMI) was calculated. Multivariable linear models were used to analyze the association of vitamin D nutritional status with the baseline and follow-up MMI measures.Results:A total of 10 890 children aged (11.5±3.3) years(boys accounting for 49.6%) were included in the analysis. The average 25(OH)D level was (35.4±12.0) nmol/L, with an adequacy ratio of 11.1%. After multivariate linear regression adjustment for age, sex, body fat mass, smoking status, alcohol use status, dairy supplement, calcium supplement, physical activity, and pubertal development, no statistically significant association between vitamin D nutritional status and baseline MMI level was observed ( P>0.05). For the follow-up MMI, the Z-score increased by 0.008 ( P=0.058) for per 10 nmol/L increase in 25(OH)D, which were 0.002 ( P=0.815) and 0.037 ( P=0.031) higher in children with insufficient and adequate vitamin D than those with vitamin D deficiency, respectively ( P for trend =0.089). Subgroup analysis showed that in the normal BMI group, for per 10 nmol/L increase in 25 (OH) D, the MMI at baseline survey and MMI Z-score at follow-up of children with adequate vitamin D and increased by 0.019 and 0.014, respectively (both P<0.05). Conclusions:Vitamin D nutritional status was related to muscle mass in children, and children with adequate vitamin D tended to obtain higher MMI. Children and adolescents are encouraged to maintain sufficient vitamin D levels, strengthen nutrition and exercise to promote body health.

Objective:To investigate the association of vitamin D with distribution of body fat in children and adolescents.Methods:Data were obtained from the baseline survey of School-based Cardiovascular and Bone Health Promotion Program in 2017. Multiple linear regression and multinomial logistic regression models were applied to analyze the relationships of body mass index (BMI), fat mass index (FMI), trunk fat mass index (TFMI), appendicular fat mass index (AFMI), and visceral fat area(VFA) with vitamin D level and status in children and adolescents.Results:A total of 11 960 children and adolescents were included in the analysis (boys accounting for 49.7%). The average age and serum vitamin D level of study population were (11.0±3.3) years and (35.0±11.9) nmol/L, respectively. The deficiency rate of vitamin D was 37.2%. Gender-specific associations of BMI, FMI, TFMI, and AFMI with vitamin D level were found ( P for interaction <0.05): they were inversely associated with vitamin D level in boys (BMI: β=-0.56; FMI: β =-0.59; TFMI: β=-0.60; AFMI: β=-0.59; all P<0.05), but not in girls ( P>0.05). VFA was positively associated with vitamin D deficiency and insufficiency in both boys and girls, and the risks of vitamin D deficiency and insufficiency all increased by 17%(95% CI: 9%-25%) for per increment of standard deviation in VFA. Conclusions:The higher level of visceral fat was associated with the lower vitamin D levels in children. Abdominal obese children and boys with excessive body fat are the key population in the prevention and control of vitamin D deficiency.

OBJECTIVE To investigate the effect of pharyngeal cavity and genoglossus muscle exercises in patients with mild obstructive sleep apnea syndrome(OSAHS)left over after palatopharyngoplasty with diastolic cardiac dysfunction.METHODS A total of 75 patients with mild OSAHS left after palatopharyngoplasty with diastolic cardiac dysfunction from January 2021 to August 2023 were selected for retrospective study.Among them,37 patients underwent pharyngeal cavity and mentoglossum muscle exercise(observation group),while 38 patients did not(control group).Using postoperative data as baseline value.mean blood oxygen saturation(MSpO2),lowest oxygen saturation(LSpO2),sleep efficiency,apnea index(AI),sleep latency,apnea hypopnea index(AHI),hypopnea index(HI),microarousal index(MAI),rapid eye movement latency,arterial blood pressure of carbon dioxide(PaCO2),pH,arterial partial oxygen pressure(PaO2),left ventricular end-systolic diameter(LVDs),blood lactic acid,left ventricular ejection fraction(LVEF),Tei index,left ventricular end-diastolic diameter(LVDd),daytime Epworth sleepiness scale(ESS)score,Pittsburgh sleep quality index(PSQI)score and incidence of adverse cardiovascular events(MACE)were compared at baseline and 3 months later.RESULTS After 3 months,AHI,HI and AI in observation group were lower than those in control group,and MSpO2 and LSpO2 were higher than those in control group(P<0.05);Sleep efficiency of observation group was higher than control group,daytime ESS score,PSQI score and MAI were lower than control group(P<0.05).There were no significant differences in PaCO2,LVDd,PaO2,blood lactic acid,sleep latency,pH,LVEF,rapid eye movement latency,LVDd,Tei index between the observation group and the control group(P>0.05).The incidence of MACE in the observation group was 5.41%(2/37),compared with 13.16%(5/38)in the control group,there was no significant difference(P>0.05).CONCLUSION In patients with mild OSAHS left after palatopharyngoplasty with diastolic cardiac dysfunction,the exercise of pharyngeal cavity and genoglossus can improve hypopnea,alleviate clinical symptoms and improve sleep quality,but it has limited effect on the improvement of cardiac function.

Objective To explore the effect of transitional care model on health recovery in discharged elderly patients with angiocardiopathy.Methods A group of transitional care of geriatric department was formed by physicians and nurses of geriatric department, physicians and therapists of rehabilitation department and so on. A total of 81 discharged patients with angiocardiopathy of geriatric department in the Second People's Hospital of Nantong were selected as research group from July 2015 to February 2016 using purposive sampling. They accepted transitional care. A total of 85 elderly patients with angiocardiopathy were recruited as control between December 2015 to June 2016 with routine health education. The effect and the patients' satisfaction were compared between two groups.Results The compliance rate of medication of patients was 93.6% in research group and 65.8% in control group in the second week after leaving hospital with a significant difference (χ2=20.447,P<0.05). There was a statistically significant difference in satisfaction between research group [(95.21±1.98)%] and control group [(88.34±1.84)%] (t=32.7470,P<0.05).Conclusions The transitional care can improve the medication compliance in discharged elderly patients with angiocardiopathy, help them build up health lifestyle and improve the quality of life of patients.

Objective:To explore the correlation between serum 25-hydroxyvitamin D3 [25(OH)D3] level and peritoneal dialysis (PD) associated peritonitis, and provide a new idea for the prevention and treatment of peritonitis.Methods:In this single-center retrospective cohort study, patients who were≥18 years old and were treated with regular PD≥3 months in PD center from January 1, 2014 to September 30, 2018 were recruited, except those who had a history of malignant tumors or systemic infectious diseases, transferred from permanent hemodialysis (HD) or failed kidney transplantation. Baseline data including demographic characteristics as well as clinical and biochemical data were collected. All the patients were followed up until death, transfer to HD, kidney transplantation, transfer to other centers or the end of our study (December 31, 2018), and were divided into low tertile [serum 25(OH)D3 ≤12μg/L], middle tertile[12 μg/L17 μg/L] according to the baseline serum 25(OH)D3 level. Multivariate adjusted Poisson model was used to evaluate the association between serum 25(OH)D3 level and PD related peritonitis.Results:A total of 642 patients were enrolled in our study, of whom 341 were male (53.12%) , and the age was (47.58±14.10) years old. The serum 25(OH)D3 level was (13.83±6.41) μg/L. As for the primary disease, 67.19% were chronic glomerulonephritis. During a median 42(19, 59) months follow-up period, 232 peritonitis occurred in 139 patients. After adjusting for confounders, including gender, age, albumin, body mass index(BMI), calcium-phosphorus product, intact parathyroid hormone (iPTH), diabetes, charlson index and drug use, multivariate Poisson regression analysis showed that the risk of peritonitis in the middle tertile and the low tertile was 92% (95% CI 0.62-1.38, P= 0.690) and 1.74 times (95% CI 1.19-2.54, P=0.004) of the high tertile respectively. The difference between the low tertile and the high tertile was statistically significant. Conclusions:The level of serum 25(OH)D3 is closely related to the occurrence of PD associated peritonitis. Low level serum 25(OH)D3 is an independent risk factor for peritonitis in PD patients.

Objective:To explore the effect of the interaction between estimated glomerular filtration rate (eGFR) and serum uric acid (SUA) on all-cause and cardiovascular mortality in patients on peritoneal dialysis (PD).Methods:Patients who performed PD catheterization at the PD center of the First Affiliated Hospital of Sun Yat-sen University and had initiated PD therapy for over 3 months from January 2006 to December 2016 were enrolled and followed up until December 2018. Demographic data, baseline clinical and laboratory examination results of the patients were collected. Kaplan-Meier survival curve and Cox regression analysis were used to explore the correlation between SUA and all-cause mortality, cardiovascular mortality in different eGFR groups of PD patients.Results:A total of 2 124 PD patients were enrolled with age of (47.0±15.2) years, among whom 1 269 patients were male and 536 patients had diabetes. The SUA level was (429±96) μmol/L and the median level of eGFR was 6.69(5.17, 8.61) ml·min -1·(1.73 m 2) -1. After a median follow-up time of 42 months, 554 patients died, among whom 275 patients were cardiovascular death. The Cox regression analysis revealed that there was a significant interaction between eGFR and SUA on all-cause mortality ( P=0.043). The Kaplan-Meier curve showed that the tertile 1 (SUA<384 μmol/L) and tertile 3 (SUA>460 μmol/L) group had significantly higher all-cause mortality ( P=0.009) than the reference group of tertile 2 (SUA 384-460 μmol/L) in the higher eGFR group [eGFR>6.69 ml·min -1·(1.73 m 2) -1]but not in the lower eGFR. After adjusting for relevant demographic data, complications, biochemical results and other variables, in patients with higher eGFR, the risk of all-cause mortality increased by 0.2% ( HR=1.002, 95% CI 1.000-1.003, P=0.019) for every 1 μmol/L increase in SUA. In addition, compared with the tertile 2 reference group, the tertile 3 group was independently correlated with higher risk of all-cause mortality ( HR=1.670, 95% CI 1.242-2.245, P=0.001). Conclusions:The eGFR and SUA level significantly interacts with all-cause mortality, and the higher SUA level in higher eGFR group is an independent risk factor for all-cause mortality in PD patients.

Objective To explore the relationship between cervical lesions and high risk HPV (HR-HPV) viral load reflected by the cycle threshold (Ct) values of Cobas 4800 HPV (Cobas 4800) system. Methods From August 2016 to September 2017, 7 000 women from Shenzhen, were recruited for cervical cancer screening with Cobas 4800 system and cytology co-test. Colposcope biopsies were performed on women who were positive of HPV 16, 18, and positive of HPV types other than 16, 18 with cytology [≥atypical squamous cell of undetermined signification (ASCUS)], or HPV negative but abnormal of cytology [≥low grade squamous intraepithelial lesion (LSIL)]. The Ct values of HPV 16, 18 and all combined other types coming from Cobas 4800 system were used as an indicator of viral load to analyze the relationship between type-specific HPV load and the cervical lesions. Results (1) Among the 7 000 screening women, 370 cases were positive for cervical cancer screening, 325 of them underwent colposcope biopsies, and coloposcopy referred rate was 87.8% (325/370). Among 325 women undergoing cervical biopsy, pathological diagnosis was 119 cases of normal cervical cervix, 151 cases of LSIL, and 55 cases of high-grade squamous intraepithelial lesion (HSIL) and above (HSIL+; including 53 cases of HSIL, 1 case of cervical adenocarcinoma, and 1 case of cervical squamous cell carcinoma). (2) The Ct value of HPV 16 was inversely correlated with the upgrading of the lesions (r=-0.617, P=0.000), and significant different among normal cervix,LSIL and HSIL+(35.4±4.5 vs 31.0±6.0 vs 26.5±4.0; F=25.537, P=0.000). There was no correlation between Ct value of HPV 18 and cervical lesions (r=-0.021, P=0.902). The Ct value of other 12 HPV types was statistically difference among normal normal cervix , HSIL+and cervicitis (33.0±5.3 vs 29.9±7.2 vs 29.8±5.8; F=5.087, P=0.007). Among them, LSIL and HSIL+ were significantly lower than normal cervix (P<0.05), but there was no significant difference between LSIL and HSIL+(P>0.05). Conclusion The Ct value of HPV 16 detecting in Cobas 4800 system as an indicator of virus load obviously correlates with different grades of cervical lesions, therefore could be a reference of cervical lesion existence and an indicator of lesion prognosis.