BACKGROUND:How to effectively reduce al ogeneic blood transfusion volume after knee arthroplasty has become a new clinical problem, but predictors of perioperative blood loss and al ogenic blood transfusion after replacement have not been wel defined. OBJECTIVE:To establish the prediction model of al ogeneic transfusion volume after total knee arthroplasty by analyzing the preoperative and intraoperative related factors that influence the postoperative al ogeneic transfusion volume, so as to provide a theoretical basis for the clinical selective application of the autologous blood retransfusion device. METHODS:The materials of 120 postoperative al ogenic transfusion patients who treated with unilateral total knee arthroplasty at Baodi Clinical Col ege of Tianjin Medical University from January 2012 to December 2013 were retrospectively analyzed. Each patient’s gender, age, height, body weight, preoperative hemoglobin value, operation time, intraoperative blood loss volume and postoperative al ogeneic transfusion volume were recorded in detail, and accordingly a prediction model of al ogeneic transfusion volume was established after total knee arthroplasty. From January 2014 to December 2014, we applied this model in clinic. A total of 90 patients who predicted need for al ogeneic transfusion after unilateral total knee arthroplasty were randomly divided into two groups. Autologous blood retransfusion device was used in the observation group. Conventional drainage was used in the control group. The blood transfusion volume of patients in these two groups was analyzed, and the prediction accuracy of the prediction model in these two groups was detected. RESULTS AND CONCLUSION:Al patients completed the experimental observation. Pearson analysis showed that the patient’s age, height, body weight, preoperative hemoglobin values, operation time and intraoperative blood loss volume associated with postoperative al ogeneic transfusion volume (P<0.01). Multivariate regression analysis showed that the patient’s preoperative hemoglobin values, operation time and intraoperative blood loss volume associated with postoperative al ogeneic transfusion volume (P<0.01). Clinical application test results showed that the postoperative al ogeneic transfusion volume in observation and control groups was respectively (611.30±191.14) mL and (571.55±200.53) mL, prediction accuracy was respectively (71.50±22.20)%and (70.94±19.23)%, the difference was not significant (P>0.05). There were significant differences in al ogeneic transfusion volume and total blood transfusion volume (including autologous and allogeneic blood transfusion volume) of patients in these two group (P<0.01). The al ogeneic transfusion volume in the observation group was significantly lower than that in the control group. These results suggest that the prediction model can successful y predict the al ogeneic transfusion volume after total knee arthroplasty. The application of autologous blood retransfusion device in those patients who predicted need for postoperative al ogenic transfusion after the replacement can effectively reduce the al ogenic transfusion volume.

Objective To measure the endogenous metabolites in synovial tissues of rheumatoid arthritis (RA) rabbits with cold syndrome;To investigate the specificity mechanisms of heat-reinforcing needling for RA. Methods A total of forty healthy purple blue rabbits were randomly allocated to normal group, model group, reinforcing-reducing needling group (RRN), twirling-reinforcing needling group (TRN) and heat-reinforcing needling group (HRN) 8 rabbits in each group. Arthritis rabbits cold model was made with ovalbumin and freezing. Except for normal groupand model group, RRN was given acupuncture of reinforcing-reducing needling at Zusanli (ST36), TRN was given acupuncture of twirling-reinforcing needling at Zusanli (ST36), HRN was administrated acupuncture of heat-reinforcing needling at Zusanli (ST36), once a day and retaining 30 min, a total of seven days. Fresh synovial tissues of rabbits knee joints were extracted after the intervention, then GC-Q/TOF-MS technology were employed to evaluate metabolic profiles. Results The synovial tissues metabolites of TCA cycle, carbohydrate and fatty acid metabolism in model group mainly increased compared with normal group (P<0.05); The synovial tissues metabolites of various kinds above-mentioned decreased compared with model group in all intervention of acupuncture group (P<0.05), and the metabolites of TCA cycle and carbohydrate metabolism in HRN were obviously less than that of RRN and TRN (P<0.05). Conclusion The specificity of heat-reinforcing needling for RA manifests in regulation of TCA cycle and carbohydrate metabolism.

Objective:To investigate the turnover intention and its influencing factors in rural general practitioners in southwest Shandong province.Methods:In May 2020, a survey with self-designed questionnaire was conducted among 2 805 rural general practitioners in southwest Shandong province selected by multi-stage sampling method. Pearson chi square test (χ2) and binary logistic regression were used to analyze the factors influencing the turnover intention of rural general practitioners.Results:A total of 2 805 questionnaires were sent out, 2 693 were collected and 2 272 were valid, with an effective rate of 84.4%. Among 2 272 participants, 1 076 (47.4%) had medium to high level turnover intention. Binary logistic regression showed that part-time job ( OR=1.443, 95% CI: 1.105-1.884, P<0.01), average monthly night shifts ≥20 times ( OR=1.340, 95% CI: 1.106-1.623, P<0.01), daily working time ≥13 hours ( OR=1.358, 95% CI: 1.107-1.666, P<0.01), insomnia ( OR=2.075, 95% CI: 1.755-2.454, P<0.01), feeling depressed at work ( OR=2.987, 95% CI: 2.516-3.546, P<0.01), degree of emotional exhaustion ( OR=3.801, 95% CI: 3.188-4.533, P<0.01) and degree of de-personalization tendencies ( OR=2.493, 95% CI: 2.086-2.981, P<0.01) were the significant factors influencing the turnover intention of rural general practitioners. Conclusions:Rural general practitioners in southwest Shandong have a high-level turnover intention, part-time jobs, average number of night shift per month, working time, insomnia, depression and job burnout are the main factors affecting the turnover intention. Necessary measures should be taken by relevant departments to enhance the stability of rural general practitioners.

OBJECTIVETo compare the efficacy differences between manual acupuncture (MA) and electroacupuncture (EA) in the treatment of hemiplegia after acute ischemic stroke.

METHODSSixty-eight patients of hemiplegia after acute ischemic stroke were randomized into a MA group (34 cases) and an EA group (34 cases). The routine western medication and bilateral Dingnieqianxiexian (MS 6) were adopted in the two groups. The needles were retained for 30 min. In the MA group, the even-needling technique was used for 3 times during the needle retaining, 1 min each time. In the EA group, on the basis of manual stimulation, EA therapy was added, with disperse-dense wave, 5 Hz/20 Hz. The treatment was given once every day, 6 treatments a week, totally for 2 weeks. US National Institutes of Health stroke scale (NIHSS) score, the simplified Fugl-Meyer motor function (FMA) score and Barthel index (BI) were observed before and after treatment in the two groups. The clinical efficacy was compared between the two groups.

RESULTSNIHSS score was reduced apparently after treatment in the two groups (both<0.01). The score in the EA group was lower than that in the MA group (<0.05). After treatment, FMA score and BI score were all increased apparently in the two groups (all<0.01) and the scores in the EA group were higher than those in the MA group (both<0.01). The total effective rate was 94.1% (32/34) in the EA group and was 85.3% (29/34) in the MA group. The efficacy in the EA group was better than that in the MA group (<0.05).

CONCLUSIONSEA acts on the rehabilitative effect on nerve defect function in the patients of hemiplegia after acute ischemic stroke. It improves limb motor function and the ability ofdaily life activity. The efficacy is better than that of MA.

OBJECTIVETo compare the differences in the clinical therapeutic effects on juvenile myopia between's stunt needling technique and traditional even needling technique.

METHODSA total of 166 cases of mild juvenile myopia (diopter <-3.00D) were randomized into an observation group ('s stunt needling technique) and a control group (traditional even needling technique), 83 cases in each one (166 affected eyes). Taiyang (EX-HN 5), Fengchi (GB 20), Cuanzhu (BL 2), Hegu (LI 4) and Guangming (GB 37) were used in the two groups. In the observation group, theneedling technique was adopted at Taiyang (EX-HN 5), theneedling technique at Fengchi (GB 20) andneedling technique at Cuanzhu (BL 2). The traditional needling technique was used at Hegu (LI 4) and Guangming (GB 37). In the control group, traditional even needling technique was applied at all the acupoints. The treatment was given once every day, continuously for 6 times as one course. There was 1 day at interval. After treatment for 4 courses, the changes in visual acuity, diopter and axial length were observed before and after treatment. The therapeutic effects were evaluated.

RESULTSAfter treatment, the visual acuity of the naked eyes, and diopter were remarkably improved in the patients of the two groups (all<0.05). The improvements in the observation group were better than those in the control group (both<0.05). The axial length did not change in the two groups (both>0.05). The total effective rate was 78.3% (130/166) in the observation group, which was better than 57.8% (96/166) in the control group (<0.05). .

CONCLUSION 's stunt needling technique effectively improves the vision, rectifies the refractive error and delays the progression of myopia. The therapeutic effects of it are better than traditional even needling technique.

OBJECTIVETo explore heat-reinforcing needling for the metabolite profiling changes in serum of rheumatoid arthritis (RA) rabbits with liquid chromatograph-mass spectrometer (LC-MS) technique, and to investigate its mechanisms.

METHODSForty clean purple blue rabbits were randomized into a normal group, a model group, a reinforcing-reducing needling (RRN) group, a twirling-reinforcing needling (TRN) group, and a heat-reinforcing needling (HRN) group, 8 cases in each group. RA rabbits with cold syndrome were made with ovalbumin and freezing except those in the normal group. No treatment was given in the normal and model groups. The corresponding manipulations for 7 days were applied at "Zusanli" (ST 36) in the three acupuncture groups, 30 min a time, once a day. After intervention the pain threshold and the local skin temperature of each group were observed. Fresh serum from heart was collected for metabonomics detection. Principal component analysis (PCA) and partial least squares-discriminant analysis (PLS-DA) were adopted. Several metabolites were screened by the variable importance in the projection values (VIP>1) andvalue (<0.05).

RESULTSThe pain threshold and the local skin temperature in the model group were lower than those in the normal group (both<0.05). The pain threshold and the local skin temperature in the three acupuncture groups were higher than those in the model group after intervention (all<0.05), which were better in the HRN group than those in the RRN and TRN groups (all<0.05). The serum metabolites of carnitine, LysoPC (14∶0), LysoPC (18∶3), LysoPE (0∶0/20∶5), LysoPE (0∶0/22∶1), decylic acid, stearic acid and lactic acid in the model group increased compared with those in the normal group, and other metabolites decreased, including leucine, valine, glutamine, pyroglutamic acid, α-ketoglutaric acid, succinic acid, fumaric acid, malic acid, galactose, mannose. Those metabolites were correlated fatty acid, amino acid, citric acid cycle, and glucose metabolism. The metabolites above-mentioned in the three acupuncture groups were regulated in various degrees (all<0.05). Lactic acid decreased and succinic acid, fumaric acid, malic acid, galactose, mannose increased more obviously in the HRN group than those in the RRN and TRN groups.

CONCLUSIONThe specificity of heat-reinforcing needling for RA presents the regulation for citric acid cycle and glucose metabolism.