BACKGROUND:Reducing blood loss could help to prevent the complications of total knee arthroplasty, relieve the swelling and discomfort postoperatively and accelerate the rehabilitation. OBJECTIVE:To explore the methods for reducing blood loss during total knee arthroplasty. METHODS:Totally 63 patients undergoing primary unilateral total knee arthroplasty were divided into two groups. Group 1 included 27 patients who received the conventional surgical techniques using tourniquet during the whole procedure with wound drainage, as control group. Group 2 included 36 patients who received the modified procedure only using tourniquet during prosthesis implantation without wound drainage, as experimental group. In the experimental group, we stitched the capsule closely. The preoperative and postoperative hemoglobin, decrease of hemoglobin, knee pain score, range of motion blood transfusion rate and wound healing were compared between the two groups. RESULTS AND CONCLUSION:(1) There was no significant difference in preoperative hemoglobin between the two groups. At 1, 4 and 7 days postoperatively, the hemoglobins were significantly lower in the control group than in the experimental group, and the decreases of hemoglobins were significantly lower in the control group than in the experimental group. (2) Knee pain score was not significantly different between the two groups. (3) The range of motion of the knee was significantly larger in the experimental group than in the control group at 7 days. (4) Blood transfusion rate was 18.5%in the control group, and wound healing was poor in one patient. There was no transfused case and wound problem in the experimental group. All wounds were healed normally. (5) There was no infection or hematoma in two groups. (6) With the modified procedure, we could reduce blood loss during total knee arthroplasty without blood transfusion after surgery, which was helpful to postoperative rehabilitation.

Objective:To investigate the effect of body mass index (BMI) on clinical pregnancy and neonatal outcomes in patients with polycystic ovary syndrome (PCOS) during frozen-thawed embryo transfer.Methods:A total of 650 patients with PCOS who received routine in vitro fertilization or intracytoplasmic sperm injection treatment for frozen-thawed embryo transfer from June 2014 to June 2019 in Tianjin Central Hospital of Gynecology Obstetrics were retrospectively analyzed. According to BMI, PCOS patients were divided into group A (18.5≤BMI<23 kg/m 2, n=253), group B (23≤BMI<25 kg/m 2, n=167), and group C (BMI≥25 kg/m 2, n=230). The general information, clinical pregnancy outcomes, pregnancy complications, the incidence of macrosomia and low-birth-weight infants were compared in the three groups, and the influencing factors of neonatal birth weight were analyzed. Results:The embryo implantation rate, clinical pregnancy rate, and ongoing pregnancy rate all showed downward trend with the increase of BMI, but the differences were not statistically significant (all P>0.05). The live birth rate in group C [47.0% (108/230)] was significantly lower than those in groups A and B, with statistical significance ( χ2 =7.43, P=0.024). The late miscarriage rate was higher in group C [9.4% (13/139)] than in groups A and B ( χ2 =7.66, P=0.022). The birth rates of macrosomia in groups B [22.2% (16/72)] and group C [21.1% (16/76)] were significantly higher than that in group A, and the difference was statistically significant ( χ2 =14.15, P=0.001). There was no statistically significant difference in the incidence of gestational diabetes between the three groups ( χ2 =3.81, P=0.149). The incidence of hypertension disorders complicating pregnancy increased with the increase of BMI, and the difference was not statistically significant ( P>0.05). Regression analysis showed that macrosomia was significantly associated with maternal pre-pregnancy BMI and gestational weeks, and the risk of macrosomia increased by 15% (95% CI: 3%-28%) for every increase in maternal BMI. Conclusions:The embryo implantation rate, clinical pregnancy rate, and ongoing pregnancy rate of PCOS patients in frozen-thawed embryo transfer cycles show downward trend with the increase of BMI. Obese patients with PCOS have a significant increase in late miscarriage rate and a significant decrease in live birth rate. The incidence of hypertension disorders complicating pregnancy in PCOS patients in the obese group has an increasing trend, and the birth rate of macrosomia has increased significantly. Therefore, it is recommended that obese women with PCOS lose weight scientifically before pregnancy to improve pregnancy and neonatal outcomes.

Objective To evaluate the effect of dexmedetomidine on humoral immune function in septic mice. Methods Ninety SPF healthy male BALB∕c mice, aged 1 month, weighing 18-22 g, were divided into 3 groups(n=30 each)using a random number table: sham operation group(group S), sep-sis group(group SEP)and dexmedetomidine group(group DEX). Sepsis was induced by cecal ligation and puncture in SEP and DEX groups, and group S only underwent exploratory laparotomy. Dexmedetomi-dine 30 μg∕kg was intraperitoneally injected immediately after peritoneum closure in group DEX, and the e-qual volume of normal saline was given instead in S and SEP groups. The orbital venous blood samples were collected at 6, 12 and 24 h after operation(T1-3)for determination of serum concentrations of IgG, IgA, IgM and complement C3 and C4 by enzyme-linked immunosorbent assay. Then the spleen was removed, and the proliferation of spleen B lymphocytes was detected by methyl thiazolyl tetrazolium assay. Results Compared with group S, the serum IgG and IgM concentrations and proliferation of spleen B lymphocytes were significantly decreased at T2,3, the proliferation of spleen B lymphocytes was enhanced at T1, the ser-um concentrations of complement C3 and C4 were increased at T1-3(P<005), and no significant change was found in serum IgA concentrations in SEP and DEX groups(P>005). Compared with group SEP, the serum concentrations of IgG and IgM were significantly increased at T2,3, the proliferation of spleen B lymphocytes was enhanced at T1,2, the serum concentrations of complement C3 and C4 were decreased at T1-3(P<005), and no significant change was observed in serum IgA concentration in group DEX(P>005). Conclusion Dexmedetomidine can improve humoral immune function in septic mice.

Objective:To explore the effect of knowledge-clinical-sharing (KCS) model in humanistic care training of pediatric nurses.Methods:A total of 182 specialist nurses who were trained in Hunan Children's Hospital from June 2019 to December 2019 were selected as the research objects. Among them, 102 specialist nurses from June 2019 to August 2019 were selected as the control group, and 80 specialist nurses from September 2019 to December 2019 were selected as the intervention group. The Jefferson empathy scale was used to compare the effect of humanistic training before and after the implementation. SPSS 22.0 statistical software was used, measurement data were test by F-test and t-test, and the counting data were analyzed by Chi-square test. Results:After the implementation of humanistic care training based on KCS model, the empathy ability score of the intervention group was higher than that of the control group [(80.23±5.33) vs. (78.14±4.37)], and the difference was statistically significant ( P < 0.01). There was no significant difference between neonatal and pediatric specialist nurses before and after the training. Conclusion:The phased humanistic training based on KCS model can improve the empathy ability of pediatric nurses and enhance their confidence in the clinical implementation of humanistic care. However, the humanistic training mode of pediatric nurses should be improved according to the hospital's own situation, so as to adapt to the development of nursing industry.

Objective:To compare the clinical efficacy between reservation and sacrifice of remnants in the footprint area in arthroscopic repair of rotator cuff tear.Methods:A retrospective study was conducted to analyze the clinical data of 32 patients with rotator cuff tear plus remnants in the footprint area (2 cm < tear size <5 cm) who had been admitted to Department of Sports Medicine, The People's Hospital of Northern Jiangsu from May 2020 to July 2021. The patients were divided into 2 groups according to reservation or sacrifice of remnants in the footprint area in arthroscopic repair of rotator cuff tear. In the remnant-reservation group (16 cases): 5 males and 11 females with an age of (61.8±9.9) years, 9 left and 7 right shoulders affected, and (3.7±1.1) cm in size of rotator cuff tear; in the remnant-sacrifice group (16 cases): 4 males and 12 females with an age of (61.3±8.8) years, 8 left and 8 right shoulders affected, and (3.9±0.9) cm in size of rotator cuff tear. The 2 groups were compared in terms of visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley shoulder function score (Constant score), and range of motion of the affected shoulder before surgery, 3 months after surgery and at the last follow-up. The ratio of bilateral abductor muscle strengths (affected side/healthy side) was analyzed and compared between the 2 groups, and the healing of the rotator cuff was evaluated by MRI at the last follow-up.Results:The 2 groups were comparable because there were no significant differences in all their preoperative demographic data ( P>0.05). The 32 patients were followed up for (14.3±3.5) months after surgery. At 3 months after surgery, the VAS score in the remnant-reservation group [1.0 (0.0,1.0) point] was significantly lower than that in the remnant-sacrifice group [1.0 (1.0,1.0) point] ( P<0.05), but there was no significant difference between the 2 groups in ASES score, Constant score or range of motion of the affected shoulder ( P>0.05). At the last follow-up, the ASES score, forward flexion, abduction and ratio of bilateral abductor muscle strengths (affected side/healthy side) in the remnant-reservation group [(96.1±4.8) points, 170.0 (170.0,170.0)°, 160.0 (160.0,170.0)°, and 85.5%±13.8%]were significantly better than those in the remnant-sacrifice group [(91.4±5.9) points, 160.0 (160.0,170.0)°, 150.0 (140.0,155.0)°, and 72.6%±16.9%] ( P < 0.05), but there were no statistically significant differences between the 2 groups in VAS score, Constant score, neutral external rotation angle, or body-side internal rotation ( P>0.05). The Sugaya grading for MRI rotator cuff healing was significantly different between the 2 groups at the last follow-up ( P<0.05). Conclusion:In arthroscopic repair of rotator cuff tear, reservation of remnants in the footprint area can significantly relieve postoperative shoulder pain, and has obvious advantages in restoration of shoulder forward flexion, abduction and abductor muscle strength, leading to better healing of the rotator cuff and the large nodule than the remnant-sacrifice technique.

Objective To evaluate the short-term clinical effect of arthroscopic repair of rotator cuff injury with all-suture anchor using a prospective and single-cohort clinical trial.Methods Twenty-five patients with rotator cuff injuries(1.5 cm0.05).Conclusion Arthroscopic rotator cuff repair with all-suture anchor is feasible and safe,and has good short-term clinical effect.