BACKGROUND: The choice of unicompartmental knee arthroplasty (UKA) vs . total knee arthroplasty (TKA) in the surgical treatment of knee osteoarthritis (KOA) remains controversial. This study aimed to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) to compare the clinical results of UKA and TKA for treating unicompartmental KOA. METHODS: PubMed, Embase, and the Cochrane Library were systematically searched for articles published up to January 2, 2023. The literature was rigorously screened to include only RCTs comparing UKA and TKA for unicompartmental KOA. A systematic review and meta-analysis were performed to calculate the mean difference (MD), relative risk (RR), and 95% confidence interval (CI) according to the Cochrane standards. RESULTS: Thirteen publications involving 683 UKAs and 683 TKAs were analyzed. Except for one study with a follow-up period of 15 years, all outcome measures reported were within 5 years of follow-up. Meta-analysis showed better knee recovery (MD: 1.23; 95% CI: 1.01-1.45; P  <0.001), greater knee function (MD: 1.78; 95% CI: 0.34-3.22; P  = 0.020), less pain (MD: 0.75; 95% CI: 0.43-1.06; P  <0.001), and better health status (MD: 3.75; 95% CI: 0.81-6.69; P  = 0.010) after UKA than TKA. However, considering the minimal clinically important difference values for these variables, the findings were not clinically relevant. Moreover, UKA patients had fewer complications (RR: 0.59; 95% CI: 0.45-0.78; P  <0.001) and shorter hospital stays (MD: -0.89; 95% CI: -1.57 to -0.22; P  = 0.009) than did TKA patients. There were no statistically significant differences in terms of postoperative range of movement, revision, failure, operation time, and patient satisfaction. CONCLUSIONS In terms of clinical efficacy, there was no obvious advantage of UKA over TKA in the surgical treatment of knee OA when considering the minimal clinically important difference. The main advantage of UKA over TKA is that it leads to fewer complications and a shorter length of hospital stay. It is ideal to perform prospective studies with longer follow-up periods to fully evaluate the long-term efficacy and safety of the two procedures in the future.
Humans ; Arthroplasty, Replacement, Knee/methods* ; Osteoarthritis, Knee/surgery* ; Randomized Controlled Trials as Topic ; Treatment Outcome

Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.

The clinical antiprotozoal drug nitazoxanide has been demonstrated to improve the experimental diabetes mellitus, lipid metabolism disorders, atherosclerosis and inhibit inflammation. Since the pathogenesis of heart failure with preserved ejection (HFpEF) is multifactorial and closely associated with the aforementioned diseases, we aim to study the effect of nitazoxanide on high-fat diet (HFD) plus L-NAME (N ω-nitro-l-arginine methyl ester)-induced HFpEF and metabolic syndrome in mice. We found that oral nitazoxanide improved cardiac hypertrophy, cardiac fibrosis, cardiac diastolic dysfunction, increased blood pressure, impaired exercise tolerance, impaired glucose handling, serum lipid disorders, hepatic steatosis, increased weight of white adipose tissues and kidney fibrosis in HFD + L-NAME-treated mice. In the established HFD + L-NAME-induced HFpEF and metabolic syndrome mouse model, therapeutic treatment with nitazoxanide rescued HFD + L-NAME-induced pathological phenotypes as mentioned above. The in vitro experiments revealed that tizoxanide, the active metabolite of nitazoxanide, increased the basal mitochondria metabolism of cardiomyocytes, inhibited cardiomyocyte hypertrophy and collagen secretion from cardiac fibroblasts, and relaxed phenylephrine- and U46619-induced constriction of rat mesenteric arteries, indicating that the direct effect of tizoxanide might partly contribute to the protective effect of nitazoxanide against HFpEF in vivo. The present study suggests that nitazoxanide might be a potential drug for HFpEF and metabolic syndrome therapy.

Objective:To analyze the effective and safety of endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (RAAA) at one tertiary center, and to improve the outcomes of RAAA under fast-track protocol.Methods:Nineteen cases of RAAA in the 940th Hospital of Joint Logistic Support Force of PLA from January 2014 to December 2020 were reviewed retrospectively. EVAR-fist strategy was employed from the emergency room to the operating room by using fast-track protocol. Preoperative management, anatomic characteristics, choice of anesthesia, operative procedures and postoperative complications were collected and analyzed. Abdominal compartment syndrome (ACS) and hospital mortality were paid special attention.Results:Nineteen cases were undergone EVAR procedures. The age was (73.4 ± 7.4) years old, and the AAA size was (67.8 ± 13.6) mm. Two cases underwent cardiopulmonary resuscitation at emergency department. General anesthesia was used in 13 patients and local anaesthesia in 6 patients. Successful stent graft deployment was achieved in all cases. The duration from emergency room to operating room was (84.8 ± 22.4) min. The hospital stay time was (9.7 ± 5.7) d. The hospital mortality was 5/19. The 5 deaths were reviewed: 3 died for multiple organ failure, 1 for irreversible shock, and 1 for ongoing bleeding.Conclusions:Excellent results were confirmed by using EVAR-first strategy for RAAA. The management of hemodynamically unstable state, standardized endovascular procedure, fast-track program and multidiscipline team collaboration were the very important determining factors for the implementation of EVAR. Focused efforts to reduce RAAA mortality are warranted.

Objective To explore the improvement of cognitive impairment in patients with mild and moderate vascular cognitive impairment( VCI) treated with cerebralcare granule ( CG) and basic treat-ment.Methods From October in 2014 to December in 2016 year,143 cases of VCI patients were admitted from six hospitals in some areas of Hebei Province as the research objects,and divided into CG treatment group (experimental group,n=98) and conventional treatment group (control group,n=66).Three months and six months after treatment,the score of mental state examination ( MMSE) ,the Montreal cognitive assess-ment scale ( MoCA) and the daily living capacity scale( ADL) of the two groups were compared after 3 and 6 moths of treatment.Results ①The total score of MMSE in the experimental group was higher than that of the control group for six months after treatment, and the difference was statistically significant ( ( 23. 76 ± 4.02) vs (21.52±5.13),P<0.05).②Six months after treatment,the total score of MoCA ((21.06±4.66) vs (18.32±5.20)) and visual spatial/executive function((3.05±1.37) vs (2.42±1.66)),calculation force ((2.24±0.84) vs (1.83±1.05)) and orientation ability((5.20±1.12) vs (4.06±1.35)) scores in the ex-perimental group were significantly higher than those in the control group (P<0.05) .③Six months after treat-ment,the ADL score in the experimental group was lower than that before treatment,and the difference was statistically significant((24.96±8.74) vs (29.20±11.55),P<0.05);while there was no significant difference in the ADL score between the experimental group and the control group after 6 months (P>0.05).Conclusion CG can improve cognitive function in mild to moderate VCI patients,mainly in visual space/execution func-tion,calculation ability and orientation ability,and with the extension of treatment time,the curative effect is more obvious.

Objective To investigate the value of three-dimensional speckle tracking imaging (3D-STI) in quantitative evaluation of left ventricular global strain in patients with atrial septal defect (ASD) before and after transcatheter closure.Methods Totally 35 patients with secondary ASD who received successful transcatheter occlusion were selected.Routine echocardiography and 3D-STI examination were performed before the operation,2 days,1 month,3 months and 6 months after the operation.Routine echocardiography was used to obtain the parameters of left ventricular end diastolic diameter (LVEDD),left ventricular end systolic diameter (LVEDS),left ventricular end diastolic volume (LVEDV),left ventricular end systolic volume (LVESV),stroke volume (SV) and other parameters.The left ventricular global peak longitudinal strain (GPLS),left ventricular global peak circumferential strain (GPCS),left ventricular global peak radial strain (GPRS) and left ventricular global peak area strain (GPAS) were examined with 3D-STI.The preoperative and postoperative parameters at each time point were analyzed statistically.Results Routine echocardiography showed that LVEDD,LVEDS,LVEDV,LVESV and SV increased significantly after operation,but no significant difference was found to compare each other 2 days,1 month,3 months and 6 months after operation (all P＞0.05).3D-STI examination showed that left ventricular GPLS,GPCS,GPRS and GPAS increased after operation,and the most increase was noticed at the second day after transcatheter occlusion.GPLS,GPCS and GPAS 6 months after operation were larger than those 3 months after operation (all P＞0.05).Conclusion 3D-STI technique can evaluate the left ventricular global strain in patients with ASD before and after occlusion.Compared with conventional echocardiography,3D-STI technique can objectively and effectively evaluate the changes of left ventricular systolic function.

Objective To analyze the clinical characteristics of suspected acute aortic dissection with ST-segment elevation detected by inferior leads in order to avoid the misdiagnosis of acute aortic dissection facilitating an appropriate treatment strategy carried out in time.Methods A total of 14 patients with suspected acute aortic dissection with ST-segment elevation detected by inferior leads were enrolled.Their clinical presentation,ECG features,imaging findings,laboratory testing,coronary angiography results, treatment and outcome were retrospectively analyzed.Results Clinical characteristics of suspected acute aortic dissection with ST-segment elevation detected by inferior leads suggested that hypertension as a single risk factor accounted for 79%.The patients with normal blood pressure or high blood pressure in emergency visits accounted for 86%.The amplitude of ST elevation in lead Ⅲ was greater than that in lead Ⅱ,and lead Ⅲ accompanied with ST elevation in lead V1 or V4R accounted for 86%.Significantly elevated D-dimer >2 000 ng/mL was found in those patients.Coronary angiography showed that the opening of coronary artery not seen,normal coronary arteries or a simple right coronary artery proximal lesion.Transesophageal echocardiography and computed tomography angiography were used to identify the diagnosis with 100%accuracy.The mortality rate of this group was 50%.Conclusions Patients with acute aortic dissection evidenced by ST-segment elevation detected by inferior leads are in critical setting of high mortality. Emergency surgical treatment can significantly improve the survival rate of patients.

ObjectiveTo investigate the efficiency of autologous transplantation of peripheral blood stem cells for treatment of patients with diabetic lower limb ischemia.MethodsEighteen patients of type 2 diabetes with diabetic lower limb ischemia (30 legs) were treated by autologous transplantation of peripheral blood stem cells.ResultsThe limb pain, cool feeling and numbness feeling improved significantly after PBSC transplantation,the improvement rate were 96.7％, 100.0％ and 95.8％ respectively.Intermittent claudication was also relieved significantly, total remission rate was 76.9％.The ABI and TcPO2 of patients increased significantly at 3 months after transplantation.After the transplantation ABI raised from 0.60 ± 0.11 to 0.71 ±0.12(t =-6.882, P ＜ 0.01) .93.3％ of patients' TcPO2 raised in different degrees.The foot infections were well controlled.Ulcer or toes gangrene got better or healed.No obvious complications or adverse reaction were observed after the transplantation.ConclusionAutologous transplantation of peripheral blood stem cells shows to be a simple, safe and effective method in treating patients with diabetic lower limb ischemia.

Objective To investigate the effects and possible mechanism of Fructus lycii on renal calcium oxalate stone formation in rats. Methods Wistar rats were divided into several groups according to different stone inducer (cigarette smoking, ethylene glycol solution drinking or combination of both), either Fructus lycii infusion interference or not and different interfering concentrations (10% and 25%). Besides, a blank control group was set. After treatment for 40 d, 24 h urine was collected, and renal tissue samples were obtained. The concentrations of calcium, oxalate and citric acid in urine were measured. The deposit condition of calcium oxalate crystals in nephric tubules was observed and scored. The levels of malondialdehyde (MDA) and activity of total-superoxide dismutase (T-SOD) in renal tissues were detected. Apoptosis cells in kidney were observed with TUNEL staining, and index of apoptosis was calculated. Results Compared with blank control group, the urine calcium concentration in group of combination of cigarette smoking and ethylene glycol solution drinking were significantly higher (P<0.01), the scores of calcium oxalate crystals in renal tubules, the levels of MDA in renal tissues and the index of apoptosis of renal tubule epithelial cells in groups of ethylene glycol solution drinking and combination with smoking were higher, while the concentrations of citric acid in urine and activity of T-SOD in renal tissues were lower. Ten percent and 25% Fructus lycii infusion significantly decreased the urine concentrations of calcium in group of combination of cigarette smoking and ethylene glycol solution drinking (P<0.01), decreased the scores of calcium oxalate crystals in renal tubules, the levels of MDA in renal tissues and the index of apoptosis of renal tubule epithelial cells in groups of ethylene glycol solution drinking and combination with smoking, and increased the concentrations of citric acid in urine and activity of T-SOD in renal tissues. There was no significant dose-effect relationship between two concentrations of Fructus lycii infusion. Conclusion Fructus lycii infusion can effectively inhibit the formation of renal calcium oxalate stone in rats with smoking and/or ethylene glycol drinking by reducing the free radicals and apoptosis of renal tissue, decreasing the concentration of elements for stone formation and increasing the concentration of elements for inhibition of stone formation in urine.