Objective:To study the effect of compliance with enhanced recovery after surgery (ERAS) program on the prognosis of patients undergoing total knee arthroplasty.Methods:A total of 229 patients who underwent unilateral total knee arthroplasty in Beijing Friendship Hospital, Capital Medical University from March 2022 to March 2024, the clinical data of patients were retrospectively analysed. The cohort included 57 males and 172 females, aged 61-79 years, the average age was (68.6±5.2) years. All patients received perioperative ERAS interventions, and compliance with each ERAS item was recorded. Based on overall ERAS compliance, patients were divided into high-compliance group ( n=140, compliance >89.9%) and low-compliance group ( n=89, compliance ≤89.9%). The characteristics of the two groups were collected, including gender, age, body mass index, smoking, comorbidities, Hospital for Special Surgery (HSS) score, preoperative visual analog scale (VAS) score, surgical time and estimated blood loss. Clinical outcomes indicators including HSS scores and knee range of motion (ROM) at 1 and 3 months postoperatively, length of hospital stay, complications within 3 months, and readmission at 3 months. Measurement data were expressed as mean±standard deviation ( ± s) and compared using t-test. Count data were expressed as cases and percentages and analyzed using Chi-square or Fisher exact probability method. Results:There was no significant statistical difference in age( P=0.167), gender( P=0.500), body mass index ( P=0.322), smoking( P=0.185), hypertension( P=0.118), diabetes( P=0.550), coronary heart disease( P=0.633), arrhythmias( P=0.564), chronic lung disease( P=0.460), depression( P=0.295), preoperative HSS( P=0.492), preoperative VAS( P=0.644), surgical time ( P=0.459) and estimated blood loss( P=0.171) between the high-compliance group and the low-compliance group. The postoperative knee ROM (115.2±8.5)° of patients with high-compliance was significantly higher than that of patients with low-compliance group (101.8±10.1)°, the difference was statistically significant ( P<0.001). The length of hospital stay was (13.7±3.7) d in the low-compliance group, which was more than that in the high-compliance group [(9.8±2.5) d], and the difference was statistically significant ( P=0.028). Conclusions:Patients undergoing total knee arthroplasty had a high overall compliance with the ERAS program. The prognosis of patients with higher compliance of ERAS is better, and ERAS compliance should be improved as much as possible in clinical work.

Background: En bloc resection is recommended for the treatment of malignant and aggressive benign spinal tumors; however, it often requires a combined anterior-posterior approach, which is usually accompanied by longer surgical duration, increased blood loss, larger trauma, and surgical complexity. The present study describes a novel rotation-reversion technique for en bloc resection of the thoracic and upper lumbar spinal tumors using a posterior-only approach and evaluate its safety and efficacy. Methods: Thirteen patients with thoracic and upper lumbar (L1-L3) spinal tumors were treated with en bloc resection using the rotation-reversion technique through a posterior-only approach at our institution between 2015 and 2023. The clinical characteristics and surgical results of the patients were reviewed and analyzed. Results: Posterior-only en bloc resection was performed successfully in all 13 patients using the rotation-reversion technique, with a median follow-up of 30.4 months (range, 6–74 months). The average maximum size of these 13 tumors was 5.7 × 5.8 × 4.8 cm.The mean operation time and blood loss were 458.5 minutes (range, 220–880 minutes) and 3,146.2 mL (range, 1,000–6,000 mL), respectively, with 4 of the 13 patients (30.8%) experiencing perioperative complications. Negative margins were achieved in all the 13 patients (100%). One patient experienced local recurrence (7.7%) and 1 patient experienced instrumentation failures. Interbody fusion was confirmed in 11 of the 13 patients (84.6%), with a median fusion time of 6.9 months. All of the 13 patients experienced varying degrees of mild postoperative neurological deficits owing to resection of the nerve roots affected by tumor invasion of the vertebrae. No vessel injury or postoperative neurological paralysis occurred, except 1 patient who had been completely paralyzed before surgery. Conclusions The rotation-reversion technique is an effective procedure for en bloc resection of selected thoracic and upper lumbar spinal tumors through the posterior-only approach.

Background: En bloc resection is recommended for the treatment of malignant and aggressive benign spinal tumors; however, it often requires a combined anterior-posterior approach, which is usually accompanied by longer surgical duration, increased blood loss, larger trauma, and surgical complexity. The present study describes a novel rotation-reversion technique for en bloc resection of the thoracic and upper lumbar spinal tumors using a posterior-only approach and evaluate its safety and efficacy. Methods: Thirteen patients with thoracic and upper lumbar (L1-L3) spinal tumors were treated with en bloc resection using the rotation-reversion technique through a posterior-only approach at our institution between 2015 and 2023. The clinical characteristics and surgical results of the patients were reviewed and analyzed. Results: Posterior-only en bloc resection was performed successfully in all 13 patients using the rotation-reversion technique, with a median follow-up of 30.4 months (range, 6–74 months). The average maximum size of these 13 tumors was 5.7 × 5.8 × 4.8 cm.The mean operation time and blood loss were 458.5 minutes (range, 220–880 minutes) and 3,146.2 mL (range, 1,000–6,000 mL), respectively, with 4 of the 13 patients (30.8%) experiencing perioperative complications. Negative margins were achieved in all the 13 patients (100%). One patient experienced local recurrence (7.7%) and 1 patient experienced instrumentation failures. Interbody fusion was confirmed in 11 of the 13 patients (84.6%), with a median fusion time of 6.9 months. All of the 13 patients experienced varying degrees of mild postoperative neurological deficits owing to resection of the nerve roots affected by tumor invasion of the vertebrae. No vessel injury or postoperative neurological paralysis occurred, except 1 patient who had been completely paralyzed before surgery. Conclusions The rotation-reversion technique is an effective procedure for en bloc resection of selected thoracic and upper lumbar spinal tumors through the posterior-only approach.

Background: En bloc resection is recommended for the treatment of malignant and aggressive benign spinal tumors; however, it often requires a combined anterior-posterior approach, which is usually accompanied by longer surgical duration, increased blood loss, larger trauma, and surgical complexity. The present study describes a novel rotation-reversion technique for en bloc resection of the thoracic and upper lumbar spinal tumors using a posterior-only approach and evaluate its safety and efficacy. Methods: Thirteen patients with thoracic and upper lumbar (L1-L3) spinal tumors were treated with en bloc resection using the rotation-reversion technique through a posterior-only approach at our institution between 2015 and 2023. The clinical characteristics and surgical results of the patients were reviewed and analyzed. Results: Posterior-only en bloc resection was performed successfully in all 13 patients using the rotation-reversion technique, with a median follow-up of 30.4 months (range, 6–74 months). The average maximum size of these 13 tumors was 5.7 × 5.8 × 4.8 cm.The mean operation time and blood loss were 458.5 minutes (range, 220–880 minutes) and 3,146.2 mL (range, 1,000–6,000 mL), respectively, with 4 of the 13 patients (30.8%) experiencing perioperative complications. Negative margins were achieved in all the 13 patients (100%). One patient experienced local recurrence (7.7%) and 1 patient experienced instrumentation failures. Interbody fusion was confirmed in 11 of the 13 patients (84.6%), with a median fusion time of 6.9 months. All of the 13 patients experienced varying degrees of mild postoperative neurological deficits owing to resection of the nerve roots affected by tumor invasion of the vertebrae. No vessel injury or postoperative neurological paralysis occurred, except 1 patient who had been completely paralyzed before surgery. Conclusions The rotation-reversion technique is an effective procedure for en bloc resection of selected thoracic and upper lumbar spinal tumors through the posterior-only approach.

Background: En bloc resection is recommended for the treatment of malignant and aggressive benign spinal tumors; however, it often requires a combined anterior-posterior approach, which is usually accompanied by longer surgical duration, increased blood loss, larger trauma, and surgical complexity. The present study describes a novel rotation-reversion technique for en bloc resection of the thoracic and upper lumbar spinal tumors using a posterior-only approach and evaluate its safety and efficacy. Methods: Thirteen patients with thoracic and upper lumbar (L1-L3) spinal tumors were treated with en bloc resection using the rotation-reversion technique through a posterior-only approach at our institution between 2015 and 2023. The clinical characteristics and surgical results of the patients were reviewed and analyzed. Results: Posterior-only en bloc resection was performed successfully in all 13 patients using the rotation-reversion technique, with a median follow-up of 30.4 months (range, 6–74 months). The average maximum size of these 13 tumors was 5.7 × 5.8 × 4.8 cm.The mean operation time and blood loss were 458.5 minutes (range, 220–880 minutes) and 3,146.2 mL (range, 1,000–6,000 mL), respectively, with 4 of the 13 patients (30.8%) experiencing perioperative complications. Negative margins were achieved in all the 13 patients (100%). One patient experienced local recurrence (7.7%) and 1 patient experienced instrumentation failures. Interbody fusion was confirmed in 11 of the 13 patients (84.6%), with a median fusion time of 6.9 months. All of the 13 patients experienced varying degrees of mild postoperative neurological deficits owing to resection of the nerve roots affected by tumor invasion of the vertebrae. No vessel injury or postoperative neurological paralysis occurred, except 1 patient who had been completely paralyzed before surgery. Conclusions The rotation-reversion technique is an effective procedure for en bloc resection of selected thoracic and upper lumbar spinal tumors through the posterior-only approach.

Objective:To analyze the impact of diagnosis-intervention packet payment (DIP) reform on hospitalization service capacity and patients′ economic burden, for references for promoting China′s medical insurance payment reform.Methods:Data were collected from the discharge summarizes of 116 545 hospitalized patients from a tertiary hospital in Guangdong Province. Among them, there were 42 534 cases before the DIP reform (January 2016 to December 2017) and 74 011 cases after the reform (January 2018 to December 2020). The all-cause in-hospital mortality rate, length of hospital stay, disease severity, readmission rate within 30 days, total hospitalization costs, and patient out of pocket expenses were used as evaluation indicators for hospitalization service capacity and patient economic burden. Intermittent time series analysis was conducted to examine the changes in indicators before and after DIP reform.Results:The slope of the change trend of all-cause in-hospital mortality rate and readmission rate within 30 days before and after DIP reform was not statistically significant ( P<0.05); The length of hospital stay showed a decreasing trend before the reform ( P=0.047), but the trend after the reform was not statistically significant ( P=0.776); The change trend of disease severity before the reform was not statistically significant ( P=0.682), but showed a significant upward trend after the reform ( P=0.012); The total hospitalization costs significantly increased during the reform ( P<0.001), but the trend of change after the reform was not statistically significant ( P=0.431); The patient′s out of pocket expenses showed an upward trend before the reform ( P=0.001), but the change trend after the reform was not statistically significant ( P=0.757). Conclusions:DIP reform could help hospitals improve their inpatient service capabilities and enhance their functional positioning; Strengthen medical cost management and control the increase in economic burden on hospitalized patients.

The clinical data of 2 pediatric patients with atypical hemolytic uremic syndrome (aHUS) who were admitted to the Department of Nephrology at the Children′s Hospital of Nanjing Medical University on July 2018 to June 2023 were retrospectively analyzed.Both patients had combined CFH and CD46 gene mutations.One patient, a 2-year-old boy, presented jaundice and darkened urine following mumps.The other patient, a 7-month-old girl and the younger sister of the boy, developed fever, cough, vomiting, and thrombocytopenia without any apparent cause.Laboratory tests revealed hemolytic anemia, thrombocytopenia, and acute kidney injury in both patients.The genetic test results revealed mutations in both CFH (c.3572C>T, p.Ser1191Leu) and CD46 genes (c.293C>T, p.Thr98Ile) in both patients.The patients′ mother is a heterozygous carrier of the CFH gene mutation, while their father is a heterozygous carrier of the CD46 gene mutation.Both parents exhibit normal phenotypes and are currently receiving regular infusions of Eculizumab.The pediatric aHUS caused by combined CFH and CD46 gene mutations is reported in this study for the first time in China.The clinical features of these patients are summarized and analyzed.

The clinical data of 2 pediatric patients with atypical hemolytic uremic syndrome (aHUS) who were admitted to the Department of Nephrology at the Children′s Hospital of Nanjing Medical University on July 2018 to June 2023 were retrospectively analyzed.Both patients had combined CFH and CD46 gene mutations.One patient, a 2-year-old boy, presented jaundice and darkened urine following mumps.The other patient, a 7-month-old girl and the younger sister of the boy, developed fever, cough, vomiting, and thrombocytopenia without any apparent cause.Laboratory tests revealed hemolytic anemia, thrombocytopenia, and acute kidney injury in both patients.The genetic test results revealed mutations in both CFH (c.3572C>T, p.Ser1191Leu) and CD46 genes (c.293C>T, p.Thr98Ile) in both patients.The patients′ mother is a heterozygous carrier of the CFH gene mutation, while their father is a heterozygous carrier of the CD46 gene mutation.Both parents exhibit normal phenotypes and are currently receiving regular infusions of Eculizumab.The pediatric aHUS caused by combined CFH and CD46 gene mutations is reported in this study for the first time in China.The clinical features of these patients are summarized and analyzed.

Objective:To analyze the impact of diagnosis-intervention packet payment (DIP) reform on hospitalization service capacity and patients′ economic burden, for references for promoting China′s medical insurance payment reform.Methods:Data were collected from the discharge summarizes of 116 545 hospitalized patients from a tertiary hospital in Guangdong Province. Among them, there were 42 534 cases before the DIP reform (January 2016 to December 2017) and 74 011 cases after the reform (January 2018 to December 2020). The all-cause in-hospital mortality rate, length of hospital stay, disease severity, readmission rate within 30 days, total hospitalization costs, and patient out of pocket expenses were used as evaluation indicators for hospitalization service capacity and patient economic burden. Intermittent time series analysis was conducted to examine the changes in indicators before and after DIP reform.Results:The slope of the change trend of all-cause in-hospital mortality rate and readmission rate within 30 days before and after DIP reform was not statistically significant ( P<0.05); The length of hospital stay showed a decreasing trend before the reform ( P=0.047), but the trend after the reform was not statistically significant ( P=0.776); The change trend of disease severity before the reform was not statistically significant ( P=0.682), but showed a significant upward trend after the reform ( P=0.012); The total hospitalization costs significantly increased during the reform ( P<0.001), but the trend of change after the reform was not statistically significant ( P=0.431); The patient′s out of pocket expenses showed an upward trend before the reform ( P=0.001), but the change trend after the reform was not statistically significant ( P=0.757). Conclusions:DIP reform could help hospitals improve their inpatient service capabilities and enhance their functional positioning; Strengthen medical cost management and control the increase in economic burden on hospitalized patients.

Objective Total thyroidectomy of C57BL/6 and KM mice was performed by two different surgical methods to verify the success of mouse hypothyroidism model modeling,and compared the success rate of different surgical methods.Methods C57BL/6 and KM mice underwent total thyroidectomy by ligation(operation method Ⅰ)or hemostasis(operation method Ⅱ),and the detailed operation processes were recorded.Serum TT3,TT4 and TSH levels detected by enzyme-linked immunosorbent assay,body weight,and hematoxylin-eosin(HE)-stained neck tissue were compared before and after surgery to verify the model.Results Serum TT3 and TT4 levels were decreased(P＜0.05)and TSH was increased(P＜0.001)in both model groups.The 28-day postoperative survival rates were 40％and 60％in groups Ⅰ and Ⅱ,respectively,and 50％and 40％in KM mice.Body weights were significantly higher in both model groups compared with the sham control group.HE staining and microscopic observation showed that the cervical tissue in both strains was thyroid tissue,and the back membrane of the thyroid remained intact after isolation.Conclusions Both surgical method can induce hypothyroidism in C57BL/6 and KM mice;however,it is necessary to consider the anatomical relationship of the thyroid gland to the surrounding tissue,improve the proficiency of the surgical operation,prevent the occurrence of postoperative hypocalcemia and infection,and thus improve the survival rate of the model mice.