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.

Objective:To compare the efficacy of in situ repair and conversion to full-thickness repair in patients with partial tears of the supraspinatus tendon bursa side in rotator cuff tears. Methods:A retrospective analysis was performed on 81 patients who underwent shoulder arthroscopic surgery due to Ellman grade III partial tears on the rotator cuff bursa side in Beijing Friendship Hospital, Capital Medical University from January 2021 to December 2022, according to the different intraoperative supraspinatus tendon repair methods, the patients were divided into the in situ repair group ( n=44) and the partial-to-full-thickness repair group ( n=37). Patients in the in situ repair group were treated with in situ repair for supraspinatus tendon repair, while those in the partial-to-full-thickness repair group were treated with partial-to-full-thickness repair for supraspinatus tendon repair. The general information, pain visual analogue scale (VAS) score, University of California, Los Angeles (UCLA) shoulder joint score and Constant score of the patients were compared and analyzed; the operation time, number of anchors used, and rotator cuff re-tear rate 1 year after surgery were compared and analyzed. The measurement data were expressed as mean ± standard deviation ( ± s), and comparisons between groups were performed using the independent samples t-test. The count data were expressed as the number of cases and percentages, and comparisons between groups were performed using the Chi-square test. Results:All 81 patients completed the follow-up. One year after surgery, the pain VAS scores of the in situ repair group and the partial-to-full-thickness repair group were 1.48±1.07 and 1.38±0.83, respectively, with no significant statistical difference ( P=0.647). The UCLA shoulder joint score and Constant score in the in situ repair group were 30.09±1.46 and 83.05±10.94, respectively, and those in the partial-to-full-thickness repair group were 30.46±1.04 and 84.95±9.20, respectively, there were no significant statistical difference ( P=0.203, 0.405). There was no significant statistical difference in the operation time between the in situ repair group and the partial-to-full-thickness repair group ( P=0.276), but the partial-to-full-thickness repair group was about 11.5 min slower on average. The number of anchors used in the in situ repair group (1.86±0.88) was significantly less than that in the partial-to-full-thickness repair group (2.51±0.65), and the difference was statistically significant ( P<0.001). There was no significant statistical difference in the re-tear rate between the two groups 1 year after surgery ( P=0.625). Conclusions:For patients with partial tears of the supraspinatus tendon bursa side in rotator cuff tears, both in situ repair and partial-to-full-thickness repair can achieve good clinical results, but conversion to full-thickness repair requires longer operation time and more anchors. The choice of specific surgical method needs to be determined based on the patient′s condition and the doctor′s technical proficiency.

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.

Objective:To compare the accuracy of two methods in reducing leg length discrepancy(LLD)during hip hemiarthroplasty.Methods:We retrospectively analyzed 89 patients of hip hemiarthroplasty who suffered from femoral neck fracture.There were 47 patients in the new method group(NM), and 42 patients in the traditional method group(traditional method, TM)which comparing the position of the greater trochanter tip and the center of the femoral head.In the NM group, the distance from the center of femoral head to the lesser trochanter(L)and the diameter of femoral head(D)of the healthy side hip were measured on preoperative anteroposterior pelvic X-ray film, and the ratio(R)of D to L was calculated.During operation, the diameter of the femoral head(d)was measured with a caliper, and the distance should be obtained from the center of the femoral head prosthesis to the lesser trochanter according to the ratio R of the healthy side.The difference of postoperative LLD between the two groups and the incidences of |LLD| in each range were compared.Results:In the NM group, the maximum LLD was 11.10 mm and the minimum LLD was -4.0 mm, with an average of(4.4±3.2)mm, 80.9%(38/47)| LLD | < 6 mm, 93.6%(44/47)| LLD | < 10 mm, 6.4%(3/47)| LLD | ≥ 10 mm.In the TM group, the maximum LLD was 13.2 mm and the minimum LLD was -8.3 mm, with an average of (6.2±5.1)mm, 42.9%(18/42)|LLD|<6 mm, 69.0%(29/42)|LLD| <10 mm, 31.0%(13/42)|LLD|≥10mm.The differences of patients of the mean postoperative LLD and the incidences of |LLD| in each range between two the groups were statistically significant( t=-2.036、 χ2=14.629, P=0.046、0.001). Conclusions:The new method is simple, convenient, more accurate and can obtain a more satisfactory LLD compared with the traditional method which refers to the relative position of the great trochanter tip and the center of the femoral head.

Objective To evaluate the short?term efficacy and safety of endoscopic photodynamic therapy ( PDT ) for esophageal squamous cell carcinoma ( ESCC ) and precancerous lesion. Methods Retrospective analysis was performed on 30 patients with early ESCC or precancerous lesions who received PDT between September 2013 and April 2015 in Endoscopy Center, Henan Tumor Hospital,and its indications were summarized. The main outcomes including histological complete response rate ( CR ) , recurrence rate and adverse events after treatment of one year were analyzed. Results Three patients with middle grade dysplasia( MGD) , 18 with high grade dysplasia( HGD) and 4 with squamous cell carcinoma in situ, all negative lymph node metastasis, received PDT. CRs were 72?0%(18/25) and 88?0%(22/25)after one PDT session in 3 months and 12 months, respectively. One?year follow?up showed 3 recurrences ( 12?0%) ,4 ( 16?0%) severe strictures, and no perforation. Five patients with advanced squamous cell carcinoma received palliative PDT. Partial remission rate was 60?0%( 3/5) after one PDT session in 3 months, and 40?0% ( 2/5) after 12 months. Two died of tumor metastasis, one died of gastrointestinal bleeding one year after PDT. No perforation occurred. Conclusion Endoscopic photodynamic therapy for esophageal squamous cell carcinoma and precancerous lesions is safe and feasible, with remarkable short?term effect. As for the patients with advanced squamous cell carcinoma, it is equally safe and effective in the short term.

OBJECTIVETo investigate the feasibility of no nasogastric intubation and early oral feeding at will after thoracolaparoscopic esophagectomy for patients with esophageal cancer.

METHODSBetween January 2013 and January 2014, the feasibility of no nasogastric intubation and early oral feeding at postoperative day(POD) 1 after thoracolaparoscopic esophagectomy was prospectively investigated in 156 patients (trial group) with esophageal cancer in the Henan Cancer Hospital. One hundred and sixty patients previously managed in the same unit who were treated routinely after thoracolaparoscopic esophagectomy were served as control group.

RESULTSOf 156 patients of trial group, 6(3.8%) patients could not take food early as planned because of postoperative complications. The overall complication rate in trial group was 19.2%(30/156), which was 25.0%(30/160) in control group (P=0.217). The anastomotic leakage in trial group and control group was 2.6%(4/156) and 4.3%(7/160) respectively (P=0.380). Compared with control group, time to first flatus [(2.1±0.9) d vs. (3.3±1.1) d, P<0.001], bowel movement [(4.4±1.3) d vs. (6.6±1.0) d, P<0.001] and postoperative hospital stay [(8.3±3.2) d vs. (10.4±3.6) d, P<0.001] were significantly shorter in trial group.

CONCLUSIONSNo nasogastric intubation and early oral feeding postoperatively in patients with thoracolaparoscopic esophagectomy is feasible and safe. This management can shorten postoperative hospital stay and fasten postoperative bowel function recovery.

Eating ; Esophageal Neoplasms ; surgery ; Esophagectomy ; Fasting ; Feasibility Studies ; Humans ; Intubation, Gastrointestinal ; Postoperative Complications ; Postoperative Period

Objective To investigate the feasibility of no nasogastric intubation and early oral feeding at will after thoracolaparoscopic esophagectomy for patients with esophageal cancer. Methods Between January 2013 and January 2014, the feasibility of no nasogastric intubation and early oral feeding at postoperative day (POD) 1 after thoracolaparoscopic esophagectomy was prospectively investigated in 156 patients (trial group) with esophageal cancer in the Henan Cancer Hospital. One hundred and sixty patients previously managed in the same unit who were treated routinely after thoracolaparoscopic esophagectomy were served as control group. Results Of 156 patients of trial group, 6 (3.8%) patients could not take food early as planned because of postoperative complications. The overall complication rate in trial group was 19.2%(30/156), which was 25.0%(30/160) in control group (P=0.217). The anastomotic leakage in trial group and control group was 2.6%(4/156) and 4.3%(7/160) respectively (P=0.380). Compared with control group, time to first flatus [(2.1±0.9) d vs. (3.3±1.1) d, P<0.001], bowel movement[(4.4±1.3) d vs. (6.6±1.0) d, P<0.001] and postoperative hospital stay [(8.3 ±3.2) d vs. (10.4 ±3.6) d, P<0.001] were significantly shorter in trial group. Conclusions No nasogastric intubation and early oral feeding postoperatively in patients with thoracolaparoscopic esophagectomy is feasible and safe. This management can shorten postoperative hospital stay and fasten postoperative bowel function recovery.

Objective To investigate the feasibility of no nasogastric intubation and early oral feeding at will after thoracolaparoscopic esophagectomy for patients with esophageal cancer. Methods Between January 2013 and January 2014, the feasibility of no nasogastric intubation and early oral feeding at postoperative day (POD) 1 after thoracolaparoscopic esophagectomy was prospectively investigated in 156 patients (trial group) with esophageal cancer in the Henan Cancer Hospital. One hundred and sixty patients previously managed in the same unit who were treated routinely after thoracolaparoscopic esophagectomy were served as control group. Results Of 156 patients of trial group, 6 (3.8%) patients could not take food early as planned because of postoperative complications. The overall complication rate in trial group was 19.2%(30/156), which was 25.0%(30/160) in control group (P=0.217). The anastomotic leakage in trial group and control group was 2.6%(4/156) and 4.3%(7/160) respectively (P=0.380). Compared with control group, time to first flatus [(2.1±0.9) d vs. (3.3±1.1) d, P<0.001], bowel movement[(4.4±1.3) d vs. (6.6±1.0) d, P<0.001] and postoperative hospital stay [(8.3 ±3.2) d vs. (10.4 ±3.6) d, P<0.001] were significantly shorter in trial group. Conclusions No nasogastric intubation and early oral feeding postoperatively in patients with thoracolaparoscopic esophagectomy is feasible and safe. This management can shorten postoperative hospital stay and fasten postoperative bowel function recovery.

Objective To evaluate the value of the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and P-POSSUM in predicting the risks of orthopedic surgeries for senile patients with femoral neck fracture.Methods A total of 108 patients with femoral neck fractures who underwent hip joint replacement were retrospectively studied using POSSUM and P-POSSUM scoring system to predict their mortality and complication rate.The difference between predictive value and observed value was analyzed by chi-square test.Meanwhile,the patients were divided into two groups based on their POSSUM scores.The differences between two groups were analyzed.Results According to POSSUM scores,47 patients were predicted to have complications(the mean rate was 43.52％),but only 37 did actually (the rate was 34.26％).There was no significant difference between predicted values and observed values (P =0.238).The predicted death toll was 11 cases (the mean rate was 10.19％),but actually only 2 patients died (the rate was 1.85％).Predicted value was higher than observed value.In terms of complications,death toll agreed well with the predicted values calculated by P-POSSUM (predicted death of 4 cases' the mean mortality being 3.70％ ; actual death of 2 cases' the mortality was 1.85％) without significant difference (P =0.625).We divided the patients into two groups with the POSSUM scores 40,and there was no significant difference between predicted values and observed values (P =0.527,P =0.285).Conclusions POSSUM has better predictive ability of morbidity,but overestimates mortality.P-POSSUM more accurately predicts mortality than POSSUM.The predicted results of POSSUM and P-POSSUM scoring systems are satisfactory in the high risk group.

Objective To investigate the feasibility of mono-segment pedicle instrumentation (MSPI)in management of thoracolumbar fracture (AO classification,A1 and A3) by being compared with short-segment(two-segment) pedicle instrumentation(SSPI).Methods Overall 141 patients with tape A1 or A3 thoracolumbar fractures,aged from 20 to 60 years (average,40.5 years),were enrolled in this prospective study.According to a simple randomized method,35 patients with type A1 fracture and 41 patients with type A3fracture were treated with MSPI,while 26 with type A1 fracture and 39 with type A3 fracture were treated with SSPI.Low back outcome score (LBOS) and ASIA2000 were used to evaluate clinical outcome.Eighteenth month postoperatively was assigned as the last follow up period.Wedge index (WI) and sagittal index (SI) of the affected vertebrae on radiography were measured and compared preoperatively,one week postoperatively and at the final follow-up.Results All patients were followed up successfully.The blood loss and duration of operation of MSPI group were significantly less than that of SSPI group,respectively.However,there were no significant differences of clinical outcome between two groups.For type A1 fracture,correction rate and correction loss of WI in MSPI group were better than those in SSPI group.For type A3 fracture,there were no significant differences of correction rate and correction loss of WI and SI between MSPI group and SSPI group; however,the failure rate of MSPI group was significantly higher than that of SSPI group.Conclusion For type A1 and partial type A3 thoracolumbar fractures,MSPI can provide the same or better fixation with less blood loss and operative duration than SSPI.Since MSPI for type A3.2 thoracolumbar fracture has a higher failure rate,the surgical indication should be strictly controlled.