Objective:To develop and verify a predictive model for hip fracture risk in the aged patients with knee osteoarthritis (KOA) on the basis of analysis of the risk factors associated with the hip fracture.Methods:A retrospective study was conducted to analyze the 701 patients who had been diagnosed with KOA (Kellgren-Lawrence grades 1 to 4) at Dongyang Hospital affiliated to Wenzhou Medical University from September 2013 to September 2023. The cohort consisted of 275 males and 426 females with an age of (76.5±8.4) years. The patients were divided into a fracture group ( n=145) and a fracture-free group ( n=556) based on whether a hip fracture occurred during the follow-up period. The 2 groups were compared in terms of age, gender, comorbidities, albumin level, absolute lymphocyte count, and Kellgren-Lawrence grade, etc. The items with P<0.05 were analyzed by a multivariate logistic regression model to identify the risk factors for hip fracture in the aged KOA patients. A clinical prediction model based on the above risk factors was constructed and validated for hip fracture risk in the aged KOA patients. Results:Multivariate logistic regression analysis identified the following as independent risk factors for hip fracture in the aged KOA patients: female ( OR=2.009, 95% CI: 1.280 to 3.154, P=0.002), age ≥75 years ( OR=2.313, 95% CI: 1.493 to 3.583, P=0.001), Kellgren-Lawrence grades of 3-4 ( OR=2.348, 95% CI: 1.533 to 3.596, P=0.001), an albumin level <35 g/L ( OR=0.316, 95% CI: 0.191 to 0.522, P=0.001), and an absolute lymphocyte count <0.8×10 9/L ( OR=0.133, 95% CI: 0.069 to 0.253, P=0.001). The area under the ROC curve (AUC) for the model developed by this study was 0.753 in the training set and 0.815 in the validation set ( P<0.05). The Hosmer-Lemeshow goodness-of-fit test showed that the consistency between the predicted risk and the actual risk was good in the training and validation sets ( P<0.05). The calibration curves for both the training and validation sets closely aligned with the ideal curve. The clinical decision curve analysis showed that the nomogram model had a good net benefit rate and a good predictive potential. Conclusions:Female, age ≥75 years, Kellgren-Lawrence grades of 3-4, an albumin level <35 g/L, and an absolute lymphocyte count <0.8×10 9/L are independent risk factors for hip fracture in the aged KOA patients. Since the nomogram prediction model based on these risk factors is satisfactory in discrimination and calibration, it shows a certain predictive ability and application value in clinic.

Objective:To develop and verify a predictive model for hip fracture risk in the aged patients with knee osteoarthritis (KOA) on the basis of analysis of the risk factors associated with the hip fracture.Methods:A retrospective study was conducted to analyze the 701 patients who had been diagnosed with KOA (Kellgren-Lawrence grades 1 to 4) at Dongyang Hospital affiliated to Wenzhou Medical University from September 2013 to September 2023. The cohort consisted of 275 males and 426 females with an age of (76.5±8.4) years. The patients were divided into a fracture group ( n=145) and a fracture-free group ( n=556) based on whether a hip fracture occurred during the follow-up period. The 2 groups were compared in terms of age, gender, comorbidities, albumin level, absolute lymphocyte count, and Kellgren-Lawrence grade, etc. The items with P<0.05 were analyzed by a multivariate logistic regression model to identify the risk factors for hip fracture in the aged KOA patients. A clinical prediction model based on the above risk factors was constructed and validated for hip fracture risk in the aged KOA patients. Results:Multivariate logistic regression analysis identified the following as independent risk factors for hip fracture in the aged KOA patients: female ( OR=2.009, 95% CI: 1.280 to 3.154, P=0.002), age ≥75 years ( OR=2.313, 95% CI: 1.493 to 3.583, P=0.001), Kellgren-Lawrence grades of 3-4 ( OR=2.348, 95% CI: 1.533 to 3.596, P=0.001), an albumin level <35 g/L ( OR=0.316, 95% CI: 0.191 to 0.522, P=0.001), and an absolute lymphocyte count <0.8×10 9/L ( OR=0.133, 95% CI: 0.069 to 0.253, P=0.001). The area under the ROC curve (AUC) for the model developed by this study was 0.753 in the training set and 0.815 in the validation set ( P<0.05). The Hosmer-Lemeshow goodness-of-fit test showed that the consistency between the predicted risk and the actual risk was good in the training and validation sets ( P<0.05). The calibration curves for both the training and validation sets closely aligned with the ideal curve. The clinical decision curve analysis showed that the nomogram model had a good net benefit rate and a good predictive potential. Conclusions:Female, age ≥75 years, Kellgren-Lawrence grades of 3-4, an albumin level <35 g/L, and an absolute lymphocyte count <0.8×10 9/L are independent risk factors for hip fracture in the aged KOA patients. Since the nomogram prediction model based on these risk factors is satisfactory in discrimination and calibration, it shows a certain predictive ability and application value in clinic.

In recent years, the incidence of adenocarcinoma of esophagogastric junction (AEG) keeps increasing. Siewert type II and type III AEG invades at 2-4 cm in the lower esophagus, and it has a higher rate of lower mediastinal lymph node metastasis. Lower mediastinal lymph node clearing through the abdomino-transhiatal (TH) approach is preferred, which can be accomplished by entering the lower mediastinum through the hiatus and mobilize the esophagus upward and the surrounding lymph and connective tissue for approximately 6.5 cm. Using the infracardiac bursa (IBC) as an anatomical landmark improves the safety and operability of the thorough dissection of the lower mediastinum. Total resection of the mesenterium at the esophagogastric junction can entirely dissect the lower mediastinal lymph nodes, which conforms to the safety principles in oncology.

In recent years, the incidence of adenocarcinoma of esophagogastric junction (AEG) keeps increasing. Siewert type II and type III AEG invades at 2?4 cm in the lower esophagus, and it has a higher rate of lower mediastinal lymph node metastasis. Lower mediastinal lymph node clearing through the abdomino?transhiatal (TH) approach is preferred, which can be accomplished by entering the lower mediastinum through the hiatus and mobilize the esophagus upward and the surrounding lymph and connective tissue for approximately 6.5 cm. Using the infracardiac bursa (IBC) as an anatomical landmark improves the safety and operability of the thorough dissection of the lower mediastinum. Total resection of the mesenterium at the esophagogastric junction can entirely dissect the lower mediastinal lymph nodes, which conforms to the safety principles in oncology.

In recent years, the incidence of adenocarcinoma of esophagogastric junction (AEG) keeps increasing. Siewert type II and type III AEG invades at 2?4 cm in the lower esophagus, and it has a higher rate of lower mediastinal lymph node metastasis. Lower mediastinal lymph node clearing through the abdomino?transhiatal (TH) approach is preferred, which can be accomplished by entering the lower mediastinum through the hiatus and mobilize the esophagus upward and the surrounding lymph and connective tissue for approximately 6.5 cm. Using the infracardiac bursa (IBC) as an anatomical landmark improves the safety and operability of the thorough dissection of the lower mediastinum. Total resection of the mesenterium at the esophagogastric junction can entirely dissect the lower mediastinal lymph nodes, which conforms to the safety principles in oncology.

OBJECTIVE[corrected] To evaluate the method and technique of single-port laparoscopic radical nephrectomy.

METHODSForm January 2009 to September 2011, 22 patients with renal carcinoma were treated with single-port laparoscopic radical nephrectomy. An incision about 5 cm in length was made through the umbilicus or in the postaxillary line under the 12th rib to establish the peritoneal or retroperitoneal working space. A single-port cannulation was deployed and the operation was carried out using standard and crooked laparoscopic equipment.

RESULTSThe operations were completed successfully in all the 22 cases without conversion to open surgery, but additional trocar was needed in 5 cases. The mean operative time of radical nephrectomy was 150 min (90-240 min). The mean postoperative hospital stay was 7.6 days (3-15 days). The operation left a roughly 5-cm-long scar in all the cases.

CONCLUSIONSingle-port laparoscopic radical nephrectomy is safe and feasible with good cosmetic effect and shows much potential in radical resection of renal carcinoma.

Adult ; Aged ; Female ; Humans ; Kidney Neoplasms ; surgery ; Laparoscopy ; methods ; Male ; Middle Aged ; Nephrectomy ; methods ; Young Adult

Objective To evaluate the efficacy of low-dose and long-term clarithromycin in treatment of chronic rhinosinusitis with positive bacterial biofilms.Methods Seventy-seven patients with chronic rhinosinusitis and positive bacterial biofilms underwent functional endoscopic sinusitis surgery between January 2008 and December 2009 in department of otolaryngology of Jinhua Central Hospital.Fortytwo patients were treated with clarithromycin 250 mg/d orally for at least 3 months (trial group).At the end of 3 months patients received endoscopic examination,for patients with mucosal epithelialization the clarithromycin therapy was stopped; for those with mucosal edema,granulation or polyoid formations the clarithromycin treatment was continued,but no longer than 5 months.Thirty-five patients in control group were not given clarithromycin.All patients were assessed by visual analogue scale (VAS) and nasal endoscopic examination (Lund-kennedy score) 6 months after surgery,the results were compared between two groups.Results Two patients in the trial group did not complete the protocol.VAS score and Lundkennedy score in trial group were 8.0 ± 0.8 and 3.6 ± 1.3 at 6 month after surgery respectively,while those in the control group were 7.3 ± 0.7 and 4.5 ± 1.7,and the differences were of statistical significance (t =5.311 and-3.187,P ＜ 0.01).Conclusion Low-dose and long-term oral administration of clarithromycin has positive impact on the prognosis of bacterial biofilms positive patients with chronic rhinosinusitis.

Objective To observe the bacterial biofilm in patients with chronic rhinosinusitis (CRS), and to investigate the possible relationship between biofilm and clinical factors. MethodsSixtynine patients with CRS ( study group), 15 patients with nasal septum deviation and 10 patients with nasal bone fracture (control group) were enrolled in the study. Mucosa specimens of uncinate process or ethmoid near the ostium of the maxillary sinus were obtained during endoscopic sinus surgery. The specimens were subjected to scanning electron microscopy. All patients were evaluated by questionnaire of chnical factors based on sino-nasal outcome test-20. SPSS 10. 0 was used for statistical analysis, and the relationship between bacterial biofilm and clinical factors was evaluated by Chi-square test. ResultsBacterial biofilms were found in 49 patients ( 71.0％ ) with CRS. A marked destruction of the epithelium and cilia was observed in all samples of study group. No bacterial biofilm was found in the control group, and scanning electron microscopy showed normal epithelium and cilia in those specimens. Chi-square test showed that bacterial biofilm was not associated with clinical factors (gender, staging, course, nasal obstruction, phlegm, nasal discharge with stinking smell, headache, bloody nasal discharge and olfactory degeneration) in CRS. ConclusionsBacterial biofilms and destruction of the epithelium and cilia can be obscrved in CRS patients, which may be involved in the pathogenesis of CRS, but the formation of bacterial biofilm is not correlated with the clinical factors in CRS.

Objective To discuss the feasibility of percutaneous nephrolithotomy (PCNL) for treating upper urinary calculi under local anesthesia.Methods One thousand three hundred and sixty-three patients who suffered with upper urinary calculi were treated with PCNL, the puncture and tracts were created using local anesthesia and guided through ultrasound.Of the 1363 patients, 475 patients had complicated renal caluli, 520 patients had kidney pelvic calculi and 368 had upper uretere calculi.Results All of the patients successfully received PCNL under the local anesthesia.Of the 1363 patients five tracts were used in two patients, four tracts were used in four patients, three tracts were used in nine patients, double tracts were used in 25 patents and one tract was used in the remaining patients.The stone-free rate was 96.0% in the kidney pelvic calculi patients, 100.0% in the upper uretere calculi patients, and 90.1% in the complicated renal caluli patients.90.0% patients were find well throught the operation, 10.0% patients find a little pain and solved by another more 5 - 10 ml lidocaine local injection or 50 - 75 mg pethidine hydrochloride intramuscular injection.No case stop operation because of pain or position changed.All without any severe complications such as damaged of liver, spleen, thorax and intestine.Conclusion The PCNL handled under local anesthesia was simple safe and effective, deserved clinical popularizing use.

Objective To develop a rapid detection method of flow cytometry for antifungal susceptibility testing.Methods The experiment conditions of flow cytometry were optimized and the minimum inhibitory concentrations (M1Cs) of 230 strains of Candida spp to flucytosin,fluconazol,itraconazole,amphotericin B were detected.The MIC results obtained by flow cytometry were compared with M27-A2 reference assay.Results The agreement of MIC results between flow cytometry and M27-A2method was 85.0％ - 100％.Conclusion Flow cytometry can be used as a rapid and reliable method for antifungal susceptibility testing.