Objective:To evaluate the association between the preoperative aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio and postoperative delirium (POD) in patients undergoing total knee/hip arthroplasty.Methods:In this nested case-control study, medical records from patients, aged ≥55 yr, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, with Mini-Mental State Examination (MMSE) scale score >24 on preoperative day 1, scheduled for elective total knee/hip arthroplasty under combined spinal-epidural anesthesia at Qingdao Municipal Hospital between November 2021 and December 2023, were collected. POD was assessed using the Confusion Assessment Method. Patients were categorized into POD and non-POD groups based on the occurrence of POD. Logistic regression was employed to identify protective and risk factors for POD. The predictive performance of preoperative AST/ALT ratio alone and its combination with cerebrospinal fluid (CSF) biomarker concentrations for POD was evaluated using receiver operating characteristic curves, and the clinical utility of the prediction models was assessed using decision curve analysis. Mediation analysis was conducted to examine the mediation role of CSF biomarkers in the relationship between the preoperative AST/ALT ratio and POD. Restricted cubic splines were used to assess the nonlinear relationship between the preoperative AST/ALT ratio and POD.Results:A total of 460 patients were finally included, with 49 in POD group and 411 in non-POD group. After adjustment for multiple confounding factors including age, sex, educational level, MMSE score, history of hypertension, history of diabetes, history of smoking and history of alcohol use, multivariable logistic regression identified that the higher preoperative AST/ALT ratio, CSF total tau protein (t-tau) and phosphorylated tau protein (p-tau) concentrations were independent risk factors for POD, whereas lower CSF β-amyloid 42 (Aβ 42) concentration, Aβ 42/t-tau ratio and Aβ 42/p-tau ratio served as protective factors ( P<0.05). The area under the receiver operating characteristic curve of the preoperative AST/ALT ratio combined with CSF biomarkers in predicting POD was 0.939 ( P<0.001), demonstrating high clinical efficacy. After adjusting for age, educational level, sex, MMSE score, history of hypertension, history of diabetes, history of smoking, history of alcohol use and body mass index, restricted cubic splines revealed a nonlinear relationship between preoperative AST/ALT levels and the probability of POD, and the probability of POD increased with rising ratios when the preoperative AST/ALT ratio ranged from 1.09 to 1.40 ( Poverall < 0.05, Pnonlinear <0.05). After stratification by sex, the preoperative AST/ALT ratio demonstrated a linear relationship with the probability of POD ( Poverall <0.05, Pnonlinear>0.05). Mediation analysis indicated that the relationship between the preoperative AST/ALT ratio and POD was partially mediated by CSF p-tau concentration (proportion mediated 18.1%), CSF t-tau concentration (proportion mediated 12.0%), and the Aβ 42/t-tau ratio (proportion mediated 15.4%). Conclusions:A higher preoperative AST/ALT ratio is an independent risk factor for POD in total knee/hip arthroplasty patients. The concentrations of CSF t-tau and p-tau and Aβ 42/t-tau ratio have a mediating role in the relationship between the preoperative AST/ALT ratio and POD.

Objective:To evaluate the association between the preoperative aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio and postoperative delirium (POD) in patients undergoing total knee/hip arthroplasty.Methods:In this nested case-control study, medical records from patients, aged ≥55 yr, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, with Mini-Mental State Examination (MMSE) scale score >24 on preoperative day 1, scheduled for elective total knee/hip arthroplasty under combined spinal-epidural anesthesia at Qingdao Municipal Hospital between November 2021 and December 2023, were collected. POD was assessed using the Confusion Assessment Method. Patients were categorized into POD and non-POD groups based on the occurrence of POD. Logistic regression was employed to identify protective and risk factors for POD. The predictive performance of preoperative AST/ALT ratio alone and its combination with cerebrospinal fluid (CSF) biomarker concentrations for POD was evaluated using receiver operating characteristic curves, and the clinical utility of the prediction models was assessed using decision curve analysis. Mediation analysis was conducted to examine the mediation role of CSF biomarkers in the relationship between the preoperative AST/ALT ratio and POD. Restricted cubic splines were used to assess the nonlinear relationship between the preoperative AST/ALT ratio and POD.Results:A total of 460 patients were finally included, with 49 in POD group and 411 in non-POD group. After adjustment for multiple confounding factors including age, sex, educational level, MMSE score, history of hypertension, history of diabetes, history of smoking and history of alcohol use, multivariable logistic regression identified that the higher preoperative AST/ALT ratio, CSF total tau protein (t-tau) and phosphorylated tau protein (p-tau) concentrations were independent risk factors for POD, whereas lower CSF β-amyloid 42 (Aβ 42) concentration, Aβ 42/t-tau ratio and Aβ 42/p-tau ratio served as protective factors ( P<0.05). The area under the receiver operating characteristic curve of the preoperative AST/ALT ratio combined with CSF biomarkers in predicting POD was 0.939 ( P<0.001), demonstrating high clinical efficacy. After adjusting for age, educational level, sex, MMSE score, history of hypertension, history of diabetes, history of smoking, history of alcohol use and body mass index, restricted cubic splines revealed a nonlinear relationship between preoperative AST/ALT levels and the probability of POD, and the probability of POD increased with rising ratios when the preoperative AST/ALT ratio ranged from 1.09 to 1.40 ( Poverall < 0.05, Pnonlinear <0.05). After stratification by sex, the preoperative AST/ALT ratio demonstrated a linear relationship with the probability of POD ( Poverall <0.05, Pnonlinear>0.05). Mediation analysis indicated that the relationship between the preoperative AST/ALT ratio and POD was partially mediated by CSF p-tau concentration (proportion mediated 18.1%), CSF t-tau concentration (proportion mediated 12.0%), and the Aβ 42/t-tau ratio (proportion mediated 15.4%). Conclusions:A higher preoperative AST/ALT ratio is an independent risk factor for POD in total knee/hip arthroplasty patients. The concentrations of CSF t-tau and p-tau and Aβ 42/t-tau ratio have a mediating role in the relationship between the preoperative AST/ALT ratio and POD.

Humans ; East Asian People ; Intellectual Disability/genetics* ; Membrane Transport Proteins/genetics* ; Lectins/genetics*

ObjectiveTo provide targeted, systematic and personalized rehabilitation guidance for orthopedic patients by building a mobile internet platform. MethodsTotally 210 orthopedic admitted in the Department of Orthopedics, Union Hospital of Tongji Medical College of Huazhong University of Science &Technology between June and September 2017 were selected using purposive sampling and divided into the treatment group (n=105) and the control group (n=105) according to the random number table. Patients in the control group received conventional guidance at discharge and telephone or home follow-up visit once every two weeks after discharge, while patients in the treatment group received conventional guidance at discharge and continued rehabilitation guidance via the mobile internet platform after discharge. Activity of daily life (ADL), compliance with continued rehabilitation guidance and patient's satisfaction were compared between the two groups 1 month and 3 months post intervention. ResultsThe ADL of the control group and the treatment group 1 month post intervention scored (66.08±3.01) and (72.00±2.66) respectively; and the ADL of the two groups 3 months post intervention scored (74.23±2.82) and (83.67±1.98) respectively (P＜ 0.05). The compliance and satisfaction were higher in the treatment group than in the control group (P＜ 0.05). ConclusionsPersonalized, targeted and visualized rehabilitation guidance for orthopedic patients via the mobile internet platform improves patient's compliance with rehabilitation exercise as well as their ADL and satisfaction.

Objective To explore the current situation and influencing factors of knowledge-attitude-practice (KAP) on early rehabilitation among elderly patients with fracture so as to provide a reference for improving rehabilitation nursing of fracture. Methods A total of 200 elderly inpatients with fracture at Liyuan Hospital of Tongji Medical College of Huazhong University of Science and Technology were selected by convenience sampling from July 2016 to Feburay 2017. The current situation of KAP of elderly patients with fracture were investigate by the self-designed early rehabilitation KAP questionnaire for fracture patients. The simple correlation and multiple linear regression was used to analyze the influencing factors of rehabilitation among elderly patients with fracture. Results The average score of knowledge, attitude and activity behavior on early rehabilitation of elderly patients with fracture was (62.45±1.32), (85.22±1.09) and (68.90±0.78). Simple correlation showed that there were statistically significant differences in the scores of knowledge, attitude and activity behavior of elderly patients with fracture among different education background, the history of fracture, length of hospital stay and whether they received guidance related to fracture (P<0.05). Multiple linear regression revealed that the independent influencing factor of the score of knowledge,attitude and activity behavior on early rehabilitation of elderly patients was the length of hospital stay, education background and whether they received guidance related to fracture respectively (R2=0.594, 0.229, 0.587). Conclusions Elderly patients with fracture were with the low awareness rate of knowledge on early rehabilitation nursing and the low compliance of self-rehabilitation behavior. Nurses in department of orthopedics should improve the special knowledge and skills on rehabilitation and provide a multilevel and multiform guidance of early rehabilitation by combining with the charactertics of low compliance of elderly patients so as to help elderly patients improve the knowledge level of early rehabilitation and promote early rehabilitation practice.

Objective To assess the left ventricular synchronization and global systolic function in patients with implanted dual-chamber (DDD) mode cardiac pacemakers by real-time three-dimensional echocardiography(RT-3DE). Methods Left ventricular systolic synchronization and global function were evaluated in 20 patients with implanted DDD mode cardiac pacemakers and 20 normal people by RT-3DE. The left ventricular end-diastolic volume (LEDV), end-systolic volume ( LESV), stroke volume (SV), left ventricular ejection fraction (LVEF), the mean value of time from the start of electrocardiographic QRS wave to the point of minimal systolic volume (Tmean) of the 17 segments and those standard deviation(T-SD),the maximal difference of time among all 17 segments(Tmax) were obtained by RT-3DE. Results Compared with control group, LESV was significantly increased,SV, LVEF were significantly decreased and T-SD,Tmax were significantly prolonged (P <0.01 ). There were no differences in LEDV and Tmean between the two groups (P>0.05). In patients group,LVEF correlated closely with T-SD (r =-0.674, P<0.05) and Tmax (r = - 0. 634, P < 0. 05). Conclusions There were left ventrieular systolic asychronization and global systolic dysfunction in patients with implanted dual-chamber (DDD) mode cardiac pacemakers,which could be assessed by RT-3DE.

OBJECTIVETo observe the effect of vertebral manipulation (VM) therapy on vertebro-basilar artery (VBA) blood flow in patients with cervical spondylosis of vertebral artery type (CS-VAT) by transcranial Doppler (TCD) ultrasonic examination.

METHODSOne hundred and fifty patients with CS-VAT were randomized into the VM group (n = 100) and the acupuncture group (n = 50), and treated for ten times as one therapeutic course. Changes of the contraction peak, the end-diastolic and average blood flow velocity of VBA before and after treatment in the two groups were observed and compared by TCD.

RESULTSVp, Vd, Vm of LVA, RVA and BA in the two groups after treatment were all lowered, showing significant difference, excepting Vp of VBA in the acupuncture group, when compared with before treatment (P< 0.05 or P <0.01). Comparison between the two groups after treatment showed significant difference in Vp and Vm of LVA, Vp, Vd and Vm of RVA, Vp and Vm of VBA respectively (P<0.05, P <0.01).

CONCLUSIONVM therapy in treating patients with CS-VAT shows therapeutic effect superior to VA therapy, which could significantly improve VBA blood flow.

Adult ; Aged ; Basilar Artery ; physiopathology ; Blood Flow Velocity ; Cervical Vertebrae ; Female ; Humans ; Male ; Manipulation, Spinal ; methods ; Middle Aged ; Spinal Osteophytosis ; complications ; therapy ; Vertebral Artery ; physiopathology ; Vertebrobasilar Insufficiency ; etiology ; therapy