Objective:To explore the risk factors of quality of life(QoL)being below normal levels in patients undergo-ing total knee arthroplasty(TKA)at 6 months after surgery,and to construct a nomogram prediction model.Method:Two-hundred and sixty-seven patients who underwent TKA at Qingdao Hospital,University of Health and Rehabilitation Sciences(Qingdao Municipal Hospital)from April 2021 to October 2022 were selected.Clini-cal data were collected on admission and within 6 months after surgery.According to the QoL assessment at 6 months after surgery,they were divided into a high-quality group(n=136)and a non-high-quality group(n=131).LASSO regression was used to screen the predictors,and multivariate Logistic regression was established to construct the predictive model of QoL of TKA patients at 6 months after surgery.Receiver operating character-istic curve(ROC curve),calibration curve and decision curve were drawn to evaluate its predictive value.Result:A total of 131(49.06%)patients had lower QoL than normal 6 months after TKA.LASSO regression selected age,surgical side,education level,duration of knee osteoarthritis(KOA),perioperative recovery,and visual analog scale(VAS)during preoperative rest as predictors.Multivariate logistic regression analysis showed that age(OR,1.08;95%CI,1.01-1.15),duration of KOA(OR,1.13;95%CI,1.05-1.22),VAS during preoperative rest(OR,1.94;95%CI,1.20-3.15),and perioperative rehabilitation(OR,0.42;95%CI,0.18-0.97)were independent risk factors for lower than normal QoL in TKA patients at 6 months after surgery(P<0.05).Statistically significant indicators in multivariate logistic regression analysis were includ-ed in the nomogram model,which underwent internal validation.The area under the ROC curve was 0.829(95%CI,0.779-0.879),indicating good predictive ability of the model.The calibration curve showed good consistency between the predicted probability and the actual probability.The decision curve analysis showed that this model is clinically applicable.Conclusion:Age,duration of KOA,VAS during preoperative rest,and perioperative rehabilitation are indepen-dent predictors of lower-than-normal QoL in TKA patients at 6 months after surgery,and the nomogram mod-el based on the above indicators had good predictive performance.

Objective:To explore the risk factors of quality of life(QoL)being below normal levels in patients undergo-ing total knee arthroplasty(TKA)at 6 months after surgery,and to construct a nomogram prediction model.Method:Two-hundred and sixty-seven patients who underwent TKA at Qingdao Hospital,University of Health and Rehabilitation Sciences(Qingdao Municipal Hospital)from April 2021 to October 2022 were selected.Clini-cal data were collected on admission and within 6 months after surgery.According to the QoL assessment at 6 months after surgery,they were divided into a high-quality group(n=136)and a non-high-quality group(n=131).LASSO regression was used to screen the predictors,and multivariate Logistic regression was established to construct the predictive model of QoL of TKA patients at 6 months after surgery.Receiver operating character-istic curve(ROC curve),calibration curve and decision curve were drawn to evaluate its predictive value.Result:A total of 131(49.06%)patients had lower QoL than normal 6 months after TKA.LASSO regression selected age,surgical side,education level,duration of knee osteoarthritis(KOA),perioperative recovery,and visual analog scale(VAS)during preoperative rest as predictors.Multivariate logistic regression analysis showed that age(OR,1.08;95%CI,1.01-1.15),duration of KOA(OR,1.13;95%CI,1.05-1.22),VAS during preoperative rest(OR,1.94;95%CI,1.20-3.15),and perioperative rehabilitation(OR,0.42;95%CI,0.18-0.97)were independent risk factors for lower than normal QoL in TKA patients at 6 months after surgery(P<0.05).Statistically significant indicators in multivariate logistic regression analysis were includ-ed in the nomogram model,which underwent internal validation.The area under the ROC curve was 0.829(95%CI,0.779-0.879),indicating good predictive ability of the model.The calibration curve showed good consistency between the predicted probability and the actual probability.The decision curve analysis showed that this model is clinically applicable.Conclusion:Age,duration of KOA,VAS during preoperative rest,and perioperative rehabilitation are indepen-dent predictors of lower-than-normal QoL in TKA patients at 6 months after surgery,and the nomogram mod-el based on the above indicators had good predictive performance.

Objective To introduce the detailed surgical procedure of parachute-like-suture double-pouch pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy (LPD),and to study its clinical results.Methods A retrospective study was conducted on 31 patients who underwent parachute-like-suture double-pouch pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy between January 2016 and June 2018 in our department.Results Of 31 patients who underwent total laparoscopic pancreaticoduodenectomy,5 patients underwent two-dimensional (2D) LPD and 26 underwent three-dimensional (3D) LPD.Total mesopancreas excision (TMpE) was performed in 12 patients,including 2 patients combined with PV-SMV segmental resection and reconstruction.The mean operative duration,and mean estimated blood loss,post-operative hospital stay were 412.8 ± 102.4 min,462.8 ± 396.7 ml,14.7 ± 8.9 d,respectively.The operating time of parachute-like-suture double-pouch pancreaticojejunostomy was 29.7 ± 6.8 min (20 ～45 min).Post-operative complications occurred in 8 patients (25.8％),3 of whom suffered from more than two types of complications.There were 2 patients (6.5％) with postoperative B/C grade pancreatic fistula,4 patients with postoperative biliary leakage (12.9％),3 patients with delayed gastric emptying (9.7％),1 patient with portal vein thrombosis (3.2％) and 1 patient with peritoneal effusion (3.2％).One patient died during perioperative period due to gastrointestinal hemorrhage.Conclusions Parachute-like-suture double-pouch pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy was a simple,convenient,reliable method.It is worthy of clinical promotion and further studied.

Objective To review our experience in laparoscopic pancreaticoduodenectomy combined with major vascular resection and reconstruction.Methods Of 183 patients who underwent laparoscopic pancreaticoduodenectomy in our department from November 2013 to January 2017,major vascular resection and reconstruction using the SMA first approach for total mesopancreas excision was performed in 7 patients.The clinical data of these 7 patients were retrospectively analyzed.Results Total 3D laparoscopic surgery was performed in all these 7 patients.The mean operation time,mean blood loss and blood flow occlusion time were (551.4 ± 83.8) min,(671.3 ± 256.3) ml and (45.8 ± 6.7) min,respectively.Six out of 7 patients were pathologically diagnosed to have pancreatic adenocarcinoma with negative surgical margins.Two patients had lymphatic metastasis (the number of metastatic lymph node was 1 in each patient).The mean number of lymph nodes resected was (12.7 ± 5.8).The portal vein-superior mesenteric vein (PV-SMV) was segmentally resected and reconstructed using an end to end anastomosis following the preoperative plan in 4 patients.These included 2 patients who underwent total pancreatectomy.The portal vein was wedge-resected and reconstructed by venorrhaphy in 2 patients.The remaining 1 patient was histopathologically diagnosed to have a mass-type chronic pancreatitis.Only 1 patient was treated in the ICU for 1 day after surgery.Post-operative complications occurred in 2 patients and they were managed with nonsurgical treatment (PV-SMV thrombosis and gastric emptying disorder in 1 and a pancreatic leakage (level A) in 1).The mean length of post-operative hospital stay was (13.7 ± 3.2) days with no in-hospital mortality.Seven patients were alive by April 2017.The mean follow-up for the 6 patients with pancreatic adenocarcinoma was 4.5 (3.5 ～9) months.Conclusions Based on our experience in skillful and masterly major vascular resection and reconstruction in open surgery and on our experience in standard laparoscopic pancreaticoduodenectomy,laparoscopic pancreatieoduodenectomy combined with major vascular resection and reconstruction was feasible and safe.This surgery requires very mature skills in laparoscopic surgery.