Objective To evaluate the clinical outcome of kidney transplantation from donation after brain death(DBD)donors complicated with acute kidney injury(AKI).Methods Clinical data of 216 DBD donors were retrospectively analyzed,and they were divided into the AKI group(n=69)and control group(n=147)according to the Kidney Disease:Improving Global Outcomes(KDIGO)guidelines.Donors in the AKI group were further divided into the KDIGO stage 1 and stage 2-3 subgroups.One hundred and thirty-five recipients were assigned into the AKI group and 288 recipients in the control group.Postoperative recovery of renal function and clinical outcomes of the recipients were recorded.The risk factors of delayed graft function(DGF)were identified.Results The highest serum creatinine(Scr)level,Scr level before procurement,the highest blood sodium level and blood sodium level before procurement in the AKI group were higher than those in the control group.The application duration of vasopressors in the AKI group was longer than that in the control group.In the AKI group,the amount of fluid resuscitation within 48 h was higher,the HCO3-level at admission was lower,and the incidence of diabetes insipidus and hypotension was higher than those in the control group.The highest Scr level and the Scr level before procurement in KDIGO stage 2-3 donors were significantly higher than those in KDIGO stage 1 counterparts(all P＜0.05).Compared with the control group,the incidence of DGF and acute rejection was higher,the proportion of continuous renal replacement therapy was higher,the Scr level within postoperative 90 d was higher,and the urine amount within postoperative 3 d was less than those of recipients in the AKI group.Compared with KDIGO stage 1 recipients,KDIGO stage 2-3 recipients had higher Scr levels at postoperative 3,4,5 and 15 d,and less urine amount at postoperative 2 d(all P＜0.05).Univariate analysis showed that donor age,the highest Scr level,the highest blood sodium level and the amount of fluid resuscitation within 48 h were the risk factors for DGF in recipients after kidney transplantation.Multivariate analysis showed that donor age was the independent risk factor for DGF in recipients after kidney transplantation(all P＜0.05).Conclusions For the application of DBD donors complicated with AKI,active organ maintenance should be performed to alleviate AKI.It exerts no effect upon graft function and survival rate at postoperative 6 months,which may achieve equivalent efficacy as non-AKI donors and may be used as a source of extended criteria donor kidneys.

Objective:To investigate the safety and efficacy of a combined anterior and posterior approach in total hip arthroplasty (THA) for fused/ankylosed hip.Methods:37 patients who underwent THA for fused/ankylosed hip from January 2015 to December 2020 were retrospectively analyzed, including 28 males and 9 females, with an average age of 47.9±12.0 years (range, 26-72 years). Etiologies included 23 cases of ankylosing spondylitis, 9 cases of infectious arthritis of the hip in youth, and 5 cases of traumatic arthritis after acetabulum or femoral neck fracture. All patients underwent THA with combined anterior and posterior approach. These factors include operation time, blood loss, amount of transfused blood, blood transfusion rate, preoperative and postoperative Harris score, postoperative range of motion of the hip, and perioperative complications, etc. were evaluated. Postoperative radiography of the hip was performed to evaluate acetabular abduction angle, anterior inclination angle, the prosthesis fixation, osteolysis and heterotopic ossification around the hip.Results:A total of 37 patients were enrolled. The mean operative time was 147.6±16.8 min (range, 129-190 min); the mean estimated blood loss (EBL) was 850.0±10.8 ml (range, 600-1,200 ml); the blood transfusion rate was 59% (22/37), and the mean blood transfusion was 420±45.0 ml (range, 0-800 ml). All patients were followed up for 4.2±0.9 years (range, 1.2-7.2 years). The average abductor angle of the acetabular was 43.7°±5.4° (range, 31°-55°), and the average inclination angle was 20.9°±6.7° (range, 10°-35°); the preoperative Harris score was 47.1±9.9 (range, 40-55) and the mean Harris score at the last follow-up was 83.4±12.4 (range, 75-90). The preoperative range of motion of the hip in all directions was 0°. Postoperative hip range of motion was good, with a mean hip flexion of 95.5°±12.2° (range, 80°-110°), mean extension of 10.5°±3.4° (range, -10°-25°), and mean abduction of 38.0°±8.2° (range, 10°-50°). Postoperative complications were minor, including 2 case with poor wound healing, 2 cases with paresthesia or tingling sensation in the anterior or anterolateral thigh, which returned to normal within 3 months after surgery, and no deep infection or dislocation occurred. The acetabular cup was in poor position in 2 cases and the femoral stem was varus in 1 case, but the prosthesis was stable and no treatment was needed. All the acetabular cups and femur stems were confirmed with bone ingrowth on the last follow-up radiographs, and one patient had heterotopic ossification (Brooker grade 1). No osteolysis or wear of the acetabular liner was observed.Conclusion:Combined anterior and posterior approach (Gibson posterolateral approach + modified Hardinge approach) in THA for fusion/ankylosed hip can fully expose the operative field and sufficiently release the soft tissue, and the function of hip recovered well postopratively.

Objective:To evaluate the efficacy and safety of non-osteotomy total hip arthroplasty (THA) in the treatment of Crowe IV developmental dysplasia of the hip (DDH).Methods:From Jan 2013 to Sep 2021, 46 patients (46 hips) in our department who underwent total hip arthroplasty without osteotomy for unilateral Crowe IV DDH were retrospectively analyzed, including 6 males and 40 females, with an average age of 41.2±7.2 years (25-61 years). The reduction of the femoral head was achieved successfully through moderate upward-posterior displacement of the movement center, gradual osteotomy of the calcar femorale, proper sinking of the femoral prosthesis and sufficient soft tissue release. The evaluation indexes included the basic condition of the operation (operation time, blood loss, blood transfusion, volume), clinical evaluation (Harris score of hip joint function, patient satisfaction, Trendelenburg sign), imaging evaluation (measurement of limb length and pelvic inclination) and incidence of complications.Results:The mean follow-up time was 72.2±8.8 months (8-101 months). The operation time was 97.2±12 min (84-112 min). The average intraoperative bleeding volume was 550±60 ml (350-850 ml). No patient had periprosthetic infection or fracture, no periprosthetic osteolysis or prosthesis loosening, and no patient needed revision surgery at the last follow-up of all cases. The average HHS score of patients increased from 42.5±12.3 points before surgery to 89.2±10.8 points at the last follow-up, and the difference was statistically significant ( t=19.35, P<0.001). Patient self-rated satisfaction: none was very dissatisfied, 1 patient were less satisfied (2%, 1/46), 4 patients were average (9%, 4/46), 19 patients were relatively satisfied (41%, 19/46), and 22 patients were very satisfied (48%, 22/46). The Trendelenburg sign of 46 cases was positive before operation, and all were negative at the last follow-up. The patients' true leg length discrepancy (LLD) measurement was -2.5±0.6 mm before surgery and 11.5±3.2 mm at the last follow-up ( t=29.17, P<0.05). Patients' perceived LLD was 28.2±5.1 mm before surgery and 3.4±1.4 mm at the last follow-up ( t=32.18, P<0.05). The length of the residual calcar femorale was 3.2±0.4 mm after THA. The limb extended distance of affected limb was 45.2±4.6 mm. The preoperative iliolumbar angle was -6.5°±2.3°, which returned to -0.5°±1.3° at the last follow-up ( F=651.97, P<0.05). Conclusion:For patients with unilateral type IV DDH, non-osteotomy THA is a safe and effective surgical method with simple operation and few complications. It can quickly correct pelvic tilt and lumbar compensatory scoliosis postoperatively.

Objective:To explore the impact of a modified blood management strategy on blood loss and transfusion rates during outpatient total hip arthroplasty(THA).Methods:The retrospective research was performed in a total of 125 patients (125 hips) who underwent outpatient primary THA from January 2019 to December 2021 at a medical center. According to whether a modified blood management protocol was used or not, all patients were divided into two groups. Group A was used the original perioperative blood management strategies (1 g tranexamic acid, intravenously, 10 minutes before skin incision), and group B was used the modified perioperative blood management strategy (on the basis of the original protocol, 2 g tranexamic acid was sprayed locally in the joint cavity before the incision was closed, 1 g tranexamic acid was injected intravenously 3 hours after surgery, and 1 g tranexamic acid was injected intravenously again on the first day after surgery). There were 52 cases in group A, including 32 males and 20 females, aged 58.5±9.8 years (range, 39-69 years), 13 cases were developmental hip dysplasia (Crowe I°-II°), 24 cases were avascular necrosis of the femoral head, 10 cases were hip osteoarthritis, 3 cases were ankylosing spondylitis involving hip joint, and 2 cases were femoral neck fracture. Among the 73 patients in group B, there were 43 males and 30 females, aged 55.8±10.4 years (range, 42-67 years), including 17 cases of developmental hip dysplasia (Crowe I°-II°), 32 cases of avascular necrosis of the femoral head, 16 cases of hip osteoarthritis, 7 cases of ankylosing spondylitis involving hip joint, and 1 case of femoral neck fracture. Intraoperative blood loss, transfusion, deep vein thrombosis (DVT) events (vascular ultrasound, 2w Postop.), the hemoglobin (Hb) drop, the hematocrit (Hct) drop and other complications were recorded.Results:After using the modified strategy, the intraoperative blood loss was significantly reduced (305.6±38.6 ml vs. 416.2±88.3 ml, t=9.51, P<0.001), and the drop of hemoglobin was significantly decreased (18.1±4.0 g/L vs. 22.3±5.8 g/L, t=4.97, P<0.001). The drop of Hct also decreased significantly (7.3%±0.7% vs. 9.6%±1.3%, t=10.21, P<0.001), and total blood loss decreased significantly (720.6±57.4 ml vs. 919.6±86.3 ml, t=15.49, P<0.001). The hidden blood loss was also significantly lower than that in group A (414.9±71.1 ml vs. 503.5±96.4 ml, t=5.91, P<0.001). One patient (in group A) developed intra-articular hemorrhage 2 h after surgery and was transferred back to the inpatient ward for treatment after transfusion. Three patients (2.4%, 1 in group A and 2 in group B) developed symptomatic anemia and were discharged successfully after conservative treatment. Calf muscular venous thrombosis occurred in 3 patients (2.4%), but no symptomatic deep vein thrombosis occurred in all patients. Conclusion:According to this retrospective research, the use of modified blood management strategy during outpatient THA can further reduce intraoperative blood loss, hidden blood loss and postoperative hematocrit drop, and does not increase the occurrence of perioperative thrombosis-related complications.

Objective:To analyze the sensitivity and specificity of SARS-CoV-2 nucleic acid testing in 20 348 close contacts of COVID-19 cases in different prevention and control stages in Guangzhou and to provide scientific evidence for optimizing epidemic response strategies.Methods:A total of 20 348 close contacts of COVID-19 cases in Guangzhou were traced between February 21 and September 22,2020. All the close contacts were tested for the nucleic acid of SARS-CoV-2. The sensitivity and specificity of nucleic acid testing and diagnosis in the different prevention and control stages were compared.Results:In 20 348 close contacts, 12 462 were males (61.24%), the median ( P 25, P 75) of age of them was 31.0 years (23.0,43.0), the median number ( P 25, P 75) of nucleic acid testing for them was 2.0 (1.0,3.0), and the median ( P 25, P 75) of their quarantine days was 12.0 (8.0,13.0) days, respectively. A total of 256 COVID-19 cases were confirmed in the close contacts after seven nucleic acid tests. In the 1 st, 2 nd, 3 rd and 7 th nucleic acid testing, the sensitivity and specificity were 69.14% and 99.99% (177 cases confirmed), 89.84% and 99.99% (230 cases confirmed), 97.27% and 99.99% (249 cases confirmed), and 100.00% and 99.98%, respectively. In the three stages of COVID-19 prevention and control in China: domestic case stage, imported case stage, and imported case associated local epidemic stage, the sensitivity of the 1 st nucleic acid testing was 70.68%, 68.00% and 67.35%, and the specificity was 99.98%, 100.00% and 100.00%, respectively. Conclusions:The sensitivity of nucleic acid testing in the close contacts at the different stages were consistent with slight decrease, which might be related to the increased proportion of asymptomatic infections in the late stage of epidemic prevention and control with COVID-19 in Guangzhou. It is suggested to give three nucleic acid tests to improve the sensitivity and reduce false negative risk.

Objective:To explore the association between resting heart rate(RHR) and all-cause mortality among the Chinese oldest-old aged more than 80.Methods:Using a total of seven surveys or follow-ups data (1998, 2000, 2002, 2005, 2008, 2011 and 2014) from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). A total of 17 886 elderly over 80 years old were selected as subjects, their resting heart rate were measured though baseline survey and the survival outcome and death time of the subjects were followed up. The subjects were divided into 6 groups according to their resting heart rate. Cox regression model was used to estimate the effect of resting heart rate on mortality risk. The interaction of age, gender and resting heart rate was also analyzed by likelihood ratio test.Results:The age of subjects M( P25, P75) was 92 (86, 100) years old, including 10 531 females (58.9%) and there were 13 598 participants died, the mortality rate was 195.5 per 1 000 person-years. Multivariate Cox regression analysis showed that compared to the control group (60-69 pbm/min), the hazard ratio of the elderly are 1.06 (95% CI: 1.02, 1.11), 1.09 (95% CI: 1.04, 1.15), 1.23 (95% CI: 1.14, 1.34), 1.25 (95% CI: 1.08, 1.44) in the group of RHR between 70-79, 80-89, 90-99 and ≥100 pbm/min and Pvalues are all less than 0.05. Likelihood ratio test showed that RHR and age had an interaction effect. ( P for interaction=0.011). Conclusion:The risk of all-cause death increased with the increase of resting heart rate and this relationship was stronger between the 80-89 years old people.

Objective:To explore the association between resting heart rate(RHR) and all-cause mortality among the Chinese oldest-old aged more than 80.Methods:Using a total of seven surveys or follow-ups data (1998, 2000, 2002, 2005, 2008, 2011 and 2014) from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). A total of 17 886 elderly over 80 years old were selected as subjects, their resting heart rate were measured though baseline survey and the survival outcome and death time of the subjects were followed up. The subjects were divided into 6 groups according to their resting heart rate. Cox regression model was used to estimate the effect of resting heart rate on mortality risk. The interaction of age, gender and resting heart rate was also analyzed by likelihood ratio test.Results:The age of subjects M( P25, P75) was 92 (86, 100) years old, including 10 531 females (58.9%) and there were 13 598 participants died, the mortality rate was 195.5 per 1 000 person-years. Multivariate Cox regression analysis showed that compared to the control group (60-69 pbm/min), the hazard ratio of the elderly are 1.06 (95% CI: 1.02, 1.11), 1.09 (95% CI: 1.04, 1.15), 1.23 (95% CI: 1.14, 1.34), 1.25 (95% CI: 1.08, 1.44) in the group of RHR between 70-79, 80-89, 90-99 and ≥100 pbm/min and Pvalues are all less than 0.05. Likelihood ratio test showed that RHR and age had an interaction effect. ( P for interaction=0.011). Conclusion:The risk of all-cause death increased with the increase of resting heart rate and this relationship was stronger between the 80-89 years old people.

Objective: To evaluate whether hemodialysis before percutaneous renal biopsy (PRB) reduces the risk of bleeding complications in patients with acute kidney injury (AKI). Methods: This study was a cohort observational study. Patients who were diagnosed as AKI and received PRB in Nanfang Hospital of Southern Medical University from January 2015 to December 2018 were included in the study. Patients were divided into preoperative dialysis group and preoperative non-dialysis group according to whether PRB patients received hemodialysis treatment. According to whether perirenal hematoma occurred after the operation, the patients were divided into the groups with and without the perirenal hematoma. The baseline clinical data of AKI stage, hemoglobin, coagulation function and renal pathological changes before PRB, and perirenal hemorrhage complications after operation, including the size of perirenal hematoma within 24 hours, gross hematuria, low back pain, decreased hemoglobin value and interventional treatment (such as interventional surgery, blood transfusion, etc) in the two groups were compared. The logistic regression model was used to analyze the risk factors of perirenal hematoma after PRB. Results: Ninety patients with AKI were enrolled in this study, including 41 in the preoperative dialysis group and 49 in the preoperative non-dialysis group. The proportion of patients AKI with stage 2-3 in the preoperative dialysis group was significantly higher than that in preoperative non-dialysis group (100.0% vs 75.5%, P<0.001). There were no significant differences in coagulation function indexes and platelet counts between the two groups. Renal ultrasound within 24 hours after PRB showed that there were no significant differences in the incidence of postoperative perirenal hematoma (56.1% vs 63.3%, P=0.489), the incidence of postoperative perirenal large size hematoma (≥5 cm, 26.1% vs 22.6%, P=0.766), and the magnitude of the decrease in hemoglobin (3.7% vs 1.2%, P=0.505) between the preoperative dialysis group and the preoperative non-dialysis group. No blood transfusion, arteriovenous fistula, renal vascular intervention or surgery, and no hospital death occurred in the two groups. The renal pathological manifestations of the patients with and without perirenal hematoma were mainly acute tubular necrosis (ATN) and there were no significant differences between the patients with and without perirenal hematoma in indicators such as age, gender, body mass index, diabetes percentage, hypertension percentage, AKI staging, preoperative dialysis or not, serum creatinine, blood urea nitrogen, hemoglobin, platelet count and renal pathological types. After adjusting for indicators such as preoperative AKI stage and renal pathological changes, logistic regression analysis results showed that perirenal after PRB was not independently correlated with preoperative dialysis (β=0.568, P=0.241); Multivariate logistic regression analysis resluts showed that hematoma (≥5 cm) after PRB was also not independently correlated with preoperative dialysis (β=0.967, P=0.958). Conclusions Preoperative hemodialysis does not reduce the risk of bleeding complications after PRB in patients with AKI. The role of preoperative hemodialysis in reducing the risk of bleeding complications after PRB needs further study and verification.

Introduction: At 11:20 on 26 May 2018, a physician from Lianyungang No. 1 People’s Hospital, China, reported that six family members were being treated in the hospital with symptoms from an unknown cause. Methods: A case series for a food poisoning investigation and an environmental survey were conducted. The patients and their relatives were interviewed in person with a questionnaire contained on a digital tablet, and an investigation of the patients’ home was conducted in the presence of police officers. Probable case and confirmed case were defined to serve as a basis for identifying additional cases. Confirmed cases were defined as those probable cases in which blood, stool or vomitus specimens tested positive for paliperidone palmitate and/or its metabolites. A descriptive analysis was performed. Follow-up by telephone was conducted four months later. Results: There were six probable cases. The median age was 35 years (range: 5–76 years). The attack rate was 100% (n = 6/6) of persons who consumed a family dinner, and the hospitalization rate was also 100% (n = 6/6). The median period between exposure and symptom onset was two hours. The main symptoms included vomiting, nausea, drowsiness, dizziness and severe abdominal pain for adults, and vomiting and severe lethargy for children. An 8-year-old girl further showed changes in the ST segment of her electrocardiogram, and a 5-year-old boy showed QT prolongation. The poisoning substance was suspected to be paliperidone palmitate based on the patients’ symptoms and epidemiological findings. Discussion: We investigated the household food poisoning outbreak through epidemiological analysis and an environmental investigation and determined that it was caused by paliperidone palmitate. The source of the paliperidone palmitate was found to be aluminium containers, taken home by the eldest son who worked at a pharmaceutical company. The containers were sent to a drug disposal centre, and the pharmaceutical company was required to enhance the regulation on the pharmaceutical waste materials to prevent drug poisoning events. By the end of September 2018, the six patients recovered and were released from the hospital, and they did not show any clinical sequelae in four follow-up visits.

Multi-modalities integration is important in improving the outcome of patients with neurovascular diseases.Based on hybrid operation, this mode also integrates modern intraoperative image and monitoring techniques such as neuronavigation and intraoperative electrophysiological monitoring, providing safe, effective and cost-efficient therapies to certain diseases with the cooperation of neurosurgery and neurology department, which has been becoming the direction of modern individualized precise neurosurgery development.