To evaluate long-term survival and clinical outcomes of patients with knee osteo-arthritis undergoing total knee arthroplasty (TKA) through long-term follow-up.

To analyze the occurrence of early complications after total hip arthroplasty (THA) in patients with systemic lupus erythematosus (SLE).

Objective To explore the relationship between the types of bicuspid aortic valves(BAV)and the outcome of functional mitral regurgitation(FMR)and the affecting factors of FMR.Methods From Jun 2018 to Sep 2022,patients with severe BAV aortic valve stenosis(AS)complicated with FMR underwent post transcatheter aortic valve replacement(TAVR)in Zhongshan Hospital,Fudan University were retrospectively analyzed.The baseline information and imaging data of different BAV patients were collected.Logistic regression was used to analyze the factors affecting the outcome of FMR(improvement and non-improvement).Result A total of 100 patients with TAVR were included,including 49 patients with type 0 of BAV and 51 patients with type 1 of BAV.Compared with patients of type 1,patients of type 0 had younger age[(72.78±6.09)y vs.(77.00±8.35)y,P=0.050],lower male ratio(47%vs.73%,P= 0.009)higher BMI[(23.19±2.62)kg/m2 vs.(21.99±3.13)kg/m2,P=0.041],and lower incidence of aortic regurgitation(69%vs.92%,P=0.040).Compared with the non-improvement group,the improvement group had a lower incidence of coronary heart disease(5%vs.18%,P=0.042),higher incidence of pulmonary hypertension(20%vs.2%,P=0.007),larger left ventricular diastolic diameter[(51.98±6.74)mm vs.(48.04±7.72)mm,P=0.009]and higher maximum flow velocity[(4.86±0.95)cm/s vs.(4.47±0.75)cm/s,P= 0.023]of the aortic valve.The results of Logistic regression analysis showed that preoperative pulmonary hypertension,left ventricular end-diastolic diameter and maximum valvular flow velocity of BAV patients were the potential affecting factors of FMR improvement after TAVR.Conclusion No significant difference was found in FMR improvement between BAV patients of type 0 and type 1 after TAVR.For BAV patients with AS,preoperative pulmonary hypertension,larger left ventricular end-diastolic diameter,and faster aortic valve flow velocity were associated with higher FMR improvement rate.

Objective To compare the early predictive value of different scoring systems for the severity,organ failure and complications of acute pancreatitis(AP)in elderly patients under the newly revised Atlanta criteria.Methods Patients with acute pancreatitis treated was collected.After admission,complete the computed tomography severity index(CTSI),the bedside index of severity in acute pancreatitis(BISAP),the pancreatis 3(PANC-3)and the harmlessness acute pancreatitis score(HAPS).The area under receiver operating characteristic(ROC)curve(AUC),sensitivity,specificity and Yordan's index of four scores for predicting SAP,local pancreatic complications and multiple organ failure were compared.Results The areas under the ROC curve predicted by the CTSI,BISAP,PANC-3 and HAPS scoring systems for SAP were 0.76,0.91,0.48 and 0.55;sensitivities of 75.87％,89.61％,61.18％and 78.38％;specificity of 80.29％,74.72％,67.48％and 69.69％;Yordan's index of 0.56,0.64,0.29 and 0.48,respectively.The AUC of CTSI,BISAP,PANC-3 and HAPS scoring systems for predicting local pancreatic complications were 0.94,0.82,0.59 and 0.64;sensitivity of 74.59％,68.23％,71.11％and 69.28％;specificity of 93.88％,83.01％,78.59％and 76.46％;Yordan's index were 0.68,0.51,0.50 and 0.46,respectively.The AUC of CTSI,BISAP,PANC-3 and HAPS scoring systems for predicting multiple organ failure were 0.60,0.84,0.64 and 0.80,sensitivities were 54.18％,74.82％,58.59％and 65.67％,specificity were 76.11％,77.20％,72.68％and 89.36％,Jordan's indices were 0.30,0.52,0.31 and 0.55,respectively.Conclusion BISAP score is higher than CTSI,HAPS and PANC-3 scoring system in predicting the accuracy of sap and the risk of multiple organ failure.

Objective To investigate the influencing factors for rebleeding and 5-year survival rate after treatment in patients with liver cirrhosis and spontaneous splenorenal shunt(SSRS),and to provide a basis for clinical prognostic assessment.Methods A total of 95 patients with liver cirrhosis and SSRS who were admitted to Zhongshan Hospital and Xiamen Branch of Fudan University from June 2014 to June 2018 were enrolled,and all patients were followed up for at least 5 years.According to the presence or absence of gastrointestinal bleeding during follow-up,the patients were divided into rebleeding group with 27 patients and non-rebleeding group with 68 patients.The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous between two groups,and the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups.Univariate and multivariate Cox regression analyses were used to investigate the influencing factors for the prognosis of patients with SSRS,and the Kaplan-Meier method was used to describe survival outcomes.A Pearson or Spearman correlation analysis was performed.Results Compared with the non-rebleeding group,the rebleeding group had significantly higher splenorenal shunt diameter[4.60(3.20—5.90)mm vs 3.45(2.10—5.45)mm,Z=1.973,P=0.048]and hepatic venous pressure gradient(18.57±6.60 mmHg vs 15.06±5.82 mmHg,t=2.280,P=0.026)and a significantly lower portal vein diameter(14.04±2.90 mm vs 15.45±2.90 mm,t=2.138,P=0.035).The correlation analysis showed that splenorenal shunt diameter was negatively correlated with portal vein diameter(rs=-0.211,P=0.040).Adverse events within 5 years after treatment included rebleeding(27.4%),portal vein thrombosis(11.6%),infection(4.2%),cerebral hemorrhage(1.1%),and cerebral infarction(1.1%).Splenorenal shunt diameter(risk ratio[RR]=1.173,95%confidence interval[CI]:1.001—1.374,P=0.048)and superior mesenteric vein diameter(RR=0.844,95%CI:0.746—0.956,P=0.007)were independent influencing factors for gastrointestinal rebleeding within 5 years after treatment.Bilirubin(RR=1.028,95%CI:1.010—1.046,P=0.002)and blood urea nitrogen(RR=1.347,95%CI:1.116—1.625,P=0.002)were independent risk factors for 5-year survival rate after treatment.Conclusion Splenorenal shunt diameter is closely associated with the prognosis of cirrhotic patients,and it is recommended to enhance imaging follow-up of splenorenal shunt diameter for cirrhotic patients with SSRS.

Objective:To explore the decision-making experience of patients undergoing abdominoplasty in our country.Methods:A semi-structured interview was conducted with patients suffering from postpartum abdominal wall laxity who were treated at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from June to August 2023. The data were sort and analyzed using the Clolaizzi 7-step analysis method for thematic description.Results:A total of 15 patients, aged 29-53 years, were included in the study. 11 had a college education or higher, while 4 had less than a college education.Thirteen were married and two were divorced. According to the interview data, four themes were extracted: (1) negative perceptual experiences; (2) decision-making dilemmas; (3) peer support; (4) a physician-led decision-making model. According to the interview, the main decision-making dilemma faced by patients with postpartum abdominal wall laxity was lack of information and family support, and the support they get was mostly from information exchange among patients, and they had insufficient cognition of surgical knowledge, improvement degree and risk, and low participation in clinical decision making.Conclusion:Patients with postpartum abdominal wall laxity in China have an urgent psychological need for abdominoplasty, but there are many factors that have adverse effects on their decision-making experience.

Clinical pathway has great similarity with DRG,and plays an important role in standardizing diagnosis and treatment behavior and controlling medical expenses.Based on the analysis of the relationship between DRG payment method reform and clinical pathway,taking a public hospital in Wuhan City,Hubei Province as an example,the clinical pathway implementation strategy of large public hospitals under the DRG payment method reform was explored from five aspects:management system,suitable disease types,doctor's order setting,information system,training and assessment.

Objective:To investigate the molecular epidemiological characteristics of coxsackievirus A16 (CVA16) in Fujian province from 2020 to 2023.Methods:The epidemiological characteristics of CVA16 associated hand, food and mouth disease (HFMD) in Fujian province from 2020 to 2023 was analyzed. The complete VP1 gene of CVA16 was amplified by RT-PCR and then sequenced, and genetic evolution was analyzed by MEGA X and other softwares.Results:From 2020 to 2023, there were 13 120 cases of HFMD in Fujian province, and the proportion of HFMD which caused by CVA16 was 16.5% (2 160/13 120). From 2020 to 2023, the proportion of accounted cases was 4.7% (94/2 019), 14.1% (457/3 243), 47.6% (1 521/3 199) and 1.9% (88/4 659) respectively. HFMD caused by CVA16 was mainly concentrated in children aged 1 to 5 years, and most of them were 3 years old. The genetic evolution and genotype analysis of 92 complete VP1 gene sequences obtained from 2020 to 2023 showed that the genetic distance between CVA16 strains in Fujian province and the prototype strain was far away. The CVA16 genotype in Fujian province from 2020 to 2023 has three clusters of B1a, B1b and B1c, among which the composition ratio of B1a and B1b in Fujian province in 2020 was 40% and 60% respectively. In 2021, B1a and B1b accounted for 81.8% and 18.2% respectively. Only B1a in 2022; in 2023, there were B1a, B1b and B1c, which respectively accounted for 44.4%, 7.4% and 48.2%. During the period from January to September, B1a was the main cluster. After October we observed an emergence of B1c cluster, which had never been found in Fujian province and was rare in China, was detected and became the dominant cluster.Conclusions:The evolutionary cluster of CVA16 dominant changed from B1b in 2020 to B1a in 2021-2023. After October 2023, the newly discovered B1c became the dominant cluster in Fujian province.

Intraosseous regional administration (IORA) combines intraosseous infusion with tourniquet technology, using the tourniquet to limit the distribution of drugs in the target limb, achieving higher tissue concentration than systemic administration. In recent years, IORA technology has gained widespread attention and application in total knee arthroplasty (TKA). At present, prophylactic antibiotics are mainly administered in TKA by IORA technology. Studies have shown that drug concentration in local tissues can be significantly increased by IORA before TKA. In addition, there are also studies using IORA technology for preoperative analgesia in TKA, and good early postoperative analgesia effect has been obtained. However, it is unclear whether giving antibiotics through IORA technology is effective in preventing artificial joint infections. At the same time, there is still controversy as to whether IORA will increase complications such as puncture site accidents and fat embolism. This study reviews the current research on the use of IORA in TKA and shows that the application of IORA in TKA will not increase the incidence of complications and can significantly increase the local drug concentration. In primary TKA, IORA technology may have advantages over traditional intravenous systemic administration in terms of postoperative infection prevention and pain control. However, the efficacy of prophylactic antibiotics administered through IORA technology is unclear in people at high risk of infection such as obesity, diabetes, and modified TKA.

Objective:To investigate the risk factors associated with one-year mortality following surgery for intertrochanteric fractures in elderly patients and develop a survival prediction model.Methods:A retrospective analysis was conducted on clinical data from 532 elderly patients with intertrochanteric fractures admitted to the People's Hospital of Xinjiang Uygur Autonomous Region and the People's Hospital of Xinyang between January 2020 and September 2022.Patient demographics, laboratory indicators, and surgical variables were documented.The primary outcome assessed was the one-year mortality rate.Risk factors were identified through univariate and multivariate Cox regression analyses, leading to the development of a prognostic model.The model's predictive performance was evaluated using the Concordance Index(C-Index), time-dependent receiver operating characteristic(ROC)curve, calibration curve, and decision curve analysis(DCA).Results:Multivariate Cox regression analysis identified several key factors associated with one-year mortality after intertrochanteric fractures in elderly patients.These factors included the modified five-item frailty index( OR=1.338, 95% CI: 1.147-1.561, P<0.001), ICU admission( OR=1.694, 95% CI: 1.230-2.333, P=0.001), preoperative hemoglobin levels( OR=1.281, 95% CI: 1.016-1.616, P=0.036), surgical waiting time( OR=1.570, 95% CI: 1.063-2.319, P=0.023), and age( OR=2.196, 95% CI: 1.712-2.816, P<0.001).The prediction model showed good consistency with a C-Index of 0.769(95% CI: 0.723-0.818)in the modeling group and 0.715(95% CI: 0.612-0.750)in the validation group.Time-dependent ROC areas under the curve were 0.802(95% CI: 0.722-0.850)and 0.718(95% CI: 0.640-0.808)for the modeling and validation groups, respectively.Calibration curves for both groups indicated a good model fit, and decision curve analysis demonstrated a positive net benefit, highlighting the clinical applicability of the model. Conclusions:The modified five-item frailty index, ICU admission, preoperative hemoglobin, surgical waiting time, and age independently predict one-year mortality after surgery for intertrochanteric fractures in elderly patients.This prognostic model, utilizing these factors, shows high predictive accuracy, assisting clinicians in quick personalized assessments and setting informed expectations in clinical practice.