[Objective] To explore the incidence and risk factors of blood transfusion undergoing total knee revision (TKR) using a nationwide database. [Methods] A retrospective data analysis was conducted based on the Nationwide Inpatient Sample (NIS), enrolling patients who underwent TKR from 2015 to 2019 with complete information. Patients under 18 years old and those using anticoagulants, antiplatelets, antithrombotic and non-steroidal were excluded. The patients were divided into two groups based on whether they received blood transfusion or not. The demographic characteristics, length of stay (LOS), total charge of hospitalization, hospital characteristics, hospital mortality, comorbidities and perioperative complications by Wilcoxon rank test for continuous data and chi-square test for categorical data. Logistic regression was performed to identify risk factors of blood transfusion undergoing TKR. [Results] The NIS database included 63 359 patients who underwent TKR. Among them, 5 271 patients received blood transfusion, with an incidence of blood transfusion of 7.8%. There was a decrease in the incidence over the years from 2015 to 2019, dropping from 10.2% to 6.5%. TKR patients requiring transfusions had experienced longer LOS, incurred higher total medical expenses, utilized Medicare more frequently, and had increased in-hospital mortality rates (all P<0.001). Independent risk factors for blood transfusion included female gender, iron-deficiency anemia, rheumatoid disease, collagen vascular disease, chronic blood loss anemia, congestive heart failure, coagulopathy, diabetes with chronic complications, lymphoma, fluid and electrolyte disorders, peripheral vascular disorders, renal failure, valvular disease and weight loss (malnutrition). In addition, risk factors for transfusion in TKR surgery included sepsis, acute myocardial infarction, deep vein thrombosis, gastrointestinal bleeding, heart failure, pneumonia, urinary tract infection, acute renal failure, postoperative delirium, wound infection, lower limb nerve injury, hemorrhage, seroma, hematoma, wound rupture and non healing. [Conclusion] Our findings highlight the importance of recognizing the risk factors of blood transfusion in TKR and establishing corresponding clinical pathways and intervention measures to reduce the occurrence of adverse events.

Objective To investigate the current situation of preoperative nursing trust in total knee replacement patients and analyze the influencing factors.Methods Using convenience sampling method,138 patients who underwent total knee ar-throplasty in our department from October 2020 to September 2021 were selected as the research objects.The patients were inves-tigated by general information questionnaire,nurse-patient relationship trust scale(NPTs),self-rating Anxiety Scale(SAS)and knee American Special Surgery scale(HSS),to explore the current situation and influencing factors of patient-nurse trust in pa-tients undergoing total knee arthroplasty.Results The total score of preoperative trust of patients(136.75±7.93);Pearson correlation analysis showed a negative correlation with total anxiety score(r =-0.419,P＜0.01)and no correlation with knee function score(r=0.063,P＞0.05).The results of the multiple linear regression analysis showed that the educational level,previous experience of hospitalization,and preoperative anxiety entered the regression equation(P＜0.05)explained 66.9% of the total variation.Conclusion In this group,the trust between nurses and patients in patients undergoing total knee arthroplas-ty is at the upper middle level,and is affected by education level,previous hospitalization experience and preoperative anxiety.Nurses should focus on patients with low education level,no previous hospitalization experience and high anxiety level,and carry out targeted intervention for theme,so as to reduce postoperative anxiety and improve postoperative function,Promote doctor-pa-tient relationship,reduce medical disputes and help patients recover as soon as possible.

Objective:To evaluate the reliability and validity of the Chinese version of HEMO-FISS-QoL(HF-QoL) questionnaire (HF-QoL-C) in the Chinese population with hemorrhoids.Methods:From November 2021 to November 2022, a self-constructed general information questionnaire, HF-QoL-C, and the 36-item short form health survey (SF-36), Goligher classification, and Giordano severity of hemorrhoid symptom questionnaire (GSQ) were used to conduct a questionnaire survey on 760 hemorrhoid patients in the anorectal department of six hospitals. The data was analyzed for reliability and validity using SPSS 21.0 and AMOS 26.0 software.Results:The Cronbach's α coefficient of HF-QoL-C and its dimension ranged from 0.831 to 0.960, and the split coefficient was 0.832-0.915. Four common factors were extracted through principal component exploratory factor analysis. Confirmatory factor analysis indicated acceptable structural validity( χ2/ df=8.152, RSMEA=0.097, CFI=0.881, IFI=0.881, NFI=0.867). HF-QoL-C was correlated with SF36 and GSQ( r=-0.694, 0.501, both P<0.01). There were differences in the total score and dimensional scores of HF-QoL-C between surgical and drug treated patients, different grades of Goligher classification for hemorrhoidal disease, and different ranges of hemorrhoid prolapse (all P<0.001). No ceiling effect was found in the total score and the scores of each dimension(0.3%-2.0%). There was a floor effect in both psychological function and sexual activity dimensions (16.7%, 35.1%). Conclusion:HF-QoL-C has good reliability and validity, which can be used to measure the quality of life of Chinese hemorrhoid patients.

OBJECTIVE: To assess the therapeutic effect of hyaluronate acid (HA) injection through the subpatellar route for treatment of chondromalacia patellae (CP). METHODS: Eighty-eight patients with the diagnosis of CP were enrolled in this prospective study, including 38 with early CP (CP group) and 50 with advanced CP (patellofemoral arthritis group) diagnosed based on image presentations. All the patients received intra-articular HA injections through a subpatellar route once a week for 5 consecutive weeks. The primary outcome measures included WOMAC index scores and Lequesne scores before and at 4, 12, 26 and 52 weeks after the injections. The secondary outcome measures included the 30-m walking time and stair ascending and descending time (one floor) before and at 1, 2, 3, and 4 weeks after the injections. RESULTS: In both groups the patients showed significantly decreased WOMAC scores and Lequesne scores at 4, 12, 26 and 52 weeks after HA injections as compared with the baseline scores (all < 0.01). No significant difference was found between the two groups in WOMAC scores and Lequesne scores at 4 or 12 weeks after the injections (both >0.05). The WOMAC scores and Lequesne scores at 26 and 52 weeks after the injections were significantly higher in patellofemoral arthritis group than in CP group (both < 0.05). In both groups, the 30-m walking time and the stair ascending and descending time decreased significantly at 1, 2, 3, and 4 weeks after HA injections (all < 0.05) without significant differences between the two groups (all >0.05). CONCLUSIONS HA injection through the subpatellar route is effective for treatment of CP. HA injection produces better long-term efficacy for treatment of early CP than for advanced CP where patellofemoral arthritis occurs.
Chondromalacia Patellae ; Follow-Up Studies ; Humans ; Hyaluronic Acid ; Injections, Intra-Articular ; Osteoarthritis, Knee ; Pain Measurement ; Prospective Studies ; Severity of Illness Index ; Treatment Outcome

The paper analyzes the status of trauma rescue and treatment informatization in Xinjiang,states the thoughts of construction of intelligent trauma medical center in southern Xinjiang (including the telemedicine system based on regional medical network,orthopedics trauma and disease diagnosis and treatment platform,etc.).It also provides the application examples and discusses the social economic benefits.

AIM To observe the effects of Qibao Meiran Oral Liquid (Polygoni multiflori Radix Praeparata,Angelicae sinensis Radix,Psoraleae Fructus,etc.) on learning and memory function,hippocampus tissue pathological morphology,SOD activity and carbonyl protein content in SAMP8 mice.METHODS Twenty-seven SAMP8 mice were randomly and equally divided into model control group,donepezil hydrochloride group and Qibao Meiran Oral Liquid group.Another nine SAMR1 mice were selected as normal control group.Mice were given successive intragastric administration for 60 days.On the 56th day,the passive avoidance test was adopted,and the learning and memory capacities were determined after 5 d;The pathological morphology was observed by HE staining;ELISA assay was used to detect the activity of SOD and the content of carbonyl protein in brain tissue.RESULTS Compared with the model control group,the escape latency of mice in the Qibao Meiran Oral Liquid group was significantly prolonged,and the number of errors decreased significantly (P ＜0.01);the pathological morphology of hippocampus tissue was significantly improved;SOD activity increased significantly,and carbonyl protein content decreased significantly (P ＜ 0.01).CONCLUSION Qibao Meiran Oral Liquid can not only improve the learning and memory function of SAMP8 mice,but also reduce the degree of hippocampus tissue degenerative disease.

BACKGROUND:Currently, X-ray examination is mainly used for diagnosis of nonunion. However, this method that relies only on the clinician’s experience and degree of calus mineralization has less accuracy because it is vulnerable to projection, processing conditions and subjective factors. OBJECTIVE:To establish an animal model of nonunion and to detect the variation of biochemical markers and bone mineral density. METHODS: Twenty New Zealand white rabbits were randomly divided into two groups, and bone defect and fracture models were made in the midshaft of the forearm radius, respectively. X-ray examination of the forearm, quantitative CT measurement of bone mineral density and serological test were carried out before and at 2, 3, 4, 5, 6, 7, 8, 10, 12 weeks after surgery.RESULTS AND CONCLUSION:Postoperative X-ray films showed that the in the bone defect group, a little calus formed in three rabbits at 2 weeks, the calus formed stably at 5 weeks, but there was stil no healing at 8 weeks; in the fracture group, the fracture line was blurred at 2 weeks and a large number of caluses formed at 6-8 weeks. Compared with the fracture group, the value of bone mineral density in the bone defect group began to decrease significantly at 5 weeks after surgery. Results from the serological test showed that in the bone defect group, the activity of bone-specific alkaline phosphatase increased after surgery, reached peak at 4 weeks, began to decrease at 5 weeks and became stable at 6 weeks; the activity of tartrate-resistant acid phosphatase 5b increased after surgery, peaked at 4 weeks, then decreased and stabilized basicaly; the expression of N-terminal telopeptide of type I colagen decreased significantly at 5 weeks after surgery and became stable at 6 weeks. These findings indicate that the systematic monitoring of changes in bone mineral density and biochemical indicators such as bone-specific alkaline phosphatase, tartrate-resistant acid phosphatase 5b and type I colagen N-terminal telopeptides may help to reflect the early progress of rabbit nonunion.

Objective To compare the effectiveness and safety of continuous and intermittent ice compression therapy following total knee arthroplasty surgery. Methods Eighty patients were divided into two groups receiving continuous or intermittent 30 minutes every 2 two hours within 48 hours after the operation. The subjective pain (VAS score), additional pain-killer use, swelling of extremity, drainage, range of motion were observed and compared. Results Patients in the observation group had less pain than those in the control group (Z values in the first 3 postoperative day was-2.722,-3.359,-2.039, respectively, P<0.05). Less pain-killers were required in the experimental group (Z=-2.559, P<0.05). The postoperative swelling by the thigh circumferences in the first day in the observation group was (1.84 ± 1.11) cm, which was milder than the (3.30 ± 1.69) cm of the control group (t=4.565, P<0.01). So was it in the calf circumferences, (0.94 ± 0.89 ) cm vs. (1.46 ± 0.91) cm (t=2.627, P=0.01). Within the first 3 days after the operation, this mildness still existed in aspect of thigh circumferences, which was (3.09±1.39) cm in the observation group vs the (4.09 ± 1.71) cm in the control group, t=2.869, P < 0.01. Conclusions Continuous ice compression therapy has better effects than intermittent 48 hours after total knee replacement, with functional training and exercise not disturbed. It is considered safe and assured, and is therefore recommended.

BACKGROUND:Detecting the serum levels of biochemical markers to assess bone fractures is simple, mini-invasive and specific. Thereafter, to predict bone nonunion by choosing an appropriate marker has become a hotspot.
OBJECTIVE:To establish an animal model of bone nonunion and explore the changing rules of the biochemical markers during the process of nonunion.
METHODS:Twenty New Zealand white rabbits aged 5-6 months were enrol ed and divided into two groups. In bone defect group, a 15-mm length of bone (including the periosteum) was removed from the left mid-radius, and the medul ary cavities were closed with bone wax. In bone fracture group, the mid-radius was fractured. X-ray examination was taken and blood samples were extracted preoperatively and at 2, 3, 4, 5, 6, 7, 8, 10, and 12 weeks after surgery. The serum levels of osteocalcin and bone-specific alkaline phosphatase (BSAP) as markers of bone formation, and C-terminal telopeptide of type I col agen (CTX), N-terminal telopeptide of type I col agen (NTX), and tartrate-resistant acid phosphatase 5b (TRACP 5b) as markers of bone resorption, were measured using biotin double-antibody sandwich ELISA.
RESULTS AND CONCLUSION:In the bone defect group, the bone metabolism was at a high level, suggesting that the early diagnosis of bone nonunion depends on several biochemical indicators. In the bone defect group, the serum level of CTX peaked at 5 weeks, and the serum levels of osteocalcin, BSAP and NTX decreased obviously at 4 or 5 weeks, while the serum TRACP 5b concentration did not change significantly, indicating that al above markers except TRACP 5b sensitively reflect the bone turnover in vivo. Further studies are needed to determine whether systematic monitoring of the biochemical markers can reflect the bone turnover effectively and can be used for the early diagnosis of nonunion in the rabbit model.

Objective To investigate the technique and clinical results of rectangular SL-PLUS/SLR-PLUS cementless stem prosthesis in treating femoral bone defects in total hip revision surgery.Methods A retrospective analysis was performed involving 57 patients underwent total hip revision using SL-PLUS/SLR-PLUS cementless stem prosthesis for femoral defects from October 2000 to April 2014,including 22 males and 35 females with average age 62 years (range 44 to 83 years).All patients underwent unilateral surgery,21 in the left and 36 in the right.Eighteen cases of Paprosky Ⅱ,23 cases of type ⅢA and 16 cases of type ⅢB were included.Revision surgeries were performed using uncemented rectangular SL-PLUS/SLRPLUS femoral stems.Femurs were split in 12 cases without bone grafting.Acetabulum revision or acetabuloplasty were conducted in 51 cases by the use of 33 spherical cups and 18 reinforcement rings.Signs for prosthesis loosing such as transparent line around prosthesis,osteolysis and subsidence were recorded at the follow-ups.The clinical effects were evaluated using visual analogue scale (VAS),Harris score and activity daily life (ADL) score.Results The average operation was 108 min,ranging from 100 to 170 min.The average blood loss was 660 ml,ranging from 300 to 850 ml.All prostheses were placed optimally and received press-fit stability in the initial state.No neurological or vascular complication occurred during or after the operation.All incision healed at stage Ⅰ without nerve traction injury,joint dislocation,fractures,acute infection and lower limb deep vein thrombosis.The average follow-up duration was 4.8 years,ranging from 2 to 16 years.Total VAS improved from 6.54±1.56 to 2.28± 1.46 (t=17.335,P＜0.001).The Harris score improved from 46.74±7.95 to 78.46±8.25 (t=-25.012,P＜0.001),and the ADL scores increased from 56.84±6.86 to 69.39±7.56 (t=-21.309,P＜O.001).No prosthesis subsidence,prosthesis fracture and other complications occurred during the follow-up.Transparent lines around the upper part of the prosthesis were observed in 18 cases.All prosthesis-bone union was intact in the distal parts.Conclusion The segmental functional reconstruction with cementless rectangular SL-PLUS/SLR-PLUS stem prosthesis is a safe and reliable surgical procedure in patients with Paprosky Ⅱ or Ⅲ bone defects.