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Objective To investigate the risk factors of abdominal infection after orthotopic liver transplantation. Methods Clinical data of 284 recipients undergoing orthotopic liver transplantation were retrospectively analyzed. All recipients were divided into the infection group (n=51) and non-infection group (n=233) according to the incidence of postoperative abdominal infection. Univariate and multivariate logistic regression analyses were used to identify the risk factors of abdominal infection. Nomogram prediction models were constructed and the prediction efficiency of these models was evaluated. The predictive value of continuous variables for abdominal infection was assessed. Results Among 284 recipients, 51 developed abdominal infection with an incidence of 18.0%. Diabetes mellitus before surgery[odds ratio (OR) 2.66, 95% confidence interval (CI) 1.13-6.14, P=0.013], long operation time (OR 1.98, 95%CI 1.03-3.57, P=0.038), low prognostic nutritional index (PNI) (OR 2.18, 95%CI 1.06-4.44, P=0.023), high systemic immune-inflammation index (SII) (OR 2.21, 95%CI 1.06-4.78, P=0.012) and high C-reactive protein/albumin ratio (CAR) (OR 1.90, 95%CI 1.05-3.49, P=0.029) were independent risk factors for abdominal infection after liver transplantation. The area under curve (AUC) of nomogram model for predicting abdominal infection after liver transplantation was 0.761. The standard model yielded high consistency. CAR, PNI and SII were all predictors of abdominal infection after liver transplantation (all P < 0.05), with AUC of 0.648, 0.611 and 0.648, and cut-off values of 2.75, 43.15 and 564.50, respectively. Conclusions CAR, SII and PNI are predictors of abdominal infection after liver transplantation. The nomogram model based on PNI, SII and CAR may effectively predict the incidence of abdominal infection after liver transplantation.
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BACKGROUND: At present, most of the literature on joint replacement focus on the causes and countermeasures of long-term complications, but seldom focuses on causes of postoperative short-term complications, such as wound exudation and delayed union. Whether the incidence of sustained exudation and delayed wound healing in patients with hypertension after hip replacement is higher than that in patients with normal blood pressure is not reported at present.OBJECTIVE: To identify the correlation of hypertension with persistent wound exudation and delayed wound healing in patients after femoral head replacement.METHODS: Data of 205 elderly patients with femoral neck fractures were retrospectively analyzed. All patients underwent femoral head replacement. In accordance with the hypertension diagnostic criteria of 2010 Chinese Guidelines for the Management of Hypertension, patients were divided into hypertension group and control group.Intraoperative blood loss, postoperative blood loss, the days of prolonged wound exudation, the wound dehiscence, and the prevalence of delayed wound healing were compared between the two groups. Then, we analyzed the relationship of hypertension with wound exudation and delayed wound healing.RESULTS AND CONCLUSION: (1) The average systolic blood pressures were 153.55 mmHg and 128.82 mmHg in the hypertension and control groups, respectively (P 0.05). (3) The time of persistent wound exudation was 4.03 days and 2.08 days in the hypertension group and control group, respectively (P < 0.05). (4) The prevalence of delayed wound healing was significantly higher in the hypertension group than that in the control group (P < 0.05). (5) Hypertensive patients had a higher risk of prolonged wound exudation and delayed healing than their normotensive counterparts, and the hypertension is one of the important influence factors for delayed wound healing.
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<p><b>OBJECTIVE</b>To investigate the effects of initiative and passive perioperative function exercises on hidden blood loss (HBL).</p><p><b>METHODS</b>Two hundreds and thirty elderly patients with hip fractures aging from 67 to 87 years (average age of 73.6 years) who underwent total hip replacement were included. By the intensity and the manner of perioperative function exercises, patients were divided into four groups: little initiative function exercises group (group A, n=51), little initiative and passive function exercises group (group B, n=54), normal initiative function exercises group (group C, n=65), normal initiative and passive function exercises group (group D, n=60). The true total blood loss, HBL and their proportion on the original blood volume and total blood loss was calculated depending on height, weight, intra-operative blood loss, post-operative blood loss, pre- and post-operative hematocrit, and blood transfused. According to the proportion of mean HBL on total blood loss, patients were divided into low HBL group and high HBL group. The data were analyzed by t test.</p><p><b>RESULTS</b>The mean HBL was 517 ml, 41.9% of the total blood loss. Thereinto, the mean HBL was 695 ml in group A, 49.3% of the total blood loss, the prevalence of high HBL was 66.7% (34/51); the mean HBL was 625 ml in group B, 46.9% of the total blood loss, the prevalence of high HBL was 59.3% (32/54); the mean HBL was 446 ml in group C, 38.4% of the total blood loss, the prevalence of high HBL was 30.8% (20/65); the mean HBL was 346 ml in group D, 32.3% of the total blood loss, the prevalence of high HBL was 20.0% (12/60). Mean HBL, mean HBL/total blood loss, prevalence of high HBL were lower in group C than that in group A and group B (all P<0.05); and were lower in group D than that in group C (all P<0.05). The prevalence was 57.4% (132 cases) in low HBL group, and 42.6% (98 cases) in high HBL. The proportion of little initiative function exercises patients in high HBL group was obviously higher than that in low HBL group (P<0.05).</p><p><b>CONCLUSIONS</b>The intensity and the manner of perioperative function exercises are strongly associated with the HBL in elderly patients with total hip replacement. The initiative combined with the passive function exercises could be effectively prevent and reduce the incidence of high HBL.</p>
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Aged , Aged, 80 and over , Humans , Arthroplasty, Replacement, Hip , Blood Loss, Surgical , Exercise Therapy , Hip Fractures , General Surgery , Postoperative HemorrhageABSTRACT
BACKGROUND:The emergence of a large number of hidden blood loss during perioperative period of intertrochanteric fracture in the elderly not only increases the risk of perioperative period and complications, but also affects the postoperative recovery of joint function. At present, there is no relevant report about nutritional status and the hidden blood loss before surgery in and outside China. OBJECTIVE:To identify the effect of nutritional status on preoperative hidden blood loss in elderly patients with intertrochanteric fracture. METHODS:183 elderly patients with fresh and initial femoral intertrochanteric fracture were included. Laboratory serological examinations on admission and preoperation were completed. By mini nutritional assessment, patients were randomly divided into normal-nourishment group, malnourishment at risk group, and malnourishment group. The original blood volume and preoperative hidden blood loss were calculated depending on height, weight, hematocrit on admission and preoperation. According to the proportion of mean preoperative hidden blood loss on the original blood volume, patients were divided into low and high hidden blood loss groups. We compared preoperative hidden blood loss, and their proportion on the original blood volume and the preoperative incidence of high hidden blood loss, and analyzed the correlations between preoperative high hidden blood loss and preoperative nutritional status. RESULTS AND CONCLUSION:(1) The nutritional status of elderly intertrochanteric fracture patients measured by mini nutritional assessment score was that the number of patients was 48 cases (26%) in normal-nourishment group, 64 cases (35%) in the malnourishment at risk group, and 71 cases (39%) in the malnourishment group. There were no obvious differences in the preoperative complications between any two groups (P>0.05). (2) Thirty-eight cases affected high hidden blood loss. The mean preoperative hidden blood loss was 260.43 mL. The proportion of preoperative hidden blood loss to the original blood volume was 6%. (3) The preoperative hidden blood loss, their proportion on the original blood volume and the incidence of high hidden blood loss were significantly higher in the malnourishment at risk group and malnourishment group than in the normal-nourishment group. Paired comparison showed significant differences (P<0.05). (4) Results confirmed that preoperative hidden blood loss, their proportion on the original blood volume and the incidence of high hidden blood loss gradual y increased with deterioration of nutritional status. The nutritional status is an important factor influencing the occurrence of preoperative hidden blood loss, and can be used as an important index for judging the high hidden blood loss and prognosis in elderly patients with intertrochanteric fracture.
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BACKGROUND:Perioperative high hidden blood loss affects the recovery of joint function after total hip replacement. OBJECTIVE:To analyze the reliability of the Mini Nutritional Assessment on evaluating the nutritional status in elderly patients with femoral neck fracture on admission, and to investigate the effect of nutritional status variation on hidden blood loss after total hip replacement. METHODS:234 elderly patients with femoral neck fracture underwent total hip replacement. By using Mini Nutritional Assessment, patients were randomly divided into three groups:wel-nourishment group (n=52), malnourishment at risk group (n=92), and malnourishment group (n=90). The results were used to analyze the correlation of Mini Nutritional Assessment and serological nutrition indicators, and to hidden blood loss. RESULTS AND CONCLUSION:(1) Hidden blood loss:101 patients suffered from high hidden blood loss. Hidden blood loss, its proportion to total blood loss and incidence of high hidden blood loss gradual y increased with the deterioration of the nutritional status (P<0.05). (2) Mini Nutritional Assessment:Pre-operative Mini Nutritional Assessment score, and the incidence of hidden blood loss evaluated by albumin, prealbumin, transferrin, lymphocyte count, the percentage of lymphocytes and hemoglobin was significantly higher in patients with high hidden blood loss than those with low hidden blood loss (P<0.01). (3) Results of correlation analysis:High hidden blood loss was positively correlated with pre-operative Mini Nutritional Assessment, albumin, prealbumin, transferrin, the percentage of lymphocytes and hemoglobin (P<0.05). (4) These findings confirm that risk evaluation with Mini Nutritional Assessment is a reliable method to assess the nutritional status in elderly patients undergoing total hip replacement. Its combination with various serum nutrition indicators can determine high hidden blood loss and the prognosis.
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BACKGROUND:Wear particles-induced osteoblasts apoptosis in vitro has been documented in many studies. However, the apoptosis of osteoblasts in osteolytic bone tissue and the selective mechanisms involved in the pathogenesis of osteolysis have been studied rarely. OBJECTIVE:To investigate the influence of endoplasmic reticulum (ER) stress on the apoptosis of osteoblasts in osteolytic bone tissue and osteolysis progression. METHODS:The mouse model of osteolysis was induced with wear particles placed onto the calvaria. The experiment was divided into four groups:blank control group (PBS stimulation);wear particle group (nano-al oy powder suspension stimulation);ER stress positive control group (nano-al oy powder+thapsin stimulation);and ER stress inhibitor group (nano-al oy powder+sodium 4-phenylbutyrate stimulation). The histopathologic change of osteolysis was assessed by hematoxylin-eosin, toluidine blue and alkaline phosphatase staining. Osteoblast proliferation and differentiation in osteolytic craniums were measured. The expression of ER stress markers in osteolytic craniums was examined by western blot analysis. Osteoblast apoptosis was analyzed by TUNEL staining and immunohistochemistry of Caspase-3 in osteolytic craniums. RESULTS AND CONCLUSION:Wear particles were capable of inducing osteolysis, aggravating the infiltration of inflammatory cells, and inhibiting the differentiation of osteoblasts in osteolytic craniums. Meanwhile wear particles upregulated the ER stress markers and promote the apoptosis in osteolytic craniums. Blocking ER stress with sodium 4-phenylbutyrate dramatical y reduced the severity of osteolysis, significantly reduced bone invasion and inflammatory infiltration, promoted the differentiation of osteoblasts, and dramatical y reduced the apoptosis. Along with apoptosis, the expression of ER stress marker was decreased. The present study suggests that the ER stress may be crucial for osteolysis and represent a potential therapeutic target in the prevention and treatment of patients with total joint replacement who are at high risk of early aseptic loosening development.
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<p><b>OBJECTIVE</b>To evaluate the effect of additives on absorption of Coptis chinensis total alkaloid and their pharmacokinetics in mice.</p><p><b>METHOD</b>The mice were fed with the mixture of C. chinensis total alkaloids and additives (1:1). And then the feces and orbital blood were taken to detect the content of total alkaloids by HPLC and their pharmacokinetics.</p><p><b>RESULT</b>Glutin could make the absorption of jatrorrhizine, coptisine, berberine and total alkaloids increased by 30%. Tween 80 and arabic gum did not affect the absorption of berberine, but inhibit that of other alkaloids. There had no influence of lecithin on the absorption of alkaloids. The peak time of total alkaloids in blood were 2 h (Cmax 1=5.9 mg x L(-1)) and 5.0 h (Cmax 2=3.4 mg x L(-1)), respectively, AUC was 17.6 mg x h x L(-1), the elimination of Half-life t1/2 was 5.2 h. After addition of glutin, the peak time of total alkaloids in blood were 1.5 h (Cmax 1=7.6 mg x L(-1)) and 4.8 h (Cmax 2=8.5 mg x L(-1)), AUC was up to 31.1 mg x h(-1) x L(-1), the elimination of Half-life t1/2 was 6.2 h.</p><p><b>CONCLUSION</b>Glutin could accelerate the mice on the absorption of C. chinensis total alkaloids, to extend the elimination half-life, increase the blood concentration and bioavailability.</p>