ABSTRACT
@#A large number of people would be exposed to irradiation in large-scale nuclear and radiation accidents or nuclear terrorist attacks. Therefore, it is urgent to establish rapid and high-throughput biodosimetry for in triage, providing a basis for emergency management. Imaging flow cytometry (IFC) possesses the high through put advantages of traditional flow cytometry and the sensitivity and specificity of microscope, and has a good application prospect in the research and development of rapid, automated, and high-throughput biological dose estimation technology. This article reviews the application progress of IFC in biodosimetry, and provides a reference for the development of biological dose estimation and detection equipment for large-scale nuclear and radiation accidents.
ABSTRACT
Objective:To establish a risk assessment system focusing on surgical and anesthesian-related indicators for the incidence of complications and mortality of hip fracture surgery in senile patients, and to evaluate its prediction accuracy, sensitivity and specificity.Methods:From January 2020 to February 2021, a total of 1 086 elderly patients (493 males and 593 females) aged 76±5 years (ranging from 60 to 94 years) underwent hip fracture surgery in Tianjin Hospital were collected. A total of 543 patients were randomly selected for the establishment of the hip fracture scoring system in senile patients, including 253 males and 290 females, aged 75±6 years (ranging from 60 to 92 years). With the preoperative physiological factor score and surgical risk factor score as independent variables and the occurrence of complications and death as dependent variables, binary logistic regression analysis was performed to establish a surgical risk scoring system for hip fracture in senile patients. The remaining 543 patients, including 240 males and 303 females, aged 74±7 years (range 60-94 years), their data were used to compare AUC, sensitivity, specificity, and compliance of the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), Daping orthopedics operative risk scoring system for senile patient (DORSSSP), and our surgical risk scoring system for hip fracture in senile patients through receiver operating characteristic (ROC) curves, and to compare the predictive value of these systems for complication incidence and mortality.Results:The predictive model equation of the elderly hip fracture scoring system is: ln R1/ (1- R1) =-7.13+0.112× PS+0.148× OS; ln R2/ (1- R2) =-6.14+0.124× PS+0.136× OS; [ R1 is the incidence of complications, R2 is the mortality, PS (physiology score) is the score of preoperative physiological factors, and OS (operation score) is the score of surgical risk factors]. Among the 543 patients whose data were used to compared with the hip fracture scoring system, POSSUM and DORSSSP, 72 actually developed complications and 36 died. The complication rate predicted by surgical risk scoring system for hip fracture in senile patients was 12.05%±6.34% (range 6.18%-61.29%), and 64 cases were predicted to have complications. The predicted mortality was 6.05%±3.26% (range 2.45%-58.36%), and 29 cases were predicted to die. The complication rate predicted by POSSUM was 25.36%±13.95% (range 9.16%-76.34%), and 126 cases were predicted to have complications. The predicted mortality rate was 10.46%±5.31% (range 6.23%-59.34%), and 54 deaths were predicted. The predicted complication rate of DORSSSP was 19.34%±9.67% (range 8.36%-70.85%), and 99 cases were predicted to have complications. The predicted mortality was 10.12%±5.16% (range 7.35%-57.54%), and 52 deaths were predicted. In predicting the incidence of complications, the AUC of surgical risk scoring system for hip fracture in senile patients, POSSUM and DORSSSP were 0.95, 0.82 and 0.75, the sensitivity was 0.89, 0.83 and 0.85, the specificity was 0.80, 0.86 and 0.92, and the compliance rate was 0.94, 0.93 and 0.94, respectively. In the prediction of mortality, the AUC of surgical risk scoring system for hip fracture in senile patients, POSSUM and DORSSSP were 0.87, 0.67 and 0.71, the sensitivity was 0.85, 0.69 and 0.75, the specificity was 0.73, 0.94, 0.95, and the compliance rate was 0.94, 0.93 and 0.94, respectively. Conclusion:Compared with POSSUM and DORSSSP, hip fracture scoring system in elderly patients has improved its ability to predict surgical risk, and can accurately predict the incidence of complications and mortality in elderly patients undergoing hip surgery.
ABSTRACT
Objective:To explore the influencing factors of delayed surgery for hip fracture in the elderly patients.Methods:A totally 779 elderly hip fracture patients who were hospitalized and operated in the first ward of the Department of Trauma and Hip Arthritis of Tianjin Hospital from January 2018 to December 2018 were collected. According to the time from admission to surgery, the patients were divided into early surgery group (received surgery within 48 hours after admission) 213 cases, delayed surgery group (received surgery more than 48 hours after admission) 566 cases. In this study, the following parameters were collected as potential factors affecting surgery, including: age, gender, fracture type, American Society of Anesthesiologists (ASA) classification, blood test indicators, chest radiograph, urine routine indicators, lower extremity venous thrombosis, and basic comorbidities, mental state, surgical methods, combined medication.Results:In the early operation group, there were 213 cases, 81 males and 132 females; age 69.9±10.2 years (range, 60-74 years); 95 cases of femoral neck, 118 of femoral intertrochanteric or subtrochanteric fractures; 128 cases of ASA I-II grade, 85 of III-V grade; 26 cases of abnormal cardiac function, 187 of normal; 23 cases of abnormal liver function, 190 of normal; 35 cases of abnormal renal function, 178 of normal; 104 cases of abnormal respiratory system, 109 of normal; 110 cases of electrolyte imbalance, 103 of normal; 96 cases were positive for urinary ketone bodies and 117 cases were negative; 86 cases had lower extremity venous thrombosis, 127 cases had no lower extremity venous thrombosis; 32 cases had mental disorders, and 181 cases had no mental disorders; internal fixation was selected in 102 cases, and artificial hip replacement was selected in 111 cases. There were 48 cases with combined medication and 165 cases without combined medication. In the delayed operation group, there were 566 cases, including 262 males and 304 females; age 71.7±15.6 years (range, 58-91 years); 224 cases of femoral neck fractures, 342 of femoral intertrochanteric or subtrochanteric fractures; 169 cases of ASA I-II, 397 of grade III-V; 169 cases of abnormal heart function and 397 of normal; 52 cases of abnormal liver function and 514 of normal; 90 cases of abnormal renal function and 476 of normal; 368 cases of abnormal respiratory system and 198 of normal; electrolyte imbalance 203 cases, 363 cases were normal; 261 cases were positive for urine ketone body, 305 cases were negative; 197 cases had lower extremity venous thrombosis, 369 cases had no lower extremity venous thrombosis; 141 cases had mental disorders, and 425 cases had no mental disorders; 226 cases had internal fixation as surgical method, 340 cases of artificial hip replacement were selected; 311 cases were combined with drugs, and 255 cases were not combined with drugs. There was no statistically significant difference between the early operation group and the delayed operation group in terms of age, gender, fracture type, abnormal liver function, abnormal renal function, urine ketone body, lower extremity venous thrombosis, and choice of surgical methods. There were statistically significant differences between the early operation group and the delayed operation group in terms of ASA classification, abnormal cardiac function, abnormal respiratory system, electrolyte disturbance, mental disorder, and combined medication. Multivariate Logistic regression analysis indicated that abnormal cardiac function, mental disorder, and combined medication were the influencing factors of delayed surgery for hip fracture in the elderly.Conclusion:The influencing factors of delayed surgery for hip fractures in the elderly are abnormal heart function, mental disorders, taking reserpine, clopidogrel and abnormal coagulation function.
ABSTRACT
Objective:To analyze the clinical characteristics of patients with femoral neck fracture in Tianjin Hospital.Methods:Data of femoral neck fracture patients discharged from Tianjin Hospital from January 1, 2016 to December 31, 2017 were retrospectively analyzed. The gender, age, fracture type, injury mechanism and treatment method were collected.Results:Total of 2,150 eligible patients including 736 males and 1414 females were selected. There were significant differences in the gender distribution in different age groups ( χ2=91.63, P<0.001). Among young patients, males were more than females, while among middle-aged and elderly patients, females were more than males. The main type of fracture was displaced type (75.56%, 1,646/2,150), the displaced rate was the lowest in young patients (55.17%, 64/116), while it was the highest in old patients (81.91%, 1,159/1,415). The main injury mechanism of the three age groups were falls [young 61.21% (71/116), middle 80.29% (497/619), eldly 91.24% (1,291/1,415)]. There was a significant difference in the treatment methods between different age groups ( χ2=1,057.11, P<0.001). The main treatment method for young and middle-aged patients was internal fixation, no matter whether the fracture was displaced or not. The proportion of undisplaced patients with internal fixation (86.22%, 169/196) was higher than that of displaced patients with internal fixation (62.88%, 266/423) in middle-aged group ( χ2=34.93, P<0.001). In the elderly, more patients used internal fixation in undisplaced group, while more patients used hemiarthroplasty in displaced group. The age of old femoral neck fracture (median age was 74) was older than that of fresh fracture (median age was 70) ( Z=-2.777, P=0.005). And the displaced rate of patients with old femoral neck fracture (92.41%, 73/79) was higher than that of the fresh ones (75.95%, 1,573/2,071)( χ2=11.48, P=0.001). The patients with old femoral neck fracture usually adopt total hip replacement, while the proportion of three kinds of operation (internal fixation, hemiarthroplasty, total hip replacement) were similar among the fresh ones, and the internal fixation was the most. Conclusion:Femoral neck fracture is the most common in elderly women. The patients with displaced fracture are more than that with undisplaced fracture. Falling is the main injury mechanism in both young and old people. Internal fixation is commonly used in young and middle-aged patients, while arthroplasty is often used in elderly patients.
ABSTRACT
BACKGROUND:Our previous studies have shown that a soft substrate has a significant effect on morphology and cytoskeleton of rat bone marrow mesenchymal stem cel. OBJECTIVE:To explore the effect of polyacrylamide gels as soft substrates with different elastic moduli on the chondrogenic differentiation of human synovial-derived mesenchymal stem cels. METHODS:The synovium was harvested from patients with osteoarthritis under sterile conditions, and primary human synovial-derived mesenchymal stem cels were separated using limiting dilution assay. The flow cytometry and multi-directional differentiation experiments were used to identify the cel surface markers and function of the human synovial-derived mesenchymal stem cels, respectively. The polyacrylamide gels with the elastic modulus of 0.4, 6, 30 kPa, which were made using various amounts of acrylamide and bis-acrylamide, were used to culture human synovial-derived mesenchymal stem cels under induction with transforming growth factor-β1 for 7 and 14 days. RT-PCR was used to test the expression of chondrogenic genes, type II colagen gene and cartilage acidic protein 1. The 6-wel cel culture plates served as controls. RESULTS AND CONCLUSION: The human synovial-derived mesenchymal stem cels showed different cel morphology in the different elastic modulus of polyacrylamide gels. The expression of type II colagen gene and cartilage acidic protein 1 were affected by the different elastic modulus of polyacrylamide gels and culture time, and there was an interaction between these two factors. At 7 days of induction, the expression of cartilage acidic protein 1 gene on 6 kPa polyacrylamide gels was the highest (F=44.350,P=0.000); meanwhile, the expression of type II colagen gene on 0.4 kPa polyacrylamide gels was the highest (F=6.384,P=0.005). These findings indicate that polyacrylamide gels with lower elastic modulus are superior to routine culture plates to promote the chondrogenic differentiation of human synovial-derived mesenchymal stem cels.