Clinical application progress of Nottingham Hip Fracture Score / 中国基层医药

Hip fracture is the most common traumatic disease in the older adult patients, and its incidence is rising year by year. There are various clinical scoring systems for predicting postoperative complications and mortality. However, most scoring systems are not suitable for predicting postoperative complications and mortality of hip fracture. This paper summarizes the establishment, calculation, application extension and clinical application of Nottingham Hip Fracture Score, and elaborates the clinical application of Nottingham Hip Fracture Score in hip fracture patients.

Feasibility of Nottingham score on predicting postoperative complications in adult patients undergoing hip surgery / 中国医师进修杂志

Objective To explore the prediction value of Nottingham hip fracture score(NHFS) on postoperative complications in patients undergoing hip surgery. Methods From January 1st 2015 to January 26th 2018, data of 904 patients who had underwent hip surgery were retrospectively analyzed. According to the NHFS, patients were divided into two groups: NHFS ≤4 scores group (783 cases) and NHFS＞4 scores group (121 cases). Patients′sex, age, height, weight, ASA grade, preoperative diagnosis, the modes of operation and anesthesia, hospital length of stay, blood loss and urinary volume, blood transfusion, using vasoactive agents, living in an institution, preoperative nurse, post-operative complications were compared. The relationship between preoperative NHFS and postoperative complications were analyzed. Results There were no significant differences between the two groups in height, weight and blood loss (P＞0.05), and 24 patients were transferred to the intensive care unit for further treatment after the operations, and 5 patients were dead during hospital stays. Compared with those in the patient of NHFS≤4 scores group, the post-operative length of stay and total hospital length of stay were significantly prolonged (P＜0.05) in the patients of NHFS＞4 scores group. Between the two groups, there were significant differences in the proportion of the male gender, body mass index, age, living in an institution, ASA grade Ⅲ- Ⅳ, proportion of fracture, the mode of anesthesia, urinary volume, proportion of blood transfusion and using vasoactive agents (P＜0.05). Postoperative renal insufficiency, pulmonary infection, heart failure or myocardial infarction, arrhythmia, deep vein thrombosis (DVT), acute cerebral infarct, electrolyte disturbance, hypoxemia, delirium, further intensive care unit treatment had significant differences between the two groups (P＜0.05). Conclusions Postoperative complications are more likely to occur in patients with higher NHFS, which might delay the postoperative length of stay and total hospital length of stay, and lead to further treatment in the intensive care unit or even mortality after the operation.

Phenotype and distribution of infiltrating lymphocytes in liver cancer tissues / 中国肿瘤临床

Objective:To identify the signature of tumor-infiltrating lymphocyte (TIL) subtypes that may affect cytokine expres-sion between different outcomes of hepatocellular carcinoma (HCC) patients by analyzing the CD molecular expression profiles of non-cancerous hepatic tissues. Methods:Surface markers of TIL in noncancerous hepatic tissues from 146 HCC patients were determined by using immunohistochemical method and flow cytometry. Univariate and multivariate Cox proportional hazards models and Kaplan-Meier method were used to analyze the association of their expression levels with tumor recurrence and survival. Results:More than 86.4%of TILs in patients were quiescent, as measured via CD4+or Foxp3 expression. Meanwhile, more than 90%of CD3+T cells ex-pressed CD8+. The proportion of T cells was low compared with CD8+T cells. The proportion of CD19 and CD20 in distant nontumor tissues almost was zero. The proportion of T cell subgroups isolated from HCC circulating whole blood did not show a significant shift compared with the normal control, as follows:CD4+T/CD8+T=1.167 ± 1.04, CD8+T/CD3+T=0.288 ± 0.116, and CD4+T/CD3+T=0.429 ± 0.178. The proportion of CD8+T cells in noncancerous hepatic tissues was higher than that in blood (P<0.001).Conclusion:TILs in HCC noncancerous hepatic tissues are increased and contain a subpopulation of CD3+CD8+T cells. CD8+T cells in cancerous tissues, rather than noncancerous tissues, show significant differences between different prognostic groups.