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The psychological distress of cancer patients seriously affects their therapeutic effects. Effective psychological rehabilitation of cancer patients significantly improves their survival chance and quality of life. Circadian rhythm results from adaptation to the environment during the organism's evolution. When the endogenous clock system is disrupted or the external environment is changed, the body and the environment are out of synchronization, and the circadian rhythm will be disrupted. Circadian rhythm disorder is a common phenomenon in cancer patients, and the changes of circadian rhythm are closely related to their psychological distress. Many studies believe that the circadian rhythm disorder of cancer patients may directly or indirectly affect their psychology through various mechanisms, and targeted intervention by regulating the circadian rhythm of patients may be an essential means to promote the psychological rehabilitation.
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Humanos , Qualidade de Vida , Ritmo Circadiano/fisiologia , Transtornos Cronobiológicos , NeoplasiasRESUMO
Objective:To investigate the effects of tranexamic acid on the drainage duration after primary unilateral total knee arthroplasty (TKA).Methods:From June 2017 to December 2018, a total of 182 patients (42 males and 140 females) who underwent primary TKA were included. The age of patients was 68.1±7.1 years (60-76 years). According to the random number table, the subjects were divided into four groups: 45 cases in tranexamic acid group 1 (TXA1), 46 cases in tranexamic acid group 2 (TXA2), 46 cases in tranexamic acid group 3 (TXA3) and others in none tranexamic acid group (NTXA). The patients in TXA1-3 groups received intravenous infusion combined with local application of tranexamic acid. The patients in NTXA group were locally perfused in the joint cavity with 100 ml normal saline after surgery. The drainage volume, total blood loss, invisible blood loss, degree of postoperative joint swelling, Hospital for Special Surgery (HSS) and visual analogue scale (VAS) of pain were compared among the four groups.Results:The postoperative drainage volume of TXA1-3 groups was 85.5±34.3 ml, 189.4±72.3 ml and 215.3±93.4 ml, respectively, which were less than that of the NTXA group (351.3±113.5 ml) with significant difference ( F=11.5, P=0.005). The postoperative drainage volume of TXA1 group was less than that of TXA2-3 groups. The total postoperative blood loss was 699.0±255.7 ml, 710.4±296.1 ml, and 715.8±248.2 ml in the TXA1-3 groups, respectively, which were less than that of the NTXA group (1 130.5±354.2 ml) with significant difference ( F=13.1, P=0.001). At the 4th day after TKA, the knee swelling degree of TXA1-3 groups was 1.25±0.07, 1.13±0.12, and 1.12±0.13, respectively, which were less severe than that of the NTXA group (1.43±0.22) with significant difference ( F=8.23, P=0.015). There were 2 cases with positive bacterial culture in NTXA group and TXA3, 3 cases with hematoma and 1 case with delayed wound healing in the NTXA group. Conclusion:The application of tranexamic acid after TKA can reduce postoperative drainage volume, latent blood loss and total blood loss. The removal of the drainage at 18 h after the operation can not only drain completely, relieve pain and promote knee joint function, but also effectively reduce the risk of infection associated drainage.
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BACKGROUND: More and more attention has been paid to the role of subchondral bone changes in knee osteoarthritis. However, previous studies mainly focused on animal experiments. Animals and humans have certain differences, so it is very necessary to obtain relevant data directly in human joints. OBJECTIVE: To evaluate the difference of subchondral plate and subchondral bone ultrastructure between normal patients and patients with knee osteoarthritis by CT technique, so as to explore the role of subchondral bone in the occurrence and development of knee osteoarthritis. METHODS: CT scan data of 30 patients with knee osteoarthritis (knee osteoarthritis group) and 30 patients without knee osteoarthritis (non-knee osteoarthritis group) were collected from the Department of Imaging of Zhengzhou Orthopedic Hospital from July 2016 to July 2018. Subchondral plate and subchondral bone ultrastructure of medial and lateral tibial plateau was compared between the two groups using MIMICS software. This study was approved by the Ethics Committee of Zhengzhou Orthopedic Hospital on June 10, 2016 (approval No. 2016 004). RESULTS AND CONCLUSION: (1) Compared with the non-knee osteoarthritis group, bone density was significantly increased and porosity was significantly decreased in the subchondral bone plate in the knee osteoarthritis group in both the lateral and medial parts, while the medial part of subchondral bone plate thickness was significantly thicker than that in the non-knee osteoarthritis group. (2) There were also significant changes in subchondral trabeculae in the knee osteoarthritis group, which showed that the thickness of subchondral trabeculae in the lateral part and the medial part of the subchondral bone in the knee osteoarthritis group was significantly increased compared with the non-knee osteoarthritis group. Meanwhile, in the medial part, the degree of cancellous bone separation in the knee osteoarthritis group was significantly lower than that in the non-knee osteoarthritis group. Structure model index and connectivity density in the knee osteoarthritis group were significantly lower than those of the non-knee osteoarthritis group. (3) Results show that the change of tibial subchondral bone plate and subchondral cancellous bone in knee osteoarthritis patients mainly lies in the destruction of ultrastructure homeostasis. This change may be one of the causes of knee osteoarthritis.
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Objective:To provide a scientific basis for reducing the rate of invalid ambulance attendance and the establishment of grades dispatch system through a retrospective analysis of the invalid ambulance attendance in prehospital emergency care.Methods:The data of the invalid ambulance attendance was collected in Huazhong University of Science and Technology Union Shenzhen Hospital (the only tertiary hospital of in Nanshan District) from 2014 to 2018, and the reasons of the invalid ambulance attendance, the time period during the invalid ambulance attendance occurred (every 3 hours was divided into one time period), and the reasons of ambulance calling were statistically analyzed.Results:① The invalid ambulance attendance rates showed a fluctuating decrease trend year by year from 2014 to 2018, the rates were 31.22% (2 515/8 055), 26.94% (2 147/7 970), 29.80% (2 398/8 046), 25.69% (1 844/7 177) and 21.89% (1 686/7 703), respectively. The total invalid ambulance attendance rate was 27.19% (10 590/38 951) in the five years. ② The top three reasons for the invalid ambulance attendance were cancelled calls, departure before the ambulance arrived, and going to hospital by themselves, accounting for 36.87%, 25.08%, and 17.03%, respectively. The constituent ratios of the causes of invalid ambulance attendance in each year were different with statistical significance (χ 2 = 217.626, P < 0.001). ③ The top three time period of invalid ambulance attendance occurred at 21:00-23:59, 18:00-20:59 and 09:00-11:59, accounting for 16.86%, 14.95% and 13.54%, respectively. There was no statistical significance in the distribution of time period in each year (χ 2 = 32.571, P = 0.252). ④ The top five reasons for ambulance calling of invalid ambulance attendance were fainting/syncope, trauma, alcoholism, traffic accident injuries, and brawls, accounting for 20.13%, 15.67%, 9.97%, 8.64%, and 6.45%, respectively, and there was statistically significant difference in the distribution of the reason for ambulance calls in each year (χ 2 = 194.213, P < 0.001). Conclusion:The invalid ambulance attendance rate is high in Nanshan District of Shenzhen. Improving the professional level and triage ability of the dispatchers, improving the system construction of prehospital emergency care system and increasing social education are conducive to reduce invalid ambulance attendance rate.
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Acoustic resolution photoacoustic microscopy (ARPAM) combines the advantages of high optical contrast, and high ultrasonic spatial resolution and penetration. However, in photoacoustic microscopy (PAM), the information from deep regions can be greatly affected by the shallow targets, and most importantly, the irreconcilable conflict between the lateral resolution and depth of fields has always be a major factor that limits the imaging quality. In this work, an ARPAM system was developed, in which a non-coaxial arrangement of light illumination and acoustic detection was adopted to alleviate the influence of the tissue surface on the deep targets, and a novel focal zone integral algorithm was applied with multiple axial scanning to improve the lateral resolution. Phantom experiment results show that, the build system can maintain a consistent high lateral resolution of 0.6 mm over a large range in axial direction, which is close to the theoretical calculations. The following tumor imaging results on nude mice indicate that, the proposed method can provide more in-depth information compared with the conventional back detection ARPAM method. With the development of fast repetition lasers and image scanning technologies, the proposed method may play an important role in cerebral vascular imaging, cervical cancer photoacoustic endoscopic detection, and superficial tumor imaging.
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Objective To discuss the treatment of periprosthetic femoral fractures (PFF) with unstable prosthesis by replacement of long-stem femoral prosthesis and internal fixation.Methods From December 2005 to December 2014,15 PFF patients with unstable prosthesis (15 hips) following were treated at our department.They were 10 men and 5 women,aged from 64 to 89 years (mean,76.2 years).Their primary surgeries included total hip arthroplasty in 13 cases and biological bi-polar replacement of femoral head in 2.Two prostheses were cement and 13 biological.By Vancouver classification,9 cases were type B2,and 6 type B3.The unstable prostheses in the 15 cases were replaced by long-stem femoral ones,followed by internal fixation.At the last follow-ups,clinical outcome were evaluated by Harris scoring and images of PFF by Beals & Tower criteria.Complications were documented.Results One died 4 months after operation.The other 14 patients were followed up for an average of 4.5 years (from 6 months to 9 years).Fracture union was achieved in 12 cases after an average of 3.9 months (from 3 to 9 months).Nonunion occurred in 2 cases.Imaging evaluation revealed 9 excellent cases,3 good ones and 2 poor ones.The Harris scores at the last follow-up averaged was 82.3 points (from 50 to 100 points).Deep vein thrombosis occurred preoperatively in one case and posterior tibial vein thrombosis occurred in 2 cases respectively on day 3 and day 10 postoperatively.No such complications occurred as malunion,fixation failure,dislocation or prosthesis loosening.Conclusion Satisfactory outcomes can be achieved by replacement of long-stem femoral prosthesis combined with appropriate fixation for treatment of PFF with unstabrosthesis.