[Effect of Diurnal Temperature Range on the Number of Residents Hospitalized Due to Stroke in Lanzhou].

Objective To analyze the relationship between diurnal temperature range (DTR) and the hospitalization of stroke in Lanzhou,so as to provide a scientific basis for probing into the mechanism of temperature changes in inducing stroke and formulating comprehensive prevention and control measures for stroke by relevant departments.Methods The information of the patients hospitalized due to stroke in Lanzhou during January 2014 to December 2019 and the air pollutants (PM10,SO2,and NO2) and meteorological data in the same period were collected for statistical analysis.Spearman rank correlation analysis was performed to analyze the correlations between air pollutants and meteorological factors.The distributed lag nonlinear model was adopted to fit the relationship between DTR and the number of stroke inpatients,and three-dimensional diagrams and the correlation diagrams of DTR against stroke risk were established.The stratified analysis was performed according to gender and age (< 65 years and ≥65 years).Results From 2014 to 2019,a total of 92 812 stroke patients were hospitalized in Lanzhou,with a male-to-female ratio of 1.35:1.There was a nonlinear relationship between DTR and the number of stroke inpatients in Lanzhou,which presented a lag effect.The low DTR at 4.5 ℃ had the largest RR value of 1.25 (95%CI=1.16-1.35) for stroke inpatients at a cumulative lag of 18 d.The effect of high DTR (18.5 ℃) on the hospitalization of stroke patients peaked at a cumulative lag of 21 d,with an RR value of 1.09 (95%CI=1.01-1.18).The stratified analysis results suggested that low levels of DTR had greater effects on the hospitalization of male stroke patients and stroke patients <65 years.Conclusions Short-term exposure to different levels of DTR had an impact on the number of stroke inpatients,and low levels of DTR had a slightly greater impact on stroke inpatients than high levels of DTR.Importance should be attached to the protection of males and people aged <65 years at low levels of DTR.

[Air Temperature Affects the Hospital Admission for Cardiovascular Diseases among Rural Residents in Dingxi City].

Objective To explore the effect of air temperature on the hospitalization of rural residents with cardiovascular diseases and its lag effect in Dingxi city. Methods The meteorological data and air pollution data of Dingxi city from 2018 to 2019,as well as the daily hospitalization data of rural residents due to cardiovascular diseases,were collected.The distributed lag non-linear models were employed to analyze the relationship between daily mean air temperature and the number of inpatients with cardiovascular diseases.Meanwhile,stratified analysis was carried out according to gender,age,and disease. Results There was a non-linear relationship between air temperature and the number of hospitalized rural residents with cardiovascular diseases in Dingxi city.The exposure-response curve approximated a bell shape.The curves for different cardiovascular diseases appeared similar shapes,with different temperature thresholds.Low temperature(-7 ℃) and moderately low temperature(0 ℃) exhibited a cumulative lag effect on the number of patients hospitalized with cardiovascular diseases.With a cumulative lag of 7 days at -7 ℃ and 14 days at 0 ℃,the RR values peaked,which were 1.121(95% CI=1.002-1.255) and 1.198(95% CI=1.123-1.278),respectively.With a cumulative lag of 14 days at 0 ℃,the RR values were 1.034(95% CI=1.003-1.077) and 1.039(95% CI=1.004-1.066) for the number of hospitalized patients with ischemic heart disease and heart rhythm disorders,respectively.The cumulative lag effects of moderately high temperature(17 ℃) and high temperature(21 ℃) on ischemic heart disease,heart rhythm disorders,and cerebrovascular disease all peaked on that day.Specifically,the RR values at 17 ℃ and 21 ℃ were 1.148(95% CI=1.092-1.206) and 1.176(95% CI=1.096-1.261) for ischemic heart disease,1.071(95% CI=1.001-1.147) and 1.112(95% CI=1.011-1.223) for heart rhythm disorders,and 1.084(95% CI=1.025-1.145) and 1.094(95% CI=1.013-1.182) for cerebrovascular disease,respectively.There was no cumulative lag effect of air temperature on the number of hospitalized patients with heart failure.In addition,stratified analysis showed that low temperature(-7 ℃) and moderately low temperature(0 ℃) affected the number of hospitalized female patients with cardiovascular diseases,and only moderately low temperature(0 ℃) affected males.The cumulative lag effect of high temperature on females was higher than that on males.Air temperature exhibited a stronger impact on female patients than on male patients. Additionally,the population aged<65 years old was more sensitive to low temperature and high temperature than that aged ≥65 years old. Conclusions Air temperature changes increase the hospitalization risk of rural residents with cardiovascular diseases in Dingxi city,which presents a lag effect.The effects of air temperature on patients hospitalized due to cardiovascular diseases varied among different etiologies,genders,and ages.It is necessary to emphasize on the impact of temperature changes on health in residents,especially for key populations such as females,people aged<65 years old,and those with ischemic heart disease.

[Effect of Air Pollution on Emergency Room Visits for Respiratory Diseases in Lanzhou].

Objective To explore the effect of air pollution on the number of emergency room visits for respiratory diseases in residents at different ages and its seasonal changes in Lanzhou,so as to provide a scientific basis for the early prevention of respiratory diseases in Lanzhou. Methods The daily number of emergency room visits for respiratory diseases in three class A hospitals in Lanzhou from January 1,2013 to December 31,2017,as well as the air pollutants and meteorological data of Lanzhou in the same period,was collected.After controlling the confounding factors including long-term trend of time,meteorological factors and day-of-week effect using a generalized additive model,we analyzed the relationships between air pollutants and the daily number of emergency room visits for respiratory diseases,and explored whether there was a lag effect of air pollutants.Results From 2013 to 2017,the emergency room visits for respiratory diseases in Lanzhou had a total number of 124 871,with an average of 69(1-367)visits per day.The single pollutant model showed that among the six conventional air pollutants monitored in Lanzhou,PM 2.5,PM10,NO2,SO2 and O38h had a lag effect on the number of emergency room visits for respiratory diseases.For every 10 µg/m 3 increase in the concentration of PM2.5 (lag02:t=4.792, P=0.001), PM10 (lag2:t=3.421, P<0.001), NO2 (lag6:t=3.654, P=0.003), SO2(lag06:t=4.712, P<0.001)and O38h (lag07:t=3.021, P=0.012), the number of emergency room visits for respiratory diseases increased by 0.900%(95% CI:0.573%-1.249%), 0.083%(95% CI:0.012%-0.153%), 1.293%(95% CI:0.867%-1.720%), 3.851%(95% CI:2.675%-5.041%)and 0.737%(95% CI:0.129%-1.348%), respectively.For every 1 mg/m3 increase in the concentration of CO(lag0:t=3.564,P<0.001),the number of emergency room visits for respiratory diseases increased by 2.556% (95%CI: 1.493%-3.629%). In gender stratification, PM2.5(male:t=3.124, P=0.019;female:t=3.418, P=0.007), PM10(male:t=2.980, P=0.160;female:t=2.997, P=0.013)and CO(male:t=4.117, P=0.001;female:t=4.629, P<0.001)in winter had stronger effects on the emergency room visits for respiratory diseases in females than that in males, while the effects of NO2(male:t=3.020, P=0.107;female:t=3.006, P=0.128), SO2(male:t=4.101, P<0.001;female:t=3.820, P<0.001)and O38h(male:t=3.660, P=0.022;female:t=3.517, P=0.018)in winter showed an opposite trend.In age stratification, the increase in the daily average concentration of PM2.5(0-14 years old:t=3.520, P=0.008), PM10(0-14 years old:t=3.840, P<0.001), SO2(0-14 years old:t=4.570, P<0.001), CO(0-14 years old:t=4.102, P=0.002)in winter would increase the emergency visits for respiratory diseases in the 0-14-year-old population.The daily average concentration of O38h(0-14 years old:t=4.210, P<0.001;15-64 years old:t=3.807, P=0.001)in summer only affected the visits of the 0-14-year-old and the 15-64-year-old populations, and the air pollutants had no significant effect on the visits of those≥65 years old.The double pollutant model analysis revealed that after introducing 5 other pollutants respectively, PM2.5, PM10, NO2, SO2 and O38h significantly increased the emergency room visits for respiratory diseases, and CO had a more obvious effect than that predicted with the single pollutant model. Conclusion The rises in the concentrations of six air pollutants in Lanzhou will increase the emergency room visits for respiratory diseases, and the patterns vary with different genders, ages and seasons.

Patient's personality predicts recovery after total knee arthroplasty: a retrospective study.

BACKGROUND: Increasing attention to psychological determinants may be useful in identifying patients undergoing total knee arthroplasty who may be at risk for poor postoperative outcome. However, little is known about the relationship between personality as a comprehensive reflection of stable psychological states and outcome after total knee arthroplasty. The purpose of this study was to describe the relationship between patients' diverse personalities and clinical outcomes. METHODS: We recruited 387 patients undergoing primary total knee arthroplasty to complete the Eysenck Personality Questionnaire (EPQ) and collected demographic information before surgery. Prior to and 6 months after surgery, we used two validated functional instruments to assess satisfaction rate-the Short Form Health Survey of 36 questions (SF-36), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS: Neuroticism, especially the classic type, tended to be displayed more frequently by women and younger patients. A statistically significant positive relationship was seen between outcome scores and extraversion levels in rating scales; there was a negative relationship between outcome scores especially from the SF-36 Mental Component Summary (MCS), WOMAC pain scores, and neuroticism subscales scores. Among four types of personality, sanguine patients displayed the best clinical outcomes and melancholic patients the worst. Despite good clinical outcomes, including in pain relief and functional improvement for choleric patients, satisfaction rate was unexpectedly the lowest. CONCLUSIONS: Our results may help clinicians identify patients at risk for poor postoperative clinical outcomes and thus proceed with better communication with patients. Also, our results may indicate conducting individual attention during the perioperative period based on patient personality determined according to the EPQ in order to help attain better recovery.

Effects of combined application of muscle relaxants and celecoxib administration after total knee arthroplasty (TKA) on early recovery: a randomized, double-blind, controlled study.

The purpose of this study was to evaluate the effectiveness of application of muscle relaxants and celecoxib in early recovery after total knee arthroplasty (TKA). One hundred and fifty patients were randomized 1:1:1 to receive either both of muscle relaxants and celecoxib or muscle relaxants alone or placebo for 2 weeks (50 patients in each group). VAS pain scores as primary efficacy, active range of motion, morphine consumption, blood loss, and postoperative complications including postoperative nausea and vomiting (PONV), extremities myasthenia and deep vein thrombosis (DVT) were determined postoperatively. Group A improved better with reduced VAS pain scores compared with another two groups. These results demonstrated that application of muscle relaxants and celecoxib into patients undergoing TKA for 2 weeks postoperative consequently improved their convalescence.

[Antibiotic-loaded cement articulating spacer made by a self-made mold system in the treatment of the infected hip replacement].

OBJECTIVES: To summarize the experience and lessons of the using of antibiotic-loaded cement articulating spacer made by a self-made mold system for the treatment of the infected hip replacement, and to evaluate its efficiency and role in the two-stage revision of infected total hip arthroplasty (THA). METHODS: The patients with infected THA treated with two-stage revision protocol from August 2005 to December 2009 were reviewed. All of the 127 patients were debridement thoroughly and followed by implantation of an antibiotic-loaded cement articulated spacer made by a self-made mold system; Two-stage revisions were not followed until the infection were controlled. Among of them, 106 patients, 107 hips were gotten fully followed up. Evaluations were made for the efficiency of infection control, convenience of making, implanting and removing of the spacers, occurrence of complications, the deal of the special circumstances, the function and satisfaction of the patients. RESULTS: The 107 hips were gotten an average of 34.3 months' (3 - 55 months) follow-up. The infection control rate was 96.3% after the first-stage surgery, the infection control rate was 94.4% at last follow-up after two-stage revisions. The breakage rate of the spacer was 4.7%, dislocation rate was 2.8%, removal of the spacers with difficulty were seen in 15 patients (14.0%). The satisfactory rate of the patients was 93.5%. CONCLUSIONS: Antibiotic-loaded cement articulating spacer made by a self-made mold system is an effective methods for the two-stage revision of the infected hip replacement, characterized by simple, good reproducible, high rates of infection control, better joint function after surgeries, high rate of patients satisfaction and other advantages. And it can decrease the complications, such as the breakage, spacer dislocation of hip joint and difficulty in removal of spacer at the second stage revision. Using of metallic internal fixation or allograft bone combined with spacer does not affect the results of infection controlling.

[A comparative study of the role of two femoral shortening techniques in total hip arthroplasty on patients with Crowe's IV congenital dislocated hips].

OBJECTIVE: To compare proximal femoral resection with transverse subtrochanteric osteotomy in the treatment of Crowe's IV congenital dislocated hip (CDH) with total hip arthroplasty (THA). METHODS: Thirty-six primary hip arthroplasties were performed in patients with Crowe grade IV CDH from April 2003 to October 2007. These patients were divided into two groups, one for proximal femoral resection (n = 20) and another for subtrochanteric osteotomy (n = 16). The leg length discrepancy, rotation center height and Harris score were measured pre- and post-operation to compare the two methods of osteotomy. RESULTS: All surgeries were successfully performed. The average leg discrepancy was 0.6 cm (range from 0 to 1.5 cm) for subtrochanteric osteotomy group and 0.3 cm (range from -1.0 to 1.5 cm) for proximal femoral resection group, there was no significant difference between them (P > 0.05). There were also no statistically significant difference between the two groups in other index. The complication rates were much higher in the proximal femoral resection group. At the latest follow up, the Harris score of subtrochanteric osteotomy group was 90 +/- 6, and the proximal femoral resection group was 83 +/- 8. There was statistical difference between the two groups (P < 0.05). CONCLUSIONS: Although both the femoral shortening techniques can restore the leg length of Crowe IV CDH, the subtrochanteric osteotomy technique has advantage of avoiding the potential complications in the high riding patients (high dislocation > 4 cm).

[Impacted cancellous autograft for reconstructing bone defects of tibial plateau in total knee arthroplasty].

OBJECTIVE: To observe the effects of a newly developed technique to transform the dish-like bone defect into contained bone defect and adopt the cancellous bone obtained from bone cut to make parvula impacted bone graft to repair the bone defect of tibial plateau in total knee arthroplasty (TKA) for osteoarthritis (OA) patients with severe varus or valgus. METHODS: 54 OA patients (74 knees) with severe varus or valgus (> 25 degrees ) received TKA. The average depth of the bone defect at the tibial plateau measured in the operation was 18.23 mm and the average thickness of the bone cut was 9.97 mm. The average depth of the dish-like bone defect left after bone cutting was 8.78 mm and the defect occupied averagely 31.5% of the total section area. The sclerotic bone layer was removed to the depth of the cancellous bone by saw blade or reamer, which made the defect to be contained. Small holes were drilled in the contained bone defect. Fragments 5-8 mm in diameter were made from the cancellous bone osteotomized from the femur and tibia were impacted into the bone defect. The defect was finally covered by a bone slice to make a flat tibial section allowing the tibia prosthesis to be firmly seated on it by routine technique. Follow-up was conducted for 32.2 months on average. RESULTS: The tibial deformity was repaired effectively and reliable support for the prosthesis at the tibia side was provided. Subsequent X ray films showed that no bone defect was seen under the prosthesis and the position of the prosthesis was fine. No autograft resorption and complete radiolucency between the graft and the tibial host bone appeared during the follow-up. The average KSS score raised from 45.6 preoperatively up to 94.5 postoperatively. CONCLUSION: In comparison with other techniques, the impacted autografting technique more effectively reconstructs the bone defects of tibial plateau in TKA. The cancellous bone obtained from the bony end can be used fully, thus over-cutting can be avoided and the mechanical characteristics of the knee joint would not be disturbed.