Establishment of a Survival Risk Prediction Model for Adolescent and Adult Osteosarcoma Patients.

To build a nomogram model for predicting the survival risk of teens and adults with osteosarcoma based on the TARGET database, patients with osteosarcoma were collected via the TARGET database, and the survival curves of the patients were plotted using the Kaplan-Meier method in SPSS 24.0. Least absolute shrinkage and selection operator (LASSO) univariate regression analysis was performed to identify risk factors that influence osteosarcoma survival. A model (nomogram) for predicting the survival risk of adolescent and adult patients with osteosarcoma was built or plotted using the rms26 package as implemented in R (ver. 3.5.3). The predictive accuracy and discriminating power of the nomogram were determined by the C-index and calibration curves. A total of 94 patients with osteosarcoma were included. Classification of cases based on the tumor site revealed 59 cases involving the femur (62.8%), 5 involving the fibula (5.3%), 6 humerus (6.4%), 2 radius (2.1%), 19 tibia (20.2%), and 3 ulna (3.2%). Classification of cases based on surgical method showed 81 cases involving limb sparing (86.2%), 9 cases of amputation (9.6%), and 4 without surgery (4.2%). Among the 94 cases, bone metastasis occurred in 3 cases (3.2%) and lung metastasis in 14 cases (14.9%). Among all survivors, the median rate of survival is 8.6 years (95% CI: 8.0210.92); the three-year and five-year survival rates are 64.6% and 52.6%, respectively. The LASSO regression analysis showed that metastasis site, definitive surgery, and histologic response were potential risk predictors. The C-index of the nomogram plotted was 0.729, and the C-index of the validated sample was 0.742. The nomogram used in this study allows physicians to objectively and accurately predict the prognosis and survival of osteosarcoma patients. In order to determine whether the method is applicable to other groups of patients, additional studies need to be conducted.

Tranexamic acid safely reduces hidden blood loss in patients undergoing intertrochanteric fracture surgery: a randomized controlled trial.

PURPOSE: To investigate the efficacy and safety of intravenous tranexamic acid (IV-TXA) in patients undergoing intertrochanteric fracture surgery. METHODS: A total of 122 patients were included in this double-blinded trial and equally randomized to receive 1 g of IV-TXA or normal saline 10 min before incision and 3 h later. The primary efficacy outcome was calculated hidden blood loss (HBL). The secondary efficacy outcome was allogeneic erythrocyte transfusion rate during hospitalization. Safety outcome was a composite of thromboembolic events including deep venous thrombosis (DVT) up to 90 days. A meta-analysis combining this study with previous randomized controlled trials in hip fracture surgery (total sample size: 1112 patients) was also conducted. RESULTS: The mean HBL in TXA group (640.96 ± 421.63 ml) was significantly lower than that in placebo group (1010.11 ± 398.96 ml, P < 0.001). The rate of erythrocyte transfusions was 29.5% in TXA group and 60.7% in placebo group (P = 0.001). The incidence of thromboembolic events at 90 days was 4.9% in TXA group and 1.6% in placebo group (P = 0.619). The updated meta-analysis showed that IV-TXA significantly reduced erythrocyte transfusion in hip fracture surgery (risk ratio 0.60, 95% confidence intervals 0.53-0.68), and IV-TXA caused no increased risk of thromboembolic events (risk difference 0.01, 95% confidence intervals - 0.02-0.04). CONCLUSION: IV-TXA could effectively reduce the HBL and allogeneic erythrocyte transfusion requirements in patients undergoing intertrochanteric fracture surgery without an increase of thromboembolic events including DVT. TRIAL REGISTRATION: Clinical trials: safety and efficiency of tranexamic acid in hip fracture patients. Date of registration: August 31, 2018. TRIAL REGISTRATION NUMBER: ChiCTR1800018110.

Comparative prospective randomized study of minimally invasive transpiriformis approach versus conventional posterolateral approach in total hip arthroplasty as measured by biology markers.

BACKGROUND: Minimally invasive surgery is becoming increasingly common, but evidence of the advantages of the minimally invasive transpiriformis approach in total hip arthroplasty is limited. Therefore, our single-centre randomized controlled trial evaluated the benefits of this approach versus the posterolateral approach. METHODS: Forty-nine patients undergoing the minimally invasive transpiriformis approach and 57 patients undergoing the posterolateral approach total hip arthroplasty were analyzed. The operative time, length of hospital stay, incision length, and peri-operative data related to the surgery were recorded. In both groups, serum CRP, IL-6, HGb, Hct, MB, CK-MB, and CK levels, Harris hip scores, and VAS scores were recorded. RESULTS: Patients who underwent the minimally invasive transpiriformis approach had a smaller surgical incision (9.10 ± 0.94 vs. 15.56 ± 1.20 cm, P = 0.00) and shorter hospital stay (6.20 ± 1.54 vs. 12.26 ± 2.97 days, P = 0.00) than those who underwent the posterolateral approach. Serum levels of CRP, IL-6, MB, CK-MB, and CK were also lower. According to the Harris hip score, the minimally invasive transpiriformis group showed significant improvement at one week and one month after surgery. CONCLUSION: Compared to the posterolateral approach, the minimally invasive transpiriformis approach for total hip arthroplasty provided rapid functional recovery, elicited a significantly reduced post-operative inflammatory response, and caused less muscle damage.