The arthroscopic minimally-invasive technique improves the clinical symptoms and facilitates the functional recovery of the lower limbs in knee joint bone trauma patients.

OBJECTIVE: This study aims to demonstrate the effect of the arthroscopic minimally invasive technique on the clinical symptoms and lower limb functional recovery in knee joint bone trauma patients. METHODS: From January 2015 to January 2020, 150 knee joint bone trauma patients were recruited as the study cohort and divided into two groups according to the different intervention method each patient underwent. The patients in the control group (the CG, n=68) were administered routine treatment, and the patients in the research group (the RG, n=82) were treated using the arthroscopic minimally invasive technique. The postoperative clinical operative indexes and the clinical effectiveness, as well as the intraoperative complications were observed in the two groups. The inflammatory factor levels before and after the surgeries were compared. The Visual Analogue Scale (VAS) was employed to evaluate the pain levels before and after the surgeries, the Hospital for Special Surgery Knee Scores (HSS) were used to assess the knee joint recoveries before and at six months after the operations, and the Fugl-Meyer Assessment Scale (FMAS) was used to determine the lower limb functional recovery before and at six months after the operations. RESULTS: The RG had significantly shorter operation times, lower intraoperative blood losses, shorter average ambulation times, shorter hospital stays, shorter fracture healing times, and smaller incisions than the CG. Postoperatively, the IL-8 and TNF-α levels were significantly lower in the RG than in the CG. The RG exhibited observably lower VAS scores after the operations, as well as evidently higher HSS scores and FMAS scores at six months postoperatively than the CG. In comparison with the CG, the RG had a significantly higher total effective rate and a noticeably lower incidence of postoperative complications. CONCLUSIONS: The arthroscopic minimally invasive technique is effective at treating patients with knee joint bone trauma, and it can promote the surgical recovery of patients and facilitate the functional recovery of the knee joint and the lower limbs.

Characteristics of contrast-enhanced ultrasound for diagnosis of solid clear cell renal cell carcinomas ≤4 cm: A meta-analysis.

Now solid renal tumors ≤4 cm is the most common, especially the subtype of clear cell renal cell carcinoma (ccRCC) of malignant kidney tumors in clinical. However, there is not specific characteristics of contrast-enhanced ultrasound (CEUS) be recommended by the EFSUMB Guidelines in distinguish the essence of the kidney tumor with different sizes. Therefore, this meta-analysis aimed to assess the ability of CEUS to diagnose solid ccRCC (sccRCC) ≤4 cm. We comprehensively searched the Cochrane Library, Embase, PubMed, and Web of Science databases from their inception to 28 July 2020, for studies reporting the CEUS features of sccRCC lesions ≤4 cm. Additional articles were identified through the Chinese National Knowledge Infrastructure database. Studies were selected independently by two investigators and the relevant data were extracted. Discrepancies were resolved via discussion with the senior author. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool, and the sensitivity and specificity of each study were determined and plotted as a receiver operating characteristic curve. Ten studies were included in this meta-analysis. Hyperenhancement showed medium sensitivity (67%-89%) and specificity (42%-75%) for diagnosing sccRCC ≤4 cm, fast-in contrast agent and heterogeneous enhancement showed high diagnostic abilities (area under curve (AUC) 0.74-0.84), but the presence of a pseudocapsule and fast-out contrast agent had poor diagnostic ability (AUC <0.70). The combination of hyperenhancement and iso-enhancement showed high sensitivity (98%) for diagnosing sccRCC ≤4 cm. Hyperenhancement, fast-in contrast agent, and heterogeneous enhancement may be specific features that could help to identify sccRCC ≤4 cm, while the presence of a pseudocapsule and fast-out of contrast agent may have low diagnostic values. The combination of multiple indexes may improve the diagnostic value of CEUS for sccRCC ≤4 cm.

Clinical application of auricular point sticking in perioperative hemostasis for elderly patients with intertrochanteric fractures of the femur.

We investigated the clinical application of auricular point sticking (APS) combined with tranexamic acid in perioperative hemostasis in elderly patients with intertrochanteric fractures of the femur.This is a prospective cohort study, and we analyzed 86 elderly patients with intertrochanteric fractures of the femur who underwent closed reduction and internal fixation with proximal femoral nail antirotation (PFNA) between January 2016 and December 2016. The patients were divided into auricular point combined with tranexamic acid group (APS group, n = 43) and tranexamic acid alone group (Control group, n = 43). APS was performed for patients using Vaccaria seeds 1 to 2 days before the operation. The 4 acupoints of hemostasis, including spleen, diaphragm, pituitary, and adrenal gland, as well as acupoint of hip joint, were selected. Routine treatment was performed using tranexamic acid alone in the control group. Blood transfusion, intraoperative, postoperative, and total blood loss were compared between the 2 groups.This study enrolled 36 males and 50 females aged 71 to 93 years (average age: 78.5 years). There were no significant differences in gender, age, height, weight, preoperative hematocrit level, fracture classification, operative time, and hospitalization stay (P > .05). Total blood loss was lower in the APS group than the control group (244.26, 197.87-258.50 ml vs 533.94, 424.00-598.09 ml, P < .01). The blood transfusion rate was 14.0% in the APS group and 34.9% in the control group (P = .02).APS can reduce perioperative bleeding and decrease the need for blood transfusion in elderly patients with intertrochanteric fractures of the femur. This noninvasive method can be applied clinically. Randomized trials may be needed to confirm the findings.

Clinical research of goal-directed fluid therapy in elderly patients with radical resection of bladder cancer.

OBJECTIVE: The aim of this study is to investigate the clinical effect of goal-directed fluid therapy in elderly patients with radical resection of bladder cancer. MATERIALS AND METHODS: Seventy-six elderly patients with radical resection of bladder cancer were selected from October 2012 to October 2014 and randomly divided into two groups, in which 38 patients received routine treatment as the control group and 38 patients received goal-directed fluid therapy based on routine treatment as the observation group. The treatment effect was compared between two groups. RESULTS: The cardiac index, stroke volume variability, mean arterial pressure, central venous pressure, central venous oxygen saturation, oxygen supply index, oxygen consumption index, and oxygen uptake rate in observation group were distinctly higher than those in control group at T1, T2, T3, and T4 while the artery serum lactate and S100-ß were apparently lower than those in control group at T1, T2, T3, and T4. The urine volume and colloidal infusion were obviously elevated when compared with those in control group at T1, T2, T3, and T4 while the crystalloid infusion volume, total liquid infusion volume, hospitalization time, and expenses were significantly less than those in control group; further, similar tendency was also found regarding the complication incidences of nausea, vomiting, or hypotension in observation group. The postoperative flatus and postoperative food-taking times were visibly earlier than those in control group (both P < 0.05). CONCLUSION: The goal-directed fluid therapy is beneficial for stabilization of hemodynamic status and maintenance of oxygen balance of supply and demand, and it is worthy of clinical expansion for good microcirculation perfusion, reduction in therapeutic time and expenses of patients, and less complications and superior security.

Effect of sevoflurane on the ATPase activity of hippocampal neurons in a rat model of cerebral ischemia-reperfusion injury via the cAMP-PKA signaling pathway.

We aim to investigate the effects of sevoflurane on the ATPase activity of the hippocampal neurons in rats with cerebral ischemia-reperfusion injury (IRI) via the cyclic adenosine monophosphate (cAMP) and protein kinase A (PKA) signaling pathway. Sixty rats were assigned into the normal, model and sevoflurane groups (n = 20, the latter two groups were established as focal cerebral IRI models). The ATPase activity was detected using an ultramicro Na (+)-K (+)-ATP enzyme kit. Immunohistochemical staining was used to detect the positive protein expression of cAMP and PKA. The hippocampal neurons were assigned to the normal, IRI, IRI + sevoflurane, IRI + forskolin, IRI + H89 and IRI + sevoflurane + H89 groups. qRT-PCR and Western blotting were performed for the expressions of cAMP, PKA, cAMP-responsive element-binding protein (CREB) and brain derived neurotrophic factor (BDNF). The normal and sevoflurane groups exhibited a greater positive protein expression of cAMP and PKA than the model group. Compared with the normal group, the expressions of cAMP, PKA, CREB and BDNF all reduced in the IRI, model and IRI + H89 groups. The sevoflurane group showed higher cAMP, PKA, CREB and BDNF expressions than the model group. Compared with the IRI group, ATPase activity and expressions of cAMP, PKA, CREB and BDNF all increased in the normal, IRI + sevoflurane and IRI + forskolin groups but decreased in the IRI + H89 group. It suggests that sevoflurane could enhance ATPase activity in hippocampal neurons of cerebral IRI rats through activating cAMP-PKA signaling pathway.