Associations between different eGFR estimating equations and mortality for CVD patients: A retrospective cohort study based on the NHANES database

To assess the associations of eGFR_CKD-EPI (estimated glomerular filtration rate (eGFR) by chronic kidney disease epidemiology collaboration equation), eGFR_MDRD (eGFR by modification of diet in renal disease), and serum creatinine (scr) on the death for American people diagnosed with cardiovascular disease (CVD) respectively, and to compare the predicted performance of eGFR_CKD-EPI, eGFR_MDRD, and scr. A total of 63,078 participants who derived from the National Health and Nutrition Examination Survey (NHANES) database, were obtained in this retrospective cohort study, and collected the baseline characteristics all participants. The outcomes of our study were defined as death, and eGFR estimating equations was defined as eGFR_CKD-EPI, eGFR_MDRD, and scr. Univariate and multivariate COX analysis were performed to assess the relationship. A subgroup analysis was conducted based on whether patients had anemia. Simultaneously, we also considered the predictive value of eGFR_CKD-EPI, eGFR_MDRD, and scr in the risk of death. All patients were followed for at most 5-years. After excluded participants who did not meet the inclusion criteria and had missing information, the present study included 2419 participants ultimately, and were divided into alive group (n = 1800) and dead group (n = 619). The mortality rate for CVD patients in this study was approximately 25.59% at the end of follow-up. After adjustment for covariates, the result showed that participants with eGFR_CKD-EPI/eGFR_MDRD < 30 mL/min/1.73 m² or 30 to 45 mL/min/1.73 m² had a higher risk of mortality. Similarly, participants with scr (Q4 ≥ 1.2) were associated with the increased risk of death. Additionally, eGFR_CKD-EPI has a higher predictive value in 1-year, 3-years, and 5-years risk of death among patients with CVD than eGFR_MDRD and scr. The lower level of eGFR was associated with higher risk of death among American population diagnosed with CVD, especially for non-anemic patients. Importantly, our study also displayed that CKD-EPI-based calculation equation of eGFR (eGFR_CKD-EPI) provided for a better predictive value than eGFR_MDRD and scr in the risk of death.     

Identification of a clinical web-based nomogram to predict overall survival in elderly retroperitoneal sarcoma patients: A population-based study

The purpose of this study was to develop a web-based nomogram and risk stratification system to predict overall survival (OS) in elderly patients with retroperitoneal sarcoma (RPS). Elderly patients diagnosed with RPS between 2004 and 2015 were identified in the Surveillance, Epidemiology, and End Results (SEER) database. We used univariate and multivariate Cox analysis to identify independent prognostic factors. We plotted the nomogram for predicting the OS of elderly RPS patients at 1, 3, and 5 years by integrating independent prognostic factors. The nomograms were subsequently validated by receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). By calculating the Nomogram score for each patient, we build a risk stratification model to evaluate the survival benefit of elderly RPS patients. A total of 722 elderly RPS patients were included in our study. The nomogram includes 5 clinicopathological variables as independent prognostic factors: age, histological subtype, grade, metastasis status, and surgery. Through the validation, we found that the nomogram has excellent prediction performance. Then web-based nomograms were established. We performed a web-based nomogram and a risk stratification model to assess the prognosis of elderly RPS patients, which are essential for prognostic clustering and decision-making about treatment.     

Liver Function Derangement in Patients with Severe Fever and Thrombocytopenia Syndrome

Background and AimsPatients with severe fever with thrombocytopenia syndrome (SFTS) commonly show liver function impairment. This study aimed to characterize the liver function indices in SFTS patients and investigate their association with mortality.MethodsClinical information and laboratory results of 459 laboratory-confirmed SFTS patients, including 78 deceased and 381 surviving patients, were retrospectively analyzed. To explore the infectivity of SFTS caused by novel Bunyavirus (SFTSV) in hepatocytes, Huh7 human hepatoma cells were infected with various concentrations of SFTSV in vitro.ResultsThe proportion of SFTS patients developing liver injury during hospitalization was 73.2% (336/459); the hepatocellular injury was the predominant type. The median time to occurrence of liver injury from disease onset was 8 d. Liver injury in the deceased group occurred earlier than that in the surviving group. Alanine aminotransferase (ALT) level between 2–5 times upper limit of normal (ULN) at 4–6 d and between 5–15 ULN at 7–12 d of disease course were independent predictors of mortality. Alkaline phosphatase (ALP) >2 ULN at 7–9 d and elevated ALP at 10–12 days after disease onset were risk factors for death. ALT and aspartate transaminase (AST) levels were correlated with lymphocyte count and platelet-to-lymphocyte ratio (PLR). Total bilirubin (TB), ALT, AST levels showed positive correlation with viral load. In the in vitro experiment, SFTSV infected and replicated inside Huh7 cells.ConclusionsLiver injury is common in SFTS patients. ALT and ALP were independent predictors of SFTS-related mortality. Frequent monitoring and evaluation of liver function indices are needed for SFTS patients.     

A Visible Analysis Approach for Table Tennis Tactical Benefit

Tactics are one of the winning factors in table tennis matches because they can reflect the technical strength and strategies of players. However, the current evaluation method of tactics is relatively simple, and it can be difficult to distinguish the pros and cons of different tactics. To solve these issues, this study used information from 60 matches played by top-25 men’s right-handed shake-hand offensive players as samples and proposed a tactical benefit algorithm and a visible evaluation model to analyse tactical performance. The model could help coaches and players find meaningful tactics quickly and easily and make reasonable comparisons between them. The results showed that 1) the numbers of tactics based on the tactical association-mining model and the L-shaped curve were 37 in the first six strokes. Among them, there were 9 selected tactics in the first to third strokes, the third to fifth strokes, and the second to fourth strokes, respectively, and 10 selected tactics in the fourth to sixth strokes. 2) The visible evaluation model of tactical benefit can determine the difference between the frequency, scoring rate, and benefit of different tactics as mapped into the model as well as quickly and effectively discover the distribution of tactics and measure the advantages and disadvantages of tactics from multiple dimensions. Key points

• The tactical benefit algorithm is the first attempt to measure the tactical features of the first six strokes in the service and receiving rounds based on the combination of the tactical frequency and scoring rate.
• Thirty-seven tactics based on the tactical association-mining model and the L-shaped curve are selected from the first six strokes of table tennis matches.
• The visible evaluation model of tactical benefit can determine the difference between the frequency, scoring rate, and benefit of different tactics.

Key words: Table tennis, tactical benefit, visible evaluation model, first six strokes, performance analysis     

Individual treatment strategy for single urethrocutaneous fistula after hypospadias repair: a retrospective cohort study

BackgroundUrethrocutaneous fistula (UCF) remains the most common complication after hypospadias repair, and the recurrence rate of UCF is still high if the surgical techniques is not chosen properly, which called for better approaches to this problem. UCF presents different clinical characteristics due to their different locations and sizes, therefore we retrospectively analyzed the effects of different surgical techniques on single UCF after hypospadias repair in order to reduce the recurrence rates of UCF.MethodsA total of 602 patients diagnosed with UCF after hypospadias repair from January 2014 to December 2021 were enrolled. Baseline clinical characteristics such as age of patients, UCF location, size, surgical techniques were recorded. Patients were followed up in the outpatient clinic. The recurrence of UCF was defined as outcomes. Patients were divided according to the location of the UCF into a coronal UCF group and a non-coronal UCF group, which was then further classified according to the diameter of the UCF. The surgical technique and the recurrence rate of different types of UCF were analyzed and summarized.ResultsA total of 425 patients satisfied the inclusion criteria and 71 patients (16.7%) had recurrent UCF. Five surgical techniques were used to repair the UCF, namely tubularized incised plate (TIP) urethroplasty, Mathieu urethroplasty, double ligation, simple classical closure and trap-door procedure. The recurrence rate was 24.1%, 14.3%, 15.1%, 16.7%, and 22.2%, respectively. TIP or Mathieu urethroplasty is recommended for patients with coronal UCF with glans dehiscence or patients with coronal UCF diameter ≥4 mm without glans dehiscence. In patients with coronal UCF without glans dehiscence, double ligation is recommended for small UCF with diameter <2 mm, and simple classical closure is recommended for UCF with diameter 2–<4 mm. In patients with non-coronal UCF, double ligation is recommended for UCF with diameter <3 mm, and simple classical closure is recommended for UCF with diameter ≥3 mm.ConclusionsSingle UCF can be classified according to the location and size of the UCF. Different types of UCF should be treated with more appropriate individualized strategies, which can effectively reduce the recurrence rate of UCF.     

Effect of chitosan‐based gel dressing on wound infection,synechia, and granulations after endoscopic sinus surgery of nasal polyps: A meta‐analysis

A meta‐analysis was performed to evaluate the effect of chitosan‐based gel dressing on wound infection, synechia, and granulations after endoscopic sinus surgery of nasal polyps. A systematic literature search until March 2022 incorporated 386 subjects after endoscopic sinus surgery of nasal polyps at the beginning of the study; 187 were using chitosan‐based gel dressing, and 199 were control. Statistical tools like the dichotomous method were used within a random or fixed‐influence model to establish the odds ratio (OR) with 95% confidence intervals (CIs) to evaluate the influence of chitosan‐based gel dressing on wound infection, synechia, and granulations after endoscopic sinus surgery of nasal polyps. Chitosan‐based gel dressing had significantly lower wound infection (OR, 0.48; 95% CI, 0.25–0.92, P = 0.03), and synechia (OR, 0.25; 95% CI, 0.13–0.50, P < 0.001) compared with control in subjects with endoscopic sinus surgery of nasal polyps. However, no significant difference was found in granulations between chitosan‐based gel dressing and control in subjects with endoscopic sinus surgery of nasal polyps. Chitosan‐based gel dressing had significantly lower wound infection, synechia compared with control in subjects with endoscopic sinus surgery of nasal polyps, and no significant difference in granulations. Further studies are required to validate these findings.     

Outcomes of Eight‐Plate Epiphysiodesis for Residual Clubfoot Deformities

ObjectiveThe outcome of congenital clubfoot treatment is still challenging if the feet deformities are not completely corrected. Here we explore a minimal invasive procedure with an eight‐plate implant to correct the residual forefoot adduction deformity after treatment of neglected or relapsed clubfoot.MethodsWe retrospectively reviewed patients with residual forefoot adduction deformity after clubfoot treatment between January 2013 and June 2016. The patients underwent temporary epiphysiodesis of the lateral column of the mid‐foot, which in detail, an eight‐plate was placed on each side of the calcaneocuboid joint. The foot deformities were recorded according to the weight‐bearing radiographic measurements including talo‐first metatarsal angle, calcaneo‐fifth metatarsal angle and medial‐to‐lateral column length.ResultsA total of 13 patients (20 feet) with an average age of 7.8 years old were located with an average duration of 40.8 months follow‐up (range, 28 to 54 months). The average talo‐first metatarsal angle improved from 28.3° (range, 19° to 47°) preoperatively to 8.3° (range, 3° to 18°) and the calcaneo‐fifth metatarsal angle improved from 29.1° (range, 19° to 40°) preoperatively to 8.4° (range, 0° to 21°) at final follow‐up. The mean ratio of the medial‐to‐lateral column length improved from 1.14 ± 0.06 to 1.55 ± 0.09 with statistical significance (t = 3.566; P < 0.001).ConclusionsEight‐plate epiphysiodesis is an easy and effective method for the correction of residual forefoot adduction deformity after clubfoot treatment in growing children without the need of osteotomy.     

Effects of Surgeon Handedness on the Outcomes of Unicompartmental Knee Arthroplasty: A Single Center's Experience

ObjectiveSurgeon handedness has been widely discussed in operative surgery, and could cause clinical discrepancy. However, few studies have reported the effect of handedness on unicompartmental knee arthroplasty (UKA). Based on our clinical observation and case analysis, we aimed to find out the effects of surgeon handedness on UKA.MethodsWe retrospectively studied 94 UKA procedures performed by one right‐handed surgeon from January 2017 to December 2018 at a single medical center. The cases were divided into two groups by operation side (49 L‐UKAs and 45 R‐UKAs). Preoperative demographic data were collected. Imaging parameters (femorotibial and hip‐knee‐ankle angles and tibial‐plateau retroversion) and joint function scores (Knee Society Score [KSS] and Oxford Knee Score [OKS]) were recorded. Patients were followed up regularly and Forgotten Joint Score (FJS) was calculated at the last follow‐up. All data were compared between the two groups with independent‐samples t‐test, and paired t‐test was used for intragroup comparisons.ResultsThe average follow‐up was 26.7 ± 3.2 months. The average patient age was 63.5 ± 9.0 years and the average body mass index was 26.89 ± 3.43 kg/m². There was no significant group difference in any preoperative characteristic. Both the KSS and OKS improved significantly after surgery (p < 0.05). No significant group difference was found between the KSS or OKS at any follow‐up visit. The varus or valgus of tibial component was 3.57 ± 1.42° on the left side and 3.19 ± 1.56° on the right side (p = 0.45). The varus or valgus of femoral component was 7.81 ± 2.43° in patients undergoing L‐UKA and 7.05 ± 2.90° in those undergoing R‐UKA (p = 0.04). No statistical differences were found in outliers of component orientation on both sides. The femorotibial and hip‐knee‐ankle angles improved significantly in both groups, and there was no significant group difference in either lower limb alignment or tibial‐plateau retroversion. The complication rate was 8.16% (4/49) in the L‐UKA group and 6.67% (3/45) in the R‐UKA group. There was no correlation between prosthesis orientation and early joint function score.ConclusionsSurgeon handedness may cause a worse prosthetic orientation on femoral side during surgeon''s non‐dominant UKA, and surgeons should be cautious of bone resection and prosthesis implantation. However, radiographic difference did not bring variations on short‐term clinical outcomes or lower limb alignment.