Association between Preoperative Long-Chain Polyunsaturated Fatty Acids and Oxidative Stress Immediately after Total Knee Arthroplasty: A Pilot Study

Quadriceps muscle atrophy following total knee arthroplasty (TKA) can be caused by tourniquet-induced ischemia–reperfusion (IR) injury, which is often accompanied by oxidative stress and inflammatory responses. n-3 long-chain polyunsaturated fatty acids (LCPUFAs), such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), exert antioxidant and anti-inflammatory effects against IR injury, whereas n-6 LCPUFAs, particularly arachidonic acid (AA), exhibit pro-inflammatory effects and promote IR injury. This study aimed to examine whether preoperative serum EPA + DHA levels and the (EPA + DHA)/AA ratio are associated with oxidative stress immediately after TKA. Fourteen eligible patients with knee osteoarthritis scheduled for unilateral TKA participated in this study. The levels of serum EPA, DHA, and AA were measured immediately before surgery. Derivatives of reactive oxygen metabolites (d-ROMs) were used as biomarkers for oxidative stress. The preoperative serum EPA + DHA levels and the (EPA + DHA)/AA ratio were found to be significantly negatively correlated with the serum d-ROM levels at 96 h after surgery, and the rate of increase in serum d-ROM levels between baseline and 96 h postoperatively. This study suggested the preoperative serum EPA + DHA levels and the (EPA + DHA)/AA ratio can be negatively associated with oxidative stress immediately after TKA.     

Association of Social Behaviors With Community Discharge in Patients with Total Hip and Knee Replacement

ObjectivesUnderstand the association between social determinants of health and community discharge after elective total joint arthroplasty.DesignRetrospective cohort design using Optum de-identified electronic health record dataset.Setting and ParticipantsA total of 38 hospital networks and 18 non-network hospitals in the United States; 79,725 patients with total hip arthroplasty and 136,070 patients with total knee arthroplasty between 2011 and 2018.MethodsLogistic regression models were used to examine the association among pain, weight status, smoking status, alcohol use, substance disorder, and postsurgical community discharge, adjusted for patient demographics.ResultsMean ages for patients with hip and knee arthroplasty were 64.5 (SD 11.3) and 65.9 (SD 9.6) years; most patients were women (53.6%, 60.2%), respectively. The unadjusted community discharge rate was 82.8% after hip and 81.1% after knee arthroplasty. After adjusting for demographics, clinical factors, and behavioral factors, we found obesity [hip: odds ratio (OR) 0.81, 95% confidence interval (CI) 0.76–0.85; knee: OR 0.73, 95% CI 0.69–0.77], current smoking (hip: OR 0.82, 95% CI 0.77–0.88; knee: OR 0.90, 95% CI 0.85–0.95), and history of substance use disorder (hip: OR 0.55, 95% CI 0.50–0.60; knee: OR 0.57, 95% CI 0.53–0.62) were associated with lower odds of community discharge after hip and knee arthroplasty, respectively.Conclusions and ImplicationsSocial determinants of health are associated with odds of community discharge after total hip and knee joint arthroplasty. Our findings demonstrate the value of using electronic health record data to analyze more granular patient factors associated with patient discharge location after total joint arthroplasty. Although bundled payment is increasing community discharge rates, post-acute care facilities must be prepared to manage more complex patients because odds of community discharge are diminished in those who are obese, smoking, or have a history of substance use disorder.     

层次分析法在确定医疗设备维护优先级中的应用研究

目的:运用层次分析法(AHP)确定医疗设备维护中的优先级,增加医疗设备的可用性并降低维护成本。方法:采用AHP对医疗设备标准、子标准和等级进行评定获取其关键评分,基于多标准决策方法确定医疗设备维护的优先级,对选定设备进行评估,以准分子激光器和视力计为例,根据其标准权重、子标准权重和强度计算其总评分,确定维护优先级。结果:医疗设备维护的优先顺序由医疗设备评分的评估结果决定,医疗设备风险是医学技术人员在确定医疗设备维护优先级时的最重要标准。准分子激光器和视力计的关键评分权重分别为0.877和0.373,准分子激光器相比视力计在设备维护方面具有更高的优先级。结论:医疗设备维护优先级评估模型能确定医疗设备维护优先级,根据优先级规模规划医疗设备维护方案,以使资源更多地集中于具有高和中关键度的医疗设备。     

分析核磁共振技术诊断膝关节损伤的临床效果

目的:研究关于核磁共振技术对膝关节损伤进行诊断的临床诊断效果和价值。方法:本文调查时间选择2019年1月~2020年1月,将在此期间到本院接受膝关节损伤治疗的35例患者作为研究对象,分别对所有患者选择采用核磁共振技术和CT诊断技术行膝关节损伤的诊断,并分析比较两种不同诊断方法诊断的效果和价值。结果:经过比较分析可以得出,应用核磁共振诊断技术对膝关节损伤进行诊断的准确率明显高于CT诊断手段,两组数据进行统计学分析比较,P<0.05,存在统计学差异性。结论:通过核磁共振技术对膝关节损伤进行诊断能够有效地提升诊断的准确率,可以实现对于各类损伤类型的诊断,可以及时地帮助患者提供相关的治疗依据。     

Impact of Sarcopenia and Obesity on Gait Speed After Total Knee Replacement

ObjectivesOlder adults with sarcopenic obesity have a higher risk of experiencing mobility difficulty. Additionally, sarcopenia and obesity are closely associated with knee osteoarthritis. This study investigated the associations of sarcopenia, obesity, and in combination of both with walking disability during postoperative rehabilitation in older adults with knee osteoarthritis who underwent total knee replacement.DesignA retrospective cohort study.Setting and ParticipantsFrom a rehabilitation center database, we retrospectively selected and investigated 482 older patients with knee osteoarthritis who had undergone total knee replacement and received postoperative rehabilitation.MethodsSarcopenia was identified in accordance with the diagnostic criteria established by the Asian Working Group for Sarcopenia and obesity was defined as body mass index ≥ 30 kg/m². Accordingly, patients were classified into four body composition groups, namely sarcopenic obese, sarcopenic, obese, and normal (reference group). After total knee replacement, all patients attended monthly follow-up admission during the postoperative rehabilitation. Gait speed was measured before surgery and monthly after total knee replacement. A gait speed cutoff of 1.0 m/s was used to identify postoperative walking disability. Kaplan–Meier curve analysis was performed to measure the probability of experiencing postoperative walking disability among the groups. Cox multivariate regression models were established to calculate the hazard ratios of postoperative walking disability.ResultsCompared with the reference group, the sarcopenic, obese, and sarcopenic obese groups appeared to have a higher probability of experiencing postoperative walking disability (all P < .001). The sarcopenic obese group were likely to have the highest risk of experiencing postoperative walking disability (adjusted hazard ratio = 3.89).Conclusions and ImplicationsSarcopenia or obesity alone may independently exert negative effects on postoperative gait speed. The participants with sarcopenic obesity were likely to have the highest risk of experiencing walking disability following total knee replacement. The findings may serve as a reference for clinicians developing rehabilitation strategies to optimize walking ability after total knee replacement, especially those preoperatively diagnosed as having sarcopenic obesity.     

透明质酸钠关节内注射治疗膝骨性关节炎

目的　观察透明质酸钠注射液对膝骨关节炎的疗效。方法　关节内注射透明质酸钠 2ml,每周一次 ,5周一疗程 ,疗程结束后连续随诊一年半以上。结果　疗程结束时总有效率为 92 7% ,随访过程 82 %患者无疼痛、肿胀、渗出等症状复发。结论　透明质酸钠可有效地抑制膝骨关节炎患者的肿胀、渗出、疼痛等症状     

全膝关节置换术后持续被动运动的临床应用研究

目的　评价全膝关节置换术后持续被动运动（ＣＰＭ）的临床应用价值。方法将１９例患者共２４个全膝置换关节随 机分成两组。ＣＰＭ治疗组１４个膝关节于术后第３天开始治疗。非ＣＰＭ治疗组１０个膝关节作为对照。结果两周后 ＣＰＭ治疗组膝关节主动屈曲度平均达到９４．６２度,比对照组大２３．３７度。结论　全膝关节置换术后ＣＰＭ治疗,可使膝关 节屈伸功能明显提高。     

The effect of cardiovascular morbidity on clinical response provided by tadalafil in patients with erectile dysfunction

We aimed to investigate the association between erectile dysfunction and severity of cardiovascular morbidity and to assess clinical responses to tadalafil of patients in different cardiovascular risk groups. Between November 2019 and August 2020, a total of 258 male patients aged 45–70 years with ED were included. They were divided into three groups according to the Framingham risk score: low-risk (n: 86, 33.3%), intermediate-risk (n: 103, 39.9%) and high-risk (n: 69, 26.8%). At admission, all domains of the International Index of Erectile Function score were worse in high-risk group compared to other risk groups (p < .001). After a 12-week follow-up, a more significant improvement was observed in all domains of erectile function in all risk groups, but high-risk group had lower sexual scores (p < .001). The lowest rate for complete responsiveness to tadalafil was observed in the high-risk group (37.7%). The rate of failure in complete responsiveness was found to be 4.127 times greater with higher Framingham score and 3.102 times greater with higher erectile dysfunction severity at admission. Our preliminary findings show that more severe sexual disorders are observed in high-risk patients with cardiovascular morbidity. Individualised treatment may be important in high-risk group since they may benefit less from tadalafil, and failure in complete responsiveness can be more common in this group.