Day Surgery, also known as Ambulatory surgery, refers to surgical procedures in which patients are admitted and discharged within 24 hours. In special cases where hospitalization is required, the stay should not exceed 48 hours. The implementation of day surgery offers several advantages, including shorter hospital stays, reduced treatment costs, improved treatment quality, enhanced patient satisfaction, and more efficient allocation of medical resources by hospitals. With the development of surgical techniques, anesthetic technique, and Enhanced Recovery After Surgery (ERAS) protocols, China is now equipped to perform hip and knee joint arthroplasty as day surgeries. This consensus has been formed by reviewing the literature, summarizing successful experiences, following evidence-based medicine principles, and undergoing extensive discussions, editing, and organization by national experts. It is intended to serve as a reference for orthopedic surgeons in their clinical practice. This consensus comprises four main sections: the day surgery implementation model, team building, outpatient screening, perioperative management, post-discharge follow-up, and day surgery quality assessment.
This study aims to clarify the causal relationship between gut microbiota and phenotype indicators of sarcopenia, grip strength and skeletal muscle mass, based on Mendelian randomization (MR) study design.
Methods
According to the data derived from the British Biological Bank database and the published genome-wide association study with available data, the genetic variation of 131 specific intestinal bacteria was selected as the tool variable. The Single Nucleotide Polymorphism (SNP) selection criteria include being significantly associated with gut microbiota at the whole-genome level, mutually independent among SNPs, and having a sufficiently high instrumental variable strength. An instrumental variable is considered sufficiently strong when F>10. The inverse variance method (IVW) was used as the main analysis method, as well as the weighted median method and MR Pleiotropy RESidual Sum and Outlier (MR-PRESSO) method were used as the sensitivity analysis methods, to evaluate the causal relationship among 131 gut microbiota species and grip strength and skeletal muscle mass. The MR-PRESSO method is used to test for horizontal pleiotropy and address heterogeneity.
Results
A total of 324, 976 subjects were included in this study. The number of SNPs ranges from 3 to 22, with a minimum F value of 14.6. The IVW results suggested a causal relationship between the 9 genetically predicted bacterial genera and host grip strength (P<0.05). Among them, Alloprevotella (β=0.012 kg, 95% CI: 0.002, 0.022) and Sellimonas (β=0.014 kg, 95% CI: 0.006, 0.022) showed a positive causal effect, while Olsenella (β=-0.012 kg, 95% CI: -0.023, 0.001) and Paraprevotella (β=-0.014 kg, 95% CI: -0.023, 0.004) showed negative causality. The causal associations between these four gut specific bacteria and host grip strength were statistically different in different MR sensitivity analyses, suggesting that the results were stable and reliable. In addition, a total of 7 genetically predicted gut specific bacterial genera had causal associations with host skeletal muscle mass (P<0.05), among which Eubacterium nodatum group (β=0.069 kg, 95% CI: 0.012, 0.125) showed a positive causal association with host skeletal muscle mass, while Erysipelatoclostridium (β=-0.090 kg, 95% CI: -0.162, 0.019) and Ruminococcaceae UCG011 (β=-0.104 kg, 95% CI: -0.199, 0.010) showed a negative causal association with host skeletal muscle mass. The causal associations between these three specific gut bacteria and host skeletal muscle mass were statistically different in different MR sensitivity analyses, suggesting that the results were stable and reliable. The results of MR-PRESSO suggest that the potential influence of horizontal pleiotropy and heterogeneity may be relatively small.
Conclusion
This study investigated specific gut microbiota have a causal relationship with host grip strength and skeletal muscle mass, such as Alloprevotella, Selemonas, and Eubacterium nodatum group, which have a positive causal relationship with phenotype indicators of sarcopenia, while Olsenella, Paraprevotella, Erysipelatoclostridium and Ruminococcaceae UCG011 have a negative causal relationship with phenotype indicators of sarcopenia, so as to provide theoretical references for elucidating the pathogenesis of sarcopenia and developing new treatment methods.
To investigate the effect of simulated realistic gait training on functional recovery and fear of falling in patients with anterior cruciate ligament injury.
Methods
A prospective selection was conducted on 92 patients with anterior cruciate ligament injury of the knee joint who met the inclusion criteria from January 2018 to December 2020, including 72 males and 20 females, aged (33.254.63) years old. They were randomly divided into an observation group and a control group based on the odd and even numbers of the hospitalization numbers. The observation group had 43 patients and the control group had 49 patients. On the basis of routine rehabilitation exercise, the two groups of patients received simulated reality gait training for 6 months in the observation group. The differences in knee joint mobility, stability, and gait characteristics between the two groups before and after intervention were compared. The TSK-11 and MFES scores were used to evaluate the impact of patients' fear of falling before and after intervention.
Results
After 3 and 6 months of intervention, the knee joint range of motion of both groups of patients increased, and the observation group had a higher range of motion (105.58±14.22 and 126.39±15.66) than the control group (95.69±12.04 and 105.28 ± 11.32) (P<0.05). Compared with the control group, the stability at 3 and 6 months after intervention (Pivotshift test positive rates at 3 and 6 months were 32.56% and 79.07%, respectively; Lachman test 3+positive rates were 48.48% and 81.40%) was higher in the observation group than in the control group (P<0.05); After intervention, the Lysholm scores of both groups of patients significantly increased. At 6 months after intervention, the observation group had (82.53±10.36) higher scores than the control group (75.28±9.34); After intervention, the duration of touchdown on the affected and healthy sides gradually decreased, and compared with the control group, the observation group had a shorter touchdown duration after intervention (P<0.05). The MFES scores of the observation group at 3 and 6 months of intervention were (7.62±1.06 points and 9.58 ± 10.33 points) higher than those of the control group (P<0.05). After 3 and 6 months of intervention, the TSK-11 scores of the observation group were (21.61±3.27 and 18.52±2.36) higher than those of the control group (P<0.05).
Conclusion
Simulated realistic gait training can improve the knee function of patients with acl injury and improve their gait and fear of falling.
Periprosthetic joint infection is a catastrophic complication after joint replacement, and with the rise in the number of joint replacement patients in China, the number of patients with periprosthetic joint infection has also increased, thus making a more accurate diagnosis of periprosthetic joint infection a hot topic of research for orthopedic surgeons. The purpose of this study was to assess the diagnostic value of ESR to C-reactive protein ratio in the diagnosis of patients with periprosthetic joint infections.
Methods
We retrospectively analyzed 81 patients hospitalized from January 2015 to December 2020, with periprosthetic joint infections diagnosed according to the Bone and Muscle Infection Society Infection Diagnosis 2014 Revised criteria. In this study we compared the diagnostic efficacy between the combined application of the ESR to C-reactive protein ratio and the classical diagnostic index ESR to C-reactive protein.
Results
In this study 46 cases were in the aseptic loosening patient group and 35 cases in the periprosthetic joint infection group; 32 men and 49 women; the mean age of patients in the infected and non-infected groups was 64.7 ± 12.2 and 61.8 ± 12.9 years old, respectively. The ESR, C-reactive protein, ESR/C-reactive protein ratio and white blood cell count were higher in the infected group than in the non-infected group. The ESR to C-reactive protein ratio had a sensitivity of 89.1% and specificity of 82.7%, with an AUC of 0.882 significantly higher than that of ESR (AUC, 0.831) and comparable to that of C-reactive protein (AUC, 0.889). The ESR to C-reactive protein ratio had a higher specificity and positive predictive value compared to other indices.
Conclusion
The ESR to C-reactive protein ratio is a new index for the diagnosis of periprosthetic joint infection and helps to accurately differentiate periprosthetic joint infection from aseptic loosening.
To explore and analyze the effect of triple prehabilitation strategy on perioperative motor function, nutritional status and psychological status in patients with degenerative spine scoliosis (DSS).
Methods
A total of 107 patients with degenerative scoliosis who were treated in the Department of Spinal Surgery of our hospital from January 2019 to December 2022 were included as the research objects. The patients in the experimental group were given triple pre-rehabilitation strategy, and the patients in the control group were given routine nursing strategy. Visual Analogue Scale (VAS), Oswestry disability index (ODI) and self-rating anxiety Scale (SAS) were recorded at admission, 1 day before surgery and on the day of discharge SF-36 scores were recorded on the day of admission and discharge. Hemoglobin, albumin, and total protein values were recorded before operation, 1 day after operation and on the day of discharge.
Results
The VAS score and ODI score showed no statistically significant difference between different groups and there was statistically significant difference between different time points (P<0.05). There was interaction between groups and time points. Further analysis of individual effects showed no statistically significant difference between the two groups at admission and before surgery. There were statistically significant differences between the two groups at discharge (P<0.05), and there were statistically significant differences between the control group and the experimental group at each time point (P<0.05). Patient satisfaction also differed significantly between the two groups, with higher satisfaction reported by patients in the experimental group (P<0.05). The repeated measurement design analysis of variance between the experimental group and the control group in the SF-36 score showed no statistical significance between different groups (P>0.05), and there were statistically significant differences between different time points except for physiological functions (P<0.05). There were interactions between groups and time points in physical pain and general health status, but no interactions in other dimensions. In the control group, there were statistically significant differences in physiological function, physical pain, energy, social function, emotional function, and mental health at each time point (P<0.05). There were statistically significant differences in physiological function, physiological function, physical pain, general health status, energy, social function, emotional function, mental health, and health change among the experimental groups at each time point (P<0.05). The main effect of the two groups receiving different treatment strategies was different, and the main effect of nursing strategies was different in different groups. The repeated measurement of hemoglobin, total protein, and albumin contents at admission, immediately after surgery, and at discharge showed no statistical significance between different groups, and statistically significant differences at different time points (P<0.05), except for hemoglobin, there was interaction between groups and time points. There was statistical significance between control group and experimental group at each time point (P<0.05). SAS and SDS scores at admission and discharge showed no significant difference among different groups, but significant difference among different time points (P<0.05). SDS scores interacted with time points. There were statistically significant differences between control group and experimental group at each time point (P<0.05).
Conclusion
The comprehensive nursing of triple prehabilitation strategy has a positive significance in the rehabilitation of postoperative motor function, nutritional status and mental health of patients with degenerative scoliosis, which can be promoted and applied in clinical nursing work.
To systematically evaluate and integrate qualitative studies on the home rehabilitation experience of patients with hip fracture, so as to provide reference for improving the quality of life of patients and constructing home rehabilitation support system.
Methods
Computer search PubMed, Embase, Web of Science, Cochrane Library, SinoMed, CINAHL, Scopus, PsycINFO literature database, CNKI, VIP database, Wanfang database, etc. The search period is up to November 2022.
Results
A total of 15 literatures were included, 58 research results were extracted, 9 new categories were summarized, and 3 integrated results were synthesized, namely, attaching importance to patients' rehabilitation experience and channelling negative emotions; Strengthen the continuous support system to improve patients' awareness of the disease; Improve the personal coping capacity of patients at home so that they can benefit and grow from the illness experience.
Conclusions
There are many obstacles in the process of home rehabilitation of patients with hip fracture after surgery. Nursing workers should attach great importance to the rehabilitation experience and needs of patients, enhance their subjective initiative, personal coping ability and enthusiasm for rehabilitation exercise, so as to restore the ability of daily activities as soon as possible and improve the quality of patients' home activities.
Bone graft materials are subject to various regulatory approval pathways by the FDA (Food and Drug Administration). The expected safety and efficacy of bone grafts may only be clear to FDA reviewers, but difficult for clinical physicians to anticipate. The FDA's regulatory pathways mainly include of four pathways: 510K approval, IDE/PMA (Investigational Device Exemption/Premarket Approval), HTC/P (human cells, tissues, and cellular and tissue-based products), and RMAT (Regenerative Medicine Advanced Therapy). The bone regeneration process involves various growth factors, such as bone morphogenetic proteins-2, 4(BMP-2, 4), fibroblast growth factors, vascular endothelial growth factors, platelet-derived growth factors (PDGF), and insulin-like growth factor-1, etc. Infuse (BMP-2) is a graft material that combines rh-BMP-2 with an absorbable collagen sponge. OP-1 (BMP-7) was approved by the FDA in 2001 to replace autograft in treating recalcitrant long bone nonunions. PDGF-BB materials are made by combining rhPDGF with β-tricalcium phosphate, and were approved by the FDA in 2015 for surgical fusion of ankle. iFactorTM is a peptide-enhanced bone graft material manufactured by adsorbing P-15 onto inorganic mineral matter and hydrogel carriers, which was approved by the FDA in 2005 for anterior cervical discectomy and fusion in single-level procedures. Four products of rhBMP-2 enhanced bone grafts are approved in China. In comparison with foreign countries, there is a significant gap in the variety of products containing growth factors and bioactive factors in China. The medical device of tissue engineering consist of three basic elements of tissue engineering such as carrier, cell, and growth factors, which were combined effectively, and enhance the scientific content and effectiveness and bone grafts and bone graft substitutes.The National Medical Products Administration should refine the approval pathways for bone graft materials containing growth factors and bioactive molecules based on product composition, improve the timeliness of the regulatory process, and enhance translational scientific level.
Osteoarthritis (OA) is a chronic inflammatory joint disease whose pathological changes are mainly degenerative changes of cartilage. The aggravation of social aging makes the incidence rate and disability rate of OA gradually rise, which has become one of the social problems puzzling human health. In recent years, there has been an increased interest in research on the correlation between metabolic abnormalities and OA, and many research results have emerged on the association between metabolic abnormalities and OA. The liver is the core organ of human metabolism, and a series of studies at home and abroad have shown that a large number of patients with OA have abnormal liver enzymology, which plays an important role in the occurrence and development of OA. In this paper, we focus on the role and mechanism of liver enzyme metabolism in the occurrence and development of OA and review the relevant literature.
