Establishment and validation of a nomogram to predict postoperative anemia after total hip arthroplasty.

BACKGROUND: Anemia is a common complication of total hip arthroplasty (THA). In this study, we evaluated the preoperative risk factors for postoperative anemia after THA and developed a nomogram model based on related preoperative and intraoperative factors. METHODS: From January 2020 to May 2023, 927 THA patients at the same medical center were randomly assigned to either the training or validation cohort. The correlation between preoperative and intraoperative risk factors and postoperative anemia after THA was evaluated using univariate and multivariate logistic regression analysis. A nomogram was developed using these predictive variables. The effectiveness and validation for the clinical application of this nomogram were evaluated using the concordance index (C-index), receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). RESULTS: Through univariate and multivariate logistic regression analysis, 7 independent predictive factors were identified in the training cohort: Lower body mass index (BMI), extended operation time, greater intraoperative bleeding, lower preoperative hemoglobin level, abnormally high preoperative serum amyloid A (SAA) level, history of cerebrovascular disease, and history of osteoporosis. The C-index of the model was 0.871, while the AUC indices for the training and validation cohorts were 84.4% and 87.1%, respectively. In addition, the calibration curves of both cohorts showed excellent consistency between the observed and predicted probabilities. The DCA curves of the training and validation cohorts were high, indicating the high clinical applicability of the model. CONCLUSIONS: Lower BMI, extended operation time, increased intraoperative bleeding, reduced preoperative hemoglobin level, elevated preoperative SAA level, history of cerebrovascular disease, and history of osteoporosis were seven independent preoperative risk factors associated with postoperative anemia after THA. The nomogram developed could aid in predicting postoperative anemia, facilitating advanced preparation, and enhancing blood management. Furthermore, the nomogram could assist clinicians in identifying patients most at risk for postoperative anemia.

Early clinical efficacy analysis of enhanced recovery following surgery combined with interscalene brachial plexus block for arthroscopic rotator cuff repair.

To explore the early clinical value of enhanced recovery after surgery (ERAS) with interscalene brachial plexus block (ISB) for arthroscopic rotator cuff repair (ARCR). We enrolled 240 patients who underwent arthroscopic rotator cuff repair, randomly divided into 3 groups (n = 80 each). Groups A, B, and C underwent only surgery, surgery + ERAS, and ISB + surgery + ERAS, respectively. We analyzed the clinical data and postoperative indicators for the 3 patient groups. Group comparisons of clinical data and postoperative indicators revealed no significant differences in clinical characteristics (P > .05). Group C showed superior Visual Analog Scale scores at 0-6 and 6-24 hours postoperatively (P < .05), and the shortest length of hospital stay (LOS) (P < .05). At 6 weeks and 3 months postoperatively, Constant-Murley shoulder score and University of California-Los Angeles scores were better in Groups B and C than in Group A (P < .05). Joint swelling was more common in Group A than in Groups B and C (P < .05) but with no significant difference in the incidence of postoperative stiffness (P > .05). ERAS can relieve postoperative pain, shorten LOS, and help restore shoulder joint mobility, thereby reducing postoperative swelling. ISB + ERAS optimized pain control and allowed a shorter LOS, but had similar effects on early functional recovery and complications.

Testosterone undecanoate supplementation together with human chorionic gonadotropin does not impair spermatogenesis in males with isolated hypogonadotropic hypogonadism: a retrospective study.

Gonadotropin therapy is commonly used to induce virilization and spermatogenesis in male isolated hypogonadotropic hypogonadism (IHH) patients. In clinical practice, 5.6%-15.0% of male IHH patients show poor responses to gonadotropin treatment; therefore, testosterone (T) supplementation can serve as an alternative therapy to normalize serum T levels and promote virilization. However, treatment with exogenous T impairs spermatogenesis and suppresses intratesticular T levels. This retrospective study aimed to determine whether oral testosterone undecanoate (TU) supplementation together with human chorionic gonadotropin (hCG) would negatively affect spermatogenesis in IHH patients compared with hCG alone. One hundred and seven IHH patients were included in our study. Fifty-four patients received intramuscular hCG and oral TU, and 53 patients received intramuscular hCG alone. The median follow-up time was 29 (range: 12-72) months in both groups. Compared with the hCG group, the hCG/TU group required a shorter median time to normalize serum T levels (P < 0.001) and achieve Tanner stage (III and V) of pubic hair and genital development (P < 0.05). However, there were no significant differences in the rate of seminal spermatozoa appearance, sperm concentration, or median time to achieve different sperm concentration thresholds between the groups. In addition, there were no significant differences in side effects, such as acne and gynecomastia, observed in both groups. This study indicates that oral TU supplementation together with hCG does not impair spermatogenesis in treated IHH patients compared with hCG alone, and it shortens the time to normalize serum T levels and promote virilization.

An Assisted Diagnosis System for Detection of Early Pulmonary Nodule in Computed Tomography Images.

Lung cancer is still the most concerned disease around the world. Lung nodule generates in the pulmonary parenchyma which indicates the latent risk of lung cancer. Computer-aided pulmonary nodules detection system is necessary, which can reduce diagnosis time and decrease mortality of patients. In this study, we have proposed a new computer aided diagnosis (CAD) system for detection of early pulmonary nodule, which can help radiologists quickly locate suspected nodules and make judgments. This system consists of four main sections: pulmonary parenchyma segmentation, nodule candidate detection, features extraction (total 22 features) and nodule classification. The publicly available data set created by the Lung Image Database Consortium (LIDC) is used for training and testing. This study selects 6400 slices from 80 CT scans containing totally 978 nodules, which is labeled by four radiologists. Through a fast segmentation method proposed in this paper, pulmonary nodules including 888 true nodules and 11,379 false positive nodules are segmented. By means of an ensemble classifier, Random Forest (RF), this study acquires 93.2, 92.4, 94.8, 97.6% of accuracy, sensitivity, specificity, area under the curve (AUC), respectively. Compared with support vector machine (SVM) classifier, RF can reduce more false positive nodules and acquire larger AUC. With the help of this CAD system, radiologist can be provided with a great reference for pulmonary nodule diagnosis timely.

Risk Analysis for Pathological Changes in Pulmonary Parenchyma Based on Lung Computed Tomography Images.

OBJECTIVE: The purpose of this study is to design a content-based medical image retrieval system, which helps excavate and assess pathological change of pulmonary parenchyma for risks analysis. METHODS: A data set including lung computed tomography images obtained from 115 patients who experienced pathological changes in pulmonary parenchyma is used. Using morphological theory, images are preprocessed and decomposed into groups of pixel blocks (words), which construct vocabulary. A latent Dirichlet allocation (LDA) model is constructed to assess each image for risk analysis with the method of leave-one-out cross-validation. The precision and recall rate are used as the performance assessment criteria. RESULTS: The LDA model generates a relevance rank of retrieval results from high to low. From the top 50 images, precision of identical tissue is 0.76 ± 0.031 and precision of each attribute of pulmonary parenchyma range from 0.776 ± 0.043 to 0.984 ± 0.008. CONCLUSIONS: The study results demonstrate that the proposed LDA model is conductive to lung computed tomography image retrieval and has reliable efficacy on risk analysis about pathological changes of pulmonary parenchyma.

[Quantitative evaluation of the degrees of traditional Chinese medicine qualitative syndromes of osteoporosis].

OBJECTIVE: To establish a quantitative estimate model for diagnosing traditional Chinese medicine (TCM) syndromes of patients with osteoporosis. METHODS: Symptoms and signs of osteoporosis and methodology related to syndrome research were collected by reviewing medical literature. The symptoms and sighs were quantitatively classified into three, two or one category according to a 100-mm visual analog scale. Fuzzy comprehensive evaluation model of TCM qualitative syndromes was performed based on analytic hierarchy process. Then "Hall for Workshop of Metasynthetic Engineering" expert symposium was held on subjects of syndrome quantification method and weight of evaluation indices in different levels for developing the analysis model of common syndromes. For clinical verification, the created models were applied to patients with osteoporosis for discriminating syndromes. Syndrome of each patient was also identified by 8 experts major in integrative medicine treating osteoporosis for comparing the coincidence rate using a self-made clinical questionnaire. RESULTS: Through literature reviewing, symptoms and signs quantification and expert discussing, the authors formed estimate models of essence deficit, qi deficiency, yin deficiency, yang deficiency, and blood stasis. A total of 220 patients with osteoporosis were enrolled and filled the clinical questionnaire. All 8 experts completed and returned the questionnaire (1 760 cases), and 1 545 of them were filled in completely. Experts' opinion on syndrome differentiation was exactly coincidence to estimate model in 611 cases and almost coincidence in 639 cases. The total coincidence rate reached to 94.05%. CONCLUSION: The estimate model for syndrome differentiation of osteoporosis has a high-coincidence rate with the fuzzy evaluation from experts, with good rationality and feasibility, and is worthy of promotion in the clinical study.

[A study of diagnostic criteria for traditional Chinese medicine syndromes in osteoporosis].

OBJECTIVE: To establish diagnostic criteria for common traditional Chinese medicine (TCM) syndromes in osteoporosis. METHODS: Based on the collection and analysis of related medical literature, clinical investigation, and expert discussion, a draft of preliminary diagnostic criteria for the basic syndromes of TCM in patients with osteoporosis was formulated. Then it was used in clinic for verification and revised repeatedly until a formal version of diagnostic criteria was satisfactorily achieved. RESULTS: The basic syndromes listed in the diagnostic criteria for patients with osteoporosis consisted of two parts: qualitative diagnosis and localization diagnosis. Results of qualitative diagnosis showed that the qualitative syndromes included damage of essence, deficiency of vital energy, deficiency of yin, deficiency of yang and blood stasis. The localization diagnosis showed that location of osteoporosis is bone and corresponds to the kidney, and also involves liver, lung, spleen (stomach) and heart. The diagnostic content has established the specific symptoms and the non-specific symptoms during various stages. Each of the above syndromes could be diagnosed according to a specific combination of its corresponding symptoms or signs. The clinical verification results showed that the total matching ratio of qualitative diagnosis was 80.56% between the diagnoses made according to the criteria and the diagnoses acquired from the experts' experience, and the total matching ratio of localization diagnosis was 85.56%. CONCLUSION: The TCM syndrome diagnostic criteria for osteoporosis is generally consistent with TCM clinical practice, worthy of further popularization and application in clinical practice.

[Effect of continuous femoral nerve block in analgesia and the early rehabilitation after total knee replacement].

OBJECTIVE: To evaluate the benefit and safety of continuous femoral nerve block in patients undergoing total knee arthroplasty. METHODS: From December 2008 to August 2009, 80 patients with total knee arthroplasty were randomly divided into two groups, 40 patients in each group. In group A the pain-control was dominanted by continuous femoral nerve block, there were 5 males adn 35 females with an average age of (65.0 +/- 4.2) years old; In group B the pump of vein odynolysis was used, there were 5 males and 35 females with an average age of (64.7 +/- 8.5) years old. The treatment of relieve pain continued for 3 days. The pain of visual analog scale (VAS), sleep condition, early-stage rehabilitation and adverse effects were recorded. RESULTS: The VAS scores of group A was lower than that of group B at 2, 6, 24, 36, 48, 56, 72 h after operation (P < 0.05 or P < 0.01); The sleep condition and early-stage rehabilitation of group A were better than that of group B. The complications of group B occurrenced more than group A; The analgetica of group B were used more than that of group A. CONCLUSION: The continuous femoral nerve block is an effective pain relieve method and is benefical to rehabilitation from total knee arthroplasty early.