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BACKGROUND: This study investigated the perioperative outcomes of patients undergoing conversion total hip arthroplasty (THA) after failed peri-hip bone flap grafting (PBFG) and compared them with those patients undergoing primary THA for osteonecrosis of the femoral head (ONFH). METHODS: From January 2010 to December 2021, 163 Chinese patients (163 hips) were treated by conversion THA after failed PBFG (containing 94 patients who had pedicled vascularized iliac bone flap grafting and 69 patients who had pedicled vascularized greater trochanter bone flap grafting), and 178 Chinese patients were treated by primary THA. The preoperative baseline data and perioperative indicators in both groups were compared. RESULTS: In the conversion group, patients had significantly greater blood loss, a longer length of stay, and greater changes in serum hemoglobin than those in the primary THA group (P < 0.05). The operative room time, transfusion volume, calculated blood loss, changes in serum hematocrit, and increased superficial infection (P > 0.05) in the conversion group were greater compared with the primary cohort; however, the difference was not statistically significant. The mean postoperative Harris Hip Scoring System (HHS) of the PBFG group at the one-month follow-up was 81, and the control group had an 82 score. Importantly, subgroup analysis of the PBFG group indicated that there was no significant difference between patients who had prior pedicled vascularized iliac bone flap grafting and pedicled vascularized greater trochanter bone flap grafting (P > 0.05), except for the operative room time (P = 0.032). CONCLUSION: Hip-sparing surgery of ONFH did not make THA more difficult or lead to more peri-operative complications, but increased blood loss and extended hospital stay from a prior PBFG are still notable problems in clinical practice. Thus, it is necessary for surgeons to focus attention on the improvement of the preoperative condition and prepare for any specific intraoperative challenges.
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Osteoarthritis (OA) is a degenerative joint disease caused by chronic inflammation that damages articular cartilage. At present, the treatment of OA includes drug therapy to relieve symptoms and joint replacement therapy for advanced OA. However, these palliatives cannot truly block the progression of the disease from the immunological pathogenesis of OA. In recent years, bone marrow mesenchymal stem cell (BMSC) transplantation has shown great potential in tissue engineering repair. In addition, many studies have shown that BMSC paracrine signals play an important role in the treatment of OA through immune regulation and suppressing inflammation. At present, the mechanism of inflammation-induced OA and the use of BMSC transplantation in joint repair have been reviewed, but the mechanism and significance of BMSC paracrine signals in the treatment of OA have not been fully reviewed. Therefore, this article focused on the latest research progress on the paracrine effects of BMSCs in the treatment of OA and the related mechanisms by which BMSCs secrete cytokines to inhibit the inflammatory response, regulate immune balance, and promote cell proliferation and differentiation. In addition, the application potential of BMSC-Exos as a new type of cell-free therapy for OA is described. This review aimed to provide systematic theoretical support for the clinical application of BMSC transplantation in the treatment of OA.
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BACKGROUND: Concomitant diseases often occur in cancer patients and are important in decision-making regarding treatments. However, information regarding the prognostic relevance of comorbidities for mortality risk is still limited among Chinese gastric cancer (GC) patients. This study aimed to investigate the association between comorbidities and 3-year mortality risk. METHODS: This retrospective study enrolled 376 GC patients undergoing radical gastrectomy at the Affiliated Zhongshan Hospital of Dalian University from January 2011 to December 2019. Demographic and clinicopathological information and treatment outcomes were collected. Patients were divided into low-, moderate- and high-risk comorbidity groups based on their Charlson Comorbidity Index (CCI) and age-adjusted CCI (ACCI) scores. Kaplan-Meier survival and Cox regression analyses were used to examine 3-year overall survival (OS) and mortality risk for each group. RESULTS: The median follow-up time was 43.5 months, and 40.2% (151/376) of GC patients had died at the last follow-up. There were significant differences in OS rates between ACCI-based comorbidity groups (76.56; 64.51; 54.55%, log-rank P = 0.011) but not between CCI-based comorbidity groups (log-rank P = 0.16). The high-risk comorbidity group based on the ACCI remained a significant prognostic factor for 3-year OS in multivariate analysis, with an increased mortality risk (hazard ratio [HR], 1.99; 95% CI, 1.15-3.44). Subgroup analysis revealed that this pattern only held for male GC patients but not for female patients. CONCLUSION: The present study suggested that high-risk comorbidities were significantly associated with a higher mortality risk, particularly in Chinese male GC patients. Moreover, the ACCI score was an independent prognostic factor of long-term mortality.
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Neoplasias Gástricas , Humanos , Masculino , Feminino , Estudos Retrospectivos , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/cirurgia , Fatores de Risco , Prognóstico , ComorbidadeRESUMO
PURPOSE: This study aims to investigate the predictive value of the combined index smni(skeletal muscle index (SMI)-prognostic nutrition index(PNI)) for the postoperative survival of patients with advanced gastric cancer(AGC). METHODS: 650 patients with AGC from two centers (290 cases from the First Affiliated Hospital of Dalian University and 360 points from the Fujian Medical University Union Hospital) were selected as the study subjects based on unified screening criteria. Clinical data, preoperative abdominal CT images, results of hematology-related examinations, tumor-related characteristics, and surgical and follow-up data of the patients were collected and organized. The L3 vertebral level muscle area was measured using computer-assisted measurement techniques, and the skeletal muscle index(SMI) was calculated based on this measurement. The prognostic nutrition index (PNI) was calculated based on serum albumin and lymphocyte count indicators. The Kaplan-Meier survival analysis of data from the First Affiliated Hospital was used to determine that SMI and PNI are significantly correlated with the postoperative survival rate of patients with advanced gastric cancer. Based on this, a novel combined index smni was fitted and stratified for risk. Cox proportional hazards regression analysis was used to determine that the index smni is an independent prognostic risk factor for patients with AGC after surgery. The ROC curve was used to describe the predictive ability of the new combined index and its importance and predictive power in predicting postoperative survival of patients with AGC, which was verified in the data of Fujian Medical University Union Hospital. RESULT: The Kaplan-Meier curve analysis of the combined indicator smni Is clearly associated with long-term survival(3-year OS (P < 0.001) and DSS (P < 0.001)), univariate analysis and multivariate analysis showed that smni was an independent prognostic risk factor, The ROC curve for the first center 3-year OS(AUC = 0.678), DSS(AUC = 0.662) show good predictive ability and were validated in the second center. CONCLUSION: The combined index smni has a good predictive ability for the postoperative survival rate of patients with AGC and is expected to provide a new reference basis and more accurate and scientific guidance for the postoperative management and treatment of patients with AGC.
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Sarcopenia , Neoplasias Gástricas , Humanos , Prognóstico , Avaliação Nutricional , Sarcopenia/complicações , Sarcopenia/diagnóstico por imagem , Estadiamento de Neoplasias , Neoplasias Gástricas/complicações , Neoplasias Gástricas/cirurgia , Estado Nutricional , Estudos Retrospectivos , Gastrectomia/efeitos adversosRESUMO
BACKGROUND AND AIMS: Serum uric acid (SUA) is involved in the development of cardiovascular disease (CVD). However, information on the dose-response relationship between SUA and CVD is limited in the Chinese population. This study aimed to investigate the potential nonlinear dose-response association of SUA with CVD risk in a Chinese population and to explore the effect of sex on these associations. METHODS AND RESULTS: Cross-sectional data, from 6252 Chinese adults aged 30-74 years who participated in the China Health and Nutrition Survey 2009, were stratified by SUA deciles. The 10-year risk of CVD was determined using the Framingham risk score. A restricted cubic spline (RCS) was incorporated into the logistic models to assess the nonlinear relationship between SUA and CVD. Among the participants, 65%, 20%, and 15% had low, moderate, and high 10-year CVD risks, respectively. Compared with the reference SUA strata of 225 to <249 µmol/L, CVD risk was significantly increased at SUA ≥294 µmol/L, with adjusted ORs ranging from 2.39 (1.33-4.33) to 4.25 (2.37-7.65). An increasingly higher nonsignificant CVD risk was found at SUA <225 µmol/L and showed a nonlinear U-shaped association. In the fitted RCS model, an approximate U-shaped association between SUA and CVD risk scores was found in women, but this significant nonlinear relationship was not found in men. CONCLUSION: This study showed that both lower and higher SUA levels were associated with a higher 10-year CVD risk among Chinese adults, forming a U-shaped relationship, and this pattern was particularly pronounced for women.
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Doenças Cardiovasculares , Ácido Úrico , Adulto , Feminino , Humanos , Masculino , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , China/epidemiologia , Estudos Transversais , População do Leste Asiático , Fatores de Risco , Pessoa de Meia-Idade , IdosoRESUMO
Fracture is one of the most common traumatic diseases in clinical practice, and metal plates have always been the first choice for fracture treatment because of their high strength. However, the bone plates have high elastic modulus and do not match the biomechanics of human bone, which adversely affects callus formation and fracture healing. Moreover, the complex microenvironment in the human body can induce corrosion of metallic materials and release toxic ions, which reduces the biocompatibility of the bone plate, and may necessitate surgical removal of the implant. In this study, tantalum (Ta) was deposited on porous silicon carbide (SiC) scaffolds by chemical vapor deposition technology to prepare a novel porous tantalum (pTa) trabecular bone metal plate. The function of the novel bone plate was evaluated by implantation in an animal fracture model. The results showed that the novel bone plate was effective in fracture fixation, without breakage. Both X-ray and microcomputed tomography analysis showed indirect healing by both pTa trabecular bone metal plates and titanium (Ti) plates; however, elastic fixation and obvious callus formation were observed after fixation with pTa trabecular bone metal plates, indicating better bone repair. Histology showed that pTa promoted the formation of new bone and integrated well with the host bone. Therefore, this novel pTa trabecular bone metal plate has good prospects for application in treating fractures.
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Objectives: This study aimed to explore the value of an artificial intelligence (AI)-assisted diagnostic system in the prediction of pulmonary nodules. Methods: The AI system was able to make predictions of benign or malignant nodules. 260 cases of solitary pulmonary nodules (SPNs) were divided into 173 malignant cases and 87 benign cases based on the surgical pathological diagnosis. A stratified data analysis was applied to compare the diagnostic effectiveness of the AI system to distinguish between the subgroups with different clinical characteristics. Results: The accuracy of AI system in judging benignity and malignancy of the nodules was 75.77% (p < 0.05). We created an ROC curve by calculating the true positive rate (TPR) and the false positive rate (FPR) at different threshold values, and the AUC was 0.755. Results of the stratified analysis were as follows. (1) By nodule position: the AUC was 0.677, 0.758, 0.744, 0.982, and 0.725, respectively, for the nodules in the left upper lobe, left lower lobe, right upper lobe, right middle lobe, and right lower lobe. (2) By nodule size: the AUC was 0.778, 0.771, and 0.686, respectively, for the nodules measuring 5-10, 10-20, and 20-30 mm in diameter. (3) The predictive accuracy was higher for the subsolid pulmonary nodules than for the solid ones (80.54 vs. 66.67%). Conclusion: The AI system can be applied to assist in the prediction of benign and malignant pulmonary nodules. It can provide a valuable reference, especially for the diagnosis of subsolid nodules and small nodules measuring 5-10 mm in diameter.
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BACKGROUND: Recently, tranexamic acid (TXA) and epsilon aminocaproic acid (EACA) have been applied in total hip arthroplasty (THA). However, doubts in clinicians' minds about which medicine is more efficient and economical in THA need to be clarified. Therefore, this study compared the efficacy and cost of the intraoperative administration of TXA and EACA per surgery in decreasing perioperative blood transfusion rates in THA. METHODS: This study enrolled patients who underwent THA between January 2019 to December 2020. A total of 295 patients were retrospectively divided to receive topical combined with intravenous TXA (n = 94), EACA (n = 97) or control (n = 104). The primary endpoints included transfusions, estimated perioperative blood loss, cost per patient and the drop in the haemoglobin and haematocrit levels. RESULTS: Patients who received EACA had greater total blood loss, blood transfusion rates, changes in HGB levels and mean cost of blood transfusion per patient (P < 0.05) compared with patients who received TXA. In addition, both TXA and EACA groups had significantly fewer perioperative blood loss, blood transfusion, operation time and changes in haemoglobin and haematocrit levels than the control group (P < 0.05). Cost savings in the TXA and EACA groups were 736.00 RMB and 408.00 RMB per patient, respectively. CONCLUSIONS: The application of perioperative antifibrinolytics notably reduces the need for perioperative blood transfusions. What's more, this study demonstrated that TXA is superior to EACA for decreasing blood loss and transfusion rates while at a lower cost per surgery. These results indicate that TXA may be the optimum antifibrinolytics for THA in Chinese area rather than EACA.
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Antifibrinolíticos , Artroplastia de Quadril , Ácido Tranexâmico , Humanos , Artroplastia de Quadril/efeitos adversos , Estudos Retrospectivos , Perda Sanguínea Cirúrgica/prevenção & controle , Aminocaproatos , Ácido Aminocaproico , HemoglobinasRESUMO
OBJECTIVE: To explore the clinical effect of a new type of bidirectional pressurized porous tantalum screw (PTS) internal fixation in treating femoral neck fractures (FNFs). METHODS: In this study, geometric models of FNF were first established via reverse engineering method, followed by stimulation of the strength of PTSs in fixation of FNFs. A randomized control trial study was then conducted of 41 patients with FNF from October 2015 to December 2018. These patients included 12 males and 29 females with an average age of 59.9. The 41 patients were randomly divided into two groups: cannulated compression screws (CCSs) group (n = 21) and PTSs group (n = 20). Treatment outcomes in patients were evaluated using multiple imaging techniques, including X-ray and digital subtraction angiography scanning as well as functional recovery Harris hip score. Without other postoperative complications, the primary outcome was defined as fracture healing after FNF internal fixation. Secondary outcomes are the incidence of the avascular necrosis of femoral head (ANFH), fracture nonunion, and reoperation rate. RESULTS: Following PTS internal fixation of FNF, finite element results revealed a firmly fixed fracture with a slight displacement of less than 0.5 mm. At follow-up, we found a statistically significant difference in Harris scores in the two groups at 1 month and 3 months post-surgery. In the PTSs group, there was no case of ANFH and fracture nonunion, and the average healing time was 94.45 ± 6.47 days. In the CCSs group, there were four cases of ANFH, the necrosis rate was 19.05% (4/21). There was one case of fracture nonunion in the CCSs group, the nonunion fracture rate was 4.76% (1/21), and the average healing time was 122.54 ± 11.37 days. Five patients underwent total hip arthroplasty, and the reoperation rate was 23.81% (5/21). There were significant differences in the postoperative complications, fracture healing time, and reoperation rate between the two groups (p < 0.05). CONCLUSIONS: PTSs fixation of FNF at the center, does not only avoid the destruction of blood supply in the femoral head and reduction in the incidence of postoperative complications of FNFs, but also induces early bone ingrowth and promotes fracture healing. These findings provide a potential surgical internal fixation system for treating FNFs.
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Fraturas do Colo Femoral , Necrose da Cabeça do Fêmur , Fraturas não Consolidadas , Feminino , Fraturas do Colo Femoral/cirurgia , Necrose da Cabeça do Fêmur/cirurgia , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Porosidade , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Tantálio , Resultado do TratamentoRESUMO
OBJECTIVE: To compare a new classification with the Garden classification by exploring their relationships with vascular injury. METHODS: This retrospective study enrolled 73 patients with subcapital femoral neck fracture from July 2015 to November 2018, including 32 males and 41 females with an average age of 47.2 years. All patients were classified by the Garden classification using anteroposterior X-ray imaging and by a new classification system based on three-dimensional CT imaging. The blood supply of the affected femoral head in these patients was evaluated based on DSA images. Correlations between the two classifications and the degree of vascular injury were assessed. RESULTS: The results of the DSA examination indicated that eight patients had no retinacular vessel injury, 20 patients had one retinacular vessel injury, 35 patients had two retinacular vessel injuries, and 10 patients had three retinacular vessel injuries. The degree of vascular injury was used to match the two fracture classifications. Forty-nine Garden classifications (Type I-IV: 8, 12, 23, 6, respectively, 67.12%) and 66 new classifications (Type I-IV: 8, 20, 32, 6, respectively, 90.41%) corresponded to the degree of vascular injury (p < 0.05). The Garden classification showed moderate reliability, and the new classification showed near perfect agreement (Interobserver agreement of k = 0.564 [0.01] in Garden classification vs. Garden classification k = 0.902 [0.01] for the five observers). CONCLUSIONS: The new classification system can accurately describe the degree of fracture displacement and judge the extent of vascular injury.
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Fraturas do Colo Femoral , Lesões do Sistema Vascular , Feminino , Fraturas do Colo Femoral/diagnóstico por imagem , Cabeça do Fêmur/diagnóstico por imagem , Fixação Interna de Fraturas , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos RetrospectivosRESUMO
BACKGROUND: Cardiovascular disease (CVD) risk among individuals with different BMI levels might depend on their metabolic health. The extent to which metabolic health status and BMI affect CVD risk, either directly or through a mediator, in the Chinese population remains unclear. OBJECTIVE: In this study, the Bayesian network (BN) perspective is adopted to characterize the multivariable probabilistic connections between CVD risk and metabolic health and obesity status and identify potential factors that influence these relationships among Chinese adults. METHODS: The study population comprised 6276 Chinese adults aged 30 to 74 years who participated in the China Health and Nutrition Survey 2009. BMI was used to categorize participants as normal weight, overweight, or obese, and metabolic health was defined by the Adult Treatment Panel-3 criteria. Participants were categorized into 6 phenotypes according to their metabolic health and BMI categorization. The 10-year risk of CVD was determined using the Framingham Risk Score. BN modeling was used to identify the network structure of the variables and compute the conditional probability of CVD risk for the different metabolic obesity phenotypes with the given structure. RESULTS: Of 6276 participants, 64.67% (n=4059), 20.37% (n=1279), and 14.95% (n=938) had a low, moderate, and high 10-year CVD risk. An averaged BN with a stable network structure was constructed by learning 300 bootstrapped networks from the data. Using BN reasoning, the conditional probability of high CVD risk increased as age progressed. The conditional probability of high CVD risk was 0.43% (95% CI 0.2%-0.87%) for the 30 to 40 years age group, 2.25% (95% CI 1.75%-2.88%) for the 40 to 50 years age group, 16.13% (95% CI 14.86%-17.5%) for the 50 to 60 years age group, and 52.02% (95% CI 47.62%-56.38%) for those aged ≥70 years. When metabolic health and BMI categories were instantiated to their different statuses, the conditional probability of high CVD risk increased from 7.01% (95% CI 6.27%-7.83%) for participants who were metabolically healthy normal weight to 10.47% (95% CI 7.63%-14.18%) for their metabolically healthy obese (MHO) counterparts and up to 21.74% and 34.48% among participants who were metabolically unhealthy normal weight and metabolically unhealthy obese (MUO), respectively. Sex was a significant modifier of the conditional probability distribution of metabolic obesity phenotypes and high CVD risk, with a conditional probability of high CVD risk of only 2.02% and 22.7% among MHO and MUO women, respectively, compared with 21.92% and 48.21% for their male MHO and MUO counterparts, respectively. CONCLUSIONS: BN modeling was applied to investigate the relationship between CVD risk and metabolic health and obesity phenotypes in Chinese adults. The results suggest that both metabolic health and obesity status are important for CVD prevention; closer attention should be paid to BMI and metabolic status changes over time.
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Metal plates have always been the gold standard in the clinic for internal fracture fixation due to their high strength advantages. However, high elastic modulus can cause stress shielding and lead to bone embrittlement. This study used an electron beam melting method to prepare personalized porous Ti6Al4V (pTi) bone plates. Then, chemical vapor deposition (CVD) technology coats tantalum (Ta) metal on the pTi bone plates. The prepared porous Ta-coated bone plate has an elastic modulus similar to cortical bone, and no stress shielding occurred. In vitro experiments showed that compared with pTi plates, Ta coating significantly enhances the attachment and proliferation of cells on the surface of the scaffold. To better evaluate the function of the Ta-coated bone plate, animal experiments were conducted using a coat tibia fracture model. Our results showed that the Ta-coated bone plate could effectively fix the fracture. Both imaging and histological analysis showed that the Ta-coated bone plate had prominent indirect binding of callus formation. Histological results showed that new bone grew at the interface and formed good osseointegration with the host bone. Therefore, this study provides an alternative to bio-functional Ta-coated bone plates with improved osseointegration and osteogenic functions for orthopaedic applications.
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Background: Some evidence indicates a potential beneficial effect of omega-6 polyunsaturated fatty acids (n-6 PUFAs) on type 2 diabetes mellitus (T2DM); however, the findings to date remains inconclusive and little is known about whether sex modifies these associations. Therefore, this study aimed to investigate potential sex-specific differences in this associations among Chinese adults. Methods: We conducted a cross-sectional study in an area of Dalian city, China; Chinese men and women who attended the Department of Clinical Nutrition and Metabolism between January and December 2020 were invited to participate in this study. All participants were assessed for basic demographic characteristics, fasting blood glucose, HbA1c, and other serum biomarkers and serum phospholipid FAs. Results: In total, 575 Chinese adult participants (270 men and 305 women) were included in the analysis. Hypertension and dyslipidaemia were more common among men than women, but there were no significant differences between the sexes in fatty acid composition, except for eicosadienoic acid (EA; 20:2n-6) and total monounsaturated fatty acids (MUFA). The age-adjusted OR for having T2DM in the highest quartile of arachidonic acid (20:4n-6) level was 0.47 (95% CI, 0.22, 0.98) in men, and this association remained consistently significant in the fully adjusted multivariate models. In contrast, no significant associations between n-6 PUFAs and T2DM risk were observed in women, regardless of model adjustment. Conclusions: In conclusion, these results demonstrate a notable sex-specific differences in the associations between n-6 PUFAs and T2DM. Higher n-6 PUFA status may be protective against the risk of T2DM in men.
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Background: Permanent pacemaker (PPM) implantation is the main complication of transcatheter aortic valve replacement (TAVR). Few studies have evaluated the requirement for PPM implantation due to ECG changes following TAVR in a Chinese population. Objective: Our study aimed to evaluate the incidence and predictors of PPM implantation in a cohort of Chinese patients with TAVR. Methods: We retrospectively evaluated 39 consecutive patients with severe native aortic stenosis referred for TAVR with a self-expandable prosthesis, the Venus A valve (Venus MedTech Inc., Hangzhou, China), from 2019 to 2021 at the Heart Center of Affiliated Zhongshan Hospital of Dalian University. Predictors of PPM implantation were identified using logistic regression. Results: In our study, the incidence of PPM implantation was 20.5%. PPM implantation occurs with higher risk in patients with negative creatinine clearance (CrCl), dyslipidemia, high Society of Thoracic Surgeons (STS) Morbimortality scores, and lead I T wave elevation. TAVR induced several cardiac electrical changes such as increased R wave and T wave changes in lead V5. The main independent predictors of PPM implantation were new-onset left bundle branch block (LBBB) (coef: 3.211, 95% CI: 0.899-7.467, p = 0.004) and lead I T wave elevation (coef: 11.081, 95% CI: 1.632-28.083, p = 0.016). Conclusion: New-onset LBBB and lead I T wave elevation were the main independent predictors of PPM implantation in patients undergoing TAVR. Clinical indications such as negative CrCl, dyslipidemia, high STS Morbimortality scores, and an increased T wave elevation before TAVR should be treated with caution to decrease the need for subsequent PPM implantation.
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Background: Although obesity is a well-known risk factor for hyperuricemia, it remains unclear whether obese subjects with metabolically healthy status have a decreased the risk of hyperuricemia and whether sex modifies the association of metabolically healthy obesity (MHO) with hyperuricemia risk. We aimed to investigate the sex-specific association between MHO and other obesity phenotypes and hyperuricemia, and to use Bayesian networks to determine and visualize the interactions among hyperuricemia and its related factors. Methods: This study was conducted using data from the China Health and Nutrition Survey 2009. Hyperuricemia was defined as serum uric acid ≥ 420 µmol/L in men and ≥ 360 µmol/L in women according to the guidelines. Body mass index (BMI) was used to define normal weight, overweight, and obese status in subjects, and metabolic health state was defined by the Adult Treatment Panel (ATP)-III and Visceral Adiposity Index (VAI) criteria, respectively. Subjects were categorized into six phenotypes according to their metabolic health and BMI level status. Results: Of the 7,364 Chinese adult individuals included, the prevalence of hyperuricemia among MHO women was only 8.5% (95% CI 4.8 to 14.3%), but increased to 30.7% among MUO women, whereas the highest prevalence among men was found in the MUOW phenotype (39.4%, 95% CI 35.4 to 43.6%), compared to 15.4% for male subjects with MHO. After adjusting for confounders, the MHO phenotype was significantly associated with an increased risk of hyperuricemia compared with their MHNW counterparts in women (OR: 1.95, 95% CI: 1.02-3.74) whereas a significant association was not found in men (OR: 1.46, 95% CI: 0.8-2.68). A complex network structure was established by BNs and then used to find connections between hyperuricemia and its related factors, as well as their interrelationships. By using BN reasoning, the probability of having hyperuricemia was 0.076 among MHO men, while it reached 0.124 in MHO women. Conclusions: In conclusion, our results demonstrated that the MHO phenotype was significantly associated with the risk of hyperuricemia only in women, not in men. This sex-specific differences in the association may suggest a favorable condition of MHO for Chinese men with respect to hyperuricemia risk, meanwhile more attention should be paid to the increased risk of hyperuricemia among MHO women.
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Hiperuricemia/etiologia , Obesidade Metabolicamente Benigna/complicações , Adulto , Idoso , Teorema de Bayes , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Hiperuricemia/epidemiologia , Masculino , Síndrome Metabólica/complicações , Pessoa de Meia-Idade , Caracteres SexuaisRESUMO
PURPOSE: The aim of the study was to investigate the curative efficacy of osteonecrosis of the femoral head (ONFH) in a hip-preserving operative approach, by transferring a vascularized greater trochanter graft combined with osteotomy of the upper third of femoral head, in an attempt to seek an innovative approach for patients who experienced middle- to late-stage ONFH with femoral head's weight-bearing area severely collapsed. METHOD: Our research included a total of 23 patients (23 hips) who accepted hip-preserving surgery by reconstructing the femoral head with transferred vascularized greater trochanter bone graft for ONFH from January 2013 to December 2017. The definition of reconstructing the femoral head is that we do the osteotomy on the upper third of the femoral head with weight-bearing area severely collapsed, and the remnant femoral head requires a hemispherical bone graft to recover the shape. A vascularized greater trochanter bone graft was next transferred and fixed at the upper portion of the remnant femoral head, and then, the shape and vascular supply of the femoral head are successfully reconstructed. The clinical assessment was performed with Harris Hip Score system. Kaplan-Meier survival curves with femoral head collapse as the end point showing the probability of progression in collapsed femoral head based on the gender, age and body mass index. RESULTS: Twenty-three patients (23 hips) were eventually contacted by telephone for an outpatient clinic follow-up, with a mean follow-up time of 41.35 months (varied from 16 to 72 months), no patients lost contact. Seven patients (7 hips) had radiographic stage progress. One patient (1 hip) had conversion to total hip arthroplasty at 24 months postoperatively because of progressive femoral head collapse and severely pain. The image success rate was 69.6%, clinical success rate was 65.2%, and the clinical survival rate was 96%. The average Harris Hip Score was 82.5 ± 5.5 points at the last follow-up, representing a great improvement compared with the 51.9 ± 7.2 points obtained preoperatively (P<0.05). Kaplan-Meier survival curves with femoral head collapsed as the end point showing the probability of progression in collapsed femoral head based on the sex, age, and body mass index. CONCLUSIONS: Reconstructing the femoral head with transferred vascularized greater trochanter bone graft provides a new method for the treatment of the young Association Research Circulation Osseous stage III-IV ONFH patients with severely femoral head collapsed, which can better improve the patient's symptoms, the quality of life, and delay the age of undergoing arthroplasty in young patients.