Exploring expectations of Chinese patients for total knee arthroplasty: once the medicine is taken, the symptoms vanish.

BACKGROUND: Preoperative expectations of total knee arthroplasty (TKA) outcomes are important determinants of patient satisfaction. However, expectations of patients in different countries are affected by cultural background. The general goal of this study was to describe Chinese TKA patients' expectations. METHODS: Patients scheduled for TKA were recruited in a quantitative study(n = 198). The Hospital for Special Surgery Total Knee Replacement Expectations Survey Questionnaire was used for survey TKA patients' expectations. Descriptive phenomenological design was used for the qualitative research. Semi-structured interviews were conducted with 15 TKA patients. Colaizzi's method was used for interview data analysis. RESULTS: The mean expectation score of Chinese TKA patients was 89.17 points. The 4 highest score items were walk short distance, remove the need for walker, relieve pain and make knee or leg straight. The 2 lowest score items were employed for monetary reimbursement and sexual activity. Five main themes and 12 sub-themes emerged from the interview data, including multiple factors raised expectations, expectations of physical comfort, expect various activities back to normal, hope for a long joint lifespan, and expect a better mood. CONCLUSIONS: Chinese TKA patients reported a relatively high level of expectations, and differences across cultures result in different expectation points than other national populations, requiring adjustment of items when using assessment tools across cultures. Strategies for expectation management should be further developed. LEVEL OF EVIDENCE: Level IV.

Computer-Assisted Volumetric Analysis and Quantitatively Anophthalmic Orbit Reconstruction With Dorsalis Pedis Flap and Bone Graft.

Current approaches to orbit reconstruction are based on the assumption of facial symmetry and surgeons' experiences, and the reconstructed orbits are not precise. Through computer-assisted volumetric quantitative analysis, the volume of the bony orbit, and the volume of the soft tissues in both the anophthalmic orbit and the contralateral orbit are calculated in 39 anophthalmic patients. The rib graft is used for orbit reconstruction; the dosalis pedis flap and lipo-injection were used for soft tissue reconstruction and skin socket reconstruction. The size and the shape of the rib graft and soft tissues were designed according to the volumetric analysis. The size and the shape of the skin socket were designed according to measurement during surgery. Asymmetry eye sockets with adequate size were created in the 37 patients. Two patients presented with a poor asymmetry with the contralateral orbit, and got gradual extrusion of the eye prosthesis 4 months after operation, which was because of necrosis of the flaps. The flaps were remedied by frontal island flap and skin grafting. Further surgeries, such as lipoinjection, lid surgery, and canthoplasty, were applied to improve the surgical results. The eye prostheses fitted well in all of the reconstructed sockets using this technique. Our studies suggest that the computer-assisted volumetric analysis technique combined with quantitative bone graft and dorsalis pedis flap transfer, ± lipoinjection proved to be an accurate method and a quality assurance for optimization of bony orbit, soft tissue and skin socket reconstruction, and promised a successful postoperative outcome for patients' functional and esthetic appearance.

Indicators and medical tests to identify lower limb swelling causes after total knee arthroplasty: a Delphi study with multidisciplinary experts.

BACKGROUND: Lower limb swelling after total knee arthroplasty (TKA) hinders surgical effectiveness. The poor results of studies on swelling interventions are due to the lack of a classification of swelling causes through appropriate medical tests. A gold standard is missing. This study aimed to clarify the causes of TKA postoperative swelling and how to identify them through indicators and medical tests by consulting a wide range of experts from multiple disciplines. METHOD: The Delphi method was used. A first draft of the index was prepared based on a systematic search of the literature. A total of 11 experts from several disciplines were invited to evaluate the rationality of the indicators and suggest modifications. After two rounds of consultation, the experts reached a consensus, and the consultation was stopped. RESULTS: The response rate of the 11 experts was 100%, and the authoritative Cr was 0.896. Kendall's W values for opinion coordination of the two rounds of consultation were 0.262 and 0.226, respectively (P < 0.001). Among the final indicators, there were 4 primary indicators for swelling cause classification (inflammatory response, poor venous return, joint hematoma, muscle damage, and healing), 19 secondary and 19 tertiary indicators. CONCLUSION: The indications obtained by systematic literature review and multidisciplinary expert consultation are reliable and scientific. Multiple causes of lower extremity swelling after TKA were identified. Blood test indicators can reflect an inflammatory response, suggest poor venous return, and reflect muscle damage and healing progress. Ultrasound scans are needed to identify underlying thrombotic or valvular problems, joint hematomas, and muscle damage. These tests help clinicians and researchers determine the cause of swelling after TKA and take appropriate management.

Mental health status and quality of life in elderly patients with coronary heart disease.

BACKGROUND: Coronary heart disease (CHD) is the leading cause of morbidity and mortality among elderly individuals. Patients with CHD are at high risk for mental health disorders, and psychological issues may affect the quality of life (QoL) of these patients. Nevertheless, there is little evidence regarding the psychological issues and QoL of patients with CHD among the elderly population. This study aimed to investigate the relationship between comorbidities and mental status as well as QoL among elderly patients with CHD. METHODS: Overall, 216 patients were included in this cross-sectional, observational, single-center study. The demographics and clinical manifestations of the patients were collected from electronic medical records. All patients were interviewed using the Chinese version of Symptom Checklist 90 (SCL-90) to assess the mental health status and the World Health Organization Quality of Life-BREF questionnaire (WHOQOL-BREF) to assess the QoL. RESULTS: In total, 96 men and 120 women, with a mean age of 71.69 ±  8.30 years, were included. When controlling for the patients' sex, marital status and stroke, multiple stepwise linear regression analyses suggested that for CHD patients, comorbid type 2 diabetes mellitus had the significant influence on average positive factors (Coef., 5.809; 95% CI [2.467-9.152] p = 0.001); when controlling for the patients' sex, marital status and type 2 diabetes mellitus, multiple stepwise linear regression analyses suggested that for CHD patients, comorbid stroke had the significant influence on average positive factors (Coef., 8.680; 95% CI [4.826-12.534]; p < 0.001); when controlling for the patients' sex, marital status, type 2 diabetes mellitus and stroke, multiple stepwise linear regression analyses suggested that for CHD patients, comorbid primary hypertension had the significant influence on phobic anxiety (Coef., 0.178; 95% CI [0.010-0.347]; p = 0.038). CONCLUSIONS: For elderly CHD patients, comorbid type 2 diabetes mellitus and stroke were at risk for psychological problems and lower QoL. Our findings may guide patients and clinicians to make better decisions and achieve better outcomes.

Association between serum γ-glutamyltransferase and chronic kidney disease in urban Han Chinese: a prospective cohort study.

PURPOSE: Limited numbers of literatures have focused on the association between γ-glutamyltransferase (GGT) and chronic kidney disease (CKD), and their results were controversial. Therefore, in this study, we set up a large-scale cohort of Chinese population to discover and verify the association between serum GGT and CKD. METHODS: Our cohort study was based on 21,818 patients who visited Health Management Center of Shandong Provincial Hospital, China, to receive routine health check-up during the period of 2005-2010, and we used multivariate Cox regression model to clarify whether elevated serum GGT increased the risk of CKD or not. RESULTS: During the follow-up of 57,891 person-years, 1456 patients developed CKD, giving rise to an incidence density of 25.15 per 1000 person-years (1456/57,891 person-years). After adjusting gender, age, baseline serum creatinine (SCr), body mass index (BMI), serum albumin (ALB), alanine aminotransferase (ALT), hemoglobin, white blood cell count (WBC), triglyceride (TG), total cholesterol (TC), hypertension, cardiovascular disease (CVD), diabetes, smoking and drinking status, the risk for CKD increased with the elevated serum GGT quartiles. The hazard ratio (HR) for CKD was 1.326 (95 % confidence interval (CI), 1.073-1.639) when the top quartile of serum GGT was compared with the bottom one, and the HR of log-transformed serum GGT for CKD was 1.658 (95 % CI, 1.294-2.125). The results were consistent in males but different in females when gender was stratified. CONCLUSION: The result reveals that there is a positive relationship between increasing serum GGT levels and the incidence of CKD which suggests that elevated GGT level could be a potential indicator for risk of CKD.