Construction and verification of risk prediction model of osteoporotic fractures in patients with osteoporosis in China.

Objective: To explore the influencing factors of osteoporotic fractures (OPF) in patients with osteoporosis, construct a prediction model, and verify the model internally and externally, so as to provide reference for early screening and intervention of OPF in patients with osteoporosis. Methods: Osteoporosis patients in the First Affiliated Hospital of Soochow University were selected, and the medical records of patients were consulted through the Hospital Information System (HIS) and the data management platform of osteoporosis patients, so as to screen patients who met the criteria for admission and discharge and collect data. SPSS 26.0 software was used for single factor analysis to screen statistically significant variables (p < 0.05). The influencing factors of OPF were determined by multivariate analysis, and a binary Logistic regression model was established according to the results of multivariate analysis. Hosmer-Lemeshow (H-L) goodness of fit and receiver operating characteristic curve (ROC) were used to test the model's efficiency, and Stata 16.0 software was used to verify the Bootstrap model, draw the model calibration curve, clinical applicability curve and nomogram. Results: In this study, the data of modeling set and verification set were 1,435 and 580, respectively. There were 493 (34.4%) cases with OPF and 942 (65.6%) cases without OPF in the modeling set. There were 204 (35.2%) cases with OPF and 376 (64.8%) cases without OPF. The variables with statistically significant differences in univariate analysis are Age, BMI, History of falls, Usage of glucocorticoid, ALP, Serum Calcium, BMD of lumbar, BMD of feminist neck, T value of feminist neck, BMD of total hip and T value of total hip. The area under ROC curve of the risk prediction model constructed this time is 0.817 [95%CI (0.794 ~ 0.839)], which shows that the model has a good discrimination in predicting the occurrence of OPF. The optimal threshold of the model is 0.373, the specificity is 0.741, the sensitivity is 0.746, and the AUC values of the modeling set and the verification set are 0.8165 and 0.8646, respectively. The results of Hosmer and Lemeshow test are modeling set: (χ2 = 6.551, p = 0.586); validation set: [(χ2 = 8.075, p = 0.426)]. The calibration curve of the model shows that the reference line of the fitted curve and the calibration curve is highly coincident, and the model has a good calibration degree for predicting the occurrence of fractures. The net benefit value of the risk model of osteoporosis patients complicated with OPF is high, which shows that the model is effective. Conclusion: In this study, a OPF risk prediction model is established and its prediction efficiency is verified, which can help identify the high fracture risk subgroup of osteoporosis patients in order to choose stronger intervention measures and management.

Application of a Knowledge, Attitude, Belief, and Practice Model in Pain Management of Patients with Acute Traumatic Fractures and Alcohol Dependence.

Objective: To evaluate the outcome of a knowledge, attitude, belief, and practice mode (KABP) in the pain management in patients with acute traumatic fractures complicated with alcohol dependence. Methods: Twenty-nine alcohol-dependent male patients with acute traumatic fractures and who received surgical treatment between January 2019 and December 2020 were included in this retrospective case-control study. The age range was 30-65 years (average 50.03 ± 7.94). Fracture Type. Six cases of spinal burst fractures and 23 cases of limb trauma fractures. Ten patients were treated with routine nursing (control group), and 19 patients were treated with pain management in KABP mode (experimental group). The control group received traditional pain care, including the conventional numerical rating scale (NRS) pain score system, with focus on symptomatic treatment. On this basis, the experimental group managed pain using KABP, including cognitive behavioral intervention, optimization programs, modification of personal beliefs, and behavior patterns. NRS, self-rated anxiety/depression scale (SAS), and quality of life (SF-36) scale were applied at admission, 1 day before surgery, and 3 months after surgery. Results: The perioperative NRS score of the KABP group was lower than that of the control group, and the postoperative anxiety levels improved. Discharge satisfaction was significantly higher than that in the control group (p < 0.05). There were behaviors promoting health in the experimental group, and five patients expressed abstinence behavior after discharge (p < 0.05). Conclusion: Patients with alcohol dependence represents a unique set of cases for perioperative pain management. To ensure patient safety, individualized pain management through the application of KABP can significantly reduce postoperative pain and promote the generation of healthy behaviors in patients.

Construction of Prediction Model of Deep Vein Thrombosis Risk after Total Knee Arthroplasty Based on XGBoost Algorithm.

OBJECTIVE: Based on the XGBoost algorithm, the prediction model of the risk of deep vein thrombosis (DVT) in patients after total knee arthroplasty (TKA) was established, and the prediction performance was compared. METHODS: A total of 100 patients with TKA from January 2019 to December 2020 were retrospectively selected as the study subjects and randomly divided into a training set (n = 60) and a test set (n = 40). The training set data was used to construct the XGBoost algorithm prediction model and to screen the predictive factors of postoperative DVT in TKA patients. The prediction effect of the model was evaluated by using the test set data. An independent sample T-test was used for comparison between groups, and the χ 2 test was used for comparison between counting data groups. RESULTS: The top five items were combined with multiple injuries (35 points), time from injury to operation (28 points), age (24 points), combined with coronary heart disease (21 points), and D-dimer 1 day after operation (16 points). In the training set, the area under the curve of the XGBoost algorithm model was 0.832 (95% CI: 0.748-0.916). CONCLUSION: The model based on the XGBoost algorithm can predict the incidence of DVT in patients after TKA with good performance.

Analysis of Influencing Factors of Medication Compliance in Patients with Recurrent Vertebral Fractures after Percutaneous Kyphoplasty and the Role of Family-Centered Education Intervention.

OBJECTIVE: To explore the influencing factors of medication compliance in patients with recurrent vertebral fractures after percutaneous kyphoplasty (PKP) and the role of family-centered education intervention. METHODS: From January 2018 to January 2021, the general disease-related data survey form and medication compliance questionnaire made by our hospital were used to evaluate the scores of 198 patients with recurrent vertebral fractures after PKP in the Department of Orthopedics of our hospital. Single-factor and multiple linear regression analyses were used to explore the influencing factors of medication compliance in patients with recurring vertebral fractures after PKP. From 198 patients, 80 eligible patients were selected for further research. According to a random number table method, they were divided into the control group (n = 40) given only antiosteoporosis drug treatment and care and the experimental group (n = 40) combined with family-centered education intervention. After 12 months of intervention, the two groups were evaluated for their knowledge of osteoporosis, medication compliance, and physical health. RESULTS: Of the 198 patients, only 65 had good medication compliance, 90 had poor medication compliance, and 43 were acceptable. Univariate analysis showed that the influencing factors of medication compliance in patients with recurrent vertebral fractures after PKP include the patient's education, living style, per capita monthly income, combined other diseases, number of hospitalizations, and time since the last hospitalization (P < 0.05). Multiple linear regression analysis showed that patients with recurring vertebral fractures after PKP with high education, living with spouse or children, combined with other diseases, frequent hospitalizations, and short time from the last hospitalization had higher medication compliance (P < 0.05). After the intervention, the disease knowledge mastery of the experimental group was significantly better than before and after the intervention in the control group (P < 0.0001). After the intervention, the medication compliance and health status of the experimental group were significantly better than those of the control group (P < 0.05). CONCLUSION: The medication compliance of patients with recurrent vertebral fractures after PKP is generally poor, and medical staff need to take targeted interventions based on the main factors that affect the patients' medication compliance. Family-centered education intervention is an effective way to improve disease awareness, medication compliance, and health status of patients with recurring vertebral fractures after PKP.

The effectiveness of extended care based on Internet and home care platform for orthopaedics after hip replacement surgery in China.

AIMS AND OBJECTIVES: To evaluate the effect of an Internet-based home orthopaedic care platform on patients' functional joint recovery, quality of life and activities of daily living after hip replacement. BACKGROUND: Most of the functional exercises after arthroplasty are performed outside the hospital. At present, the WeChat platform is used mainly in the inland of China for continuous nursing of patients with chronic disease in the Department of Orthopedics. DESIGN: An experimental design was applied. METHODS: Four hundred patients who had undergone hip replacement from April to October 2016 were selected from 18 hospitals with nurse specialists in clinical orthopaedics. These patients were randomised into control and intervention groups (n = 200 per group). In the control group, only routine nursing care was carried out after discharge. In the intervention group, continuous intervention was performed via the Internet-based orthopaedic care platform. The patients in the two groups were compared in terms of functional recovery (Harris hip score), quality-of-life score (MOS SF-36) and activities of daily living (Barthel index) at 3 and 6 months after discharge. RESULTS: In total, 389 patients were enrolled in this study. There were no significant differences in the baseline data between the two groups. After 6 months of continuous intervention, the mean MOS SF-36 score, Barthel index and Harris hip score in the intervention group were significantly higher than those in the control group. CONCLUSION: The study gives full play to the role of clinical nurse specialists and provides professional home care services to patients in the region after hip replacement through home care orthopaedic platform. The platform guides the patients to master the correct disease knowledge and rehabilitation exercise methods, promotes the recovery of joint function, improves the activity of daily living, elevates the quality of life and meets the need of long-term management. RELEVANCE TO CLINICAL PRACTICE: Internet and home care orthopaedic platform is a nursing system designed specifically for extended care management outside of the hospital, which is helpful for patients who undergone hip replacement to obtain effective home care services after discharge, improving patients' quality of life and rehabilitation efficacy.

Performance evaluation of a novel anaerobic digestion operation process for treating high-solids content chicken manure: Effect of reduction of the hydraulic retention time at a constant organic loading rate.

A novel feeding strategy was adopted in this study and the effect of reduction in hydraulic retention time (HRT) on the anaerobic digestion of chicken manure (CM) with a constant organic loading rate of 6.0gVS/L/d was investigated. The lab-scale CSTR was operated at 38°C and HRTCM was reduced from 52days to 5days. At HRTCM of 20-45days, the reactor was relatively stable in terms of the volumetric biogas production rates and specific biogas production (SBP), which were 2.2-2.4L/L/d and 338.3-418.7mL/gVSadded, respectively. However, process instability and VFA accumulation occurred when the HRTCM was reduced to 10days due to excess microbes washout. The reduction in HRTCM to 5days caused SBP to decrease to 198.7mL/gVSadded and the acetic acid content to exceed 6000mg/L. The biomass balance model showed that the biomass concentration at HRTCM of 20-52days (0.473-0.615gVSS/L) was notably higher than that at HRTCM of 5-10days (0.173gVSS/L).

Chiral phosphine-catalyzed enantioselective construction of gamma-butenolides through substitution of Morita-Baylis-Hillman acetates with 2-trimethylsilyloxy furan.

Chiral multifunctional phosphine (R)-N-(2'-diphenylphosphanyl-[1,1']binaphthalenyl-2-yl)methanesulfonamide L2 or (R)-N-(2'-diphenylphosphanyl-[1,1']binaphthalenyl-2-yl)acetamide L3 is an efficient catalyst in the allylic substitutions of MBH acetates 1 with 2-trimethylsilyloxy furan 2 to provide gamma-butenolides 3 in good to excellent yields and enantiomeric excesses in the presence of water.