Using Illness Rating Systems to Predict Discharge Location Following Total Knee Arthroplasty

PURPOSE: Total knee arthroplasty (TKA) is increasing in frequency and cost. Optimization of discharge location may reduce total expenditure while maximizing patient outcomes. Although preoperative illness rating systems—including the American Society for Anesthesiologists Physical Classification System (ASA), severity of illness scoring system (SOI), and Mallampati rating scale (MP)—are associated with patient morbidity and mortality, their predictive value for discharge location, length of stay (LOS), and total costs remains unclear. MATERIALS AND METHODS: We conducted a retrospective analysis of 677 TKA patients (550 primary and 127 revision) treated at a single institution. The influence of ASA, SOI, and MP scores on discharge locations, LOS, and total costs was assessed using multivariable regression analyses. RESULTS: None of the systems were significant predictors of discharge location following TKA. SOI scores of major or higher (β=2.08 days, p < 0.001) and minor (β=−0.25 days, p=0.009) significantly predicted LOS relative to moderate scores. Total costs were also significantly predicted by SOI scores of major or higher (β=$6,155, p=0.022) and minor (β=−$1,163, p=0.007). CONCLUSIONS: SOI scores may be harnessed as a predictive tool for LOS and total costs following TKA, but other mechanisms are necessary to predict discharge location.

Application of the third generation dual source CT in head and neck angiography / 中华老年心脑血管病杂志

Objective To study the application of the third generation dual source CT in head and neck angiography.Methods Sixty patients admitted to our hospital for head and neck CT angiography were randomly divided into group A (n=30) and group B (n=30).The patients in group A were given 50 ml contrast medium and 50 ml normal saline with the tube voltage set at 90 kV while those in group B were given 40 ml contrast medium and 50 ml normal saline with the tube voltage set at 80 kV.The patients in two groups were given a different dose of contrast mediumnaproyan (370 mgI/ml).The signal noise ratio (SNR),contast noise ratio (CNR),effective dose and iodine intake volume at bilateral common carotid artery bifurcation were compared between the two groups.Results No significant difference was found in the image subjective score between groups A and B (4.167±0.698 vs 4.500±0.572,P=0.682).The mean idione intake volume was 14％ lower in group B than in group A (P=0.00).No significant difference was found in the SNR and CNR at bilateral common carotid artery bifurcation between the two groups.The effective dose was 17％ and 14％ lower in group B than in group A after plane scanning and contrast medium injection.Conclusion Application of the third generation dual source CT in head and neck angiography can achieve rather good images and is thus of a high value in its clinical application.

Effects of oxidative stress reaction for the Eisenia fetida with exposure in Cd2.

Earthworms are widely used in all kinds of pollutants as sensitive bio-indicator organisms because of their immediately oxidative stress response under the stress of heavy metal. However, there are a large number of indexes associated with the oxidative stress response. Finding out the key monitoring indexes in the stress process becomes a practical demand of the pollution monitoring and warning process. We studied two groups, the short-term test and the long-term test. The former one is for 10 days, taking out an earthworm every day. The latter test lasted 30 days, taking out an earthworm every 10 days. The Cd2+ concentration was set at 50, 100, 125, 250, and 500 mg kg-1. Post-clitellum segments of earthworms were chosen to determine superoxide enzyme (SOD), peroxidase (POD), glutathione peroxidase (GSH-Px), glutathione-S transferase (GST), catalase (CAT), vitamin E (VE), malondialdehyde (MDA), and acetylcholinesterase (AChE). The results showed that the main bio-indicators associating with oxidative stress reaction in short-term group were CAT, SOD, and POD. MDA could be used as a bio-indicator in the early and mid-term. VE was only the bio-indicator in the mid-term stress. While with the long-term test, the main bio-indicators associated with oxidative stress reaction were GSH-Px and MDA. The AChE activity was only suitable for oxidative stress response caused by heavy metal stress more than 30 days.

Anatomy of the petrous apex as related to the endoscopic endonasal approach.

The endoscopic endonasal approach (EEA) has been reported to be an efficient approach for treating lesions of the petrous apex. However, there have been only limited anatomic studies for the EEA. Furthermore, most of the relevant distances for EEA cannot be measured easily on a cadaveric skull. Two fresh adult cadaver heads and five formalin-fixed adult cadaver heads were dissected using the EEA to identify groups of landmarks for safe guidance during this approach. The distances between these landmarks were then measured by CT angiography by using three-dimensional software. The EEA to the petrous apex can be divided into five phases. In each phase, a group of landmarks, rather than a single landmark, can be identified easily for guiding the next phase of the approach. There was no significant difference between males and females in any of the distances reported in the present study. The EEA can be performed to manage a petrous apex lesion more safely by referring to multiple landmarks and the distances between them.

Clinical research of T tube implantation on children with chronic otitis media / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the appropriate time to take out T tube, long-term effect and adverse consequence of children with chronic otitis media subjected to adenoidectomy and tonsillectomy plus tympanostomy.@*METHOD@#One hundred and eighteen children with 226 ears operated were analyzed and summarized.@*RESULT@#T tubes taken out at 1, 3, 6 and 12 month were 6, 102, 88 and 23 ears, respectively, and T-tubes were not taken out in 7 ears.@*CONCLUSION@#At present, the treatment is curable and reliable with fewer complications. The appropriate time to take out the T-tube should be 3 months after the operation.

The MRI characteristics of Hashimoto encephalopathy / 中华放射学杂志

Objective To study the MRI findings of HE and the pathological mechanism and to improve the diagnosis and differential diagnosis of HE. Methods Five patients of HE diagnosed by clinical and laboratory examination were examined with conventional MRI scan. Additional DWI, MRA and enhancement MRI scan were performed on 3 patients in which abnormal findings was detected on the conventional MRI. The distribution of lesions and signal characteristics were analyzed. The ADC values of the lesions and of the contralateral non-lesion area were measured. Moreover, the possible pathological mechanisms of HE were discussed on the basis of changes of clinical and imaging manifestations in the two cases with serial clinical and MRI data. Results Of 5 patients, brain abnormalities were found in 3 cases,which showed scattered spotted supratentorial white matter lesions of isointensity on T1 WI and DWI, and high signal intensity on T2WI and fluid-attenuated inversion recovery (FLAIR). Meanwhile, multiple plaque-like lesions involving both white matter and gray matter were found, mainly located at the basal ganglia nuclei, hippocampus and cingulate cortex. The lesions demonstrated iso-or hypo-intensity on T1 WI,and iso-or hyper-intensity on T2 WI, FIAIR and DWI at the initial stage. No enhancement was found in these lesions and MRA disclosed no remarkable findings. The ADC value of the lesions [ (0. 449 ± 0. 092) ×10-3 mm2/s] was decreased significantly compared with the contralateral noninvolved area [ (0. 838 ±0. 062) × 10-3 mm2/s] at the early onset. In 2 cases with glucocorticoid therapy, together with symptom relief, MRI follow-up scan demonstrated the reduction of lesion volume, the signal change to hyperintensity on T1 WI and hypo-intensity on DWL The ADC of the lesions increased significantly. Conclusion The MRI could be one of the effective tools for diagnosis, differential diagnosis, and judging the prognosis and therapeutic results of HE. Meanwhile, it may be a non-invasive method to study the pathological mechanism of HE.

The value of 64-slice CT angiography in diagnosing spinal vascular malformations / 中华放射学杂志

Objective To evaluate 64-slice CT angiography in diagnosing spinal vascular malformations. Methods Fifteen patients,who were suggestive of spinal vascular malformations bv clinical manifestation and MRI,underwent CT angiography with a 64-slice spiral CT(GE lightspeed VCT).DSA were performed later within 1 week in all the patients and four of them were treated with operation as well.We evaluated CTA images in displaying the lesions according to the following aspects:the type of malformation,lesion range,feeding artery,draining vein and possible fistula.and compared those details with DSA and operation findings.Results All 15 patients acquired their final diagnosis by DSA and operation,which were intramedullary axteriovenous malformation in 6 cases,perimedullary arteriovenous fistula in 2,spinal dural arteriovenous fistula in 3 and Cobb syndrome in 4 cases. CTA was consistent with DSA in the classification of lesions and in the determination of the involved regions and it reveaIed the main feeding arteries and draining veins in all patients.CTA showed four arteriovenous fistulae confinned bv DSA.but it failed in a complex arteriovcnous fistula.In Cobb syndrome patients,not only the intramedullary but also paravertebral and subcutenous vascular malformation could be clearly seen on CTA images.Conclusion 64-slice CT angiography can be a preliminary method in spinal vascular malformation because it can determine the classification and reveal almost all the main lesions quickly,atraumatically.

Pharmacoeconomic Evaluation on the Literature of Aripiprazol vs.Risperidone in the Treatment of Schizophrenia / 中国药房

0.05).CONCLUSION: There is no pharmacoeconomic difference between aripiprazol and risperidone in the treatment schizophrenia.