A predictive nomogram for surgical site infection in patients who received clean orthopedic surgery: a retrospective study.

BACKGROUND: Surgical site infection (SSI) is a common and serious complication of elective clean orthopedic surgery that can lead to severe adverse outcomes. However, the prognostic efficacy of the current staging systems remains uncertain for patients undergoing elective aseptic orthopedic procedures. This study aimed to identify high-risk factors independently associated with SSI and develop a nomogram prediction model to accurately predict the occurrence of SSI. METHODS: A total of 20,960 patients underwent elective clean orthopedic surgery in our hospital between January 2020 and December 2021, of whom 39 developed SSI; we selected all 39 patients with a postoperative diagnosis of SSI and 305 patients who did not develop postoperative SSI for the final analysis. The patients were randomly divided into training and validation cohorts in a 7:3 ratio. Univariate and multivariate logistic regression analyses were conducted in the training cohort to screen for independent risk factors of SSI, and a nomogram prediction model was developed. The predictive performance of the nomogram was compared with that of the National Nosocomial Infections Surveillance (NNIS) system. Decision curve analysis (DCA) was used to assess the clinical decision-making value of the nomogram. RESULTS: The SSI incidence was 0.186%. Univariate and multivariate logistic regression analysis identified the American Society of Anesthesiology (ASA) class (odds ratio [OR] 1.564 [95% confidence interval (CI) 1.029-5.99, P = 0.046]), operative time (OR 1.003 [95% CI 1.006-1.019, P < 0.001]), and D-dimer level (OR 1.055 [95% CI 1.022-1.29, P = 0.046]) as risk factors for postoperative SSI. We constructed a nomogram prediction model based on these independent risk factors. In the training and validation cohorts, our predictive model had concordance indices (C-indices) of 0.777 (95% CI 0.672-0.882) and 0.732 (95% CI 0.603-0.861), respectively, both of which were superior to the C-indices of the NNIS system (0.668 and 0.543, respectively). Calibration curves and DCA confirmed that our nomogram model had good consistency and clinical predictive value, respectively. CONCLUSIONS: Operative time, ASA class, and D-dimer levels are important clinical predictive indicators of postoperative SSI in patients undergoing elective clean orthopedic surgery. The nomogram predictive model based on the three clinical features demonstrated strong predictive performance, calibration capabilities, and clinical decision-making abilities for SSI.

[Three-year follow-up results of visual inspection with acetic acid/Lugol's iodine (VIA/VILI) used as an alternative screening method for cervical cancer in rural areas].

BACKGROUND AND OBJECTIVE: In China, there has been no established national program for cervical cancer prevention, the screening methods and experiences are especially deficient in the rural areas. The aim of this paper is to evaluate the effects of acetic acid/Lugol's iodine (VIA/VILI) used for screening of cervical cancer and pre-cancerous lesions in a rural area of China by analyzing the large-scale population-based screening data from the demonstration site. METHODS: Women aged 30-59 years from Xiangyuan County in Shanxi Province were recruited for cervical cancer screening from 2005 to 2007. VIA/VILI was the primary screening method followed by colposcopy if the VIA/VILI was positive. Cervical lesions were diagnosed by directed biopsy under the colposcopy. The VIA/VILI negative women or cervical intraepithelial neoplasia 1 (CIN1) were re-screened using the same procedure in the next year. RESULTS: In total, 7145 women received the cervical cancer screening, with a participation rate of 74.75%. Their average age was 42.16 years. A total of 1287 women were consecutively screened for three times from 2005 to 2007. The detection rates of CIN2, CIN3 and cervical cancer were 0.70% (9/1287), 1.01% (13/1287) and 0.23% (3/1287) for the first round screening, and were 0.22% (2/976), 0.11% (1/976) and 0% (0/976) for the second round screening, respectively. Only one CIN2 was found in the third round screening. In the years of 2006-2007, 3490 women were screened consecutively twice. The detection rates of CIN2, CIN3 and cervical cancer were 0.26% (9/3490), 0.52% (18/3490) and 0.15% (5/3490) for the first round screening, and 0.40% (14/2943), 0.40% (14/2943) and 0.03% (1/2943) for the second round screening. Likewise, 2 368 women were screened consecutively twice in the years of 2007-2008. The detection rates of CIN2, CIN3 and cervical cancer were 0.55% (13/2368), 0.25% (6/2368) and 0.12% (3/2368) for the first round screening, and 0.42 (10/2040), 0.04% (1/2040) and 0% for the second round screening. The cumulative detection rates for CIN2, CIN3 and cervical cancer were 0.81% (58/7145), 0.74% (53/7145) and 0.17% (12/7145), respectively. And 53.45% (31/58) of CIN2, 68.81% (37/53) of CIN3 and almost all cervical cancers (11/12) were found during the first round screening, except for an early stage cervical cancer (Ia). Only one CIN2 was detected in the third round screening in the same population. The average age of CIN1, CIN2, CIN3 and cervical cancer were 38.65, 40.61, 44.10 and 46.73 years, respectively. CONCLUSIONS: VIA/VILI can be used as an alternative screening method for cervical cancer and high-grade pre-cancerous lesions among the women aged 30-59 years in China's rural areas because of its low cost, easy training for the local health providers, and less depending on facilities. One round screening by VIA/VILI can detect more than a half of CIN2, two-thirds of CIN3 and almost all the cervical cancer in the population, and the detection rates of CIN2/3 can be increased by two consecutive rounds of screening.

[Lipid peroxidation injury and endoplasmic reticulum stress in Al-induced apoptosis].

OBJECTIVE: To study the role of lipid peroxidation injury and endoplasmic reticulum stress in Al-induced apoptosis. METHODS: Neurons from 0-3 day rats were cultured and treated with different concentrations of AlCl3.6H2O. Morphologic changes of neurons and endoplasmic reticulum were observed under fluorescent and transmission electron microscope; activities of superoxide dismutase (SOD), malondialdehyde (MDA) and ATP enzymes were detected. RESULTS: Typical morphologic changes in neurons apoptosis and endoplasmic reticulum were found under fluorescent and transmission electron microscope; SOD enzyme viability and ATP enzyme viability were significantly increased in the low-dosage group, but reduced in mid and high-dosage group (P < 0.01), whereas MDA levels decreased in the low-dosage group, but increased in mid and high-dosage group (P < 0.01). CONCLUSION: Aluminum may induce neurons apoptosis, and lipid peroxidation injury in endoplasmic reticulum plays an important role in the apoptosis progression.

[Selection of bax siRNA sequences and its influence on aluminum induced glioma cell apoptosis].

OBJECTIVE: To decrease bax expression by RNA interference, and inhibite the apoptosis in glioma cells induced by aluminum. METHODS: We had designed three siRNA sequences, and transfected them into glioma cells. The optimal sequence was selected based on the results of cell viability at various transfection concentrations and different transfection times. Fluorescent staining was used to detect the transfection efficiency, interference efficiency was determined by QRT-PCR method, and protein expression was measured with immunohistochemistry. RESULTS: The optimal siRNA sequence was selected based on the cell viability. The transfection efficiency was above 90%, the interference efficiency of bax gene was 62.3%, and the optimal transfection time was 72h after transfection, the optimal transfection concentration was 20nmol/L, besides, there was a significant decrease in Bax protein content after transfection. CONCLUSION: The optimal bax siRNA sequence can effectively inhibit the expression of bax gene and Bax protein, which may decrease apoptosis in aluminum-induced toxicity.

[Characteristic of the neurobehavioral functional changes in coke oven workers].

OBJECTIVE: To explore the effect of polycyclic aromatic hydrocarbons on the neurobehavioral function of coke oven workers. METHODS: 200 healthy adult male coke oven workers were selected from a coke plant of a state-owned steel enterprise in Taiyuan City. 88 controls occupationally unexposed to polycyclic aromatic hydrocarbons (PAHs) were selected from the same enterprise. All the subjects participated in this investigation voluntarily in their consent. Concentration of B(a)P in the working environment was monitored by High Performance Liquid Chromatography (HPLC). Urine samples were sampled immediately after working shifts. The level of urinary 1-hydroxypyrene was determined by HPLC. General information of workers correlated with the investigation was collected in a questionnaire according to the same criteria by well-trained investigators. Neurobehavioral core test battery (NCTB) recommended WHO was performed on coke oven workers and controls to test the neurobehavioral changes and the mood state. RESULTS: the concentration of B(a)P at oven bottom,oven side and oven top were 0.0195 microg/m3, 0.186 microg/m3 and 1.624 microg/m3 respectively, that at oven side and oven top being higher than the one stipulated by the occupational hygiene criterion. Urinary 1-hydroxypyrene was significantly different between the exposure group (3.42 +/- 0.98 micromol/mol creatinine) and control group (2.75 +/- 1.09 micromol/mol creatinine). No significant differences were found between exposure group and control group of age, working years, smoking, drinking and unhealthy food consumption; however, compared to the controls, the scores of total digital span, the forward digital span, and right dotting in the coke oven workers were lower, but that of total dotting was higher, with a statistical significance. According to urinary 1-hydroxypyrene concentration, all the subjects were divided into three groups. (<3.10 micromol/mol creatinine, 3.10 micromol/mol creatinine, >3.87 micromol/mol creatinine). Significant differences of the total digital span, the forward digital span, backward digital span, digit symbol and Benton visual retentions existed in different urinary 1-hydroxypyrene concentration groups and showed a dose-response tendency. Results of multiple stepwise regression analysis and correlation analysis showed that the level of urinary 1-hydroxypyrene affected memory and perception of coke oven workers and negative correlations between the level of urinary 1-hydroxypyrene and changes in neurobehavioral function were found. CONCLUSION: PAHs mainly causes decrease of memory and perception in coke oven workers.

Effects of benzo[a]pyrene on autonomic nervous system of coke oven workers.

Objectives are to investigate the effects of benzo[a]pyrene (B[a]P) on the autonomic nervous system of coke oven workers. One hundred eighty-four coke oven workers were divided into 3 groups according to their working sites (coke oven bottom group, coke oven side group and coke oven top group), and 93 referents were recruited. B[a]P monitored by air sampling pumps as well as urinary 1-hydroxypyrene (1-OH-Py) was determined by high performance liquid chromatograph with a fluorescence detector (HPLC-FD). The autonomic nervous system (ANS) function was determined by 4 tests: Valsalva Manoeuvre heart rate variation (HR-V), variation of heart rate when breathing deeply (HR-DB), variation of heart rate when instantly standing up (HR-IS, including RR30:15 and RRmax:min) and variation of blood pressure when instantly standing up (BP-IS). The B[a]P mean concentrations in coke oven bottom, coke oven side and coke oven top were 19, 185 and 1,623 ng/m(3), respectively. The levels of urinary 1-OH-Py were markedly higher in the 3 exposed groups than that in the referent group (p<0.01). No significant difference was found in each group between smokers and non-smokers (p>0.05). Compared with referents, HR-V decreased significantly in coke oven workers (p<0.01), representing modulation of parasympathetic nervous function. However, no statistical differences were found in HR-DB, RR30:15, RRmax:min and BP-IS between the exposed groups and the control group (p>0.05). HR-V decreased with the increment of 1-OH-Py (p<0.05), and results of multiple linear stepwise regression demonstrated that external exposure level and duration of education entered the HR-V model; age was a significant factor of HR-DB and RRmax:min, but no variable was involved in RR30:15 and BP-IS regression. Benzo[a]pyrene affects the autonomic nervous function of coke oven workers mainly by down-regulating the parasympathetic nervous function.

[Study of neurocytes apoptosis in vitro culture rat induced by aluminum].

OBJECTIVE: To study the rat neurocytes apoptosis induced by aluminum. METHODS: 0-3 day rats neurons, neuroglia cells and co-cultured neurocytes were cultured, which were treated by different concentration of AlCl3 x 6H2O, the cells by light microscope, fluorescent staining and fluorescent analysis were observed. RESULTS: (1) Under light microscope and fluorescent staining, Al could cause strong typical morphology apoptosis changes in neurons, which appeared more earlier and typical than those in neuroglia cells and co-cultured neurocytes. (2) The results of fluorescent analysis reviewed that the early stage, late stage and total apoptosis rate of neurons apoptosis could be associated with Al concentration. However, Al could not induce neuroglia cells and co-cultured neurocytes apoptosis at the low and mid doses of aluminum, the apoptosis rates in four groups demonstrated no significance, in contrast only significant difference between control group and high dose group. CONCLUSION: It was suggested that Al could induce apoptosis of neurocytes in rat.

[Relationship between lipid peroxidation in blood and neurobehavioral function changes in coke oven workers].

OBJECTIVE: To explore the coincidence of lipid peroxidation and neurobehavioral function changes in coke oven workers. METHODS: One hundred and thirty-four coke oven workers were divided into three groups: 35 in the oven-bottom group, 49 in the oven-side group and 50 in oven-top group. WHO recommended NCTB was performed on coke oven workers and 36 controls from material conservation department; The contents of total superoxide dismutases (T-SOD), glutathione (GSH) and malondialdehyde (MDA) in blood were determined by test kits. RESULTS: Compared with the controls, the coke oven workers showed lower levels of T-SOD and GSH (P < 0.01), significantly higher MDA levels in blood (P < 0.01), higher score on negative mood state, lower scores on positive mood state, and poorer performance in NCTB test (P < 0.05). Further analysis revealed that there was a weak positive correlation between neurobehavioral function changes and the level of lipid peroxidation with a coefficient lower than 0.25. CONCLUSION: The level of lipid peroxidation in coke oven workers' blood increased and coincided with neurobehavioral function impairment.

[Change of neurocytes in acute intoxicated encephalopathy induced by 1, 2-dichloroethane after intervention with antagonists].

OBJECTIVE: To study the role of N-methyl-D-aspartate receptor and Ca(2+) in acute intoxicated encephalopathy induced by 1, 2-dichloroethane (1, 2-DCE) in vitro. METHODS: Neurocytes of new born rats were cultured in vitro, which were administered with different doses of 1, 2-DCE, and NMDAR and Ca(2+) antagonists including Ketamine and Nimodiping respectively. The cell morphologic structures were observed under light microscope, and its proliferation was detected by Cell Counting Kit-VIII. RESULTS: 1, 2-DCE could damage the normal morphological structure of neurocytes: the cell body swelled and broke down, the karyon slurred or disappeared, the axone became shorten and thick, connection of neurocytes was reduced, the cell membrane was half-baked, injury of neurocytes became severer with the increase of the dose of 1, 2-DCE. There was no statistical difference in the proliferation of neurocytes between every 1, 2-DCE groups (P > 0.05), but there was significantly statistical difference between 1, 2-DCE groups, the control group, and the retarder groups (P < 0.01). CONCLUSION: 1, 2-DCE can damage the normal morphological structure of neurocytes, and the damage will become severer with the increase of the dose of 1, 2-DCE. However, the cell morphologic structures and proliferation of antagonist groups are much better than those in the 1, 2-DCE groups.

[Role of Bcl-2 and Bax protein contents and their gene expression in Al-induced neurons apoptosis].

OBJECTIVE: To study the role of Bcl-2 and Bax protein contents and their gene expression in Al-induced neurons apoptosis. METHODS: Neurons from 0 - 3 day rats were cultured and treated with different concentrations of AlCl(3 x 6) H2O. The cell apoptosis was observed by the TUNEL method and under the scan electron microscope. Bcl-2 and Bax protein contents were detected by the immunochemistry method while their gene expressions were measured by the RT-PCR method. RESULTS: (1) DNA fractions in the TUNEL method increased with the rising aluminum concentration. Blebbings and apoptosis bodies on the surface of the neurons were clearly observed under the scan electron microscope. (2) Bcl-2 protein contents and their gene expression decreased with the rising aluminum concentration (P < 0.01, r = -0.695; P < 0.05, r = -0.647), while Bax increased at the same time (P < 0.01, r = 0.676; P < 0.01, r = 0.794), the value of Bcl-2/Bax was related with the aluminum concentration (P < 0.01, r = -0.655; P < 0.01, r = -0.777). CONCLUSION: The aluminum may induce neurons apoptosis. Bcl-2 and Bax protein contents and their gene expression may play an important role in Al-induced apoptosis.