BackgroundRecent research indicates that the monocyte lymphocyte ratio (MLR), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), C-reactive protein (CRP), and systemic immune-inflammation index (SII) may serve as valuable predictors of early postoperative mortality in elderly individuals with hip fractures. The primary objective of the study was to examine the association between preoperative MLR, NLR, PLR, CRP, and SII levels and 3-year mortality risk in geriatric patients after hip fracture surgery.Patients and methodsThe study included patients aged 65 years or older who underwent hip fracture surgery between November 2018 and November 2019. Admission levels of MLR, NLR, PLR, CRP, and SII were measured. The median follow-up period was 3.1 years. Cox proportional hazards models were used to calculate the hazard ratio (HR) for mortality with adjusting for potential covariates. Time-dependent receiver operating characteristic (ROC) curves were employed to assess the predictive capability of inflammatory indicators for mortality.ResultsA total of 760 patients completed the follow-up (79.4 ± 7.8 years, 71.1% female). A higher preoperative MLR was found to be significantly associated with an increased 3-year postoperative mortality risk (HR 1.811, 95% CI 1.047–3.132, P = 0.034). However, no significant correlations were observed between preoperative NLR, PLR, CRP, SII and 3-year mortality. The areas under the ROC curve (AUCs) of MLR for predicting 30-day, 120-day, 1-year, and 3-year mortality were 0.74 (95% CI 0.53–0.95), 0.70 (95% CI 0.57–0.83), 0.67 (95% CI 0.60–0.74), and 0.61 (95% CI 0.56–0.66), respectively.ConclusionPreoperative MLR is a useful inflammatory marker for predicting 3-year mortality in elderly hip fracture patients, but its predictive ability diminishes over time.

Tourniquets are widely used in limb fracture surgeries. Controversies still exist about the pressure inflated, including unified tourniquet inflation pressure (UTIP) and personalized tourniquet inflation pressure (PTIP). This study evaluated the hemostatic effect between UTIP and PTIP based on systolic blood pressure (SBP) in extremity fracture patients. Patients with fresh extremity fractures requiring tourniquets during surgeries were prospectively enrolled and randomly assigned to the UTIP and PTIP groups. The inflation pressure was set to 250 mmHg for the upper extremities and 300 mmHg for the lower extremities in the UTIP group and SBP plus 50 mmHg for the upper extremities and SBP plus 100 mmHg for the lower extremities in the PTIP group. The primary outcome was a hemostatic effect evaluated by the surgeon (satisfied or dissatisfied). Other secondary outcomes included postoperative changes in limb swelling and tourniquet-related complications. A total of 144 patients were enrolled and randomly assigned to the UTIP group or the PTIP group, and each group has 72 patients (36 upper limb and 36 lower limb). Totally, the hemostasis effect of the PTIP group was worse than that of the UTIP group by non-inferiority test. The hemostatic effect of upper limb fractures with SBP plus 50 mmHg for tourniquet inflation pressure was also worse than that with 250mmHg; however, there was no statistically significant difference between 300mmHg and SBP plus 100 mmHg in the lower limb group hemostasis effect due to a lack of power. Also, no difference was observed in the incidence of complications (p = 1.000) and postoperative changes in limb swelling during 2 days after surgery (upper limb: P1 = 0.546, P2 = 0.545; lower limb: P1 = 0.408, P2 = 0.857) between the PTIP and UTIP group. In the surgery of limb fractures, setting SBP + 50mmHg as tourniquet pressure may not be sufficient for upper limbs. Also, we found no difference between the SBP + 100mmHg and the unified 300mmHg for lower limb surgeries.

ObjectiveThe prognostic nutritional index (PNI) has been reported as a significant predictor in various diseases. However, the prognostic value of the PNI in geriatric hip fracture patients has not been thoroughly evaluated. This study aimed to investigate the association between admission PNI and 3‐year mortality in those patients.MethodsIn this post hoc analysis, we included patients aged ≥65 years who underwent surgery for hip fracture between 2018 and 2019. The admission PNI was calculated as serum albumin (g/L) +5 × total lymphocyte count (×109/L). Patients were categorized into four groups based on PNI quartiles (≤ 43.55, 43.55–46.55, 46.55–49.20, and >49.20, respectively). The median follow‐up duration was 3.1 years. Cox proportional hazards models were used to calculate the hazard ratio (HR). Receiver operating characteristic curve (ROC) was conducted for using PNI to predict mortality.ResultsOf the 942 eligible patients, 190 (20.2%) patients died during the follow‐up. Compared to patients in the first quartile (Q1), those in the second (Q2), third (Q3), and fourth (Q4) quartiles had significantly lower mortality risks (HRs 0.50, 95% CI 0.35–0.74; 0.41, 95% CI 0.26–0.64; and 0.26, 95% CI 0.15–0.45, respectively). The optimal cutoff of PNI for predicting mortality was set as 45.275 (sensitivity, 0.674; specificity, 0.692; area under the curve (AUC), 0.727). Patients with higher PNI (>45.275) had a significant lower mortality risk (HR 0.39, 95% CI 0.28–0.55) compared to those with lower PNI (≤ 45.275).ConclusionPNI is a reliable and independent predictor of 3‐year mortality after hip fracture surgery in the elderly.

Background: In the field of orthopedic surgery, tourniquets are often used to achieve a clear operative field, expedite operations, and minimize hemorrhagic events. However, determining the optimal tourniquet inflation pressure is a topic of debate. The current approach involves using a constant tourniquet pressure, although this is associated with the potential to augment the risk of tourniquet-associated complications. The Association of Surgical Technologists recommends a tourniquet pressure of systolic blood pressure plus 50 mm Hg for the upper limb and 100 mm Hg for the lower limb. Nevertheless, this method lacks robust support from high-quality medical literature. Therefore, the study aimed to compare the hemostatic efficacy and disparities in tourniquet pressure settings based on systolic blood pressure versus those using the constant-pressure method. The findings might outline the theoretical framework necessary for advocating for tourniquet pressure setups guided by systolic blood pressure. Methods/design: This randomized controlled study classified the tourniquet pressure regimen into two groups: one based on the patient's systolic blood pressure (the study group) and the other using a constant pressure (the control group). The study included patients aged between 16 and 70 who presented with fresh fractures (less than 3 weeks) of the lower and upper limbs. All the included patients required surgical treatment involving the intraoperative use of a tourniquet and had no contraindications to this surgery. Our primary outcome was to assess the surgeon's satisfaction with the hemostasis achieved in the operative field. We also examined the changes in the circumference of the limb where the tourniquet was applied and tracked any postoperative complications and their incidence. The study ultimately encompassed 144 patients. Discussion: Despite the prevalent use of tourniquets in surgical operations related to limb fractures, conflicting viewpoints persist concerning the adjustments in pressure and other elements. The study aimed to compare the hemostatic efficacy and disparities in tourniquet pressure settings based on systolic blood pressure versus those using the constant-pressure method. Study registration: The study was duly recorded in the Chinese Clinical Trial Registry on May 13, 2022 (Registration number: ChiCTR2200059867). Registration website: https://www.chictr.org.cn/showproj.aspx?proj=162504.

The prognostic nutritional index (PNI) is a useful tool for assessing nutritional status using serum albumin and lymphocyte count. This study indicates that a higher preoperative PNI correlates with improved mobility and health-related quality of life during the initial postoperative period in elderly patients with hip fractures. To investigate the prognostic value of the prognostic nutritional index (PNI) in predicting mobility and health-related quality of life (HRQoL) in elderly hip fracture patients after surgery. We prospectively involved patients aged 65 and above, who could walk freely before injury and underwent surgery between 2018 and 2019. Admission PNI was calculated as serum albumin (g/L) + 5 × total lymphocyte count (× 109/L). Patients were classified into two groups based on PNI median value. All patients were followed up by telephone for four times (30-day, 120-day, 1-year, and 3-year after surgery). The Fracture Mobility Score (FMS) and EuroQol 5-Dimension 5-Level (EQ-5D 5L) were used to evaluate mobility and HRQoL, respectively. Of 705 eligible patients, 487 completed all assessments. Patients in the higher PNI group had a significantly increased possibility of achieving unrestricted mobility at the 120-day follow-up (OR 1.69, 95

BACKGROUND It is unclear whether preoperative thyroid-stimulating hormone (TSH) level is correlated with long-term mortality in the elderly after hip fracture surgery. We aimed to assess the association between TSH levels and 3-year mortality in these patients. MATERIAL AND METHODS We enrolled patients aged 65 and above who had hip fracture surgery and thyroid function tests upon admission from 2018 to 2019. Patients were categorized based on TSH median value, quartiles, or thyroid function status. The median follow-up time was 3.1 years. Cox proportional hazards models were used to examine the correlation between TSH levels and mortality, adjusting for covariates. RESULTS Out of 799 eligible patients, 92.7% (741/799) completed the follow-up, with 20.6% (153/741) of those having died by the end of the follow-up. No statistically significant differences in mortality risks were found when stratified by TSH median value (HR 0.88, 95% CI 0.64-1.22, P=0.448) or quartiles (HR ranging from 0.90 to 1.13, P>0.05). Similarly, when categorized based on admission thyroid function status, patients who presented with hypothyroidism, subclinical hypothyroidism, hyperthyroidism, and subclinical hyperthyroidism upon admission did not demonstrate a statistically significant difference in mortality risk compared to those who were considered euthyroid (HR 1.34, 95% CI 0.72-2.49, P=0.359; HR 0.77, 95% CI 0.38-1.60, P=0.489; HR 1.15, 95% CI 0.16-8.30, P=0.890; HR 1.07, 95% CI 0.34-3.38, P=0.913, respectively). CONCLUSIONS Admission TSH is not significantly associated with 3-year mortality in geriatric patients after hip fracture surgery.

[This corrects the article DOI: 10.3389/fsurg.2024.1440990.].

Objective To evaluate the clinical effectiveness of orthogeriatric co-management care in long-lived elderly hip fracture patients (age ≥ 90). Methods Secondary analysis was conducted in long-lived hip fracture patients between 2018 to 2019 in 6 hospitals in Beijing, China. Patients were divided into the orthogeriatric co-management group (CM group) and traditional consultation mode group (TC group) depending on the management mode. With 30-day mortality as the primary outcome, multivariate regression analyses were performed after adjusting for potential covariates. 30-day mobility and quality of life were compared between groups. Results A total of 233 patients were included, 223 of whom completed follow-up (125 in CM group, 98 in TC group). The average age was 92.4 ± 2.5 years old (range 90–102). The 30-day mortality in CM group was significantly lower than that in TC group after adjustments for (2.4% vs. 10.2%; OR = 0.231; 95% CI 0.059 ~ 0.896; P = 0.034). The proportion of patients undergoing surgery and surgery performed within 48 h also favored the CM group (97.6% vs. 85.7%, P = 0.002; 74.4% vs. 24.5%, P < 0.001; respectively). In addition, much more patients in CM group could walk with or without aids in postoperative 30 days than in the TC group (87.7% vs. 60.2%, P < 0.05), although differences were not found after 1-year follow-up. And there was no significant difference in total cost between the two groups ( P > 0.05). Conclusions For long-lived elderly hip fracture patients, orthogeriatric co-management care lowered early mortality, improved early mobility and compared with the traditional consultation mode.

Purpose To explore the epidemiological trends in acetabular fracture and report the mid-term to long-term clinical outcomes of the elderly treated with operation. Methods Retrospective study. Patients aged ≥ 14 years with operative treatment of the Acetabular fracture from Jan 2010 to Dec 2019 at a level-1 trauma centre were identified to analyze the epidemiological trends, and the difference in fracture patterns between young and elderly patients (≥ 60 years old) were compared. The elderly patients were followed up to evaluate their clinical outcomes and satisfaction degree (worst to best: 0 to10). The patients were divided into the 2010–2014 group and the 2015–2019 group according to the year of admission, and the clinical outcomes of the two groups were compared to verify the stability from mid-term to long-term after surgery for acetabular fracture. Results A total of 1024 patients (mean age 43.35 years, range 14–86 years) with acetabular fractures received operative treatment in this decade. The mean age of the acetabular fracture patients increased from 41.1 years to 47.7 years, and the proportion of elderly patients increased from 5.7% to 24.0%, with some volatility. The ratio of male to female decreased year by year, and the proportion of female patients increased with age. And the anterior fracture patterns were more common in the elderly patients compared to the young patients ( P < 0.001). 118 elderly patients (82 males, 36 females; mean age 66.91 years, range 60–86 years) were followed-up (mean 77.4 months, range 35–152 months). The overall mortality rate of the elderly patients was 7.69% (9/118). The Harris hip score of those alive patients was 90.41 ± 12.91 points (excellent and good rate 84.4%). 87 patients completed the SF-12 with a normal HRQoL (PCS 50.49 ± 8.88 points; MCS 55.66 ± 8.86 points). 90.8% of the patients achieved a satisfaction score of 9 or higher. And there was no significant difference in clinical outcomes between the 2010–2014 group and the 2015–2019 group ( P > 0.05). Conclusions In conclusion, acetabular fractures presented an obvious ageing trend in China, and the fracture patterns of the elderly patients differed from those in the young patients. Operative treatment for elderly acetabular fractures yielded satisfactory and persistent clinical outcomes from mid-term to long-term clinical.

目的:研究周末入院对老年髋部骨折患者疗效的影响.方法:采用回顾性研究方法,连续纳入2018年11月至2019年11月收治的老年(年龄≥65岁)髋部骨折患者1 009例,根据患者入院时间分为工作日入院组(周一至周四入院)388例和周末入院组(周五至周日入院)621例.收集患者基线资料和治疗相关资料,并于入院后30 d、120 d、1年进行随访,随访患者生存情况和并发症情况.结果:周末入院组与工作日入院组患者基线资料差异均无统计学意义(P＞0.05).与工作日入院组患者相比,周末入院组患者入院48 h内手术率显著降低(64.2％vs.81.6％,P＜0.001),术前等待时间和住院时间均显著增加(P＜0.05),30 d内并发症发生率显著增加(11.9％vs.7.7％,P=0.028).两组患者院内、30 d、120 d和1年死亡率及1年内再次手术率差异均无统计学意义(P＞0.05).结论:周末入院会延长老年髋部骨折患者术前等待时间,增加并发症发生率,应制定相应的流程和路径以降低周末入院对老年髋部骨折患者疗效的影响.

Objective:To evaluate the emergency iliosacral screw fixation assisted by TiRobot for unstable posterior pelvic ring fracture.Methods:The 26 patients with unstable pelvic fracture were analyzed retrospectively who had undergone emergency iliosacral screw fixation at Department of Orthopedics & Traumatology, Beijing Jishuitan Hospital from June 2018 to December 2020. They were divided into 2 groups depending on whether orthopaedic TiRobot was used to assist screw insertion. In the observation group of 14 cases subjected to TiRobot-assisted insertion of iliosacral screws, there were 10 males and 4 females with an age of (45.9 ± 10.1) years; in the control group of 12 cases subjected to conventional manual insertion of iliosacral screws, there were 9 males and 3 females with an age of (49.2 ± 11.3) years. All the surgeries were conducted within 24 hours after injury. The 2 groups were compared in terms of screw insertion time, pin insertion, intraoperative blood loss, fluoroscopy time, postoperative screw position, fracture reduction and Harris hip score at the final follow-up.Results:The 2 groups were comparable because there was no significant difference between them in their preoperative general clinical data or follow-up time ( P>0.05). The screw insertion time [(16.1 ± 3.4) min] and fluoroscopy time [(8.1 ± 3.3) s] in the observation group were significantly shorter than those in the control group [(26.4 ± 5.4) min and (25.2 ± 7.4) s], and the pin insertions [1 (1, 2) times] and intraoperative blood loss [(10.5 ± 6.4) mL] in the former were significantly less than those in the latter [6 (3, 8) times and (24.8 ± 6.7) mL] (all P<0.05). Postoperatively, the sacroiliac screw position was excellent in 18 cases and good in 2 in the observation group while excellent in 14 cases, good in 2 and poor in 2 in the control group; the fracture reduction was excellent in 12 cases, good in one and fair in one in the observation group while excellent in 10 cases, good in one and fair in one in the control group, showing insignificant differences in the above comparisons ( P>0.05). There was no significant difference either in the Harris hip score at the final follow-up between the 2 groups ( P>0.05). Conclusion:Compared with conventional manual insertion of iliosacral screws, emergency iliosacral screw fixation assisted by TiRobot can effectively decrease surgical time and reduce operative invasion due to a higher accuracy rate of screw insertion.

目的:探讨一种简易的肘关节旋转轴导针安置方法的可靠性及其临床应用价值.方法:前瞻性选择2017年1月至2019年1月收治的需使用铰链式肘关节外固定支架的患者.应用简单随机化分组法分为高年资组和低年资组,分别由高年资(>3年)主治医师和低年资(≤3年)主治医师完成肘关节旋转轴导针置入.最终纳入43例患者,包括急性肘关节脱位11例,陈旧性骨折脱位7例,肘关节僵硬25例.其中高年资组22例,低年资组21例.术中记录肘关节旋转轴同心圆确认时间、透视次数、完成导针安置时间、术中肘关节无外力活动度.常规术后康复及随访,术后6周拆除外固定支架.记录末次随访时肘关节屈伸活动度及Mayo肘关节功能评分(MEPS).结果:所有患者均完成术后随访,随访时间12～30个月,平均随访(16.4±5.7)个月.末次随访时,43例患者肘关节伸直活动度为0°～15°,平均(7.1±6.8)°;肘关节屈曲活动度为110°～140°,平均(122.9±22.0)°;MEPS评分为80～95分,平均(86.9±13.4)分.高年资组和低年资组定位肘关节旋转轴同心圆用时分别为(3.8±1.1)min、(5.0±1.4)min,差异有统计学意义(P<0.05);而两组透视次数、导针安置操作时间、术中支架安置后即刻肘关节活动度差异均无统计学意义(P>0.05).末次随访时两组患者肘关节屈伸活动度及MEPS评分差异均无统计学意义(P>0.05).结论:对于需要安装肘关节铰链式外固定支架的患者,固定C型臂X线机确定旋转轴的方法操作简单,可重复性强,学习曲线短,定位导针安置准确可靠,低年资医师也能较快掌握.

Background The enhanced recovery after surgery (ERAS) program is aimed to shorten patients' recovery process and improve clinical outcomes. This study aimed to compare the outcomes between the ERAS program and the traditional pathway among patients with ankle fracture and distal radius fracture. Methods This is a multicenter prospective clinical controlled study consisting of 323 consecutive adults with ankle fracture from 12 centers and 323 consecutive adults with distal radial fracture from 13 centers scheduled for open reduction and internal fixation between January 2017 and December 2018. According to the perioperative protocol, patients were divided into two groups: the ERAS group and the traditional group. The primary outcome was the patients' satisfaction of the whole treatment on discharge and at 6 months postoperatively. The secondary outcomes include delapsed time between admission and surgery, length of hospital stay, postoperative complications, functional score, and the MOS item short form health survey-36. Results Data describing 772 patients with ankle fracture and 658 patients with distal radius fracture were collected, of which 323 patients with ankle fracture and 323 patients with distal radial fracture were included for analysis. The patients in the ERAS group showed higher satisfaction levels on discharge and at 6 months postoperatively than in the traditional group (P < 0.001). In the subgroup analysis, patients with distal radial fracture in the ERAS group were more satisfied with the treatment (P=0.001). Furthermore, patients with ankle fracture had less time in bed (P < 0.001) and shorter hospital stay (P < 0.001) and patients with distal radial fracture received surgery quickly after being admitted into the ward in the ERAS group than in the traditional group (P=0.001). Conclusions Perioperative protocol based on the ERAS program was associated with high satisfaction levels, less time in bed, and short hospital stay without increased complication rate and decreased functional outcomes.

Ganoderma lucidum (Lingzhi) polysaccharide peptide (GL-pp) is a component of the globally acknowledged traditional Chinese medicine Ganoderma lucidum ; Ganoderma lucidum is known for its sedative, hypnotic, immune regulatory, antitumor, and other pharmacological effects. In recent years, sleep disorders have been linked to many diseases and human body disorders, including cancer. Some experimental studies in mice found that sleep fragmentation could promote tumor development and progression. However, effects on GL-pp on tumor metastasis under circumstances of sleep disorders have rarely been studied. Thus, in this study, we used mice with sleep fragmentation (SF) bearing B16-F10-luc-G5 melanoma tumors to investigate the effect of SF on melanoma metastasis. Furthermore, we investigated the antitumor and antimetastatic effects of GL-pp (80 mg/kg) in mice suffering from SF and bearing B16-F10-luc-G5. Then, whole proteomics was used to analyze the differences in protein expression in the lung tissue between SF mice bearing B16-F10-luc-G5 with and without GL-pp administration. High-throughput pyrosequencing of 16S rRNA was also used to analyze the impact of GL-pp on the gut microbiota composition in SF mice bearing B16-F10-luc-G5. Last, the effects of GL-pp on macrophage polarization and TNF-α serum levels were detected. Collectively, we found that SF significantly facilitated the B16-F10-luc-G5 melanoma tumor metastasis in mice, while GL-pp significantly reduced B16-F10-luc-G5 melanoma tumor metastasis under the condition of SF, in which proteomics and gut microbiota had been changed greatly.

In recent years, studies have shown that there is a correlation between sleep disorders and cancer, but at the present stage, the research on sleep disorders and tumor related animal models is relatively insufficient. Our research will focus on mice bearing B16 F10-luc-G5 melanoma tumor with sleep fragmentation, detecting promoting effect of sleep fragmentation（SF） on the metastasis of melanoma. At the same time, we used Ganoderma lucidum polysaccharides peptide(GL-pp, 80 mg·kg -1 ), a component of traditional Chinese medicine Ganoderma lucidum, which has long enjoyed a good reputation at home and abroad, to observe its anti-tumor metastasis effects on B16 F10-luc-G5 mice with SF. Then we used whole proteomics to analyze the difference proteins expressed in lung tissue and compared between groups, includes mice bearing B16 F10-luc-G5, mice bearing B16 F10-luc-G5 with SF and GL-pp administered mice bearing B16 F10-luc-G5 with SF. With the analysis using bioinformatics, we found several key proteins, their genes name are Adcy9, ptk2, Yap1 and Lpin2, Per1 and Tim. And several important clusters, they are, immune system, platelet aggression, energy metabolism, cell cytoskeleton, cell adhesion and circadian rhythms. Moreover, we detected the TLR4 signal pathway and macrophage differentiation to reconfirm the results of proteomics and trying to elucidate the mechanism of SF on tumor growth and metastasis and the effects of GL-pp.

细胞质分裂付出蛋白1(dedicator of cytokinesis 1,DOCK1)作为Rho GTP酶家族的关键上游分子,在细胞迁移过程中发挥关键性的作用.细胞表面受体与配体结合后,通过一系列衔接蛋白招募并活化DOCK1蛋白,进而促进细胞生长和迁移等生物学过程.活化的DOCK1通过激活Rac1调节下游的肌动蛋白组装,从而影响细胞迁移、粘附和存活.DOCK1在癌细胞迁移和侵袭中的作用越来越受到重视.DOCK1在肺癌、膀胱癌、卵巢癌、急性髓系白血病等多种肿瘤中的过度表达与其预后差相关.DOCK1在肿瘤细胞的迁移、肿瘤血管生成以及肿瘤耐药方面发挥重要作用.提示DOCK1是一个治疗癌转移的可能靶点.