Psoriasis is a chronic inflammatory skin disease. Metabolic syndrome (MS) is a combination of central obesity, dyslipidemia, glucose intolerance, and elevated blood pressure. Many epidemiological surveys have revealed the association of psoriasis with MS. Narrowband ultraviolet radiation b (NB-UVB) is an effective and widely used treatment for psoriasis. The purpose of this study was to investigate whether the presence of MS in patient with psoriasis affects NB-UVB treatment and whether this syndrome correlates with systemic inflammation.From June 2016 to December 2016, 243 adults with a diagnosis of psoriasis vulgaris eligible to treatment with NB-UVB were admitted to the phototherapy unit of Dermatology department, Chinese PLA General Hospital. Fifty-five included patients were grouped based on the presence of MS. They accepted the treatment of NB-UVB and the following data were collected: serum levels of IL-17 (interleukin), TNF-α (tumor necrosis factor) and IL-6, Psoriasis Area and Severity Index (PASI) scores before and after 10 sections of NB-UVB treatment.Significant PASI improvement was observed in psoriatic patients without MS after 10 sections of phototherapy, while patients with MS showed a less improvement (P < .001). There was statistically significant difference in percentage of patients achieving 50% reduction in PASI scores between the 2 groups (P < .05). Multivariate logistic regression analysis showed MS was an independent factor that affecting the treatment of NB-UVB (P < .05). Psoriatic patients with MS showed a much less reduction of IL-17 and IL-6 before and after 10 sections of NB-UVB treatment respectively than patients without MS (P < .05).Psoriatic patients with MS have poorer improvement in comparison those without MS using NB-UVB treatment. MS was an independent factor that affecting the treatment of NB-UVB. In addition, psoriatic patients with MS showed a much less reduction of systemic biomarkers (interleukin—IL-17, TNF-α, IL-6) than patients without MS. Namely, they may need a longer course of treatment to achieve improved skin lesions.
Obesity not only gives rise to more blood loss volume but also correlates with postoperative rehabilitation and complications in surgical patients. It is not clear at present whether tourniquet utilization is associated with blood loss, rehabilitation, and complications, and it is imperative to ascertain the tactics of utilizing tourniquet in obese patients undergoing total knee arthroplasty (TKA). The present study was designed to explore the association of tourniquet utilization with blood loss, rehabilitation, and complications, and ascertain the tactics of utilizing tourniquet in obese patients undergoing TKA.A total of 130 patients from January 2014 to December 2014 were categorized into tourniquet group (n = 94) and non-tourniquet group (n = 36) based on whether the tourniquet was utilized or not during operation. Recorded data were as follows: total blood loss volume, intraoperative blood loss volume, hidden blood loss volume, blood transfusion volume, drainage volume, difference between hemoglobin value before operation and that on the fifth day after operation (5d Hb D-value), thigh swelling rate and visual analogue scale (VAS) score of motion pain, and Knee Society Score (KSS) score.Mean age was 65.27 ± 7.43 (49–82) years, and 15 patients (11.5%) were men. No significant difference in total blood loss volume, drainage volume, blood transfusion volume, and 5d Hb D-value was noted between the 2 groups (P > .05 for all). Tourniquet group had significantly less intraoperative blood loss volume and significantly more hidden blood loss volume than the non-tourniquet group (P < .05 for all). Tourniquet group had significantly higher thigh swelling rate and VAS score of motion pain on the third day after operation, and significantly lower KSS function score in the third week after operation than non-tourniquet group (P < .05). No significant difference in KSS function score in the first year after operation was found between the 2 groups (P > .05). No difference in postoperative complications was observed between the groups (P > .05).The current study demonstrated that the tourniquet is not associated with reduced blood loss and increased postoperative complications in obese patients undergoing TKA. Step-down postoperative rehabilitation related to tourniquet is short-term rather than long-term in obese patients undergoing TKA.
Simultaneous bilateral TKA (SBTKA) has been a favored surgical solution due to reduced costs and patient suffering. The purpose of the present study was to investigate the risk factors of asymmetric recovery in patients who underwent SBTKA and whether that affected quality of life. A total of 187 patients undergoing SBTKA were included. During this study, patients underwent physical examination (knee swelling, active range of motion (ROM) of knee and quadriceps strength) and completed three surveys (VAS pain rating, Short Form-36 and requisite information lists in this study). Our results reveal interlimb asymmetries existed at least two years postoperatively. Between-limb differences in active ROM, quadriceps strength, and VAS pain scores were significantly detected in our study. Risk factors included being female, being older, and having high BMI and high levels of anxiety and depression; different diagnosis and different component size could be risk factors. Finally, interlimb differences in VAS pain scores and active ROM were negatively associated with SF-36 scores. However, interlimb differences in swelling and quadriceps strength were unrelated to SF-36 scores. Risk factors of asymmetric recovery should be evaluated and appreciated due to their significant impact on patients’ quality of life. Before performing SBTKA, clinicians should consider possible risk factors and inform patients of asymmetric recovery between limbs, which could help decrease the unnecessary consultations and postoperative patient dissatisfaction.
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