The partial pressure of oxygen decreases as altitude increases, the preoperative chronic hypoxemia (CH) may have a plausible clinical impact. Risk factors for postoperative serious adverse events (pSAEs) in patients living in high altitudes during primary hip arthroplasty (HA) are not clear.This is an observational study embracing patients from January 1, 2011 to December 31, 2015 at Yan’an Hospital of Kunming City, a 1338-bed municipal teaching hospital of Kunming Medical University. Univariate analysis revealed that significant differences between patients with and without preoperative CH occurred in intraoperative hypotension (77 [33%] vs 34 [47%], P = .040) and that significant differences between patients with and without pSAEs occurred in following variables: preoperative CH (32 [57%] vs 199 [80%], P < .001), intraoperative hypotension (37 [66%] vs 74 [30%], P < .001), highest noradrenaline support (.09 [.01–.21] vs .03 [.01–.05] μg/kg/min, P < .001), higher application of general anesthesia (15 [27%] vs 29 [12%], P = .004), and lower of combined-spinal epidural anesthesia (CSEA) (21 [37%] vs 165 [66%], P < .001). The general anesthesia and intraoperative hypotension remained the independent risk factors for pSAEs (P < .05), while the preoperative CH presented by decreasing its risk (P < .05).This study suggests that various intraoperative events including general anesthesia, hypotension were risk factors for the development of pSAEs. Preoperative CH, presenting with decreased incidence of intensive care unit (ICU) admission and pSAEs, may mimic hypoxic preconditioning in organic protection, for which further study is needed to uncover the underlying mechanisms.

Editor-The successful hip arthroplasty (HA) can greatly relieve pain and improve the quality of postoperative life, in patients suffering severe hip diseases including osteoarthritis or fracture. 1 2 However, patient-and surgery-related factors have been linked to a decrease in the quality of life, both perioperatively and later. 3 4 Age, anaesthesia, hypoxaemia, hypotension and anaemia appear to be associated with the development of postoperative outcomes, including delirium in geriatric patients after orthopaedic surgery. 5 6 Surprisingly, few studies have tested the associations between anaesthesia, chronic hypoxaemia, high altitude, patient age, perioperative management and serious adverse events (SAEs) during hip arthroplasty. In view of the above and increasing international recognition that perioperative management demanding a multidisciplinary approach 3 7 does affect patient outcome, we designed a multidisciplinary perioperative management plan for primary hip replacement.Firstly, we retrospectively explored cases of primary HA and then conducted regression analyses to identify outcome risk factors. We found the intraoperative hypotension and general anaesthesia were the independent risk factors for postoperative serious adverse events (SAEs, including ICU admission, malignant arrhythmia, delirium, etc.) with odds ratio (OR) 4.29 and 95% confidence interval (CI) (1.66-11.10), and OR 5.09 with 95% CI (1.96-13.24) respectively. And we conclude that intraoperative hypotension (a mean arterial pressure that was decreased by 30% for more than 3 min) were risk markers of postoperative SAEs in high altitude practice.Secondly, we conducted a multidisciplinary management implementation in patients with moderate to severe hypoxaemia. Then the subsequent patients were shared with shorter postoperative length of stay, of which the median were decreased from 15 days to 11 after implementation (P < 0.001). The perioperative SAE ratios decreased from 21.1% (32/152) initially to 9.4% (18/192) after modification (P ¼ 0.002). The all-cause mortality rate within 30 days decreased by 80% (P ¼ 0.040).A systematic approach optimized to achieve stable haemodynamics with combined-spinal epidural anaesthesia (the most popular method in HA in this hospital) was associated with improved outcome up to 30 days after operation. We must now postulate that a randomized trial is necessary to determine if the multidisciplinary management programme can improve patient outcomes, additional to just measures of hypotension or method of anaesthesia. However, high-quality prospective studies are required to confirm these findings and to establish evidencebased clinical guidelines. Declaration of interestNone declared.

Objectives Interstitial lung disease (ILD) is frequent in patients with rheumatoid arthritis (RA) and is a potentially life-threatening complication with significant morbidity and mortality. This meta-analysis aims to systematically determine the factors associated with the development of rheumatoid arthritis–related interstitial lung disease (RA-ILD). Materials and methods All primary studies which reported the factors associated with of RA-ILD were eligible for the review except case reports. The Cochrane Library, PubMed, Embase, Web of Science, Chinese Biological Medicine Database (CBM), China National Knowledge Infrastructure (CNKI), and WANFANG electronic databases were searched through to December 30, 2022, for studies investigating the factors associated with RA-ILD. The methodological quality assessment of the eligible studies was performed using the Newcastle-Ottawa Scale (NOS). 2 reviewers extracted relevant data independently. Then, weighed mean differences (WMDs) or pooled odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were obtained for the relationships between the factors and RA-ILD. The statistical meta-analysis, subgroup and sensitivity analyses were performed using the Review Manager 5.3, and publication bias with Egger’s test were performed using the Stata12.0 software. Results A total of 22 articles were screened for a meta-analysis which involved 1887 RA-ILD patients and 8066 RA without ILD patients. Some identified factors that were associated with an increased risk of RA-ILD included male sex (OR = 1.92, 95% CI: 1.54–2.39; P < 0.00001), older age (WMD = 5.77 years, 95% CI: 3.50–8.04; P < 0.00001), longer duration of RA (WMD = 0.80 years, 95% CI 0.12–1.47; P = 0.02), older age at onset of RA (WMD = 6.41 years, 95% CI: 3.17–9.64; P = 0.0001), smoking (OR = 1.69, 95% CI: 1.30–2.18; P < 0.0001). Five factors of laboratory items associated with the development of RA-ILD were evaluated in the meta-analysis. Compared with RA without ILD patients, positive rheumatoid factor (RF) (OR = 1.72, 95% CI: 1.47–2.01; P < 0.00001) and positive anti-citrullinated protein antibodies (ACPA) (OR = 1.58, 95% CI: 1.31–1.90; P < 0.00001) increased the risk of RA-ILD. Meanwhile, RF titer (WMD = 183.62 (IU/mL), 95% CI: 66.94–300.30; P = 0.002) and ACPA titer (WMD = 194.18 (IU/mL), 95% CI: 115.89–272.47; P < 0.00001) were significantly associated with increased risk of RA-ILD. Elevated erythrocyte sedimentation rate (ESR) (WMD = 7.41 (mm/h), 95% CI: 2.21–12.61; P = 0.005) and C-reactive protein (CRP) (WMD = 4.98 (mg/L), 95% CI: 0.76–9.20; P = 0.02) were also significantly associated with the development of the RA-ILD, whereas antinuclear antibody (ANA) positive status was not significantly associated with increased risk of RA-ILD (OR = 1.27, 95% CI: 1.00–1.60; P = 0.05). Conclusions This meta-analysis showed that male gender, older age, longer duration of RA, older age at onset of RA, smoking, positive RF, positive ACPA, elevated RF titer, elevated ACPA titer, higher ESR and higher CRP were associated with RA-ILD.

Background: This study aims to explore the clinical efficacy of radiofrequency ozone and injection of anti-inflammatory analgesic solution into the internal orifice of nerve root combined with traditional Chinese medicine hook operation in the treatment of lumbar disc herniation. Methods: The patients with lumbar disc herniation in our hospital from December 20, 2017 to June 19, 2019 were selected as the main research subjects, and the patients were numbered according to the order of their first visits, and the included patients were divided into treatment group and control group using random number table method. Patients in the treatment group were treated with radiofrequency ozone and injection of anti-inflammatory analgesic solution into the internal orifice of nerve root combined with traditional Chinese medicine hook operation. Patients in the control group were treated with traditional lumbar intervertebral disc radiofrequency treatment. The clinical treatment effects of the two groups were observed. Results: A total of 113 patients were included in this study, of which 73 were in the treatment group and 40 were in the control group. The results of the study showed that the NRS scores of patients in the treatment group before treatment were 5±1.68 points, and the NRS scores were 2±0.78 points, 1±0.54 points, and 1±0.77 points 1 month, 3 months, and 1 year after treatment, respectively. The NRS scores of patients in the control group were 3±0.48 points, 2±0.63 points, and 2±0.85 points 1 month, 3 months, and 1 year after treatment. Compared with before treatment and the control group, there were significant differences (P<0.01). Conclusion: Compared with single lumbar intervertebral disc radiofrequency treatment, radiofrequency ozone and injection of anti-inflammatory analgesic solution into the internal orifice of nerve root combined with hook operation can obtain good short-term and medium-term effects in the treatment of lumbar disc herniation. It is a safe and effective minimally invasive treatment method.

We investigated risk factors for postoperative serious adverse events (SAEs) in elderly patients with preoperative chronic hypoxaemia undergone total hip arthroplasty (THA) or hemiarthroplasty and performed an implementation to modify and improve clinical outcome. A retrospective medical record review was performed to identify geriatric patients who receiving THA or hemiarthroplasty at a single university teaching hospital, Kunming, Yunnan, China between January 2009 and August 2017. Total of 450 elderly patients were included in the study. Data were collected on baseline characteristics, detailed treatments, and adverse events. Univariate and multivariate logistic regression analysis were used to identify risk factors for SAEs. In multivariate regression analysis, a higher occurrence of general anaesthesia and multiple episodes of hypotension were associated with higher risk of SAEs (general anesthesia: odds ratio [OR] 5.09, 95% confidence interval [CI] 1.96–13.24, P = 0.001; hypotension time: OR 4.29, 95% CI 1.66–11.10, P = 0.003). After the multidisciplinary implementation, the postoperative length of stay was decreased from 15 days to 10 days (P < 0.0001); incidence of SAEs was decreased from 21.1% to 7.0% (P = 0.002), and the all-cause mortality rate within 30 days decreased from 4.6% to 1.0% (P = 0.040). Our observational study demonstrated that an increasing application of general anaesthesia and longer time of hypotension were associated with an increased risk of postoperative SAEs in patients after THA or hemiarthroplasty. Additionally, optimizing stable haemodynamics under higher application of combined-spinal epidural anaesthesia was associated with improved outcome up to 30 days after THA or hemiarthroplasty.