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Background: The impacts of rheumatoid arthritis (RA) on perioperative risks among patients undergoing revision total knee arthroplasty (rTKA) have not been investigated yet. Thus, we hypothesized that patients with RA sustained increased perioperative risks and higher resource consumption burdens as compared to patients with osteoarthritis (OA) during the perioperative period.Patients and Methods: The National Inpatient Sample (NIS) database was used to compare the demographic characteristics, major inhospital complications, resource consumptions, and in-hospitalization mortality between patients with RA and OA after rTKA. A 1:1 propensity score-matching, x 2 test, independence-sample T-test, and logistic regression analysis were done in statistical analyses to answer our hypotheses.Results: 4.3% (6363/132,405) of rTKA patients were diagnosed with RA. They tended to be women and received revision for infection but with similar ages as compared to patients with OA. Except for acute postoperative anemia (odds ratio [OR] = 1.196), blood transfusion (OR = 1.179), prolonged hospitalization (OR = 1.049), and higher total cost (OR = 1.145), patients with RA sustained decreased odds of acute renal failure (OR = 0.804) and urinary complications (OR = 0.467). Besides, the other observed in-hospital complications showed no differences between patients with RA and OA. Conclusion:Despite consuming greater in-hospital resources, patients with RA did not suffer increased odds of most in-hospital complications and in-hospital mortality for a revision TKA during the perioperative period. Compared with patients with OA, patients with RA sustained equivalent perioperative risks in the United States between 2002 and 2014.

BackgroundIntercellular adhesion molecule-1 (ICAM-1) K469E polymorphism has been implicated in susceptibility to coronary artery disease (CAD). Several studies investigated the association of this polymorphism with CAD in different populations but the results were contradictory. A meta-analysis was conducted to assess the association between ICAM-1 K469E polymorphism and CAD susceptibility.Material/MethodsDatabases including PubMed, EMBASE, China National Knowledge Infrastructure (CNKI), and Weipu Database were searched to find relevant studies. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the strength of associations. A random-effects model was used.ResultsFifteen case-control studies including 3088 cases and 3466 controls were included. Overall, a significant association between ICAM-1 K469E polymorphism and CAD was observed in the dominant model (OR=1.80; 95% CI 1.62–2.01; P<0.00001; Pheterogeneity=0.40). In subgroup analysis by ethnicity, a significant association was found among Asians (OR=1.92; 95% CI 1.51–2.43; P<0.00001; Pheterogeneity=0.98) and among Caucasians (OR=1.64; 95% CI 1.30–2.08; P<0.0001; Pheterogeneity=0.04). In the subgroup analysis by age, a significant association was found among young patients (OR=1.46; 95% CI 1.10–1.93; P=0.008; Pheterogeneity=0.21) and old patients (OR=1.92; 95% CI 1.75–2.10; P<0.00001; Pheterogeneity=0.99).ConclusionsResults of this meta-analysis suggest that ICAM-1 K469E polymorphism confers a risk factor of CAD.

Targeted therapy is an important anti-cancer therapy in non-small cell lung cancer (NSCLC). Pruritus are the common side-effect with gefitinib, an anti-EGFR antibody and tyrosine-kinase inhibitor. We reported case reports to confirm the effects of aprepitant, a neurokinin receptor to management of refractory rash and pruritus in Chinese malignancy population. patients showed a rapid recovery from refractory pruritus, no adverse events occurred. Weekly follow-up visits showed the pruritus were stable and no further episodes was recorded.

In this study, we summarized the association of IL-23R gene polymorphisms with hepatocellular carcinoma (HCC). A total of 270 HCC patients were selected as HCC group, and 251 healthy individuals served as the control group. PCR-RFLP was performed to detect IL-23R gene polymorphism, including rs17375018 and rs11805303. Survival rate and risk factors of HCC were identified. The findings suggested that IL-23R rs17375018 was correlated with genetic susceptibility to HCC, and GC haplotype was closely linked with the risk factors of HCC. Moreover, rs17375018 polymorphism was related to portal vein tumor thrombus (PVTT) and alcohol consumption in HCC patients, while prognosis was better in HCC patients with AA genotype of rs17375018 polymorphism. Lastly, GG genotype in rs17375018, PVTT and TNM stage III and IV were identified as independent risk factors for HCC. In conclusion, IL-23R rs17375018 polymorphism might serve as a prognostic factor in patients with HCC after interventional therapy.

Background Postoperative delirium (POD) is a common complication after major surgery, resulting in various adverse reactions. However, incidence and risk factors associated with POD after shoulder arthroplasty (SA) have not been well studied using a large-scale national database. Methods A retrospective database analysis was performed based on the Nationwide Inpatient Sample (NIS) from 2005 to 2014, the largest fully paid hospital care database in the United States. Patients undergoing SA were included. The patient’s demographics, comorbidities, length of stay (LOS), total costs, type of insurance, type of hospital, in-hospital mortality, and medical and surgical perioperative complications were assessed. Results A total of 115,147 SA patients were obtained from the NIS database. The general incidence of delirium after SA was 0.89%, peaking in 2010. Patients with delirium after SA had more comorbidities, prolonged LOS, increased hospitalization costs, and higher in-hospital mortality (P < 0.0001). These patients were associated with medical complications during hospitalization, including acute renal failure, acute myocardial infarction, pneumonia, pulmonary embolism, stroke, urinary tract infection, sepsis, continuous invasive mechanical ventilation, blood transfusion, and overall perioperative complications. Risk factors associated with POD include advanced age, neurological disease, depression, psychosis, fluid and electrolyte disturbances, and renal failure. Protective factors include elective hospital admissions and private insurance. Conclusion The incidence of delirium after SA is relatively low. Delirium after SA was associated with increased comorbidities, LOS, overall costs, Medicare coverage, mortality, and perioperative complications. Studying risk factors for POD can help ensure appropriate management and mitigate its consequences. Meanwhile, we found some limitations of this type of research and the need to establish a country-based POD database, including further clearly defining the diagnostic criteria for POD, investigating risk factors and continuing to collect data after discharge (30 days or more), so as to further improve patient preoperative optimization and management.