ObjectiveTo preliminarily explore the effect of Osteoporosis Self-assessment Tool for Asians (OSTA) and Fracture Risk Assessment Tool (FRAX) on predicting osteoporosis and osteoporosis fracture in postmenopausal patients with maintenance hemodialysis (MHD).MethodsThirty-six postmenopausal patients undergoing MHD from August 2017 to October 2018 in Hemodialysis Center of Nephrology Department, West China Hospital of Sichuan University were selected. Relevant data such as age, height, and weight were collected. OSTA index and the 10-year probability of major osteoporotic fractures and 10-year probability of hip fractures of FRAX score were calculated. Bone mineral densities (BMD) of the hip and lumbar spine were measured by dual energy X-ray absorptiometry (DXA) at the same time. The value of OSTA index and FRAX scale in evaluating the risk of osteoporosis predicated on T value ≤−2.5 determined by DXA BMD and fracture in postmenopausal patients with MHD were analyzed.ResultsThe DXA BMD of the 36 patients showed that 50.0% (18/36) had a T value≤−2.5, and 30.6% (11/36) had a fracture history. BMD in postmenopausal patients with MHD was negatively correlated with FRAX score (model without BMD values), and positively correlated with OSTA index. The sensitivity and specificity of OSTA in the prediction of osteoporosis were 94.4% and 61.1%, respectively; and the sensitivity and specificity of FRAX (the model without BMD values) in the prediction of osteoporosis were 88.9% and 50.0%, respectively. The FRAX score with or without BMD had the same clinical value in predicting osteoporosis.ConclusionsPostmenopausal MHD patients have a higher risk of osteoporosis and fracture. Both OSTA index and FRAX scale can predict osteoporosis risk among postmenopausal MHD patients, and the FRAX scale with or without BMD has the same clinical value in predicting osteoporosis risk. In clinical work, for primary hospitals and dialysis centers lacking DXA, preliminary screening of osteoporosis in MHD patients can be performed with OSTA and FRAX scales.
ObjectiveTo discuss and analyze the sense of dignity and its influencing factors of maintenance hemodialysis (MHD) patients.MethodsPatients with MHD in hemodialysis center of West China Hospital of Sichuan University were selected from November 2019 to January 2020. Patients were selected by convenience sampling. The patients were investigated with Patient Dignity Inventory (PDI), Connor-Davidson Resilience Scale (CD-RISC) and Hospital Anxiety and Depression Scale.ResultsA total of 150 patients were included. The average scores of CD-RISC, anxiety, depression and PDI were 61.20±14.54, 4.97±1.38, 5.90±2.42 and 41.32±16.24, respectively. Among them, 121 cases (80.67%) had mild dignity impairment, 22 cases (14.67%) had moderate dignity impairment, 6 cases (4.00%) had severe dignity impairment, and 1 case (0.67%) had very serious dignity impairment. The results of multiple linear stepwise regression showed that depression, economic burden, social support, and vascular access were all positive predictors of esteem scores (P<0.001).ConclusionsClinical nurses can aim at the main factors affecting the sense of dignity of MHD patients. And individualized nursing plan and intervention measures can be formulated to improve the sense of dignity of patients and improve the quality of life of maintenance hemodialysis patients.
ObjectiveTo investigate the effectiveness of tibial transverse transport (TTT) combined with modified neurolysis in treatment of diabetic foot ulcer (DFU) through a prospective randomized controlled study. Methods The patients with DFU and diabetic peripheral neuropathy, who were admitted between February 2020 and February 2022, were selected as the research objects, of which 31 cases met the selection criteria and were included in the study. The patients were divided into two groups by random number table method. The 15 patients in the trial group were treated with TTT combined with modified neurolysis, and the 16 patients in the control group received treatment with TTT alone. There was no significant difference in gender, age, duration of DFU, ulcer area, Wagner classification, as well as preoperative foot skin temperature, visual analogue scale (VAS) score, ankle-brachial index (ABI), motor nerve conduction velocity (MNCV) of the common peroneal nerve, MNCV of the tibial nerve, MNCV of the deep peroneal nerve, two-point discrimination (2-PD) of heel, and cross-sectional area (CSA) of the common peroneal nerve between the two groups (P>0.05). The time for ulcer healing, foot skin temperature, VAS scores, ABI, 2-PD of heel, and CSA of the common peroneal nerve before operation and at 6 and 12 months after operation were recorded and compared between groups. The differences in MNCV of the common peroneal nerve, MNCV of the tibial nerve, and MNCV of the deep peroneal nerve between pre-operation and 12 months after operation were calculated. Results All patients in both groups were followed up 12-24 months (mean, 13.9 months). The surgical incisions in both groups healed by first intention and no needle tract infections occurred during the bone transport phase. Ulcer wounds in both groups healed successfully, and there was no significant difference in the healing time (P>0.05). During the follow-up, there was no ulcer recurrences. At 12 months after operation, the MNCV of the common peroneal nerve, the MNCV of the tibial nerve, and the MNCV of the deep peroneal nerve in both groups accelerated when compared to preoperative values (P<0.05). Furthermore, the trial group exhibited a greater acceleration in MNCV compared to the control group, and the difference was significant (P<0.05). The foot skin temperature, VAS score, ABI, 2-PD of heel, and CSA of the common peroneal nerve at 6 and 12 months after operation significantly improved when compared with those before operation in both groups (P<0.05). The 2-PD gradually improved over time, showing significant difference (P<0.05). The 2-PD of heel and VAS score of the trial group were superior to the control group, and the differences were significant (P<0.05). There was no significant difference in ABI, foot skin temperature, and CSA of the common peroneal nerve between groups after operation (P>0.05). Conclusion Compared with TTT alone, the TTT combined with modified neurolysis for DFU can simultaneously solve both microcirculatory disorders and nerve compression, improve the quality of nerve function recovery, and enhance the patient’s quality of life.