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Objective: The volume based procurement (VBP) program in China was initiated in 2022. The cost‐effectiveness of robotic arm assisted total knee arthroplasty is yet uncertain after the initiation of the program. The objective of the study was to investigate the cost‐effectiveness of robotic arm‐assisted total knee arthroplasty and the influence of the VBP program to its cost‐effectiveness in China. Methods: The study was a Markov model‐based cost‐effectiveness study. Cases of primary total knee arthroplasty from January 2019 to December 2021 were included retrospectively. A Markov model was developed to simulate patients with advanced knee osteoarthritis. Manual and robotic arm‐assisted total knee arthroplasties were compared for cost‐effectiveness before and after the engagement of the VBP program in China. Probability and sensitivity analysis were conducted. Results: Robotic arm‐assisted total knee arthroplasty showed better recovery and lower revision rates before and after initiation of the VBP program. Robotic arm‐based TKA was superior to manual total knee arthroplasty, with an increased effectiveness of 0.26 (16.87 vs 16.61) before and 0.52 (16.96 vs 16.43) after the application of Volume‐based procurement, respectively. The procedure is more cost‐effective in the new procurement system (17.13 vs 16.89). Costs of manual or robotic arm‐assisted TKA were the most sensitive parameters in our model. Conclusion: Based on previous and current medical charging systems in China, robotic arm‐assisted total knee arthroplasty is a more cost‐effective procedure compared to traditional manual total knee arthroplasty. As the volume‐based procurement VBP program shows, the procedure can be more cost‐effective. [ABSTRACT FROM AUTHOR]

Resin-based spherical activated carbon (RSAC) with high specific surface area and large mesopore volume (HRSAC) was prepared from spherical solid waste ion exchange resin by CO2 activation and acid treatment, and HRSAC supported polyethyleneimine (PEI-HRSAC) adsorption materials were prepared. The effects of PEI loading and adsorption temperature on CO2 adsorption performance were systematically investigated. The results indicate that the optimal activation conditions are the activation temperature of 950 °C and activation time of 1 h. Subsequently, the as-prepared RSAC is treated with hydrochloric acid, and the obtained supported HRSAC has a specific surface area of 1365 m²/g. The mesopore volume of 2.04 cm³/g, and the mesopore diameter is mainly distributed in the range of 10 -40 nm. The CO2 adsorption performance of PEI-HRSAC adsorption materials increases firstly and then decreases with the increasing of adsorption temperature and PEI loading, respectively. When the PEI loading is 65% and the adsorption temperature is 75 °C, the CO2 adsorption capacity of the obtained adsorption materials reaches the maximum value of 4.09 mmol/g, and remains at a high level (3.66 mmol/g) after 4 cycles of adsorption and desorption. [ABSTRACT FROM AUTHOR]

Objective: Blood pressure (BP) fluctuation has been demonstrated to be closely associated with stroke. However, at present, no attention is paid to the BP fluctuation following total knee arthroplasty (TKA). The aim of this study is to investigate what is BP fluctuation patterns in stroke and transient ischemic attack (TIA) patients after primary TKA, compare clinical characteristics among different BP fluctuation patterns and determine whether it could predict the occurrence of a 90‐day stroke. Methods: A retrospective study was conducted from February 1, 2011 to February 15, 2021. Stroke or TIA patients within 90 days after TKA were included. Data from a hospitalization management system were analyzed, including demographics, smoking status, comorbidities, medications, surgical variables, and 90‐day stroke, mortality, and readmission rates. BP fluctuation patterns were defined based on the average BP in the first 3 days after TKA. A logistic regression analysis model was used to identify risk factors for 90‐day stroke or TIA following TKA. Results: Of the 1687 patients who underwent primary TKA, 4.0% (68/1687) experienced a 90‐day stroke or TIA. A total of 63 patients met the inclusion criteria, with an average age of 67.5 years and 55.6% (35/63) female. The number of stroke or TIA patients in each BP fluctuation pattern (T1–T5) was 6 (9.5%), 5 (7.9%), 4 (6.3%), 13 (20.6%), and 35 (55.6%) respectively. Patients with a T5 pattern tended to be older and had a greater reduction in average systolic blood pressure (SBP) 3 days after surgery compared to other patterns. The T5 pattern was associated with a higher occurrence of stroke and a lower occurrence of TIA. Patients with a T5 pattern also had a longer length of stay within 90 days following TKA. After adjusting for confounding factors, average SBP fluctuation ≥40 mmHg and the T5 pattern of BP fluctuation remained risk factors for 90‐day stroke or TIA after TKA. Conclusion: BP fluctuation patterns in the early postoperative period are associated with 90‐day stroke and TIA following primary TKA. [ABSTRACT FROM AUTHOR]