Objective To investigate the comprehensive efficacy and cost-effectiveness of early nutritional intervention combined with acupoint electrical stimulation under the enhanced recovery after surgery (ERAS) concept in elderly patients undergoing total hip arthroplasty (THA), and to verify the robustness of the results through Monte Carlo validation. Methods Elderly patients who underwent THA in the Ziyang Central Hospital between January 2022 and December 2024 were retrospectively selected. Patients who did not implement the ERAS protocol between January and December 2022 were included in the control group, while patients who implemented the ERAS protocol between January 2023 and December 2024 were included in the intervention group. Total hospitalization costs, postoperative complication rates, patient satisfaction, and clinical indicators were collected to construct a comprehensive efficacy score. Monte Carlo validation was used to analyze the incremental cost-effectiveness ratio and parameter uncertainty. Results A total of 140 patients were enrolled, with 70 in each group. There were no statistically significant differences in gender, age, and preoperative indicators between the two groups (P>0.05). The Richmond Agitation-Sedation Scale scores [(?0.03±0.87) vs. (0.53±0.85) points; P<0.05] and the incidence of agitation [5.7% (4/70) vs. 34.3% (24/70); P<0.05] were lower in the intervention group compared to the control group. The total incidence of adverse reactions in the postoperative intervention group [5.7% (4/70) vs. 18.6% (13/70); P<0.05] was lower than that in the control group. The comprehensive efficacy score, hospitalization costs, and cost-effectiveness ratio were all superior in the intervention group compared to the control group (P<0.05). Monte Carlo validation results further confirmed the advantages of early nutrition combined with acupoint electrical stimulation in improving cost-effectiveness. Conclusions ERAS-based early nutritional intervention combined with acupoint electrical stimulation can significantly enhance the comprehensive efficacy and reduce medical costs in elderly THA patients. Monte Carlo validation verifies the robustness of its cost-effectiveness, providing health economic evidence for clinical decision-making.
Objective To study the quantitative changes of ubiquitin l igase MAFbx mRNA and protein expression, muscle atrophy and muscle function following free muscle transplantation and to explore relationshi ps among them. Methods Thirty-six female SD rats, SPF grade, weighing (250 ± 25) g, were used. One hind l imb of the rat was randomly selected as experimental side to receive in situ free gracil is muscle transplantation, and the counterlateral hind l imb underwent no operation serving as control side. General condition of the rats was observed after operation. Muscle contractivecapacity and muscle wet weight maintenance rate of the experimental and the control side were detected 1, 2, 4, 10, 15, and 30 weeks after operation, and 6 rats were killed at each time point. Meanwhile, HE staining was performed to observe muscle fibre cross-sectional area, real-time quantitative PCR was appl ied to detect relative expression of MAFbx/Atrogin-1 mRNA, and Western blot test was used to observe MAFbx protein expression. Results All rats survived till the end of the experiment, all incisions healed well, and no dysfunction occurred in the experimental sides. The value of muscle contractive capacity, muscle wet weight maintenance rate, muscle’s maximal force of single contraction, and muscle’s maximal force of tetanic contraction in the experimental sides dramatically decreased in the first 4 weeks after operation and increased gradually over 4 to 30 weeks. The MAFbx mRNA expression of the experimental sides peaked and was seven times greater than the control sides 2 weeks after operation, then the value gradually decreased over 15 to 30 weeks after operation and was 1.1 to 1.5 times greater than the control sides, and significant difference was evident between the experimental sides and the control sides at each time point (P lt; 0.05). Significant difference was evident between the experimental sides and the control sides in terms of MAFbx protein expression of the muscle 1 to 15 weeks after operation according to the Western blot result (P lt; 0.05), and no significant difference was noted at 30 weeks (P gt; 0.05). The correlation coefficient between muscle wet weight maintenance rate and muscle’s maximal force of single contraction maintenance rate was 0.95, between muscle wet weight maintenance rate and muscle’s maximal force of tetanic contraction maintenance rate was 0.75, between muscle fibre cross-sectional area recovery rate and muscle’s maximal force of single contraction maintenance rate was 0.93, and between muscle fibre cross-sectional area recovery rate and muscle’s maximal force of tetanic contraction maintenance rate was 0.68 (P lt; 0.05). The correlation coefficient between MAFbx mRNA expression and the parameter of muscle wet weight maintenance rate, muscle fibre cross-sectional area recovery rate, muscle’s maximal force of single contraction maintenance rate, and muscle’s maximal force of tetanic contraction maintenance rate was — 0.62 (P lt; 0.05), — 0.45 (P gt; 0.05), — 0.72 (P lt; 0.05) and — 0.78 (P lt; 0.05), respectively; the correlation coefficient between MAFbx protein relative expression and the parameter of muscle wet weight maintenance rate, muscle fibre cross-sectional area recovery rate, muscle’s maximal force of single contraction maintenance rate, and muscle’s maximal force of tetanic contraction maintenance rate was — 0.95 (P lt; 0.05), — 0.82 (P lt; 0.05), — 0.89 (P lt; 0.05), and — 0.54 (P gt; 0.05), respectively. Conclusion Decrease of muscle function after transplantation correlates closely with muscle atrophy. The high expression of MAFbx mRNA and protein, especially their persistent increases from 4 to 15 weeks after nerve reinnervation, is a junction between the muscle atrophy and thedecrease of muscle function.