Objective To investigate the indications,techniques and effects in surgical treatment of stale acetabular comminuted fractures.Methods A retrospective review was made on 24 cases (24 hips) of obsolete acetabular fractures undergone delayed reconstruction due to the combined injuries in other organs from October 2003 to June 2010.There were 18 males and 6 females,at 22-68 years of age [mean (42.2 ± 10.5) years].Mean time from injury to operation was (4.6 ± 1.3) weeks (range,3-6 weeks).According to Letournel classification,there were 11 simple fractures including six posterior wall fractures,one anterior wall fracture,one posterior column fracture,one anterior wall fracture and two transverse fractures and 13 compound fractures including six posterior column with posterior wall fractures,two transverse with posterior wall fractures,one T-shape fracture,two posterior semitransverse fractures and two both-column fractures.Surgery was performed via ilioinguinal approach in two cases,posterior acetabular approach in 13 and the combined approaches in nine.Results All 24 cases were available to average (15.6 ± 10.5) months of follow-up (range,10-36 months).Quality of reduction based on Matta standard was anatomic in 21 cases,unsatisfactory in two and poor in one.Clinical results evaluated using modified d' Aubigne-Postel score were excellent in 21 cases,good in two and poor in one.There were one femoral head necrosis,11 heterotopic ossification and six sciatic nerve transient palsy after operation.Conclusion Delayed open reduction and internal fixation is effective in treatment of obsolete acetabular comminuted fractures.

Objective:To investigate the perioperative alterations and management of coagulation function in patients of massive blood transfusion during retroperitoneal tumor (RT)resection.Methods:Fourty-seven RT patients at Peking University International Hospital from Jan 2016 to Dec 2021 undergoing resection with massive blood transfusion more than 20 U within 24 h were reviewed for coagulation function before and after surgery.Results:Intraoperative bleeding was 3 000-25 800 ml, 10 patients had blood loss ≥10 000 ml. During the operation, (25.3±9.9) U of red blood cells were transfused, (2 720±1 369) ml plasma transfused, and (2.4±3.3) U platelets were transfused in 6 patients. Fourty-five patients received intraoperative albumin of (79.5±46.5) g; All 47 patients received fibrinogen of (2.3±1.3) g; Prothrombin complex was given in 45 patients (1 205±807) U. Preoperative hemoglobin was statistically different compared to postoperatively and days 1, 3 and 5 ( W=1 790, P<0.001; W=1 672, P<0.001; W=1 704, P<0.001; W=1 486, P=0.004);As with platelets, the difference was also statistically significant compared to postoperative days 1, 3, and 5 ( W=2 153, P<0.001; W=2 092, P<0.001; W=1 732, P<0.001); Preoperative albumin was different compared to postoperative days 1 and 3 ( W=1 568, P<0.001; W=1 578, P<0.001,); Preoperative fibrinogen was different compared to postoperative day 1 ( W=1 964, P<0.001). PT and APTT were prolonged on postoperative days 1 and 3 ( W=628, P<0.001, W=804, P=0.023) ( W=661, P<0.001, W=796, P=0.02). Patient's preoperative fibrin degradation products and D-dimer were above the normal value and were higher on postoperative days 3 and 5 ( W=498, P<0.001, W=345, P<0.001). Conclusions:Coagulation disorders occur perioperatively in patients with massive transfusion while undergoing surgery for RT.The implementation of ratiional transfusion strategy and close postoperative survey and management of coagulation dysfunction help avoid the coagulation related morbidities.

BackgroundSuicidal behavior in adolescence and early adulthood is a major public health concern， and suicide attempts are found to be associated with reasons for living and self-control， whereas there remains a striking lack of empirical research exploring the association among the three in college students. ObjectiveTo explore the relationship among suicide attempts， reasons for living and self-control， and to inform targeted efforts to prevent the development of suicidal behavior. MethodsFrom April to May 2023， a sample of 775 college students from 10 colleges and universities in Shaanxi province， Sichuan province and Chongqing municipality were selected using random sampling method. All students were subjected to complete Self-Control Scale （SCS）， the Reasons for Living Inventory for Adolescents （RFL-A）， and the self-administered Suicide Attempt Questionnaire. Spearman correlation analysis was utilized to examine the correlation among the above scales in students， and mediation analysis was performed using Mplus 8.3. ResultsA total of 738 college students （95.32%） completed the effective questionnaire survey.Suicide attempts were detected in 99 college students （13.41%）. SCS score was positively correlated with RFL-A score （r=0.329， P<0.01）， and SCS score and RFL-A score were both negatively correlated with the risk of suicide attempts （r=-0.194， -0.285， P<0.01）. The indirect mediation effect value of self-control on the relationship between reasons for living and suicide attempts was -0.059 （95% CI： -0.105~-0.018）， accounting for 11.07% of the total effect. There was a gender difference in the mediating effect of self-control， among which the effect was significant in male group， with an indirect effect value of -0.089 （95% CI： -0.163~-0.030） and accounting for 15.72% of the total effect， whereas the mediating effect was not significant in female group （95% CI： -0.407~0.115）. ConclusionReasons for living can negatively predict suicide attempts among college students， and self-control may play a mediating role in the relationship between reasons for living and suicide attempts among college students， and the mediating effect of self-control appears to be statistically significant only in male but not in female students.

Simulations can mimic the environment that refers to the surgery operation to improve the technical skills of the trainees. In this paper, we designed a new cardiac surgery simulative training system. The isolated pig heart was selected as the heart model. A mechanical device was designed to achieve the beating of heart model. At the same time, adjusting frequencies of mechanical movement could change the rating of heartbeat. In order to validate the rationality of the system, 12 non-medical specialty students and 12 medical specialty students were divided into two groups, which consecutively accepted seven-days of training for off-pump coronary artery bypass grafting using the cardiac surgery simulative training system. The time for completing bypass grafting before and after training were recorded. And the bridging outcomes of each trainee were assessed by 3 surgery cardiac surgeons using the object structured assessments of technical skill (OSATS) criteria. After training, each trainee could finish the bypass suturing in a shorter time than before training, and the scores of each trainee assessed by OSATS criteria were also improved. The results showed that the cardiac surgery simulative training system had better training effect in improving the surgical techniques, operation skills and proficiency of surgical instruments of trainees.