Objective To observe the effect of motor nerve baby-sitting and different babysitting stages on nerve regeneration in nerve root re-implantation for brachial plexus avulsion injury.Methods Twenty-four SD rats were used to induce the brachial plexus avulsion injury.C5-7 roots were avulsed and C6 anterior root was re-implanted to the spine cord via a posterior approach.Branches erupting from C6 and the branches affiliated to the musculocutaneous nerve were cut away via an anterior approach.Re-implanted C6 anterior root was connected singly with musculocutaneous nerve.After that,the end of one branch of medial pectoral nerve was sutured to the lateral musculocutaneous nerve.The animal was divided into persistence motor nerve baby-sitting group (Group A,n =12) and protophase motor nerve baby-sitting group (Group B,n =12) according to the random number table.Electrophysiological evoked potential,muscle wet weight and muscle fiber cross-sectional area were measured at postoperative 2 and 3 months.Results At postoperative 2 and 3 months,the restoration rates of motor evoked potential in Group A [(12.2 ± 3.3) ％ and (15.1 ± 3.5) ％] revealed significant differences from these in Group B [(30.1 ±4.2)％ and (54.8 ±9.6)％] (P ＜0.01),the restoration rates of muscle wet weight in Group A [(75.9 ± 5.3) ％ and (92.7 ± 8.6) ％] were similar with (76.4 ± 7.3) ％ and (94.3 ± 4.4) ％ in Group B (P ＞ 0.05),and the restoration rates of muscle fibrin cross section area in GroupA [(74.4±5.5)％ and (88.5±7.5)％] were similar with (76.9±6.7)％ and (92.9± 3.5) ％ in Group B (P ＞ 0.05).Conclusions Motor nerve end-lateral baby-sitting can improve functional restoration of the skeletal muscle in the early stage after nerve root re-implantation,but prevent functional restoration of skeletal muscle in the late stge.On the contrary,protophase motor nerve babysitting avoid the inhibitory effect in the late stage,which gains better restoration rate of muscle motion evoked potential.

Objective To examine the difference in the effectiveness between proximal femoral nail anti-rotation (PFNA) and femoral head replacement (FHR) of intertrochanteric fracture in elderly patients.Methods This study collected 69 patients that underwent PFNA or FHR after intertrochanteric fractures between June 2012 and September 2014.PFNA group was composed of 41 subjects (17 males and 24 females) aged 80-101 years (mean,86.7 years),and time from injury to operation was (3.12 ± 0.95)days.FHR group was composed of 28 subjects (13 males and 15 females) aged 80-99 years (mean,87.2 years),and time from injury to operation was (3.2 ± 1.0) days.Comparison of operation time,intraoperative blood loss,postoperative blood transfusion,off-bed time,complication incidence,hemoglobin concentration and hip function was made between groups.Results Duration of follow-up was 1-3 years (mean,1.8 years).Operation time and intraoperative blood loss in PFNA group were (46.8 ± 4.4) minutes and (77.0 ± 24.2) ml respectively,differed from (57.4 ± 5.9) minutes and (150.7 ± 46.5) ml in FHR group (P ＜ 0.05).Three days after operation,a similar decrease in hemoglobin concentration was seen in PFNA group [(21.3 ±6.1)g/L] and FHR group [(23.2 ±5.8)g/L] (P ＞ 0.05).Off-bed time in FHR group was (3.2 ± 1.2) days,shorter than (7.1-± 2.5) days in PFNA group (P ＜ 0.05).Incidence of postoperative complications in FHR group was 14％,lower than 37％ in PFNA group (P ＜ 0.05).Hip function of the two groups presented no significant difference six months after operation,but the proportion of excellent results in FHR group was higher than that in PFNA group (82％ vs.73％) (P ＞ 0.05).Conclusion FHR provides better results over PFNA regarding off-bed time,complication incidence and hip function,and hence is preferred for the treatment of elderly patients with intertrochanteric fractures,especially in those with severe osteoporosis.

In various types of inspections and self-inspections, it was found that compliance and rationalization in diagnosis and charging were the more common problems in hospital, leading to refusal of medical insurance payment. In 2022, the failure mode and effect analysis was conducted in a Grade-A tertiary hospital in Jinhua to identify the high-risk points in the process of diagnosis and treatment and charging, and building six major information technology transformation scenarios and formulating specific transformation measures, to avoid or reduce the refusal of medical insurance payment in advance. Through the digital transformation of medical insurance supervision system, a whole process intelligent supervision has been implemented, including pre event review, mid event reminder and intelligent correction, and post event big data precise analysis. It promoted compliant diagnosis and treatment of medical personnel and accurate charging, which could provide reference for other medical institutions to use medical insurance funds reasonably.