Objective: To analyze the cluster effect of urban health care expenditure and the impact of carbon emissions. Methods:Calculating spatial correlation Moran index and building spatial panel econometric model. Results: There are significant spillover effects of health care expenditure from 2007 and 2010; per capita carbon emissions, per capita income and age structure significantly affect health care expenditure. Conclusions:It is needed to pay more attention to environmental protection.

Objective To explore the diagnostic and score value of ultrasound on hemophiliac arthropathy referring to MRI on the diagnosis and score of hemophiliac arthropathy Methods The ultrasound and MRI examinations were performed on 42 joints of 42 hemophilia patients 14 knees 14 ankles and 14 elbows The consistency of ultrasound and magnetic resonance imaging in the detection and score of joint diseases was compared Finally inter-and intra-observer agreement of ultrasound scoring system were tested Results The consistency of ultrasound and magnetic resonance imaging was excellent κ=0 763-0 896 P < 0 001 in the detection of early soft tissue lesions effusion or hemarthrosis synovial hypertrophy hemosiderin excellent κ=0 793 P <0 001 in the detection of cartilage loss poor κ=0 133 P = 0 132 in the detection of erosions and poor κ= 0 100 P = 0 137 in the detection of subchondral cysts The consistency of ultrasound and magnetic resonance imaging was good to excellentκ=0 684-0 833 P < 0 001 in the score of early soft tissue lesions effusion or hemarthrosis synovial hypertrophy and hemosiderin and poor to good κ=0 145 -0 635 P <0 001 in the score of advanced osteochondral lesions cartilage loss and bone erosions The inter-observer agreement was good to excellent κ=0 676-0 870 P <0 001 for early soft tissue lesions and moderate to excellent κ=0 421- 0 75 1 P < 0 001 for advanced osteochondral lesions The intra-observer agreement was good to excellent κ=0 705-0 885 P <0 001 for early soft tissue lesions and moderate to good κ=0 532 -0 732 P <0 001 for advanced osteochondral lesions Conclusions Ultrasound plays an important role in detecting early soft tissue changes effusion or hemarthrosis synovial hypertrophy hemosiderin and cartilage loss which helps follow-up and guide clinical treatment.

Objective:To investigate the clinical value of hematoma volume estimated by 3D-Slicer in predicting symptomatic cerebral vasospasm (sCVS) after aneurysmal subarachnoid hemorrhage (aSAH).Methods:CT images on admission of 84 aSAH patients, admitted to our hospital from January 2018 to June 2021, were collected. The hematoma volume of these patients was measured by 3D-Slicer (3D-Slicer hematoma volume). Patients were divided into sCVS group and non-sCVS group according to the occurrence of postoperative sCVS. The differences of 3D-Slicer hematoma volume, Fisher grading scale and modified Fisher grading scale between the two groups were compared by statistical methods, and the independent risk factors for sCVS after aSAH were screened. The differences of 3D-Slicer hematoma volume among patients with different Fisher grading scale or modified Fisher grading scale were compared.Results:There was no significant difference in Fisher grading scale and modified Fisher grading scale between sCVS group and non-SCVS group ( P>0.05), but the 3D-Slicer hematoma volume in sCVS group was significantly larger than that in non-SCVS group ( P<0.05). 3D-Slicer hematoma volume ( OR=1.061, 95%CI: 1.004-1.120, P=0.034) was independent risk factors for sCVS after aSAH. The comparison of 3D-Slicer hematoma volume among patients with different Fisher grading scale or modified Fisher grading scale showed statistical difference ( P<0.05). Conclusion:As compared with Fisher grading scale and modified Fisher grading scale, the hematoma volume measured by 3D-Slicer has more advantage in predicting sCVS after aSAH.

Objective To investigate the effect ofcranioplasty on prognosis of patients accepted intracranial aneurysm clipping combined with simultaneous decompressive craniectomy.Methods One hundred and forty-four patients accepted intracranial aneurysm clipping combined with simultaneous decompressive craniectomy (first-stage operation) in our hospital from January 2013 to June 2017 were chosen;there were 56 patients without cranioplasty in the control group and 88 patients with cranioplasty (second-stage operation) in the observation group.The degrees of coma before first-stage operation were assessed by Glasgow coma scale (GCS).The general state three months after first-stage operation was assessed by GCS and activity of daily living (ADL) scale.The prognoses of these patients 9 and 15 months after first-stage operation were assessed by Glasgow outcome scale (GOS) and ADL scale.The clinical data,prognoses and incidence of hydrocephalus of patients from the two groups were compared.Related factors associated with hydrocephalus were analyzed by multivariate Logistic regression analysis.Results GCS,GOS and ADL scale scores in the observation group 9 and 15 months after first-stage operation were all significantly higher than those in the control group (P＜0.05);incidence of hydrocephalus in the observation group after first-stage operation (31.82％) was significantly lower than that in the control group (62.5％,P＜0.05).Logistic regression model revealed that cranioplasty,Hunt-Hess grading and Fisher grading were independent related factors for incidence of hydrocephalus (P＜0.05);cranioplasty was the protective factor of hydrocephalus (OR=0.126),and Hunt-Hess grading and Fisher grading were the risk factors of hydrocephalus (OR=5.311 and 5.073).Conclusion Cranioplasty can reduce the incidence of hydrocephalus and improve the prognosis of patients accepted intracranial aneurysm clipping combined with simultaneous decompressive craniectomy.