Objective To comparetheproximalfemoralnailantirotation(PFNA)anddynamichipscrew(DHS)treatmentonin-tertrochanteric femur fractures in the elderly .Methods Retrospective analysis was conducted on 60 patients with intertrochanteric femur fracture collected from December 2009 to December 2012 ,which underwent these two methods ,including 32 cases of PFNA group ,28 cases of DHS group .The 5 indicators including operation time ,intraoperative blood loss ,complications ,fracture healing time and hip function recovery were analyzed .Results Sixty cases were followed up for 10 to 25 months ,average 17 months ,com-pared with DHS group ,PFNA group was with short operation time ,less bleeding ,less complications ,short time of fracture healing , according to standard of Harris score ,the hip function recovered well .Conclusion PFNA treatment on intertrochanteric femur frac-tures is with little trauma ,reliable fixation ,fewer complications ,with which the hip function recovered well ,and it is the preferred method of operation in treatment of senile intertrochanteric femur fracture .

Objective To analyze the postoperative complications of external fixator in treatment of elderly high-risk intertrochanteric fractures and its effect on length of hospital stay and on in-hospital fees.Methods The study involved 55 elderly patients with high-risk intertrochanteric fractures fixed with Orthofix external fixators from January 2009 to December 2011.There were 21 males and 34 females at age range of 70-79 years.All patients were associated with one underlying disease at least.Relationship of complications with patients' age,preoperative underlying diseases,surgery operation and postoperative care were analyzed.Results Common postoperative complications were lung infection (11％),screw channel exudation (25％),superficial pin tract infection (13％) and pain around the screws (22％).Factors for lung infection included the underlying lung disease and cerebral infarction before operation.Influential factor of screw channel exudation was the degree of damage to soft tissue intraoperatively.Influential factor of the superficial pin tract infection was postoperative care level.Average length of hospital stay was 5.17 days longer for patients who experienced complications after operation.Conclusions Common postoperative complications are influenced by preoperative occurrence of underlying lung disease as well as cerebral infarction,intraoperative damage to soft tissues and postoperative care level.Postoperative complications prolong the length of hospital stay and increase the treatment expense.

Objective To investigate the applicative effect of cardiopulmonary resuscitation in pre-hospital care of emergency pa-tients with cardiac arrest and provide the basis for pre-hospital care of cardiac arrest.Methods Selected 93 cases of cardiac arrest in January 2011 to May 2013 occurred out of Hainan Province Nongken Sanya Hospital,including 51 cases of cardiopulmonary resusci-tation of pre hospital rescue as the study group,42 cases of the application of artificial compression cardiopulmonary resuscitation as control group.Compared blood oxygen saturation,oxygen and carbon dioxide partial pressure and blood pressure changes,CPR time,spontaneous breathing recovery time and the recovery of the function of two groups.Used chemiluminescence method to detect NSE,NT-proBNP,cTnI and H-FABP.Results The two groups of patients with blood oxygen saturation,oxygen and carbon diox-ide partial pressure showed no statistical difference(P>0.05);the DBP and SBP levels of the study group were significantly higher than the control group(P<0.05);the study group CPR time and spontaneous circulationtime were significantly higher than that in control group(P<0.05).Two groups of intraoperative heart rate,respiration,blood pressure and oxygen saturation had no signifi-cant difference(P>0.05).Study group of patients with spontaneous breathing recovery,the restoration of spontaneous circulation, survival is greater than 24 h and rehabilitation discharge rates were significantly higher than the control group(P<0.05).There was no significant difference in the serum levels of NSE,NT-proBNP,cTnI immediately,H-FABP recovery in spontaneous circula-tion(P>0.05);after 24 h,NSE,NT-proBNP,cTnI,H-FABP levels in study group were significantly lower than those in the control group(P<0.01).Conclusion The application of cardiopulmonary resuscitation in patients with cardiac arrest before salvage can ef-fectively shorten the recovery time of CPR patients and spontaneous circulation time,reduce the damage to heart,brain,lung and other organs,improve the success rate of cardiopulmonary resuscitation,worthy of clinical application.

Mandibular shape change caused by the decompression treatment of large unicystic ameloblastoma(UA) involving condylar process was observed in 2 cases and the reasons were analysed.

Objective To investigate distribution of Klebsiella pneumoniae infection and its drug resistance change in elderly pa‐tients during 2011 and 2013 .Methods API system was used to identify bacteria ,collected from clinical samples of elderly patients during 2011 and 2013 .Drug sensitivity was tested by using disk diffusion method .Results The isolation rate of Klebsiella pneu‐moniae from 2011 to 2013 was 9 .93% ,11 .56% and 13 .37% .During these three years ,the isolation rate of strains was the highest in Intensive Care Unit ,and the specimens mainly distributed in sputum .There was an increasing tendency of the resistance rates of Klebsiella pneumoniae to commonly used antibiotics ,though the resistant rate to piperacillin/tazobactam ,ceftazidime ,meropenem and amikacin was below 30% .Conclusion Observation on changes of drug resistance of Klebsiella pneumoniae and reduction of risk factors for bacteria infection ,might be important for prohibiting the increasing of drug resistance of Klebsiella pneumoniae .

Objective To investigate the clinical significance of changes of serum insulin-like growth factor-Ⅱ(IGF-Ⅱ),carbohydrate antigen 19-9(CA19-9)and alpha fetoprotein(AFP)levels after intervention and percutaneous ethanol injection therapy in patients with primary hepatic cancer.Methods Serum levels of IGF-Ⅱ,CA19-9 and AFP(with RIA)were repeatedly determined in 57 patients with primary hepatic cancer before intervention therapy,1 month after intervention and percutaneous ethanol injection therapy and 6 months after intervention and percutaneous ethanol injection therapy as well as in 42 controls.Results Before intervention therapy,serum leveh of IGF-Ⅱ,CA19-9 and AFP in the patients were significantly higher than those in the controls(P＜0.01).One month after intervention and percutaneous ethanol injection therapy,all the serum levels were near to normal.Six months later,the levels in the patients without recurrence remained normal.However,the levels in the 10 patients with recurrence returned to those before intervention therapy again.Conclusion Changes of serum IGF-Ⅱ,CA19-9 and AFP levels are closely related to the tumor burden and may reflect the presence of recurrence.

Objective To evaluate the clinical efficacy of radial head prosthesis replacement in treatment of comminuted fracture of the radial head and discuss relative operative announcements.Methods There were 27 patients with comminuted fracture of the radial head who were treated with radial head prosthesis replacement. Results Of all,26 patients were followed up for averaged 14months.According to Broberg score,the post-operative function was excellent in 9 patients(35%),good in 13(50%)and fair in 4(15%),with no poor results and with excellence rate of 85%. Conclusion Radial head prosthesis replacement can better restore the stability,flexion and extension of the elbow as well as the rotational motion of the forearm and is worthy of clinical application.

BACKGROUND:The key of intertrochanteric fractures in elderly patients is to select the appropriate fixation, but few clinical studies concerned different fixation methods for blood volume of blood circulation system in elderly patients with intertrochanteric fractures. OBJECTIVE:To compare the effects of proximal femoral intramedul ary nail and dynamic hip screw on blood volume of blood circulation system in elderly patients with intertrochanteric fractures.
METHODS:A total of 48 elderly patients with intertrochanteric fractures, who were treated in the Jiangyin Hospital Affiliated to Nanjing University of Traditional Chinese Medicine from January 2012 to September 2014, were enrol ed in this study. These patients were assigned to two groups (n=24). Patients in the observation group received treatment with proximal femoral intramedul ary nail, and patients in the control group received treatment with dynamic hip screw. Postoperative blood loss, perioperative blood transfusion, preoperative and 3-day postoperative hemoglobin difference, incidence of postoperative complications, dominant blood loss, and hidden blood loss were compared between the two groups. Range of motion of the hip and Harris score of the hip were compared between the two groups at 4 and 12 months post surgery. RESULTS AND CONCLUSION:Intraoperative blood loss was less in the observation group than in the control group (P<0.05). No significant differences in perioperative blood transfusion and preoperative and 3-day postoperative hemoglobin were detected between the two groups (P>0.05). The operation time was significantly longer in the observation group than in the control group (P<0.05). The incidence of postoperative complications was significantly lower in the observation group than in the control group (P<0.05). No significant difference in length of hospital stay was detected between the two groups (P>0.05). Within the same time period, the range of motion of the hip and Harris score of the hip were better in the observation group than in the control group (P<0.05). The total amount of blood loss and dominant blood loss were less in the observation group than in the control group (P<0.05). These findings indicate that compared with the dynamic hip screw, proximal femoral nail fixation for intertrochanteric fracture has less intraoperative blood loss, lower incidence of postoperative complications, postoperative range of motion of the hip and better hip score. However, operation time of proximal femoral nail was long. There were no significant differences in hemoglobin difference and perioperative blood transfusion between the two fixation methods.

BACKGROUND:The most important influence caused by patel ar fracture is the breakage of knee extension apparatus continuity and potential uncoordination of patel ofemoral joint. The aim of patel ar fracture surgery is to restore the smoothness of patel ar articular surface and to maintain the continuity of knee extension apparatus, to provide stable effective fixation, so as to do early functional exercises. OBJECTIVE:To evaluate the clinical effectiveness of a fixation technique for patel ar fractures using QWIX combined with Kirschner wire and wire. METHODS:From September 2011 to September 2012, 30 patients with patel ar fractures were treated using QWIX screws combined with Kirschner wire and wire in the First Affiliated Hospital of Chongqing Medical University, China. There were 17 males and 13 females, at the age of 47.7 years on average. In accordance with the situation of comminuted fracture and the degree of displacement, QWIX screws or QWIX screws+tension band wire or QWIX screws+Kirschner wire+tension band wire were used for fixation. Active and passive knee motion exercises began at 1 day after surgery, without any external fixation. At 6 weeks, 3, 6, 12 months, and 1 year after surgery, the patients were fol owed up in out-patient clinic to identify fracture healing and to make sure whether complications appeared or not. The range of flexion and extension of bilateral knee was measured. The knee function of the affected side was evaluated using Bostman score at 1 year postoperatively. RESULTS AND CONCLUSION:Al patients were fol owed up for 12 to 24 months. 24 cases were healed within 3 months after surgery, and 6 cases were healed within 4 months after surgery, with an average healing time of 3.2 months. With time prolonged, the range of flexion and extension of bilateral knee gradual y increased. The knee function of patients recovered to the level before injury at 1 year after surgery. During fol ow-up, one patient experienced knee pain due to Kirschner wire loosening. No infection, knee pain, fixation failure, or flexion dysfunction occurred in the remaining patients. In accordance with Bostman score, there were excellent in 27 cases, good in 3 cases, and poor in 0 case, with an excellent and good rate of 100%at 1 year fol owing surgery. Results data suggested that QWIX screws combined with Kirschner wire and wire fixation in repair of patel ar fracture have some advantages such as continuous dynamic and static pressure at the broken ends of the bones, early flexion and extension exercises, and reducing the fixation-related complications. It is an effective method to repair patel ar fracture.

Objective: To study an epidemiological methodology for domestic violence. Methods:A program was drawn,the epidemiological instruments were developed, investigators were trained, not only according to the principles of epidemiology but also being suited to Chinese condition. Then,We win over the support of government bodies, arouse the messes to action, and all clues from investigation were confirmed by interview with persons concerned.Spot check randomly was used for control of quality.Results:The reliability of the epidemiological instruments was 97%, the sensitivity was 95%, the specificity was 100%. The prevalence of domestic violence in life-time and past year was 16.2% and 11.6% respectively.Conclusion:This was a practical methodology in epidemiological survey for domestic violence in China.