Objective To explore the clinical efficacy of proximal femoral locking compression plate (LCP)fixation in elderly intertrochanteric fractures patients. Methods 30 cases of intertrochanteric fracture fixed with LCP were collected,and the functional recovery of all hip joints was observed. Results The average follow-up and healing time of all cases was 10 months(6 to 14 months)and 3.5 months respectively. Hip joint function of 27 cases was excellent( Harris scoring≥90) ,that of the other 3 cases was good ( Harris scoring:80 ～ 89). Conclusion The proximal femoral LCP fixation had a good clinical value in treatment of elderly intertrochanteric fracture patients. It had many advantages, such as simplicity, rigid fixation, less trauma and bleeding, shorter operative time, less complications, high heal rate, etc.

OBJECTIVE:To observe the anesthetic effect of dexmedetomidine in pelvic floor reconstructive surgery of elderly patients with pelvic organ prolapse(POP). METHODS:60 elderly patients with pelvic floor reconstructive surgery were randomly di-vided into observation group and control group. Observation group was treated with 0.5 μg/kg dexmedetomidine by pumping and control group was treated with 0.125 ml/kg 0.9% sodium chloride injection by pumping 15 min before anesthesia,and conventional intravenous induction was conducted after 15 min. MAP,HR and bispectral index(BIS)in entering the room(T0),5 min after ad-ministration(T1),immediate intubation(T2),1 min after intubation(T3),5 min after intubation(T4),surgical skin incision(T5), immediate extubation(T6)and 5 min after extubation(T7),restlessness score,sedation score,recovery time and incidence of ad-verse reactions in 2 groups were observed. RESULTS:MAP and HR in observation group in T1-7 were significantly lower than T0 and control group,MAP and HR in control group in T2-7 were significantly high than T0 except that T1 was significantly lower than T0,the differences were statistically significant(P<0.05);BIS in 2 groups T1-7 was significantly lower than T0,the differences were statistically significant(P<0.05),however,there was no significant difference between 2 groups(P>0.05). Restlessness score in observation group was significantly lower than control group,sedation score was significantly higher than control group,the differ-ence was statistically significant(P<0.05),there was no significant difference in the recovery time between 2 groups(P>0.05). There were no obvious adverse reactions in 2 groups during treatment. CONCLUSIONS:Dexmedetomidine can effectively reduce the stress response and maintain cycle stability in the treatment of elderly patients with pelvic floor reconstructive surgery,with good safety.

OBJECTIVETo analyze the present situation and influencing factors of discrimination against hepatitis B patients and carriers among rural adults in three eastern provinces in China.

METHODSBy using the method of probability proportionate to size (PPS), we involved a sample of 9 269 rural adults aged above 18 years old from 22 villages of 7 counties in Beijing, Hebei, Shandong in 2011 and 2012. We used a self-designed interview questionnaire with questions about the individual and household characteristics, attitudes toward hepatitis B patients and carriers, individual HBV vaccination history, etc. We analyzed the hepatitis B discrimination score and its distribution, and we also created a multinomial logistic regression model to analyze the influencing factors of discrimination.

RESULTSOf all the participants, 51.15% (4 741) were afraid of being infected with HBV when getting on with hepatitis B patients or carriers; 51.29% (4 754), 61.14% (5 667) and 52.22% (4 841) of them were not willing to accept gifts from hepatitis B patients or carriers, have dinner with them, or hug and shake hands with them, respectively; 73.92% (6 852) were unwilling to their children's playing with kids whose parents were hepatitis B patients or carriers, and 86.68% (8 034) were unwilling to their children's marrying hepatitis B patients or carriers. Of all the participants, only 0.88% (82) were totally discrimination-free (discrimination score = 0); mild or without discrimination (< 0 discrimination score ≤ 5) accounted for 23.70% (2 197/9 269); severe discrimination (discrimination score ≥ 6) accounted for 76.30% (7 072). The multiple multinomial logistic regression showed that migratory workers, other occupations like technician, civil servants and village doctors were less likely to show severe HBV-related discrimination compared with farmers, with OR (95% CI) 0.86 (0.75-0.98), 0.77 (0.67-0.87), 0.57 (0.41-0.79), respectively. Compared with the lowest income group (< 10 000 RMB/year per person), and the highest income group (> 40 000 RMB/year per person) had an OR (95% CI) of 0.57 (0.46-0.70). People with higher education tended to show less severe discrimination. The high education group had an OR (95% CI) of 0.64 (0.51-0.80) based on the low education group. And compared with people whose self-assessment of health status was very good, those who assessed their health status as very poor showed less severe discrimination, with an OR (95% CI) of 0.41 (0.25-0.67).

CONCLUSIONThe situation of discrimination against hepatitis B patients and carriers among rural adults in three eastern provinces was serious. It is of great urgency to eliminate the discrimination. Work on eliminating hepatitis B discrimination should focus on farmers, people with low incomes, and people with low educational level.

Adult ; Beijing ; Carrier State ; Family Characteristics ; Health Knowledge, Attitudes, Practice ; Hepatitis B ; psychology ; Humans ; Logistic Models ; Occupations ; Rural Population ; Social Discrimination ; Surveys and Questionnaires

Objectives:To investigate the long-term efficacy of balloon assisted endplate reduction with vertebral augmentation combined with pedicle screw fixation in the treatment of thoracolumbar burst fractures, and to compare the clinical efficacy of calcium sulfate cement (CSC) and calcium phosphate cement(CPC).Methods:This study is a retrospective cohort study.The clinical data of 39 patients with thoracolumbar burst fractures admitted to Hefei Hospital Affiliated to Anhui Medical University from November 2013 to December 2017 were retrospectively analyzed.All patients were treated with pedicle screw reduction and fixation of the injured vertebra,balloon-assisted reduction of the collapsed endplate of the injured vertebra,and artificial bone vertebral body augmentation,and the follow-up time was >5 years.There were 24 males and 15 females,aged (42.9±13.3) years (range: 29 to 56 years).According to the Frankel spinal nerve dysfunction grading standard, there were 4 cases of grade C, 7 cases of grade D and 28 cases of grade E. There were 21 cases of CSC augmentation(CSC group) and 18 cases of CPC augmentation (CPC group). X-ray and CT were performed at 1 week, 1-, 2-, 5-year after surgery and at the last follow-up, and the imaging indicators were measured, including the injured vertebra anterior edge height ratio,the injured vertebra middle height ratio,the injured vertebra wedge angle,and the sagittal plane Cobb angle. The pain visual analogue scale (VAS) and the Oswestry disability index (ODI) was used for functional evaluation, nervous function was evaluated according to the Frankel spinal nerve dysfunction grading standard.Independent sample t test was used for inter-group comparison, and paired sample t test and repeated measure ANOVA were used for intra-group comparison. Results:All operative procedures were successfully completed, no spinal nerve function damage occurred. The postoperative imaging indexes of the patients were significantly improved compared with those before surgery (all P<0.01). The follow-up time of patients was (6.7±2.8)years (range: 5 to 9 years). Among the 11 patients with symptoms of neurological impairment before surgery, 9 patients completely recovered at the last follow-up, and 2 patients recovered from Frankel grade C to D. There were no significant differences in imaging indexes between the first week after surgery and the last follow-up in the CPC group (all P>0.05), while there were significant differences in imaging indexes between the CSC group and the last follow-up (all P<0.05). CPC group was superior to CSC group in frontal height ratio, middle height ratio, wedge angle variation and sagittal Cobb angle correction loss at 2 year, 5 year after surgery and the last follow-up, with statistical significance (all P<0.05). At the last follow-up, there were no differences in VAS and ODI between the two groups (all P>0.05). After absorption of CSC in the filling area, a hardened zone was formed around the area, and the central cavity remained without bone tissue filling. CPC absorption was very slow, and the CPC group was still filled satisfactorily at the last follow-up. Conclusions:Balloon assisted endplate reduction and vertebral augmentation combined with pedicle screw fixation through the injured vertebra have good long-term efficacy in the treatment of thoracolumbar burst fractures. Compared with CSC, CPC vertebral augmentation can better maintain the shape and spinal sequence of the injured vertebra in the long term, and can effectively reduce the collapse of the space above the injured vertebra.

Objectives:To investigate the long-term efficacy of balloon assisted endplate reduction with vertebral augmentation combined with pedicle screw fixation in the treatment of thoracolumbar burst fractures, and to compare the clinical efficacy of calcium sulfate cement (CSC) and calcium phosphate cement(CPC).Methods:This study is a retrospective cohort study.The clinical data of 39 patients with thoracolumbar burst fractures admitted to Hefei Hospital Affiliated to Anhui Medical University from November 2013 to December 2017 were retrospectively analyzed.All patients were treated with pedicle screw reduction and fixation of the injured vertebra,balloon-assisted reduction of the collapsed endplate of the injured vertebra,and artificial bone vertebral body augmentation,and the follow-up time was >5 years.There were 24 males and 15 females,aged (42.9±13.3) years (range: 29 to 56 years).According to the Frankel spinal nerve dysfunction grading standard, there were 4 cases of grade C, 7 cases of grade D and 28 cases of grade E. There were 21 cases of CSC augmentation(CSC group) and 18 cases of CPC augmentation (CPC group). X-ray and CT were performed at 1 week, 1-, 2-, 5-year after surgery and at the last follow-up, and the imaging indicators were measured, including the injured vertebra anterior edge height ratio,the injured vertebra middle height ratio,the injured vertebra wedge angle,and the sagittal plane Cobb angle. The pain visual analogue scale (VAS) and the Oswestry disability index (ODI) was used for functional evaluation, nervous function was evaluated according to the Frankel spinal nerve dysfunction grading standard.Independent sample t test was used for inter-group comparison, and paired sample t test and repeated measure ANOVA were used for intra-group comparison. Results:All operative procedures were successfully completed, no spinal nerve function damage occurred. The postoperative imaging indexes of the patients were significantly improved compared with those before surgery (all P<0.01). The follow-up time of patients was (6.7±2.8)years (range: 5 to 9 years). Among the 11 patients with symptoms of neurological impairment before surgery, 9 patients completely recovered at the last follow-up, and 2 patients recovered from Frankel grade C to D. There were no significant differences in imaging indexes between the first week after surgery and the last follow-up in the CPC group (all P>0.05), while there were significant differences in imaging indexes between the CSC group and the last follow-up (all P<0.05). CPC group was superior to CSC group in frontal height ratio, middle height ratio, wedge angle variation and sagittal Cobb angle correction loss at 2 year, 5 year after surgery and the last follow-up, with statistical significance (all P<0.05). At the last follow-up, there were no differences in VAS and ODI between the two groups (all P>0.05). After absorption of CSC in the filling area, a hardened zone was formed around the area, and the central cavity remained without bone tissue filling. CPC absorption was very slow, and the CPC group was still filled satisfactorily at the last follow-up. Conclusions:Balloon assisted endplate reduction and vertebral augmentation combined with pedicle screw fixation through the injured vertebra have good long-term efficacy in the treatment of thoracolumbar burst fractures. Compared with CSC, CPC vertebral augmentation can better maintain the shape and spinal sequence of the injured vertebra in the long term, and can effectively reduce the collapse of the space above the injured vertebra.