Objective To investigate the impact of rivaroxaban and low molecular weight heparin on hidden blood loss after unilateral first half artificial hip replacement surgery.Methods According to the digital table,a total of 80 cases because of femoral neck fractures in elderly patients with unilateral arthroplasty artificial hip and a half after surgery were randomly divided into the rivaroxaban group and low molecular weight heparin (LMWH) group,40 cases in each group.In both groups,respectively,after 12 h begin daily oral rivaroxaban 10 mg and subcutaneous low molecular weight heparin 5 000 u,compared the two groups around the actual amount of perioperative blood loss,blood loss was dominant,recessive blood loss and hidden blood loss accounts,the actual percentage of total blood loss,and recorded 35d bleeding events.Results The total amount of blood loss,dominant blood loss,hidden blood loss and the hidden blood loss accounted for the actual percentage of the total amount of blood loss of the rivaroxaban group were (671.00 ± 55.61) mL,(313.88 ± 14.53) mL,(350.00 ± 29.41) mL,(52.00 ± 5.22) ％,respectively,which of the the LMWH group were (662.00 ± 30.19) mL,(288.87 ± 15.33) mL,(372.00 ± 35.10) mL,(56.00 ± 6.71) ％,there were no significant differences between the two groups (t =0.93,0.93,0.83,1.03,all P ＞ 0.05).Conclusion For patients first underwent unilateral hip replacement surgery artificial half,perioperative using rivaroxaban or LMWH has no significantly differences in hidden risk of bleeding and bleeding event rate.

The role of discipline inspection departments in public hospitals is often insufficient,and the effectiveness of preventive and punitive measures is inadequate.Taking Taizhou People's Hospital as a case study,this paper analyzes the cur-rent situation and shortcomings of the hospital's discipline inspection team.By adopting a problem-oriented approach,it focuses on addressing the key issues of personnel selection,strengthening institutional construction,and improving training and practical experience.The aim is to enhance the effectiveness of the discipline inspection work in the hospital and promote high-quality con-struction.

Objective: To analyze the comprehensive intervention effect of post-traumatic stress disorder (PTSD) in patients with acute hand injury, and its correlation with hand function recovery. Methods: A total of 120 patients with hand trauma admitted to Wenzhou Hospital of Traditional Chinese Medicine from April 2016 to April 2018 were selected.The patients were randomly divided into observation group (60 cases) and control group (60 cases) according to the digital table.The observation group received routine treatment and comprehensive intervention.The control group was given routine treatment.The PDST scale (CAPS), depression self-rating scale (SDS) and Hamilton anxiety scale (HAMA) rating scale used by clinicians were used to assess the psychological status, depression and anxiety of patients with PTSD, and to evaluate the upper limb function of patients. Results: After intervention, the scores of CAPS, SDS and HAMA in the control group were (24.51±8.43)points, (50.61±7.59)points and (10.63±2.11)points, respectively, which were significantly higher than those in the observation group[(16.53±7.62)points, (40.26±4.18)points, (8.24±1.86)points](t=5.61, 5.59, 4.73, all P<0.05). The CAPS, SDS and HAMA scores of the two groups were significantly improved compared with before intervention (t=4.11, 5.04, 3.98, 5.18, 3.86, 4.72, all P<0.05). After intervention, the upper limb function scale (DASH) scores of the observation group and the control group were (89.27±6.08)points and (82.11±7.92)points, respectively.The DASH scores of the two groups were significantly higher than those before intervention (t=6.14, 5.28, all P<0.05). The DASH score of the observation group was superior to the control group (t=3.96, P<0.05). The DASH score of patients with hand injury was negatively correlated with CAPS score and SDS score (r=-0.362, -0.425, P=0.012, 0.008). Conclusion Comprehensive intervention for PTSD in patients with acute hand injury can significantly improve the degree of depression and anxiety, and improve the upper limb function of patients.

ObjectiveTo classify subtypes among middle-aged and elderly type 2 diabetes mellitus (T2DM) patients aged between 35‒74 years in Shanghai suburbs, to compare their characteristics and analyze incidence risk for cerebrovascular disease among these subtypes, so as to promote personalized and precise treatment of T2DM. MethodsA total of 7 792 patients with T2DM who completed a baseline survey from 2016 and 2019 were selected as the research subjects, based on the data from a natural population cohort and biobank in Shanghai suburbs. Patients were stratified by gender and clustered into subtypes using k-means method based on baseline parameters including the age at T2DM diagnosis, body mass index (BMI), fasting blood glucose, and triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C). Patients were followed up until March 31, 2023. Multivariate Cox regression models were used to analyze the association between subtypes and incidence risk for cerebrovascular disease, and those with cerebrovascular disease within 1 year of follow-up survey were excluded from sensitivity analysis. ResultsAmong the 7 792 patients with T2DM, 3 615 were males and 4 177 were females. Stratified by gender, 4 subgroups were identified through k-means clustering analysis, namely poor blood glucose control subgroup, severe insulin-resistant subgroup, younger onset subgroup, and older onset subgroup. The median follow-up time was 4.30 years, during which 1 960 cerebrovascular disease events were observed (844 in males, 1 116 in females). After adjusting for smoking, alcohol consumption, weekly exercise, family history of diabetes mellitus, and duration of diabetes mellitus, among male patients, the incidence risk for cerebrovascular disease was lower in the younger onset subgroup (HR=0.59, 95%CI: 0.48‒0.73, P<0.001), poor blood glucose control subgroup (HR=0.81, 95%CI: 0.65‒1.00, P=0.046), and severe insulin-resistant subgroup (HR=0.61, 95%CI: 0.50‒0.75, P<0.001), compared to the older onset subgroup. While among female patients, the incidence risk for cerebrovascular disease was also lower in the younger onset subgroup (HR=0.68, 95%CI: 0.57‒0.80, P<0.001), poor blood glucose control subgroup (HR=0.73, 95%CI: 0.60‒0.89, P=0.002), and severe insulin-resistant subgroup (HR=0.72, 95%CI: 0.61‒0.85, P<0.001), compared to the older onset subgroup. Results of the sensitivity analysis were consistent with the main findings. ConclusionAmong middle-aged and elderly T2DM patients in suburban Shanghai, both male and female patients have the highest incidence risk for cerebrovascular disease in the older onset subgroup. Subtyping of T2DM patients can help to identify the high-risk populations of cerebrovascular disease.