Objective To explore the applicability of the three commonly used CT examination decision rules in Chinese head injured children. Methods This prospective observational study included 1538 children and adolescents (aged < 18 years), who were treated at the Emergency Department of First Hospital of Shanxi Medical University after head injuries. The three clinical decision rules include the Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE; UK); the prediction rule for the identification of children at very low risk of clinically important traumatic brain injury, that was developed by the Pediatric Emergency Care Applied Research Network (PECARN; USA), and the Canadian Assessment of Tomography for Childhood Head Injury (CATCH) rule. Diagnostic accuracy had been evaluated by using the rule-specific predictor variables to predict each rule-specific outcome measure in populations who met inclusion and exclusion criteria for each rule. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and ROC curve were referred to the diagnostic accuracy. Indicators were characterized by 95％ CI. Results Of the 1538 patients, CTs were obtained for 339 patients (22.04％). Forty-nine patients (3.19％) had positive CT results, 8 patients (0.52％) underwent neurosurgery, 2 patients (0.13％) died, and 1 patient (0.07％) may be missed. In this study, CHALICE was applied for 1394 children (90.70％; 95％ CI: 89.24％-92.15％), PECARN for 801 children (52.11％; 95％ CI: 49.62％-54.61％), and CATCH for 325 patients (21.15％; 95％CI: 19.10％-23.19％). The validation sensitivities of CHALICE, PECARN, and CATCH rules were 92.6％(74.2％-98.7％), 100％ (56.1％-100％), and 85.7％ (42.0％-99.2％), respectively; the specificities were 78.1％(75.7％-80.2％), 48.0％ (44.5％-51.5％) and 70.8％ (65.4％-75.6％); positive predictive value were 7.7％ (5.1％-11.3％), 0.9％ (0.4％-1.9％) and 6.1％ (2.5％-13.2％); and negative predictive value were 99.8％ (99.2％-100％), 99.1％ (98.1％-99.6％), and 99.6％ (97.2％-100％), respectively. Conclusions The clinical decision rules of CHALICE, PECARN and CATCH have high sensitivities. The specificity of PECARN rule is lower than those of CHALICE and CATCH rules. The above three clinical decision rules can be used for the decision of CT examination in Chinese children with head injury in practice.

Objective:To analyze the risk factors for postoperative one-year mortality in elderly patients with femoral intertrochanteric fracture following multidisciplinary treatment (MDT) by intramedullary nailing.Methods:The clinical data were retrospectively analyzed of the 158 elderly patients with femoral intertrochanteric fracture who had undergone MDT by proximal femoral intramedullary nailing between January 2018 and August 2020 at Department of Orthopedics, Trauma Center, Zhongda Hospital Affiliated to Southeast University. There were 41 males and 117 females with an average age of 82.5 years (from 65 to 95 years). By the modified Evans classification, there were 15 cases of type Ⅰ, 16 cases of type Ⅱ, 35 cases of type Ⅲ, 81 cases of type Ⅳ, and 11 cases of type Ⅴ. The one-year mortality was documented in the patients after surgery. To screen for risk factors, univariate analysis was conducted of gender, age, body mass index (BMI), modified Evans classification of fractures, time from injury to operation, American Society of Anesthesiologists (ASA) classification, Charlson comorbidity index (CCI) and comorbidities, as well as preoperative hemoglobin (Hb), serum albumin (ALB) and total lymphocyte count (TLC). The factors with P<0.05 were included in the multivariate logistic regression model analysis to determine the risk factors. Results:A total of 13 patients died within one year after surgery, yielding a mortality of 8.2% (13/158). Univariate analysis showed significant differences in age, body mass index, modified Evans classification of fractures, CCI and Hb between the surviving and dead patients ( P<0.05). Multivariate logistic regression analysis showed that age >85 years ( OR=0.122, 95% CI: 0.018 to 0.834, P=0.032), BMI>23.9 kg/m 2 ( OR=0.083, 95% CI: 0.013 to 0.510, P=0.007), CCI≥3 points ( OR=0.051, 95% CI: 0.090 to 0.275, P=0.001) and preoperative Hb<90 g/L ( OR=4.733, 95% CI: 1.036 to 21.624, P=0.045) were the independent risk factors for postoperative one-year mortality in the elderly patients with intertrochanteric fracture following MDT by proximal femoral intramedullary nailing. Conclusions:After MDT by proximal femoral intramedullary nailing of femoral intertrochanteric fractures, the geriatric patients with an age >85 years, BMI>23.9 kg/m 2, CCI≥3 points and Hb<90 g/L are likely to die. Therefore, special care should be taken for them.

Objective To investigate the effect of Gexia Zhuyu decoction combined with diosmin on coagulation mechanism in patients with great saphenous varicose vein surgery.Methods A total of 60 patients who received great saphenous varicose vein surgery in Shaoxing Hospital of Traditional Chinese Medicine from January 2019 to April 2022 were selected and divided into control group and observation group according to random number table method,with 30 patients in each group.Control group was treated with diosmin,and observation group was treated with diosmin + Gexia Zhuyu decoction.Coagulation indexes,vascular endothelial function and inflammatory factor levels were compared between two groups.Results After treatment,Krüppel-like factor 2,activated partial thromboplastin time,thrombin time,prothrombin time,nitric oxide,and interleukin(IL)-10 in observation group were significantly higher than those in control group,while plasminogen activator inhibitor type 1,von Willebrand factor,endothelin 1,hypersensitive C-reactive protein,IL-2 and IL-6 were significantly lower than those in control group(P<0.05).Conclusion Gexia Zhuyu decoction combined with diosmin can improve the hypercoagulable state and vascular endothelial function in patients with great saphenous varicose vein surgery,and reduce the level of inflammatory factors in the body,which is worth popularizing.