BACKGROUND:The key difference between closed reduction and open reduction for femoral neck fracture is the incision of joint capsule or not. As for this problem, scholars have different opinions, but there is no unified conclusion. OBJECTIVE:To compare reduction quality and the rate of femoral head necrosis of open reduction and closed reduction in the treatment of femoral neck fracture in middle-aged and young patients with displaced femoral neck fracture. METHODS: Clinical data of 102 middle-aged and young patients with femoral neck fracture, who were treated in the Department of Traumatic Orthopedics, Guizhou Orthopedic Hospital from June 2008 to June 2014, were analyzed. They were folowed up. According to the manner of reduction, they were divided into open reduction group (n=39) and closed reduction group (n=63). General data, postoperative fracture healing, the rate of femoral head necrosis and reduction quality were compared between the two groups. RESULTS AND CONCLUSION:No significant difference in general information, preoperative and postoperative hemoglobin difference, fracture healing time and fracture nonunion rate was detected between the two groups (P > 0.05). The rate of femoral head necrosis was lower in the open reduction group than in the closed reduction group, but reduction quality was higher in the open reduction group than in the closed reduction group (P < 0.05). These results indicate that in the treatment of displaced femoral neck fractures in middle-aged and young patients, postoperative femoral head necrosis rate of open reduction and fixation is low, and the quality of reduction is better. Open reduction has a certain advantage, but the case number and case study have a certain limitation. We should choose the appropriate way of operation treatment according to the patient’s condition.

Objective To investigate the effect of percutaneous transforaminal endoscopic surgery for lumbar prolapse upwards type disc herniation.Methods According to the digital table,90 patients with lumbar prolapse upwards type disc herniation were randomly divide into the observation group and the control group,45 cases in each group.The observation group was treated with percutaneous transforaminal endoscopic surgery,the control group was treated with conventional open surgery.The curative effect,operation and adverse reactions were compared between the two groups.Results All patients were satisfied with the location,and they were completely removed from the nucleus.Compared with the control group,the operation time[(75.3±23.1)min vs.(103.4±35.4)min]and hospitalization time[(6.8±1.2)d vs.(8.7±1.8)d]of the observation group were shorter,the bleeding volume[(24.5±8.5)mL vs.(51.6±12.7)mL]was lower,the differences were statistically significant(t=4.453,5.632,4.269,all P<0.05).After one month and three months,the VAS score[(2.53±0.65)pints and(1.33±0.48)points]and ODI[(21.40±5.04)% and(12.93±3.50)%]of the observation group were significantly lower,there were statistically differences between the two groups compared with those before treatment(t=6.755,8.765,all P<0.05).And after one month,the VAS score and ODI of the observation group were significantly lower than those of the control group,the differences were statistically significant(t=4.342,3.985,all P<0.05).There was no significant difference between the two groups in the excellent and good rate(86.7% vs.82.2%,X2=1.011,P>0.05).ConclusionPercutaneous endoscopic discectomy surgery in the treatment of lumbar prolapse upwards type disc herniation is reliable,and it has less trauma and shorter hospital stay.

Objective To investigate the pathological findings and diagnosis value of CT and MRI in detec-tion of primary centralnervous system lymphoma (PCNSL)so as to improve diagnostic accuracy of the condition. Methods The results of CT and MRI for 32 patients with PCNSL were analyzed retrospectively,and the results were compared with the finally obtained surgical-pathological examination.Results Of 32 cases,the foci were single in 29 cases and multiple in 4 cases,and there were 41 foci in total.Most foci were located near the surface or middle line of brain.On CT scan appearances,most foci were hyperdensity or slightly hyperdensity masses with the well definite margin,on MRI,it showed low signal of T1 -weighted imaging (T1 WI)and slightly increased non-uniform signal of T2 -weighted imaging (T2 WI).All the foci were equally and markedly enhanced after enhancement.The diagnostic coincident rate of combination diagnosis (93.8%)was significantly higher than that of CT (71.9%)and MRI (75.0%)(χ2 =7.234 6,P=0.003 2;χ2 =6.953 8,P=0.003 7).Conclusion CT,MRI have characteristic mani-festation for PCNSL,and according to the manifestation of CT,MRI,predilection site,mass effect,and combined with pathological examination,which can effectively improve the sensitivity and accuracy of diagnosis.

Objective To evaluate the efficacy of narrow-band imaging (NBI) in diagnosis of color-ectal neoplasm. Methods A total of 96 colorectal neoplasm from 78 patients were observed under NBI, and the findings were compared with those from magnifying chromo-endoscopy and pathologic examinations. Re-suits The sensitivity of conventional colonoscopy in diagnosis of polyps was 78. 7%, which was increased to 99% (P < 0. 05) under NBI, with the clear identification of the shape and boundary of the lesions. Magnif-ying NBI colonoscopy provided images of pit patterns similar to those from chromo-endoscopy in diagnosis of type Ⅱ , ⅢL, Ⅳ and ⅤN, which showed better recognition than conventional colonoscopy, but less sensitiv-ity than chromo-endoscopy. Superficial vascular morphologic features could be better classified with NBI, with sensitivity of 100% and specificity at 87. 8%, which was superior to conventional colonoscopy but infe-rior to chromo-endoscopy. Conclusion Both chromo-endoscopy and NBI colonoscopy have better sensitivity and specificity in detection of colon polyps, while chromo-endoscopy reveals clear superficial structure of le-sion and pit pattern, and NBI demenstrates capillary morphology, which can distinguish neoplasm from non-neoplasm colorectal lesions. NBI, easy and convenient to switch, is an effective technique to make early di-agnosis of colorectal neoplasm.

Postoperative gastrointestinal dysfunction (PGD) is one of the most common complications following major surgeries under general anesthesia (GA). Despite ongoing research and new drug treatments, abdominal distension within 24 h postoperatively occurs in 8%-28% of all surgeries. We aim to analyze the effectiveness of preventing PGD by preoperatively stimulating Neiguan (PC6), Zusanli (ST36) and Shangjuxu (ST37) bilaterally twice a day compared with sham-acupuncture treatment and standard treatment.

Objective:To investigate the changes of circulating tumor cells in locally advanced esophageal squamous cell carcinoma pa-tients treated with concurrent chemoradiotherapy. The effect of these alterations on the patients’prognosis was also analyzed. Meth-ods:Circulating tumor cells were detected by immunomagnetic enrichment and fluorescence in 48 cases of locally advanced esopha-geal carcinoma patients treated with concurrent chemoradiotherapy. The dynamic changes of circulating tumor cells were compared between pre-and post-chemoradiotherapy. Moreover, the association of these changes with the clinical characteristics and two-year survival rate were analyzed. Results:The positive rate of circulating tumor cells was closely associated with the T stage, lymph node metastasis, and clinical stage (P<0.05), and the positive rates in pre-and post-chemoradiotherapy were 52.1%(25/48) and 20.8%(10/48), respectively. The difference was statistically significant (P<0.05). Kaplan-Meier analysis showed that the positive rate of circulating tumor cells predicted an adverse two-year survival rate in both pre-and post-chemoradiotherapy (P<0.05). Cox regression analysis showed that the clinical stage and circulating tumor cells after concurrent chemoradiotherapy were independent prognostic factors in the patients with esophageal carcinoma. Conclusion:Circulating tumor cells can reflect the disease progression in patients with locally advanced esophageal cancer. These cells can also predict the prognosis of esophageal cancer patients treated with concurrent chemo-radiotherapy.

Objective To detect the disinfectant-resistant geneqacA/B in the strains ofStaphylococcous aureus isolated from January 2014 to December 2014.Methods Fifty-one isolates were collected. PCR assay was used to detectmecA gene andqacA/B gene in the isolates followed byStaphylococcus protein A (spa) typing. Antimicrobial-resistant phenotypic typing was conducted to analyze the homology of theseqacA/B positive strains. The clinical information of the patients from whom the strains were isolated was collected to further understand the clinical background ofqacA/B-carryingS. aureus.Results The prevalence ofmecA and qacA/B genes was 21.6% (11/51) and 13.7% (7/51), respectively in the strains. The prevalence ofqacA/B gene in the methicillin-resistantS. aureus strains (54.5%, 6/11) was signiifcantly higher than that in the methicillin-sensitiveS. aureus strains (2.50%, 1/40). The prevalence ofmecA gene inqacA/B gene positive strains (6/7) was signiifcantly higher than that inqacA/B gene negative strains (1/7). TheseqacA/B positive strains were classiifed into 4 spa types (t037, t091, t932 and t895). The main type was t037 (4/7), which was from the pediatric ward.Conclusions The prevalence ofqacA/B gene is low in theS. aureus strains. However, the prevalence of this gene in methicillin-resistantS. aureus strains is far higher than that in methicillin-sensitiveS. aureus. spa type t037 may be a prevalent clone in pediatric ward.

Objective To compare the efficacy and safety of hypobaric and hyperbaric bupivacaine in combined spinal - epidural anesthesia for elderly patients with lower extremity surgery. Methods A total of 72 patients underwent lower limb surgery were randomly divided into control group and observation group according to the digital table,36 patients in each group. The patients were given hypobaric or hyperbaric bupivacaine in combined spinal-epidural anesthesia. The anesthesia effect during surgery and hemodynamics related indicators were compared between the two groups,and the intraoperative and postoperative anesthesia-related adverse reactions were recorded. Results The excellent and good rate of sedation in the observation group was 88. 91% (32/36),which in the control group was 91. 67% (33/35),the difference was not statistically significant (χ2 =0. 16,P=0. 69). The incidence rates of adverse events of the observation group,including back pain,urinary retention and neurological symptoms were significantly lower than those of the control group (all P<0. 05). Conclusion The effect of hypobaric bupivacaine is excellent,the effect of hemodynamics is small,the postoperative circulatory system is relatively stable,the operation safety is better,it is superior to the middle and elderly patients with lower limb surgery anesthesia.

Objective To summarize the diagnosis and surgical treatment of mesenteric cyst in children.Methods The clinical records of mesenteric cyst cases from January 2011 to December 2015 were reviewed retrospectively.The diagnosis and treatment options were analyzed, and the prognosis of laparoscopic surgery and laparotomy was compared.Results The main clinical symptoms included abdominal mass, abdominal pain, and abdominal distension.Abdominal ultrasound and/or CT scan were the diagnostic tools in all cases.Traditional laparotomy was performed in 14 cases, while laparoscopy in 7 cases (1 case switched to laparotomy).2 cases had emergency surgery due to acute abdomen, laparotomy and laparoscopy in each case.Simple cyst resections were completed in 14 cases, of which 2 cases with a small amount of residual in the mesenteric root.Intestinal resection and anastomosis were required in other 7 cases.The average time of hospital stay for laparotomy group was 12 days, and 10.14 days for laparoscopy group.There was no significant difference.All patients were discharged without postoperative complications.With 1-4 years follow-up, there was no recurrence.Conclusion The operation for mesenteric cysts depends on the relationship between the cyst and the adjacent bowel or organs, and the overall outcome is favorable.The selective use of laparoscopy will benefit more children.

Objective:To investigate the clinical value of peripheral monocyte and neutrophil count in predicting the response of patients with metastatic non-small cell lung cancer (mNSCLC) to immunosuppressive checkpoint inhibitors (ICI).Methods:The clinical data of 34 adult mNSCLC patients who received nafulizumab or pabolizumab in Danzhou People's Hospital of Hainan Province from January 2017 to March 2019 were retrospectively analyzed. The correlation of the demographic characteristics, clinical data, hematological examination results in the first two weeks before the treatment and two weeks after ICI treatment with prognosis was recorded and observed.Results:The baseline mean monocyte count [(0.52±0.09)×10 9/L vs. (0.60±0.12)×10 9/L] and neutrophil count [(4.27±0.87)×10 9/L vs.(5.39±1.02)×10 9/L] of patients with ICI reaction were lower than those of patients without ICI reaction, and the differences were statistically different ( t = -2.572, -2.727, all P < 0.05). However, there was a negative correlation between the monocyte count of the patients who responded to ICI and the reaction time ( r = -0.507, P < 0.05). The median reaction time in patients with monocyte count >0.70×10 9/L was shorter than that in patients with monocyte count ≤0.70×10 9/L (8 weeks vs. 12 weeks, χ2=4.162, P = 0.041). There was no correlation between monocyte count and time of reaction duration, progression of free survival (PFS) and overall survival (OS) ( r = -0.214, 0.182, 0.232, all P > 0.05). The decrease rate of neutrophil count in response group was higher than that in non-response group (22% vs. 2%, P < 0.05). After the first administration, cutoff value of neutrophil count was 4.2×10 9/L; the response rate of patients with neutrophil count ≤ 4.2×10 9/L was higher than that of patients with neutrophil count > 4.2×10 9/L [86.7% (13/15) vs. 36.8% (7/19), χ2=6.657, P < 0.05]. Conclusion:Peripheral blood monocyte and neutrophil count can predict the response to ICI therapy in patients with mNSCLC.