Objective To study the relationship between C reactive protein ( CRP) and postoperative deliri-um of elderly patients after hip fracture , and to explore the possible mechanism of delirium .Methods A total of 186 elderly patients with hip fracture who received operation were included in the study .24h after operation,according to the patients'awareness of ICU fuzzy evaluation method ,the patients were divided into the delirium group and non delirium group .The levels of CRP and procalcitonin were detected and compared .Results The CRP levels in the de-lirium group and non delirium group were (207 ±86)mg/L,(87 ±42)mg/L,there was significant difference between two groups (t =2.427,P <0.01).The procalcitonin levels in the delirium group and non delirium group were (0.32 ±0.11)μg/L,(0.27 ±0.13)μg/L,the difference between the two groups was not significant (t=0.347,P>0.05).Conclusion CRP may be related with delirium.Inflammatory response without systemic infection may be one of the mechanisms of delirium .

Objective To establish a way to measure the injury severity of articular surface due to posterior malleolus fracture and investigate its clinical significance based on three-dimensional reconstruction technique.Methods Between May 2009 and March 2014,138 cases of peri-ankle injury combined with posterior malleolus fracture were treated.Lateral radiographs were reviewed to measure the ratio of posterior fragment area to distal tibial plafond area using the common method.Three-dimensional CT images were examined to measure ratio of the area of injury using the three-dimensional measuring method.Statistical comparison was made using the t-test and intraclass correlation coefficient (ICC).Results Measurement failed on 33 lateral radiographs and 13 three-dimensional CT images.Six cases cannot be measured by both imaging technology,so results of 98 cases were compared.Ratio of posterior fragment area to tibial plafond area was (16.2 ± 7.2) ％ measured by radiographs and was (29.6 ±10.1) ％ by three-dimensional CT scans (P ＜ 0.05).Three-dimensional CT measurements showed higher intra and inter-observer agreement (ICC of 0.973 to 0.942) than that in radiographic measurements (ICC of 0.875 to 0.860).Conclusion Three-dimension CT assessment of the extent of injury to articular surface because of posterior malleolus fracture is reliable and reproducible,but radiographic assessment may underestimate the injury and influence the choice of surgical indications.

Objective To study effect of Xuebijing injection on coagulation function and prevention of deep venous thrombosis in elderly fracture patients with mechanical ventilation.Methods 60 patients were randomly divided into control group(30 cases) and Xuebijing group(30 cases).Xuebijing group received Xuebijing injection, besides physical therapy for prevention of deep venous thrombosis received by control group.Coagulation parameters and Lac at different time points,thrombosis incidence,hemorrhage incidence APACHE II score and 28 -day mortality were compared between the two groups.Results In Xuebijing group,PT,APTT,DD on d3 and Fg 48 on d5 had statistically significant differences compared with before treatment.PT,APTT on d3,d5 and DD on d5 were statistical-ly different compared with the control group(P <0.05).PLT,Lac,hemorrhage incidence and 28 -day mortality had no significant differences between the two groups.Thrombosis incidence in Xuebijing group was significantly lower than the control group(20.00% vs 3.33%) (χ2 =4.043,P =0.044,P <0.05).Both of APACHE II score were lower than before treatment,but the Xuebijing group was significantly decreased(t =5.48,P =0.000,P <0.05). Conclusion Xuebijing injection could improve coagulation function,and decrease thrombosis incidence in elderly fracture patients with mechanical ventilation.

Objective To investigate the three-dimensional morphological characteristics of tibial plateau based on CT image post-processing technique and analyze its significance in preoperative planning of tibial plateau fractures.Methods Multi-slice spiral CT data of 98 humans (56 males and 42 females) with normal tibial plateau and 30 patients (15 males and 15 females) with tibial plateau fractures were extracted.Morphological measurements of the tibial plateau were achieved by means of a three-dimensional measurement method based on points,lines and surfaces.Differences in threedimensional parameters between genders in normal tibial plateau and differences between normal tibial plateau and tibial plateau fractures were analyzed.Results Differences of males and females were significant in width of tibial plateau [(73.2 ± 3.7) mm,(65.5 ± 3.7) mm],anteroposterior dimension of medial tibial plateau [(39.8 ± 3.5) mm,(34.8 ± 2.6) mm] and anteroposterior dimension of lateral tibial plateau [(34.0 ± 3.3) mm,(29.8 ± 3 5) mm] (P ＜ 0.05),but not in varus inclination of tibial plateau [(3.19 ± 1.98) °,(3.16 ± 1.89) °],medial plateau posterior slope [(7.31 ± 3.04) °,(8.16 ± 2.46)°] and lateral plateau posterior slope [(5.23 ±2.35)°,(5.60 ±2.55)°] (P ＞0.05).Above parameters in three-dimensional morphological measurements of tibibial plateau fractures varied compared to the normal reference value (P ＜ 0.05).Intraclass correlation coefficient (ICC) for intra-observe and inter-observer agreement in normal tibial plateau measurement was excellent.Conclusions Present research provides a series of scientific and objective data for preoperative planning of tibial plateau fractures.Measurements of tibial plateau can assist the evaluation of reduction of tibial plateau fractures.

Objective To discuss the clinical application of homemade airway exchange catheter on the extubation of patients with difficult tracheal intubation in intensive care unit(ICU). Methods Sixty-two patients with difficult tracheal intubation who failed their initial extubation trial were randomly divided into conventional group (31 cases)and observation group(31 cases). The patients in the conventional group received routine extubation process,while the patients in the observation group were extubated under the guidance over a homemade airway exchange catheter. The changes in heart rate(HR),blood pressure,respiratory rate(RR)and pulse blood oxygen saturation(SpO2)were compared at 12 hours after extubation,so as the re-intubation rate,intubation success rate at first attempt and re-intubation time in two groups,and the tolerance and complications after extubation were observed. Results After extubation,the HR,blood pressure and RR were increased significantly(all P<0.05), and the SpO2 was much lower in conventional group(P<0.05),while those parameters were changed little and basically in the normal ranges in the observation group. At 12 hours after extubation,the re-intubation rate was much lower(6.45%vs. 25.81%,P<0.05)in the observation group,with shorter re-intubation time(seconds:27±14 vs. 49±28,P<0.01),higher intubation success rate at first attempt(90.32%vs. 54.84%,P<0.01)and better tolerance (77.4% vs. 61.3%,P<0.05)compared with those in the conventional group. There was no severe complication in the observation group,and there were 1 cases of glottic edema with cricothyroid membrane puncture,2 cases of broncheal mucous membrane bleeding and 2 cases of bucking in the conventional group. Conclusion Compared with conventional extubation process,the extubation over homemade airway exchange catheter can increase the rate of extubation,reduce re-intubation rate and the re-intubation time,with favorable tolerance and no occurrence of serious complications,and is one of the safe and effective extubation strategies in patients with difficult tracheal intubation in ICU.

Objective To discuss the curative effect of computer assisted pre-operation plan (CAPP) in treating the geriatric intertrochanteric femoral fracture.Methods The data of intertrochanteric fractures treated with PFNA-Ⅱ between March 2012 and June 2015 were retrospectively analyzed.They were divided into two groups by preoperative design.One group was the CAPP group consisting of 53 patients with a mean age of 75.3 years (range,60-92 years).According to the Evans Classification,there were 12 Evans type Ⅰb,9 Evans type Ⅰc,15 Evans type Ⅰd and 17 Evans type Ⅱ fractures.The other group was the non-CAPP group consisting of 74 patients with a mean age of 76.6 years (range,62-95 years).There were 18 Evans type Ⅰb,15 Evans type Ⅰc,20 Evans type Ⅰd and 21 Evans type Ⅱ fractures.Operation time,intraoperative blood loss,times of fluoroscopy during operation and days of hospital stay were compared.The hip joint function was evaluated by Harris score at the final follow-up.Results The CAPP meanly cost 24.7 min.The consistency of the surgery and CAPP was up to 100％.In the CAPP group,the average operation time was 46.8±6.5 min;the average times of fluoroscopy during operation were 12.0±2.3 times;and the average blood loss was 154.4±27.6 ml.In the non-CAPP group,the average operation time was 57.8±10.3 min;the average times of fluoroscopy during operation was 20.9±3.2;and the average blood loss was 235.0±65.8 ml.All above data in the CAPP group were significantly lower than those in the non-CAPP group.The mean days of hospital stay were 13.9±1.3 days in the CAPP group and 14.3±1.4 days in non-CAPP group.The days of hospital stay had no significant difference between the two groups.Forty-five patients with an average follow-up period of 18.3 months were reviewed in the CAPP group.Fifty patients were followed up with an average period of 19.2 months in the non-CAPP group.At the final follow-up,the average Harris score was 88.6±2.8 points (range,84-96 points) in the CAPP group and 87.5±3.2 points (range,80-95 points) in the non-CAPP group.Conclusion CAPP system is convenient and efficient.It can facilitate the treatment of intertrochanteric fracture effectively.

Objective To study the effect of Xuebijing injection on transfusion and systemic inflammation in traumatic coagulopathy patients. Methods Seventy-nine patients were randomly divided into Xuebijing Group (36 cases) and Control Group (43 cases). Xuebijing group received Xuebijing injection in addition to the regular treatment received by control group. Levels of TNF-α, IL-6, IL-8 and transfusion amount between two groups were compared. Results Coagulation abnormality was almost corrected in all patients after treatment. In Xuebijing Group, transfusion of RBC, FFP and cryoprecipitate were significantly less than that in control group (P<0.05). At 72 h after admission, TNFα, IL-6 and IL-8 were significantly lower in Xuebijing Group (P < 0.05). Conclusion Xuebijing injection could reduce transfusion in traumatic coagulopathy patients , possibly resulting from its antagonism against systemic inflammation.

Objective To provide references for anatomical reduction and correct implantation in treatment of distal fibular fracture by analyzing morphological characteristics of distal fibula on three-dimensional (3D) modes.Methods 16-row spiral CT scans of 126 normal ankle structures from May 2009 to June 2014 were collected.Surface shaded display technique was used to reconstruct 3-D images of bones around the ankle.The distal fibula was extracted using 3D segmentation technique.The parameters of distal fibula were measured by selecting points,lines and surfaces on the 3D models.Results The morphological characteristics of distal fibula were complicated.Significant differences were observed between males and females in most parameters (P ＜ 0.05),but not in the length between the plane of the most lateral point of the tibial anterior node and the most distal point of the fibula,the length between the midpoint of lateral border of the fibula and its opposite cortex on the plane of the most proximal border of the fibular fossa or the mean angle of posterior crest of the fibula (P ＞ 0.05).The intra and interclass correlation coefficients (ICC) were excellent.Conclusions When a lateral plate is used for internal fixation of distal fibula,the plate should be placed as proximally as possible.When a posterior-lateral plate is used,the screws to be inserted on the plane proximal to the initial point of anterior node of the tibia can be fixed bi-cortically.When a posterior plate is used,pre-contour of the plate before insertion is required.

Objective: To investigate the promotional effect of the new teaching method of goal orientation combined with plan-do-check-act (PDCA) cyclic improvement on specialized medical knowledge and operation skills among physicians in critical care medicine. Methods: A total of 84 physicians who received critical care medicine training in Department of Critical Care Medicine in Foshan Hospital of Traditional Chinese Medicine from January 2013 to December 2015 were selected, and according to the time of admission, they were divided into control group with 41 physicians and experimental group with 43 physicians. The physicians in the experimental group received the new teaching method of goal orientation combined with PDCA cyclic improvement, i.e., the physicians started systematic learning according to the learning goals sent out by the teaching secretary, summarized problems during learning and looked for optimal solutions every week, and then continued learning in the next week through PDCA cyclic improvement. The physicians in the control group received traditional teaching combined with bedside teaching, but no learning goals were set for them. The two groups were compared in terms of theoretical examination scores, clinical operation skills, and results of the questionnaire survey. The t-test and Wilcoxon ranksum test were used for comparison of scores between the two groups by SPSS 18.0. Results: Compared with the control group, the experimental group had significant increases in the scores of theoretical examination (91.50±4.18 vs. 87.80±3.63) and operation skills (88.80±3.34 vs. 85.40±2.88). The questionnaire survey showed that compared with the control group, the experimental group had a significantly higher degree of satisfaction, significantly greater learning interests, and significantly greater improvements in operation skills, clinical thinking ability, and self-confidence. Conclusion The new teaching method of goal orientation combined with PDCA cyclic improvement can stimulate learning interests, clarify learning goals, help physicians to master important and difficult issues, and thus improve their learning outcomes and scores in Department of Critical Care Medicine.

Objective To study the therapeutic effect of Xuebijing injection in severe craniocerebral injury patients with coagulation disturbance.Methods Sixty-five patients were randomly divided into Xuebijing treatment group (n=35) and control group (n=30).They all received regular treatment,while Xuebijing treatment group received Xuebijing injection additionally (0.9％ sodium chloride injection 100 mL adding 30 mL Xuebijing twice daily for a consecutive 10 d).Prothrombin time (PT),active partial thromboplastin time (APTT),levels of blood platelet (PLT),d-dimer (DD),tumor necrosis factor α (TNF-α),interldeukin (IL)-6 and IL-8,and Glasgow coma scale (GCS) scores at different time points,progressive intracranial hemorrhage (PIH) rate within 72 h,survival rate of 28 d were compared between two groups.Results Coagulation in all patients after treatment was significantly improved as compared with that before treatment (P＜0.05).At 72 h after treatment,the PT,APTT,and levels of DD and PLT in Xuebijing treatment group were significantly improved as compared with those in the control group (P＜0.05);levels ofTNF-α,IL-6 and IL-8 at 72 h after treatment in the treatment group ([1.41±0.32] ng/L,[80.4±25.1] ng/L and [5.17±0.59] ng/L) were significantly lower than those in the control group ([1.74±0.30] ng/L,[96.6±23.4] ng/L and [8.32±0.72] ng/L],P＜0.05).The PIH rate within 72 h in the treatment group (31.4％) was significantly lower than that in the control group (46.7％,P＜0.05).Conclusion Xuebijing injection could improve the abnormal coagulation and lower the PIH rate in severe craniocerebral injury patients with coagulation disturbance,possibly because Xuebijing injection could ameliorate inflammation.