BACKGROUND:Exchange nailing has been reported to be a very good method for metaphyseal nonunion after femoral shaft fracture treated with intramedul ary nail. However, the effect of intramedul ary nail exchanging is not ideal for the treatment of nonisthmal femoral shaft nonunions.
OBJECTIVE: To compare the clinical and imaging outcomes between intramedul ary nail exchanging and intramedul ary nail retention plus augmentation plating for the treatment of nonisthmal femoral shaft nonunions.
METHODS:The clinical data of 39 patients with nonisthmal nonunions of femoral shaft fractures after failure of intramedul ary nail were retrospectively analyzed, and 21 patients were treated with intramedul ary nail exchanging and 18 patients were treated with intramedul ary nail retention plus augmentation plating. Clinical therapeutic effect was evaluated by Tohner-Wrnch standard.
RESULTS AND CONCLUSION:Al cases were fol owed-up for more than 15 months. In the intramedul ary nail exchanging group, postoperative internal fixator loosening occurred in three cases who obtained bony union by intramedul ary nail retention plus augmentation plating combined with autogenous iliac bone graft. The fixation time, blood loss, volume for suspended red blood cel s transfusion, hospitalization costs and re-operation rate in the intramedul ary nail retention plus augmentation plating group were lower than that in the intramedullary nail exchanging group (P<0.05). Al the patients in two groups obtained bony union, and the clinical and radiographic healing time in the intramedul ary nail exchanging group were longer than those in the intramedul ary nail retention plus augmentation plating group (P<0.05);according to Tohner-Wrnch standard at final fol ow-up, excel ent in 10 cases, good in six cases and poor in five cases in the intramedul ary nail exchanging group, and the excel ent and good rate was 76%;in the intramedul ary nail retention plus augmentation plating group, there were 11 cases of excel ent and seven cases of good, and the excel ent and good rate was 100%;there was significant difference between two groups (P<0.05). Due to relatively simpler manipulation, shorter fixation time, less intraoperative blood loss, slighter trauma, less hospitalization cost, lower re-operation rate and more satisfactory therapeutic effect, intramedul ary nail retention plus augmentation plating combined with autogenous iliac bone graft has been a better method for the treatment of nonisthmal nonunions of femoral shaft fractures after failure of intramedul ary nailing when compared with intramedul ary nail exchanging.

BACKGROUND: Metal-on-metal hip surface arthroplasty has improved the abradability for hip joint prosthesis and has the characteristics of normal biological stress transfer.OBJECTIVE: To observe the long-term state of hip-joint function of patients who underwent metal-on-metal hip surface arthroplasty.DESIGN: Follow-up study for cases.SETTING: Department of Orthopaedics, Jiangsu Provincial Corps Hospital of the Chinese People's Armed Police Force; Department of Orthopaedics, Affiliated Hospital of Nantong University.PARTICIPANTS: Eighteen cases (23 hips) who underwent a metal-on-metal hip surface arthroplastyprocedure in the Department of Orthopaedics, Jiangsu Provincial Corps Hospital of the Chinese People's Armed Police Force, and Department of Orthopaedics, Affiliated Hospital of Nantong University between September 2004 and July 2005 were recruited in this study. All cases, aged 28 to 54 years, include 11 males and 7 females. According to the classification of etiology, there were 13 cases of osteonecrosis(16 hips),3 cases of osteoarthritis( 4 hips ),1 case of congenital hip dysplasia (2 hips) and 1 case of posterior trauma arthritis(1 hip ). All cases applied the Conserve Plus resurfacing prosthesis (manufactured by Wright Medical Technology, USA), of which the pattern number of acetabular cup (press-fit depth: 1-2 mm) ranged from 38 mm to 56 mm in the inner diameter and from 44 mm to 62 mm in the outer diameter and that of femoral head cup ranged from 38 mm to 56 mm in the outer diameter. Preoperatively all patients signed the informed consent for the surgery, and the application of this technique also gave the approval of the Ethics Committee of the hospital.METHODS: ①After the epidural and lumbar combination anesthesia was satisfactory, the coxacava was exposed at first and the suitable size acetabular cup coated by hydroxyapatite ceramic was selected to be implanted, to be tightened and to be fixed by press-fit referring to the anatomical position. Subsequently to install the femoral head prosthesis, femoral cup was laid on the ready caput femoris and impacted by the presser to make the metal cup paste close-up with sclerotin when the concocted bone cement was overlaid on the prefabricated caput femoris surface and internal surface of prosthesis. Further, short-term of femoral cup should be kept the conformity with axial ray of the femoral neck. ②Patients were allowed to make the function exercise such as initiative stretch and contract of quadriceps muscle of thigh, passive motion of the knee joint and initiative motion of the knee joint under the non-weight loading on bed. Then they were encouraged to walk with two walking sticks two weeks after operation, progressing to get out of the two walking sticks six weeks postoperatively. All affected extremities were fixated with T-shaped tabula shoes in the abduction position after operation. ③All patients were reviewed with taking the anteroposterior radiographs of pelvis, evaluation of the clinically curative effect on the procedure of metal-on-metal hip surface arthroplasty and biocompatibility between the prosthesis and the host one year and two years after operation. Moreover, Harris score was assessed for all affected hips preoperatively, one year and two years postoperatively.MAIN OUTCOME MEASURES: ①The clinically curative effect on metal on metal hip surface arthroplasty; ②Biocompatibility;③The Harris score for the affected hips; ④The pain status of hip after operation.RESULTS: Eighteen cases were all brought into the outcome analysis at last.①The curative effect on the metal-on-metal hip surface arthroplasty: The femoral component of one case had a varus deformation of 10°six weeks after operation, but such complications as component loosening and femoral neck fractures, etc. Did not occur during the coming follow-up. The locations of rest prosthesis were satisfactory. Substantial radiolucencies were found at the rim of acetabular component (1 and 2 zone) in two hips, respectively one and two years after operation. But there was no evidence of radiolucencies around the short-stem of femoral component.②Biocompatibility: No patients were found to have obvious reactions including renal toxicity, pyretogen and rejection. No radiograph showed signs of loosening, dislocation, heterotopic bone formation, femoral neck narrowing, femoral head necrosis and prosthesis fixation failure, etc.③Harris score for the affected hips: The Harris score of all disease hips was improved from the mean 46 preoperatively to 85 one year after operation to 93 two years postoperatively. Of these,15 hips were excellent(> 90),6 hips good (80-89), and 2 hips fair(70–79).④The pain status of hip after operation: Two patients complained of slight pain, one patient of moderate pain, and no cases of severe pain happened.CONCLUSION: The long-term outcome for hip disease patients who undergo metal-on-metal hip surface arthroplasty is satisfactory.

Objective: To explore the relationship between eHealth literacy and social support and depressive symptoms in female nursing students, and to provide a reference for improving the mental health of female nursing students. Methods: In November 2019, 1 115 female nursing students from freshmen to junior years in four medical colleges in Changsha were investigated eHealth Literacy Scale, Perceived Social Support Scale, Center for Epidemiological Studies Depression Scales and demographic information questionnaire. Results: The detection rate of depressive symptoms in female nursing students was 20.1%(224/1 115), and the qualification rate of eHealth literacy was 29.2%(326/1 115). The incidence of depressive symptoms were higher in female nursing students with urban household registration and their parents with high school education and above and poor family economic status(χ2=9.46, 20.02, 7.16, 12.40, P<0.05). Multivariate Logistic regression analysis showed that poor eHealth literacy and low social support were positively correlated with depressive symptoms in female nursing students(OR=3.16, 3.65, P<0.05). There was a correlation between the interaction of eHealth literacy and social support with depressive symptoms. In the same type of social support, the lower eHealth literacy level, the greater the risk of depressive symptoms was for female nursing students(P<0.05). Conclusion Health literacy and social support are the influencing factors of depressive symptoms in female nursing students. The occurrence of depressive symptoms can be reduced by improving the level of electronic health literacy and social support.

Objective To explore the effect of primary exchange reamed nailing (ERN) and augmentation compression plating (ACP) combined with autogenous bone grafting (ABG) on health-related quality of life in patients with dystrophic or atrophic nonunion of femoral shaft after intramedullary nailing. Methods The study used a prospective study method. Sixty- two patients with femoral shaft nonunion after intramedullary nailing from August 2010 to October 2016 were selected, and the patients were divided into ERN group (group A, 32 cases) and ACP group (group B, 30 cases) by random digits table method. In group A, isthmus nonunion was in 18 cases (56.2％), and non-isthmus nonunion in 14 cases (43.8％); in group B, isthmus nonunion was in 16 cases (53.3％), and non-isthmus nonunion in 14 cases (46.7％ ). The health- related quality of life was compared between 2 groups, including physical component summary (PCS) and mental component summary (MCS) in the- 12- item short form health survey (SF- 12), brief pain inventory- severity (BPI- S) and brief pain inventory- interference (BPI- I). Results Fifty-four patients were followed-up for more than 1 year, and the mean follow-up time was 18.3 (13 to 37) months. All patients successfully achieved bone union, and the mean time was 5.8 (4 to 8) months. Significant improvements in terms of SF-12 PCS and SF-12 MCS score were noted after operation for patients with isthmus nonunion in both groups (t=3.148, 2.156, 2.456 and 2.559; P < 0.05), but there were no significant differences before and after operation in group A with non-isthmus nonunion (P >0.05). At the last follow-up, SF-12 PCS and SF-12 MCS in group B were significantly improved compared with those in group A: (45.2 ± 5.8) scores vs. (33.6 ± 4.7) scores and (48.8 ± 6.5) scores vs. (39.4 ± 5.6) scores, and there were statistical difference (P<0.05); SF-12 BPI-S and BPI-I showed obvious relief: (4.6 ± 2.1) scores vs. (6.2 ± 2.5) scores and (5.2 ± 1.9) scores vs. (6.8 ± 2.7) scores, and there were statistical differences (P<0.05); however there were no statistical difference in SF-12 PCS, SF-12 MCS, BPI-S and BPI- I between 2 groups (P>0.05). Conclusions Compared with ERN combined with ABG, ACP combined with ABG can significantly improve the quality of life in patients with dystrophic or atrophic nonunion of femoral shaft after intramedullary nailing. It has greater advantage on the improvement of health-related quality of life, especially for patients with non-isthmus nonunion.

Objective:To investigate the latent classes and influencing factors of vicarious posttraumatic growth among emergency nurses.Methods:Convenience sampling method was used to select the 498 emergency nurses of 20 public general hospitals in Anhui province as the survey objects. The general information questionnaire and Posttraumatic Growth Inventory were used to investigate. Latent class analysis was used to classify vicarious posttraumatic growth of emergency nurses, and the influencing factors of latent classes were analyzed by binary logistic regression.Results:There were two latent classes of vicarious posttraumatic growth of emergency nurses including high growth-high fluctuation group (24.1%, 120/498) and low growth group (75.9%, 378/498). Binary logistic regression analysis showed that professional title, average monthly income and self-rated health status were the factors influencing the latent classes (all P<0.05). Conclusions:There are obvious classification characteristics of vicarious posttraumatic growth among emergency nurses. Nursing managers should formulate and implement targeted intervention measures according to the classification characteristics and influencing factors to improve their vicarious posttraumatic growth level.

Objective To study the factors affecting hospital death in elderly patients with novel coronavirus infec-tion/disease 2019(COVID-19),and to build a risk prediction model.Methods According to the diagnostic criteria of Diagnosis and Treatment Protocol for COVID-19 Infection(Trial 10th Edition).Totally 775 elderly patients(≥60 years old)diagnosed as COVID-19 infection in the emergency department and fever clinic of the First Hospital of Changsha were selected as the research objects.General data and serum biomarkers of patients were collected.After treatment,the patients'data were divided into survival group and hospital death group.Binary Logistic regres-sion was used to screen the independent influencing factors of death,and ROC curve was used to analyze the pre-dictive value of related indicators on hospital death.Results After treatment,712 patients(91.9%)survived and 63 patients(8.3%)died in hospital.Binary Logistic regression analysis showed that:≥90 years old[OR=5.065,95%CI(1.427,17.974)],type 2 diabetes mellitus[OR= 3.757,95%CI(1.649,8.559)],COPD[OR= 5.625,95%CI(2.357,13.421)],monocyte ratio[OR=0.908,95%CI(0.857,0.963)],plasma fibringen[OR=1.376,95%CI(1.053,1.800)]and lactate dehydrogenase[OR=1.005,95%CI(1.001,o1.008)]were independent factors of in-hospital death(P＜0.05).The predictive value of diabetes mellitus+COPD+age+monocyte ratio+plasma fibrinogen+lactate dehydrogenase was proved in hospital death from COVID-19 infected patients:the area under the curve(AUC)was 0.883(95%CI:0.827,0.940,P＜0.001),the critical value≥0.710 suggested the risk of death in hospital,the specificity was 0.851,the sensitivity was 0.857.Conclusions The hospital mortality of the elderly after COVID-19 infection is higher and closely related to type 2 diabetes,COPD,monocyte ratio,plasma fibrinogen and lactate dehydrogenase.