Objective To observe the clinical effects and safety of vertebroplasty combined with zoledronic acid for osteoporotic thoracolumbar vertebral compression fractures .Methods 56 osteoporotic thoracolumbar vertebral compression fractures patients were radomly divided into the two groups ,each group had 28 cases.All patients had re-set treatment including lying on the hard bed and Padded waist .The treatment group had the surgery of vertebroplasty , 3 days after surgery these patients treated with 100mL Zoledronic acid by means of intravenous drip .The control group had the conservative treatment ,these patients received the closed reduction ,after operations the patients had the treat-ment of traction suspension ,lying on the hard bed ,padded the fractures .The two groups were compared at the time be-fore treatment,24h after treatment and 6 months after treatment .The anterior height of vertebral body ,kyphosis Cobb's
angle,low back pain visual analog scale ,Oswsetry dysfunction index score and complications were included into the study.Results (1) The anterior height of vertebral body: The difference of the anterior height of vertebral body at different time before or after the treatment was statistically significant , that showed the time effect [ the treatment group:(13.81 ±2.09)mm,(20.14 ±2.26)mm,(21.89 ±2.60mm;the control group:(15.24 ±2.21)mm,(17.39 ± 2.57)mm,(17.40 ±1.81) mm].The difference of the overall anterior height of vertebral body between the two groups was statistically significant ,which showed the grouping effect .(2) Kyphosis Cobb's angle: The difference of Kyphosis Cobb's angle at different time was statistically significant ,which showed the time effect [ the treatment group:(26.18 ±2.03)°,(9.56 ±1.11)°,(9.57 ±1.08)°;the control group:(27.36 ±2.71)°,(14.59 ±1.28)°, (14.52 ±1.48)°],the difference of the overall Kyphosis Cobb's angle between the two groups was statistically signifi-cant,which showed the grouping effect .(3) Low back pain visual analog scale:The difference of low back pain visual analog scale at different time was statistically significant ,which showed the time effect[the treatment group:(8.31 ± 0.94)points,(1.86 ±0.74) points,(1.87 ±0.77) points;the control group:(8.12 ±0.95) points,(3.85 ± 1.07)points,(3.82 ±1.08)points].The difference of the overall low back pain visual analog scale between the two groups was statistically significant , which showed the grouping effect .( 4 ) Oswsetry dysfunction index score: The difference of Oswsetry dysfunction index score at different time was statistically significant , which showed the time effect[the treatment group:(73.27 ±4.55)points,(32.11 ±2.57)points,(29.14 ±3.60)points;the control group:(75.49 ±4.20)points,(43.83 ±2.98)points,(38.67 ±5.28)points].The difference of the overall Oswsetry dys-function index score between the two groups was statistically significant ,which showed the grouping effect .Conclusion The treatment of vertebroplasty combined with zoledronic acid for osteoporotic thoracolumbar vertebral compression fractures was effective .It is able to relieve low back pain ,improve bone density and quality ,improve life quality ,and prevent Osteoporosis from further development .

This article introduced the peritoneal dialysis nursing model of Home Dialysis Unit in the affiliated hospital of Colorado University,including:overall status,setting and distribution,responsibilities of staff,work model of PD (pre-dialysis education,catheter insertion,CAPD/CCPD training,clinic visit model,home visit model,etc),and explored the enlightenment of this model on PD nursing in our country.This model provided references for dialysis center distribution,staff arrangement,pre-dialysis education,home visit,increase of social support and so on.

Objective To investigate the risk factors of delirium in elderly patients with intertrochanteric fracture after internal fixation.Methods The data of 160 patients with intertrochanteric fractures who received internal fixation in our hospital from January 2012 to July 2014 were analyzed retrospectively.The risk factors such as age,sex,preoperative complications,preoperative cognitive function,fracture location,operation mode,operation time,anesthesia method,hospital-to-operation time and intraoperative blood loss were summarized.Results The incidence of postoperative delirium was 28.15％ in postoperative elderly patients with intertrochanteric fractures.Univariate analysis showed that delirium had correlated with preoperative cognitive impairment,preoperative preparation time,serum sodium,fentanyl,atrial fibrillation,anesthesia method,operation time and perioperative blood loss (P ＜ 0.05).The multivariate Logistic regression analysis showed that the independent risk factors of postoperative delirium were preoperative cognitive dysfunction,operative time more than 2 hours and preoperative preparation time more than 4 days.Conclusion The occurrence of postoperative delirium was associated with anesthesia method,cognitive deficits,preoperative preparation time and perioperative blood loss.The anesthesia method which had less effect on the whole body condition and less time of operation preparation can decrease the occurrence of postoperative delirium in a certain extent,which is conducive to improving the prognosis.

Objective To explore the factors influencing pneumococcal vaccination uptake among the el-derly people in Guangzhou. Methods A survey by questionnaire was performed among 827 subjects aged 60 years or above and living in Guangzhou for five consecutive years. Chi-square test and multiple logistic regression analysis were applied to identify factors influencing pneumococcal vaccination uptake among the elderly. Results The positive factors for vaccination uptake among the elderly people included age of over 70 years (OR=1.677, 95%CI: 1.156 ~ 2.434), mental workers (OR = 1.837, 95%CI: 1.214 ~ 2.779), education background of over-three-year-course training (OR=1.769, 95%CI:1.039~3.012), and history of chronic diseases (OR=1.659, 95%CI:1.096~2.512) were positively associated with pneumococcal vaccination uptake. Monthly disposable income was not an influencing factor (OR=1.420, 95%CI: 0.895 ~ 2.251). Conclusion Strengthened publicity of pneumo-coccal vaccination among the elderly people and flexible measures tailored to the needs of different groups are rec-ommended in order to improve pneumococcal vaccination uptake among the elderly people.

Objective To build the indicators system for clinical pathway management as required by clinical pathway control.Methods An indicators system was proposed by means of evidence-based review,focus group discussions,and ratings of the indicators' importance by doctors and nurses.A multidisciplinary panel of 60 experts from across the country were selected.A 3-round Delphi survey was made on the proposed indicators.The weights of the indicators were established by analytical hierarchy process (AHP).The response rate,Cronbach's α,and the authority coefficient of experts were used as a measure of reliability.Results The response rates of the 3 rounds were 85％,70％,and 94％; the experts authority coefficient was 0.80.The ccoefficient of variation falls with the rising number of consultations.The Kendall's W ranged from 0.40 to 0.83.Following the 3 rounds,consensus was achieved among experts as such a system comprising three first-level,9 second-level,and 36 third-level indicators.Conclusion The expert consultation has achieved reliable results.The established indicators system can serve as a useful instrument for standardized development of clinical pathways management and constant improvement.

To investigate the changes of endocrine, cyclic nucleotide and immune systems in subjects of yang deficiency constitution, and to explore the relationship among characteristics and causes of yang deficiency constitution, the physiological and biochemical parameters.

Objective To investigate the clinical efficacy of mesh repair via inguinal approach in acute femoral hernia.Methods The retrospective cohort study was conducted.The clinical data of 48 patients with acute femoral hernia who were admitted to Huadong Hospital Affiliated to Fudan University between January 2007 and December 2016 were collected.Of 48 patients,29 undergoing hernia repair with polypropylene mesh and 19 undergoing hernia repair with suture were allocated into the study group and control group respectively.All the patients underwent hernia repair via inguinal approach.Observation indicators:(1) surgical and postoperative situations;(2) follow-up and survival situations.Follow-up was performed by outpatient examination and telephone interview to detect complications,hernia recurrence,survival situations at 1-,3-month and 1 year postoperatively for 1 year up to December 2017.Measurement data with normal distribution were represent as x±s and comparison between groups was done by the t test.Comparison of count data was analyzed using the chi-square test or Fisher exact probability.Results (1) Surgical and postoperative situations:patients in the 2 groups underwent successful incarcerated or strangulated acute femoral hernia repair.There were 3 and 4 patients receiving small bowel resection in the study group and control group respectively,with no statistically significant difference between groups (x2=1.50,P＞0.05).The operation time was respectively (82±16)minutes and (96± 13)minutes in the study group and control group,with statistically significant difference between groups (t =-2.94,P＜0.05).There was no femoral vascular injury in the 2 groups.The time of drainage-tube removal and duration of postoperative hospital stay were respectively (4.5 ± 1.6) days and (9±4) days in the study group and (3.9± 1.3)days and (10±4)days in the control group,with no statistically significant difference between groups (t =1.36,-0.33,P＞0.05).(2) Follow-up and survival situations:all the 48 patients were followed up for one year.No mesh infection was found in the study group.[ncisional infection was detected in 4 and 2 patients of the study group and control group respectively,with no statistically significant difference between groups (x2 =0.11,P＞ 0.05).Patients with incisional infection were cured after incision open drainage.Two and 2 patients had postoperative chronic pain in the study group and control group respectively,with no statistically significant difference between groups (x2 =0o 20,P＞0.05).The 4 patients had mild intermittent pain,without special treatment.There were no seroma occurred in the 2 groups.Hernia recurrence was occurred in 0 aud 5 patients of the study group and control group respectively,with statistically significant difference between groups (x2 =8.52,P＜0.05).There were 2 and 1 patient dead in the study group and control group respectively,with no statistically significant difference between groups (P ＞ 0.05).Conclusions Hernia repair with Polypropylene mesh via inguinal approach in acute femoral hernia is safe and feasible.Compared to suture repair,it can not only shorten operation time and reduce hernia recurrence,but also had no mesh infection and cannot iucrease postoperative complications.

Objective:To explore the role of internal stenting for preventing biliary anastomotic complications during complex duct-to-duct biliary reconstruction of orthotopic liver transplantation.Methods:From December 1, 2018 to April 30, 2020, intraductal stent was placed in 6 cases of complex biliary tract reconstruction during liver transplantation. Postoperative prognosis, recovery of bilirubin and biliary enzymes, management of intraductal stent and occurrence of postoperative biliary complications were observed.Results:All of them recovered and were discharged smoothly and bilirubin and biliary enzymes normalized before discharge. The average peak values of total bilirubin, alkaline phosphatase, total bile acid and γ-glutamyl transpeptidase were 83.8±56.4 μmol/L, 151.5±76.3 U/L, 301.7±177.0 U/L and 98.4±80.9 μmol/L and the average turning points of total bilirubin, alkaline phosphatase, total bile acid and γ-glutamyl transpeptidase 2.3±1.0, 3.0±1.1, 3.8±1.2 and 1.8±0.8 days; average time of complete recovery of total bilirubin, alkaline phosphatase, total bile acid and γ-glutamyl transpeptidase 7.7±5.1, 5.0±4.9, 23.5±7.6 and 3.8±2.4 days respectively. Intraductal stent was removed by gastroduodenoscopy ( n=3) and slipped off ( n=3). Except for one case of asymptomatic anastomotic stricture at 1 year post-operation, no biliary complications occurred during follow-ups. Conclusions:The placement of intraductal stent during complex biliary reconstruction of liver transplantation can effectively promote the recovery of postoperative liver function, enhance the quality-of-life of patients, effectively avoid the occurrence of biliary anastomotic complications and ensure the safety of patients.

Objective:To explore the clinical evaluation outcomes of COVID-19 risk assessment scale on organ donation and procurement during the pandemic of novel coronavirus pneumonia (NCP) and reduce the incidence of donor-derived infection and medical staff infection.Methods:From January 20 to February 29 in 2020, the organ procurement team adopted the COVID-19 risk assessment scale for evaluating 8 potential donors. They were classified into the levels of high/low/uncertain risk by analyzing the risk levels of donation hospitals, clinical characteristics and exposure history. The coordinators, organ evaluators and ward medical staff adopted essential protective measures. The infection status of 2019-nCoV in the above mentioned staff was examined and graft function in the corresponding recipients were observed.Results:Based upon the COVID-19 risk assessment results, the risk level was high (n=8), low (n=5) and uncertain (n=2) and underwent organ procurement. A total of 19 grafts including liver, kidney, pancreas and heart were harvested and successfully utilized for organ transplantation. During the observation period of 14 days, there was no suspected or confirmed infection of 2019-nCoV among coordinators and medical staff. No graft dysfunction or acute rejection was observed during a follow-up period of 4 to 30 days. No recipient was suspected or confirmed to be infected with 2019-nCoV and 6 of them were negative for 2019-nCoV nucleic acid testing after organ transplantation.Conclusions:During the COVID-19 pandemic, it is safe to proceed with donor organ evaluations and procurements according to the result with the COVID-19 risk assessment scale. Low-risk donor organ donation may be carried out, uncertain risk donor organ donation should be performed cautiously and high-risk donations discouraged.

Objective To analyze the clinical value of laparoscopic and hybrid technique for the repair of incisional hernia.Methods The clinical data of 70 cases of incisional hernia undergoing laparoscopic and hybrid repair from Jan 2014 to Dec 2015 in Huadong Hospital were analyzed retrospectively.Results All cases were operated on successfully and recovered.The operation time was (60 ± 27) min for laparoscopic and (120 ± 32) min for hybrid repair.The length of incision was (6 ± 4) cm for laparoscopic repair and (8 ± 6) cm for hybrid.Postoperative complications included seroma in 1 case in laparoscopic group,incisional fat liquefation in 1 case in hybrid group.All were cured with conservative treatment.Hospital stay was (8 ± 5) days in hybrid group and (14 ± 16) days in hybrid group.No recurrence was observed during 6-30 months of follow-up.Conclusion Both laparoscopic and hybrid technique for incisional hernia repair are safe and effective.