Endoscopy ; Humans ; Pterygopalatine Fossa ; surgery

Objective To analyze and summarize the risk factors of failed internal fixation for intertrochanteric fracture.Methods From April 2008 to April 2011,267 patients with intertrochanteric fractures in 4 hospitals were treated with internal fixation.The relationship between the failure of internal failure and possible factors as age,gender,hypertension,diabetes,the abuse of alcohol and tobacco,use of glucocorticoid,the degree of osteoporosis and fractures type were studied.According to the surgical risk assessment table,the patients were divided into low-risk,mid-risk,and high-risk group.The rate of internal fixation failure was compared in the 3 groups.Results We found 42 cases which showed radiographic failures.The internal fixation failure directly related with advanced age,diabetes,severe osteoporosis,unstable type fracture,but not gender,hypertension,the abuse of alcohol and tobacco,use of glucocorticoid.Risk factors of internal fixation failure included diabetes,osteoporosis degree,and fracture stability.Failed intertrochanteric fracture fixation mainly occurred in the mid-risk and high-risk groups.Conclusion Severe osteoporosis,unstable fracture,diabetes are risk factors of failure of intertrochanteric fracture fixation.These factors will affect the quality of surgery.For the patient with intertrochanteric fractures in the low-risk groups,internal fixation should be the first choice for treatment.For the patients in the mid-risk and high-risk group,internal fixation should be applied cautiously.For the aged patients in high-risk groups,hip arthroplasty is a wise option.

Objective:To study the effect of social support on depression-posttraumatic stress disorder(PTSD) comorbidity among people living with human immunodeficiency virus/acquired immunodeficiency syndrome(PLWHA).Methods:Using questionnaire to one-to-one investigate the newly-diagnosed PLWHA in Wuhan Jingyintan Hospital HIV/AIDS clinic from October 2016 to February 2019. The content of the questionnaire included general demographic characteristics, HIV-related high-risk behaviors before diagnosis, social support, depression and PTSD.Patients with depression and PTSD were collected as P+ D group.Patients without depression or PTSD were collected as N group. The statistical software was SPSS 21.0. Chi-square test, t test and rank sum test were used to compare the differences between the two groups, and multivariate Logistic regression analysis was used to identify the influencing factors of depression combined with PTSD. Results:Among 320 PLWHA, 72 subjects(22.50%) had depression with PTSD(P+ D group), 161 subjects(50.31%) had neither depression nor PTSD(N group). Between the two groups, the differences of constituent ratios of gender(χ 2=9.84), routes of infection(χ 2=11.16), whether ever used drug(χ 2=30.00)were statistically significant(all P<0.05). There were statistically significant differences in the scores of social support((30.64±10.90) vs (25.51±8.55)), objective social support((7.20±3.08) vs (5.76±2.24)), subjective social support((16.70±6.87) vs (14.04±5.61)) and utility of social support((6.74±2.59) vs (5.71±2.60)( t=3.56, 3.57, 2.88, 2.81, all P<0.05). The results of Logistic analysis revealed that gender as male( β=-1.48, OR= 0.23, 95% CI=0.09-0.61) was protective factor for depression co-occuring with PTSD, while lower level of social support ( β=1.40, OR=4.05, 95% CI=1.36-12.10) was a risk factor. Conclusion:The prevalence of depression co-occuring with PTSD in PLWHA is high. The influence of gender and social support should be paid more attention to PLWHA.

Surgical innovation is an important part of surgical research and practice. The evaluation of surgical innovation through the stages is similar to those for drug development, but with important differences. The Idea, Development, Exploration, Assessment, and Long-term follow-up (IDEAL) Framework and Recommendations represent a new paradigm for the evaluation of surgical intervention and devices which was developed in 2009. The IDEAL is a five-stage framework involving the nature stages of surgical innovation, together with recommendations for surgical research pathway. The Framework and Recommendations were updated and published in 2019, which added a pre-IDEAL stage if necessary. The updated IDEAL also underlines the purpose, key question and ethical issues for each stage. In the first paper of IDEAL Framework and Recommendations series, we conducted a comprehensive introduction of IDEAL (e.g. the development, updates and application of IDEAL) to promote the dissemination and application of IDEAL in China.