Objective To investigate the risk factors of polytrauma combined with multiple organ dysfunction syndrome (MODS).Methods A retrospective case control study was performed on the clinical data of 299 polytrauma patients admitted to the Affiliated Hospital of Jiangsu University from December 2011 to June 2017.The collected information included gender,age,length of hospital stay,number of injured parts,injury severity scores (ISS),neutrophil count,leukocyte level,hemoglobin level,platelet count,activated partial thromboplastin time (APTI),and D-dimer level within 24 hours since admission.In addition,shock within 24 hours since admission,infection after 3 days since admission,damage control surgery,underlying diseases and prognostic outcomes were also recorded.All the patients were divided into MODS group (94 patients) and non-MODS group (205 patients).Univariate and multivariate logistic regression analyses were used to determine the risk factors of polytrauma combined with MODS.Receiver operating characteristic (ROC) curve was applied to further analyze those risk factors identified by the former analyses.Results In the univariate analysis,there were statistically significant differences between the two groups in the number of injured parts,ISS,hemoglobin level,platelet count,APTT,D-dimer level within 24 hours since admission,shock within 24 hours since admission,infection after 3 days since admission,damage control surgery and prognostic outcomes (P ＜ 0.05).No significant differences were found in gender,age,underlying disease,length of hospital stay,neutrophil level,the leukocyte level within 24 hours since admission between the two groups (P ＞ 0.05).The multivariate logistic regression analysis showed that ISS (OR =1.048),shock within 24 hours since admission (OR =3.913),infection after 3 days since admission (OR =27.715),and D-dimer level within 24 hours since admission (OR =1.015) were significantly associated with polytrauma combined with MODS (P ＜ 0.05).In addition,the area under ROC curve of ISS was 0.726 (95 ％ CI 0.667-0.784),and the area under ROC curve of D-dimer was 0.638 (95％ CI 0.571-0.706).Conclusions The risk factors of polytrauma patients combined with MODS include ISS,infection after 3 days since admission,D-dimer level and shock within 24 hours since admission.In the treatment of polytrauma patients,attention should be paid to assessment of injury severity and coagulation function,active resuscitation to correct shock,prevent and control infection,which can reduce and prevent the risks for polytrauma patients combined with MODS.

[Objective]To discuss the diagnosis and treatment of lumbar disc herniation from the theory of kidney governor Qi pulse founded by Professor LYU Lijiang.[Methods]Firstly,analyze the relationship among the kidneys,the Governing Vessel and the spine,clarify the roles of the kidneys and the Governing Vessel on the spine,and understand the theoretical basis of the theory of kidney governor Qi pulse.Then the etiology and pathogenesis of lumbar disc herniation were analyzed based on the theory of kidney governor Qi pulse.Finally,the treatment principles of lumbar disc herniation were analyzed from different treatment methods.[Results]The three elements of kidney-Governing Vessel-spine are closely related to each other.The fundamental pathogenesis of lumbar disc herniation lies in the deficiency of the kidney and stagnation of Governing Vessel.Deficiency of the kidney results in emptiness of Governing Vessel,while Governing Vessel stagnation leads to a dysfunction in the ascending and descending of Yin and Yang in Governing Vessel.This disruption causes an inadequate circulation of Qi,blood,essence and body fluids,leading to a lack of nourishment for the tendons and bones and an obstruction in the flow of Qi and vessels.The treatment principle is to benefit the kidney and pass the Governing Vessel.By supplementing and tonifying the kidney Qi and replenishing the kidney essence,the Governing Vessel becomes filled,allowing the ascent of Governing Vessel Yang Qi and the descent of Governing Vessel Yin Qi.This facilitates the transformation of essence and marrow,promoting the smooth circulation of Qi,blood,essence and body fluids.Consequently,the lumbar vertebrae becomes stable,the lumbar muscles strengthen,the meridians and collaterals regulate properly,and the flow of Qi and vessels becomes unobstructed.[Conclusion]The theory of kidney governor Qi pulse can guide the clinical diagnosis and treatment of lumbar disc herniation,benefiting the kidney and passing the Governing Vessel is an important principle of treating lumbar disc herniation,and it can be carried through the whole process of treating lumbar disc herniation.

[Objective]Based on the propensity score matching method to explore the therapeutic effect of lever positioning manipulation in the treatment of L4/5 different types of lumbar disc herniation.[Methods]A prospective cohort design was used to select 122 patients with L4/5 lumbar disc herniation and divide them into unilateral group,bilateral group and central group.Samples with balanced covariates were obtained after matching,including 36 patients in unilateral group,35 patients in bilateral group and 35 patients in central group.All patients in the three groups were treated with leverage positioning technique,and all patients in the three groups were treated 3 times a week,once every other day,for a total of 2 weeks.Pain Visual Analogue Scale(VAS)score and Japanese Orthopaedic Association(JOA)score were observed before and after treatment to evaluate the differences in the postoperative effects of the three groups.[Results]The covariates of age,sex,course of disease,VAS score and JOA score were all balanced after matching(P>0.05).The results of following-up after 2 weeks and 6 months of treatment showed that the VAS score and JOA score were statistically significant(P<0.05),the distant and near term curative effect of lever positioning manipulation in the treatment of unilateral lumbar disc herniation was better than bilateral and central disc herniation(P<0.05).[Conclusion]The clinical efficacy of unilateral lumbar disc herniation is superior to bilateral and central disc herniation in the treatment of the same segment of lumbar disc herniation with leverage positioning manipulation.