Hip fracture in the elderly is characterized by high incidence, high disability rate, and high mortality and has been recognized as a public health issue threatening their health. Surgery is the preferred choice for the treatment of elderly patients with hip fracture. However, lower extremity deep venous thrombosis (DVT) has an extremely high incidence rate during the perioperative period, and may significantly increase the risk of patients′ death once it progresses to pulmonary embolism. In response to this issue, the clinical guidelines and expert consensuses all emphasize active application of comprehensive preventive measures, including basic prevention, physical prevention, and pharmacological prevention. In this prevention system, basic prevention is the basis of physical and pharmacological prevention. However,there is a lack of unified and definite recommendations for basic preventive measures in clinical practice. To this end, the Orthopedic Nursing Professional Committee of the Chinese Nursing Association and Nursing Department of the Orthopedic Branch of the China International Exchange and Promotive Association for Medical and Health Care organized relevant nursing experts to formulate Expert consensus on perioperative basic prevention for lower extremity deep venous thrombosis in elderly patients with hip fracture ( version 2024) . A total of 10 recommendations were proposed, aiming to standardize the basic preventive measures for lower extremity DVT in elderly patients with hip fractures during the perioperative period and promote their subsequent rehabilitation.

Objective To investigate the clinicopathological characteristics and the factors affecting the prognosis of patients with resectable sarcomatoid carcinoma of the bladder(SCB).Methods A retrospective analysis was conducted with the clinical data of patients with resectable SCB treated at the Second Hospital of Tianjin Medical University between September 2008 and December 2023.The patients were divided into two groups,a bladder-preserving surgery(BPS)group and a radical cystectomy(RC)group,according to the specific surgical approach used for each patient.Kaplan-Meier survival curves were used to evaluate overall survival(OS)in both groups,and Cox regression models were employed to identify risk factors affecting survival.Results A total of 77 patients with resectable SCB were included.Among them,35 patients(45.5％)underwent BPS,while 42 patients(54.5％)underwent RC.Ki-67 expression≥30％was observed in 91.7％of the patients.A total of 92.2％of the patients was tested positive for cytokeratin(CK)and 98.1％for vimentin.In addition,62.5％and 37.5％of patients had the human epidermal growth factor receptor 2(Her-2)scores of 0 and 1+,respectively.The median follow-up time was 23.2 months(ranging from 0.4 to 164.7 months).The 1-year,3-year,and 5-year survival rates for the BPS group and the RC group were as follows,76.2％vs.84.9％,46.7％vs.61.1％,and 35.6％vs.43.2％,respectively.Multivariate Cox regression analysis revealed that in the RC group,age ≥ 75 years old(hazard ratio[HR]=3.836,95％confidence interval[CI]:1.168-12.595,P=0.027),tumor multiplicity(HR=3.439,95％CI:1.235-9.574,P=0.018),and lack of adjuvant therapy(HR=3.164,95％CI:1.015-9.862,P=0.047)were independent risk factors affecting survival.In the BPS group,female sex was identified as an independent risk factor for survival(HR=3.601,95％CI:1.200-10.804,P=0.022).Conclusion Ki-67,CK,and vimentin are significantly overexpressed in SCB patients,while Her-2 is either unexpressed or expressed at low levels.In the RC group,tumor multiplicity,age ≥75 years,and lack of postoperative adjuvant therapy are independent risk factors for overall survival.Female sex is an independent risk factor affecting prognosis in the BPS group.

Objective:To investigate the clinical efficacy of neuroendoscopic hematoma removal versus soft channel drainage in the treatment of chronic subdural hematoma. Methods:The clinical data of 102 patients with chronic subdural hematoma who received treatment in Jincheng People's Hospital from May 2018 to May 2020 were retrospectively analyzed. They were divided into the neuroendoscopy group ( n = 50) and the soft channel group ( n = 52) according to different surgical methods. Perioperative indexes, hematoma clearance rate, China Stroke Scale score, the activity of daily living score, and oxidative stress indexes were compared between the two groups. All patients were followed up for 3 months. The incidence of complications during the follow-up period was calculated. Results:The retention time of the drainage tube in the neuroendoscopy group was shorter than that in the soft channel group [(2.45 ± 0.63) days vs. (3.30 ± 0.78) days, t = 6.06, P < 0.001]. The length of hospital stay in the neuroendoscopy group was shorter than that in the soft channel group [(7.14 ± 1.65) days vs. (9.07 ± 2.11) days, t = 5.15, P < 0.001]. The hematoma clearance rate at postoperative 7 days in the neuroendoscopy group was higher than that in the soft channel group [(93.45 ± 5.50)% vs. (81.86 ± 7.24)%, χ2 = 9.12, P < 0.001]. There were no significant differences in operation time and intraoperative blood loss between the two groups (both P > 0.05). At postoperative 30 days, the China Stroke Scale score in the neuroendoscopy group was lower than that in the soft channel group [(12.74 ± 2.23) points vs. (18.67 ± 2.45) points, t = 12.79, P < 0.001]. The activity of daily life score in the neuroendoscopy group was significantly higher than that in the soft channel group [(77.69 ± 7.11) points vs. (91.35 ± 7.25) points, t = 9.60, P < 0.001]. At postoperative 7 days, glutathione peroxidase level in the neuroendoscopy group was significantly lower than that in the soft channel group [(130.75 ± 13.66) U/L vs. (148.60 ± 14.64) U/L, t = 6.37, P < 0.001]. Malondialdehyde level in the neuroendoscopy group was significantly lower than that in the soft channel group [(5.11 ± 0.65) nmol/L vs. (6.19 ± 0.74) nmol/L, t = 7.83, P < 0.001]. Superoxide dismutase level in the neuroendoscopy group was significantly higher than that in the soft channel group [(275.60 ± 22.33) U/L vs. (254.60 ± 18.55) U/L, t = 5.15, P < 0.001]. There was no significant difference in the incidence of complications between the two groups ( P > 0.05). Conclusion:Compared with soft channel drainage, neuroendoscopic hematoma removal can obtain better short-term curative effects and less oxidative stress response in the treatment of chronic subdural hematoma. Neuroendoscopic hematoma removal does not increase the incidence of postoperative complications and is highly safe.

Objective:To evaluate the association between the use of emergency medical services (EMS) and the severity of disease among patients admitted to the emergency room, to analyze the characteristics of the patients, and to build prediction model providing evidence-based use of EMS resources.Methods:The data of patients admitted to the Emergency Room of the First Affiliated Hospital of University of Science and Technology of China from January 2020 to July 2021 were extracted from the Chinese Emergency Triage Assessment and Treatment (CETAT) database. Patients were divided into the EMS use group (AB+ group) and self-seeing group (AB-group) according to whether they used EMS. The patients’ general condition, vital signs and laboratory tests results were recorded. The severity of patients’ condition was judged based on whether the patient was admitted to the department of critical medicine, specialized care unit, emergency operation and/or emergency percutaneous intervention. A 9-variable model that did not require laboratory inspection and 22-variable model that required laboratory inspection were established to correct the propensity score to analyze the correlation between the severity of disease and the EMS use. In the subgroup analysis, the correlation between the EMS use and severity of the patients was analyzed according to the reason of the patient’s visit.Results:During the study period, 16 489 patients were admitted to the emergency room, and 6975 patients were finally enrolled in this study. There were 2768 patients (39.7%) in the AB+ group and 4207 patients (60.3%) in the AB-group. In the AB+ group 522 patients (18.9%) were in high risk, and in the AB-group 563 patients (13.4%) were in high risk. Compared with the AB-group, patients in the AB+ group were older and had a higher proportion of coma, a faster autonomic heart rate, and a lower diastolic blood pressure and peripheral oxygen saturation (SpO 2). In the 9-variable model, sex, consciousness, temperature, heart rate and diastolic blood pressure were associated with the EMS use. In the 22-variable model, consciousness, SpO 2, neutrophils, and albumin were the relevant factors for patients using EMS. Before the correction of propensity score, the EMS use was an independent risk factor for critically ill patients ( OR=1.5, 95% CI 1.32-1.72, P<0.001). After adjusted using 9-variable propensity score, the EMS use ratio decreased significantly compared with that without correction ( OR=1.24,95% CI 1.08-1.42, P<0.001). Interestingly, after adjusted with propensity score match with 22-variable model, there was no association between the severity of disease and t the EMS use ( OR=1.10,95% CI 0.95-1.28, P=0.195). In subgroup analysis, patients’ chief complaint of central nervous system, cardiovascular system, and trauma were the top three reasons at admission. Before the propensity score correction, the EMS calling patients with chief complaint of central nervous system, digestive system, and trauma were related to the severity of the patients. After adjusted with 9-variable model the EMS use was associated with the severity of the disease only in trauma patients, and after adjusted with 22-variable model there was no statistical difference considering the severity of the disease in all subgroups. Conclusions:The EMS use is common. However, the association of the EMS use with the severity of disease is decreased with variable models using propensity score. These findings indicate that the EMS use should be based on multivariable models, which may be important in detecting critically ill patients, optimizing the EMS use, and avoiding unnecessary call in the future.

Objective To understand the prevalence,treatment and influence factors of hypertension in maintenance hemodialysis (MHD) patients in Anhui Province.Methods A total of 2724 adult patients on MHD from January 1st 2014 to March 31st 2014 in 26 hospitals of southern,northern and central Anhui Province were investigated.Their demographic characteristics,primary disease,complications,medications,dialysis and laboratory examination were explored.The prevalence treatment rate and control rate of hypertension were analyzed.Associated factors for controlling hypertension [systolic blood pressure (SBP) ＜ 140 mmHg and diastolic blood pressure (DBP) ＜ 90 mmHg] were assessed by logistic regression analysis.Results (1) The prevalence of hypertension in the hemodialysis patients was 87.0％.Their treatment rate and control rate were 93.2％ and 23.9％ respectively.The average of SBP was (145.90±21.18) mmHg,and the DBP on average was (83.60± 12.21) mmHg.The most commonly used anti-hypertensive drug is calcium channel blocker (88.2％).Over one third (45.7％) of patients were treated with two kinds of anti-hypertensive drug,26.2％ with 1 kind,21.7％ with 3 kinds,and 6.4％ with 4 kinds or more.(2) Compared with non-hypertension patients,patients with hypertension have older age,higher body mass index (BMI),phosphorus,SBP and DBP,as well as lower hemoglobin and Kt/V (all P ＜ 0.05).(3) The multivariate logistic regression analysis showed that Ca ＞ 2.50 mmol/L (OR=2.084,95％CI 1.008-4.307,P=0.047) positively correlated with controlling hypertension,while smoke (OR=0.594,95％CI 0.356-0.911,P=0.046) and BMI 18.5 ～ 23.9 kg/m2 (OR=0.516,95％CI 0.293-0.907,P=0.022) negatively correlated with it.Conclusions High prevalence yet low control rate of hypertension in MHD patients in Anhui Province were observed.Hypocalcemia may be a protective factor for hypertension control,while smoke and BMI may be risk factors for it.

Objective To study the effect of two different percutaneous transhepatic cholangiography and drainage (PTCD) procedures for malignant obstructive jaundice.Methods According to whether the tip of the catheter was carried across the ampulla and into the duodenum,patients were divided into external drainage group (54 cases) and both internal and external drainage group (57 cases).The effects of two surgical procedures on reducing jaundice,the postoperative complications,hospitalization days,and total hospitalization expenses were evaluated.Results Postoperative TBiL decreased significantly in both the two groups (t =2.338,P ＜ 0.05).The postoperative DBiL values went even lower in both external and internal group (t =2.201,P ＜ 0.05).There were 14 cases of biliary tract infection in the external drainage group,and 27 cases in two ways group (x2 =5.473,P ＜0.05).Total hospitalization expenses were statistically different between the two group (t =-2.200,P ＜ 0.05).Conclusion The internal and external drainage has a better drainage effect than the external drainage group,but more likely to cause infection of biliary tract,increase hospitalization expenses.

OBJECTIVE:To understand the pharmacists’knowledge for the rational drug use in the elderly,and to provide ref-erence for promoting the role of pharmacists in it. METHODS:A questionnaire was designed according to the Beers Criteria(2012 edition)to investigate the situation of pharmacists’(who were from some third-grade class-A hospitals in Guangzhou and some sec-ond-grade class-A hospitals in Foshan)knowledge for rational drug use in the elderly,and the data was statistically analyzed. RE-SULTS:Totally 190 questionnaires were sent out,and 176 were recycled with effective recovery of 92.63%. In the investigation, 30.11% of the pharmacists knew the knowledge well,23.30% was poor,and the rest was moderate. From 20 questions,the cor-rect answer rate more than 80% was only 5. Pharmacists in clinical pharmacy department showed higher score than those in non-clinical pharmacy department,the difference was statistically significant(P<0.05);the pharmacists worked in clinical pharma-cy,or pharmacists with higher title and longer working time acquired higher score,there was significant difference in the scores of pharmacists with different titles and working time(P<0.05);there was no significant difference among pharmacists from differ-ent grades of hospitals and education background(P>0.05). CONCLUSIONS:The pharmacists are not familiar with the rational use of drugs knowledge in the elderly well,and the understanding is related to working department,professional title and working time. It is necessary to strengthen the training and examination of pharmacists in rational drug use in the elderly,value and develop the construction of clinical pharmacy for the elderly actively.

OBJECTIVETo investigate the tissue distribution of berberine in rats after oral administration of Rhizoma Coptidis with Cortex Cinnamomi powder.

METHODAfter oral administration of Rhizoma Coptidis powder and Rhizoma Coptidis with Cortex Cinnamomi powder (6:1) at the dosage of 6 g x kg(-1) and 6.6 g x kg(-1) respectively per day for 1 week, the drug concentrations in various tissues were determined by HPLC method. The variations of berberine concentrations in tissues of two treated group of rats were compared by t test using software of SAS.

RESULTWith repeated administration of Rhizoma Coptidis powder, berberine distributed widely in tissues of rats and the concentrations of berberine in tissues increased, yet berberine existed mainly in liver. Berberine concentrations in all organs investigated in the group of rats treated with Rhizoma Coptidis and Cortex Cinnamomi powder showed obvious difference with those of the group of rats treated with Rhizoma Coptidis powder (P < 0.01). The berberine concentrations increased in heart, liver and kidney, while decreased in spleen and lung.

CONCLUSIONRhizoma Coptidis coadministration with Cortex Cinnamomi can obviously change the distribution of berberine in rat organs.

Animals ; Berberine ; administration & dosage ; pharmacokinetics ; Chromatography, High Pressure Liquid ; Drugs, Chinese Herbal ; pharmacology ; Male ; Rats ; Rats, Sprague-Dawley ; Reproducibility of Results