Objective To construct and validate a predictive model for the risk of deep vein thrombosis(DVT)after lower extremity orthopedic surgery.Methods Clinical records of hospital-ized patients who underwent lower extremity orthopedic surgery in Wuxi Traditional Chinese Medicine Hospital from January 2017 to October 2019 were collected.The univariate and multivariate analysis with the backward stepwise method were applied to screen variables and build a nomogram prediction model,and the performance of the nomogram was evaluated with respect to its discriminant capabili-ty,calibration ability,and clinical utility.Results A total of 5 773 hospitalized patients with ortho-pedic surgery of lower extremity were included in the study,with the incidence of DVT of 0.9％.Through single factor and multi-factor stepwise regression analysis,5 variables were selected from 31 variables to construct the prediction model,including age,mean corpuscular hemoglobin concentra-tion(MCHC),D-dimer,platelet distribution width(PDW),and thrombin time(TT).The receiver operating characteristic(ROC)curve showed that areas under the ROC curve in the training and vali-dation cohort were 0.859 and 0.857,respectively.The model had good calibration ability and clini-cal practicability.Conclusion The DVT risk prediction model constructed in this study has good dif-ferentiation ability,calibration ability and clinical practicability,which is helpful for doctors to classi-fy DVT patients after lower extremity orthopedic surgery and formulate early treatment plan.

Objective To construct and validate a predictive model for the risk of deep vein thrombosis(DVT)after lower extremity orthopedic surgery.Methods Clinical records of hospital-ized patients who underwent lower extremity orthopedic surgery in Wuxi Traditional Chinese Medicine Hospital from January 2017 to October 2019 were collected.The univariate and multivariate analysis with the backward stepwise method were applied to screen variables and build a nomogram prediction model,and the performance of the nomogram was evaluated with respect to its discriminant capabili-ty,calibration ability,and clinical utility.Results A total of 5 773 hospitalized patients with ortho-pedic surgery of lower extremity were included in the study,with the incidence of DVT of 0.9％.Through single factor and multi-factor stepwise regression analysis,5 variables were selected from 31 variables to construct the prediction model,including age,mean corpuscular hemoglobin concentra-tion(MCHC),D-dimer,platelet distribution width(PDW),and thrombin time(TT).The receiver operating characteristic(ROC)curve showed that areas under the ROC curve in the training and vali-dation cohort were 0.859 and 0.857,respectively.The model had good calibration ability and clini-cal practicability.Conclusion The DVT risk prediction model constructed in this study has good dif-ferentiation ability,calibration ability and clinical practicability,which is helpful for doctors to classi-fy DVT patients after lower extremity orthopedic surgery and formulate early treatment plan.

Objective:To investigate the current situation with regard to a sense of coherence in major caregivers of enterostomy patients and analyze its relationship with self-efficacy and perceived social support.Methods:From July to December 2019, a total of 118 major caregivers of enterostomy patients were investigated using a general information questionnaire, a self-efficacy scale, and a perceived social support scale.Results:The score of sense of coherence in major caregivers of enterostomy patients was 58.40±9.17, and the average scores of all dimensions, from high to low, were “controllable sense，” “understandable sense，”and “meaningful sense.” Sense of coherence was positively correlated with self-efficacy and perceived social support ( r=0.457, P<0.01; r=0.369, P<0.01). Hierarchical multiple regression analysis showed that self-efficacy and perceived social support had a positive predictive effect on sense of coherence and explained 35.2% of the variance ( R′ 2=0.352, F=25.639, P<0.001). Conclusions:The main caregivers of enterostomy patients had a low level of sense of coherence. Self-efficacy and perceived social support have a positive effect on sense of coherence. Medical staff should take targeted measures to help caregivers improve their self-efficacy and social support system in order to improve their sense of coherence.

Objective:To explore benefit finding and its influencing factors among enterostomy patients.Methods:A total of 120 enterostomy patients were investigated with general information questionnaire, Benefit Finding Scale, Simplified Scale of Resilience and Perceived Social Support Scale.Results:The score of benefit finding among enterostomy patients was 49.44±5.86. Multiple regression analysis showed that education level, self-care, complications, resilience, perceived social support were influencing factors of benefit finding, and explained 51.1% of the variance.Conclusions:The benefit finding among enterostomy patients was grim. It is suggested that clinical staff pay more attention to the patients with low education, poor self-care and complications of stoma, and also pay more attention to the positive psychology and the social support system of patients, guide patients to pay attention to the positive significance of the disease, so as to improve the level of benefit finding.

Objective:To explore rumination status and its influencing factors among enterostomy patients, so as to provide references for the formulation of interventions.Methods:Using convenience sampling method, 120 patients with enterostomy who were treated and followed up in the Fifth Affiliated Hospital of Sun Yat-Sen University from July to December 2019 were selected as the research subjects. General information questionnaire, Event Related Rumination Inventory Scale, Simplified Scale of Resilience and Perceived Social Support Scale were applied in the investigation.Results:The invasive rumination score of enterostomy patients was (13.64±4.88) and the purposive rumination score was (14.90±3.72) . Multiple linear regression analysis showed that age, self-care degree of stoma, resilience and perceived social support explained 38.1% of the variance of invasive rumination ( P<0.01) . Education, occupation, resilience and perceived social support explained 41.9% of the variation of invasive rumination ( P<0.01) . Conclusions:The rumination of enterostomy patients was in the lower middle level. It is suggested that clinical staff pay more attention to the patients with low age, poor self-care ability of colostomy, low education level and unemployed state. At the same time, measures should be taken to improve the level of patients' resilience and improve their social support system, so as to promote the patients' positive psychological adjustment.

Objective:To evaluate the monitoring value of amplitude-integrated electroencephalography (aEEG) in brain injury among neonates with severe hyperbilirubinemia.Methods:This study retrospectively recruited 223 full-term infants with severe hyperbilirubinemia who underwent aEEG in the Department of Neonatology of Guangzhou Women and Children Medical Center from October 2018 to June 2020. Differences in serum bilirubin level and the incidence of acute bilirubin encephalopathy (ABE) between the normal group ( n=180) and abnormal aEEG group ( n=43) were compared. The monitoring value of aEEG in ABE, and its association with brain stem auditory evoked potential (BAEP) and MRI were studied. Two-independent sample t-test, Mann-Whitney U test and Chi-square test were used for comparing the differences between groups. Goodman-Kruskal Gamma was used for correlation analysis. Results:The total serum bilirubin level [(536.2±154.6) vs (422.1±103.0) μmol/L, t=-5.109, P<0.001] and the incidence of ABE [62.8% (27/43) vs 9.4% (17/180), χ2=62.366, P<0.001] in the abnormal aEEG group were significantly higher than those in the normal aEEG group. The sensitivity and specificity of aEEG in the diagnosis of ABE were 61.3% and 91.1%, respectively. With the progression of ABE from warning period to spasmodic stage, more severe voltage suppression (Gamma=0.847, P=0.003), more disordered sleep-wake cycles (Gamma=0.941, P<0.001) and a more frequent epileptic discharge (Gamma=0.976, P<0.001) were observed. Out of the 223 cases, 148 underwent BAEP. The abnormal rate of aEEG in abnormal BAEP group was significantly higher than that in normal BAEP group [32.7% (33/101) vs 6.4% (3/47), χ2=12.040, P=0.001]. The incidence of abnormal voltage in severe abnormal BAEP group was significantly higher than that in mild abnormal BAEP group [20.6% (7/34) vs 2.6% (1/38), χ2=5.858, P=0.016]. The incidence of epileptic discharge in severe abnormal BAEP group was significantly higher than that in mild abnormal BAEP group [32.4% (11/34) vs 2.6% (1/38), χ2=11.413, P=0.001] and moderate abnormal BAEP group [32.4% (11/34) vs 3.5% (1/29), χ2=8.480, P=0.004]. Among the 223 cases, 108 received MRI examination. The incidence of epileptic discharge in the cases with bilirubin brain injury image was significantly higher than those with normal MRI images [28.6% (10/35) vs 2.6% (1/39), χ2=9.864, P=0.002] and those with other abnormal images [28.6% (10/35) vs 2.9% (1/34), χ2=8.451, P=0.004]. Conclusions:aEEG monitoring is helpful in the diagnosis of ABE and can reflect disease severity. Severe hyperbilirubinemia-induced brain injury in neonates mainly manifests as increased and more frequent epileptic discharge on aEEG. There is a correlation between aEEG monitoring with BAEP and MRI findings.

Objective: To understand the characteristics of injuries among rural children, and to determine the relationships between school-level factors with anxiety among injury-prone children, to provide a reference for making effective measures to prevent and control the injuries. Methods: A cross-sectional survey was conducted in the Qingxin District of Qingyuan City. Six primary schools and middle schools were randomly selected from two towns. A total of 5 250 students in grades 3-9 were investigated. Students filled out the questionnaire themselves. Screen for Child Anxiety Related Emotional Disorders (SCARED) was used to assess anxiety. Results: Among the 770 rural children who suffered injuries during the past year, the leading cause of injury was falling(44.62%), falling at home(29.61%), getting injuried in low limbs(29.45%), getting injuried by oneself (41.00%) and mainly unintentional injuries(68.66%) . About 35.06% of children reported anxiety symptoms. Approximately 14.94% of children were injury-prone type. Significant differences in educational stage, boarding school, fighting involvement, and somatization/panic between injury-prone children were found in control group(P<0.05). The robust Poisson-GEE model showed that primary school students in high grade and middle grade, fighting with classmates, somatic/panic associated with injury risk (PR value was 2.11, 1.75, 1.58 and 1.58, respectively). Conclusion Injury-prone children in rural are affected by school-level factors as well as anxiety symptoms. In addition to safety education, mental health promotion and prevention of school bullying should be adopted in schools.

Objective: To investigate the sources of meaning in life of the elderly in the community. Methods: The phenomenological approach was conducted in Guangzhou Yuexiu Liurong community health service center and Shouxing nursing home in Baiyun District, a total of 21 elderly were interviewed by semi-structured in-depth interviews. Interviews data were analyzed by Nvivo11. Results: The elderly in the community were less concerned about the meaning in life. The level of meaning in life ranges from nothing to high, and some elderly had not explored it yet. Sources of meaning in life for elderly were quite different from when he was young: one valued work, earn money and self-improvement more when young, but as the growth of age, one would pay more attention to family and health. The sources of meaning in life included suffering, autonomy, family, make contributions and faith. Conclusion In the future, the sense of meaning in life of the elderly can be enhanced from the perspective of individuals, families and society by identifying the sources of meaning of the elderly.

Objective To investigate the clinical effect on incomplete spinal injury by ganglioside intravenous injection combined with intrathecal injection.Methods From January 2011 to January 2015, seventy-nine cases with irreducible articular process interlocking of cervical spine fracture with dislocation of cervical spinal cord injury,underwent one stage anterior and posterior surgical treatment,postoperative routine use of antibiotics to prevent infection,and the hormone,dehydration to promote bone cell growth and neurotrophic drugs treatment.The patients were randomly divided into the intravenous injection group(42 cases),given intravenous injection of monalsialic acid four hexose ganglioside sodium(GM-1)40 mg/d,mecobalamin tablets 0.5 mg/time,3 times/d,30 d oral;the combined intrathecal injection group(37 cases)was given GM-1 40 mg/d,intravenous injection at 15 d after intrathecal injection,1 time a week 40 mg,with a total of 4 weeks.The degree of spinal cord injury was evaluated according to Frankel classification; cervical function was evaluated according to JOA score; bone graft fusion,stability of cervical spine and degree of spinal cord injury were evaluated by imaging.Results The operation time in the intravenous injection group and the combined intrathecal injection group were(4.15 ± 0.65)h and(4.10 ± 0.85)h,and the intraoperative blood loss was(850.50±35.10)ml and(858.60±25.20)ml,respectively,and there were no significant differences between the two groups(t=1.375,1.452,P>0.05).The total dose of GM-1 in the combined intrathecal injection group was(785.20 ± 3.28)mg,significantly higher than that in the intravenous injection group((610.55 ± 5.28) mg),the difference was statistically significant(t=12.542,P<0.05);79 patients were followed up for 12-24 months,with an average of(15.2 ± 1.3)months.The improvement rate of nerve function of the combined intrathecal injection group was(64.35±4.33)%,significantly higher than that in the intravenous injection group (55.50±5.44)%,the difference was statistically significant(t=8.813,P<0.05);the postoperative JOA scores of the intravenous injection group((13.55 ± 1.75)points)and combined intrathecal injection group((12.85 ±1.97)points)were significantly higher than those before the surgery((7.25± 0.83)points,(7.19± 0.93) points),the differences were statistically significant(P<0.05).There was no significant difference in the JOA scores between the two groups before and after the operation(P>0.05).At the last follow-up,X-ray showed bone fusion at the bone graft site,and the internal fixation was good and firm.MR showed that the degeneration signal area of the cervical spinal cord decreased in varying degrees,and edema and inflammatory reaction disappeared.Conclusion Postoperative treatment of ganglioside intravenous injection combined with intrathecal injection is safe and feasible in the treatment of incomplete cervical spinal cord injury caused by cervical fracture dislocation with irreducible articular process interlocking.

Objective To investigate the clinical efficacy of Cerus and cucumis polypeptide injection in the prevention of heterotopic ossification for the drug treatment of traumatic knee joint fracture after operation.Methods To retrospect the analysis about 150 cases with fracture reduction and internal fixation of traumatic around the knee joint fracture from January 2010 to January 2014 in Daliang Hospital of Shunde District of Foshan,including 89 cases of reduction and internal fixation were performed in group A,and with safflower injection infusion therapy,61 cases with allergic constitution were not given by Cerus and cucumis polypeptide injection in group B.According to the activity degree and HSS scoring system,the function of knee joint was evaluated before and after operation.According to the condition of arounding knee joint bone fracture healing and heterotopic ossification in X-ray and CT examination and to compare the correlation of probability between heterotopic ossification and Cerus and cucumis polypeptide injection in traumatic around knee joint fracture.Results All were followed up with 12.0-24.0 months,with average(13.6±2.2)months.Activity of knee joint between group A and B were respectively(47.2±7.3)°,(46.4±6.8)°before treatment,and HSS score of group A and B were respectively(50.8±10.0)points,(51.5±9.6)points,so there were no statistically significant difference(P＞0.05).Activity of knee joint between group A and B were respectively(115.1±6.5)°,(112.1±7.8)°at the time of the last follow-up,and HSS score of group A and B were respectively(86.2±5.0)points,(85.5±7.0)points,so there were no statistically significant difference(P＞0.05).There were statistically significant difference in activity of knee joint and HSS scores in group A or in group B at the time of the last follow-up(t=13.322,12.898,10.052,10.435,P＜0.05).The incidence of heterotopic ossification was 8.99％(8/89)in group A,the incidence of heterotopic ossification was 1.64％(1/61)in group B,there were statistically significant difference between A and B(x2=10.873,P＜0.05).Conclusion During the drug treatment,there is a correlation between heterotopic ossification and Cerus and cucumis polypeptide injection used in traumatic around knee joint fracture after operation.