Objective To explore the application effect of ultrasound-guided long axis iliac fascia block through femoral nerve for pain management in elderly patients with hip fractures.Methods A total of 60 elderly patients with hip fractures admitted to the Second Affiliated Hospital of Jiaxing University from March to June 2023 were selected,and they were divided into S group and L group according to random number table method,with 30 cases in each group.Patients in S group underwent short axis iliac fascia block through femoral nerve by ultrasound,while patients in L group underwent long axis iliac fascia block through femoral nerve by ultrasound.The static numerical rating scale(NRS)scores,dynamic NRS scores of two groups were compared before nerve block(T0),and 10min(T1),2h(T2),6h(T3)and 12h(T4)after nerve block,effective cases of nerve branch block,and occurrence of adverse events related to nerve block were compared between two groups.Results The static and dynamic NRS scores of two groups decreased first and then increased slightly with the extension of time.At time points T2 and T3,the static and dynamic NRS scores of patients in L group were significantly lower than those in S group(P<0.05).The effective cases of lateral femoral cutaneous nerve block and obturator nerve block in L group were significantly higher than those in S group(P<0.05).No adverse events such as local anesthetic poisoning,peripheral nerve injury,and analgesia covering up the disease occurred in both groups.Conclusion Ultrasound-guided long axis iliac fascia block through femoral nerve can effectively reduce early pain in elderly patients with hip fracture,and it is safe.

Objective To explore the characteristics of sleep structure in chronic insomnia disorder(CID)with disharmony between heart and kidney pattern and liver qi stagnation pattern.Methods A total of 74 patients with CID who were treated in Tongde Hospital of Zhejiang Province from June 2021 to December 2022 were selected and divided into disharmony between heart and kidney group and liver qi stagnation group according to TCM syndrome differentiation types,with 37 cases in each group.Relevant parameters of both groups were collected and analyzed using polysomnography(PSG).Results The age of patients in disharmony between heart and kidney group was significantly higher than that in liver qi stagnation group(P<0.05).There were statistically significant differences in total sleep time,sleep efficiency,rapid eye movement sleep period,N1 stage and N3 stage between two groups(P<0.05).The results indicated that patients in disharmony between heart and kidney group had light sleep,low sleep efficiency and short total sleep time.Conclusion With the increase of age,most of the syndromes of CID patients are disharmony between heart and kidney pattern,and there are obvious differences between the two types of sleep structure.Patients with disharmony between heart and kidney pattern have light sleep and low efficiency,while patients with liver qi stagnation pattern have many dreams.

Objective To explore the diagnostic value of musculoskeletal ultrasound in patients with limb pain.Methods A total of 80 patients with limb pain admitted to the First Hospital of Nanchang from January 2021 to December 2022 were included in the study.All patients received magnetic resonance imaging(MRI)and musculoskeletal ultrasound on admission.The consistency and coincidence rate of musculoskeletal ultrasound and MRI in diagnosing the cause of limb pain were compared.Results In the 80 patients,MRI and musculoskeletal ultrasound detected positive results in 78 cases,accounting for 97.50%,and 2 cases had no clear disease type.According to the results of MRI,there were 75 cases in which musculoskeletal ultrasound diagnosis of the cause of limb pain was consistent with the MRI results,and total coincidence rate was 96.15%(75/78),with excellent consistency(Kappa=0.907).Conclusion Musculoskeletal ultrasound can clearly display the fine tissue structure,and the diagnosis accuracy of limb pain is high,and the diagnosis consistency with MRI is excellent.

Objective To explore the effect of enhanced recovery after surgery(ERAS)in perioperative period of complicated appendicitis in children.Methods A total of 248 children with complicated appendicitis who underwent laparoscopic surgery in Quanzhou Children's Hospital from January 2020 to January 2023 were selected and divided into control group and ERAS group according to random number table method,with 124 cases in each group.Both groups of patients underwent laparoscopic appendectomy.The control group received traditional treatment during perioperative period,while the ERAS group received treatment based on the concept of ERAS.The first postoperative exhaust/defecation time,hospital stay,visual analogue scale(VAS)score,postoperative complications and hospitalization satisfaction were compared between two groups.Results The time of first postoperative exhaust/defecation and hospital stay in ERAS group were significantly shorter than those in control group,total incidence of postoperative complications and postoperative VAS score were significantly lower than those in control group,and hospitalization satisfaction was significantly better than that in control group(P<0.05).Conclusion ERAS implementation during perioperative period of complicated appendicitis in children can promote early postoperative recovery,reduce postoperative pain,reduce the incidence of complications,and improve hospitalization satisfaction,which is worthy of clinical promotion and application.

Objective To investigate the risk assessment and model construction of intermittent oro-esophageal tube feeding(IOE)for stroke patients with dysphagia.Methods A total of 146 patients with stroke dysphagia who received IOE in the Second Affiliated Hospital of Wenzhou Medical University from January 2020 to December 2022 were selected as study objects.According to whether or not they were aspirated after IOE,they were divided into non-aspiration group(117 cases)and aspiration group(29 cases).Clinical data of patients were collected.Multivariate Logistic regression was used to analyze the risk factors of aspiration in patients,and a nomogram prediction model was established.The C-index was used for differentiation evaluation,and the calibration curve was used to detect the nomogram fit degree.Results There were statistically significant differences in stroke history,aspiration history,stroke site,spontaneous cough,Wada drinking water test,National Institutes of Health stroke scale(NIHSS)score,catheter placement position,and catheter depth between two groups(P<0.05).Multivariate Logistic regression analysis showed that stroke history,aspiration history,brain stem location of stroke,grade 4 to 5 of Wada drinking water test,high NIHSS score,lateral position tube,and low catheter depth were all risk factors for aspiration in IOE patients with dysphagia of stroke(P<0.05),spontaneous cough was a protective factor for aspiration in IOE patients with dysphagia of stroke(P<0.05).The C-index of nomogram prediction model to judge aspiration risk was 0.705(95%CI:0.591-0.857),and Hosmer-Lemeshow test model fit well.The receiver operating characteristic curve results showed that the area under the curve of nomogram prediction model was 0.756,the sensitivity was 75.42%,and the specificity was 77.09%.Conclusion Stroke history,aspiration history,stroke site,spontaneous cough,Wada drinking water test,NIHSS score,placement position,and placement depth were all influential factors for aspiration in IOE patients with stroke dysphagia.The model was successfully constructed,and the constructed model had good differentiation and fitting degree.

Objective To compare the efficacy and difference of transvaginal natural orifice transluminal endoscopic surgery(v-NOTES),transumbilical laparoendoscopic single site surgery(TU-LESS)and traditional laparoscopic surgery in the treatment of ectopic pregnancy.Methods A total of 121 patients with ectopic pregnancy admitted to Yangzhou Maternal and Child Care Service Centre,Affiliated to Yangzhou University Medical School from June 2019 to June 2022 were retrospectively selected.According to different surgical methods,the included patients were divided into traditional laparoscopic group(49 cases),TU-LESS group(43 cases)and v-NOTES group(29 cases).Age,body mass index(BMI),hemoglobin(Hb),operation time,intraoperative bleeding,postoperative exhaust time,and 24h postoperative visual analogue scale(VAS)score,postoperative hospital stay and satisfaction of patients in each group were observed.Results The exhaust time and postoperative hospital stay in v-NOTES group were significantly shorter than those in traditional laparoscopic group and TU-LESS group,and 24h postoperative VAS score was significantly lower than that in traditional laparoscopic group and TU-LESS group(P<0.05).There was significant difference in postoperative satisfaction among three groups(H=57.364,P<0.001),and v-NOTES group>TU-LESS group>traditional laparoscopic group.Conclusion Compared with TU-LESS and traditional laparoscopic surgery,v-NOTES treatment of ectopic pregnancy recovery faster,less pain,more beautiful appearance,but need to be mastered by the operator.

Objective To analyze pathogenic microorganisms and related clinical features in patients with acute cholangitis.Methods The pathogenic microorganism culture results and related clinical data of 229 patients with acute cholangitis in People's Hospital of Haining from 2019 to 2022 were collected and analyzed.Results Among 229 patients,160(69.87%)patients were positive in bile culture,of which 58 patients were infected with multiple bacteria.A total of 227 strains of pathogenic bacteria were isolated from 160 positive bile specimens,of which 136(59.91%)strains were Gram-negative,79(34.80%)strains were Gram-positive and 12(5.29%)strains were fungi.Escherichia coli mixed with Enterococcus faecium was the most common infection(10/58,17.24%).The susceptibility rate of Gram-negative bacteria to amikacin and tigecycline was the highest,and Gram-positive bacteria were highly sensitive to linezolid,vancomycin and tigecycline.Previous biliary surgery history and cirrhosis were independent risk factors for biliary tract infection(P<0.05).Cirrhosis was an independent risk factor for co-infection(P<0.05).Conclusion The pathogenic microorganisms of acute cholangitis are complex in distribution and have some resistance to common antibiotics.Clinicians should pay close attention to patients with acute cholangitis who have a history of biliary tract surgery,cirrhosis and chronic renal insufficiency,and rationally select initial antibiotics.

Objective To investigate the application value of γ-glutamyltransferase(GGT),alkaline phosphatase(ALP)and peripheral blood neutrophil to lymphocyte ratio(NLR)in liver cancer.Methods 100 patients with liver cancer admitted to Wuming Hospital Affiliated to Guangxi Medical University from January 2012 to December 2020 were retrospectively selected to be included in liver cancer group,100 patients with cirrhosis to be included in cirrhosis group,100 patients with hepatitis to be included in hepatitis group,and 100 healthy physical examination subjects from our hospital during the same period were included in physical examination group.The GGT,ALP and NLR levels of the four groups were compared.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficacy of each index for liver cancer.Results The levels of NLR,GGT and ALP in liver cancer group were significantly higher than those in cirrhosis group,hepatitis group and physical examination group(P<0.05).The NLR in cirrhosis group was significantly higher than that in physical examination group and hepatitis group(P<0.05).GGT and ALP in cirrhosis group and hepatitis group were significantly higher than those in physical examination group(P<0.05).Spearman correlation analysis showed that NLR was positively correlated with GGT and ALP,and GGT was positively correlated with ALP(P<0.05).When NLR,GGT and ALP were detected separately,area under the curve(AUC)of NLR was the largest(0.943,95％CI:0.901-0.971,P<0.001),and AUC of ALP was the smallest.The AUC of three combined detections was 0.987(95％CI:0.959-0.998),and the sensitivity was 99.0％.Conclusion The combined detection of NLR,GGT and ALP can significantly improve the detection rate of liver cancer,and the combined detection has better application value.

Objective To investigate predictive value of combined lung injury prediction score(LIPS)and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)scores in patients with severe traumatic brain injury(sTBI)complicated with acute lung injury(ALI).Methods Seventy-five sTBI patients admitted to Provincial Hospital of Anhui Medical University from January 2019 to December 2021 were retrospectively selected and divided into ALI group(n=24)and non-ALI group(n=51)according to whether they were complicated with ALI.Basic data,laboratory indicators,APACHE Ⅱ score,LIPS score and Glasgow coma scale(GCS)score were collected.Logistic regression was used to analyze the risk factors of patients with sTBI complicated with ALI,and predictive value of the evaluation index of the receiver operating characteristic(ROC)curve for sTBI complicated with ALI was drawn.Results APACHE Ⅱ score and LIPS score in ALI group were significantly higher than those in non-ALI group,GCS score and red cell volume distribution width were significantly lower than those in non-ALI group(P<0.05).Logistic regression analysis showed that APACHE Ⅱ score,LIPS score and GCS score were independent risk factors for sTBI complicated with ALI(P<0.05).ROC curve analysis showed that area under the curve(AUC)of LIPS score and APACHE Ⅱ score in the diagnosis of sTBI complicated with ALI were 0.869 and 0.754,respectively.The AUC was 0.916(95％CI:0.855-0.976),and the sensitivity and specificity were 83.4％and 84.3％,respectively.Conclusion LIPS score combined with APACHE Ⅱ score can effectively predict the risk of sTBI complicated with ALI.

Objective To explore the diagnostic value of serum interleukin(IL)-1β and IL-18 levels in the severity of pneumonia.Methods A total of 200 patients with pneumonia treated in the Affiliated Yongchuan Hospital of Chongqing Medical University from January to December 2022 were retrospectively selected and divided into mild group(n=100)and severe group(n=100)according to the severity of pneumonia,and 100 healthy people who underwent physical examination in our hospital were included as normal group.The general clinical data,hematology index,fever peak,cough,rales and complications were analyzed.Propensity score matching was performed for patients in mild group and severe group,and the receiver operating characteristic(ROC)curve was used to calculate the diagnostic efficacy of IL-1β and IL-18 before and after matching.Results There were statistically significant differences in IL-1β and IL-18 levels among the three groups(P<0.05),and severe group>mild group>normal group.The cut-off values of IL-1β and IL-18 in the diagnosis of severe pneumonia before matching were 12.169pg/ml and 194.535pg/ml,respectively.IL-1β was more effective than IL-18 in the diagnosis of severe pneumonia(0.490 vs.0.380).The cut-off values of IL-1β and IL-18 in the diagnosis of severe pneumonia after matching were 10.542pg/ml and 191.372pg/ml,respectively.IL-1β was more effective than IL-18 in the diagnosis of severe pneumonia(0.493 vs.0.360).Conclusion IL-1β and IL-18 increase with the severity of pneumonia and have high diagnostic value for severe pneumonia.