Objective To explore the predictive value of coagulation indexes on the risk of venous thrombosis in perioperative period of hip fracture.Methods Totally 160 patients with hip fracture admitted to our hospital from February 2020 to December 2022 were retrospectively included.They were randomly divided into training set(n=112 cases)and verification set(n=48 cases).Further,according to whether deep vein thrombosis(DVT)occurred in the perioperative period,the patients in the training group were further divided into the occurrence group and the non-occurrence group.Use the least absolute shrinkage and selection operator(LASSO)to select variables to form a LASSO regression model.Draw receiver operating characteristic(ROC)curve to analyze the prediction efficiency of the model;The prediction efficiency of the verification model is realized through the verification set data.Results There was no statistically significant difference in gender,age,and other general and clinical data between the training set and the validation set(P>0.05).There were significant differences in sex,age,time from fracture to admission,body mass index,D-dimer,fibrinogen,total protein,albumin,prealbumin,globulin,hemoglobin,serum calcium,red blood cell volume,white blood cell count,red blood cell volume distribution width,activated partial thromboplastin time,prothrombin time and lymphocyte ratio between the patients in the training set(P<0.05).Six optimal variables with non-zero coefficients were selected by intraclass correlation coefficient(ICC)and LASSO,namely age,body mass index,D-dimer,fibrinogen,prothrombin time and activated partial thromboplastin time.The non-zero coefficients were 9.104,1.792,1.270,2.447,3.037 and-1.561 respectively.Conclusion The LASSO regression model formed by the combination of age,body mass index,D-dimer,fibrinogen,prothrombin time and activated partial thromboplastin time variables can serve as an auxiliary tool for predicting the risk of perioperative DVT formation in patients with hip fractures.

Objective:Tumor-treating fields (TTFields) is a kind of non-invasive anti-mitotic tumor therapy, which has been approved for patients with newly diagnosed and recurrent glioblastoma. This study aims to explore the efficacy and safety of TTFields in high-grade gliomas in clinical practice settings.Methods:The clinical data of 15 patients with recurrent glioma and 9 patients with newly diagnosed high-grade glioma admitted to our center from April 2019 to January 2021 were retrospectively analyzed. All patients accepted TTFields≥1 month. Follow-up was performed for 5.3 months (ranged from 2.3 to 10.7 months); Response Assessment in Neuro-Oncology Working Group (RANO) criteria was used to evaluate the glioma responses. The progression-free survival (PFS) and overall survival (OS) were calculated according to Kaplan-Meier method. Common Terminology Criteria for Adverse Events v5.0 (CTCAE v5.0) and TTFields related skin adverse reaction (dAE) criteria were used to evaluate the adverse events. Quality of life questionnaire-core 30 (QLQ-C30) and QLQ-brain cancer module (QLQ-BN20) questionnaires were used to evaluate the health-related quality of life (HRQoL). Treatment compliance was evaluated by data on the use of NovoTTF-200A devices, and calculated as a percentage of daily TTFields usage.Results:The median duration of TTFields was 4.2 months (ranged from 1.0 to 10.7 months), with a median compliance rate of 91.5% (67.0%-97.0%). TTFields was used alone in 2 patients and used with combination of chemotherapy in 22 patients. From follow-up to April 2021, 14 patients had stable symptoms and 10 had disease progression (8 died). The median PFS and OS of recurrent patients were 5.9 months ( 95%CI: 3.3-8.6 months) and 8.5 months ( 95%CI: 3.2-13.8 months), respectively; and the median PFS and OS of newly diagnosed patients were both 10.7 months (without 95%CI). The common adverse events included grading 1 dAE (58.3%) and grading 2 dAE (12.5%), without grading 3 or 4 dAE, manifested as contact or allergic dermatitis, erosion, folliculitis and ulcers. And 87.5% patients had stable HRQoL. Conclusions:The preliminary results showed that the survival of recurrent high-grade glioma patients treated by TTFields is similar to that reported in foreign literature; and the newly diagnosed patients need further survival follow-up. The patients' treatment compliance and safety are good. The dAE incidence (grading 1-2) is higher than that reported in the literature, and the toxicity was acceptable.

From January 2014 to June 2018, 12 patients with skin and soft tissue defects in shoulder and elbow were admitted to General Hospital of Ningxia Medical University with skin and soft tissue defect size of 6 cm×5 cm to 11 cm×8 cm, including 9 males and 3 females aged 15-56 years. Wounds of 5 patients were repaired with rotator scapular artery perforator flap (flap area of 8 cm×7 cm to 12 cm×6 cm), and the donor flap area was sutured directly. Wounds of 3 patients were repaired with lateral thoracic perforator flap (flap area of 8 cm×7 cm to 13 cm×9 cm). The donor flap area of two patients was sutured directly, the majority of the donor flap area of one patient was sutured directly, and a small part was covered by split-thickness skin graft from ipsilateral thigh. Wounds of 4 patients were repaired with medial brachial artery perforator flap (flap area of 6 cm×5 cm to 12 cm×10 cm). The donor flap area of two patients was sutured directly, and two patients were covered with split-thickness skin graft from left chest wall. The flaps of 11 patients survived after surgery. Blood flow disorder at the distal end of the flap was observed in one patient. After treatment, the distal end of the flap presented 3 cm×2 cm necrosis, and the skin graft survived after second skin grafting and debridement. During the follow-up of 6 to 24 months post surgery, all patients had good texture of flap, with light scar hyperplasia in the donor flap area, and good recovery of elbow and shoulder joint function. The rotator scapular artery perforator flap, lateral thoracic perforator flap, and medial brachial artery perforator flap with the advantages being of relatively simple operation, high survival rate, and good surgical outcome, are good choices for repairing the skin and soft tissue defects in shoulder and elbow.

It is of great clinical significance in the differential diagnosis of primary central nervous system lymphoma (PCNSL) and glioblastoma (GBM) because there are enormous differences between them in terms of therapeutic regimens. In this paper, we propose a system based on sparse representation for automatic classification of PCNSL and GBM. The proposed system distinguishes the two tumors by using of the different texture detail information of the two tumors on T1 contrast magnetic resonance imaging (MRI) images. First, inspired by the process of radiomics, we designed a dictionary learning and sparse representation-based method to extract texture information, and with this approach, the tumors with different volume and shape were transformed into 968 quantitative texture features. Next, aiming at the problem of the redundancy in the extracted features, feature selection based on iterative sparse representation was set up to select some key texture features with high stability and discrimination. Finally, the selected key features are used for differentiation based on sparse representation classification (SRC) method. By using ten-fold cross-validation method, the differentiation based on the proposed approach presents accuracy of 96.36%, sensitivity 96.30%, and specificity 96.43%. Experimental results show that our approach not only effectively distinguish the two tumors but also has strong robustness in practical application since it avoids the process of parameter extraction on advanced MRI images.

Objective To investigate the risk factors of perioperative heart failure in the elderly patients with femoral neck fracture treated with hip joint replacement so as to provide relevant clinical reference.Methods A retrospective case control study was conducted to analyze the clinical data of 155 elderly patients with femoral neck fractures who underwent total hip or hemiarthroplasty in Wenzhou Traditional Chinese and Western Medicine Hospital from May 2012 to August 2016.There were 62 males and 93 females,aged (75.6 ± 7.4)years.The patients were divided into heart failure group (26 patients)and non heart failure group (129 patients).Heart failure group included 10 males and 16 females,aged (78.3 ± 8.2)years.There were 52 males and 77 females in the non heart failure group,aged (74.5 ±6.7) years.Information including age,gender,history of hypertension,history of heart diseases,American Society of Anesthesiologists (ASA) physical status classification,duration from injury to surgery,preoperative renal function,perioperative fluid balance,operation method,operation time,postoperative pain score,perioperative blood loss,and constipation were collected.Univariate analysis was firstly performed on the above data,and multivariate logistic regression analysis was conducted on the significant factors generated by the univariate analysis so as to identify independent risk factors for perioperative heart failure.Results According to the univariate analysis,age,history of heart diseases,preoperative renal function,and perioperative fluid balance were statistically different between the two groups (P ＜ 0.05).Multivariate analysis results showed that the independent risk factors of perioperative heart failure included age (OR =5.351,95％ CI 1.459-19.623,P ＜ 0.01),history of heart diseases (OR =5.717,95 ％ CI 2.399-13.624,P ＜ 0.01),preoperative renal function (OR =2.670,95％ CI 1.125-6.336,P ＜ 0.05),perioperative fluid balance (OR =2.980,95％ CI 1.287-6.899,P ＜0.01).Conclusions Age,history of heart diseases,preoperative renal function,and perioperative fluid balance are the risk factors of perioperative heart failure in elderly patients with femoral neck fracture.Therefore,more attention should be paid to these risk factors and corresponding preventative measures should be taken to reduce the incidence of perioperative heart failure.

Objective: To observe the analgesic and sedative effect and safety of application of dexmedetomidine combined with remifentanil in dressing change of conscious patients with non-intubation in burn intensive care unit. Methods: Forty patients conforming to the study criteria hospitalized in our burn intensive care unit from April 2015 to April 2017 were selected. Prospective, randomized, and double-blind method was used for the design. Patients were divided into dexmedetomidine group and dexmedetomidine+ remifentanil group according to the random number table, with 20 cases in each group. Patients in the two groups were respectively given corresponding drugs during dressing change. The frequency and time of dressing change, Verbal Rating Scale (VRS) score of patients during dressing change (at drug administration for 25 minutes) and after dressing change (25 min after dressing change), Ramsay Sedation Score (RSS) during dressing change, satisfaction level for anesthesia of the patients and physicians after dressing change, dosage of remifentanil, and various adverse effects during and after dressing change were recorded. The heart rate, mean arterial blood pressure (MAP), respiratory rate, and pulse oxygen saturation (SpO₂) before drug administration and at 10, 15, and 25 minutes after drug administration were also recorded. Data were processed with analysis of variance for repeated measurement, t test, chi-square test, and Fisher′s exact probability test. Results: (1) Totally 38 patients completed the trial. There were no statistically significant differences between patients in two groups in gender, American Association of Anesthesiologist Grading, age, weight, and total burn area (χ²=0.230, 0.146, t=0.224, 0.351, 0.367, P>0.05). (2) The frequency of dressing change of patients in two groups were both 48 times. The time of dressing change and VRS scores during dressing change of patients in two groups were similar (t=0.821, 1.522, P>0.05). The VRS score of patients in dexmedetomidine+ remifentanil group after dressing change was (3.1±0.4) points, obviously lower than (3.8±0.8) points in remifentanil group (t=2.213, P<0.05). The RSS, satisfaction level scores for anesthesia of the patients and physicians after dressing change in dexmedetomidine+ remifentanil group were (3.13±0.32), (3.44±0.41), and (3.13±0.25) points, respectively, obviously better than (1.82±0.24), (2.71±0.23), (2.53±0.41) points in remifentanil group (t=2.226, 2.684, 7.702, P<0.01). The dosage of remifentanil of patients in dexmedetomidine+ remifentanil group was (282±19) μg, obviously less than (340±31) μg in remifentanil group (t=9.896, P<0.01). There were no statistically significant differences between patients in two groups in rates of respiratory inhibition and hypotension (χ²=0.211, 0.154, P>0.05). Compared with those in remifentanil group, the rates of nausea, vomiting, and other gastrointestinal symptoms of patients in dexmedetomidine+ remifentanil group were obviously reduced (P<0.05), but the rate of bradycardia was obviously increased (χ²=6.008, P<0.05). (3) There were no statistically significant differences between patients in two groups in heart rate, MAP, respiratory frequency, and SpO₂ before drug administration (t=0.444, 0.892, 1.059, 1.039, P>0.05). The heart rates of patients in dexmedetomidine+ remifentanil group at 10, 15, and 25 minutes after drug administration were (83±11), (78±10), and (82±14) times per minute, respectively, significantly lower than (95±10), (87±12), and (89±12) times per minute in remifentanil group (t=5.592, 3.992, 2.630, P<0.05 or P<0.01). The MAP of patients in dexmedetomidine+ remifentanil group at 15 and 25 minutes after drug administration were (69.4±3.1) and (73.8±2.2) mmHg (1 mmHg=0.133 kPa), respectively, significantly lower than (75.4±3.0) and (78.1±3.5) mmHg in remifentanil group (t=9.181, 7.206, P<0.01). There were no statistically significant differences between patients in two groups in respiratory frequency at each time point after drug administration (t=1.489, 1.862, 1.963, P>0.05). The SpO₂ of patients in dexmedetomidine+ remifentanil group at 15 minutes after drug administration was 0.972±0.018, obviously lower than 0.979±0.015 in remifentanil group (t=2.070, P<0.05). Conclusions Application of remifentanil with small dosage has effective analgesia for conscious burn patients with non-intubation during dressing changes, however, adverse effects such as nausea and vomiting are likely to occur. Remifentanil combined with dexmedetomidine not only guarantee the analgesic effect, but also reduce the dosage of analgesics, improve the sedative effect and satisfaction of the patients for anesthesia, and reduce various adverse effects. However, it will increase the incidence of bradycardia and has some inhibition effect on circulation at the same time.

Objective To compare the short and long-term effects of different approaches in the treatment of distal tibia post-pilon fractures. Methods A retrospective analysis was carried out in 29 patients with distal tibia post-pilon fractures. They were divided into group A ( postmedial approach, n =16 ) and group B ( anterolateral approach,n=13) according to different operative approaches. The length of stay,healing time,postoperative complica-tions and excellent and good rate of hip functional recovery in the two groups were compared. Results There were no significant differences in length of stay and bone healing time between the two groups(all P>0. 05). There was no significant difference in the incidence rate of postoperative complication between the two groups(6. 3% vs. 23. 1%,χ2 =1. 708,P>0. 05),but the incidence rate of partial necrosis in incision corner of group A was significantly lower than that of group B(0. 0% vs. 23. 1%,χ2 =4. 118,P<0. 05). There was no significant difference in excellent and good rate of hip functional recovery between group A(93. 8%) and group B(76. 9%) (χ2 =1. 708,P >0. 05). Conclusion Posterior approach can fully expose the field of operation with good reduction effect,provide possible for anatomical reduction of ankle mortise,good long-term efficacy can be obtained through stable fixation and postopera-tive early hip functional rehabilitation training,can be used as great reference,but need to grasp the indications.

Objective: To observe the effects of arnebia root oil on wound healing of rats with full-thickness skin defect, and to explore the related mechanism. Methods: Eighty SD rats were divided into arnebia root oil group and control group according to the random number table, with 40 rats in each group, then full-thickness skin wounds with area of 3 cm×3 cm were inflicted on the back of each rat. Wounds of rats in arnebia root oil group and control group were treated with sterile medical gauze and bandage package infiltrated with arnebia root oil gauze or Vaseline gauze, respectively, with dressing change of once every two days. On post injury day (PID) 3, 7, 14, and 21, 10 rats in each group were sacrificed respectively for general observation and calculation of wound healing rate. The tissue samples of unhealed wound were collected for observation of histomorphological change with HE staining, observation of expressions of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) with immunohistochemical staining, and determination of mRNA expressions of VEGF and bFGF with real time fluorescent quantitive reverse transcription polymerase chain reaction. Data were processed with analysis of variance of factorial design, t test, and Bonferroni correction. Results: (1) On PID 3, there were a few secretions in wounds of rats in the two groups. On PID 7, there were fewer secretions and more granulation tissue in wounds of rats in arnebia root oil group, while there were more secretions and less granulation tissue in wounds of rats in control group. On PID 14, most of the wounds of rats in arnebia root oil group were healed and there was much red granulation tissue in unhealed wounds, while part of wounds of rats in control group was healed and there were a few secretions and less granulation tissue in unhealed wounds. On PID 21, wounds of rats in arnebia root oil group were basically healed, while there were still some unhealed wounds of rats in control group. (2) On PID 3 and 7, the wound healing rates of rats in arnebia root oil group were (39±5)% and (46±4)% respectively, which were close to (34±3)% and (44±4)% of rats in control group (with t values respectively 0.807 and 0.481, P values above 0.05). On PID 14 and 21, the wound healing rates of rats in arnebia root oil group were (76±4)% and (90±3)% respectively, which were significantly higher than (60±6)% and (73±5)% of rats in control group (with t values respectively 2.308 and 3.072, P<0.05 or P<0.01). (3) On PID 3, 7, and 14, granulation tissue, fibroblasts, and nascent capillaries in unhealed wound tissue of rats in the two groups both gradually increased, and more ranulation tissue, fibroblasts, and nascent capillaries were seen in unhealed wound tissue of rats in arnebia root oil group. On PID 21, granulation tissue, fibroblasts, and nascent capillaries in unhealed wound tissue of rats in the two groups both gradually decreased. (4) On PID 3, 7, and 14, the numbers of VEGF positive cells and bFGF positive cells in unhealed wound tissue of rats in the two groups both gradually increased; there were more VEGF positive cells and bFGF positive cells in unhealed wound tissue of rats in arnebia root oil group than those in control group. On PID 21, positive expressions of VEGF and bFGF both decreased in unhealed wound tissue of rats in the two groups. (5) On PID 3, 7, and 14, mRNA expressions of VEGF in unhealed wound tissue of rats in arnebia root oil group were higher than those of control group (with t values from 2.967 to 4.173, P values below 0.01). On PID 21, mRNA expression of VEGF in unhealed wound tissue of rats in arnebia root oil group was lower than that of control group (t=-4.786, P<0.001). From PID 3 to 21, mRNA expressions of bFGF in unhealed wound tissue of rats in arnebia root oil group were higher than those of control group (with t values from 2.326 to 4.702, P<0.05 or P<0.01). Conclusions Arnebia root oil can promote wound healing of rats with full-thickness skin defect, which may relate to increasing expressions of VEGF and bFGF.

Objective To evaluate radiofrequency ablation (RFA) assisted splenic preservation in traumatic splenic rupture.Methods Data of 70 cases with traumatic rupture of the spleen at our hospital from Septembcr 2009 to June 2014 were retrospectively analysed.Patients were divided into two groups according to different surgical methods,namely,RFA group (n =35) and control conventional surgery group (n =35).Results In the RFA group,34 cases underwent successful spleen preserving operation,the success rate was 97％.In control group,26/35 cases received splenic preservation operations successfully,the success rate was 74％ (26/35) (x2 =7.467,P ＜ 0.05).Average operation time,bleeding during operation and intra-operative transfusion in RFA group were (80 ± 22) min,(116 ± 66) ml and 5 cases,rcspectively,significantly better than that in control of group.(122 ± 80) min,(237 ± 192) ml and 13 cases,respectively (t =4.58,t =3.324;x2 =4.786,P ＜ 0.05).Postoperative bleeding,hospital stay and cases receiving transfusion in RFA group were (113 ± 72)ml,(7.8 ± 1.2) d and 2 cases,respectively,which were remarkably better than those in control group of (246 ± 140) ml,(10.2 ± 1.6) d and 8 cases (t =3.267,t =4.536;x2 =4.9;P ＜ 0.05).Postoperative complications in the two groups were similar (x2 =0.913,P ＞ 0.05).Conclusions Compared with traditional spleen preserving surgery,RFA is simple and effective.It can greatly reduce the difficulty and risks of splenic preservation surgery,increasing the preservation of ruptured spleen.

Objective To compare the clinical effect for treatment of scapula neck or body fractures by straight incision approach and the Judet approach.Methods From July 2001 to July 2011,32 patients with scapula neck or body fractures were treated using the two different approaches:(1) the straight incision approach in 15 patients including 11 males and 4 females,the average age of 38.10 years,fractures classified by Ada-Miller including 4 ⅡA,6 ⅡB and 5 Ⅳ; (2) the Judet approach in 17 patients including 12 males and 5 females,the average age of 39.47 years,fractures classified by Ada-Miller including 5 ⅡA,4 ⅡB and 8 Ⅳ.All patients were followed up.Intraoperative data and postoperative pain of two groups were compared by visual analogue score (VAS),the efficacy were evaluated by Rowe-Zarins scores and the patient's postoperative shoulder function were assessed by Constant-Murley functional score.Results All fractures were preliminary healed after 8 weeks of surgery,there was no wound infection,no internal fixation loosening,no shoulder deformity and other complication.Length of incision,operative time and blood loss of straight incision approach was 6.73±0.96 cm,58.67±4.39 min,94.25±6.14 ml and length of incision,operative time and blood loss of Judet approach was 18.88±1.41 cm,82.24±4.49 min,227.77±23.08 ml.VAS of straight incision approach and Judet approach were 2.60±1.55 and 4.65±1.93,mild and moderate postoperative pain evaluated by VAS were significant differences between two groups.The excellent rate by Rowe-Zarins scores of straight incision approach and Judet approach were 93.3％(14/15) and 88.2％(15/17),they were no significant differences.There was no significant differences in the shoulder joint mobility and muscle strength of Constant-Murley functional score between two groups.However,pain and daily life of Constant-Murley functional score were significant differences between two groups and Constant-Murley functional score of straight incision approach and Judet approach were 85.60±3.31 and 80.65±3.44.Conclusion Compared with Judet approach,straight in cision approach has many advantages,such as a short time of surgery,minor injury,light postoperative pain,good postoperative functional recovery.It is the better surgical approach for the treatment of scapular fractures.