Objective:To investigate the efficacy of proximal femoral intramedullary nail antirotation fixation in the treatment of intertrochanteric fracture of the femur and its effects on Harris hip scores.Methods:Sixty-eight patients with intertrochanteric fracture of the femur who received treatment in Cixi People's Hospital from April 2018 to October 2019 were included in this study. They were randomly assigned to receive dynamic hip screw fixation (control group, n = 34) or proximal femoral intramedullary nail antirotation fixation (observation group, n = 34). Clinical efficacy, Harris score, surgical indicators, and the incidence of complications were compared between the two groups. Results:The response rate was significantly higher in the observation group than in the control group [94.12% (32/34) vs. 76.47% (26/34), χ2 = 5.81, P < 0.05]. The excellent and good rate of hip function as evaluated by Harris hip scores was significantly higher in the observation group than in the control group [91.18% (31/34) vs. 73.53% (25/34), χ2 = 6.05, P < 0.05]. The operative time, blood loss, incision length, and fracture healing time in the observation group were (51.66 ± 10.52) minutes, (120.26 ± 12.29) mL, (8.09 ± 2.62) cm, and (9.86 ± 2.67) weeks respectively, and those in the control group were (78.32 ± 12.23) minutes, (238.45 ± 17.85) mL, (12.95 ± 3.29) cm, and (13.65 ± 3.46) weeks, respectively. There were significant differences in these indices between the two groups ( t = 14.55, 14.03, 14.85, 14.60, all P < 0.05). The incidence of complications was significantly lower in the observation group than in the control group [5.88% (2/34) vs. 23.53% (8/34), χ2 = 6.51, P < 0.05]. Conclusion:Proximal femoral intramedullary nail antirotation fixation is superior to dynamic hip screw fixation in the treatment of intertrochanteric fracture of the femur. The former increases Harris hip score, decreases the incidence of complications, and is of great clinical innovation.

Objective:To investigate the influencing factors for prognoses of patients with high-grade aneurysmal subarachnoid hemorrhage (aSAH).Methods:A retrospective analysis was performed on clinical data of 104 patients with aSAH, admitted to our hospital from January 2012 to March 2010. According to the modified Rankin scale (mRS) scores 3 months after discharge, these patients were divided into good prognosis group (mRS scores≤2) and poor prognosis group (mRS scores >2). Clinical data of patients from the 2 groups were compared. Multivariate Logistic regression analysis was used to analyze the influencing factors for prognoses.Results:Forty patients (38.5%) were with good prognosis and 64 (61.5%) were with poor prognosis. As compared with patients in the poor prognosis group, patients in the good prognosis group had significantly lower proportion of patients>60 years old, and significantly lower Graeb scores, cast fourth ventricle (CFV) incidence, Fisher grading, blood glucose content, diastolic blood pressure, systolic blood pressure and mean arterial pressure, and statistically higher serum potassium content ( P<0.05). There were significant differences in treatment methods and incidence of complications between the two groups ( P<0.05). Multivariate Logistic regression analysis showed that age>60 years ( OR=13.470, 95%CI: 2.177-83.347, P=0.005), Fisher grading ( OR=6.649, 95%CI: 1.141-38.736, P=0.035), conservative treatment ( OR=6.348, 95%CI: 1.048-38.742, P=0.044), mean arterial pressure at admission ( OR=29.721, 95%CI: 3.177-278.012, P=0.003), serum potassium ( OR=5.296, 95%CI: 1.138-24.653, P=0.034), CFV ( OR=9.855, 95%CI: 1.785-51.456, P=0.008), and chronic hydrocephalus ( OR=19.298, 95%CI: 3.294-113.069, P=0.001) were influencing factors for prognoses of high-grade aSAH patients. Conclusion:Severe aSAH patients with advanced age, high Fisher grading, high mean arterial pressure, low serum potassium content, fourth ventricle casting and chronic hydrocephalus under conservative treatment are more likely to have poor prognosis.

Objective: To investigate the clinical practicability and prognostic value of Helsinki CT score in patients with traumatic brain injury (TBI). Methods: A retrospective case series study was conducted to analyze the clinical data of 124 TBI patients admitted to First Affiliated Hospital of Xinjiang Medical University from September 2016 to October 2018. There were 91 males and 33 females, aged 14-84 years, with an average age of 49 years. Glasgow coma score (GCS) at admission ranged from 3-8 points in 45 patients, 9-12 points in 42 patients, and 13-15 points in 37 patients. According to Glasgow outcome scale (GOS) at 6 months after injury, 26 patients were classified into the poor prognosis group with GOS of 1-3 points and 98 patients were in the good prognosis group with GOS of 4-5 points. The prognosis-related risk factors were analyzed, and the role of Helsinki CT score to predict the adverse prognosis and mortality of TBI patients in the two groups was investigated. The sensitivity and specificity of Helsinki CT Score for 6-month poor prognosis were evaluated by receiver operation characteristic (ROC) curve and area under the curve (AUC). Results: Univariate analysis suggested that there were significant differences in terms of subdural hematoma, intracranial hematoma, extradural hematoma, hematoma volume >25 cm^3, intraventricular hemorrhage and suprasellar cistern pressure between the poor prognosis group and good prognosis group (P<0.05). Multivariate logistic regression analysis showed that the mortality and bad prognosis were related to the hemorrhage of ventricles, the pressure of suprasellar cistern and the disappearance of suprasellar cistern in the poor prognosis group and the good prognosis group (P<0.05), while intracranial hematoma and hematoma volume showed no association with mortality and poor prognosis (P>0.05). The Helsinki CT score could independently predict the adverse prognosis and mortality of TBI patients at 6 months (multivariate logistic regression: OR_death=1.21, OR_{adverse prognosis}=1.14). Helsinki CT score had a better predictive ability of 6-month mortality (AUC=0.85) than that of 6-month adverse prognosis (AUC=0.76), and had a predictive value for 6-month mortality and adverse prognosis. Conclusions Subdural hematoma, extradural hematoma, intraventricular hemorrhage and suprasellar cistern state (compression or disappearance) are the risk factors for the poor prognosis of TBI patients. Intraventricular hemorrhage and suprasellar cistern state are the main risk factors for predicting the mortality of 6 months. Helsinki CT score can independently predict the adverse prognosis and mortality of TBI patients at 6 months, and has relatively better value in predicting the mortality.

Objective To explore the effect of preoperative platelet (PLT) count on the prognosis of patients with laryngeal squamous cell carcinoma.Methods The clinical data of 286 patients with laryngeal squamous cell carcinoma were retrospectively analyzed to determine the optimal critical value of PLT count for end point of recurrence and death.The effects of preoperative PLT count on the recurrence and 5-year survival rates of patients with laryngeal squamous cell carcinoma after surgery were analyzed.Results The optimal critical value of PLT count for end point of recurrence was 242.5 × 109/L.The patients were divided into PLT ≥242.5 × 109/L group (n =115) and PLT ＜242.5 × 109/L group (n =171).Single factor analysis indicated that the recurrence was not related to age (x2 =0.005,P =0.942),gender (x2 =0.309,P =0.579) and pathological differentiation (Z =2.858,P =0.240),and was related to T staging (x2 =10.509,P =0.001),lymph node metastasis (x2 =7.297,P =0.007),primary tumor site (x2 =16.797,P ＜ 0.001) and preoperative PLT count (x2=12.081,P =0.001).Multivariate analysis indicated that T staging (OR =0.518,95 ％ CI:0.281-0.954,P =0.035),primary tumor site (OR =2.371,95 ％ CI:1.283-4.382,P =0.006),and PLT count (OR =2.885,95％ CI:1.607-5.179,P ＜ 0.001) were the independent factors affecting the recurrence of laryngeal squamous cell carcinoma.The optimal critical value of PLT count for end point of death was 251.5 × 109/L.The patients were divided into PLT≥251.5 × 109/L group (n =94) and PLT ＜ 251.5 ×109/L group (n =192).Single factor analysis indicated that the 5-year survival rate was not related to age (x2 =0.030,P =0.863),gender (x2 =0.000,P =0.945) and pathological differentiation (x2 =4.050,P=0.133),and was related to T staging (x2 =41.630,P ＜ 0.001),lymph node metastasis (x2 =58.110,P ＜0.001),primary tumor site (x2 =36.250,P ＜ 0.001) and preoperative PLT count (x2 =4.790,P =0.029).Multivariate analysis indicated that T staging (HR =0.353,95％ CI:0.193-0.645,P =0.001),primary tumor site (HR =2.151,95 ％ CI:1.312-3.526,P =0.002),lymph node metastasis (HR =2.819,95 ％ CI:1.633-4.867,P＜0.001),and PLT count (HR=1.853,95％CI:1.160-2.960,P=0.010) were the independent factors affecting 5-year survival rates of laryngeal squamous cell carcinoma.Kaplan-Meier survival analysis indicated that the 5-year survival rate of PLT≥251.5 × 109/L group and PLT ＜ 251.5 × 109/L group were 58.23％,67.87％,with significant difference (x2 =4.79,P =0.029).Conclusion Preoperative PLT count is the influence factor of recurrence and 5-year survival rate of laryngeal squamous cell carcinoma patients,which has important significance to the prognosis of laryngeal squamous cell carcinoma patients.

The efficacy of decompressive craniectomy (DC) in reducing traumatic brain injury mortality has been affirmed,but there are also many serious complications.Syndrome of the trephined (ST) and paradoxical herniation (PH) are rare complications.ST is characterized by a series of neurological deterioration due to skin flaps subsidence from weeks to months after DC.These neurological impairments are closely related to the subsequent repair of skull defects.PH shows progressive decrease in consciousness on the basis of ST,changes in pupils on the side of skull defects,low touch pressure at the defect window,and obvious midline shift and brain stem compression on CT.ST and PH have common inducements in pathophysiology,including cerebrospinal fluid dynamics,atmospheric pressure,cerebral blood flow and brain material metabolism.There is no consensus on the diagnosis of ST and PH,and early cranioplasty is suggested in terms of treatment.This article reviews the clinical manifestations,pathophysiological changes,diagnosis and treatment of ST and PH after DC operation,so as to provide references for clinicians to further understand ST and PH.

Objective To investigate the appropriate age of primary and secondary school students for cardiopulmonary resuscitation (CPR) training.Methods A total of 437 students aged 9-15 years at 3 to 6 grade in the primary schools or 1 to 2 grade in the secondary schools were selected from 2 Yuyao primary and secondary schools by stratified random sampling between March 2017 and January 2018.The numbers of students with the age of 9,10,11,12,13,14 and 15 y were 61,62,66,64,63,63 and 58,respectively.All students received chest compression training provided by Yuyao emergency department People's Hospital according to the 2015 Cardiopulmonary Resuscitation Guidelines.The training included 30 min theoretic teaching and 6 min practice in the simulator.The quality of chest compression performed by students was assessed;the depth,rate,position and retention of chest compression were recorded.Results The mean depth of chest compression in the students aged 9-15 years was 3.8,4.1,4.6,5.1,5.2,5.6 and 5.6 cm,respectively;the accuracy rate was 24.6％(14/61),25.8％ (16/62),50.2％ (33/66),70.5％ (45/64),79.4％(50/63),88.9％(56/63) and 91.4(53/58),respectively.Compared with the students aged 9-11 years,the mean depth of chest compression was significantly increased and accuracy rate was significantly improved in the students aged 12-15 years (Compared with 9-y students,t=-8.936,-9.502,-10.640 and-11.370;x2=35.019,47.599,63.013 and 65.671;compared with 10-y students,t=-6.927,-8.179,-10.70 and-11.047;x2=24.977,35.967,50.916 and 52.727;compared with 1 1-y students,t=-3.095,-4.177,-6.785 and-6.995;x2=5.586,12.114,22.786 and 24.870;all P＜0.05).The mean rate of chest compression was 110-116/min and its accuracy rate was 86.4％-95.2％;the accuracy rate of chest compression position was 90.9％-96.8％ in all students,there were no significant differences among the 7 groups.The mean retention rate of chest compression in the 7 groups was 81.3％(122/150),67.3％(101/150),64.7％ (94/150),48.0％(72/150),48.7％(73/150),33.3％(50/150) and 27.3％(41/150),respectively.Compared with the students aged 9-11 years,the mean retention rate of chest compression was significantly decreased in the students aged 12-15 years (compared with the 9-y students,x2=36.472,35.179,70.64 and 119.92;compared with 10-y students,x2=11.483,10.728,34.682 and 72.150;compared with 11-y students,x2=6.528,5.927,25.855 and 59.11;all P＜0.05).Correlation analysis showed that the depth (r=0.96,0.89,0.91 and 0.86;P＜0.01) and retention rate (r=-0.99,-0.90,-0.93 and-0.86;all P＜0.01) of chest compression were significantly associated with the age,body weight,height and body mass index of students.Conclusion The students with an age of 12 years or more are able to effectively perform chest compression;thus,12 years and above might be the appropriate age for CPR training.

Objective To investigate the clinical efficacy of intracranial pressure monitoring in ventricular puncture for patients with posttraumatic diffuse brain swelling under guidance of real-time intraoperative ultrasound. Methods Sixty-seven patients with posttraumatic diffuse brain swelling, admitted to and accepted intracranial pressure monitoring in ventricular puncture under real-time intraoperative ultrasound in our hospital from January 2015 to December 2017, were chosen as experimental group; and other 71 patients with posttraumatic diffuse brain swelling, admitted to and accepted traditional intracranial pressure monitoring in ventricular puncture in our hospital from January 2012 to June 2014, were chosen as control group. The clinical data were retrospectively analyzed, and the success rate of primary puncture and complications were compared between the two groups. Results The success rate of primary puncture in the experimental group was 100％ (67/67), and that in the control group was 77.5％ (55/71), with significant difference (P<0.05). No catheter-related infection was noted in either group. Only one patient in study group had puncture tract bleeding, while 9 patients in the control group had puncture tract bleeding; abnormal puncture location was noted in 8 patients of the control group, including 5 failing to be punctured in the ventricle, one puncturing to the contralateral ventricle, and two having excessive puncture depth; occurrence of postoperative complications in study group was significantly lower than that in control group (P<0.05). Conclusion Real-time intraoperative ultrasound-guided puncture ventricle drainage is superior to conventional bind-puncture in traumatic patients with diffuse brain swelling, and can be widely used in clinical practice.

Objective To evaluate the feasibility and safety of prostatic artery embolization (PAE)via transradial approach in treating prostatic hyperplasia.Methods The clinical data of 18 patients with prostatic hyperplasia,who received C-arm CT-guided PAE via left or right radial artery access,were retrospectively analyzed.The following indexes were recorded:arterial spasm and injury of upper limbs,incidence of puncture point bleeding,postoperative radial artery pulse and congestion,blood supply and nerve injury of fingers,the surgical success rate,incidence of perioperative cerebral vascular complications,operation time,radiation dose and clinical curative effect.Results Among the 18 patients,PAE via left radial artery access was employed in 14,and PAE via right radial artery access was performed in 4.Bilateral PAE was carried out in 16 patients,and only unilateral PAE was able to be successfully accomplished in 2 patients as the prostatic artery opening of the other side was tortuous with stenosis.After PAE,decreased radial pulse was observed in one patient and ultrasound examination revealed decreased blood flow.The operation time ranged from 96 min to 245 min.The radiation dose received by the patient varied from 2435 mGy to 4958 mGy with a mean of (3342±156) mGy,which was not significantly different from the radiation dose received by the patients who underwent PAE via femoral artery access during the same study period (P=0.1167).Conclusion In treating prostatic hyperplasia,PAE by using transradial approach is clinically safe and technically feasible.

Objective To explore the effects of residual renal function (RRF) on quality of life (QOL) in patients with continuous ambulatory peritoneal dialysis (CAPD),and analyze the factors influencing QOL.Methods One hundred and eighteen patients treated with CAPD for at least 3 months in No.455 Hospital of People's Liberation Army were enrolled.All patients were divided into two groups according to residual glomerular filtration rate (rGFR):the group with RRF [rGFR≥ 1 ml·min-1 · (1.73 m2)-1],and the group without RRF [rGFR ＜ 1ml · min-1 · (1.73 m2)-1].The demographic characteristics,laboratory data,cardiothoracic ratio,dialysis adequacy parameters,rGFR,blood pressure,urine volume,ultrafiltration volume and dialysis prescription were investigated.Patient's QOL was evaluated by Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36).Results There was no significant differences between the groups with and without RRF in the age,gender,causes of disease,complication,body mass index (BMI),systolic blood pressure (SBP),diastolic blood pressure (DBP),haemoglobin (Hb),cholesterol,triglyceride,high-density lipoprotein,low-density lipoprotein,normalized protein catabolic rate (nPCR) and cardiothoracic ratio (all P ＞ 0.05).Compared with the patients with RRF,PD duration,ultrafiltration volume,serum creatinine (Scr),calcium,phosphorus,C-reactive protein (CRP),parathyroid hormone (PTH) and peritoneal dialysis dose in the patients without RRF were significantly higher,and urine volume,serum albumin (Alb),potassium,and urea total Kt/V were significantly lower (all P ＜ 0.05).The patients without RRF had a significantly lower score in physical function and physical component summary as compared to the patients with RRF (all P ＜ 0.05).There was no significant differences in role physical,bodily pain,general health,vitality,social function,role emotional,mental health,mental component summary and SF-36 scores (all P ＞ 0.05).Simple linear regression showed that there was no correlation between rGFR and SF-36 scores (β=1.330,P=0.070).Multiple linear regression revealed that SF-36 scores were correlated with CRP (β=-0.477,P ＜ 0.001),Scr (β=0.020,P ＜ 0.001),cardiothoracic ratio (β=-57.823,P=0.004),Alb (β=0.772,P=0.016) and ultrafiltration volume (β=-0.006,P=0.031),but not correlated with rGFR (β=0.099,P=0.302).Conclusions PD patients without and with RRF perceived different scores in physical health,but their scores were similar in mental health and QOL.RRF was no related to QOL in PD patients.Chronic inflammation,fluid overload and malnutrition were the main factors that affect QOL.

Objective To explore the effect of preoperative neutrophil lymphocyte ratio (NLR) on the prognosis of patients with laryngeal carcinoma.Methods Clinical data of 202 patients with laryngeal carcinoma treated from January 2004 to October 2009 were retrospective analyzed to determine the optimal critical value of NLR.To study whether NLR is an independent factor affecting the recurrence and 5-year survival rate of patients with laryngeal cancer after surgery,single factor and multivariate analyses were performed.The factors included age,gender,T stage,pathological differentiation,lymph node metastasis,primary tumor site and NLR value.The relationship between NLR and cervical lymph node metastasis was analyzed.Results The optimal critical value of NLR was 2.85,by which cases were divided into high NLR group (NLR≥2.85) and low NLR group (NLR ＜ 2.85).Single factor and multivariate analyses indicated that T staging,lymph node metastasis,primary tumor location,and NLR were the independent factors affecting the recurrence of laryngeal carcinoma.T stage and lymph node metastasis were the independent factors affecting 5-year survival rate of laryngeal carcinoma.The increase of NLR value increased the rate of cervical lymph node metastasis.Conclusion Preoperative NLR level influences the recurrence and cervical lymph node metastasis of laryngeal carcinoma and can be considered a prognosis factor of laryngeal cancer.