Objective To evaluate the results of operative treatment of acetabular fractures and to investigate its influence factors. Methods The cl inical data were analyzed retrospectively from 82 patients with acetabular fractures treated between September 2004 and June 2009. Of 82 patients, 65 were male and 17 were female, aged 26-72 years (mean, 38 years).Fractures were caused by traffic accident in 62 cases, by crush in 13 cases, and by fall ing from height in 7 cases. The time from injury to admission was 30 minutes to 12 days (median, 7.6 hours) in 70 cases, 12 cases were transferred because poor result after 34-67 days of conservative treatment. According to Judet classification, there were 24 cases of posterior wall fracture, 3 cases of posterior column fracture, 1 case of anterior wall fracture, 2 cases of anterior column fracture, 6 cases of transverse fracture, 16 cases of transverse and posterior wall fracture, 4 cases of posterior column and posterior wall fracture, 5 cases of T-type fracture, 3 cases of anterior and posterior hemitransverse fracture, and 18 cases of complete both-column fracture; 24 cases combined with dislocation of the hip. During operation, Kocher-Langenbeck approach was used in 49 cases, anterior il ioinguinal approach in 19 cases, and the combination of anterior and posterior approaches in 14 cases. Reconstructive plate (74 cases) and hollow lag screw (8 cases) internal fixation were used. The function of the hip was evaluated according to the modified Merled’Aubigne- Postel hip score system postoperatively. According to fracture type, age, lower extremity fracture before operation, qual ity of reduction, timing of surgery, hi p dislocation and time of reduction, operative approach, deep vein thrombosis (DVT), and heterotopic ossification (HO), the patients were divided into the groups and the results were compared. Results Accordancewith the Matta X-ray evaluation criteria, anatomic reduction was achieved in 21 cases, good reduction in 37 cases, fair reduction in 16 cases, and poor reduction in 8 cases, and the excellent and good rate was 71%. All the cases were followed up 12-52 months mean, 34 months). Iatrogenic sciatic nerve injury occurred in 8 cases, infection in 3 cases, HO in 16 cases, DVT in 3 cases, hip posttraumatic arthritis in 12 cases, and avascular necrosis of the femoral head in 9 cases. X-ray examination showed that 80 cases achieved fracture union at 10-24 weeks after operation (mean, 14 weeks) and 2 cases had fracture delayed union at 10 months and 12 months after operation. According to the modified Merled’Aubigne-Postel hip score system, the function of the hip was rated as excellent in 26 cases, good in 32, fair in 20, and poor in 4 at 6 months after operation; the excellent and good rate was 71%. The affecting factors of cl inical results of acetabular fractures were fracture type, age, lower extremity fracture before operation, qual ity of reduction, timing of surgery, hip dislocation and time of reduction (P lt; 0.05). However the operative approach, DVT, and HO were not affecting factor of the acetabular fractures (P gt; 0.05). Conclusion Operative treatment of acetabular fractures has a satisfying therapeutic effect. Fracture type, age, lower extremity fracture before operation, qual ity of reduction, timing of surgery, hip dislocation, and time of reduction are risk factors affecting postoperative results.
Objective To evaluate the results of operative treatment of complex acetabular fractures and to investigate its influence factors. Methods From June 2000 to August 2006, 54 patients with complex acetabular fractures were treated, including 44 males and 10 females aged 20-75 years old (average 39.1 years old). Fractures were due to traffic accidentin 40 cases, fall ing from high places in 8 cases and crush by heavy objects in 6 cases. All cases were fresh and close fractures and the time from injury to operation was 5-72 days. There were 5 cases of posterior column and posterior wall fracture, 25 of transverse and posterior wall fracture, 2 of T-type fracture, and 22 of double column fracture. During operation, Kocker- Lagenbach approach was used in 23 cases, anterior il ioinguinal approach was appl ied for 3 cases and the combination of anterior and posterior approaches was performed on 28 cases. AO reconstructive plate and screw internal fixation were used in all the cases. Results Fifty-two cases were followed up for 12-74 months (average 31.3 months). Anatomical reduction was achieved in 23 cases, satisfactory reduction in 19 cases, poor reduction in 10 cases, and the excellent and good rate reached 80.77%. During operation, 1 case suffered from a tear in the external il iac vein and healed after vein repair; 2 cases had sciatic nerve injury and took mecobalamin as oral administration, one of them fully recovered, and the other had incomplete recovery at 18-month follow-up. At the final follow-up, there were 6 cases of severe heterotopic ossification, one of them received heterotopic bone resection and the rest 5 patients received conservative treatment; there were 9 cases of traumatic osteoarthritis, one of them received total hip replacement and the rest 8 patients received conservative treatment; there were 5 cases of avascular necrosis of the femoral head, two of them received total hip replacement, 1 received no further treatment because the femoral head didn’ t collapse, and the rest 2 patients gave up total hip replacement; 75.00% patients were graded as excellent and good according to the modified Merled’Aubigné-Postel hip score system. Patients’ qual ity of l ife was compared with local population normsmatched for age and sex by using SF-36 scales, their overall score were below the local population norms, and their general health, vital ity, role l imitation due to emotional problems and mental health were comparable to the local population norms. Logistic regression analysis revealed the time to reduce hip dislocation, qual ity of fracture reduction nd traumatic arthritis were independent risk factors affecting postoperative functional outcomes. Conclusion Applying open reduction and internal fixation in the treatment of displaced complex acetabular fractures has a satisfying therapeutic effect. Time to reduce hip dislocation, qual ity of fracture reduction as well as traumatic arthritis are independent risk factors affecting postoperative functional outcomes.
ObjectiveTo observe the effect of health education on hand, foot and mouth disease knowledge of the parents and their psychological status, in order to provide a reference for regulating clinical intervention measures. MethodsBetween October 2011 and February 2013, self-made questionnaire was used to survey the parents of 286 children with hand, foot and mouth disease for their knowledge about the disease. We promoted health education including distributing pamphlets, holding lectures, and carrying out psychological counseling. Then, parents' knowledge and their psychological status were compared before and after the implementation of health education. ResultsAfter health education, parents' suspicion, anxiety, fear, indulgence in children and other negative psychological scores were significantly lower than those before intervention (P<0.05). Their knowledge on the disease was also significantly enhanced (P<0.05). Gender, age and educational background were the main influence factors for health education. ConclusionMulti-form comprehensive health education can enhance parents' knowledge on hand, foot and mouth disease effectively and alleviate various negative psychological situations, which assists them to participate in the treatment work actively, thus greatly promotes early rehabilitation of the child patients.
ObjectiveTo know the life attitude and its influence factors of nursing undergraduates in a school of nursing,so as to provide the theoretical evidence for the exploration of the way of life education. MethodsA cluster sample of 246 nursing undergraduates were asked to complete the survey,who were sampled from grade 2008 to grade 2011 in a University of Sichuan province between Nevember and December 2011.Then we used the way of questionnaire to analyze and research the life attitude and its influence factors of nursing students,and this study mainly used the Life Attitude Scale (LAS) questionnaire which was made by Taiwan scholar Manying Xie. ResultsThe total score of the investigated nursing students'attitude to life was 365.1±43.6,and the total and each level scores were higher than Taiwan college students and the differences were statistically significant (P<0.01).Female students'total score of attitude to life and the existence sense dimension were significantly higher than male students'(P<0.05).The third grade students'score of love and care level had a significant difference with the second grade and the first grade students (P<0.05).Through correlation analysis,nursing students'life attitude and self-rating interpersonal relationship (r=0.256,P=0.000),the situation of families talking about death (r=0.210,P=0.001),whether there was a Dutch act idea (r=0.172,P=0.007),family income (r=0.151,P=0.017),gender (r=0.130,P=0.042) and whether had siblings (r=-0.143,P=0.025) were positively correlated. ConclusionWe should carry out targeted life and death education for nursing students to promote them to establish positive life attitude and value.
ObjectiveTo analyze the influence factors of the stable angina pectoris patients' medication compliance based on health belief model. MethodsFrom January to December, 2013, 107 patients with stable angina pectoris were interviewed using the self-design questionnaires, and multiple stepwise linear regression statistical was used to analyze. ResultsThe influence factors of increasing medication compliance were as follows:"myocardial infarction can lead to death", "patients with stable angina pectoris may suffer a sudden myocardial infarction", "over the past year the number of the angina pectoris", "standard treatment is good for prevention of myocardial infarction", "suffering myocardial infarction, even if not dying, there is no more chance to live", "take medicine on time can get family's praise", and "among the people that I know there are patients who die of myocardial infarction". The partial regression coefficients were 0.245, 0.251, 0.248, 0.099, 0.234, 0.162, 0.095, respectively; while "worry about side effects of the drugs", "can't afford the medicine", the partial regression coefficients were -0.164 and -0.114. ConclusionHealth belief model is helpful for general practitioners to evaluate the effect factors of medication compliance on stable angina pectoris.
Objective To study the influence factors of surgical site infection (SSI) after hepatobiliary and pancreatic surgery. Methods Fifty patients suffered from SSI after hepatobiliary and pancreatic surgery who treated in Feng,nan District Hospital of Tangshan City from April 2010 and April 2015 were retrospectively collected as observation group, and 102 patients who didn’t suffered from SSI after hepatobiliary and pancreatic surgery at the same time period were retrospectively collected as control group. Then logistic regression was performed to explore the influence factors of SSI. Results Results of univariate analysis showed that, the ratios of patients older than 60 years, combined with cardiovascular and cerebrovascular diseases, had abdominal surgery history, had smoking history, suffered from the increased level of preoperative blood glucose , suffered from preoperative infection, operative time was longer than 180 minutes, American Societyof Anesthesiologists (ASA) score were 3-5, indwelled drainage tube, without dressing changes within 48 hours after surgery, and new injury severity score (NISS) were 2-3 were higher in observation group (P＜0.05). Results of logistic regression analysis showed that, patients had history of abdominal surgery (OR=1.92), without dressing changes within 48 hours after surgery (OR=2.07), and NISS were 2-3 (OR=2.27) had higher incidence of SSI (P＜0.05). Conclusion We should pay more attention on the patient with abdominal surgery history and with NISS of 2-3, and give dressing changes within 48 hours after surgery, to reduce the incidence of SSI.
Objective To investigate the medical charge of in-patients with diabetes and its influencing factors for effective hospital costs controlling. Methods The inpatients with diabetes (the first diagnosis was diabetes; the first three ICD-10 codes of which were between E10 to E14) in Fifth Peoples' Hospital of Chengdu during January to September of 2014 were analyzed for their hospital costs with descriptive statistical method, ANOVA and multiple linear regression method. Statistical analysis was conducted by using SPSS 18.0 software. Results A total of 1 389 cases of diabetes were included. The median of total medical costs and daily costs were 4 554.45 yuan and 446.46 yuan, respectively. The differences of total medical costs and daily costs between diabetes patients with different amount of complications were statistically significant (P<0.001). The factors including age, the way of the medical expense, the number of complications, with acute complications, CCI score and the hospital-stay length were proved to be significantly correlated to total medical costs of diabetes inpatients (P<0.05). Conclusion Age, the way of the medical expense, the number of complications, with acute complications, CCI score and the hospital-stay length are influence factors of medical costs of diabetes inpatients.
Malignant tumors are the major diseases which threat human beings. Anti-cancer medicines play important roles in the treatment of malignant tumors, especially for the new targeted therapies. They bring the life hope for cancer patients who were sentenced to death, and improve quality of life, and some patients may achieve normal lifetime. However, the new anti-cancer medicines are usually too expensive to afford, and most of them have not yet been included in Chinese public health security system, the accessibility of the new anti-cancer medicines is seriously limited. This paper introduces the accessibility of high-cost anti-cancer medicines in China, analyzes the influence factors, and proposes policy recommendations to improve the accessibility of high-cost anti-cancer medicines in China.
ObjectiveTo explore the distribution of choroidal thickness and its influence factors in university students.MethodsA cross-sectional study. A total of 896 eyes of 896 college students were included in the study. Among them, there were 350 males (350 eyes) and 546 females (546 eyes). All the eyes were right eyes. The average age was 19.18 ± 1.36 years old. According to the spherical equivalent refraction (SER), the eyes were divided into non-myopia group, low myopia group, moderate myopia group and high myopia group, which were 59, 251, 356 and 230 eyes, respectively. The subfoveal ChT (SFCT) was measured using a swept-frequency source optical coherence tomography scanner. According to the ETDRS, the choroid within 6 mm of the fovea was divided into three concentric circles centered on the fovea of the macula, which were the central area with a diameter of 1 mm, the inner ring area of 1-3 mm and the outer ring area of 3-6 mm. The outer ring area of 3-6 mm has a total of 9 zones. The inner ring and outer ring 4 regions were superior, inferior, nasal and temporal, respectively. The distribution characteristics of ChT in different regions, genders and diopter groups were observed. Bivariate correlation analysis were used to analyze the correlation of ChT and SER, axial length (AL).ResultsThe average SFCT of 896 eyes was 221.28±67.35 μm. The mean SFCT of males and females were 227.20±69.38 and 217.50±65.80 μm, respectively. The difference of SFCT between different genders was statistically significant (t=2.075, P=0.038). Compared with the central region ChT, there was no significant difference in ChT between the outer ring and the outer region (t=0.086, P=0.932). The difference of ChT in other regions was statistically significant (t=-21.973, -5.818, 36.328, -3.065, -18.017, -10.595, 57.007; P＜0.001, ＜0.001, ＜0.001, ＜0.002, ＜0.001, ＜0.001, ＜0.001). In the horizontal direction, ChT gradually thickens from nasal to temporal (F=2 251.558, P＜0.001); in the vertical direction, ChT gradually decreases from superior to the central, but have a little increased from central to inner inferior, then decreased to outer inferior again (F=45.425, P＜0.05). Correlation analysis showed that SFCT was negatively correlated with AL (r=0.478, P＜0.01) and a negative correlation with axial length (r=−0.395, P＜0.01), and positively correlated with SER (r=0.478, P＜0.01). SFCT decreased by 12.29 μm for every in myopic refractive error of 1 D, or by 20.14 μm for every increase in AL of 1 mm.ConclusionsChT is changed by different location. The horizontal direction is gradually thickened from nasal to temporal. The vertical direction is thicker than the center. The inferior inner ring area is thicker than the outer ring area. Gender, SER and AL are the influencing factors of SFCT.
ObjectiveTo observe the clinical effect of vitrectomy with internal limiting membrane peeling and air tamponade in the treatment of idiopathic macular hole (IMH).MethodsA prospective, non-randomized controlled case cohort study. Twenty eyes of 20 patients with IMH in Ophthamology Department of The Second Hospital of Jilin University from September 2016 to January 2017 were included in this study. There were 4 males (4 eyes) and 16 females (16 eyes), with the mean age of 60.60±9.50 years and the mean disease course of 9.55±15.5 months. The stage of macular hole ranged from Ⅱ to Ⅳ. All patients underwent BCVA, intraocular pressure, spectral-domain OCT (SD-OCT) and multifocal ERG examinations. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. The minimum diameter (MIN), bottom diameter (BD), height (H), the defective diameter of ellipsoid zone, the defective diameter of external limiting membrane (ELM) of the macular hole were measured by SD-OCT (German Heidelberg). Then the macular hole index (MHI=H/BD), hole traction index (THI=MD/BD) and hole diameter index (DHI=H/MD) were calculated. The response density in P1 wave was detected by mf-ERG. The logMAR BCVA was 1.18±0.54. There were 5 eyes with less than 400 μm MIN, 13 eyes with 400-700 μm MIN and 2 eyes with over than 700 μm MIN. All the patients were underwent vitrectomy with internal limiting membrane peeling and air tamponade. According to the SD-OCT image features after surgery, IMH closure was divided into type Ⅰ closed, type Ⅱ closed and unclosed. The follow-up was equal or greater than 3 months. The closure rate of IMH, BCVA and the changes of microstructure parameters of macular area were observed. Spearman correlation analysis was used to analyze the correlation between BCVA and the wave response density in P1 before surgery and the efficacy after IMH surgery.ResultsClosure rate of IMH: 18 eyes (90.0%) were completely closed (all type Ⅰ closed). The closure rate of macular hole with the MIN less than 400 μm was 100.0% (5/5), 400-700 μm was 92.3% (12/13), and over than 700 μm was 50% (1/2). BCVA: the mean logMAR BCVA at 1 week, 1 month, 3 months after surgery were 0.83±0.54, 0.65±0.41, 0.48±0.34, and there was statistically significant difference between preoperative and postoperative BCVA (t=3.382, 4.459, 5.250; P=0.003, 0.007, 0.004). The outcomes of SD-OCT at 3 months after surgery: 18 eyes (90.0%) with intact ELM. The defective diameter of ellipsoid zone was 260.34±272.08 μm, there was statistically significant difference between before and after surgery (t=13.545, P=0.002). The outcomes of mf-ERG: the P1 wave response density of the ring 1 and ring 2 after surgery were increased compared with before surgery (t=-16.748, -6.151; P＜0.01,＜0.01). The results of Spearman correlation analysis: there was a positive correlation between postoperative BCVA and preoperative MIN, the defective diameter of ellipsoid zone and ELM, and postoperative the defective diameter of ellipsoid zone (r=0.56, 0.59, 0.68, 0.52; P=0.010, 0.006, 0.001, 0.019). The postoperative BCVA was negatively correlated with the P1 wave response density of ring 1 and ring 2 of mf-ERG (r=－0.34, －0.16; P=0.006, 0.020). The IMH closure had a significant negative correlation with MIN and the defective diameter of ELM (r=－0.449, －0.449; P=0.047, 0.047). MHI and THI were positively correlated with the closure of the hole (r=0.474, 0.546; P=0.035, 0.013). Intraocular pressure increased in 2 eyes during the follow-up period, and returned to normal within 1 week after the administration of antihypertensive drugs. There were no complications during or after the operation.ConclusionsVitrectomy with internal limiting membrane peeling and air tamponade in the treatment of IMH is safe and effective. The MIN, MHI THI are significantly correlated with the curative effect after IMH surgery, which could be used as the index to predict and evaluate the curative effect. The response density of ring 1 and ring 2 in P1 wave of mf-ERG is signifi-cantly improved compared with before surgery, and which is negatively correlated with BCVA.