Objective:To establish a prediction model of postoperative 1-year mortality risk in elderly patients undergoing hip fracture surgery and verify its efficacy.Methods:Patients of both sexes, aged ≥65 yr, of American Society of Anesthesiologists physical status Ⅰ-Ⅳ, who underwent an operation for traumatic hip fracture in the Second Affiliated Hospital of Wenzhou Medical University from January 2017 to December 2018, were enrolled and randomly assigned to model group and verification group in a ratio of 3∶1.The demographic characteristics, clinical data and results such as laboratory examinations were collected.In model group, the logistic regression analysis was used to recognize the independent risk factors for 1-year mortality after procedure, and the prediction model was established.In verification group, the prediction efficacy was analyzed using the receiver operating characteristic curve, and the degree of fitting was evaluated by Hosmer-Lemeshow goodness-of-fit test.Results:Multivariate logistic analysis indicated that age ≥84 yr, Charlson comorbidity index ≥2 points, Braden score on admission to hospital ≤16 points, preoperative urea nitrogen ≥8.8 mmol/L and postoperative albumin ≤ 29.6 g/L were the independent risk factors for 1-year mortality after hip fracture surgery in elderly patients ( P<0.05). The prediction model was established based on the risk factors mentioned above.The area under receiver operating characteristic curve was 0.870, and the sensitivity and specificity were 82.8% and 80.0%, respectively.The prediction model showed good fitting ( χ2=4.672, P=0.700). Conclusion:Age ≥84 yr, Charlson comorbidity index ≥2 points, Braden score on admission to hospital≤16 points, preoperative urea nitrogen ≥8.8 mmol/L and postoperative albumin ≤ 29.6 g/L are the independent risk factors for 1-year mortality after hip fracture surgery in elderly patients, and the prediction model established based on the above indicators has good efficacy.

目的 观察胫后动脉与桡动脉在血管参数和穿刺成功率上的差异,以探讨胫后动脉是否能够作为有创压力监测的备选动脉.方法 选择进行择期手术的患儿90例,软件法随机分为桡动脉穿刺组(R组)和胫后动脉穿刺组(P组).记录动脉直径、横截面积、距皮肤表面的深度、一次成功率以及成功完成穿刺置管的时间.结果 胫后动脉与桡动脉的直径差异无统计学意义(P＞0.05).胫后动脉横截面积大于桡动脉(P＜0.05).胫后动脉距离皮肤表面的深度大于桡动脉(P＜0.05).两组患儿穿刺置管时间和穿刺一次成功率差异均无统计学意义(均P＞0.05).结论 胫后动脉可作为婴幼儿有创压力监测的备选动脉.

Past studies have evidenced the strong relationship between hematoma enlargement after intracerebral hemorrhage (ICH) and early neurological deterioration, indicating poor clinical outcome. Hematoma enlargement is a potentially important therapeutic target. However, hemostatic therapy to all ICH patients indiscriminately does not improve functional outcome, but increases the incidence of arterial thromboembolic adverse events (TAE). Contrast extravasation on CT angiography, namely “spot sign”, predicts hematoma expansion and poor prognosis in acute intracerebral hemorrhage with safety and efficacy. It plays a central role in prevention of early deterioration and improvement of functional outcome to rely on the “spot sign” for the selection of patients to receive early hemostatic therapy with safe and economical hemostatic agents. This study summarizes the related research situation and trend, so as to provide reference for clinical practice.

The current situation of the teaching of medical psychology is negative,and revolution is to be appealed.Medical situational case teaching method,which is based on problems occurring in reality of medical situation,can help lead medical students to analyze and solve practical problems,and then master doctor-patient communication skills.Medical situational case this teaching method is novel,and students feedback well,which is significantly instructive in improving the teaching quality of medical psychology.