Effect comparison of knee-chest elastic bandage fixation and Pavlik harness fixation on the treatment of femoral shaft fractures in newborns

Objective:To study and analyze the clinical efficacy of fixation of the elastic bandage of immobilization of knee-chest position and Pavlik harness fixation in the treatment of neonatal femoral shaft fractures.Methods:A retrospective analysis was conducted from May 2010 to March 2017 with a total of 37 cases of femoral shaft fracture of the newborn.Among them,17 newborns with femur shaft fracture were treated using this fixation of the elastic bandage of immobilization of knee-chest position,and 20 newborns were treated utilizing Pavlik harness fixation.All patients were followed up for 24 months.It was compared between the two groups in length of hospitalization,hospitalization cost,the incidence of complications,fracture healing rate and post-operation angulation,rotation and shortening indexes.Results:Compared with the Pavlik harness fixation group,the hospitalization cost of knee-chest elastic bandage fixation group was lower(P<0.05),the difference was statistically significant.There is no significant difference between the two groups in terms of length of hospitalization,complications and fracture healing.The two groups of treatment methods compared in angle formation,rotation and shortness(P>0.05),with no statistical difference.Conclusions:Both knee-chest elastic bandage fixation and Pavlik harness fixation are effective methods for the treatment of neonatal femoral shaft fractures.But the former has lower cost and simpler operation,which is worthy of clinical application.

Effect of adjuvant ozone autohemotherapy combined with naloxone therapy on respiratory function and neurological function in COPD patients with pulmonary encephalopathy

Objective:To study the effect of adjuvant ozone autohemotherapy combined with naloxone therapy on respiratory function and neurological function in COPD patients with pulmonary encephalopathy.Methods: A total of 30 COPD patients with pulmonary encephalopathy who were treated in our hospital between May 2013 and January 2016 were collected and divided into the control group and observation group (n=15) according to the random number table. Control group of patients received conventional treatment + naloxone therapy, observation group of patients received conventional treatment + ozone autohemotherapy combined with naloxone therapy, and the therapies lasted for 10 d. Differences in the levels of arterial blood gas indexes, peripheral blood nerve injury indexes and cerebrospinal fluid nerve autophagy indexes were compared between two groups of patients before and after treatment.Results:Before treatment, differences in the levels of arterial blood gas indexes, peripheral blood nerve injury indexes and cerebrospinal fluid nerve autophagy indexes were not statistically significant between two groups of patients. After treatment, the arterial blood gas pH value and PaO2 level of observation group were higher than those of control group while PaCO2 level was lower than that of control group;peripheral blood nerve injury indexes S100β, NSE and MBP contents were lower than those of control group;cerebrospinal fluid neural apoptosis indexesβ-GBA and Atg7 contents were lower than those of control group.Conclusion: Adjuvant ozone autohemotherapy combined with naloxone therapy can optimize the respiratory function and reduce the nerve injury in COPD patients with pulmonary encephalopathy.

Predictive performance of the variation rate of the driving pressure on the outcome of invasive mechanical ventilation in patients with acute respiratory distress syndrome

Purpose:To assess the value of the driving pressure variation rate(ΔP%)in predicting the outcome of weaning from invasive mechanical ventilation in patients with acute respiratory distress syndrome.Methods:In this case-control study,a total of 35 patients with moderate-severe acute respiratory distress syndrome were admitted to the intensive care unit between January 2022 and December 2022 and received invasive mechanical ventilation for at least 48 h were enrolled.Patients were divided into successful weaning group and failed weaning group depending on whether they could be removed from ventilator support within 14 days.Outcome measures including driving pressure,PaO2:FiO2,and positive end-expiratory pressure,etc.were assessed every 24 h from day 0 to day 14 until successful weaning was achieved.The measurement data of non-normal distribution were presented as median(Q1,Q3),and the differences between groups were compared by Wilcoxon rank sum test.And categorical data use the Chi-square test or Fisher's exact test to compare.The predictive value ofΔP%in predicting the outcome of weaning from the ventilator was analyzed using receiver operating characteristic curves.Results:Of the total 35 patients included in the study,17 were successful vs.18 failed in weaning from a ventilator after 14 days of mechanical ventilation.The cut-off values of the medianΔP%measured by Operator 1 vs.Operator 2 in the first 4 days were≥4.17%and 4.55%,respectively(p<0.001),with the area under curve of 0.804(sensitivity of 88.2%,specificity of 64.7%)and 0.770(sensitivity of 88.2%,specificity of 64.7%),respectively.There was a significant difference in mechanical ventilation duration between the successful weaning group and the failure weaning group(8(6,13)vs.12(7.5,17.3),p=0.043).The incidence of ventilator-associated pneumonia in the successful weaning group was significantly lower than in the failed weaning group(0.2‰vs.2.3‰,p=0.001).There was a significant difference noted between these 2 groups in the 28-day mortality(11.8%vs.66.7%,p=0.003).Conclusion:The medianΔP%in the first 4 days of mechanical ventilation showed good predictive performance in predicting the outcome of weaning from mechanical ventilation within 14 days.Further study is needed to confirm this finding.

Sex differences in outcomes of total hip arthroplasty for the treatment of ankylosing spondylitis

To the Editor:Ankylosing spondylitis(AS)has always been viewed as a male-dominated disease with previous studies showing a male-female ratio of approximately 3:1.However,more recent surveys have shown increasing[1]homogeneity in gender prevalence.1 Female patients with AS tend to have a longer diagnosis delay compared with male patients.AS patients with delayed diagnosis displayed worse outcomes in disease activity,function,spinal mobility,and radiographic damage.

A quantitative study of airway ultrasound in predicting difficult laryngoscopy:A prospective study

Purpose:As common clinical screening tests cannot effectively predict a difficult airway,and unanticipated difficult laryngoscopy remains a challenge for physicians.We herein used ultrasound to develop some point-of-care predictors for difficult laryngoscopy.Methods:This prospective observational study included 502 patients who underwent laryngoscopy and a detailed sonographic assessment.Patients under 18 years old,or with maxillofacial deformities or fractures,limited mouth opening,limited neck movement or history of neck surgery were excluded from the study.Laryngoscopic views of all patients were scored and grouping using the modified Cormack-Lehane(CL)scoring system.The measurements acquired comprised tongue width,the longitudinal cross-sectional area of the tongue,tongue volume,the mandible-hyoid bone distance,the hyoid boneglottis distance,the mandible-hyoid bone-glottis angle,the skin-thyrohyoid membrane distance,the glottis-superior edge of the thyroid cartilage distance(DGTC),the skin-hyoid bone distance,and the epiglottis midway-skin distance.ANOVA and Chi-square were used to compare differences between groups.Logistic regression was used to identify risk factors for difficult laryngoscopy and it was visualized by receiver operating characteristic curves and nomogram.R version 3.6.3 and SPSS version 26.0 were used for statistical analyses.Results:Difficult laryngoscopy was indicated in 49 patients(CL grade III-IV)and easy laryngoscopy in 453 patients(CL grade I-II).The ultrasound-measured mandible-hyoid bone-glottis angle and DGTC significantly differed between the 2 groups(p<0.001).Difficult laryngoscopy was predicted by an area under the curve(AUC)of 0.930 with a threshold mandible-hyoid bone-glottis angle of 125.5and by an AUC of 0.722 with a threshold DGTC of 1.22 cm.The longitudinal cross-sectional area of the tongue,tongue width,tongue volume,the mandible-hyoid distance,and the hyoid-glottis distance did not significantly differ between the groups.Conclusion:Difficult laryngoscopy may be anticipated in patients in whom the mandible-hyoid boneglottis angle is smaller than 125.5or DGTC is larger than 1.22 cm.