Objective To investigate the efficacy and safety of negative pressure suction sheath lithotriptic for incarcerated ureteral calculi. Methods Ninety-eight patients with ureteral embedded stones admitted to our hospital were selected for the study.They were divided into 2 groups according to the differences in surgical methods.Forty-five patients in the study group were treated with negative pressure suction sheath ureteral lithotripsy,while 53 patients in the control group were treated with conventional ureteroscopic lithotripsy,comparing the clinical efficacy and other differences between the two groups.Results The operation time and renal pelvis pressure in the study group were lower than those in the control group,and the stone clearance rate was higher than that in the control group(P<0.05).There was no difference in the relevant test indexes between the two groups before surgery(P>0.05),while the relevant test indexes in the study group improved significantly after surgery than those in the control group(P<0.05).Postoperative day 1,the complication rate of patients in the study group was significantly lower than that of the control group(P<0.05).After surgery,the prognosis of patients in the study group was significantly better than that of patients in the control group(P<0.05).Conclusion The efficacy of negative pressure suction sheath ureterolithotripsy in patients with incarcerated decrease the occurrence of postsurgical complications,which not only significantly improves the stone removal rate,but also reduces the inflammatory response of patients to surgery and ultimately improves their prognosis.

Objective To investigate the effect of laparoscopic partial nephrectomy with renal artery occlusion (LPN) in the treatment of cT1 stage renal carcinoma (RCC) and its effect on renal function. Methods 108 cT1 RCC patients admitted from January 2014 to January 2019 were divided into LPN group and LAPAROSCOPIC radical nephrectomy (LRN) group according to surgical methods.Perioperative related indicators,postoperative renal function and complications of the two groups were compared,and the mortality of the two groups was analyzed during 2-24 months follow-up. Results In LPN group,the operative time was (120.65±20.36) minutes,the intraoperative blood loss was (124.65±19.47) ml,and the postoperative feeding time was (1.59±0.36) days.LRN group were (86.63±17.85) min,(113.64±17.74) ml and (1.18±0.32) days,respectively,and the difference between the two groups was statistically significant (P<0.05).LPN group drainage tube removal time (4.26±1.14) days,postoperative hospital stay (8.71±2.27) days,LRN group (4.03±1.02) days,(8.16±2.15) days,there was no significant difference between the two groups (P>0.05).There was no significant difference in postoperative complication rate between the two groups (P>0.05).After surgery,serum creatinine (SCr) and glomerular filtration rate (eGRF) levels in both groups were significantly higher than those before surgery (P<0.05),while SCr and eGFR levels in LPN group were significantly lower than those in LRN group (P<0.05).The mean follow-up time was (15.41±3.36) months.During the follow-up period,2 patients died in the LPN group and no death in the LRN group.There was no significant difference in mortality between the two groups (P>0.05).Conclusion LPN is as safe as LRN in the treatment of cT1 renal cancer,and LPN can effectively preserve functional nephron and reduce the risk of postoperative chronic kidney disease and cardiovascular disease.However,LPN still has the risk of incomplete tumor resection,so it is recommended to carefully evaluate the body conditions and tumor status of patients with renal cancer and select an appropriate surgical method.

Objective To investigate efficacy and safety of holmium laser enucleation of the prostate in the treatment of BPH with urinary retention(UR). Methods 198 patients with BPH were selected and divided into UR group(Sixty nine cases with UR) and non-UR group(129 cases without UR).Holmium laser enucleation of prostate was operated.The specimen quality,operation time,enucleation time,enucleation rate,postoperative urinary catheter indwelling time,bladder irrigation time,hospitalization time and hemoglobin change value were recorded.Postoperative complications were statistically analyzed.Patients were followed up for 1,3 and 6 months after operation,and their post-voiding residual(PVR),maximum urinary flow rate(Qmax),international prostatic symptom score(IPSS) and quality of life score(QoL) were recorded. Results The positive rates of urine white blood cells,urine culture and PVR in the UR group were higher than those in the non-UR group( P＜0.05).The PVR,IPSS and QoL of the two groups were decreased compared with those before operation,and the Qmax was increased compared with that before operation(P＜0.05).There was no significant difference in enucleation specimen quality,enucleation rate,indwelling time of urinary catheter,bladder irrigation time,hospitalization time,hemoglobin change value,incidence of complications,PVR,IPSS,QoL and Qmax between the two groups(P＞0.05).The PVR,IPSS and QoL of the two groups were decreased compared with those before operation,and the Qmax was increased compared with that before operation(P＜0.05).Conclusion Holmium laser enucleation of prostate is effective,safe and reliable in the treatment of BPH complicated with UR.

Objective To detect the expression of prostate specific membrane antigen (PSMA) in prostate cancer tissues,and to analyze the relationship between PSMA and clinicopathological characteristics of patients and its prognostic value. Methods Data of 280 cases of prostate cancer patients and 40 cases of prostate hyperplasia patients treated in our hospital from January 2015 to September 2018 were retrospectively analyzed.Paraffin section specimens of the patients were collected and immumohistochemical staining was performed.Using IHC to detect the expression of PSMA,and to analyze the correlation between PSMA expression and clinicopathological characteristics.Finally,Cox proportional risk model was used to analyze the independent prognostic factors affecting the biochemical relapse-free survival (BRFS) of patients. Results Of the 280 prostate cancer patients,216 cases (77.1%) were positive for PSMA.Of the 40 cases of prostate hyperplasia,17 cases (42.5%) were positive,and the positive rate was lower than that of the prostate cancer group(P<0.05).The positive expression rate of PSMA in patients with lymph node metastasis and Gleason score > 7 was higher than that in patients without lymph node metastasis and Gleason score ≤7,and the difference was statistically significant(P<0.05).Positive expression of PSMA and lymph node metastasis were independent prognostic factors affecting BRFS in prostate cancer patients(P<0.05). Conclusion The high expression of PSMA in prostate cancer tissues is closely related to lymph node metastasis and Gleason score,and can be used as an independent prognostic factor affecting BRFS of prostate cancer patients.

Objective To evaluate the effect of partial mobilization of urogenital sinus in the treatment of sexual dysplasia(DSD) caused by female congenital adrenal hyperplasia(CAH). Methods The clinical data of 46,XX DSD children caused by CAH who were diagnosed and treated in the First Affiliated Hospital of Xinjiang Medical University from April 2016 to November 2019 were retrospectively analyzed.Preoperative cystoscopy was performed to measure the common channel length of the urogenital sinus,and 15 children suitable for partial mobilization of the urogenital sinus(PUM) combined with clitoroplasty and labioplasty to complete the feminization of the external genitalia in one stage were selected.Postoperative perineal appearance,urodynamic studies,and lower urinary tract symptoms were followed up to assess efficacy. Results All children were followed up for 6 months,1 year and 2 years after operation.The common channel length of the urogenital sinus was 0.9-1.9cm,with an average of 1.45cm.The incisions of the children were healed by first intention;13 cases had realistic vaginal shape,1 case had large and small labia minora,poor symmetry,1 case had vaginal stenosis,but none had lower urinary tract symptoms(LUTs);15 cases who underwent PUM had postoperative urodynamic examination:maximum urinary flow rate:12-27ml/s,no abnormality of bladder during filling period,bladder capacity in the normal range,no urine leakage;no abnormality of maximum voiding pressure.Conclusion PUM has an ideal therapeutic effect on 46,XX DSD children with short common channel of urogenital sinus(less than 1.9cm),with realistic.

Objective To explore the expression and significance of POU3F2 in glioma based on the Chinese Glioma Genome Atlas(CGGA). Methods Based on CGGA,GEPIA2,String,Metascape and other databases,we analyze the differences in the expression of POU3F2 gene in different WHO grade groups of glioma with R program language.Meanwhile,IHC staining was conducted to detect the protein expression level of POU3F2 in collected glioma tumor tissues.Then the relationships between POU3F2 gene expression and molecular subtypes of glioma,molecular biomarkers and clinical prognosis were analyzed. Results The expression of POU3F2 was increased in the high grade glioma group(P=0.0037).Immunohistochemistry indicated that POU3F2 expression was also up-regulated in high grade glioma group (P<0.001).The expression levels of POU3F2 was the highest in the classical glioma,and the difference was significant between other molecular subtypes (all P<0.001),and the AUC value of POU3F2 predicted the classical glioma was 0.784.The expression levels of POU3F2 gene were significantly lower in glioma with chromosome 1p19q co-deletion.High levels of POU3F2 expression tended to have a poorer prognosis(P=0.013)and was verified in the TCGA database（P=0.0055）.Conclusion The increased expression level of POU3F2 is associated with malignant glioma phenotype,and might be a molecular biomarker of glioma.

Objective To observe the value of serum hypoxia inducible factor-1 α(HIF-1 α) and interleukin-6(IL-6) in predicting the recurrence of elderly patients with pituitary adenomas after the treatment of transsphenoidal surgery. Methods 95 elderly patients with pituitary adenomas after the treatment of transsphenoidal surgery treated in our hospital from January 2015 to December 2017 were selected,all patients received surgical treatment in our hospital and received the results of 3 months of follow-up,the recurrence of patients was observed;the serum HIF-1 α and IL-6 levels were detected at admission,the value of the two in predicting the recurrence of elderly patients with pituitary adenomas after the treatment of transsphenoidal surgery was analyzed. Results Of 95 cases of elderly patients with pituitary adenomas after the treatment of transsphenoidal surgery through follow-up evaluation,18 cases had recurrence,the recurrence rate was 18.95%;the proportion of tumor invasion of patients in the recurrence group was higher than that in the non occurrence group,and the serum HIF-1 α and IL-6 levels were higher than those in the non occurrence group at admission(P<0.05);ROC curve was drawn,the results showed that the AUC of serum HIF-1 α and IL-6 alone or combined to predict the risk of recurrence in patients with pituitary adenoma surgery were all >0.80,which had certain predictive value.Conclusion  The overexpression of HIF-1 α and IL-6 at admission may be associated with recurrence in elderly patients with pituitary adenomas after the treatment of transsphenoidal surgery,which had certain value in predicting the risk of recurrence in patients.

Objective To investigate the efficacy of surgical and nonsurgical treatments for granulomatous lobular mastitis(GLM) and the risk factors for recurrence. Methods We retrospectively reviewed the clinical and pathological data from 174 patients diagnosed with GLM between July 2017 and December 2019.Treatment modality was divided into surgery+steroid group(n=101) and steroid treatment(n=73).The t-tests and χ² tests were used to compare the effects of the two treatments.Possible risk factors of GLM were analyzed using univariable logistic regression,followed by multivariable logistic regression. Results The breast appearance of the steroid group was better than that of surgery+steroid group(P< 0.05);there was no significant difference in the course of disease,clinical efficacy,and recurrence rate between the two groups(P>0.05).The results of univariate and multivariate logistic analysis showed that breastfeeding time≥8 months、history of breast infection and Corynebacterium were independent risk factors for recurrence of GLM(P< 0.05). Conclusion Oral steroid can be considered as a first-line treatment for GLM.To shorten the breastfeeding time appropriately and control the infection actively can reduce the recurrence of GLM.

Objective To explore the effects of breast cancer cell exosomes miR-27a on the polarization of macrophages and on tumor growth and metastasis. Methods qRT-PCR was used to detect the expression of miR-27a in M1 and M2 macrophages,and to detect the effect of miR-27a on the polarization of macrophages.Differential centrifugation was used to extract breast epithelial cells MCF10A and breast cancer cells MDA-MB-231 exosomes,qRT-PCR to detect the expression of miR-27a in exosomes,to detect the effect of exosomes miR-27a on the polarization of macrophages,and culture the macrophages after exosomes induction After the base supernatant(CM) was incubated with MDA-MB-231 cells,the proliferation,migration and invasion ability of MDA-MB-231 cells were detected.Results miR-27a was highly expressed in M2 type macrophages(P＜0.05),and miR-27a mimic significantly promoted the expression of CD206 and MRC-2(P＜0.05),and miR-27a inhibitor inhibited the expression of CD206 and MRC-2(P＜0.05),miR-27a was highly expressed in MDA-MB-231 exosomes(P＜0.05),MDA-MB-231 exosomes can significantly promoted the polarization of M2 macrophages(P＜0.05).The polarized macrophage culture supernatant could significantly induce the proliferation,migration and invasion of MDA-MB-231 cells(P＜0.05),and MDA-MB-231 exosomes with low expression of miR-27a could significantly inhibit M2 Type macrophages were polarized(P＜0.05),and the M2 type cell culture supernatant could significantly inhibit the proliferation,migration and invasion of MDA-MB-231 cells(-P-＜0.05).Conclusion The breast cancer cell exosomes miR-27a can promote the polarization of M2 macrophages and promote the growth and metastasis of breast cancer cells.

Objective To analyze the characteristics of breast microcalcification(MC) in patients with T1～2 stage human epidermal growth factor receptor 2(HER2) positive and non-positive invasive breast cancer(IBC). Methods Retrospectively analyzed the clinicopathological data of 254 patients with T1～2 stage IBC.To analyze the occurrence and characteristics of MC in HER2 positive and non-positive patients. Results In this study,the incidence of MC was 53.54%(136/254),The incidence of MC in the HER2 positive group was higher than that in the non-positive group(79.37%vs 45.03%， P<0.05).In HER2 positive group,MC was mainly branching samples of thin lines distributed along ducts,while in non-positive group,it was more common to have needle tip like cluster distribution.There were significant differences in MC morphology and distribution between the two groups(P＜0.05).In HER2 positive patients,the incidence of MC in patients who was older than 50 years was higher than that in patients who was 50 years and younger(P＜0.05). Conclusion The incidence of MC was higher in HER2-positive IBC patients,and the morphology and distribution of MC had certain guiding significance in predicting the expression status of HER2.

To explore the related risk factors and treatment strategies of anastomotic leakage after radical esophagectomy. Methods A total of 684 patients with esophageal cancer who were treated in our hospital from January 2009 to January 2016 were retrospectively analyzed.Seventeen factors that might affect the occurrence of postoperative anastomotic leakage were included in the study,mainly including clinical and tumor related factors. Results Preoperative serum albumin levels,surgical methods,anastomotic position,and tumor TNM stage were closely related to postoperative anastomotic leakage in patients with esophageal cancer(P<0.05).Multivariate logistic regression analysis revealed that preoperative serum albumin levels and tumor TNM stage are independent risk factors(P<0.05).The incidence of anastomotic leakage was 21.2%(7/33) in patients with serum albumin level <35g/L and 6.6%(43/651) in patients with albumin level ≥ 35g/L,the difference was statistically significant(P<0.05).The incidence of anastomotic leakage in patients with TNM stage Ⅲ was 9.8%(31/315),which was significantly higher than that of 5.1%(19/369) in patients with stage 0+Ⅰ+Ⅱ(P<0.05). Conclusion Preoperative serum albumin levels and tumor TNM stage are independent risk factors of postoperative anastomotic leakage in patients with esophageal cancer.

Objective To analyze the characteristics of gastrointestinal pancreatic neuroendocrine neoplasm(GEP-NENs) and the risk factors that affect the prognosis of patients. Methods The clinical data and 36 month follow-up data of 108 patients with GEP-NENs who were hospitalized in the First Affiliated Hospital of Air Force Military Medical University from January 2009 to December 2016 were collected.Analyze its clinical characteristics,pathological characteristics and other indicators.Univariate and multivariate Cox regression models were used to study the prognostic factors affecting survival,and Kaplan-Meier method was used for survival analysis. Results The ratio of male to female was 1.16∶1,and the average age was (50.90±12.94) years.The predominant sites were pancreas,rectum,and stomach.The tumor diameter ranged from 0.2cm to 13.2cm,with a mean of (1.90±1.94)cm.Pathological classification:neuroendocrine tumor accounted for 88.9% and neuroendocrine carcinoma 11.1%.Pathological grade:G1 grade accounted for 52.8%,G2 grade accounted for 36.1%,and G3 grade accounted for 11.1%.Among them,95.4% of patients underwent surgical treatment,and 69.9% underwent radical surgical resection.The 3year overall survival rate was 87.1%.Univariate analysis of pathological type,grade,clinical stage,nonfunctional tumor,tumor diameter,Ki67 index,lymph node metastasis and distant metastasis are important factors affecting the prognosis of GEP-NENs patients(P＜0.05).Multivariate analysis showed that tumor size and lymph node metastasis were independent risk factors affecting the prognosis of patients with GEP-NENs.Conclusion The prognosis of patients with GEP-NENs is related to pathological type,grade,clinical stage,non-functional tumor,tumor diameter,Ki-67 index,lymph node metastasis and distant metastasis.Tumor size and lymph node metastasis are independent risk factors that affect the prognosis of patients.

Objective To investigate the Clavien-Dindo classification of complications after laparoscopic-assisted radical gastrectomy and the impact factors.Methods Clinical data of 478 patients with gastric cancer undergoing laparoscopic-assisted radical resection from January 2014 to June 2019 were analyzed retrospectively.The postoperative complications were assessed by Clavien-Dindo classification,and the impact factors associated with postoperative complications were assessed by using the Logistic regression model． Results Of the 478 patients,postoperative complications occurred in 84 patients(17.6%)．The Clavien-Dindo classification of postoperative complication：6 patients were detected in gradeⅠ,59 in gradeⅡ,11 in grade Ⅲa,4 in grade Ⅲb,3 in grade Ⅳa and 1 in grade Ⅴ,respectively.On univariate logistic analysis,postoperative complication was associated with age,BMI,preoperative comorbidity,surgical duration,intraoperative blood loss,tumor size and perioperative transfusion．Multivariate analysis revealed that age age≥65 years,BMI≥28kg/m²,surgical duration time>180min,intraoperative blood loss≥200ml and perioperative transfusion were independent risk factors for postoperative complications.The grades of Clavien-Dindo classification were significantly different between patients with different age,BMI,surgical duration,intraoperative blood loss and perioperative transfusion(all P＜0.05)．Conclusion Clavien-Dindo classification of complicationsis beneficial to the comprehensive evaluation of safety of laparoscopic-assisted radical gastrectomy.The mainly complications after laparoscopic-assisted radical gastrectomy are grade Ⅱ of Clavien-Dindo　classifification.Age,BMI,surgical duration,intraoperative blood loss and perioperative transfusion were independent risk factors for postoperative complications in laparoscopic-assisted radical gastrectomy.

Objective To explore the predictive value of modified colonic leakage score for anastomotic leakage in patients undergoing left colorectal surgery. Methods Prospectively selected 150 patients who underwent left colorectal surgery in our hospital from January 2016 to December 2020 as the research objects.All patients underwent left colorectal surgery and postoperative anastomosis.Patients were collected before and after surgery.Intraoperative and postoperative clinical data,a follow-up of 30 days after operation,150 cases of 5 patients were lost to follow-up due to different reasons,the loss to follow-up rate was 3.33%,and a total of 145 patients completed the follow-up.Among them,17 patients had anastomotic leakage,which was the occurrence group.The difference in the improved colon leakage score between the two groups was compared,and the improved colon leakage score prediction model was established to analyze the predictive performance of the prediction model. Results 145 patients with left colorectal surgery had a modified colonic leakage score ranging from 1 to 20 points,with an average of ( 9.54 ±2.89) points,of which the incidence group score was 10-20 points,with an average of (14.78±3.45) points;the non-occurring group The scores were 1-14 points,with an average of (7.89±2.01) points;the modified colonic leakage score of the occurrence group was higher than that of the non-occurring group(P＜0.05).ROC curve analysis showed that the modified colonic leakage score predicted the AUC of the risk of anastomotic leakage in patients undergoing left colorectal surgery was 0.967. Conclusion The modified colonic leakage score prediction model has a high efficiency in predicting the risk of anastomotic leakage in patients undergoing left colorectal surgery,and is an effective tool for predicting the occurrence of anastomotic leakage in patients undergoing left colorectal surgery.

Objective To observe the effect of apatinib on the invasion ability and mesenchymal-epithelial transition(MET) of colon cancer cell line SW480 and its molecular mechanism. Methods Different doses of apatinib were incubated with the SW480 cells,then the effect of apatinib on the invasion of SW480 cells was detected by Transwell assay,and the expression of MET related proteins were detected by Western blot. Results The cell viability of SW480 was remain the same when the concentration of apatinib was ≤ 120nM,thus 60nM and 120nM apatinib were used in the further experiments.The invasion of SW480 cells was reduced after apatinib incubation for 48h,and the expression of E-cadherin was enhanced,with the depresion of Vimentin，Snail and Slug.Conclusion Apatinib could induce the MET,and reduced the invasion ability of SW480 cells.

Objective To investigate the risk factors of infectious complications after hepatectomy in patients with intrahepatic bile duct stones.Methods The clinical data of 592 patients with intrahepatic bile duct stones who underwent hepatectomy were collected.According to whether there were infectious complications after hepatectomy,the patients were divided into infected group and uninfected group.The risk factors that may affect the occurrence of postoperative infectious complications were analyzed by univariate and multivariate logistic regression.Meanwhile,a nomogram visual prediction model was established,and the prediction efficiency of the model was evaluated by c-index value.Results The incidence of infectious complications after hepatectomy was 16.55%.Logistic regression analysis showed that preoperative serum albumin(Alb) level,combined with biliary cirrhosis,operation distance from acute cholangitis control interval,cholangiojejunostomy,rapid rehabilitation Surgical Nursing(preoperative diet control,preoperative intestinal preparation Intraoperative management) was a predictor of infectious complications after hepatectomy in patients with intrahepatic bile duct stones.Based on the nomogram constructed by the above five risk factors,the training set c-index is 0.825(95%CI 0.321 ~ 1.329),and Hosmer lemeshow deviation detection χ²=8.773(P＞0.05).The c-index value of the validation set was 0.813(95%CI 0.284 ~ 1.342),Hosmer lemeshow deviation detection χ²=8.931(P＞0.05).Conclusion Nomogram prediction model can effectively predict the risk of infectious complications after hepatectomy in patients with intrahepatic bile duct stones.Rapid rehabilitation surgical nursing is an important part of nursing after hepatectomy for intrahepatic bile duct stones.Its implementation effect is closely related to the risk of postoperative infectious complications.

Objective To explore the effect of early and delayed laparoscopic cholecystectomy on cholecystolithiasis and the influence of postoperative intestinal function. Methods The data of 84 cases of cholecystitis due to cholecystolithiasis treated in our department from January 2018 to January 2020 were retrospectively analyzed.According to the time of laparoscopic cholecystectomy from the onset of the disease to the onset of the disease,the patients were divided into the early group(within 48h) in 44 cases and the delayed group(more than 48h) in 40 cases.The indicators related to surgery,complications,and the rate of conversion to open surgery were compared between the two groups,and the differences of postoperative intestinal function indicators were compared between the two groups.Results The differences of operation time [(64.51±5.27)min vs(85.34±7.64)min],intraoperative bleeding volume [(41.26±5.41)ml vs(86.54±9.28)ml],hospital stay [(3.1±0.7)d vs(4.6 ±0.9)d] between the early group and the delayed group were statistically significant(P<0.05).The conversion rate was 2.27% in the early group and 17.50% in the delayed group.The difference was statistically significant between the two groups(P<0.05).The incidence of postoperative complications was 4.55% in the early group and 12.50% in the delayed group.There was no significant difference between the two groups(P>0.05).The differences of postoperative recovery time of borborygmus [(15.74±4.21)h vs(24.27±6.35)h],postoperative first exhaust time [(1.25±0.43)d vs(2.47±0.64)d],and postoperative first defecation time [(2.43±0.76)d vs(3.79±0.81)d] between the early group and the delayed group were statistically significant(P<0.05).Conclusions Early laparoscopic cholecystectomy for acute biliary pancreatitis caused by cholecystolithiasis is safe,and the intestinal function recovers quickly after operation.Its clinical effect is better than that of delayed laparoscopic cholecystectomy.

Objective To investigate the clinical effect of vacuum sealing drainage(VSD) combined with silver ion dressing to treat infectious orthopedic wounds. Methods 30 patients who met the screening criteria from October 2019 to June 2021 were selected and randomly divided into experimental group and control group,15 patients in each group.The control group was treated with conventional VSD,and the experimental group was treated with VSD combined with silver ion dressing.One week later,the bacterial clearance rate and granulation tissue coverage rate of the two groups were analyzed and compared.The wound healing time and total effective rate of the two groups were recorded and statistically analyzed. Results After one week,the bacterial clearance rate of the experimental group was (97.90±1.34)%,which was significantly higher than that of the control group(89.58±1.26)%(P<0.05).The coverage rate of granulation tissue in experimental group was (89.59±2.05)%,which was significantly higher than (76.02±1.69)% in control group(P<0.05).The wound healing time of the experimental group was (17.67±1.18)days,which was significantly shorter than that of the control group(22.33±2.09)days(P<0.05).The effective rate of the experimental group was 93.33%,higher than that of the control group(73.33%),and the difference was statistically significant(P<0.05).Conclusion For infectious orthopedic wounds,VSD combined with silver ion dressing can effectively reduce wound infection and promote wound healing.

Objective To compare the therapeutic effects of proximal femoral locking compression plate and artificial femoral head replacement in the treatment of femoral intertrochanteric fractures in the elderly. Methods Totally 78 elderly patients with femoral intertrochanteric fractures who were admitted to Tangdu Hospital Affiliated to Air Force Medical University between January 2015 and June 2018 were divided into control group (proximal femoral locking compression plate,n=46) and observation group (artificial hip replacement,n=32) according to the surgical method.Surgical indexes,bone mineral density and Harris hip scores were compared between the two groups. Results The operation time and incision length of the observation group were significantly shorter than those of the control group (P<0.05),and the intraoperative blood loss was significantly more than that of the control group (P<0.05).The postoperative recovery related indexes in the observation group were significantly better than those in the control group (P<0.05).The excellent and good rate in the observation group was 90.63%,significantly higher than 60.86% in the control group (P<0.05);After treatment,the bone mineral density and Harris hip scores of the two groups increased (P<0.05),and the increases in the observation group were significantly greater than those in the control group (P<0.05).Conclusion Artificial femoral head replacement is more effective than the proximal femoral locking compression plate in the treatment of femoral intertrochanteric fractures in the elderly.

Objective To explore whether the application of high frequency linear array ultrasound assisted localization before puncture can improve the success rate of subarachnoid anesthesia in patients with difficulty in locating anatomical landmarks. Methods A randomized controlled trial was used to localize the anatomic landmarks.110 cases of patients who could not be touched the spinous process clearly were divided into two groups:the traditional anatomical positioning group(Group J) and the ultrasound assisted group(Group C),each group were 55 cases.The main outcome include the success rate of one-time puncture.Secondary outcome include the distance,puncture angle and puncture times between anatomical and ultrasound localization of L2-3 and L3-4. Results The success rate of one-time puncture was 26.53% in anatomy group and 61.11% in ultrasound group,the  difference was statistically significant(P<0.05). Conclusion The application of high-frequency linear array probe ultrasound assisted localization in patients with difficulty in anatomic localization of subarachnoid anesthesia can effectively improve the success rate of one-time puncture and reduce the times of puncture.