ABSTRACT
Objective:To explore the risk factors of hemothorax after rib fracture and evaluate its predictive value for hemothorax.Methods:A retrospective case control study was made on the data of 449 patients with rib fracture admitted to Jiangsu Shengze Hospital affiliated to Nanjing Medical University from January 2018 to November 2019. There were 308 males and 141 females，with the age range of 19-97 years［（57.4±14.0）years］. The hemothorax was defined as pleural effusion on chest CT or X examination on admission or within one week after admission. There were 330 patients in hemothorax group and 119 patients in non-hemothorax group. Indices were compared between the two groups，including gender，age，occupation，weight，height，underlying diseases［diabetes，chronic obstructive pulmonary disease（COPD），hypertension，hyperlipidemia］，causes of injury，imaging findings［number of rib fracture，flail chest，bilateral rib fractures，locations of rib fracture and intramural injuries（pneumothorax，pulmonary contusion，mediastinal emphysema and myocardial contusion）］，thoracic cavity drainage，injury to admission time，vital signs（blood pressure and heart rate），routine blood［white blood cell，hemoglobin（Hb），platelet，hematocrit（Hct）］，blood type，urine routine（urinary occult blood，urinary protein，urinary ketone body），biochemical examination［total cholesterol（TCHO），triglyceride（TG），high density lipoprotein（HDL-C），low-density lipoprotein（LDL-C），albumin（ALB），total bilirubin（TBIL），glutamic oxalacetic transaminase（AST），alanine transaminase（ALT），urea nitrogen（BUN），creatinine（CRE），glycosylated hemoglobin（HbA1C）］，coagulation tests［prothrombin time（PT），fibrinogen（FIB），plasma D-dimer（D-D），thrombin time（TT）］after admission，trauma score［chest wall injury score（CIS），injury severity score（ISS），new injury severity score（NISS）］and length of hospital stay. The univariate analysis was used to observe the correlation between each factor and hemothorax after rib fracture and to screen the significant correlation factors，followed by multivariate logistic regression analysis to further identify the independent risk factors. The receiver operating characteristic（ROC）curve was used to analyze the predictive value of continuous variables in independent risk factors and to calcuate the optimal threshold.Results:The two groups showed no significant differences in gender，occupation，weight，height，diabetes，COPD，hyperlipidemia，injury to admission time，blood pressure，heart rate，platelet，urine protein，urine ketone body，TCHO，HDL-C，TBIL，ALT，CRE，HbA1C or PT（ P>0.05）. The hemothorax group showed significantly decreased Hb，Hct，TG，LDL-C and TT and significantly increased age，number of rib fracture，white blood cell count，AST，FIB，D-D，trauma score（CIS，ISS，NISS）and length of hospital stay when compared to non-hemothorax group（ P<0.05）. There were significant differences in hypertension，causes of injury，flail chest，bilateral rib fractures and locations of rib fracture and urinary occult blood between the two groups（ P<0.05）. The univariate analysis showed that age，hypertension，number of rib fractures，flail chest，bilateral rib fractures，locations of rib fracture（upper chest anterolateral segment，middle chest anterolateral segment，middle chest posterolateral segment，middle chest proximal spinal segment，lower chest posterolateral segment，lower chest proximal spinal segment），pneumothorax，pulmonary contusion，myocardial contusion，thoracic cavity drainage，white blood cell count，urinary occult blood，BUN，FIB，trauma score（CIS，ISS，NISS）and length of hospital stay were significantly associated with hemothorax（ P<0.05）. The multivariate Logistic regression analysis showed that locations of rib fracture（including middle chest posterolateral segment，middle chest proximal spinal segment，lower chest posterolateral segment and lower chest proximal spinal segment），pulmonary contusion，thoracic cavity drainage，BUN and trauma score（CIS，ISS，NISS）were significantly associated with hemothorax after rib fracture（ P<0.05）. The ROC curve analysis of continous variables in independent risk factors showed BUN area under the curve（AUC）of 0.587（95% CI 0.529-0.645），CIS AUC of 0.824（95% CI 0.779-0.870），ISS AUC of 0.789（95% CI 0.739-0.840）and NISS AUC of 0.876（95% CI 0.835-0.917）（ P<0.05），and the optimal thresholds for the above variables were 5.0 mmol/L，2.5 points，15 points and 21.5 points，respectively. Conclusion:Locations of rib fracture（including the middle chest posterolateral segment，middle chest proximal spinal segment，lower chest posterolateral segment，lower chest proximal spinal segment），pulmonary contusion，thoracic cavity drainage，BUN，trauma score（CIS，ISS，NISS）are independent risk factors for hemothorax after rib fracture. BUN>5.0 mmol/L and trauma score（CIS>2.5 points，ISS>15 points，NISS>21.5 points）have significant values in predicting hemothorax.
ABSTRACT
Objective:To evaluate the efficacy of Tui Na therapy combined with self-made Jianpi-Tiaogan Decoction in the treatment of anorexia in children. Methods:A total of 92 patients with pediatric anorexia in our hospital from January 2018 to June 2019 who met the inclusion criteria were divided into 2 groups by random number table method, with 46 patients in each group. The control group was treated with the Tui Na therapy mainly by manipulating on the abdomen and pushing the spleen, and the treatment group was given the self-made Jianpi-Tiaogan Decoction on the basis of the treatment of the control group. Both groups were treated for 4 weeks. The TCM syndrome scores were performed, serum Leptin and Ghrelin levels were measures by enzyme linked immunosorbent assay, serum neuropeptide Y (NPY) was measured by radioimmunoassay, contents of blood zinc and salivary amylase ptyalase were measured by flame atomic absorption spectrometry and Western blot, and D-xylose absorption test was carried out respectively before and after treatment. And the clinical efficacy was evaluated. Results:The total effective rate was 91.3% (42/46) in the treatment group and 73.9% (34/46) in the control group. The difference between the two groups was statistically significant ( χ2=4.821, P=0.028). After treatment, the scores of anorexia, antifeedance, irritability, agitation, hiccup and belching, fullness of chest and flank, thin shape, sleep difficulty and total score in the treatment group were significantly lower than those in the control group ( t values were 6.782, 7.524, 9.100, 5.643, 4.796, 6.066, 4.069, 3.197, 5.073, respectively, all Ps<0.01). After treatment, the serum NPY (133.7 ± 12.4 ng/L vs. 105.6 ± 10.8 ng/L, t=11.589) and Ghrelin (329.6 ± 26.1 ng/L vs. 275.4 ± 25.0 ng/L, t=12.211) levels in the treatment group were significantly higher than those in the control group ( P<0.01), but Leptin (21.7 ± 4.0 g/L vs. 25.2 ± 4.3 g/L, t=4.042) was significantly lower than that of the control group ( P<0.01). After treatment, blood zinc (9.9 ± 2.5 mol/L vs. 8.7 ± 2.3 mol/L, t=2.396), salivary amylase ptyalase content (23.5 ± 4.2 U/L vs. 17.9 ± 3.6 U/L, t=6.866), D-xylose absorption test (0.9 ± 0.4 ng/L vs. 0.7 ± 0.3 ng/L, t=2.713) were significantly higher than those in the control group ( P<0.05 or P<0.01). Conclusions:Tui Na therapy combined with self-made Jianpi-Tiaogan Decoction can improve TCM syndromes of children, regulate the levels of NPY, Leptin and Ghrelin, and improve clinical efficacy.