Objective To discuss the subcutaneous hematoma of the chest wall after artificial femoral head replacement in order to improve the prognosis of patients. Methods One patient complicated with subcutaneous hematoma of the chest wall after artificial femoral head replacement on October,2009.Aborative treatment and nursing was given and the treatment effect was observed. Results The hematoma and congestion were all absorbed after two weeks of treatment and nursing. Conclusions The nursing point of subcutaneous hematoma of the chest wall after artificial femoral head replacement includes monitoring of vital signs, drainage volume, identification of anemia feature, scrupulosly systemic observation and nursing of hematoma.

BACKGROUND:Mesenchymal stem cels isolated from cord blood and bone marrow have multi-directional differentiation ability under a certain condition of induction. OBJECTIVE:To compare the difference of differentiation of umbilical cord blood and bone marrow mesenchymal stem cels into osteoblasts. METHODS:Human umbilical cord blood and bone marrow mesenchymal stem cels were isolated and cultured by density gradient method. When reached 90% confluency, mesenchymal stem cels were digested by trypsin for subculture. At the third passage, umbilical cord blood mesenchymal stem cels and bone marrow mesenchymal stem cels at 8×104/wel were incubated. When reached 80% confluency, cels were treated with low-glucose DMEM supplemented with 10% fetal bovine serum, 0.1 μmol/L dexamethasone, 50 μmol/L vitamin C and 10 mmol/L β-sodium glycerophosphate. RESULTS AND CONCLUSION:There was no significant difference in morphology and biological properties of the two kinds of mesenchymal stem cels. Cels were highly expressed CD44, CD29, but did not express CD34. They had the ability to differentiate into osteoblasts, which had a positive staining for known markers: alkaline phospatase and calciumin vitro mineralization. There was no significant difference in the activity of osteoblasts of two kinds of cels. Results verify that umbilical cord blood and adult bone marrow mesenchymal stem cels can be induced into osteoblasts with a similar ability, and they can be used as seed cels for bone tissue engineering.

Objective The aim of this study was to determine the effects of ulinastatin, a broad spectrum proteinase inhibitor, on fibrinolytic system and platelet function during open heart surgery performed with cardiopulmonary bypass (CPB) .Methods Twenty ASA Ⅰ-Ⅱpatients of both sexes undergoing cardiac surgery under CPB were randomly divided into two groups of ten patients: control group(C) and ulinastatin group (U). In group U patients received ulinastatin 12 000 U?2kg-1 . Half of the dose was given iv 10 min before CPB and the other half was added to the priming solution. In group C patients received normal saline instead of ulinastatin. Blood samples were taken before CPB (T1 ) , 30 min after CPB was started (T2), at the end of CPB (T3), 2 h and 4 h after CPB(T4 , T5) for determination of plasma levels of D-Dimer, ?-granule membrane protein-140 (GMP-140), thromboxane B2 (TXB2) and 6-Keto-prostaglandin F1? (6-Keto-PGF1?) .Results The demographic data, aortic cross-clamping time, CPB time and duration of operation were comparable between the two groups. The plasma levels of D-Dimer, GMP-140, TXB2 and TXB2/6-Keto-PGFl? were significantly increased at T2 , T3 and T4 as compared with the baseline (T1 ) in both groups, but the increase was significantly larger in group C than in group U(P

Objective To evaluate the clinical effects and complications in treating colonic polyps between endoscopic submucosal dissection and laparoscopy.Methods 69 colonic polyps patients diagnosed by colonoscopy with the basal body diameter of the colonic polyp >2.0 cm were enrolled in this study. All the patients were divided into study group (n = 41) and control group (n = 28) according to patients' decision, and then treated with ESD and laparoscopic surgery separately. After treatment, all the patients were followed up and repeated colonoscopy after 6 months. Clinical data were recorded and analyzed at the end of the research.Results Patients were successfully operated in both groups. 1 case in each group was diagnosed of malignant tumor and needed further treatment. The average operation time in study group and the control group was (85.00± 36.50) min and (110.00 ± 45.70) min (P < 0.05), length of hospital stay of the two groups were (10.69 ± 3.09) d and (11.61 ± 6.41) d (P < 0.05), and average cost of hospitalization of the two groups were (15.7 ± 2.7) ten thousand RMB and (30.6 ± 5.9) ten thousand RMB (P < 0.05). Percentage of complications in the study group was 2.43% comparing to 14.29% of control group(P < 0.05). 1 case in the study group complicated with enteron hemorrhage. Complications in the control group was 2 cases of ileus, 1 case of infection, 1 case of intestinal fistula. No recurrence was found in the two groups after 6 months in the repeat colonoscopy.Conclusion Both of the two treatments are effective for patients with wide base colonic polyps, but malignant tumor must be cautioned when treating with wide base colonic polyps. Endoscopic submucosal dissection requires proficient skill while with less impairment and cost.

Objective To evaluate the feasibility,safety,and cosmetic results of single-incision laparoscopic appendectomy by using conventional instruments. Methods From January 2013 to May 2014,clinical data of 52 patients undergoing single-incision laparoscopic appendectomy in our hospital were retrospectively analyzed. The appendectomy was performed by using conventional instruments through three 5-mm trocars via a 2-cm curved incision above the umbilical margin. Results The single-incision laparoscopic appendectomy was successfully completed in all the 52 cases without conversion to conventional laparoscopic or open surgery.The mean operative time was 43 ±7 min (range,30 -90 min).The average postoperative hospital stay was 2.5 ±0.5 days (range,1 -7 days).During follow-up visits for 1 -3 months,there were no postoperative complications.The scars were not obvious in all the patients. Conclusion Laparoscopic appendectomy can be achieved through a single incision by using conventional instruments.This approach is feasible,safe,and concealing.

Objective To investigate the expression of C/EBP homology protein (CHOP) in peripheral brain tissue of patients with severe traumatic brain injury (TBI) and its correlation with the injury severity.Methods The study included peripheral brain tissues of 41 TBI patients (TBI group).Another 16 autopsy specimens succumbed to other diseases (except for TBI or other central nervous system diseases) were selected as controls.The control group and TBI group were subdivided into immaturity group (≤18 years),adult group (18-59 years) and elderly group (＞59 years).According to Glasgow Coma Scale (GCS) on admission,TBI group was classified as severe TBI group (GCS of 6-8) and particularly-severe TBI group (GCS of 3-5).CHOP expression in peripheral tissues after TBI was compared in between different age,gender and GCS.Nerve cell apoptosis was detected by TUNEL technique and correlation between CHOP level and apoptotic number was analyzed.Results There were no age and gender differences regarding CHOP expression in control group (P ＜ 0.05).Compared with control group,expression of CHOP presented notable up-regulation in TBI group (P ＜ 0.05).Expression of CHOP presented no gender difference in TBI group (P ＞ 0.05),but its expression was lower in the aged than in adult or immaturity (P ＜ 0.05) as well as notably higher in particularly-severe TBI group than in severe TBI group (P ＜ 0.05).Nerve cell apoptosis in TBI group was far greater in number than that in control group (P ＜0.05).A positive correlation was observed between CHOP level and apoptotic index (r =0.72,P ＜ 0.05).Conclusion Expression level of CHOP after TBI is closely related to the injury severity and nerve cell apoptosis,but the apoptosis pathway induced by CHOP may not be a major factor in secondary brain injury after TBI in the aged patients.

Objective To investigate the application of automatic biopsy gun in CT-guided percutaneous biopsy for the diagnosis of pulmonary sub-centimeter nodules (≤1 cm).Methods A total of 78 patients with pulmonary sub-centimeter nodules were enrolled in this study. Under CT guidance, percutaneous multi-point and multi-sampling puncture biopsy with automatic biopsy gun was carried out in all patients. The success rate of puncturing, the complications and pathological results were analyzed. Results The success rate of puncturing was 91.0% (71/78). The incidence of pneumothorax was 17.9% (14/78) and the incidence of hemorrhage was 30.8%(24/78). In all patients, no pulmonary infection, tumor tract seeding or metastasis was observed during the follow-up period. Among the 71 patients who had a successful biopsy, squamous cell carcinoma was detected in 7, adenocarcinoma in 25, small cell carcinoma in 5, metastatic lesion in 3, chronic interstitial lung inflammation in 13, granulomatous inflammation in 12, pulmonary fungus in 4, pneumoconiosis nodule in one and pulmonary hamartoma in one. Conclusion For CT-guided percutaneous puncture biopsy of pulmonary sub-centimeter nodules, the use of automatic biopsy gun is safe and reliable with higher success rate.

For a long time, limited by the factors such as laparoscopic technology, and limited medical resources , the residents accepting standardized training are lack of mastery of the technology . Meanwhile, it is the key to the training of personnel training and reserve in the field for residents to contact the laparoscope as soon as possible and carry out scientific and effective training. Therefore, based on the traditional method, we have developed a new type of laparoscopic teaching system for the standardized training residents and increased and integrated the LAP GAME R operations training system and the real-time multimedia teaching platform. The preliminary practice effect is good.

Objective To compare the results of three different registration methods in the kilovolt CBCT guided IMRT for nasopharyngeal cancer (NPC).Methods Total 560 CBCT images of 24 NPC patients who received kilovolt CBCT guided IMRT were analyzed off line.Three registration methods were used for alignment between CBCT and planning CT,including translational and rotational errors for bone and grey (BoneT + R,GreyT+ R),only translational errors for grey (GreyT).The registration results were analyzed by mean paired t-test respectively.Results With method BoneT+R,the translational errors on x,y and z axes were (-0.11 ± 1.35) mm,(0.40 ± 2.09) mm and (0.95 ± 1.56) mm and the rotational errors were 1.06° ±0.67°,0.01° ± 1.28° and 0.92° ± 1.00° respectively.With GreyT+R,the translational errors on x,y and z axes were (-0.02 ± 1.06) mm,(0.68 ± 1.92) mm and (0.81 ± 1.46) mm and the rotational errors were 0.85° ±0.61°,-0.05° ± 1.32° and 0.91° ±0.72° respectively.With GreyT,the translational errors on x,y and z axes were (0.58 ± 1.02),(0.52 ± 1.89) and (0.44 ± 1.43) mm.The results of compared mean t-test for different registration methods groups have significant difference (P =0.00-0.01) except for the rotational errors on y and z axes between BoneT+R and GreyT+R (P =0.05,0.62).Conclusions There have different alignment errors when different registration methods used for NPC kilovolt CBCT guided radiotherapy.If there have correct methods for rotation errors,GreyT+R registration method may be a better choice.In opposite,GreyT+R registration method would be used firstly to verify whether the rotational error ＞ 2°or 3°.If the rotational error ＞ 2°or 3°,the patient should be re-setup.If not,according to these alignment results,the GreyT method,manual method would be used to compensate the translational errors.

Objective To evaluate the correlation between the elastic modulus of prostate and the degree of bladder outlet obstruction (BOO) in benign prostatic hyperplasia (BPH) patients in order to build a new non-invasive diagnostic indicator for BOO.Methods From november 2011 to November 2012,a total of 34 BPH patients were enrolled in this prospective study.Clinical information of the patients including age,international prostate symptom score (IPSS) and quality of life (QOL) were collected.The morphological features of prostate including total prostate volume,transitaion zone volume and transition zone index were detected by transrectal ultrasound (US),and prostate elastic modulus was detected using shear wave sonoelastograhy.After US examination,urodynamic study was performed by the urologist and pressure-flow curves were used to determine the diagnosis and the degree of bladder outlet obstruction.The correlation of prostate elastic modulus and other features including clinical information,morphological features and urodynamic features with the degree of bladder outlet obstruction were evaluated.ROC curves were evaluated.The feature with the best diagnostic performance was obtained,the diagnostic values of which were calculated.Results 9 patients had no BOO,with the average prostate elastic modulus of (27.3±5.0) kPa; 12 patients had mild to moderate BOO,with the average prostate elastic modulus of (30.7±2.8) kPa; 13 patients had severe BOO,with the average prostate elastic modulus of (34.7±2.4) kPa.The prostate elastic modulus had higher correlation coefficient with the degree of bladder outlet obstruction than the other features (r =0.754,P=0.000).It also had the highest AUC of 0.853 (95％CI 0.720-0.986).At a cutoffof 31.65 kPa,the sensitivity,specificity and accuracy of the prostate elastic modulus for the diagnosis of BOO were 72％,90％and 81％ respectively.Conclusion The prostate elastic modulus is highly correlated with the degree of bladder outlet obstruction,which might serve as a novel,promising indicator to evaluate BOO in BPH patients.