Objective To introduce a new computer-assisted external frame for osteotomy to correct complex tibial and fibular deformity.Methods From January 2012 to December 2013,15 patients with complex tibial and fibular deformity were treated with a computer-assisted external frame and related computer software for surgical correction.All were unilateral limb deformity,involving the left lower limb in 8 cases and the right lower limb in 7 cases.They were 8 males and 7 females,15 to 43 years of age (average,26.8 years).The deformity was caused by old osteomyelitis in 9 cases and trauma sequela in 6.The related angles,distances and rotations were measured on the postoperative radiographs of the lower limbs.The data were input into the software to calculate the daily adjustment lengths of the frame rods.Daily frame adjustments were conducted according to the data calculated.The frame was removed when expected results were achieved.The patients lived independently during the adjustment.Results The 15 patients were effectively followed up for 10 to 22 months (average,15 months).Frame fixation time averaged 8.4 months (from 5.5 to 13.1 months).The reunion time averaged 8.0 months (from 5.4 to 12.1 months).The hospitalization time averaged 2.4 months (from 2.0 to 2.8 months).In 10 cases of limb shortening,the shortening lengths averaged 0.5 cm (from 0 to 0.9 cm) after adjustment.In 12 cases of angulation deformity,the angulation averaged 3.3° (from 0° to 5.4°) after adjustment.In 5 cases of rotation deformity,the maximum internal rotation was 5° and the maximum external rotation 10° after correction,deviating from the normal values by 3.5° on average.In 6 cases of horizontal displacement,the displacements averaged 0.5 crn after correction.All patients were satisfactory with corrected lower limb alignment,improved symptoms and appearance,giving a subjective satisfaction rate of 100％.Conclusion Use of computer-assisted external frame in surgical correction of tibial and fibular deformity can achieve satisfactory outcomes in simple,accurate,standardized,minimally invasive manners.

Objective:To investigate the effect of holistic nursing intervention in perioperative nursing for patients underwent radical hysterectomy under laparoscopy. Methods: 80patients with cervical cancer were divided into observation group (40cases) and control group (40cases), and patients of control group received routine nursing modein perioperative period while patients of observation group received holistic nursing mode in the same stage. The complication of the two groups were compared and analyzed, and the satisfaction degree for nursing mode was investigated.Results: Under the intervention of holistic nursing, the number of complication of observation group was significantly lower than that of control group (x2=8.205,P<0.05). And the satisfaction degree for nursing of observation group was significantly higher than that control group(x2=5.000,P<0.05).Conclusion: The holistic nursing intervention in perioperative nursing for patients underwent radical hysterectomy under laparoscopy can significantly improve the life quality of patients, and reduce the occurrence of complication, and enhance the satisfaction degree of patients for nursing.

Objective To explore the effects of early growth response gene-1 (Egr-1) on bone marrow mesenchymal stem cells (BMSC) proliferation and osteogenic differentiation,which is aimed at providing new molecular targets for the treatment of osteoporosis.Methods Bone marrow was collected from adult men and the BMSCs were cultured primarily and observed by microscope.Meanwhile,flow cytometry was used for BMSCs phenotypic identification;After transfection of pcDNA3.1/Egr-1 into BM SCs,the level of BMSCs proliferation was determined by MTT respectively on the 2 d,4 d and 6 d;On the 7 d after transfection,the ALP activity assay was used for testing the ALP activity in BMSCs.And then,alizarin red S-calcium kit was used for measuring the calcified knots respectively on the 7 d,14 d and 21 d;On the 21 d after transfection,real-time qPCR and Western blotting were used respectively for measuring the expression of mRNA and protein of Egr-1,Runx2 and NDRG1;Further,BMSCs were transfected with Egr-1 siRNA,and the content of calcium nodules,ALP activity,the expression of Egr-1,Runx2 and NDRG1 were detected as above methods.Results The cells cultured in vitro showed high level of CD90 and CD29 and very low level of CD34 and CD45,which is accorded with the characteristic of BMSCs.The pcDNA3.1/Egr-1 transfection for BMSCs had no effect on cells prolifera tion.However,the calcified knots,ALP activity and the expression of Egr 1,Runx2 and NDRG1 were increased after transfection of pcDNA3.1/Egr-1 for BMSCs.In addition,Egr-1 siRNA showed the opposite effect with pcDNA3.1/Egr-1 transfection for BMSCs.Conclusion Egr-1 induces osteogenic differentiation of BMSCs by promoting NDRG1 but has no effects on proliferation of BMSCs.

Objective To comparatively study the differences of 18F‐FDG imaging agent by three kinds of different intravenous injection method for conducting PET / CT examination in aspects of the puncture success rate ,residual amount of drug injection and staff ray exposure time and their significance .Methods 240 patients with PET /CT examination were randomly divided into the group A ,B and C ,80 cases in each group .The drug injection adopted the traditional direct injection ,indwelling catheter injection and scalp venous needle connecting syringe(indwelling bubbles) .The puncture success rate ,drug residues and staff contacting radio‐pharmaceuticals time were compared among 3 groups .The obtained relevant data were statistically analyzed .Results The puncture success rate in the scalp venous needle connecting syringe (indwelling bubbles) and the indwelling catheter injection was higher than that in the traditional direct injection and the staff contacting radiopharmaceuticals time was significantly decreased ,the differ‐ences among them were statistically significant(P< 0 .01) ;the radioactive drugs residue in the scalp venous needle connecting syr‐inge was significantly decreased than that in other two kinds of injection method ,the difference was statistically significant (P <0 .01) .Conclusion The injection method of scalp intravenous needle connecting syringe (indwelling bubbles) significantly increases the puncture success rate ,reduces the radioactive drug residue ,at the same time decreases the staff radiation exposure time ,this method has the advantage in the radionuclide injection .

Objective To investigate the role of chemokine ligand 2 (CCL2) in the spinal cord expression in a rat model of tibia bone cancer pain.Methods Eighty-four female SD rats weighing 160-180 g were randomly divided into 3 groups ( n =28):control group (group C),sham operation group (group S) and tibia bone cancer pain group (group P).Tibia bone cancer pain was induced by intra-tibial inoculation of Walker-256 breast cancer cells.Paw withdral threshold to mechanical stimulation (MWT) was measured with von Frey filaments at 1 d before and at 1,3,7,10,14 and 21 d after inoculation.Six rats in each group were sacrificed after the measurement of MWT at 1 d before inoculation and at 7,14 and 21 d after inoculation.Lumbar 4-6 segments of the spinal cord were removed for determination of the expression of CCL2 by ELISA.The coexpression of CCL2 with Iba-1 (a specific marker of microglia),GFAP(a specific marker of astrocyte) and NeuN (a specific marker of neuron) was determined by double immunofluorescence assay after the measurement of MWT at 14 d after inoculation in group P.Results Compared with groups C and S,MWT was significantly decreased from 7 d to 21 d after inoculation,the expressive of CCI-2 in the spinal cord up-regulated at 7,14 and 21 d after inoculation in group P ( P ＜ 0.05).CCL2 was expressed in the microglia and astrocyte but not in neuron in the spinal cord dorsal horn in a rat model of tibia bone cancer pain.Conclusion Release of CCL2 from microglia and astrocytes in the spinal cord was involved in mechanical hyperalgesia in a rat model of tibia bone cancer pain.

Objectives To understand essential basis data availability for implementation of cost accounting in TCM hospitals. Methods Costs of a total of 1588 TCM hospitals were investigated by conducting the baseline survey via questionnaires in 2013. Results Departmental basic data (including ratio of office staff and entire staff, ratio of outpatient and inpatient departments in clinical department), and construction data for housing were well accessible, while utility fee and internal service data were not. Conclusion ①Public TCM hospitals need to improve and specify the basic cost data. ②Differences exit among different types and levels of hospitals in the availability of data. ③There are still difficulties in carrying out cost accounting in public TCM hospitals, which needs strong supports from all relevant departments.

Objective To objectively evaluate the effectiveness of reminder system in reducing catheter-associated urinary tract infections.Methods Databases were electronically searched to collect the trials.According to the inclusion and exclusion criteria,the literatures were screened,the data were extracted and the methodological quality of the included studies was assessed.Then Meta-analysis was performed by using RevMan 5.0 software.Results A total of 10 literatures involving 5 662 participants were included.The results of Meta-analysis showed that the reminder system group was superior to the control group in decreasing the incidence rate of catheter-associated urinary tract infections,shortening the days of indwelling catheter,and there were statistical differences.Conclusions Reminder system can shorten the days of indwelling catheter,decrease catheter-associated urinary tract infections,

Objective To evaluate comparability of two different assay system for detecting CRP.Methods Following the profile of Clinical and Laboratory Standard Institute (CLSI)document EP9-A2,50 blood samples with anti-coagulant ED-TA-2K were collected from emergency patients at Changhai Hospital.The test result of samples by the i-CHROMA Reader was compared and evaluated with those by Beckman Immage 800.Results The linear regression equation for plasma CRP was:Y=1.076 5X-3.031 5,R2=0.986.The linear regression equation for whole blood CRP was:Y=0.882 6X-1.180 8, R2=0.931 1.For whole blood samples with low HCT (<30.45%).Used correction equation:CRP (after corrected)=CRP (before corrected)/(1-HCT).The regression equation (after corrected)was:Y=1.006 8X-3.612 2,R2=0.950 9.Con-clusion CRP concentration detected by i-CHROMA showed good correlation and comparability compared to laboratory ref-erence system by using plasma samples.Results form whole blood samples with low HCT should be corrected to improve comparability.

Objective To compare the analgesic effects of epidural Morphine versus lumbosacral plexus block in patients undergoing hip joint replacement.Methods A total of 94 ASA Ⅰ ～ Ⅱpatients undergoing hip surgery with combined spinal epidural anesthesia(CSEA) were selected and randomized into 4 groups:Group M received a single epidural injection of 2 mg Morphine for analgesia,Group MN1 received an epidural injection of 1 mg Morphine combined with lumbosacral plexus block,Group MN2 received an epidural injection of 2 mg morphine combined with lumbosacral plexus block,and Group N received lumbosacral plexus block.All patients were administered intramuscular parecoxib for 3 days after surgery and,if the visual analogue scale(VAS)≥4,additional intramuscular tramadol.Patient-controlled intravenous analgesia(PCIA) was applied if pain relief was insufficient after Tramadol treatment.Postoperative analgesic effects,the ability to ambulate and side effects were monitored.Results VAS scores gradually increased in the 4 groups after surgery and were higher between the morning of the 1st day and the evening of the next day than at 4 hours after surgery in all the 4 groups.There were no significant differences in VAS scores between rest and exercise conditions in any of the 4 groups.Ambulatory VAS scores were lower in Groups MN1 and MN2 than in Groups M and N 6 hours after surgery,while resting VAS scores had no significant differences between the 4 groups.Resting and ambulatory VAS scores were both lower in Groups MN1 and MN2 than in Groups M and N 6 hours after surgery,while they had no significant differences between either Groups MN1 and MN2 or Groups M and N 4-8 hours after surgery.Resting and ambulatory VAS scores were lower in Groups M,MN1 and MN2 than in Group M on the morning of the day after surgery,and more patients in Group N needed early tramadol and PCIA for rescue analgesia.Muscle strength was lower in Groups MN1 and MN2 than in Groups M and N 4 hours and on the morning of the day after surgery.No significant differences between the groups were found in standing ability 6 hours after surgery and in motor activity on the morning of the day after surgery.The incidence of urinary retention was higher in Groups M and MN2 than in Groups MN1 and N,and was higher in Group MN1 than in Group N.The incidence of pruritus was higher in Groups M and MN2 than in Group N.There was no significant difference in Ramsay sedation scores and postoperative nausea and vomiting (PONV) between the groups.Conclusions Epidural morphine combined with lumbosacral plexus nerve block can provide better analgesic effects than a single dose of epidural morphine or lumbosacral plexus nerve block in elderly patients undergoing hip joint replacement.Although the synergy of the combination has certain influence on early muscle strength recovery,it does not affect early postoperative rehabilitation training.With the combined use of parecoxib and lumbosacral plexus nerve block,epidural injection of 1 mg and 2 mg morphine provides similar analgesic effects,but epidural injection of 2 mg morphine results in a higher incidence of urinary retention.Thus,a small dose of epidural morphine combined with lumbosacral plexus nerve block is recommended for postoperative analgesia in elderly patients receiving hip joint replacement.

Objective To investigate the effects of regular insulin (RI)on duodenal smooth muscle in diabetic mice. Methods Diabetes mellitus (DM) model was established by intraperitoneal injection of 150 mg/kg streptozotocin (STZ) in male BALB/c mice. The model mice were divided into DM group and DM treated with RI group with 6 each. Meanwhile, 6 normal mice were served as controls. The mice in treatment group were intraperitoneally injected with 40 U/kg of RI daily.Whereas the mice in DM and control groups were intraperitoneally injected with phosphate buffer solution (pH = 7. 40). After 6 weeks, the small intestinal transit rate of mice was determined by lavage of Indian ink. Interstitial cells of cajal (ICC) in duodenal myenteric plexus were counted using immunohistochemical staining. Slow waves of duodenal smooth muscle cells were recorded with intracellular recordings. Data were analysed by SPSS 17.0 software, and comparisons among three groups were done using LSD test. Results After intervention for 6 months, the clinical presentations,such as more water and food intake and polyuria, were improved in treatment group. The body weight was increased in treatment group [(23.33±3.13) g] compared with DM group [(15.42±1.40) g,P＜0.01] ,but dereased compared with control group [(26.78 ± 2.09) g, P＜0.05]. The level of blood glucose in DM group was significantly higher than that in control and treatment groups(P＜0.01). Small intestine transmission rate was significantly reduced in DM group than that in control and treatment groups (P＜0.01), but it was slower in treatment group than that in control group (P＜ 0. 01 ). Immunohistochemical study showed that the number of c-kit positive cells reduced obviously in DM group than that in control group and treatment group (P＜0.05), whereas it was lower in treatment group than that in control group (P ＜ 0.05). The slow wave frequency and amplitude of duodenal smooth muscle cells in DM group were reduced when compared with control and treatment groups (P＜0.01) and both were lower in treatment group than that in control group (P＜0. 01 ). Conclusion The findings indicate that DM mice have gastrointestinal dysmotility and exogenous insulin may improve small intestinal dysmotility in DM mice.