Porous titanium is a kind of new biomaterial. After being implanted into the bone, the ingrowth of the bone was demonstrated. This ingrowth of bone tissuse was thought to be beneficial to fixation of a prosthesis and filling of a bone cavity.In this study, the porous sample was abtained from sintered amorphous titanium powder, with the mean size of pores larger than 150? in diameter, and the porosity in the range of 45-47%. It was implanted into the femurs of rabbits and dogs, and specimons were taken for examination 2, 4, 6 and 12 weeks after operation.It was shown that the shear strength of the samples at the implant bone surface was 7.51kg/cm2 2 weeks after surgery. It was demonstrated that bone tissue had begun to grow into the meshwork 2 weeks after surgery, and deeper penetration was seen after 4 weeks. Scanning electron microscopy was done to show the appearance of bony growth into the meshwork. Bony growth was verified by x-ray diffraction scan analysis for calcium. Bone ingrowth could be seen in the majority of the interstices of the meshwork 12 weeks after surgery. Bone lacuna and tubules could be seen when stained with silver nitrate. The deepest penetration of bone ingrowth was 1400?. There was no obvious tissue reaction or formation of fibrous membrane.The use of the porous material may help to prevent loosening of a prosthesis. It is believed that porous titanium we used possesses the characteristics that a porous material should possess. Further research should be done to ascertain its clinical usefulness.

Objective To evaluate the etiology, pathogenesis, clinical manifestation, imaging features, treatments and factors related to prognosis of acute spinal spontaneous hematoma.Methods The clinical data of 38 patients with acute spinal hematoma treated in our hospital from 2011 till now were analyzed retrospectively.Duration of follow-up was 6 months.The factors influencing the prognosis were analyzed.Results Acute epidural hematomas (n=29) were much more common than subdural (n=5), subarachnoid (n=1) and intramedullary (n=3).Most hematomas were located in the cervical and thoracic vertebra regions.The etiology of acute spinal spontaneous hematoma was unknown in most patients.Twenty-nine patients were dealt with surgical intervention and 9 patients were treated conservatively.After 6-month follow up, recovery rate measured by JOA score in patients of spinal injury ASIA level A and B was (51.26 ±38.97), and level C, D and E was (80.33 ±25.83), P<0.05.Recovery rate in patients with hematoma discovered in less then 24 hours treated with surgical decompression was (64.79 ±36.10), and that in those with hematoma present over 24 hours was (34.54 ±30.17), P<0.05.Conclusions Acute spinal hematoma always caused by unknown etiology, and usually manifests itself in a sudden onset of pain and neurological deficits.The early diagnosis mainly depends on MRI.Patients presenting with severe neurologic dysfunction or showing signs of progressive deficit should have immediate surgical intervention. The status of neurological deficits before surgery and the length of interval between onset and surgical intervention are associated with recovery.

Objective To investigate the factors associated with contralateral recurrence of primary spontaneous pneumothorax And prosvide referencee for how to prevent primary spontaneous Pneumothrorax with Contralateral recurrence.Methods From January 2006 to December 2011,the clinical follow-up data of 203 patients with primary spontaneous pneumothorax were reviewed.The median follow-up time was 43 months.Results Two hundred and three patients developed 241 recurrences,among which 27 patients had contralateral recurrences.The average time of contralateral recurrence was 20.19 months.Patients with contralateral recurrence of primary spontaneous pneumothorax had smaller age(P ＜ 0.05),lower body weight (P ＜ 0.05) and lower body mass index (P ＜0.01).All patients with contralateral recurrence of primary spontaneous pneumothorax received surgical treatment and were found bullae during surgery.Three patients had unilateral recurrences of pneumothorax during follow up,with single-stage bilateral video-assisted thoracoscopic surgery for bilateral primary spontaneous pneumothorax.Conclusions Contralateral recurrence of primary spontaneous pneumothorax is more common in patients with small age,low body weight and low body mass index.These patients could perform high-resolution computerized tomographic scan of the lung before surgery.Single-stage bilateral video-assisted thoracoscopic surgery may be considered for these patients with contralateral bullae on high-resolution computerized tomographic scan of the lung to prevent contralateral recurrence of primary spontaneous pneumuothorax.

Objective To provide the anatomical basis for the flap based on the perforator of Plantar arch,through investigation of the morphological features of the perforator of the arch of the foot.Methods From November,2015 to March,2016,the first metatarsal base and the fifth metatarsal tuberosity were chosen as the observation point on 25 specimens of adult human feet perfused with red latex.The following contents were observed under surgical magnifier:①The origin,courses,branches and distribution of the perforator of Plantar arch.②The anastomoses among the perforator of Plantar arch and the fete arteriosum dorsale pedis.Mimic operation was performed on another fresh specimen perfused with red latex.Results There were 3 perforators in Plantar arch,which passed through the 2nd-4th metatarsal dorsal muscles to the dorsi pedis and then divided into an ascending branch and a descending branch.The ascending branch anastomosed with the rete arteriosum dorsale pedis,and the descending branch stretched to the 2nd-4th plantar arteries.The initiative outer diameters of the 1st-3rd dorsal perforators of Plantar arch were (1.5 ± 0.3)mm,(1.1 ± 0.4) mm and (0.9-± 0.3) mm respectively,and the lengths of the stem were (1.1 ± 0.2) cm,(1.5 ± 0.1) cm and (1.5 ± 0.5) cm respectively.Conclusion The flap can be used for repair of soft-tissue defects of dorsal and front foot through dorsal transposition or a V-Y advancing flap with the perforator of Plantar arch as its vascular pedicle.

Objective:To explore the application effect of the modified early warning score (MEWS) in the allocation of nursing human resources per shift in ICU.Methods:A total of 470 critically ill patients admitted to the ICU of Xuancheng People′s Hospital from January to December 2019 were selected as the experimental group. In each shift, the nursing leader conducted MEWS score for patients in the ward, and assigned nurses at the corresponding level according to the MEWS score. A total of 346 critically ill patients admitted to ICU from January 2018 to December 2018 were selected as the control group. The head nurse assigned nurses daily according to clinical experience.The incidence of accidental events, nurse error events and medical satisfaction were compared between the two groups.Results:The incidences of accident and nurse error in ICU patients in the experimental group were 5.96% (28/470) and 12.13% (57/470), respectively, which were lower than those in the control group [11.56% (40/346) and 17.92% (62/346)]. The difference between the two groups was statistically significant ( χ2=8.19, 5.37, both P<0.05). The satisfaction degree of the experimental group was 98.63 ± 1.06 and 95.96 ± 1.84, respectively, which were higher than that of the control group 92.13 ± 2.17 and 90.43 ± 2.91, and the difference between the two groups was statistically significant ( t=7.62, 8.56, both P<0.05). Conclusions:Using MEWS score to guide the allocation of nursing human resources in each shift of ICU is helpful to reduce the incidence of accidental events in ICU patients and the incidence of nurses′ errors, ensure patient safety and improve medical satisfaction.

Objective:To investigate the effect of applying foam dressing combined with self-made adhesive penile hood fixation in children after circumcision.Methods:A total of 101 cases of children who received circumcision from January to December 2020 in the urology department of the People′s Hospital of Xuancheng City were selected. The patients were randomly divided into experimental group (50 cases) and control group (51 cases). In the experimental group, the incision was wound with foam dressing combined with the self-made adhesive penile hood fixation method, while in the control group, the incision was wound with the conventional sterile gauze dressing combined with the simple plastic basket fixation method.The postoperative incision bleeding, prepuce edema, incision pain, incidence of complications and the satisfaction of the children′s family members on postoperative dressing and fixation were compared between the two groups.Results:The incidence of prepuce edema in the experimental group was 88.00% (44/50), 12.00% (6/50), 0, which in the control group was 43.14% (22/51), 45.10% (23/51), 11.76% (6/51), and the difference between the two groups was statistically significant ( Z= -4.80, P<0.05). In the experimental group, pain score at 24 hours after operation and at the time of dressing change were 3.50 ± 1.04, 2.48 ± 0.54, respectively, which were lower than that of the control group 5.31 ± 1.36 and 7.12 ± 0.97, and the difference between the two groups was statistically significant ( t=7.53, 29.66, all P<0.05). The incidence of postoperative infection and urinary retention in the experimental group were 0 and 2.00% (1/50), respectively, which were lower than 7.84% (4/51) and 7.84% (4/51) in the control group, and the difference between the two groups was statistically significant (Fisher′s exact probability method, P<0.05). The degree of family satisfaction in the experimental group was 96.00% (48/50), which was higher than that in the control group (78.43%, 40/51), and the difference between the two groups was statistically significant ( χ2=6.95, P<0.05). Conclusions:The application of foam dressing combined with pasting penile hood after circumcision can reduce the degree of foreskin edema, pain and the incidence of complications, and improve the satisfaction of the children′s family members.

Objective: To investigate the morphological characters of the dorsal perforators originated from the deep palmar arch, so as to provide anatomic basis for V-Y advanced perforator flap. Methods: The following contents were investigated in 30 adult hand specimens perfused with red latex under surgical magnifier: ①The origin, courses, branches and distribution of the dorsal perforators originatedd from the deep palmar arch. ②The characters of anastomosis among the dorsal perforators, the dorsal carpal and metacarpal arteries. Mimic operation was performed on another fresh specimens perfused with red latex. Results: There were three perforators originated from the deep palmar arch, which passed through the 2nd-4th dorsal interossei and then divided into an ascending branch and a descending branch at the dorsum of hand. Then the ascending branch anastomosed with the dorsal carpal artery, and the descending branch stretched to the 2nd-4th dorsal metacarpal arteries. The originating outer diameters of the 1st-3rd perforators were (1.1±0.2) mm, (0.9±0.3) mm and (0.7±0.1) mm respectively, and the length of the stems were (1.1±0.3) cm, (1.0±0.2)cm and (0.9±0.1) cm respectively. Conclusions The V-Y advanced perforator flap with the dorsal perforator of the deep palmar arch as its vascular pedicle could be used to repair the dorsal carpal or dorsal metacarpal soft tissue defects.

Objective To explore the feasibility of the perforator-based intermediate dorsal pedal flap with vessels of cutaneous nerve nutrition for repair of soft tissue defects of the forefoot.Methods A retrospective case series study was performed for seven cases of soft tissue defects of the forefoot hospitalized between February 2013 and January 2017.There were five males and two females,with a mean age of 38 years (range,18-73 years).Injury regions were lateral plantar skin defect in the forefoot in three cases,dorsal skin defect in the third webbed toe in two cases and proximal dorsal skin defect in the fourth toe in two cases.The defect area was about 2.5 cm × 1.5 cm-4.5 cm × 2.0 cm.The perforator-based intermediate dorsal pedal flap with vessels of cutaneous nerve nutrition was designed on the lateral dorsum of the foot and then was incised and transferred to repair the forefoot wound based on its surgical anatomy.The time of surgery and the amount of intraoperative blood loss were recorded.An observation was done on feeling,appearance,texture,blood supply and survival of the flap as well as swelling,hypertrophic scar,itching,paralysis of the skin grafting area.The recovery of the activity function was assessed by American Orthopedic Foot & Ankle Society (AOFAS) score.Results The surgery time was 1.0-1.5 h (mean,1 h),and intraoperative bleeding was about 50 ml (range,30-100 ml).Seven cases of perforator-based dorsal medial skin flap with vessels of cutaneous nerve nutrition all survived,with early wound healing.After 2 to 15 months follow-up,two-point discrimination of flaps was 9-15 mm(average,12.5 mm).Skin flaps were with excellent texture and without swelling,the color of which was close to normal color with good appearance.The postoperative foot did not have bone resorption,wound infection,tendon adhesion,line-type or flaky scar left locally,lower limb walking dysfunction or other complications.Patients were satisfied with the functions of donor and recipient sites and the appearance of the flap.Conclusions Perforation-based dorsal flap with vessels of cutaneous nerve nutrition has high survival rate,satisfaction of appearance and fast recovery of recipient site,with no obvious foot pain,limitation of joint movement or other complications,and therefore is a reliable method to repair soft tissue defects in forefoot.

Objective:To investigate the efficacy of different laparoscopic surgeries for gastrointestinal stromal tumors (GIST) of gastric cardia and fundus.Methods:The retrospective cohort study was conducted. The clinicopathological data of 251 patients with GIST of gastric cardia and fundus who underwent laparoscopic radical resection in 14 medical centers, including Guangdong Provincial People′s Hospital et al, from December 2007 to December 2021 were collected. There were 123 males and 128 females, aged 58(24,87)years. Observation indicators: (1) treatment; (2) clinicopathological data of patients undergoing different laparoscopic surgeries; (3) subgroup analysis for special laparoscopic techniques. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test or ANOVA. Measure-ment data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test or Kruskal-Wallis H test. Count data were described as absolute numbers or percentages. Comparison of ordinal data was conducted using the rank sum test. Results:(1) Treatment. Of the 251 patients,202 cases underwent gastric wedge resection, 26 cases underwent special laparoscopic techniques including 10 cases with serotomy and dissection and 16 cases with transluminal gastrectomy, 23 cases underwent structural gastrectomy including 6 cases with total gastrectomy and 17 cases with proximal partial gastrectomy. There were 24 patients had postoperative complications after surgery. (2) Clinicopathological data of patients undergoing different laparoscopic surgeries. The gender (male, female), age, tumor diameter, operation time, volume of intraoperative blood loss, length of incision, time to postoperative initial whole liquid food intake, time to postoperative initial semi-liquid food intake, duration of postoperative hospital stay, cases with perioperative complications, cases with mitotic count as ≤5/50 high power field, 6?10/50 high power field, >10/50 high power field, cases be classified as very low risk, low risk, medium risk, high risk according to the National Institutes of Health risk classification, cases with tumor located at fundus and gastric cardia were 93, 109, (59±11)years, 3.50(0.40,10.00)cm, 88.00(25.00,290.00)minutes,20.00(25.00,290.00)mL, 4.00(2.00,12.00)cm, 3.00(1.00,9.00)days, 4.00(1.00,16.00)days, 5.00(1.00,18.00)days, 14, 164, 31, 7, 47, 83, 50, 22, 30, 172 in patients undergoing gastric wedge resection, respectively. The above indicators were 19, 7, (49±14)years, 2.55(0.20,5.00)cm, 101.00(59.00,330.00)minutes, 27.50(2.00,300.00)mL, 4.50(0,6.00)cm, 2.50(1.00,10.00)days, 4.00(1.00,16.00)days, 6.00(1.00,18.00)days, 3, 20, 5, 1, 15, 5, 2, 4, 24, 2 in patients undergoing special laparos-copic techniques, and 11, 12, (52±10)years, 5.00(0.80,10.00)cm, 187.00(80.00,325.00)minutes, 50.00(10.00,300.00)mL, 6.00(4.00,12.00)cm, 4.00(2.00,8.00)days, 6.00(3.00,14.00)days, 8.00(2.00,18.00)days, 7, 11, 5, 7, 2, 6, 6, 9, 13, 10 in patients undergoing structural gastrectomy. There were significant differences in the above indicators among the three groups of patients ( χ2=6.75, F=10.19, H=17.71, 37.50, 35.54, 24.68, 16.09,20.20, 13.76, χ2=13.32, Z=28.98, 32.17, χ2=82.14, P<0.05). (3) Subgroup analysis for special laparoscopic techniques. The time to postoperative initial whole liquid food intake, time to postoperative initial semi-liquid food intake, classification of tumor location (endophytic type, exophytic type, parietal type) were 4.50(1.00,10.00)days, 8.00(3.00,12.00)days, 0, 8, 2 in patients undergoing serotomy and dissection, versus 2.00(1.00,4.00)days, 3.00(1.00,6.00)days, 16, 0, 0 in patients undergoing transluminal gastrectomy. There were significant differences in time to postoperative initial whole liquid food intake, time to postoperative initial semi-liquid food intake between them ( Z=-2.65, -3.16, P<0.05); and there was a significant difference in classification of tumor location between them ( P<0.05). Conclusions:Gastric wedge resection is the most commonly used laparoscopic technique for GIST of gastric cardia and fundus. The application of special laparoscopic techniques is focused on the GIST of cardia to preserve the function of the cardia.