-mid stage ONFH. It provided good blood supply and enough mechanical support as to reduce the progress of femoral head collapse.

Objective On the basis of the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ), to establish and appraise a new prognostic evaluation system for elder patients with respiratory failure undergoing mechanical ventilation in order to predict hospital mortality in the respiratory intensive care unit. Methods Two hundred and thirty-eight senile patients with respiratory failure having had mechanical ventilation during their hospitalization were retrospectively analyzed. Patients were randomly divided into 2 groups: model group (n=138) and validation group (n=100). Data of model group were analyzed by monofactorial and multifactorial regression analysis to screen the risk factors. Risk factors were given numerical values according to different grades, and complementary scoring system was then established. APACHE Ⅱ system was combined with complementary scoring system with Logistic multiple regression to form SRFMV system, a special evaluation system for the senile patients with respiratory failure undergoing mechanical ventilation. One hundred patients from validation group were evaluated by both SRFMV system and APACHE Ⅱ system, and the results were then compared to assess the validity and reliability of SRFMV system. Oxygenation index, positive end expiratory pressure (PEEP), tidal volume, phlegm quantity and character, and pulmonary auscultation were selected to serve as standard for complementary scoring system. Mortality equation was set up with logistic multiple regression analysis. Results The predication sensitivity and specificity evaluated by SRFMV system in validation group (0.878 and 0.821, respectively) outstripped that evaluated by APACHE Ⅱsystem (0.818 and 0.771, respectively); the area under ROC curve in SRFMV system and the X2 value in Lemesshow-Hosmer statistic (0.911 and 13.77, respectively) also outstripped that in APACHE Ⅱsystem (0.860 and 11.808, respectively). Conclusions SRFMV system is of better sensitivity and specificity, in which the prediction of mortality is closely consistent with the reality. SRFMV system can be applied to obtain valid predictions of relevant outcomes in senile patients with respiratory failure underwent mechanical ventilation.

BACKGROUND: A discussion is ongoing whether the elderly patients with femoral neck fractures should be treated with a non-cemented or a cemented hemiarthroplasty.OBJECTIVE: To evaluated the results of cemented hemiarthroplasty for femoral neck fractures in the patients older than 85 years with high-risk clinical problems and functional outcomes.METHODS: Thirty-two patients with femoral neck fractures were treated with cemented bipolar hemiarthroplasty. X-ray examination after operation was done at 1, 3 and 6 months and annually in all patients. The mean follow-up period was 2 to 5 years.RESULTS AND CONCLUSION: Medical complications occurred in five patients (16%) and four patients (25%) died within the follow-up period. Dislocation occurred in one patient (3%). None of the patients had heterotopic ossification. The mean Harris-hip score was 84. Cemented hemiarthroplasty can provide stability, security and good outcomes for the treatment of femoral neck fractures in elderly patients.

Objective To study the effect of repairment of articular cartilage defects in non weight-bearing area of rabbit with bone marrow-derived mesenchymal stem cells (BMSCs) seeded on human acellular amniotic membrane (HAAM).Methods From July 2012 to March 2013,bone marrow-derived mesenchymal stem cells were isolated and purified from rabbit in vitro.The cells were seeded on human acellular anniotic membrane at the concentration of 1.63 × l05/cm2.From 7 days to 8 days after cultured,the complexes of BMSC and HAAM were examined under electronmicroscope,light microscope and by HE stain.Full thickness empty defects measuring 4 mm in diameter by 3 mm depth were prepared in femoral intercondylar fossa of 24 rabbits.The rabbits were randomized into two groups:group A and group B with 12 each group.The defects of right knees were served as control and the left as experimental group.BMSCs/HAAM composite was cultured and then transplanted into the defect of left knee joint in group A as group BMSCs/HAAM and HAAM into group B as group HAAM.These rabbits were killed at 4 and 12 weeks after surgery in each group and the newly cartilage samples were evaluated grossly,histologically are graded.Results In the 4th and 12th week after the operation,the regenerated tissue were white,soft and smooth.Chondrocytes were found in the tissue In the 12th week,the morphology,distribution and arrangement of the regenerated tissues were similar to normal cartilage in the knees with HAAM-BMSCs transplantation.The regenerated tissues grew to be integrated with the surrounding normal cartilage with obscure boundary between them.Chondrocytes were found in all layer of the tissue,surrounding normal cartilage with obscure boundary between them.In the HAAM transplantation,the rough surface of regenerated tissue sunk obviously and the fibmblasts in all layer were found.While there were no regenerated tissue in the control side.Conclusion BMSCs seeded on HAAM could repair the articular cartilage defects of femoral intercondylar fossa from rabbits.

BACKGROUND: An important development orientation of osteomyelitis treating is to prepare a drug delivery system which has the characteristics of excellent biocompatibility, degradable, lengthen drug-released time, source sufficient, as well as use security. Alginate and chitosan can be used as drug delivery system due to the superordlnary biological properties. OBJECTIVE: To explore the feasibility and safety of alginate/chitosan incorporated vancomycin (VCM/ACA) as release carrier, in addition, to compare the difference from systematic injection. DESIGN, TIME AND SETTING: An in vivo drug concentration determination, matching grouping experiment. The experiment was performed at the animal and orthopedics laboratories, Affiliated Zhongshan Hospital of Dalian University from August 2008 to March 2009. MATERIALS: The alginate solution and vancocin solution was uniform mixed followed by adding CaCO_3 and citrate sodium solution, then the mixed liquor was prepared for vancocin-calcium alginate gel beads with microcapsule preparation instrument. After that, the vancocin-calcium alginate gel beads were reacted with chitosan/vancocin mixed liquor and cellulose acetate to prepare for VCM/ACA release carrier. METHODS: Forty rabbits were prepared for middle of left femur bone defect models, and then randomized divided into 2 groups, with 20 animals in each group. In the local medication group, VCM/ACA release carrier was inlaid to the defects. In the systemic administration group, rabbits were intravenous injected 10% vancocin (10 mg/kg). MAIN OUTCOME MEASURES: The drug concentrations in the serum and bone tissues of the local medication group was detected by high performance liquid chromatograph at hours 0.5, 1, 6, 24, 72 and weeks 1, 2 after operation. In the systemic administration group, the drug concentrations in the serum, bone and muscle tissues were measured at minute 10 and hours 0.5, 1, 6, 24, and 72 after operation. In addition, histological sections of body tissues were prepared to look for signs of systemic toxicity of the implants. RESULTS: The serum drug concentrations of the systemic administration group were obvious greater than the local medication group at each time points prior to 24 hours, which less than the local medication group at hour 24. The drug concentration in bone and muscle tissues of local medication group were significant greater than the systemic administration group at different time points, which sustained for at least 2 weeks, while serum concentration in the systemic administration group was much lower than minimum inhibitory concentration after 24 hours. However, no multiple tissues revealed histological evidence of toxicity. CONCLUSION: There has feasibility and safety in vivo in course of ALM/VCM release carrier, which has superior effect to systemic administration.

Objective To explore the clinical outcome of vascularized iliac bone flap combined with tantalum rod implantation for the treatment of osteonecrosis of the femoral head (ONFH).Methods Totally 28 cases (36 hips) of non traumatic avascular necrosis of the femoral head patients from January 2010 to January 2011,which were 15 males and 13 females; a mean age of 40 years (ranged,18-53years),according to ARCO stages:eight hips of stage Ⅱ a,ten hips of stage Ⅱ b,nine hips of stage Ⅲ a,nine hips of stage Ⅲ b,adopt to vascularized iliac grafting combined with tantalum rod Implantation for osteonecrosis of the femoral head.The Harris hip score and VAS score of pre-and post-operation was recorded to evaluate the clinical outcome,and to compare observe and analyze the change of postoperative of patients by used three-dimensional gait.Results All 28 cases (36 hips) were followed up 6 ～20 months,averaged 12 months.The results of Harris hip score and VAS score of the 6 months postoperatively and last follow-up were significantly higher than preoperative ones (P ＜0.05).And the Harris hip score of the last follow-up was also significantly higher than the one of 6 months postoperatively (P ＜ 0.05).However,there was no significant different in that of VAS score (P ＞0.05).There were 13 cases in excellent,fourteen in good and 4 in fair with an excellent and good rate of 89.8％,which shows that the extension of time and changes in patients gait tends to normal by three-dimensional gait analysis.Conclusion Vascularized iliac bone flap transplantation combined with tantalum screw was an effective method with high clinical success rate for treatment of younger patients with early-mid stage ONFH.It provided good blood supply and enough mechanical support to reduce the progress of femoral head collapse.

Objective: To investigate the value of pulse indicator continuous cardiac output (PiCCO) monitoring in the treatment management of patients with severe heart failure. Methods: Sixty patients of severe heart failure admitted to intensive care unit (ICU) of Fujian Provincial Hospital from August 2017 to February 2019 were enrolled, and they were divided into control group and treatment group according to random number table method, with 30 in each group. The treatment group used bedside PiCCO to carry out minimally invasive hemodynamics monitoring, according to the monitoring data target guidance for vasoactive drugs and liquid management. The control group was based only on traditional electrocardiogram (ECG) monitoring and lung sound, urine volume of vasoactive drugs and liquid management. The changes of cardiac index (CI), global end diastolic volume index (GEDVI), extravascular lung water index (EVLWI), systemic vascular resistance index (SVRI), invasive mean arterial pressure (MAP) and central venous pressure (CVP) were observed before and 72 hours after treatment in the treatment group. The 7-day total effective rate, the length of ICU stay and 28-day mortality were compared between the two groups. Results: Compared with before treatment, CI and MAP in the treatment group were significantly increased after treatment [CI (mL·s^-1·m^-2): 53.34±16.67 vs. 35.01±13.34, MAP (mmHg, 1 mmHg = 0.133 kPa): 72.6±10.6 vs. 62.5±10.3, both P < 0.05], GEDVI, EVLWI, SVRI, CVP were significantly decreased [GEDVI (mL/m²): 760.3±90.2 vs. 960.2±110.3, EVLWI (mL/kg): 6.5±1.3 vs. 12.5±6.2, SVRI (kPa·s·L^-1·m^-2): 297.3±35.1 vs. 434.1±58.8, CVP (mmHg): 10.1±2.6 vs. 12.2±3.4, all P < 0.05]. Compared with the control group, the 7-day total effective rate of the treatment group was significantly higher (90.0% vs. 80.0%), the length of ICU stay was significantly shorter (days: 8.2±4.5 vs. 10.3±2.5), and the 28-day mortality was significantly lower, with statistically significant difference (all P < 0.05). Conclusion PiCCO monitoring is a goal-oriented treatment management for patients with severe heart failure, which is helpful to individualized accurate treatment, shorten the length of ICU stay and improve short-term prognosis.

Objective To evaluate the safety and accuracy in treating the avascular necrosis of femoral head (ANFH) with computer navigated core decompression and bone marrow stream cell transportation and to guide the clinical treatment. Method Within the prospective study, 36 patients suffered ANFH (ARCO Ⅰ - Ⅱ ) and treated with computer navigated core decompression and bone marrow stream cell transportation were studied. The operating time, blood loss, x ray exposure, preoperative and 6 week postoperative Harris score and imaging evaluation were recorded and compared with conventional core decompression and bone marrow stream cell transportation. Results There were no obvious difference between the two groups in imaging evaluation, operating time and blood loss ( P ＞ 0. 05 ). There were statistical difference between the two groups in x ray exposure and 6 week postoperative Harris score [ (4. 1 ± 1.8 ) s,(13.6±3.2)s,P ＜0. 01,and89.4±10. 1,83.1±10. 5, P ＜0.01]. Conclusion Computer navigated core decompression and bone marrow stream cell transportation have good security and precision in treating early stage ANFH.

OBJECTIVETo determine the optimal fertilization method for primary infertility patients without definite causes undergoing in vitro fertilization and embryos transfer (IVF-ET).

METHODSA total of 321 IVF-ET cycles for primary infertility without definite causes were divided into two groups, namely group A with infertility period ≥ 5 years (165 cycles) and group B with infertility period <5 years (156 cycles). Each group was further divided into IVF, ICSI, and partial ICSI subgroups. The fertilization rate, incidence of low fertilization rate and clinical pregnancy rate were analyzed.

RESULTSThe fertilization rate of IVF in group A was 67.5%, significantly lower than that of ICSI and partial ICSI in the same group (82.0% and 77.7% respectively) and that in IVF control group (76.3%, P<0.05). The incidence of low fertilization rate of IVF in group A was 33.3%, significantly lower than that of ICSI and partial ICSI (8.3% and 15.8%, P<0.05); in group B, the incidence of low fertilization rate of IVF was 12.3%, significantly lower than that of IVF in group A but showed no significant differences from that of ICSI and partial ICSI in group B (P>0.05). In group A, IVF resulted in a significantly lower clinical pregnancy rate (21.1%) than ICSI (43.3%, P<0.05), half ICSI (40.0%, P<0.05), IVF in the control group (48%, P<0.05), and IVF in group B (50.0%, P<0.05).

CONCLUSIONICSI treatment can increase the fertilization rate in IVF-ET cycles in patients with primary infertility for unknown causes, and may improve the clinical outcome of patients with long infertility period.

Adult ; Embryo Transfer ; Female ; Fertilization in Vitro ; methods ; Humans ; Infertility ; therapy ; Male ; Ovulation Induction ; Sperm Injections, Intracytoplasmic ; Young Adult

Objective To explore the effect of expressive writing intervention on social support,resilience and school maladjustment in university freshman.Methods Selecting the freshmen volunteer of 600 university freshmen of Shandong,through the scale before the test recovery and comprehensive scoring chosen the part of low grade college students as the intervention object and were divided into writing expression(n=60) person and control group(n=60).The intervention group received a positive subject writing expression and the control group in the normal writing.Before and after the intervention tested the social support rating scale,the resilience scale for Chinese adolescents and the the student adaptation to college questionnaire were tested to evaluate the effect of active writing expression intervention.Results (1)After intervention,the intervention group and the control group had significant differences among the scales,objective support (t =-2.36,P＜0.05),learning adaptation(t=-1.98,P＜0.05) and subjective support (t=-2.56,P＜0.05),target focus(t=-2.66,P＜0.01),emotional control(t=-2.81,P＜0.01),family support (t=-3.46,P＜0.01),adaptation (t=-2.73,P＜0.01),support utilization (t=-5.91,P＜0.01) and social support score (t =-4.04,P＜ 0.01),positive cognition (t=-2.73,P＜0.01),interpersonal assistance (t=-3.13,P＜0.01),resilience score (t=-7.40,P＜0.01),life adaptation (t=-3.83,P＜ 0.01),emotional state (t =-3.39,P＜ 0.01),and school adaptation score (t=-3.46,P＜0.01).(2)There was no significant difference in objective support between the control group before intervention and after intervention.In addition,the remaining dimensions such as subjective support (20.72±2.46,22.96±2.81,t=4.54,P＜0.01),support utilization (7.49± 1.40,9.86± 1.90,t =7.56,P＜0.01) and social support score (36.79±4.24,41.89±5.18,t=5.76,P＜0.01) were significantly increased.The intervention group had significant difference among target focus (15.98±2.86,17.89±3.35,t=3.28,P＜0.01),emotional control (14.98±2.77,15.70±2.71,t=3.35,P＜0.01),positive cognition (14.61 ± 2.04,16.26±3.09,t=3.36,P＜0.01),interpersonal assistance (15.30±2.44,17.49±2.73,t=4.52,P＜0.01),resilience score(77.65±6.01,88.25±5.74,t=9.63,P＜0.01) and family support(16.77±2.28,19.58± 2.44,t =6.35,P＜ 0.01).In the intervention group of school adaptation scale,life adaptation (40.44± 6.36,45.12± 7.21,t=3.68,P＜0.01),emotional state (34.04±6.99,38.84±5.95,t=3.95,P＜0.01) and school adaptation score (145.21 ±22.86,160.51±21.78,t=3.66,P＜0.01),interpersonal assistance (32.30±5.34,35.23±5.18,t=2.98,P＜0.01),learning adaptation (38.44±7.06,41.32± 5.92,t=2.36,P＜0.05) were significantly increased.Conclusion Written expression intervention has a positive effect on improving the low level of social support,the poor resilience and freshman's adaptation to college.