Objective To explore and analyze the optimal timing of surgery and clinical efficacy of minimally invasive drilling drainage in the treatment of hypertensive cerebral hemorrhage .Methods 150 patients with hyperten-sive cerebral hemorrhage ,according to a random number table method ,were randomly divided into the three groups , 50 patients in each group.Patients in group A received minimally invasive drainage drilling within 6h after the onset of disease,patients in group B received minimally invasive surgery 6-24h after the onset,patients in group C were given elective minimally invasive surgery 24-72h after the onset.Another 50 patients with hypertensive cerebral hemorrhage who received craniotomy surgery over the same period ,were selected as the control group .The clinical effects were observed and compared in four groups .Results The total effective rate of group B was 88%,which was significantly higher than the other three groups (χ2 =4.00,6.38,12.70,all P<0.05).The early cure rate of the observation group was 40%,which was significantly higher than the control group (χ2 =8.57,P<0.05).After treatment,the number of cases whose activities of daily living degree recovered to grade I in the observation group was significantly higher than the other three groups (χ2 =4.11,5.00,8.32,all P<0.05).The excellent rate of group B was 88%(44/50),which was significantly higher than the other three groups (χ2 =6.83,5.83,15.43,all P<0.05).After treatment,the incidence rate of complications in group B was significantly lower than the other three groups ,the inci-dence rate of complications in the control group was the highest (χ2 =5.32,8.58,32.97,all P<0.05).Conclusion Minimally invasive drilling drainage in the treatment of hypertension cerebral hemorrhage can obtain significant effect , the optimal timing of surgery is 6-24h,minimally invasive treatment has advantages of less invasive ,faster recovery,fe-wer complications ,and less costs ,which is worthy of widely used in clinical practice .

OBJECTIVETo investigate the clinical value of pleural biopsy in the etiological diagnosis of pleurisy in children.

METHODTotally 213 cases with pleurisy, who underwent pleural biopsy and hospitalized in Children's Hospital of Chongqing Medical University from January 2007 to April 2014 were enrolled into this study. Clinical symptoms, imaging manifestations, pleural fluid characteristics, the results of pleural biopsy and postoperative complications were retrospectively analyzed to evaluate the clinical value and security of pleural biopsy in making the etiological diagnosis of pleurisy.

RESULT(1) Of the 213 cases, 144 were boys and 69 were girls, their mean age was (6. 5 ± 4. 1) years. (2) Two hundred and thirteen patients had a surgical pleural biopsy under general anesthesia, the cause of 97 cases (45. 5%) were made clear by histopathological examination, including 35 purulent pleurisy, 55 tuberculous pleurisy and 7 paragonimus infection. For the remaining 83 (41. 3%) cases a final diagnosis was made based on the full analysis of clinical data, including 63 cases of purulent pleurisy, 3 cases of tuberculous pleurisy and 17 cases of paragonimiasis pleurisy but for 33 patients no exact cause was found at the end. (3) The mean operating time of the biopsy was (1. 4 ± 0. 6) hours. Seventy one (33. 3%) patients required blood transfusion during or after the operation. Thirty one (14. 6%) cases used the ventilator after surgery, and the ventilator supporting time was (6. 6 ± 5. 8) hours on average. The wound healing reached grade A in 200 cases (93. 9%), grade B in 13 cases (14. 6%). Postoperative complications included pneumothorax in 92 cases (43. 2%), subcutaneous emphysema in 18 cases (8. 5%), bronchopleural fistula in 3 cases(1. 4%). The average days of hospitalization was (17. 7 ± 7. 1) d.

CONCLUSIONPleural biopsy is of great diagnostic value in the etiological diagnosis and differential diagnosis of pleurisy in children, and it is considered reasonable to be used in the clinical practice when appropriate.

Biopsy ; Child ; Diagnosis, Differential ; Female ; Humans ; Infection ; diagnosis ; Male ; Pleura ; Pleurisy ; diagnosis ; etiology ; Retrospective Studies ; Tuberculosis, Pleural ; complications ; diagnosis

In order to improve the Chinese medical students' ability to gain the latest medical information and adapt the development of modern medical education,we carried out bilingual teaching of Urology in undergraduate students.Based on students English level,we teach students step by step in accordance with their aptitude and build English study group.The practice shows that we will achieve better teaching effect if we sum up our experiences constantly.

AIM: To observe the clinical efficiency of intravitreal conbercept on diabetic macular edema(DME).METHODS: This was a single arm, open-babel prospective study.Twenty eyes from 20 patients (12 males and 8 females) with DME diagnosed by fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) were enrolled.Before the injection, best-corrected visual acuity (BCVA) of early treatment of diabetic retinopathy study (ETDRS), non-contact tonometer, ophthalmoscope, fundus photography, fundus fluoresein angiograph (FFA), and OCT were examined.All affected eyes were treated with intravitreal conbercept 0.05mL (10mg/mL).Patients were followed up for 6 to 11mo, with a mean duration of 8.55±1.96mo.Post-treatment BCVA, CMT, leakage of macular edema and complications were compared with baseline using repeat analysis.RESULTS: The initial average visual acuity (ETDRS letters) were 43.35±17.45, range from 9 to 70.The initial average central macular thickness (CMT) was 576.30±167.92μm, range from 337 to 987μm.The mean BCVA showed significant improvement during 1, 3, 6mo post-treatment and the latest follow up, with a mean increase of 11.2±5.9, 13.8±7.9, 15.7±6.8 and 14.7±8.6, respectively (P<0.01).The changes of BCVA between before and at 1mo after treatment were different compared with the changes between before and at 6mo (P<0.01).During the latest follow up, the mean BCVA was obviously improved in 10 eyes (50%), improved in 7 eyes (35%), stable in 3 eyes (15%).Likewise, the mean CMT significantly decreased during the follow-up period with a mean CMT reduction of 183.8±159.5, 292.9±169.0, 271.4±167.2 and 286.4±166.9μm respectively (P<0.001).The CMT at 1mo were different with that 3, 6mo and final follow-up (P<0.01).During the latest follow up, macula lutea leakage disappeared in 6 eyes (30%), decreased in 12 eyes (60%) and increased in 2 eyes (10%).No adverse events such as secondary retinal detachment or endophthalmitis were found during the follow-up.CONCLUSION: Intravitreal conbercept significantly improve visual acuity and macular edema exudation.

?Objective: To study the effects of endogenous bone morphogenic protein 2(BMP 2) and 6(BMP 6) in rat facial nerve after injury. Methods: Facial nerve trunk was cut and then anastomosed in 30 adult male Sprague Dawley rats,another 6 rats without operation were used as the controls. Every 6 rats were killed 6 ,72 h,1, 2 and 4 weeks respectively after operation and nerve specimens were immunohistochemically examined for BMP 2 and BMP 6 expression. Result:In the control nerve the gray level of BMP 2 and BMP 6 were 210.89?8.21 and 232.03?9.25 respectively. 6, 72 h,1, 2 and 4 weeks after operation the gray level of BMP 2 were 242.83?11.01,240.67?7.91,234.46?5.28,232.12?7.27 and 220.71 ?10.19;that of BMP 6 210.75?5.19,204.08?10.85,198,91?8.58,186.37?4.11 and 184.62? 8.45 ,respectively. Conclusion: BMP 2 may play a role in the early irritable actions when facial nerve was injured. However, BMP 6 might have functions in the regeneration of facial nerve during later period after injury.

Objective: To find out the effect of mineralization condition medium on bone marrow stromal cells(MSCs) proliferation,differentiation and the secretion of extracellular matrix. Methods: MSCs of the third passage were induced by minerlization condition medium (?=10%FBS,10 nmol/L dexamethasone,50 mg/L L-vitamin C and 10 mmol/L ?-sodium glycerophosphate in DMEM). The control cells were cultured in DMEM with ?=10% FBS. The cells were observed by inverted microscope. The proliferation status and alkaline phosphatase level of cells were investigated with MTT assay. Mineralization potential was studied by Von-Kossa staining. TypeⅠ,type Ⅲ collagen and BMP synthesis were examined by immunohistochemistry stains. Results:The proliferation of MSCs in mineralization condition medium was decreased, but ALP level was increased(P

BACKGROUND: The urinary fistula rates following kidney transplantation are varying in each center, which lack of unified classification criteria and treatment standard. OBJECTIVE: To explore optimal treatments for urinary fistula following kidney transplantation by retrospective analyzing the characteristics, etiological factors and therapeutic efficacy of urinary fistula. METHODS: Totally 68 patients with urinary fistula were collected, including 42 males and 26 females, aged 21-57 years. The urinary fistula occurred at days 1-17 after operation. According to the location of urinary fistula, patients were divided into stomas fistula and ureter fistula groups. The location of fistula was determined by cystography, magnetic resonance hydrography (MRH) or operation research. In both groups, conservative treatment was first adopted, namely, placing a negative pressure drainage tube draining the wounds and placing a double-J catheter or a urinary canal in, however, if invalid, a surgical repair was performed. There were 45 patients underwent surgery. The location, onset period, therapeutic efficacies of urinary fistula was analyzed. RESULTS AND CONCLUSION: Among the 68 cases of fistula, 20(29.4%) were stomas fistula and 48 (70.6%) were ureter fistula. The onset period was (5.1±2.5) and (8.8±5.5) days after transplantation, respectively (P < 0.05). Fifteen of 20 stomas fistula (75.0%) were cured successfully by conservative treatment. Whereas, for the remaining 5 cases (25.0%), we attempted open surgery, among which 4 were cured, free of recurrence, and 1 case underwent nephrectomy because of acute rejection. For the 48 cases of ureter fisula, only 8 (16.7%) were cured by conservative treatment, but the other 40 (83.3%) must accept further open surgery, among which 35 were cured (including 6 cases of recurrent fistula). Three cases underwent nephrectomy failure of repair owing to acute rejection, besides 2 died of pulmonary infection. The achievement ratio of conservative treatment in lower fistulae was significantly higher than that of upper fistulae (P < 0.01). It is necessary to determine the location of urinary fistula following kidney transplantation. Compared to ureter fistula, stomas fistula occurred earlier with great leaked volume. Conservative treatment can first selected for stomas fistula, only if it is invalid can we resort to open surgery. However, for. ureter fistula, it is wise to adopt open surgery as soon as possible.

Objective To investigate the value of remifentanil IV PCA joint doula in labor analgesia.Methods 480 single fetus at term vaginal delivery of maternal patients were randomly divided into four groups:120 cases voluntary implementation of remifentanil IV PCA joint doula maternity paternity were selected as the experimental group; 120 cases in control group an order to carry out the studies in our hospital childbirth select one to one Doula paternity maternal; 120 cases voluntary implementation of the control group 2 intravenous analgesia with remifentanil maternal;120 cases in control group three normal deliveries in our hospital does not take any measures of maternal.The analgesic effect,labor time,postpartum hemorrhage,cesarean section rate,neonatal asphyxia,the medical staff satisfaction were compared in four groups.Results Analgesic effect of experimental group and control group 2 was significantly better than the control group 1 and the control group 3,the differences were statistically significant (t =4.34,4.76,4.94,5.32,6.32 ;4.42,4.71,4.86,5.28,6.26,all P ＜ 0.05).The first,second,third labor stage of experimental group were (516 + 123)min,(29 + 10)min,(8 + 4)min,which were shorter than those of the other groups (t =3.76,4.21,4.18,all P ＜ 0.05).Conclusion Remifentanil IV PCA joint Doula is safe and easy for labor analgesia.

BACKGROUND: Present existed procedure protocol for urinary fistula has some limitations, which can not reflect diseased region, pathological change, or severe condition of patients, OBJECTIVE: To establish the procedure protocol for urinary fistula diagnosis and treatment following renal transplantation, in addition, to investigate its significance in clinical practice. METHODS: A total of 102 cases with urinary fistula, including 67 male and 35 female, range in age from 21 to 57 years. According to the business management mode, we have designed the "five-step procedure protocol" for the diagnosis and treatment of urinary fistula after renal transplantation. Four diagnosis steps consisting of qualitative, located, quantitative and classified, as well as one treatment step. Among 102 cases of urinary fistula, 34 were adopted conservative treatment, including 24 cases with drainage tube and retention type catheter, 10 cases with indwelling ureteric stents at tubal bladder. Other 68 cases received surgical treatment. In 47 cases with simple fistula, 36 cases received ureter/bladder replantation, 11 cases with ureteral anastomosis. Twenty-one cases with complex fistula were treated with surgical prosthesis using omentum majus after repairing. RESULTS AND CONCLUSION: Among the 34 cases receiving conservative treatment, 2 got urinary tract infection repeatedly, and 5 got the stenosis of ureterovesical anastomotic stoma. Among the 68 cases receiving surgical treatment, 2 had ureteral stoma stricture, 1 ureterovesical anastomotic stoma stricture, and 1 ureteral countercurrent. In the surgical treatment series, 3 cases died from severe pulmonary infection elicited by urinary fistula. 77 cases were available for long-term follow-up, 22 were dropped out. In the 57 cases with simple fistula were followed up for 1-10 years, the transplanted renal function was normal in 40 cases, and 17 cases suffered from chronic rejection. 20 cases with complex fistula treated with surgical prosthesis using omentum majus were followed up for 1-7 years, 19 cases were normal, 1 patient had increased creatinine, which was returned to normal after intravenous glucocorticoid therapy. The design of "qualitative, located, quantitative and classified" standard for urinary fistula diagnosis following renal transplantation, and the establishment of "five-step procedure protocol", make urinary fistula diagnosis and treatment more ordered and standard, which is more feasible for selecting optimal therapeutic scheme.

This study established a finite element (FE) model of human body head (HBM-head) in accordance with human head anatomy.The anatomical structure of HBM-head was described in detail,primarily consisting of scalp,skull,dura mater,cerebrospinal fluid,pia mater,cerebrum,cerebellum,ventricle,brain stem,falx,and tentorium.The kinematic and kinetic responses,as well as the intracranial pressure distribution of the head model were compared with the data from the cadaveric impact tests to validate the head FE model.Experimental results confirmed that the head FE model had good biofidelity and could be used to study head-brain trauma in vehicle collisions and the underlying injury mechanisms.