BACKGROUND:Core decompression may provide insufficient support for the subchondral bone in the treatment of early avascular necrosis of the femoral head and increase the risk of fracture and colapse. Quadratus femoris implantation cannot only provide good biological support, but also promote the revascularization at necrotic regions, thus repairing the necrosis of femoral head. OBJECTIVE: To compare the clinical effects of core decompression with bone paste implantation and core decompression with quadratus femoris implantation on early and middle-stage avascular necrosis of the femoral head. METHODS:Eighty-three patients with early avascular necrosis of the femoral head (92 hips) admitted at the Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, China, from January 2009 to January 2012 were enroled and divided into groups of core decompression with bone paste implantation (46 cases, 49 hips) and core decompression with quadratus femoris implantation (37 cases, 43 hips) that were respectively injected with bone meal and autogenous bone and osteoinductive materials. RESULTS AND CONCLUSION: Al involved patients were folowed up. After 1 year of treatment, Harris scores in the two groups were both increased (P < 0.05). But the Harris score of core decompression with bone paste implantation group was lower than that of core decompression with quadratus femoris implantation group (P < 0.05). After 3 years of treatment, X-ray scores in the core decompression with quadratus femoris implantation group were significantly higher than those in the core decompression with bone paste implantation group (P < 0.05). These findings indicate that compared with core decompression with bone paste implantation, core decompression with quadratus femoris implantation is better to prevent femoral head colapse, improve hip function and delay the process of osteonecrosis of the femoral head.

Objective Intrahepatic biliary papillomatosis(IBP)is a rare disease that is characterized by multiple numerous papillary adenomas in the intrahepatic biliary duct(IBD).The clinical features and outcome,however,are not well known.The clinicopathologic features,treatments and follow-up results were retrospectively analyzed in order to improve the efficiency of diagnosis and treatment for the disease.Methods Between August 2006 and October 2008,9 patients were diagnosed with IBP by histological findings at a tertiary referral center,Ningbo Medical Center(University of Ningbo,College of Medicine,Ningbo,China).The authors retrospectively reviewed the medical records to obtain clinical,radiological and pathologic data.The therapeutic results and follow-up data were also reviewed.Results The ratio of male to female was 2:7 and the middle age was 59 years.Repeated episodes of fever and right upper quadrant abdominal pain with or without jaundice were the common clinical manifestations.There were intrahepatic choledocholithiasis and/or history of previous biliary operation in 8 cases.The level of CA19-9 and CEA were almost normal.Imaging workup demonstrated cyst-like dilatation of intrahepatic biliary tree with or without liver atrophy,which were more obvious in the mucin-hypersecreting IBP.All of the 9 cases underwent curative resection with an adequate resection margin.Macroscopic findings demonstrated that the tumors of 9 cases were all located in the left lobe with mucin-hypersecreting type in 7 cases.The diameter of numerous papillary granular was usually less than 10 mm(from 2 to 5 mm.frequently)and friable,that filled the dilated IHD dispersive.Fine fibrovascular cores lined by dysplastic epithelial cells were frequently found under microscope.Few foci of stromalinvasion were noticed in the two cases with malignant transformation.All of the 9 cases survived and there was no recurrence.Conclusion IBP occurs more often in middle and old women who have history of biliary disease. Repeated episodes of cholangitis are the common clinical manifestations. Extra- and intrahepatic biliary tract dilatation is the common imaging finding.MRCP/ERCP is more valuable than others in diagnosis. Clinical and histological finding shows that IBP is a premalignant disease with high malignant potential. Curative resection should be done as earlyas possible for the long-term survival rate. The use of cholangioscopy in operation and rapid biopsy of resection margin will benefit the curative resection.

Objective To investigate the impact of aging and vascular endothelial function on arterial stiff- ness in patients with isolated systolic hypertension.Methods Patients with isolated systolic hypertension (ISH,n=75)age-matched healthy subjects(n=30)and young healthy subjects(n=50)were submitted to deter- mination of aortic pulse wave velocity(baPWV)and vascular endothelial function evaluated by flow-mediated dila- tion(FMD).Results baPWV was progresively decreased(ISH:2459.2?436.8 vs elderly healthy:2097.2? 315.7 vs young healthy:1619.7?214.2 cm/s,P

Objective To investigate the difference of quality of life in patients with different symptom dimensions of obsessive-compulsive disorder(OCD).Methods Collected 54 cases of outpatient and the first inpatient with OCD to be the research group and 54 normal persons were the control group.The quality of life was assessed with SF-36,and compared the scores.An analysis was performed on the major categories of the YBOCS-SC to derive symptom dimension scores.Results Compared to the control group,patients with OCD showed significant impairment in seven domains of quality of life,especially in the mental health(t=12.474,P＜0.01),the roleemotional(t=9.407,P＜0.01),the social functioning(t=8.862,P＜0.01) and the vitality(t=8.057,P＜0.01).The patients with distinct symptom dimensions of ①symmetry/order,contribution rate 21.60％ ; ②contaminate/clean,contribution rate 16.37％; ③ aggression/religion,contribution rate 12.34％; ④ sex/check,contribution rate 10.90％.They showed different severity of the impairments in four domains of quality of life,the role-physical(F=5.199,P=0.004),the bodily pain (F=3.169,P=0.034),the role-emotional (F=9.350,P=0.000),the mental health(F=4.854,P=0.005).The differences mainly found between the ①②③group and the ④group by LSD multiple testing.Conclusion The mental health is severely damaged with OCD patients.There is stability with the structure of the symptom dimensions of OCD.And it maybe showed the heterogeneity of the symptoms for the significant difference of impairments of quality of life in patients with OCD.

Objective: To understand the situation of blood pressure control and its influencing factors in elderly patients with hypertension in Hangzhou, and to provide basis for the management of elderly patients with hypertension in community. Methods: The subjects of this study were hypertension patients aged 60 years and over in Hangzhou community health management of basic public health services. Demographic data and life behaviors were collected by a questionnaire survey, physical examination and laboratory tests were carried out. The multivariate logistic regression model was used to analyze the influencing factors for blood pressure control in elderly patients with hypertension. Results: A total of 109 583 people were investigated, with 50 500（46.08%） males and 59 083（53.92%） females. The control rate was 47.70% ( 52 273/109 583 ). After adjusted for age and gender, regular medication ( OR=0.874, 95%CI: 0.838-0.912 ) was the protective factor, obesity ( OR=1.291, 95%CI: 1.260-1.324 ), abnormal fasting plasma glucose ( OR=1.218-1.344, 95%CI: 1.178-1.410 ), the number of unhealthy lifestyles ( OR=1.271-1.292, 95%CI: 1.231-1.344 ), the items of dyslipidemia ( OR=1.047-1.253, 95%CI: 1.017-1.311 ), and the number of cardiovascular risk factors above ( OR=1.254-2.109, 95%CI：1.175-2.281 ) were the risk factors for blood pressure control in elderly patients with hypertension. Conclusions The control rate of elderly patients with hypertension in Hangzhou is 47.70%, which is associated with irregular medication, unhealthy lifestyle, obesity, dyslipidemia, abnormal fasting plasma glucose and clustering of these factors.

Ulcerative colitis (UC) is a chronic inflammatory disease and its involvement area in colon is influenced by a complex network of gene interactions.We analyzed the weighted gene co-expression networks in microarray dataset from colonic mucosa of patients with UC and identified one gene co-expression module that was highly associated with the progression of involved area in UC colon (Pearson coefficient=0.81,P＜0.0001).In total,523 hub genes in this module were found to be involved in immune system process after enrichment analysis in Gene Ontology.By the STRING and Cytoscape analysis,we observed that interleukin-8 (IL-8) and matrix metalloproteinase-9 (MMP-9) were centered in the network of hub genes.We then detected the expression of IL-8 and MMP-9 in mucosa from left-sided colon of patients using quantitative PCR and immunofluorescence assay respectively.Both quantitative PCR and immunofluorescence assay revealed the expression levels of IL-8 and MMP-9 were significantly different among the healthy controls,left-sided colitis group and pancolitis group (P＜0.05).IL-8 and MMP-9 were detected with an enhanced expression in pancolitis as compared with left-sided colitis and healthy controls,respectively (P＜0.05).This study demonstrates that immune system process is indispensable in the progression of disease in colon,and identifies that IL-8 and MMP-9 play potential critical roles for the progression.

This paper is a follow-up study of 329 children in factory-run nurseries in urban Shanghai. The investigation lasted for a period of one year for each index-child, focusing on the conditions of nutrition, development and diseases of the children of various ages.Comparison between nutritionl findings and RDA of China disclosed that calorie intake of most of the index-child groups were 80-85% of RDA, the only exception being the 6-12 months group where the average calorie intake showed 90%. Protein intake of all groups was over 80% of RDA. Fe intake was lower than RDA, except for 18-month-old and over.Weight and height of the children were compared with the anthropo-metric data established in 1985 (1985 data) for Shanghai children under six years of age. It was found that the average weight and height appeared differently according to their age. Average weight of children under one year old was slightly higher than 1985 data, while average height was lower than 1985 data once the children reached 10 months old. Average weight, however, became lower than the 1985 data after the children were two years old. Over 60% of the index between 6-18 months old suffered from anemia (IDA).Accordingly, it is requested that calorie and iron intake should be supplemented.

Objective To explore the effect of self hypnosis therapy on alleviating nurses'psychological pressure.Methods 120 nurses of Chinese PLA General Hospital were investigated and randomly divided into the observation group and the control group,each with 60 nurses.The observation group was treated with self hypnosis therapy while the control group received traditional psychological support therapy.SDS scale and MBI-GS scale were used to investigate two group' s degree of depression and tiredness before intervention and after 4 weeks of intervention.Results There was no difference in both SDS scale and MBI-GS scale between two groups before intervention (P ＞ 0.05).After 4 weeks of intervention,the overall score of SDS scale was (47.52 ±7.81) in the observation group,obviously lower than that in the control group which was (50.37 ± 4.33),and the difference was statistically significant (t =2.467,P ＜ 0.05).The scores of three dimensions in MBI-GS scale in the observ ation group were:(21.28 ± 4.42) for emotional exhaustion,(5.65 ± 1.76) for depersonalization and (33.28 ± 7.69) for personal accomplishment,all of which were lower than those in the control group [(24.58 ± 5.34),(6.76 ± 1.99),(30.34 ± 6.75),respectively].And the differences were statistically significant (t =3.688,3.236,2.226,respectively; P ＜ 0.05).Conclusions Self hypnosis therapy can effectively alleviate nurses' psychological stress,and improve their mental health.

Objective To discuss the methods of perioperative care for patients with esophageal achalasia (EA) under peroral endoscopic myotomy (POEM) treatment.Methods 21 patients received nursing including preoperative health education,postoperative care,complication observation and discharge guidance.Results All 21cases of patients with EA successfully underwent POEM.3 months after operation,their Eckardt score was (1.8 ± 1.2) and LES pressure was (21.4 ± 8.6) mm Hg,both were obviously lower than before [(9.8 ±1.3) and (58.1 ± 13.5)],and the differences were statistically significant (t =34.384,15.069,respectively;P ＜ 0.05).And patients' average weight increased (6.1 ± 2.6) kg compared with before,the differences were statistically significant (Z =-3.742,P ＜ 0.05).The rate of fever was 52.3％,chest pain was 76.1％,aerodermectasia in the cervico-thoracic region was 9.5％,aerothorax was 4.7％,and no complications concerning hemorrhage of digestive tract.The successful rate of POEM was 100％.Conclusions Improving perioperative care of patients with EA is important to ensure a successful operation,which can promote the rehabilitation,reduce the recurrence,and enhance patients' quality of life.

Objective To explore the effectiveness and safety of the improved preoperative guidance on bowel preparation in elderly patients undergoing colonoscopy .Methods One hundred and twenty elderly patients undergoing colonoscopy were randomly divided into the observation group and the control group , each with 60 cases.The patients all received the non-residue diet three days before examination , liquid diet at the dinner one day before examination , fasting at the day of examination , and the sodium phosphate oral solution as the purgation medicine .The observation group received the improved preoperative guidance , and the control group received the conventional preoperative guidance .The quality of bowel preparation , the incidence rates of adverse reactions including nausea and vomiting , and the variabilities in blood pressure , heart rate and respiration were observed .Results The cases of patients who were pleased with the quality of bowel preparation were 53 cases in the observation group , and were significantly higher than 40 cases in the control group , and the difference was statistically significant (χ2 =8.0765, P <0.01 ).The incidence rates of adverse reactions including nausea and vomiting in the observation group were significantly lower than those in the control group , and the differences were statistically significant (χ2 =11.116 6, 13.330 8, 10.108 6, 7.529 4, respectively;P<0.01).No differences were found in the blood pressure , heart rate and respiration before the examination in two groups (P>0.05);The blood pressure, heart rate and respiration in the observation group were lower than those in the control group after the examination, and the difference was statistically significant (P<0.01). Conclusions The improved preoperative guidance is more effectiveness and safety in bowel preparation in elderly patients with colonoscopy , and has important clinical significance .