Objective To discuss the subcutaneous hematoma of the chest wall after artificial femoral head replacement in order to improve the prognosis of patients. Methods One patient complicated with subcutaneous hematoma of the chest wall after artificial femoral head replacement on October,2009.Aborative treatment and nursing was given and the treatment effect was observed. Results The hematoma and congestion were all absorbed after two weeks of treatment and nursing. Conclusions The nursing point of subcutaneous hematoma of the chest wall after artificial femoral head replacement includes monitoring of vital signs, drainage volume, identification of anemia feature, scrupulosly systemic observation and nursing of hematoma.

Objective The aim of this study was to determine the effects of ulinastatin, a broad spectrum proteinase inhibitor, on fibrinolytic system and platelet function during open heart surgery performed with cardiopulmonary bypass (CPB) .Methods Twenty ASA Ⅰ-Ⅱpatients of both sexes undergoing cardiac surgery under CPB were randomly divided into two groups of ten patients: control group(C) and ulinastatin group (U). In group U patients received ulinastatin 12 000 U?2kg-1 . Half of the dose was given iv 10 min before CPB and the other half was added to the priming solution. In group C patients received normal saline instead of ulinastatin. Blood samples were taken before CPB (T1 ) , 30 min after CPB was started (T2), at the end of CPB (T3), 2 h and 4 h after CPB(T4 , T5) for determination of plasma levels of D-Dimer, ?-granule membrane protein-140 (GMP-140), thromboxane B2 (TXB2) and 6-Keto-prostaglandin F1? (6-Keto-PGF1?) .Results The demographic data, aortic cross-clamping time, CPB time and duration of operation were comparable between the two groups. The plasma levels of D-Dimer, GMP-140, TXB2 and TXB2/6-Keto-PGFl? were significantly increased at T2 , T3 and T4 as compared with the baseline (T1 ) in both groups, but the increase was significantly larger in group C than in group U(P

Objective To evaluate the feasibility,safety,and cosmetic results of single-incision laparoscopic appendectomy by using conventional instruments. Methods From January 2013 to May 2014,clinical data of 52 patients undergoing single-incision laparoscopic appendectomy in our hospital were retrospectively analyzed. The appendectomy was performed by using conventional instruments through three 5-mm trocars via a 2-cm curved incision above the umbilical margin. Results The single-incision laparoscopic appendectomy was successfully completed in all the 52 cases without conversion to conventional laparoscopic or open surgery.The mean operative time was 43 ±7 min (range,30 -90 min).The average postoperative hospital stay was 2.5 ±0.5 days (range,1 -7 days).During follow-up visits for 1 -3 months,there were no postoperative complications.The scars were not obvious in all the patients. Conclusion Laparoscopic appendectomy can be achieved through a single incision by using conventional instruments.This approach is feasible,safe,and concealing.

BACKGROUND:Mesenchymal stem cels isolated from cord blood and bone marrow have multi-directional differentiation ability under a certain condition of induction. OBJECTIVE:To compare the difference of differentiation of umbilical cord blood and bone marrow mesenchymal stem cels into osteoblasts. METHODS:Human umbilical cord blood and bone marrow mesenchymal stem cels were isolated and cultured by density gradient method. When reached 90% confluency, mesenchymal stem cels were digested by trypsin for subculture. At the third passage, umbilical cord blood mesenchymal stem cels and bone marrow mesenchymal stem cels at 8×104/wel were incubated. When reached 80% confluency, cels were treated with low-glucose DMEM supplemented with 10% fetal bovine serum, 0.1 μmol/L dexamethasone, 50 μmol/L vitamin C and 10 mmol/L β-sodium glycerophosphate. RESULTS AND CONCLUSION:There was no significant difference in morphology and biological properties of the two kinds of mesenchymal stem cels. Cels were highly expressed CD44, CD29, but did not express CD34. They had the ability to differentiate into osteoblasts, which had a positive staining for known markers: alkaline phospatase and calciumin vitro mineralization. There was no significant difference in the activity of osteoblasts of two kinds of cels. Results verify that umbilical cord blood and adult bone marrow mesenchymal stem cels can be induced into osteoblasts with a similar ability, and they can be used as seed cels for bone tissue engineering.

Objective To evaluate the clinical effects and complications in treating colonic polyps between endoscopic submucosal dissection and laparoscopy.Methods 69 colonic polyps patients diagnosed by colonoscopy with the basal body diameter of the colonic polyp >2.0 cm were enrolled in this study. All the patients were divided into study group (n = 41) and control group (n = 28) according to patients' decision, and then treated with ESD and laparoscopic surgery separately. After treatment, all the patients were followed up and repeated colonoscopy after 6 months. Clinical data were recorded and analyzed at the end of the research.Results Patients were successfully operated in both groups. 1 case in each group was diagnosed of malignant tumor and needed further treatment. The average operation time in study group and the control group was (85.00± 36.50) min and (110.00 ± 45.70) min (P < 0.05), length of hospital stay of the two groups were (10.69 ± 3.09) d and (11.61 ± 6.41) d (P < 0.05), and average cost of hospitalization of the two groups were (15.7 ± 2.7) ten thousand RMB and (30.6 ± 5.9) ten thousand RMB (P < 0.05). Percentage of complications in the study group was 2.43% comparing to 14.29% of control group(P < 0.05). 1 case in the study group complicated with enteron hemorrhage. Complications in the control group was 2 cases of ileus, 1 case of infection, 1 case of intestinal fistula. No recurrence was found in the two groups after 6 months in the repeat colonoscopy.Conclusion Both of the two treatments are effective for patients with wide base colonic polyps, but malignant tumor must be cautioned when treating with wide base colonic polyps. Endoscopic submucosal dissection requires proficient skill while with less impairment and cost.

Objective To investigate the expression of C/EBP homology protein (CHOP) in peripheral brain tissue of patients with severe traumatic brain injury (TBI) and its correlation with the injury severity.Methods The study included peripheral brain tissues of 41 TBI patients (TBI group).Another 16 autopsy specimens succumbed to other diseases (except for TBI or other central nervous system diseases) were selected as controls.The control group and TBI group were subdivided into immaturity group (≤18 years),adult group (18-59 years) and elderly group (＞59 years).According to Glasgow Coma Scale (GCS) on admission,TBI group was classified as severe TBI group (GCS of 6-8) and particularly-severe TBI group (GCS of 3-5).CHOP expression in peripheral tissues after TBI was compared in between different age,gender and GCS.Nerve cell apoptosis was detected by TUNEL technique and correlation between CHOP level and apoptotic number was analyzed.Results There were no age and gender differences regarding CHOP expression in control group (P ＜ 0.05).Compared with control group,expression of CHOP presented notable up-regulation in TBI group (P ＜ 0.05).Expression of CHOP presented no gender difference in TBI group (P ＞ 0.05),but its expression was lower in the aged than in adult or immaturity (P ＜ 0.05) as well as notably higher in particularly-severe TBI group than in severe TBI group (P ＜ 0.05).Nerve cell apoptosis in TBI group was far greater in number than that in control group (P ＜0.05).A positive correlation was observed between CHOP level and apoptotic index (r =0.72,P ＜ 0.05).Conclusion Expression level of CHOP after TBI is closely related to the injury severity and nerve cell apoptosis,but the apoptosis pathway induced by CHOP may not be a major factor in secondary brain injury after TBI in the aged patients.

Objective To investigate the features of gallbladder carcinoma in two-phase spiral CT, and to analysis the values of two-phase spiral CT for the differential diagnosis between gallbladder carcinoma and chronic cholecystitis. Methods The two-phase spiral CT manifestations of 30 cases of gallbladder carcinoma, proved by surgery and pathology, and 30 cases of chronic cholecystitis were analyzed. Results According to the CT findings, the gallbladder carcinoma was categorized into 3 types: intraluminal mass of gallbladder in 6 out of 30 (20.0%), thickening of the gallbladder wall in 11 (33.7%), and mass replacing the normal gallbladder in 13(43.4%). The most common enhancement patterns of the wall in gallbladder carcinoma were hyperattenuation during the arterial phase, while isoattenuation with the adjacent hepatic parenchyma during the venous phase; or hyperattenuation during both phases. The most common enhancement pattern of the wall in chronic cholecystitis was isoattenuation during both phases, with clear hypoattenuation linear shadow in the gallbladder fossa. Other ancillary features of gallbladder carcinomas included: infiltration of the adjacent parenchyma, local lymphadenopathy and intrahepatic metastasis. Conclusion Two-phase spiral CT scan can identify the features of the gallbladder carcinoma and is helpful for the differential diagnosis of these two different disease entities.

OBJECTIVE:To explore the clinical efficacy and safety of nalmefene combined with monosialotetrahexosylganglio-side sodium in the treatment of patients in brain tumor operation. METHODS:64 patients in brain tumor operation were randomly divided into observation group and control group,32 cases in each group. Control group received brain cell protection,reducing in-tracranial pressure,anti-infective,vasodilator and other conventional treatment;observation group additionally received 0.7μg/(kg· h) nalmefene combined with 100 mg/d monosialotetrahexosylganglioside sodium from the first day of operation,for continuous 7 d. The plasma cortisol,adrenocorticotropic hormone (ACTH) before and 3,7 d after treatment,changes of serum IL-6,TNF-αand Barthel index (BI) in 2 groups were observed,improvement of neurological function and ADR were observed;Karnofsky (KPS)score was determined after 90 d follow-up used to assess the patient’s ability to take care of themselves. RESULTS:After treatment,plasma cortisol and ACTH content,serum TNF-αand IL-6 levels in 2 groups significantly decreased than before,the dif-ference was statistically significant(P<0.05);cortisol,ACTH and TNF-α levels 3,7 d after treatment,IL-6 level 7 d after treat-ment in observation group decreased more significantly than control group,the differences were statistically significant(P<0.05). After treatment,BI score in 2 groups significantly increased,and observation group increased more significantly than control group,the differences were statistically significant (P<0.05). 7 d after treatment,improvement rate of neurological function was 50.00%,which was significantly higher than that of the control group(18.75%),the difference was statistically significant(P<0.05). There was no significant ADR occurred of 2 groups in the study. Following-up for 90 d,the KPS score in observation group with not less than 70 points accounted for 71.88%,which was significantly higher than the control group(46.87%),the difference was statistically significant (P<0.05). CONCLUSIONS:Nalmefene combined with monosialotetrahexosylganglioside sodium can promote the recovery of patients in brain tumor operation,reduce cortisol,ACTH,IL-6 and TNF-α levels and improve prognosis of patients.

Objective To explore preliminarily the role of the E2 subunit of pymvate dehydrogenase (PDC-E2) modified by xenobiotics (e.g.2-octynic acid,2-OA) in the pathogenesis of primary biliary cirrhosis (PBC).Methods Patients of PBC (102 cases),primary sclerosing cholangitis (PSC,34 cases) and healthy controls (HC,50 cases) were selected.The anti-PDC-E2,anti-2-OA and anti-lipoic acid (LA) antibody in the peripheral blood of the 3 groups were tested by enzyme linked immunosorbent assay (ELISA).By inhibitive ELISA (iELISA),30 of the 102 PBC patients with anti-PDC-E2 antibody but without anti-2-OA antibody were selected to detect whether there was any new epitope on the PEC-E2 conjugated with 2-OA.The chi-square test and Fisher exact test were taken to analyze the enumeration data.The two-tailed unpaired t test with Welch's correction was used to compare the measurement data.Spearman rank correlation analysis was also employed for proper test.Results The positive rate of anti-PDC-E2,anti-LA and anti-2-OA antibody in PBC patients was 94.1％(96/102),73.5％(73/102) and 53.9％(55/102) respectively,all of which were statistically significantly higher than those in healthy controls group but were of no significant difference between PSC and healthy controls group.There was no significant relevance between the levels of Anti-LA and anti-2-OA antibody in the PBC group (r=-0.065,P=0.520).The iELISA results showed that the antibody,which only identified the epitopes on 2-OA-PDC-E2 induced by the 2-OA conjugation with PDC-E2,existed in 40％(12/30) of the PBC patients,and more interestingly,this antibody was predominantly appeared in PBC patients at their early clinical stage.Conclusion There are anti-LA antibody and anti-2-OA antibody in PBC patients,which have shown no significant association with each other.It is very likely that new antigenic conformational epitopes on PDC-E2 modified by 2-OA would emerge,which might led to the immune response in the individuals who are susceptible to PBC,and thus contribute for the breaking of PDC-E2 immune tolerance,and PBC occurrence finally.

Objective To investigate the CT findings of three types of pulmonary fungal disease in non-immunosuppressed patients. Methods We retrospectively collected 109 cases diagnosed with pulmonary fungal disease with pathological evidence which between January 2011 and October 2015 in the First Affiliated Hospital of Zhengzhou University, among which pulmonary aspergillosis were 48 cases, pulmonary cryptococcosis 45 cases and pulmonary mucormycosis 16 cases. Each patient underwent a chest MSCT scan. The data were analyzed that including underlying diseases, lesion types, lesion size, number, accompanying signs of CT scan, etc. χ2 test or Fisher exact test were used when compared underlying disease, lesion types, various of CT signs etc between different types of pulmonary fungal disease. Kruskal-Wallis H test were used when compared the incidence rate of lesions numbers and diameter. The ROC curve was used to analyze probability of predicting the fungal types by combined signs. Results The incidence of pulmonary mucormycosis with diabetes was higher than pulmonary aspergillosis and pulmonary cryptococcosis(χ2=2.704, 17.509, P<0.017) .The incidence of pulmonary mucormycosis with no underlying disease was lower than pulmonary aspergillosis and pulmonary cryptococcosis(Fisher test, P<0.017). Nodular or mass were main CT findings in the three pulmonary fungal disease. Consolidation, ground glass opacity and other manifestations were rare. Nodular or mass lesions in pulmonary aspergillosis accompany with CT signs like tree-in-bud, bronchogram sign, cavities, the air crescent sign, halo sign, the reversed-halo sign were rspectively 18, 10, 19, 10, 23, 0 cases;To pulmonary cryptococcosis were 4, 14, 6, 0, 11, 0 cases. To pulmonary mucormycosis were 2, 0, 4, 0, 4, 6 cases. Lesion number's distribution had a statistically difference between pulmonary aspergillosis and pulmonary cryptococcosis in nodular or mass lesions(P<0.05). Lesions size's distribution had statistically differences respectively between pulmonary mucormycosis and pulmonary aspergillosis, pulmonary cryptococcosis(P<0.05). Nodular lesions of pulmonary aspergillosis had higher incidence of tree-in-bud, cavity and air-crescent compared to pulmonary cryptococcosis(χ2=9.972,21.841,8.047,P<0.017). Reversed halo sign was mostly seen in pulmonary mucormycosis than in pulmonary aspergillosis and pulmonary cryptococcosis(Continuous correctionχ2=23.936,21.374, P<0.017). The area under the ROC curve for the combined signs predictive fungal disease type was 0.819. Conclusions Nodules or masses are the most common image findings in pulmonary aspergillosis, pulmonary cryptococcosis and pulmonary mucormycosis. The distribution of size and numbers and CT accompanied signs have a higher diagnostic efficacy in diagnosing and distinguishing pulmonary fungal disease.