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.

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 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.

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 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 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.

Objective To explore the short and long term curative effects of percutaneous transhepatic cholangioscopic lithotomy (PTCSL) in the treatment of intrahepatic stone (IHS).Methods 38 IHS patients were enrolled,who were treated with PTCSL between January 2008 and July 2013.Results PTCSL was successfully completed in all the 38 IHS cases.Stone clearance rate was 84.2％ and the average episode of stone removal was (2.6 ± 0.9) times.Average diameter of percutaneous transhepatic fistula was (18.4 ± 0.6) F and the average time from percutaneous transhepatic puncture and fistulization to cholangioscopic lithotomy was (7.2 ± 0.7)d.The average operation time was (68 ± 20) min,intraoperative blood loss was (20 ± 13) ml,and hospitalization was (4 ± 2) days.The hepatolith recurrence rate in patients with stones completely removed was 37.5％ (12/32),and 1 case developed into biliary cirrhosis.Patients with calculi residual suffered from higher hepatolith recurrence rate of 83.8％ (5/6),with biliary cirrhosis found in 1 case.Conclusions PTCSL is safe and effective in treating primary IHS,which is indicated in multiple recurrent IHS especially in after biliary surgery patients.It has the advantages of minimally invasion,less bleeding,less postoperative pain,less complications,and fast postoperative recovery.

Objective To compare the results of three different registration methods in the kilovolt CBCT guided IMRT for nasopharyngeal cancer (NPC).Methods Total 560 CBCT images of 24 NPC patients who received kilovolt CBCT guided IMRT were analyzed off line.Three registration methods were used for alignment between CBCT and planning CT,including translational and rotational errors for bone and grey (BoneT + R,GreyT+ R),only translational errors for grey (GreyT).The registration results were analyzed by mean paired t-test respectively.Results With method BoneT+R,the translational errors on x,y and z axes were (-0.11 ± 1.35) mm,(0.40 ± 2.09) mm and (0.95 ± 1.56) mm and the rotational errors were 1.06° ±0.67°,0.01° ± 1.28° and 0.92° ± 1.00° respectively.With GreyT+R,the translational errors on x,y and z axes were (-0.02 ± 1.06) mm,(0.68 ± 1.92) mm and (0.81 ± 1.46) mm and the rotational errors were 0.85° ±0.61°,-0.05° ± 1.32° and 0.91° ±0.72° respectively.With GreyT,the translational errors on x,y and z axes were (0.58 ± 1.02),(0.52 ± 1.89) and (0.44 ± 1.43) mm.The results of compared mean t-test for different registration methods groups have significant difference (P =0.00-0.01) except for the rotational errors on y and z axes between BoneT+R and GreyT+R (P =0.05,0.62).Conclusions There have different alignment errors when different registration methods used for NPC kilovolt CBCT guided radiotherapy.If there have correct methods for rotation errors,GreyT+R registration method may be a better choice.In opposite,GreyT+R registration method would be used firstly to verify whether the rotational error ＞ 2°or 3°.If the rotational error ＞ 2°or 3°,the patient should be re-setup.If not,according to these alignment results,the GreyT method,manual method would be used to compensate the translational errors.

Objective To establish a model fit for axonal regeneration research after its mechanical injury.Methods Cortical explants from mice were planted on culture dishes by microglass pipettes or routine glass pipettes.The cell body and dendrites in axonal area were detected by immunofluorescence and RT-PCR.Besides,purity of regenerated axons was also tested by immunofluorescence and RT-PCR after mechanical transection of axons under microscopy.Results Compared with explants planting by routine glass pipettes,in the outside 1/2 axons of explants planted by micro-glass pipettes,the immunofluorescence and RT-PCR showed negative nucleus and dendrites.In the regenerated axons following mechanical transection of explants planted by micro-glass pipette,the immunofluorescene and RT-PCR showed no regenerated axons nucleus mixed into the dendrites and nucleus.Conclusions Explants planted by micro-glass pipette obtains enough pure axons and regenerated axons.The establishment of models of axonal mechanical transection lays foundation for its molecular study after trauma.