ObjectiveTo evaluate endovascular stenting for TASC TASC Ⅱ C/D femoropopliteal arterial disease.MethodsBetween January 2008 and June 2011,Endovascular treatments of 51 limbs TASC Ⅱ C/D femoropopliteal artery occlusions in 46 patients(27 male and 19 female) were retrospectively reviewed.Mean age was (70 ± 8 ) years ( range,52 years to 88 years).Severe intermittent claudication,rest pain,minor tissue defect and foot ulceration or gangrene were in 29 limbs,12 limbs,6 limbs and 4 limbs,respectively. Technical success rate,ankle brachial index (ABI),complication rate, and cumulative primary patency rate were evaluated. ResultsTechnical success rate was 90.2％.93 stents were placed in 46 limbs of the 42 patients.Postoperative ABI was increased in all patients.42 patients(46 lower limbs) were followed up for a mean period of 14.6 months.Primary,assisted-primary,and cumulative patency rates at 6 months were 81.0％,88.1％ and 90.5％.Primary,assisted-primary,and cumulative patency rates at 12 months were 66.7％,71.8％ and 79.5％ respectively. ConclusionsEndovascular treatment of TASC Ⅱ C/D femoropopliteal arterial lesions is microinvasive,safe and effective.

Objective To observe the clinical efficacy of relatively proximal humeral locking compression plate( LPHP) with the traditional plate for treatment of proximal humeral fractures .Methods The proximal humeral fractures in patients with 58 cases,the patients were divided into two groups ,the treatment group of 32 cases of locking compression plate in the treatment of T plate ,clover plate in the treatment of 26 patients of the control group received traditional.According to the Neer score compared with two groups of patients with postoperative recovery and compli -cations.Results All the 58 patients for 11 ~15 months of follow-up,the treatment group found no fracture ,fracture nonunion,screw and plate humeral head necrosis ,4 cases of shoulder pain was limited;15 cases of excellent score Neer function,good in 12 cases,5 cases,the excellent and good rate was 84.4%.The control group had 3 cases,2 ca-ses of screw loosening of plate fracture ,3 cases of nonunion ,2 cases of humeral head necrosis ,7 cases of shoulder pain limited.6 cases of excellent score Neer function ,good in 9 cases,3 cases,poor in 8 cases,the excellent and good rate was 57.7%.There was significant differences between the two groups (χ2 =5.113,P <0.05) excellent rate. Conclusion LPHP exact treatment of proximal humeral fractures has fewer complications , which can help patients with early rehabilitation exercises .

Objective To observe the efficacy and safety of Shenqiwuweizikeli for treating chronic insomnia.Methods One hundred and ninety-six cases of subjects were randomly divided into Shenqiwuweizikeli group (n =98) and Estazolam tablets group (n =98).The pittsburg sleep quality index (PSQI) was adopted to evaluate the clinical effects and records of adverse reactions during the study period.Also the lab routine inspection(blood routine,urine routine,liver and kidney function, electrocardiogram were conducted to evaluate safety.Results The Shenqiwuweizikeli and Estazolam tablets all had significant effects for chronic insomnia.The total effective rate of Shenqiwuweizikeli group was 92.86％ (91/98), of Estazolam tablets group was 93.88％(92/98) ,and there was no significant difference (P＞0.05).There were no abnormalities in terms of each routine inspection index.After stopping take the medicine, The adverse reactions including bounce sex insomnia(60 cases), daytime sleepiness/drowsiness (55 cases), dizziness with lacking of power and light headedness(23 cases) in Estazolam tablets group were all more than Shenqiwuweizikeli group with significant difference(P＜0.01).Conclusion The Shenqiwuweizikeli has definite efficacy and safety for treated with chronic insomnia without withdrawal of recoil and dependence.

Objectives To evaluate the safety and efficacy of endovascular angioplasty for extracranial vertebral artery ( VA ) stenosis caused by atherosclerosis. Methods We analyzed retrospectively data of the 24 patients with extracranial vertebral artery stenosis who had been placed endovascular angioplasty from April 2006 to March 2010. According to Mori classification, there were 21 type A and 3 type B among all cases.The artery stenosis rate was 60％ -95％ , the average was 79％ ± 10％. Results Twenty-four balloon mounted stents were placed, the successful rate was 100％. Postoperatively the stenosis rate decreased to 4％ ± 6％. Patients were followed up from 3 to 36 months, the average was 22 months. Symptomes disappeared in 15 out of 17 patients. Postoperative restenosis on the treatment site with transient brain ischemia occurred in one patient. The symptoms in another patient of multiple cerebral infarction with ataxia and episodic vertigo were not relieved, although the patient didn't suffer from apoplectic seizure after the intervention. Postoperative color Doppler ultrasound revealed an over 50％ residual stenosis in 5 patients. The postoperative restenosis rate was 20. 8％. According to Malek scoring, 22 patients were scored 1 point, 1 patient scored 2 and one scored 4. Conclusions Endovascular angioplasty with stent placement is a safe and effective treatment. The restenosis rate could be futher reduced by technology improvement.

Objective To compare the clinical results of surgical and conservative treatment of acute patellar dislocations.Methods Retrospective analyzed the clinical data of 35 patients with acute patellar dislocations from June 2004 to October 2009,and divided the patients into 2 groups.One group with 18 patients underwent surgical treatments,and the other group with 17 patients underwent conservative treatments,record the number of relapses cases of both the two groups.A radiographic examination was performed in the evaluation of the patients,and the Kujala questionnaire was applied with the intention of analyzing the improvement of pain and quality of life.Results All patients were followed up for more than 12 months.(1) The conservative treatment group exhibited a higher number of recurrent dislocations (7 patients) (41.2％) than the surgical treatment group,which did not have any relapses (x2 =9.265,P =0.002).(2) The patellar tilt returned to normal in the surgical group,while 8 patients returned to normal in the conservative group,with statistical difference between groups (x2 =10.980,P =0.001).And the lateral shift ratio returned to normal in the surgical group,while 6 patients returned to normal in the conservative group,with statistical difference between groups(x2 =7.667,P =0.006).(3)The surgical treatment group obtained a significantly better mean score on the Kujala test than preoperative ((90 ± 5) vs.(58 ± 6),t =16.465,P ＜ 0.01) ; The conservative treatment group,compared with the preoperative,is not improved obviously ((72 ± 6) vs.(62 ± 8),t =0.943,P ＞ 0.05) ;Postoperative group comparison,surgical group was higher than that in conservative group,there was significant difference between two groups (t =12.256,P ＜ 0.01).Conclusion For acute patellar dislocation,surgical treatment can significantly restore patellar stability,improve the function of knee joint.

Objective To evaluate the safety and efficacy of endovascular intervention to revise peripheral bypass problems through prosthetic approach.Methods Among 17 cases undergoing graft bypass anastomotic stenosis and graft thrombosis was identifled in 16 cases(inflow or outflow obstructive lesions in 10),inflow obstructive lessions in 1(without anastomotic and graft thrombosis).All revision procedures were taken under local anesthesia,16 patients were treated by means of surgical thrombectomy followed by endovascular intervention through prosthesis itself in addition to one who had no thrombectomy.The graft patency and clinical outcome were observed.Resuits Thirteen stents were implanted in 13patients with distal anastomotic stenosis and 1 with proximal anastomotic stenosis including 10 stentings/PTAs in iliac popliteal,posterior tibial or anterior tibial arteries.One stent was implanted in 1 patient with common femoral stenosis.Stenting were not used(abandoned)in 2 patients,of which one underwent a foot amputation and calf gangrene occurred a week later,and the other had a redo of grafting.Follow-up time is 1-35 months.with an average of 12±4 months.One had a below-knee amputation two months after intervention,the other had symptoms recurred and treated with a redo 3 months afterwards.the third died of myocardial infarction six months later.Grafts remained patent in the rest 13 patients at follow-up.Conclusions Endovascular intervention through prosthesis is a safe and effective method,which offers an alternative means to treat anastomotic stenosis.inflow or outflow obstructive lesions.

Objective:To report our experience in treatment of patients with orthopaedic trauma during COVID-19 epidemic.Methods:We retrospectively analyzed the 67 patients with orthopedic trauma who had been treated at Department of Orthopaedics, Peking Union Medical College Hospital from February 1 to March 31, 2020. After screening for COVID-19 infection was performed under strict protection, the patients were diagnosed and assigned to outpatient emergency treatment or hospitalization according to their specific condition. Twenty-six patients were treated at the outpatient emergency department. They were 8 males and 18 females with an average age of 69.5 years. Of them, 6 with vertebral compression fracture were placed on bed brakes, 14 with limb fracture immobilized after close reduction, 2 with skin laceration treated with debridement and suture, and 4 with hip fracture immobilized in bed. In the 41 hospitalized patients, there were 14 males and 27 females with an average age of 68.5 years. In them, hemiarthroplasty was performed for 7 femoral neck fractures, kyphoplasty for 5 vertebral compression fractures, total elbow arthroplasty for one humeral intercondylar fracture, exploration and suture for one case of Achilles tendon rupture, and internal fixation surgery for the remaining 27 cases.Results:Most of the patients had osteoporotic fractures which accounted for 61.5% (16/26) of the outpatients and 68.3% (28/41) of the inpatients, respectively. The duration from injury to surgery averaged 2.3 days and the length of hospitalization 4.5 days for the 41 hospitalized patients, decreased compared with the corresponding data (3.1 days and 11.5 days) for the similar inpatients in the same period last year. In the 41 inpatients, fever was observed upon hospitalization in 4 cases and after operation in 26 cases, and related to their primary injury or surgical trauma in all. Acute pulmonary embolism happened during operation in one patient with femoral shaft fracture.Conclusions:The prevention and control of COVID-19 should be continued. The awareness and behavior of health care providers are expected to be enhanced by strict screening protocol, protection and supervision. The proportion of elderly patients with osteoporotic fracture increased during the COVID-19 pandemic. Shortage of blood was the major problem affecting the treatment. Timely surgical treatment should be indicated for the patients with orthopedic trauma, especially those with lower extremity fracture.

Objective To evaluate the intraoperative identification of ectopic parathyroid tissue in the central neck region using autofluorescence point-spectral analysis(AFPSA)combined with immune colloidal gold technique(ICGT),for guiding total parathyroidectomy(TPTX)or clean parathyroidectomy(CPTX)in the management of secondary hyperparathyroidism(SHPT).Methods Retrospectively collected and compared the clinical data of 64 patients with SHPT from October 2019 to June 2023.In the observation group,TPTX was performed as the initial procedure in 36 cases,followed by sampling of suspicious targets using AFPSA in the central neck area and subsequent detection through ICGT.CPTX was then conducted if a positive result was obtained.On the other hand,the control group consisted of 28 cases where only TPTX was performed without any additional tests during surgery.The surgical data,parathyroid hormone(PTH)levels,blood calcium levels,blood phosphorus levels,alkaline phosphatase(ALP)levels,regression of clinical symptoms,changes in parathyroid function and occurrence of hypocalcemia were compared between these two groups.Results In the observation group,there were 9 cases of AFPSA-ICGT positivity,including 2 left-sided cases,4 right-sided cases,and 3 thymic cases;among these posi-tive cases,there were a total of 10 locations with mildly hyperplastic or nonhyperplastic microscopic parathyroid tissue.The difference in the number of total parathyroid glands removed(including ectopic)between the two groups was statistically significant(P<0.05).At both 3 and 6 months postoperatively,ALP levels in the observation group were significantly lower than those in the control group(P<0.01 and P<0.001 respectively);at 6 months postoperatively,differences in PTH and blood phosphorus levels between the two groups were also statistically significant(P<0.05 and P<0.001 respectively).Joint bone pain and skin itching recurred in some patients within the control group at six months after surgery(P<0.05),whereas recurrence of SHPT was less frequent within the observation group compared to controls(P<0.05);however,no statistically significant differences were observed regarding postoperative hypoparathyroidism or hyperparathyroidism as well as hypocalcemia between either groups.Conclusion The AFPSA-ICGT intraoperative test can be utilized to guide surgery for SHPT,enabling accurate and efficient identification as well as safe targeting of parathyroid tissues that may not exhibit obvious hyperplasia in the central cervical region.