Objective To assess the interobserver reliability and intraobserver reproducibility of Neer classification system and its influencing factors.Methods The present study reviewed the series preoperative radiographs (including those of scapular anteroposterior view,scapular lateral view and modified Velpeau axillary view and an axial CT scan) of 40 patients who had been treated in our department from January 2010 to December 2010 for proximal humeral fractures.The radiographs were assessed by 12 individual observers on 2 separate occasions with an interval of 3 months at least Half of the observers (the professional group; n =6) had received a shoulder fellowship training and the other half (the control group; n =6) had not All the observers were asked to categorize the radiographs according to the Neer classification system of 16 types of fractures in a same process.The reliability and reproducibility of the system were assessed with the Kappa statistics.Comparisons of classification agreement were made between the professional group and the control group.We also evaluated the simplified Neer system of only 6 types of fractures with recombinant data.Results The interobserver reliability coefficients were 0.534 and 0.473 for the first and second assessments,with an intraobserver reproducibility coefficient of 0.669.The agreement level in the professional group was significantly higher than in the control group ( P ＜ 0.05).The interobserver reliability coefficients of the simplified Neer system were 0.581 and 0.502,with an intraobserver reproducibility coefficient of 0.680.Use of the modified Neer system did not elevate the agreement level beyond the moderate range.The classification was agreed on by all the observers in 17.5％ of the fractures during the first assessment and in 15.0％ during the second assessment.Conclusions Neer classification may have fair interobserver reliability and moderate intraobserver reproducibility.Experience of shoulder fellowship training is an important factor influencing the reliability of the Neer system.Simplification of the system may not help increase its reliability.

Objective To study the relationship between perioperative detection of forkhead box protein P 3(Foxp3) mRNA level in peripheral blood mononuclear cell (PBMC ) of patients with kidney transplantation and chronic allograft nephropathy (CAN ) . Methods 35 cases of renal allografts completed in this hospital defined clinically and confirmed histopathologically were observed as CAN group ,simultaneously a retrospective case-control study was performed on 35 renal transplant recipients with normal graft function observed(control group) .Foxp3 levels of PBMC in perioperative period were dynamically determined in two groups .Real time PCR was applied to detect the expression of Foxp3 mRNA .In order to find out other risk factors influencing chronic allograft nephropathy and eliminate disturbance .The related clinic factors were compared between the CAN group and the control group .Re-sults The Foxp3 mRNA level was lower in the CAN group than the control group [(24 .1 ± 16 .2) × 10-4 vs .(52 .3 ± 27 .4) × 10-4 ,P<0 .01] .Among risk factors influencing chronic allograft nephropathy ,only acute rejection(AR) was probably different in two groups .In order to avoid disturbance ,further classification was done according to AR .The statistical results show that the Foxp3 mRNA level in two groups was not be affected by AR .Conclusion The Foxp3 mRNA level in perioperative period is associ-ated with CAN which maybe a risk factor for CAN .Foxp3 may be an index to predict the occurrence risk of chronic allograft ne-phropathy after kidney transplantation and guide individual treatment .

Objective To evaluate the large field diffusion weighted imaging (DWI) (from head vertex to lower leg) in detection of bone metastases from prostate cancer. Methods One hundred and sixty-six consecutive patients who were suspected of prostate cancer received pelvic MRI and large field diffusion weighted imaging examination. Forty-nine of them underwent bone scintigraphy within one month of the examination of large field DWI. The images were double-blindly evaluated without the knowledge of the pathology result. Conventional MR T1 and fat saturation T2 weighted images were taken as standard for the diagnosis of bone metastasis. The sensitivity, specificity, and area under curve between large field DWI and bone scintigraphy were compared with McNemar test. Five patients with bone metastases exceeding 10 per patient were excluded in the lesion-by-lesion analysis. Results Ten of the 49 patients were diagnosed as bone metastases. The diagnosis of bone metastasis were made in 15 patients by large field DWI and in 17 patients by bone scintigraphy. With patient number as study units (n =49) , the diagnostic sensitivity of bone metastases with large field DWI and bone metastases were both 100% (10/10), and specificity were 87. 2% (34/39) vs. 82. 1% (32/39), respectively. ROC study showed the area under curve (AUC) of large field DWI and bone scintigraphy were 0. 936 vs. 0. 910, respectively. Totally 68 abnormal foci were identified from large field DWI and/or bone scintigraphy in 44 patients (while 5 patients with bone metastases exceeding 10 foci per patient were excluded ), 20 of them were diagnosed as foci of bone metastasis. The diagnosis of bone metastases was made in 23 foci by large field DWI and in 34 by bone seintigraphy. With lesion numbers as study units ( n = 68), the diagnostic sensitivity of large field DWI and bone scintigraphy were both 90. 0% ( 18/20), and specificity were 89.6% (43/48) vs. 66. 7% (32/48) , respectively. ROC study showed the area under curve of large field DWI and bone scintigraphy were 0. 898 vs. 0. 783, respectively. The difference of specificity between large field DWI and bone scintigraphy showed statistical significant difference (P < 0. 01 ). The AUC between large field DWI and bone scintigraphy showed statistical significant difference (P < 0. 05). Conclusion Large field DWI may allow us to screen for bone metastasis in patients with prostate cancer, and its diagnostic specificity and accuracy may be higher than that of bone scintigraphy.

Objective To compare the results of locking intramedullar nail and Locking plate in treating proximal humerus fractures and discuss features of each instrument. Methods A total of 54 patients with fresh two-part surgical neck fracture of proximal humerus were divided into intramedullar nail fixation group(26 patients)and locking plate fixation group(128 patients).with no statistical difference upon age,gender and dominate hand involvement in two groups.At final follow-up,physical examination and X-ray films were used to evaluate fracture healing of shoulder ioint.In the meantime,VAS score,ASES score,Constant-Murley score,UCLA and SST questionnaire were used to evaluate the function of the shoulder in two groups. Results All fractures were healed basically within 8 weeks postoperative-ly.No infection or av&scular necrosis were fouml during follow-up.The incidence rate of complication in locking plate fixation group was higher than that in intramedullar nail fixation group.Both groups obtained satisfactory functional recovery of shoulder ioint.There was no statistieal difference in regard to active for-ward elevation,external rotation besides body,active height of internal rotation,Constant-Murley scores,and SST scores in both groups.The average ASES score and VAS score of locking plate fixation group was significantly better than those of intramedullar nail fixation group. Conclusions Both fixations can treat surgical neck fractures of proximal humerus well.Locking intramedullar nail causes less trauma to the patient while Locking plate has advantages in patients'final functional recovery.

Objective To evaluate the results of delayed proximal humeral fractures treated by open reduction and internal fixation. Methods From January 2005 to July 2008, 26 patients with delayed proximal humeral fractures were treated by open reduction and internal fixation. There were 11 males and 15 females. The patients ranged from sixteen to 22-81 years old, with an average age of 49.3 years. The interval from injury to operation ranged 22 to 510 days, with a mean of 88 months. There were two-part fractue in surgical neck in 12 cases, two part in lesser tubercles of in one case,two part in greater tubercles in seven cases, three part in greater tubercles in three cases, four part in 2 cases and the splitting fracture in the head of humerus in one ease.The range of motion, VAS for pain, ASES (American sboulder and elbow surgeon's form) score, Constant score, UCLA (University of California-Los Angels scoring system)score and SST(Sim-pie Shoulder Test) for function evaluation were all recorded. The results were evaluated according to sex,age, injury side, operation times and combined injury by ANOVA.The correlation analysis was performed between operative time and results. Results The average forward flexion was 137.3°±35.1°, average exter-nal rotation was 28.9°±24.1° and internal rotation was T_(10). The mean VAS score was 0.7±1.2, the mean Constant was 83.1±17.9, the mean UCLA was 28.9±6.0, the mean SST was 8.7. There were no difference re-gaming sex, age, injury side, operation time and combined injury, fracture type and complications groups. No correlation existed between operative time and results. Conclusion It is very hard to treat delayed proximal humeral fracture due to high complication and demanding experience. With appropriate surgical technique, satisfactory results can be expected by open reduction and internal fixation.

BACKGROUND: Taohong Siwu Tang is made up of Taoren, Honghua,Danggui, Chishao and Chuangxiong. Paeoniflorin is one of the major effective components in Radix Paeoniae Rubra Extracts and Taohong Siwu Tang, and it can promote blood circulation and remove blood stasis and has the effect of anti-acute myocardial ischemia.OBJECTIVE: To compare the serum concentration of paeoniflorin in mice after intragastric administration (i.g.) of Radix Paeoniae Rubra extracts and Taohong Siwu Tang.DESIGE: Rndomized controlled observation.SETTING: Department of Pharmacy and Department of Basic Medicine,Hebei North University.MATERIALS: The trial was performed in the first laboratory of Department of Pharmacy, Hebei North University during February to June 2005.Eighty involved Kunming mice of either gender and of clean grade, with body mass of 18 to 22 g, were purchased from Experimental Animal Center, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences. Taoren, Honghua, Danggui, Chishao, Shengdi and Chuanxiong 6 Chinese herbs were all purchased from Zhangjiakou Institute of Traditional Chinese Medicine.METHODS: ①Blank serum was isolated from eight mice which were fasted for 12 hours. Control sample solution of paeoniflorin was added into blank serum. Acetonitrile was used to deposit protein, the solution was centrifugated and isolated ,and 20μL supernatant was taken to obtain regression equation. ② Seventy-two Kunming mice were randomized into Radix Paeoniae Rubra extracts group and Taohong Siwu Tang group, with 36 mice in each. After being fasted for 12 hours, the mice in each group were intragastric administration of Radix Paeoniae Rubra extracts and Taohong Siwu Tang, respectively and the concentration of paeoniflorin was 300 mg/kg.1 mL blood was taken respectively at 15, 30, 60, 90, 120 and 180 minutes after intragastric administration and prepared into serum sample (6 mice at each time point in each group). The time to peak and difference in peak concentration of serum paeoniflorin were compared between intragastric administration of Radix Paeoniae Rubra extracts and Taohong Siwu Tang.The concentration of paeoniflorin was measured with high-performance liquid chromatography (HPLC). Chromatographic condition: chromatographic column YWG-C18 (250×4.6 mm,10 μm). The mobile phase was methanolKH2PO4 (0.05 mol/L) (38∶62) at a flow rate of 1.0 mL/min. The detective wavelength was set at 230 nm. The column temperature was 25 ℃.MAIN OUTCOME MEASURES: Serum concentration of paeoniflorin after administration of Radix Paeoniae Rubra extracts and Taohong Siwu Tang in mice.RESULTS: Seventy-two mice were used for Radix Paeoniae Rubra extr acts and Taohong Siwu Tang tests, and all of them entered the stage of result analysis without deletion. ① Chromatographic isolation results: Paeoniflorin could be well isolated from other components. The linear range for detection of paeoniflorin was 5.40-646.0 μg/mL. The mean recovery rate was 93.6% and the limit of detection was determined as 1.08 mg/L. ②Comparison of concentration of serum paeoniflorin of mice between two groups: The concentration of serum paeoniflorin in the Radix Paeoniae Rubra extracts group and Taohong Siwu Tang group reached the peak at 30 and 60 minutes after intragastric administration, respectively. The peak concentration of paeoniflorin of Taohong Siwu Tang group was lower than that of Radix Paeoniae Rubraextracts group [(36.27±5.72) mg/L vs.(46.82±5.29) mg/L, P ＜ 0.01 )].CONCLUSION: The concentration of serum paeoniflorin is significantly decreased after intragastric administration. It was further confirmed the decreased concentration of the crude paeonifiorin in the mice sera might result from promotion of its metabolic conversion by other chemical components in the complex prescription. This result needs further investigation.

In order to explore more reasonable and scientific accounting method of community health service costs, to improve the accounting method system of community health service cost. In the current existing community health services costing methods, based on the analysis of hospital cost accounting methods system, analyze and imitate the accounting method of hospital costs, establish a more scientific and implemented accounting method system of community health service costs: divide parts of clinics scientifically, redesign the center acollation method of indirect cost, confirm different cost accounting methods for different cost accounting objective and provide suggestion for the improvement of project cost accounting.

Objective To investigate and compare the biomechanical stability between anatomical and overlapping reconstruction of the greater tuberosity in cadaveric humeral head replacement model. Methods Eight pair (16) fresh-frozen shoulder cadavers were match-paired into 2 groups. Four-part fracture model was created in all cadavers. Standardized humeral head replacement procedure was carried out in all specimens, and anatomical and overlapping reconstruction of the greater tuberosity was applied to each group respectively. Custom mounting apparatus and fixation jigs were designed for designated shoulder motion. A Binocular 3D Computer Vision metrical method was employed to measure the displacement of greater tuberosity relative to the humeral diaphysis. Results When the shoulder was external rotated to neutral position, the mean displacement of greater tuberosity in anatomical reconstruction group was (1.81?1.75) mm,while the mean displacement was (3.23?2.91) mm in overlapping group. Statistical difference was found between the 2 groups. When the glenohumeral joint was elevated to 30? and 60? forward flexion, the mean displacement of greater tuberosity in anatomical group was (4.01?5.00) mm and (5.99?6.97) mm respectively, while the mean displacement was (3.02?5.27) mm and (6.97?7.00) mm respectively in overlapping group. No statistical difference was found between the 2 groups during forward flexion measurement. Conclusion In cadaveric humeral head replacement model, anatomic greater tuberosity reconstruction shows better mechanical stability compared with overlapping reconstruction during external rotation to neutral position. This result suggests that there may be some loss in mechanical stability in overlapping fixed greater tuberosity. Even though standardized postoperative rehabilitation protocol are strictly followed, evident displacement of the greater tuberosity was detected. Postpone of the postoperative rehabilitation program after humeral head replacement for a decent period of time may benefit tuberosity healing.

Objectives: To observe the clinical course of diffuse lamellar keratitis(DLK) after laser in situ keratomileusis(LASIK) and to investigate the presentation and management of DLK. Methods:Among 3500 patients underwent LASIK in our center, 18 eyes in 10 patients received DLK were examined. All eyes were examined with slitlamp biomicroscope at the course of 3 days,7 days,14 days,1 month, 2 months and 6 months after the operation. Visual actuity was measured. Results:Symptoms were controlled after 1 week treatment of topical corticosteroids and antibiotics. Resolution of DLK occurred after 1 to 2 months. Uncorrected visual acuity is 1.0 to 1.5 in 16 eyes and 0.8 to 1.0 in 2 eyes. Conclusions:DLK is a complication after LASIK, it usually occurs in 1 to 7 days postoperatively, more likely in male. Topical corticosteroids and antibiotics can get a satisfied outcome. Systemic corticosteroids and antibiotics are needed in serious cases. Early stage of DLK must be distinguished from corneal epithelial implantation and interface infection.

Recurrent anterior shoulder instability is a common problem we have to deal with in clinic. With the progress in shoulder and elbow surgery, there have appeared many new concepts about the etiology, diagnosis and treatment of this disease. About 2 decades ago, people realized the important role of glenohumeral ligaments. Now we believe that the stability of the glenohumeral joint relies heavily on the congruent articulating surfaces and surrounding soft tissues that act as static and dynamic stabilizers. Many new methods, such as MRI, physical examination under anesthesia and arthroscopy, can help us diagnose the disease accurately. Moreover, substantial progress has been made in the treatment of anterior shoulder instability. Open Bankart repair has become the golden standard for the treatment. With the advance of techniques, however, arthroscopic stabilization of anterior shoulder instability can now achieve good results comparable with those of open surgery.