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 .

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.

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.

The technique of amniotic membrane transplantation is developping rapidly in treating ocular surface disease recently. Amniotic membrane is widely used in this area due to its unique structure, procurment and graft puparation. The authors describe the methods of processing and preservation of human amniotic membrane, and the histological study and clinical application experiences as well.

Objective To summarize the methods and results of treatment of displaced humeral su rgical neck fractures with closed reductio n and percutaneous pin fixation.Methods We reviewed 46patients who had been diagnosed as the displaced hume ral surgical neck fractures and trea ted with closed reduction and percut aneous pin fixation using?2.5mm Kirschner wire with terminal t hread from January 2001to December 2002in our hospital.Results34patients received a complete follow-up.The mean follow-up time was 22months(10to 34months).Evaluation was done with Constant-M urley rating system.The mean absolu te Constant-Murley score was 92(76～100).86%(29/34)of the cases were excellent or good,14%(5/34)were fair,and none were poor.All the fractures united 6to 8weeks after operation,a nd no fixation failure or humeral hea d necrosis was found.Conclusion Treatment of displaced humeral surg ical neck fractures with closed reduction and percutaneous pin fixation can shorten operation time,lead to minimal soft tissue lesion and reliable fixation,and allow early functional exercis e after op-eration and easy removal of the wire. [

The shoulder is a complex joint which consists of sternoclavicular joint, clavicle, acromioclavicular joint, scapula, glenohumeral joint,proximal humerus and scapulothoracic joint. It is important for us to have a good knowledge of the normal biomechanics of the shoulder when we treat shoulder problems. So this article intends to help its readers to get familiar with the characteristics of functional anatomy, biomechanics and motion of the shoulder under physiological condition.

The article gives a brief account of the functional anatomy of the shoulder, and analyzes the movement of the shoulder and the function of each muscle involved in the movement. On the basis of the anatomy, the article also describes the anterior, lateral and posterior approaches to the shoulder, surgical procedures and points for attention related to the approaches.

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.

Objective To investigate clinical presentation, diagnosis,gestational outcome and treatment of Eisenmenger’s syndrome during pregnancy. Methods Two patients with Eisenmenger’s syndrome during pregnancy were reported retrospectively. Results The first case was admitted in labor at 34 weeks and 4 days in pregnancy,She had dysphoria,tachypnea and dyspnea right after vaginal delivery and died immediately The diagnosis of pulmonary embolism was highly suspected clinically. The second case was admitted because of fetal growth restriction Cesarean section was performed after cyanosis worsened at 35 weeks and 4 days She was discharged from the hospital two weeks after delivery. Conclusion Eisenmenger’s syndrome during pregnancy was associated with extremely poor maternal and fetal outcome Pregnancy is contraindicated in such patients Contraception is necessary after marriage Pregnancy should be terminated as early as possible in such women. In cases who intends to continue the pregnancy,closely observation must be provided to ensure the safety for both mother and the fetus.