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 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 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.

Objective] To observe the clinical effect of Shaoyao Gancao Decoction on treating children functional abdominal pain to offer reference for further observation. [Method] Choose 200 children patients in pediatric outpatient department of Changxing County TCM Hospital, randomly divide them into treatment and control groups in order, n=100. The treatment one was administered revised Shaoyao Gancao Decoction, the control one orally took Medilac-Vita; both for 4 courses, then observe the cure effects. [Result] In treatment group, total effective rate 94.00%; for control one, it was 86.00%. The comparison of both had difference of statistical meaning( P<0.05). On comparing their abdominal pain relieve, in treatment group, there's more in first 2w and showed marked summit value in the first week; while in control one, there's no marked summit value; so the treatment group was more obvious than other one on relieving pain in the first 2w(P<0.05). The side effect occurrence rate of treatment group was less than other one, the difference between them had statistical meaning(P<0.05). [Conclusion] The revised Saoyao Gancao Decoction has marked cure effect on children functional abdominal pain, worth clinical promotion.

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 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.

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. [