Objective Due to the anatomy of the scapula itself is exceptional,fracture is often associated with other damage.So it is particularly important to evaluate the patients,physical examination,as well as the choice of surgical approach during perioperative period.By studing of the relevant literatures,this article reviewed the anatomy and classification of the shoulder blades,patient assessment,surgical indications and approaches,as well as the functional exercise.

The superficial temporal artery and the occipital artery on both side of 50 Chinese adult cadavers were dissected and the course and distribution of these two arteries were studied and their length, external diameter, internal diameter and the thickness of the walls were meassured.1. The main stem of the superficial temporal arteries runs upward and forward in front of the orifice of the external auditory meatus at an angle on the average of 12.44?8.16? away from the vertical line. This artery was found in 68.68?4.66％ situated before the superficial temporal vein and auriculo-temporal nerve. The average length of the main stem is 3.88?1.04cm; the external diameter 1.64?0.42mm; the internal diameter 1.19?0.10 mm and the thickness of its wall 0.23?0.08 mm. 2. The parietal branch of the superficial temporal artery runs upwards and backwards to the vertex of the skull at an angle of 25.92?10.09 away from the vertical line. The average length is 7.56?1.63 cm. It may be classified into three typs: (1) the single-stem type (2) the bifurcate type (3) the double-stem type. The average external diameter of the branch is 1.24?0.28mm, the internal diameter 0.91?0.19mm, the thickness of its wall 0.17?0.06 mm. There arr 7.45?2.71％ of the cases that the internal diameter is less or equal to 0.5 mm.3. The frontal branch of the superficial temporal artery runs forwards and upwards to the frontal tuber or above the lateral-upper angle of the orbital, then turns upwards to the vertex of the skull. Its average external diameter is 1.31?0.35mm; the internal diameter, 0.91?0.29 mm, and the thickness of its wall, 0.18?0.08mm.4. The Occipital artery runs out to the skin through the fascia between the trapizius and sterocleidomastoid, but sometimes it porferates the muscular fibers of one of these two muscles. The point from which it runs out is located at 2.23?1.12 cm below the external occipital protuberans and 3.41?0.85cm lateral to the midline. Three types of the branching patterns were found: the main-stem, the bifurcate and the plexiform type. The average external dianeter of the occipital artery is 1.47?0.14 mm, the internal diameter,1.13?0.29 mm, and the thickness of its wall, 0.18?0.08mm.

Objective To investigate the elinicopathoiogical features of Castleman disease with kidney injury. Methods Clinicopathological data of 10 Castleman disease patients with kidney injury from Peking University First Hospital and China-Japan Friendship Hospital were analyzed retrospectively. All the cases received biopsies of lymph node and kidney. Their renal tissues were examined by light microscopy, immunofluorescence and electron microscopy. Results Ten patients were all male with mean age (493:14) years. They presented edema and proteinuria, with mean urinary protein at (2.79±3.56) g/24 h, including one nephrotie syndrome (NS). Hematuria occurred in 8 cases, acute renal insufficiency in 6 cases, hypertension in 4 cases. Most of the patients had fever, fatigue, anorexia, weight loss, increased ESR and CRP, hypergammaglobulinaemia and decreased complements. Other abnormalities included anemia, thrombocytopenia, pleural effusion, hepatomegaly, splenomegaly, hypothyroidism, etc. Two cases demonstrated POEMS syndrome, one presented Sjogren syndrome. The enlargement of multiple cervical, axillary and inguinal lymph nodes were identified in all the patients. The pathological patterns of lymph node were plasma cell type in 4 cases, hyaline-vascular type in 3 cases, and mixed type in 3 cases. Pathological examination of renal biopsy showed thrombotic microangiopathy in 5 cases, crescentic glomerulonephritis in 2 cases, renal amyloidosis, minimal change disease and chronic tubular interstitial nephropathy in 1 case respectively. After immunosupressive reagents or COP therapy, lymph nodes became smaller, systemic symptoms were alleviated, proteinuira was decreased or disappeared, and renal function was recovered in most of patients. Conclusions Castleman disease with kidney injury manifests various symptoms with high prevalence of renal insufficiency and multiple systemic damage. Renal lesions present many patterns of pathological change with a higher frequency of thrombotic microangiopathy. It is necessary to examine the lymph nodes by ultrasound, radiology or biopsy for the patients of renal diseases with multiple systemic symptoms.

Objective To investigate the proliferation and collagen secretion of transplanted human fibroblasts.Methods The solution containing human fibroblasts(2?1010L-1)was prepared and 1 mL was injected into the dermis of BALB/CNU nude mice.Animals were killed by the end of the 1st,2nd and 3rd month after injection.The dermis in the injected area was taken out and stained with HE.Immunohistochemical staining for type I and type Ⅲ collagen was performed at the same time.Results Mitosis was observed by the end of the 1st,2nd and 3rd month.The concentration of type I and type Ⅲ collagen in the extra cellular matrix increased with the passing of time.Conclusion Transplanted human fibroblasts can proliferate automatically in the dermis of nude mice and manufacture the type I and type Ⅲ collagen in situ.Long period of survival and secretion will make it possible for fibroblasts to become promising option to correct minimal tissue defects.

Distal radius fractures often occur in the elderly.At present,there has not yet reached a consensus on how to take effective measures for the treatment of such fractures in clinical.There are many different therapeutic methods for this fracture with different effect.Based on the summary of the relevant literature,the epidemiological characteristics of fractures of the distal radius,treatment,implant selection,surgical procedure,complications and prevention were summarized,in order to provide references for clinical treatment.

Objective To report the clinicopathological features of 2 cases of nephronophthisis-medullary cystic kidney disease (NPH-MCKD). Methods The clinical data and pathological changes of renal biopsy in two patients of NPH-MCKD from our hospital were analyzed, and associated literatures were reviewed simultanously. The clinicopathological featuresand diagnosis of NPH-MCKD were discussed. Results Two adolescent patients were admitted to our hospital for indolent renal insufficiency, polyuria accompanied by polydipsia as first signs.Urine analysis showed low specific density urine, mild proteinuria, and few formed elements in urinary sediments. The ability of urine concentration and acidification was decreased. Familial history of renal disease and extra-renal lesions were not found. Renal ultrasound presented an increased echogenicity with diminished cortico-meduUary differentiation, and multiple small cysts in renal corticomedullary border were identified in one case by computed tomography. Pathological examination of renal biopsy revealed diffuse tubular interstitial lesion which was characterized by the triad of tubular basement disintegration, tubular atrophy with cyst development, and interstitial fibrosis. Some of glomerular sclerosis occurred. Cyst development at the corticomedullary border of the kidneys was the specific feature of NPH-MCKD. Conclusions Young patients with impaired tubular function should be suspected of NPH-MCKD. Renal ultrasound or computed tomography can provide an important clue. Multiple renal cysts at the corticomedullary border identified by renal biopsy can be a diagnostic indication for NPH-MCKD.

During the psychological intervention for patients injured and patients with internal disease in earthquake in Sichuan,psychological assessment of anxiety,depression and sleep disorder was carried for them by conversation and observation.By analysis,it showed that the patients suffering from depression and anxiety was 41.8% and sleep disorder WaS 73%.Further more,sleep disorder was significantly correlated with depression and anxiety.

Objective In clinic, the elderly with femoral intertrochanteric fracture are suggested surgical treatment, with the continuous deepening of the research and technology innovation, the new type of internal fixator for treating this fracture are emerging?At present,a wide variety of internal fixators in clinic,but each has its advantages, disadvantages and indications, and considering?The right choice of internal fixator directly affects patient's prognosis?This article reviewed several common internal fixators in clinic, so as to provide a reference for the clinical selection.

Objective To elucidate the clinical and pathological characteristics of patients with mercury poisoning-associated glomerulonephropathy. Methods Seven patients with mercury poisoning-associated glomerulonephropathy were enrolled in this study. The pattern of mercury exposure, feature of mercury toxicity, and clinicopathological presentation of the kidneys were investigated. Results They were all female, averaged (28.9 ±8.1) years old. Skin-whitening cream was the only cause of mercury poisoning. Proteinuria occurred 5 to 8 months after exposure. Serum mercury were 27.0 to 98.0 μg/L, and spot urinary mercury were 34.4 to 204.0 μg/L. The presentation of all the patients was mild to moderate edema with proteinuria and decreased serum albumin level. Five patients (5/7) were diagnosed as nephrotic syndrome. Six patients underwent renal biopsy: 3 cases with minimal change disease, 2 cases with membranous nephropathy and 1 case with focal segmental glomerular sclerosis. All the patients were administrated chelation therapy with sodium dimercaptopropanal sulfonate or sodium dimercaptosuccinic acid for 3 to 7 courses. They got complete remission by 3 to 5 weeks treatment. Conclusions Patients in this study with glomerulonephropathy induced by mercury poisoning are all from skin-whitening cream exposure. Mild to moderate edema and proteinuria are the common clinical pattern. Minimal change disease, membranous nephropathy and focal segmental glomerular sclerosis are found pathologically. Chelation therapy is effective.

Objective:To investigate the clinicopathological characteristics of renal light and heavy chain amyloidosis (AHL).Methods:Ten patients with renal AHL diagnosed by renal biopsy in Peking University First Hospital and Institute of Nephrology of Peking University from January 2015 to June 2020 were enrolled. Clinicopathological data of these patients was collected and reviewed.Results:AHL typically affected older patients, with a male/female ratio of 7:3. The clinical manifestations were mainly edema and heavy proteinuria. At the same time, 7/10 of patients presented with nephrotic syndrome, 7/10 presented with microscopic hematuria, and 3/10 presented with renal insufficiency. Laboratory examinations showed monoclonal immunoglobulin in blood and urine in all patients, and IgGλ was the most common one (5/10). Decreased serum complement could be seen in some patients. The ratio of serum free κ light chain and free λ light chain was abnormal in all patients who underwent serum free light chain test. None of the 10 patients met the diagnostic criteria of multiple myeloma. Except for one of the 10 patients who was diagnosed as Waldenstrom's macroglobulinemia, the rest were diagnosed as monoclonal gammopathy of renal significance (MGRS). Bone marrow of 2/6 of patients were positive for amyloid. Cardiac involvement was confirmed in only one patient. Renal biopsy demonstrated amorphous eosinophilic material, which was Congo red positive, was deposited in glomerular mesangial area (10/10), capillary vessels (8/10), renal interstitium (9/10), peritubular capillary walls (9/10) and arterioles (8/10). This material showed apple green birefringence under polarized light. Immunofluorescence showed that single heavy chain and single light chain were positive at the same time, which was consistent with the results of mass spectrometry analysis. Ultrastructural evaluation revealed randomly oriented, non-branching fibrils with a diameter of 8-12 nm.Conclusions:Main clinical manifestations of AHL amyloidosis are edema and massive proteinuria, along with a high incidence of hematuria, a low portion of heart involvement and high frequency of whole molecule of monoclonal immunoglobulin (IgGλ dominant) by serum immunofixation electrophoresis. Renal pathology shows the commonly involved kidney compartments of amyloid deposits are glomerular capillary walls and peritubular capillary walls in patients with AHL amyloidosis.