We herein overviewed the history,achievement and plan of the twelfth-five program for the development of key medical disciplines in Zhejiang Province.We summarized the practice and characteristics of establishing of the key medical discipline in the Zhejiang Province,and a systemic survey was conducted on the effectiveness of the program.We then proposed several improvements strategies including academic training,multidiscipline coordination,and fund managements to eventually establish the new pattern of discipline development.

Objective To build a clinical key disciplines evaluation index system for county level hospitals in Chengdu city.Methods Literature meta analysis, focus group discussion, expert consultation method, boundary value method, brainstorming and hierarchy analysis method were comprehensively used.Results The clinical key disciplines evaluation index system for county level hospitals in Chengdu city comprises 5 level-1 indexes,1 6 level-2 indexes,47 level-3 indexes.Among the level-1 indexes,service capacity,medical quality,technical personnel,scientific research and education, and foundation of specialty was 0.474 6,0.202 7,0.148 2,0.097 7,0.076 8 respectively.Conclusion The clinical key disciplines evaluation index system for county level hospitals in Chengdu city is scientific, guiding and practical,which can be used to evaluate the status of the clinical key disciplines for county level hospitals in Chengdu city.

Objective:To investigate the clinical efficacy of MIPO combined with non-contact bridging periprosthesis fracture plate (NCB.PP) in the treatment of re-fracture around the nail after intramedullary fixation of intertrochanteric fracture.Methods:From October 2015 to January 2020, 12 patients with re-fracture around the nail after intramedullary fixation of intertrochanteric fracture were treated in our hospital. There were 7 males and 5 females with an average age of 74.88±12.1 years (range, 65-83 years old); 8 patients on the left side and 4 patients on the right side received short nail of proximal femoral nail (PFN), 6-36 months after operation, they fell down and caused closed fracture around the nail body. According to Vancouver classification system, all the patients were Vancouver type B; preoperative bone mineral density examination showed that 1 case had normal bone mass, 10 cases had osteoporosis, and 1 case had low bone mass. All patients were treated with minimally invasive plate osteosynthesis (MIPO) technique for reduction and fixation, and fixed with proximal femur NCB.PP. The visual analogue scale (VAS) and Harris hip score at 1 day, 3 months and the last follow-up were compared.Results:The average operation time was 68.7±4.33 min (range, 65-75 min); the average intraoperative blood loss was 291.67±114.48 ml (range, 150-400 ml); the average postoperative drainage volume was 79.17±17.17 ml (range, 50-100 ml). After fracture reduction, all patients were able to obtain 2-5 bicortical screws fixation, with an average of 3.25±0.96. Among them, 3 cases were fixed with additional binding straps; 3 cases underwent autologous iliac bone grafting during the operation. All cases were followed up for 9-60 months, with an average of 16 months. At the last follow-up, 10 patients had fracture healing, the healing time was 7.75±2.83 months (range, 4-13 months), and the fracture healing rate was 83.3% (10/12). Among the other two patients, one was an 83 years old patient with severe osteoporosis, who was bedridden after operation and remained unhealed after 12 months of follow-up; a 68 years old patient had bone restoration at the broken end of the fracture 6 months after operation. The second operation was performed. Iliac combined with allogeneic bone graft was taken from the broken end. At the end of 13 months after operation, the fracture was partially healed. The VAS at one week, three months and the last follow-up were 8.00 (8.00, 9.00), 2.50 (2.00, 3.00) and 0.00 (0.00, 0.75), respectively. There were significant differences in VAS scores between 1 week after operation and 3 months after operation, 1 week after operation and the last follow-up, and 3 months after operation and the last follow-up ( Z=-3.129, -3.097, -3.134, all P < 0.05). The Harris scores at 3 months after operation and at the last follow-up were 72.50±2.91 and 86.67±5.30 respectively. After statistical analysis, the difference was statistically significant ( t=8.857, P< 0.001). At the last follow-up, except for 1 case of fracture nonunion and 1 case of reoperation, the Harris score of hip joint of the other 10 patients was excellent in 6 cases and good in 4 cases, and the excellent and good rate was 83.3% (10/12). One case of superficial wound infection was healed by intravenous drip of sensitive antibiotics. One patient had incision fat liquefaction and was given local dressing change to heal the incision. Conclusion:MIPO combined proximal femoral NCB.PP in the treatment of re-fracture around the nail after intramedullary fixation of intertrochanteric fracture has the advantage of less surgical damage, less blood loss, higher healing rate, and it can obtain satisfactory short and medium-term clinical efficacy.

Objective: To explore the treatment outcome of triangular osteosynthesis (TOS) for the treatment of unilateral Isler type II lumbosacral junction injuries (LSJIs). Methods: Data of sixteen patients with unilateral Isler type II LSJIs surgically who were treated in our Hospital from March 2015 to February 2017 were retrospectively analyzed. There were 13 males and 3 females with an average age of 35.5 years (range, 24-61 years). Seven patients were multiple injuries including head, thoracic, musculoskeletal and nerve injuries. According to Isler classification of LSJIs, there were 5 cases of type IIa, 9 of type IIb and 2 of type IIc. All the LSJIs combined with ipsilateral sacral fractures. The sacral fractures were classified by Denis classification with 1 case of zone I, 13 cases of zone II and 2 cases of zone III. According to Tile classification of pelvic fractures, there were 3 cases of type B2, 11 of type C1 and 2 of type C3. There were 3 cases combined with sacral nerve injury among which there were 2 cases of grade II and 1 case of grade III according to Gibbons classification of neurologic deficits. All cases were surgically treated with triangular osteosynthesis. There were 14 cases combined with iliosacral screws fixation in S₁ and 2 cases combined with posterior locking plates. Results: All patients were followed up for 20.6 months (range, 16-30 months). CT scan was conducted 12 to 24 months after surgery which showed all the sacral fractures were union, and 2 cases achieved bony fusion in L₅S₁ facets while the other 14 didn’t. According to Majeed’s pelvic injury evaluation, clinical outcomes were rated with excellent in 12 cases, good in 2 cases, fair in 2 cases. The excellent and good rate was 87.5% (14/16) . According to Mears-Velyvis evaluation criterion, there were 14 cases with anatomical reduction and 2 cases with satisfactory reduction. Among the 3 cases with sacral nerve injury, 2 cases were improved from Gibbons grade II to grade I and the other 1 case was improved from Gibbons grade III to grade II, still feeling numbness on the lateral foot. There were no intraoperative complications in all patients such as neurovascular injuries. No incision infection, fat liquefaction and other incision related complications occurred postoperatively. Irritation and pain in iliac spine about prominent implant occurred in 1 case and lumboscaral stiffness in 1 case, in which the symptom relieved and disappeared after implants removal. Conclusion Triangular osteosynthesis can provide enough stabilization for Isler type II LSJIs and achieve satisfactory outcomes.

Oridonin is an en-kaurene diterpenoids compound which was found to have effect on tumor in vitro.But the clinical application has been limited because of poor water solubility,low bioavailability and oral absorption.Many scholars conducted a large number of structure modification researches of oridonin to search for new diterpenes with higher bio-activities and better bio-availabilities,and to develop new antitumor drugs.In this paper,studies on this aspect of oridonin were re-viewed.

Objective:To evaluate the clinical outcomes of traumatic spinopelvic dissociation treated with robot-assisted bilateral triangular fixation.Methods:From March 2016 to March 2020, 30 patients with traumatic spinopelvic dissociation were retrospectively analyzed. According to operation and fixation methods, the patients were divided into robot-assisted minimally invasive bilateral triangular fixation group (Robot triangular group) and traditional open reduction lumbopelvic fixation group (Lumbopelvic group). There were 16 patients in the Robot triangular group, 4 males and 12 females, average age 35.7±13.3 years (range, 16-58 years). There were 10 cases of U-shaped, 4 cases of H-shaped, 2 cases of Y-shaped sacral fractures according to shape classification of sacral fractures. According to ROY-Camille classification, there were 4 cases of type I, 9 cases of type II, 3 cases of type III. There were 13 cases with sacral nerve injuries, including 10 cases of Gibbons grade II, 3 cases of grade III. There were 14 patients in the Lumbopelvic group, 4 males and 10 females, average age 37.4±15.1 years (range, 18-66 years), there were 10 cases of U-shaped, 3 cases of H-shaped, 1 case of Y-shaped sacral fractures according to shape classification of sacral fractures. According to ROY-Camille classification, there were 1 case of type I, 10 cases of type II, 3 cases of type III. There were 10 cases with sacral nerve injuries, 7 cases of Gibbons grade II, 3 cases of grade III. The patients' age, operation time, intraoperative blood loss, and Majeed score of the two groups were compared by independent sample t-test; gender, sacral fracture classification, ROY-Camille classification, fracture reduction quality, postoperative wound infection, and sacral nerve recovery were compared by Chi-square test. Results:All patients were followed up for 23.6 months (range, 12-54 months). In the Robot triangular group, the operation time was 95.3±27.5 min (range, 70-180 min), and intraoperative blood loss was 98.7±47.5 ml (range, 50-250 ml). According to Mears and Velyvis imaging evaluation criteria, anatomical reduction was achieved in 6 cases, satisfactory reduction was achieved in 9 cases and unsatisfactory reduction in 1 case. The Majeed score was 85.5±7.7 points. 8 cases of Gibbons grade II sacral nerve injury were recovered to grade I after surgery, 1 case of grade III recovered to grade I, and 1 case recovered to grade II. In the Iliolumbar fixation group, the operation time was 148.6±59.1 min (range, 90-240 min), and intraoperative blood loss was 582.1±244.6 ml (range, 300-1 200 ml). According to Mears and Velyvis imaging evaluation criteria, anatomical reduction was achieved in 7 cases, satisfactory reduction was achieved in 6 case and unsatisfactory in 1 case. The Majeed score was 77.6±7.7 points. 5 of 7 cases of Gibbons grade II sacral nerve injury were recovered to grade I after surgery, and 2 of 3 cases of grade III recovered to grade I. Compared with the Iliolumbar fixation group, the Robot triangular group has shorter operation time ( t=3.23, P<0.05), less bleeding ( t=7.76, P<0.05), and higher postoperative Majeed score ( t=2.83, P<0.05). There are statistical differences in the above indicators significance. Conclusion:For traumatic spinopelvic dissociation, especially fractures involving the lumbosacral junction, those who do not require sacral nerve decompression, Robot-assisted bilateral triangular fixation shows satisfactory clinical outcomes, which is minimally invasive, with fewer postoperative complications.

Objective To investigate the clinical effect of arthroscopy-assisted percutaneous cannulated screw fixation for Ideberg Ⅲ glenoid fractures.Methods A retrospective case series study was conducted to analyze the clinical data of 28 patients with Ideberg Ⅲ glenoid fracture admitted to the Honghui Hospital Mfiliated to Medical College of Xi'an Jiaotong University from January 2014 to January 2017.There were 19 males and nine females,aged 20-49 years [(32.5 ± 3.5)years].All patients were classified as Ideberg Ⅲ glenoid fractures.All patients were treated with arthroscopy-assisted percutaneous cannulated screw fixation.The length of incision,complications and range of motion of shoulder joint were recorded.The shoulder function was evaluated by University of California at Los Angeles (UCLA) score and visual analogue score (VAS) before and after operation.Results All patients were followed up for 24-36 months [(25.6-± 4.5) months].The incision ranged from 2.0 cm to 3.7 cm [(2.3 ± 0.8) cm].No infection,re-displacement or nonunion occurred.One year after operation,the results of range of motion were as follows:anterior flexion (160.7 ± 5.5)°,abduction (150.8 ± 6.8)°,and external rotation (38.4 ± 7.5) °.The mean UCLA score was increased from preoperative (7.2 ± 1.2) points to (33.5 ± 3.2) points (P ＜ 0.05),and the mean VAS score was decreased from preoperative (7.8 ± 3.2) points to (1.3 ± 0.5) points (P ＜ 0.05).Conclusion For Ideberg Ⅲ glenoid fractures arthroscopyassisted percutaneous cannulated screw fixation can relieve the pain and reduce complications,which is beneficial to the recovery of shoulder function.

Objective:To compare the population characteristics, the positive rate of screening, the detection rate of breast cancer, early diagnosis rate and the cost between the mass screening group and opportunistic screening group of breast cancer.Methods:This study is a prospective multicenter cohort study conducted from January 1, 2014 to December 31, 2016. The participants were enrolled for mass screening or opportunistic screening of breast cancer. After completing the questionnaire, all the participants received breast physical examination and breast ultrasound examination every year for 3 rounds by year. The participants′ characteristics and screening results of the two groups were compared by χ 2 test, Fisher exact test or Wilcoxon rank-sum test. Results:A total of 20 080 subjects were enrolled. In the mass screening group, 9 434 (100%), 8 111 (85.98%) and 3 940 (41.76%) cases completed the 3 rounds of screening, and 10 646 (100%), 6 209 (58.32%) and 2 988 (28.07%) cases in the opportunistic screening group, respectively. In the opportunistic screening group, the proportions of less than 3 months lactation (1 275/9 796 vs. 1 061/8 860, χ2=4.597, P=0.032), non-fertility (850/10 646 vs. 574/9 434, χ2=27.400, P<0.01), abortion history (6 384/10 646 vs. 5 062/9 434, χ2=81.232, P<0.01), postmenopausal (2 776/10 646 vs. 2 217/9 434, χ2=17.757, P<0.01), long-term oral contraceptives(>6 months) (171/10 646 vs. 77/9 434, χ2=25.593, P<0.01) and family history of breast cancer in first-degree relatives (464/10 646 vs. 236/9 434, χ2=51.257, P<0.01) were significantly higher than those in mass screening group. The positive rate of screening (514/10 646 vs. 128/9 434, χ2=194.736, P<0.01), the detection rate of breast cancer (158/10 646 vs. 13/9 434, χ2=107.374, P<0.01), and positive rate of biopsy (158/452 vs. 13/87, χ2=13.491, P<0.01) in the opportunistic screening group were significantly higher than those of the mass screening group. The early diagnosis rate of the mass screening group was significantly higher than the opportunistic screening group (10/12 vs. 66/141, χ2=5.902, P=0.015). The average cost for detecting each breast cancer case of the mass screening group was 215 038 CNY, which was 13.6 times of the opportunistic screening group (15 799 CNY/case). In the opportunistic screening group, the positive rate of biopsy in primary hospitals was significantly lower than that in large-volume hospitals (79/267 vs. 79/185, χ2=8.267, P=0.004), but there was no significant difference in the mass screening group (6/37 vs. 7/50, χ2=0.082, P=0.774). Conclusions:Breast cancer screening can improve early detection rate. Compared with the mass screening mode, the opportunistic screening mode has the advantages of higher proportion of high-risk factors, higher positive rate of screening, higher detection rate of breast cancer, higher positive rate of biopsy, and lower cost of screening. However, the early diagnosis rate of breast cancer of opportunistic screening is lower than that of mass screening. The positive rate of opportunistic screening in primary hospitals is lower than that of large-volume hospitals. The two screening modes have their own advantages and should be chosen according to local conditions of different regions in China.

Objective:To compare the population characteristics, the positive rate of screening, the detection rate of breast cancer, early diagnosis rate and the cost between the mass screening group and opportunistic screening group of breast cancer.Methods:This study is a prospective multicenter cohort study conducted from January 1, 2014 to December 31, 2016. The participants were enrolled for mass screening or opportunistic screening of breast cancer. After completing the questionnaire, all the participants received breast physical examination and breast ultrasound examination every year for 3 rounds by year. The participants′ characteristics and screening results of the two groups were compared by χ 2 test, Fisher exact test or Wilcoxon rank-sum test. Results:A total of 20 080 subjects were enrolled. In the mass screening group, 9 434 (100%), 8 111 (85.98%) and 3 940 (41.76%) cases completed the 3 rounds of screening, and 10 646 (100%), 6 209 (58.32%) and 2 988 (28.07%) cases in the opportunistic screening group, respectively. In the opportunistic screening group, the proportions of less than 3 months lactation (1 275/9 796 vs. 1 061/8 860, χ2=4.597, P=0.032), non-fertility (850/10 646 vs. 574/9 434, χ2=27.400, P<0.01), abortion history (6 384/10 646 vs. 5 062/9 434, χ2=81.232, P<0.01), postmenopausal (2 776/10 646 vs. 2 217/9 434, χ2=17.757, P<0.01), long-term oral contraceptives(>6 months) (171/10 646 vs. 77/9 434, χ2=25.593, P<0.01) and family history of breast cancer in first-degree relatives (464/10 646 vs. 236/9 434, χ2=51.257, P<0.01) were significantly higher than those in mass screening group. The positive rate of screening (514/10 646 vs. 128/9 434, χ2=194.736, P<0.01), the detection rate of breast cancer (158/10 646 vs. 13/9 434, χ2=107.374, P<0.01), and positive rate of biopsy (158/452 vs. 13/87, χ2=13.491, P<0.01) in the opportunistic screening group were significantly higher than those of the mass screening group. The early diagnosis rate of the mass screening group was significantly higher than the opportunistic screening group (10/12 vs. 66/141, χ2=5.902, P=0.015). The average cost for detecting each breast cancer case of the mass screening group was 215 038 CNY, which was 13.6 times of the opportunistic screening group (15 799 CNY/case). In the opportunistic screening group, the positive rate of biopsy in primary hospitals was significantly lower than that in large-volume hospitals (79/267 vs. 79/185, χ2=8.267, P=0.004), but there was no significant difference in the mass screening group (6/37 vs. 7/50, χ2=0.082, P=0.774). Conclusions:Breast cancer screening can improve early detection rate. Compared with the mass screening mode, the opportunistic screening mode has the advantages of higher proportion of high-risk factors, higher positive rate of screening, higher detection rate of breast cancer, higher positive rate of biopsy, and lower cost of screening. However, the early diagnosis rate of breast cancer of opportunistic screening is lower than that of mass screening. The positive rate of opportunistic screening in primary hospitals is lower than that of large-volume hospitals. The two screening modes have their own advantages and should be chosen according to local conditions of different regions in China.

Objective To analyze clinicopathological characteristics and the potential risk-related factors of female breast hyperplasia in different age groups.Method From Jan 2015 to Dec 2016,patients diagnosed with breast hyperplasia in 12 hospitals were evaluated.All patients completed the self-designed questionnaires on women'health,including basic demographic information,clinic examination information,radiologic information and pathologic results.The patients were divided into a young group (＜ 45 years old) and an elderly group (from 45 to 75 years old).Results There were 3 684 cases of breast hyperplasia,including 2 291 cases in young group and 1 393 cases in elder group,respectively Clinically breast pain type were most commonly observed in both young and older groups (50.3％ vs.42.7％,P ＜ 0.001).While pathological research based on biopsy showed that breast adenopathy were the most common changes in both groups (67.9％ vs.61.7％,P ＜0.001).More breast cancer cases were identified in elder group than that in young group,especially in clinically lump type patients (9.4％ vs.4.2％,P ＜ 0.001).Compared with elder group,patients in young group have different distribution characteristics regarding to fertility factors,lifestyle factors and psychology scale including anxiety and depression.Conclusion Distributions of clinicopathological characteristics and risk factors of female breast hyperplasia differ across different age groups.