Objective To study the classification, management and outcome of the injury of hamatometacarpal joint. Methods Retrospective analysis was carried out in 17 patients with injury of hamatometacarpal joint. There were 16 males and 1 female aged 19-51 years old. 3 in left hand and 14 in right hand were injuried. The dominant hands of all were right hand. The injury of hamatometacarpal joint might be classified into 4 major groups based on the condition of the hamate, and subdivided into 2 subtypes based on the isolated dislocation(subluxation) or fracture-dislocation of metacarpal base. Carpometacarpal joint ligment injury without fracture of hamatum and the fourth or fifth metacarpal base dislocation without fracture was defined as typeⅠa. When there was a fracture of the fourth or fifth metacarpal base following typeⅠa was defined as typeⅠb. Avulsion fracture of the back of hamatum and the fourth and/or the fifth metacarpal base dislocation without fracture was defined as type Ⅱa. With the fracture of the fourth or fifth metacarpal base following the typeⅡa was defined as type Ⅱb. Splintered fracture of the back of hamatum with the fourth and/or fifth metacarpal base dislocation without fracture was defined as typeⅢa. With the fracture of metacarpal base following typeⅢa was defined as typeⅢb. The split fracture of coronal side of hamatum with the fourth and/or fifth metacarpal base dislocation and without fracture was defined as type Ⅳa. With fracture of the fourth and/or fifth metacarpal base following type Ⅳa was defined as type Ⅳb. There were 7 typeⅠb, 2 typeⅡa, 1 typeⅡb, 2 typeⅢb, 1 typeⅣa, 4 type Ⅳb in our group. We chose conservative or operative treatment according to the type of injury. Results The follow-up was 4-96 months. The patients had fracture union rate of 100%, and no traumatic osteoarthritis was occurred. There was a statistical significance when the motion of two-side joints was compared post surgery. There was no significant difference between bilateral hand in grip strength. Subjective evaluations of the patients were good or excellent. No complications was occurred. There is no case involved in any complications such as traumatic arthrositis, inflammation, neural injuries and adhesion of tendon. Conclusion The stable injury of hamatometacarpal joint should be ideally treated by closed reduction and immobilization in a well-moulded cast or splint. Satisfactory outcome can be got if keeping under strict surveillance. The unstable or intra-articular fracture should be treated by surgery. The outcome is also satisfactory and the rate of the complication of traumatic arthritis is low in short period follow-up. The outcome of fresh injury is much better than old one.

Objective Twenty- four case of non- traumatic paralysis of radial nerve were reviewed. Methods Between 1985 and 2000, 24 patients with non- traumatic paralysis of radial nerve were referred to this hospital for treatment. There were 18 men and 6 women with a mean age of 38 years (range, 10 to 65 years). Eleven patients had occupations with unduly stress of the forearm. Tendon transfer was performed in 1 patient, operative neurolysis in 18, nerve- grafting in 3, neurorrhaphy in 2. Results Of the 12 patients with the palsy attributed to entrapment of the fibrous edge of muscles, 8 occurred at the supinator, 1 at the tendinous edge of extensor digitorum communis and 3 at multiple sites.The palsy was caused by marked constrictions of the nerves in 5 patients, by benign tumors or tumorous conditions in 4 (by a ganglion in 2, by lipoma in 1 and by haemangioma in 1), by a neurilemmoma on the nerve in 1. The cause was unknown in 1. The patients who accepted neurolysis were followed up from 6 months to 15 years postoperatively. An excellent or good functional result was documented in 14 patients, fair in 3, and poor in 1. The patients who were treated with neurorrhaphy or nerve- grafting were followed- up from 4 months to 6 years, 3 recovered completely, 2 were in the convalescent stage (1 was treated by nerve- grafting and the other by neurorrhaphy). Conclusion The etiology of non- traumatic paralysis of radial nerve was miscellaneous. The results of surgical treatment were satisfactory.

Objective To introduce a new optimal operation for the reconstruction of thumb opposition in patients with late median nerve injury. Methods From July 1992 to January 2002, 46 patients of late median nerve injury with loss of thumb abduction were treated surgically by transposition of the flexor pollicis brevis muscle for the reconstruction of thumb opposition. There were 35 males and 11 females aging from 18 to 46 years with the average of 32 years. All of the patients suffered from median nerve injury and nerve repair had been undergone. The interval from injury to the second operation was 2.25 years ranging from 6 months to 4 years. Results All patients were followed up for 4-36 months with an average of 20 months. According to our functional evaluation system designed in 1992, the recovery ratio with favorable function was 100%, no complications and disadvantages were found. Conclusion The new optimal transpositional operation of the flexor pollicis brevis muscle for the reconstruction of thumb opposition is suitable for the patients with late median nerve injury, especially when the ulnar nerve branch to the deep head of the flexor pollicis brevis muscle is uninjured. This method has the following advantages: 1) Minimal operative trauma, only a small incision is required in contrast to the conventional method that need multiple incisions; 2)No other tendon transposition is needed, it does not interfere with other functions of the hand; 3) Postoperatively, it is unnecessary to keep many neighbouring joints in extreme flexion position, except for the thumb in opposition position, movements of all fingers and the wrist are not restrained.

Nonunion remains a major complication after skeletal trauma. In the last decade, extracorporeal shock wave therapy has become a common tool for the treatment of delayed unions or non-unions. With the help of a review of the literature, the current author gave an overview of indications, choices of devices, success rates and complications for ESWT in the treatment of non-unions. The conceivable mechanism was also outlined.

Objective To design technique of local flap transposition to refine the aesthetic appearance of reconstructed fingers by toes transfer.Methods Nine cases with 21 reconstructed finger were included,which involved 6 males and 3 females with an average age of 21.8 years(range,18-34years).A lingual contour flap with a lateral pedicle Was shifted from the inflated distal pulp to the narrow middle part of the"finger"to refine the aesthetic appearance.Overall results were evaluated in terms of the survival of the flap,the appearance improvement and the functional influence of the reconstructed finger.Results All of the flaps survived and healed perfectly.After a mean follow-up of 9.3 months(range,6-12months),the appearance of the reconstructed fingers were impmved apparently.There was little influence on the function of the finger.The results showed that all the patients gained more acceptable fingers.Conclusion From our experience,local flap transposition is a useful method for remolding of reconstructed fingers by toes transfer.

Objective To study the periodontal status and risk factors for periodontitis in periodontitis patients at different ages in wuhan. Methods From January 2007 to March 2008, the cross-sectional survey on periodontal conditions of 493 physical examinees in Wuhan city was carried out with random cluster sampling method. 458 cases of them were in accordance with the inclusive criteria and were stratified into two groups: young and middle-aged adults (aged 30-59 years) and old adults (aged 60 years and over). A case-control study was carried out in the periodontitis cases group (n=280) and the control group (n=178). Database was created by SQSERVER2000 and SPSS11.0 was used for statistical analysis. The relationship of periodontitis with age, gender, nation, educational background, diabetes mellitus, smoking, drinking, mental pressure and oral hygiene habits were analyzed by univariate and multivariate logistic regression analysis. Results The prevalence of periodontitis was 61.1% (280/458). Univariate analysis revealed that age, educational background, diabetes mellitus, smoking and oral hygiene habits were related factors for periodontitis (OR:0.44, 2.27, 3.44, 1.75, 9.82, P<0.05 or P<0.01). Meanwhile, multivariate analysis showed that suffering from diabetes mellitu and low educational background were the independent risk factors for periodontitis (OR=2.66, 1.95, all P<0.05). After stratification by age, multivariate logistic regression analysis showed that there was no correlation between diabetes mellitus and periodontitis prevalence in young and middle-aged adults and diabetes mellitus was a risk factor for periodontitis in old adults(OR=6.91, 95%CI: 1.27～37.42). Conclusions There are many risk factors for periodontitis and diabetes plays a major role in the development of periodontitis in old adults.

Objective To discuss a optimal culture method of primary hippocampal neurons and a more suitable method of mor-phological observation ,and provide basis to the study of synapse in Alzheimer′s Disease .Methods Postnatal 0 -1 days (P0 -1 ) C57BL/6J mice were decollated and bilateral hippocampus were separated .Low level concentration of trypsin and mechanical disso-ciation were adopted .And culture medium without serum was used to culture neurons .After 17 days culturing ,transfected neurons with Green Fluorescent Protein(GFP) by calcium phosphate precipitation ,and then observed neurons and spines by fluorescence mi-croscope .Results The neurons looked good and healthy by using this method .And the axons ,dendrites and spines which were typ-ical structure of neurons were observed clearly after transfected with GFP .Conclusion The cultured hippocampal neurons look good by this method .And the morphological characteristics of neurons and spines are observed much more clearly after transfected GFP by calcium phosphate precipitation .

Objective To observe the clinical efficacy of ebastine combined with Runzao Zhiyang capsules in the treatment of patients with chronic urticaria. Methods A total of 126 patients with chronic urticaria admitted to Department of Dermatology of Tianjin Third Central Hospital from January 2015 to May 2017 were enrolled and they were divided into two groups by the random number table method. The patients in control group (62 cases) were given oral ebastine administration 10 mg once per day, and those in observation group (64 cases) received oral administration of ebastine 10 mg once per day combined with Runzao Zhiyang capsule 2 g, 3 times per day, the therapeutic course being 4 weeks. The changes of clinical efficacy and the symptom scores, including urticaria activity score (UAS) and dermatolo-gical disease life quality index (DLQI) scores of the two groups were observed after treatment of 4 weeks;the incidence of adverse reactions and the recurrence situation after drug withdrawal for 4 weeks at follow-up were analyzed. Results Compared with the control group, the total effective rate of the observation group was significantly increased [92.2% (59/64) vs. 79.0% (49/62), P ＜ 0.05]. After treatment, the overall UAS score and DLQI score in two groups were both significantly decreased, the degree of decrease in observation group were more siginificant than those in control group [UAS: 1.26 (0.52 - 7.35) vs. 1.68 (0.75 - 8.65), DLQI: 0.56±0.52 vs. 1.57±0.96, P ＜ 0.01]. In addition, the total decrease degree of symptom score reducing index (SSRI) in the observation group was significantly greater than that in the control group [(76±21)% vs. (69±23)%, P ＜ 0.05], the incidence of adverse reactions [7.8% (5/64) vs. 12.8% (8/62)] and recurrence rate [8.3% (3/64) vs. 23.8% (5/62)] in the observation group were obviously lower than those in the control group (both P ＜ 0.05). Conclusion The efficacy of ebastine combined with Runzao Zhiyang capsule in the treatment of patients with chronic urticaria is prominent and superior to that of using ebastine alone, the combined method is capable of elevating the therapeutic effect obviously and has less adverse reactions.

Objective: To analyze risk factors, cardiovascular complications, time of death, gestational age of delivery and offspring outcomes in the maternal deaths with cardiovascular diseases (CVD). Methods: Totally 4 112 cases of pregnant women with CVD in Shanghai obstetric heart disease intensive care unit within 26 years (from January 1993 to December 2018) were collected, and 20 maternal deaths within these cases were analyzed retrospectively. Results: (1) Among the 20 deaths, structural heart diseases accounted for 90% (18/20), pregnancy induced heart diseases was 10% (2/20) while there was no dysfunctional heart disease. The mortality of pregnant women with CVD was 0.486% (20/4 112). (2) The following risk factors were common in these women, getting pregnant without counselling (95%, 19/20) , New York Heart Association classⅢ or Ⅳcardiac function (70%, 14/20), complicated with pulmonary hypertension (75%, 15/20) and prior heart events (60%, 12/20). And 85% (17/20) deaths occurred in puerperium, 15% (3/20) occurred before labor,while no death occurred during labor. And 65% (13/20) deaths died due to heart failure, 20% (4/20) deaths were due to pulmonary hypertension crisis, 5% (1/20) died on sudden cardiac arrest, rupture of aortic dissection and sudden death, respectively. Conclusions Women with CVD should get pregnant after strict evaluation. Pulmonary hypertension is one of the most severe contraindications to pregnancy, especially in patients with moderate to severe pulmonary hypertension. The puerperium period is a critical period that threatens the safety of these patients. Since heart failure is the most common cause of death, it is necessary to prevent and treat heart failure and to monitor heart function dynamically, especially in those with structural abnormal heart diseases. Moreover, it is also of importance to standardize antenatal care and to identify the severity of heart diseases in time.

Objective To investigate the effect ofatorvastatin on angiogenesis of brain tissues in focal cerebral ischemia rats,and explore the corresponding mechanism.Methods Ninety male SD rats were randomly divided into sham-operated group,model group and treatment group (n=30);and then,each group was divided into three subgroups:1 d group,3 d group and 7 d group (n=10).The focal cerebral ischemia models were induced by middle cerebral artery occlusion (MCAO);3 h after MCAO,rats in the treatment group received a gavage of atorvastatin 4 mg/(kg.d),and others were given the same amount of normal saline at corresponding time.The nerve function defects were estimated at 3 h after MCAO and before being killed;the protein expressions of vascular endothelial cell markers CD105 and glucose-regulated protein 78 (GRP78) were analyzed by immunohistochemistry;the vascular endothelial growth factor (VEGF) mRNA expression was analyzed by real time-PCR;the caspase-12 protein expression was analyzed by Western blotting.Results (1) Nerve function defects scores:there was no significantly statistical difference between model group and treatment group at 3 h after MCAO (P＞0.05),but statistical differences at different time points before being killed were noted (P＜0.05).(2) Microvessel density (MVD):at all time points,that of model group was increased as compared with that of sham-operated group,that of treatment group was increased as compared with that of model group,and the differences were all statistically significant (P＜0.05).(3)The VEGF rmRNA expression gradually increased over time;at all time points,the VEGF mRNA expression of model group was significantly higher than that in the sham-operated group,and that of treatment group was significantly higher than that in the model group (P＜0.05).(4)The GRP78 and caspase-12 expressions were gradually decreased over time;at all time points,the GRP78/BiP and caspase-12 expressions in the model group were significantly higher than those in the sham-operated group;those in the treatment group were statistically lower than those in the model group,but obviously higher than those in the sham-operated group (P＜0.05).Conclusion The angiogenesis of brain tissues in MCAO rats is obvious,and atorvastatin can enhance this effect;the mechanism may be that atorvastatin can weaken the endoplasmic reticulum stress,and then,reduce the apoptosis of endothelial cells.