Based on the digital and network environment, this paper analyzes the problems existing in the teaching of traditional orthopedics in medical colleges and universities, including single teaching form, neglecting the students' practical skills and the phenomenon of students' poor learning initiative. It points out that the orthopedics teaching under the digital and network environment should be integrated through interactive teaching, multimedia teaching, WeChat network teaching, simulation teaching, practice teaching and other teaching forms and should pay attention to the reasonable use of teaching methods, make clear teachers and students' subject status, pay attention to students' learning ability training, so as to improve the teaching quality of orthopedics in medical colleges.

Objective: To explore the risk factors in patients with chronic heart failure (CHF) combining atrial ifbrillation (AF) and to identify the predictive factors for AF recurrence after cardio version. Methods: A total of 246 CHF patients treated in our hospital were divided into 2 groups: CHF+AF (AF) group,n=71 and CHF without AF (Non-AF) group,n=175. The baseline information was recorded. The risk factors for AF occurrence were screened by Logistic regression analysis. There were 66 AF patients with successful cardio verse and they were followed-up for 18 months, the predictors for AF recurrence were studied by Cox regression analysis. Results: The baseline information showed that age, CHF duration, left atria diameter (LAD), the levels of BNP, uric acid and serum creatinine in AF group were all higher than those in Non-AF group, allP<0.05. Logistic regression analysis presented that age (RR=1.89, 95% CI 1.08-3.31,P<0.05), CHF duration (RR=1.35, 95% CI 1.05-1.74,P<0.05), BNP level (RR=1.82, 95% CI 1.30-2.53,P<0.01), LAD (RR=1.51, 95% CI 1.09-2.08,P<0.05) were the risk factors for AF occurrence. Cox regression analysis indicated that BNP level (RR=1.30, 95% CI 1.09-1.54,P<0.01) and LAD (RR=1.74, 95% CI 1.30-2.34, P<0.01) were the predictors for AF recurrence. Conclusion: The elder age, longer CHF duration, increased BNP level and LAD were the risk factors for AF occurrence in CHF patients. The increased BNP level and LAD were the objective predictors for AF recurrence after cardio version.

Objective To observe the effect of obstructive sleep apnea syndrome (OSAHS) patients with glycosylated hemoglobin (HbA1c) levels, assessment of continuous positive airway pressure (CPAP) effect on the level of HbA1c in patients with OSAHS. Methods From January 2013 to December 2016, eighty patients with OSAHS were divided into mild group, eighteen cases, moderate group twenty cases, severe group forty-two cases according to the apnea hypopnea index (AHI). Thirty healthy subjects were chosen as the control group. All the treatment groups were treated with CPAP for three months. Overnight polysomnography and HbA1c test were performed before and after treatment, and the control group was examined by HbA1c before treatment. Results The level of glycosylated hemoglobin in the middle and severe group was higher than that of the control group(P<0.05). After treatment, the glycated hemoglobin levels in the moderate and severe groups were significantly lower(P<0.05), and the sleep apnea hypopnea index, the lowest SaO2 and the average SaO2 level were significantly improved(P<0.01). Conclusion Glycated hemoglobin levels increased significantly in patients with moderate and severe OSAHS, and decreased HbA1c levels in patients with moderate and severe OSAHS after CPAP treatment.

Objective To assess the effectiveness of Bankart repair under arthroscope in treatment of recurrent anterior shoulder joint instability. Methods From February 2010 to February 2015, 63 patients with recurrent anterior shoulder dislocation under arthroscipic Bankart repair, and 53 patients (28 male, 25 female) were available for follow-up. The mean age at the time of surgery was 27.9 years (range, 16 ~ 51). All of the 63 patients underwent surgical treatments, and the effectiveness was evaluated with University of California at Los Angeles (UCLA), American Shoulder and Elbow Surgeon scores (ASES), Constant-Murley scores, forward elevation, abduction and external rotation and X-ray. Results The ASES scores, UCLA scores were (97.0 ± 6.8), (29.6 ± 2.5) respectively, improved significantly higher after the surgery (P < 0.05). No significant change was found regarding Constant-Murley scores (99.1 ± 2.4), forward elevation (168.7 ± 2.7)°, abduction and external rotation (72.6 ± 8.7)° compared with the pre-operation. Conclusions Significant difference between pre-operation and post-operation suggests that Arthroscopic Bankart repair is a good option for the treatment of recurrent anterior shoulder dislocation without large glenoid bone loss and poor quality Ligament and joint capsule. Risk factors of recurrence should be evaluated before the surgery to reduce the recurrence rate of dislocation.

Objective To provide reference for exploring the senile chronic disease health management new model by apply‐ing the chronic disease health management model into the practice of home‐based care service center in community .Methods The chronic disease health management team was established and the management platform of home‐based care service centers in com‐munity was applied to implement the chronic disease health management service .The senile chronic disease management and service situation were compared between before and after implementing chronic disease health management ,and the difference of service be‐tween the home‐based care service center and community health service center after implementing the chronic disease health man‐agement was compared as well .Results The service content implementation in the home‐based care service center was significantly improved after senile chronic disease health management (P<0 .01) ,and the chronic disease management satisfaction was increased by 39 .66% .Meanwhile ,the management rate and control rate of chronic diseases in the community home‐based care service center were superior to those in the community health service center (P<0 .01) .Conclusion Applying the chronic disease health manage‐ment model into the platform of the home‐based care service center can provide more comprehensive ,specific and efficient chronic disease health management service ,w hich provides a new model of senile chronic disease management application .

BACKGROUND:It is stil disputed about the treatment of subacromial impingement syndrome at present, arthroscopic subacromial decompression or open subacromial decompression. OBJECTIVE:To assess the clinical therapeutic effects of arthroscopic subacromial decompressionversus open subacromial decompression in the treatment of subacromial impingement syndrome. METHODS:Controled trials on arthroscopic subacromial decompressionversus open acromioplasty in the treatment of subacromial impingement syndrome were colected in different databases through computer search. There was no limitation for language, randomized controled trials or blinded studies. At last, the meta-analysis was conducted by using RevMan5.0 software. RESULTS AND CONCLUSION:Four randomized controled trials and six non-randomized controled trials were included in this study, involving 583 patients with subacromial impingement syndrome. The results of meta-analysis prompted that as to the hospital inpatient days and time until return to work, the group of arthroscopic subacromial decompression was shorter than open subacromial decompression. However, as to the postoperative shoulder functional scores, the operative time, patient’s satisfaction, and the rate of excelent and good results of postoperative UCLAs, there were no significant statistical differences between two groups. Due to the certain limitations and deficiencies of the quantity and quality in the included trials, there must stil need large-sample, multi-centered, high-quality randomized controled trials to confirm these results.

Objective:To explore whether perioperative intravenous flurbiprofen axetil can reduce the incidence and intensity of chronic pain for breast cancer atfer surgical treatment. Methods:This randomized, double-blind, controlled trial enrolled 60 patients undergoing mastectomy and axillary lymph node dissection under general anesthesia. All patients accepted Hospital Anxiety and Depression Scale (HAD) tests the day before the surgery to evaluate depression and anxiety. hTe patients were randomly assigned to receive either 50 mg lfurbiprofen axetil intravenously 15 minutes before the surgical incision and 6 hours later (group F) or intravenous 5 mL intralipid as a control (group C). All patients received patient-controlled intravenous analgesia (PCIA) with fentanyl postoperatively. Peripheral venous blood samples were drawn before the surgery, at 4 and 24 h atfer the surgery to detect the plasma level of PGE2 and tumor necrosis factor-α(TNF-α). Postoperative fentanyl consumption, Numerical Rating Scale (NRS) scores and adverse effects were recorded at 2, 6, 12, 24 and 48 h after the surgery. hTe duration and intensity of pain were followed up by telephone at the 2nd-12th month atfer the surgery. Results:The incidence of pain at 2, 4, 6, and 12 months after the breast surgery was 33%, 20%, 15%, and 10%, respectively, and the average pain score was 0.77, 0.57, 0.28, and 0.18, respectively. Compared with group C, the scores of pain in group F were significantly lower at 2, 4, 6 and 12 months postoperatively (F=7.758, P=0.007). The incidence of pain in group F was significantly lower at 2, 4 and 6 months postoperatively (P<0.05). There was no significant difference in the incidence of pain between the groups at 12 months postoperatively (P>0.05). Preoperatively and at 4 and 24 h atfer the surgery, there was no signiifcant difference in the level of TNF-αbetween the two groups (F=0.530, P=0.470);but plasma concentration of PGE2 in group F was significantly lower than that in group C (F=5.646, P=0.021). No patients developed abnormal bleeding, peptic ulcer, impaired liver or renal function and respiratory depression. Conclusion:Perioperative intravenous infusion of 100 mg flurbiprofen axetil can decrease the intensity and incidence of chronic pain for breast cancer atfer surgical treatment.

Objective To investigate the distribution,epidemiologic features and antibiotic resistance of the enteric pathogens i-solated from children with diarrhea.Methods Enteric pathogens were isolated from children’s stool samples.The children with diarrhea were treated in the outpatient and inpatient of Shanghai Children’s Hospital between 2008 and 2013.Antimicrobial susceptibility testing was conducted by disk diffusion method for Salmonella and Shigella with 6 antimicrobial agents.Results A total of 545 enteric pathogens were collected.Salmonella was the dominant pathogen,accounting for 67.2%,followed by Shigella (20.7%),S.aureus (4.6%),C.jejuni (3.7%),Aeromonas (2.4%),and enteropathogenic E.coli (0.9%).The main serotypes of Salmonella were S.typhimurium and S.enteritidis.Approximately 56.3% of the patients were boys.A-bout 72.7% of the patients were infants under 2 years.The prevalence of diarrhea peaked in summer and autumn (72.9%). The susceptibility of these isolates was only tested with seven antibiotics.Shigella showed higher level of resistance to ampicil-lin and trimethoprim-sulfamethoxazole than Salmonella (P<0.05).Significantly higher percentage of S.flexneri isolates were resistant to sulbactam-ampicillin,ceftriaxone,ciprofloxacin,and chloramphenicol than S.sonnei (P<0.001).Further-more,the prevalence of multidrug resistant strains in Shigella (68.3%)was much higher than that in Salmonella (44.7%,P<0.001).Conclusions A variety of diarrhea-causing enteric pathogens are isolated from the children in Shanghai Children’s Hospital.The isolates are predominantly Salmonella and Shigella species.The epidemiological features of Salmonella and Shigella species are different in terms of gender,age,season and geographical distribution.The resistance to antibiotics is a serious problem and varies with different types of pathogens. Intensive and ongoing surveillance of enteric pathogens and their changing resistant pattern is required to control diar-rhea in children.

The roles of voltage-dependent K(+) channels during activation and damage in alveolar macrophages (AMs) exposed to different silica particles were examined. Rat AMs were collected by means of bronchoalveolar lavage, and were adjusted to 5x10(5)/mL. After AMs were exposed to different concentrations (0, 25, 50, 100, 200 mug/mL) of quartz particles and 100 mug/mL amorphous silica particles for 24 h, the voltage-depended K(+) current in AMs was measured by using patch clamp technique. Meanwhile the leakage of lactate dehydrogenase (LDH) and the viability of AMs were detected respectively. Patch clamp studies demonstrated that AMs possessed outward delayed and inward rectifying K(+) current. Exposure to quartz particles increased the outward delayed K(+) current but it had no effect on inward rectifier K(+) current in AMs. Neither of the two K(+) channels in AMs was affected by amorphous silica particles. Cytotoxicity test showed that both silica particles could damage AM membrane and result in significant leakage of LDH (P<0.05). MTT studies, however, showed that only quartz particles reduced viability of AMs (P<0.05). It is concluded that quartz particles can activate the outward delayed K(+) channel in AMs, which may act as an activating signal in AMs to initiate an inflammatory response during damage and necrosis in AMs induced by exposure to quartz particle. K(+) channels do not contribute to the membrane damage of AMs.