[Objective]To discuss the diagnosis and treatment method of scoliosis associated with Chiari malformation.[Method]Twelve patients were suffered from scoliosis associated with Chiari malformation,in which there were 7 patients also complicated with syringomyelia.Firstly,posterior suboccipital craniectomy to enlarge foramen occipital magnum was performed,then the patients underwent the scoliosis correction with instrumentation.[Result]Preoperatively,the mean Cobbs angle on the coronal plane was 71?,and 24? postoperatively,with an average correction of 66%.During a follow-up from 1 year to 4 years,there were no release of the hook,no breaking of pedicle screw,no false articulation and no new nervous lesion,while few improving was found about the sensory disability and superficial abdominal hyporeflexia.[Conclusion]We should first consummate the examination and make a definite diagnosis for the patients who were suffered from scoliosis associated with Chiari malformation and syringomyelia;posterior suboccipital craniectomy to enlarge foramen occipital magnum or syrinx-subarachnoid space shunting should be performed firstly to reduce nervous lesion during scoliosis correction surgery.

[Objective] To disuse the traumatic mechanism,clinical feature and treatment of the occult osteochondral avulsion of the posterior ankle joint.[Method]The data of 6 patients had been reviewed.From 2003.9 to 2006.6,6 patients had been treated,including 4 male and 2 female,with the average ages of 31.7 years(27~38 years).They all had injury history of their ankle but no fracture or dislocation had been found in X-ray film immediatey after the trauma.Four of them had been treated by plastic cast fixation of their ankle for 3 weeks,2 received treatment without fixation,but all the patients suffered pain and tenderness in the medial-posterior or the lateral-posterior of the ankle with leg or/and food radiation.The symptoms were persistent even when they were rest.The diagnosis of osteochondrl avulsion fracture had not been made until they were admitted in 4 mouth to 1 year after the injury.The fractured bone debris were showed by X-ray film and CT scan.All patients had been treated by operation of ablating the fractured fragment.[Result]All symptoms in the ankle had disappeared 2~3 days after the operation and no recurrence during 6 mouth to 2 years follow up.[Conclusion]It shoud be attaching importance to the occult osteochondral avulsion in early time after ankle injury,and when the diagnosis is made,operation is the appropriate treatment.

This paper made systematic description of the three objectives of sustainable development designed for the policy based on the sustainability theory for the health sector.The essential drug system for secondary hospitals comprises the list coverage and allocation percentage of essential drugs,requirements for bidding and purchasing as well as pricing practice; management and conditions of these hospitals,including leadership determination and competency,doctors prescription behavior,and supportive reforms at these hospitals; external policies and social environment,including government financial subsidy,medical service prices adjustment,medical insurance,and the awareness and attitude of the people on essential drugs.

Substance P (SP) and calcitonin gene-related peptide (CGRP) are the neuropeptides released from the sensory nerve endings.Neuropeptides play a role in bone and the relevant organs.It exerts functions in regulation of the bone metabolism,fracture healing and pain by a certain way.The biological properties and distributions of SP and CGRP are closely related to the pathogenesis and development of bone metabolism,fracture healing and pain.

BACKGROUND: Most of the scoliolosis patients with Marfan syndrome are young, and in the growth and development period. Scoliosis develops rapidly, so a great number of patients need operation. Many patients accompanied with severe cardiorespiratory disfunction, which brings about a great difficulty for operation.OBJECTIVE: To observe the effect of CD orthosis on spinal function of patients with Marfan syndrome.DESIGN: A self-control observation.SETTING: Department of Orthopaedics, Renji Hospital Affiliated to Medical College, Shanghai Jiao Tong University (i.e. Shanghai Second Medical University).PARTICIPANTS: A total of 8 severe scoliolosis patients with Marfan syndrome who were treated at Department of Orthopaedics, Renji Hospital Affiliated to Medical College, Shanghai Jiao Tong University (i.e. Shanghai Second Medical University) were enrolled from May 1999 to July 2003. Of them, there were 2 one-side curvatures, 6 two-side curvatures; 4 cases of cardiorespiratory function lost lightly, 2 cases midrange lost. Mean Cobb angle was 88°.METHODS: The patients were at prone position under general anesthesia.Incision was made at middle posterior after fixing the position. Erector spinal muscle beneath periosteum was stripped and vertebral plate to transverse process root was revealed. Claws or nails were used in multiple segments of vertebrae by CD orthosis such as CD, CD-Horison, TSRH, USS and so on.MAIN OUTCOME MEASURES: Changes of Cobb angle, height, grafting bone fusion and cardiorespiratory function of patients after operation.RESULTS: After 12-month follow-up, 8 patients were involved in the result analysis. The incision of 8 patients was healed, no infection. Scoliolosis was corrected effectively, and the height increased by 5-8 cm. Cardiorespiratory function recovered satisfactorily after operation. Grafting bone was fused. The lost Cobb's angle was less than 25° after correction.CONCLUSION: CD orthosis can correct the lateral curvature and effectively correct that of patients combined with rotational deformity, consisting of large distraction, multiple segment frame style fixation, average distributed force placement, so it is not easy to have the complications such as release, broken stick and so on. Selective multiple segment fixation and derotation are adopted, so good three-dimension correction is gained, which can reconstruct satisfactorily trunk balance, prevent post-operative loss,with less complication, high fusion rate, less correction lost. External fixation is not needed after operation, which is helpful for early rehabilitation.

BACKGROUND: Traditional anterior release followed by posterior correction and fusion is frequently used to treat severe and rigid adolescent idiopathic scoliosis, which is considered as Cobb angle of the major curve > 65° and flexibility < 34.5%; however, there are a great majority of complications. Whether isolated posterior correction using pedicle screw fixation combining with bone grafting and fusion may provide better effects on severe and rigid adolescent idiopathic scoliosis needs to be further studied.OBJECTIVE: To evaluate isolated posterior correction using pedicle screw fixation combining with bone grafting and fusion for the treatment of severe and rigid adolescent idiopathic scoliosis. DESIGN: Case analysis.SETTING: Department of Orthopaedics, Renji Hospital, Medical College of Shanghai Jiao Tong University.PARTICIPANTS: Twenty patients with severe and rigid adolescent idiopathic scoliosis, including 8 males and 12 females, were selected from Department of Orthopaedics, Renji Hospital, Medical College of Shanghai Jiaotong University from June 1999 to August 2005. They were 12-18 years old, and the mean age was 14.6 years. All patients were finally diagnosed as X-ray of whole spine. According to King-Moe criteria, patients were classified into type Ⅰ(n =4), type Ⅱ(n =6), type Ⅲ (n =5), type Ⅳ(n =3) and type Ⅴ(n =2). Before surgery, mean Cobb angle of the major curve was 82° (75°-92°), mean flexibility was 30% (20%-40%), and mean shoulder height difference was 15 mm (5-35 mm). Moreover, according to Risser syndrome, patients were classified into degree 1 (n =3), degree 2 (n =5), degree 3 (n =6), degree 4 (n =5) and degree 5 (n =1). All patients and their relatives provided the informed consents, and the experiment was approved by the local ethical committee. Artificial bone was Osteoset provided by Wright Company, USA.METHODS: Patients underwent isolated posterior correction using pedicle screw fixation combining with bone grafting and fusion, and spinous process, lamina of vertebra, zygapophysial joints and transverse process were exposed in a preconcerted fusion area. Pedicle screw was inserted into strategy vertebra using free hand technique according to the anatomic landmark of entry point. Six patients underwent fixation with TSRH system, and the other patients with CDH M8 system. Operative time and blood loss were evaluated after surgery. At 7 days after operation, Cobb angle was measured with X-ray, and correction rate of major curve was calculated. While shoulder height difference and admission duration were evaluated simultaneously. Complications and recovery states were followed up in the next 4 years.MAIN OUTCOME MEASURES: ① Operative time and blood loss; ② Cobb angle and correction rate of major curve; ③ shoulder height difference and admission duration; ④ follow-up results.RESULTS: All 20 patients were included in the final analysis. ① Operative time and blood loss: Operative time lasted from 3.2 to 4.3 hours, and the mean time was 3.5 hours. Blood loss ranged from 660 to 1 070 mL, and the mean loss was 865 mL. ② Cobb angle and correction rate of major curve: Cobb angle of the major curve ranged from 82° (75°-92°) before surgery to 31° (22°-37°) after surgery, and the mean correction rate was 62%. ③ Shoulder height difference and admission duration: Mean should height difference before surgery was 15 mm (5-35 mm). Postoperative lateral film of spine indicated that thoracic and lumbar vertebra generally suffered from normal posterior and anterior convexity, and mean shoulder height difference after surgery was 7.5 mm (0-11 mm). The admission duration lasted from 8 to 11 days, and the mean duration was 9 days. ④ Follow-up results: All patients were followed up in the next 4 years after surgery. The cobb angle correction of major curve remained unchanged, and the instrumented segments were completely fused without instrumentation failure.CONCLUSION: Isolated posterior correction using pedicle screw fixation combining with bone grafting and fusion may effectively cure severe and rigid adolescent idiopathic scoliosis, which is considered as Cobb angle of the major curve between 75° and 92° and flexibility ≥ 20%.

A field survey of three counties in a province in west China analyzed the public health performance from the dimensions of input, output and outcomes, and computed the composite evaluation indexes for public health performance of the sample areas. The indexes so obtained are as follows: Low public health input in general; gap of public health outcomes among various public health programs;generally high outcome performances. The paper proposed to improve the fund raising mechanism for rural public health, build a performance-based investment mechanism, balanced provision of primary public health services, and secure supports from all the society, in an effort to promote public health development in rural areas.

Objective To evaluate the application of scenario-based training and medical simulator in the orthopedics education. Methods A total of 60 students from Shanghai Jiao Tong University School of Medicine who finished their orthopedics internship from January 2016 to July 2016 were involved. They were randomly divided into the study group and control group with 30 students each. The study group re-ceived 2 classes of scenario-based training and medical simulator assisted education during their internship in the orthopedics department while the control group received 2 classes of traditional lessons instead. Sur-veys were conducted after the internship and the scores of internship were also recorded. Result The overall satisfaction was higher in the study group than the control group [(8.6±0.6) vs. (8.1±0.5), P=0.001]. On the part of learning interest, clinical thinking, clinical practice and group working, the study group also received better evaluation (P<0.05). The study group achieved better scores in the final examination than the control group [(84.4±2.6) vs. (82.5±3.4), P=0.018]. Conclusion The combination of scenario-based training and medical simulator can improve the ability of medical students in the orthopedics education, and receive higher satisfaction.

Objective To observe the treatment effect of minimally invasive surgery on bone defects. Methods Bone defect model was established in bilateral shaft of radius in 30 rabbits. Forefoots of each rabbit were then randomized into open grafting group(group A) and minimally invasive grafting group(group B). Minimally invasive bone grafting was performed in group B with self-made instruments. DEXA and electron microscopy were investigated in radial bone defect after six rabbits were sacrificed randomly at different time after bone grafting. Results DEXA showed bone density increased gradually in both groups, the bone density in minimally invasive group was higher than that in open group with significant difference(P

An ultrastructural analysis of distal nephron has been investigated using morphometric method for rats with hyperthyroidism and hypothyroidism. The cells analysed were distal convoluted tubule cells (DCT cells), distal straight tubule cells (DST cells), intercalated cells (I cells) and principal cells (P cells) of collecting duct. The cells were sampled from superficial cortex. The results revealed that in DCT, DST and P cells the profile area of cells, the surface density of plasma membrane (Sv), the boundary length of cell surface [B(A)], the volume density (Vv) of mitochondria, and the length of microvilli were significantly decreased in the rat with hypothyroidism. However, in the rat with hyperthyroidism there were an obvious increase of profile area of cell and Vv of mitochondria in I cells. The results suggest that thyroid hormone is an important factor for maintaining the normal cellular structure in the distal nephron. The morphometry shows that the changes of DCT, DST and P cells are distinct in the rat with hypothyroidism, and the ultrastructural changes of I cell are obvious in the rat with hyperthyroidism.