Objective To summarize the clinical characteristics of 15 cases of Poland's syndrome and to explore the suitable treatment strategies. Methods A retrospective study of 15 adult patients with Poland's syndrome was conducted and the related literature was reviewed. According to the development of pectoralis muscles and breast, chest deformities were classified into 2 grades: mild and severe. Mild form was limited to absence of partial pectoralis major muscle, with variable hypoplasia of other minor components (such as the size of breast and the size and position of the nipple-areola complex), leading to a mild chest wall asymmetry. Severe form was characterized by absence or severe hypoplasia of the pectoralis major muscle and mammary gland with an evident chest wall asymmetry. Combined with gender, adult patients were divided into 4 types: female mild, female severe, male mild, and male severe. Each type had its own treatment strategies based on its anatomic features: silicone implant insertion for female mild type;latissimus dorsi muscular flap transposition and silicone implant insertion for female severe type;fat injection for male mild type;latissimus dorsi muscular flap transposition for male severe type of the patients. From 2003 to 2008, 15 adult cases were admitted to our ward, aged from 16 to 34 years.The case number of each type was 6, 6, 2 and 1, respectively. One severe female patients rejected any surgical interventions;the others were all treated as the above. Results Follow-up periods ranged from 6 months to 4 years. This series had got satisfactory results with good breast symmetry and natural texture. All the latissimus dorsi muscular flaps survived well. No postoperative complications, such as implant capsular contracture or implant displacement, were observed. Conclusion The manifestations of Poland's syndrome are extremely varied. This classification method is simple but useful, which could effectively direct the individualized treatment for the complete and adequate rehabilitation. Latissimus dorsi muscular flap, pedicled or free transplanted, pulsing silicone implant in females, are the first choices for severe chest deformations of this syndrome.

Objective To investigate the epidemiological characteristics of multiple-injuries of bone and joint in the belief that a better knowledge of such injuries may help their prevention and treatment. Methods A retrospective study was done on the data of 346 patients with multiple-injuries of bone and joint who had been ad- mitted to our department from January 2001 to December 2004. On the basis of CAI's classification, the following data were statistically analyzed: gender, age, cause of injury, injured part, number of injured parts, associated injuries and mortality. Results Of the 346 injured patients, there were 278 males and 68 females, with an av- erage age of 32.8 years (9months to 89 years). Two hundred and twenty-six cases resulted from traffic accidents, 65 from crush by a heavy object, and 52 from falling. There were 159 fractures of shaft of tibia and fibula, 96 fractures of femoral shaft, 87 fractures of shaft of ulna and radius, 58 fractures of ankle and foot, 57 chest injuries, 50 knee injuries, 50 hip injuries, 49 injuries at the pelvis region, 46 wrist and hand injuries, 36 injuries of shoulder, 36 skull fractures, 33 fractures of humeral shaft, 23 spinal fractures, and 17 elbow injuries. Two hundred and forty-two patients had two parts injured, 83 had three parts, 20 had four parts, and one had six parts. The average number of injured parts was 2.3. Two hundred and five patients suffered from close injuries, and 141 from open ones. The associated injuries included skull and brain injury in 51 cases, chest injury in 23, abdomen injury in five, urine system injury in three, nerve and vessel injury in 21, shock in 78, and fat embolism in six. Five patients died. Conclusions Male young people tend to be the majority of victims of multiple-injuries of bone and joint. Traffic accidents result in most of such injuries. Since multiple-injuries mostly involve lower limbs, they are easy to diagnose while the associated close injuries involving brain, chest, abdomen and pelvic are likely to be overlooked or misdiagnosed. Strengthening safety education and technical training of first aid is important to im- provement of treatment and to decrease of disability rate and mortality.

Objective To learn the status of disabled elderly in community,and to analyze the influencing factors on activities of daily living. Methods With the method of cluster stratified random sampling, a self -designed questionnaire and Modified Barthel Index (MBI)was used in investigation of survival status and activities of daily living (ADL)of the elderly in community of Sijiqing Street,Jianggan District,Hangzhou City,and the logistic regression model was used to analyze its influencing factors.Results A total of 883 valid questionnaires were completed and analyzed,and 1 91 interviewees was found to be with disability according to the disability standards with the percentage 21 . 6%.Logistic regression analysis suggested that age(OR=4. 99,95%CI:4. 52-5. 66),chronic disease situation(OR=2. 1 9,95%CI:1. 74-2. 72),stroke(OR=3. 78,95%CI:2. 65 -5. 06),osteoarthritis(OR=1. 87,95%CI:1. 55 -2. 39),chronic bronchitis(OR=2. 1 7,95%CI:1 . 73-2. 91 ),visual(OR=1 . 73,95%CI:1 . 37 -2. 28),dementia(OR=1 . 92,95%CI:1 . 23-2. 69 ),lumbocrural pain (OR =2. 04,95%CI:1 . 47 -2. 89 )were the risk factors of disability.Educational background(OR=0. 87,95%CI:0. 82-0. 95),income(OR=0. 81 ,95%CI:0. 76 -0. 87),outdoor activity(OR=0. 69, 95%CI:0. 63-0. 81 ),physical exercise(OR=0. 67,95%CI:0. 56 -0. 79)were protective factors.Conclusion The status of disabled in community of Hangzhou affected by various factors,and it is necessary to provide them health management and comprehensive intervention.