Objective To evaluate more than 5-year follow-up outcome of avulsion fracture of the anterior cruciate ligament from the tibial insertion site in skeletally immature patients treated with modified arthroscopic internal fixation with cannulated screw and washer. Methods Thirty-nine patients with open physis were treated by modified arthroscopic internal fixation with cannulated screw and washer from March 2000 to November 2003. Regular X-ray plain films at AP and lateral views were conducted to detect the healing of avulsed fragments. Follow-up period of 31 patients was more than 5 years. Functional outcome before and after surgery was evaluated using the Lysholm Knee Score and the Tegner Activity Score. Angular deformity, or leg length discrepancy was assessed by clinical examination and anteroposterior-lateral radiographs of the knee. Instrumented knee laxity was performed using the KT-2000 arthrometer. Results Arthroscopic removal of implants was performed between 3 and 6 months postoperatively, when all fractures were revealed to have healed on X-ray films. No growth disturbance, angular deformation or knee instability was found in 31 patients during more than 5-year follow-up. The Lysholm score was improved from (19.2?14.8) (range 12-48) preoperatively to (98.5?3.1) (range 97-100) postoperatively, with significant statistical difference by the student-t test (t=18.395, P=0.000); The Tegner score was improved from (4.1?1.1) (range 3-5) preoperatively to (8.5?0.8) (range 7-9) postoperatively, with significant statistical difference by the student-t test (t=4.13, P=0.008). Physical examination showed Lachman test (+) in 14 of 31 patients. Instrumented knee laxity (KT-2000) showed manual-maximum side-to-side difference greater than 2 mm (range 2.1-3.8 mm) in 14 of 31 patients. Conclusion Modified arthroscopic internal fixation of avulsion fracture of the anterior cruciate ligament from the tibial insertion site with cannulated screw and washer in skeletally immature patients is a simple, safe, and effective ARIF procedure without growth disturbance.

OBJECTIVE:To investigate the utilization of opioid analgesic drugs in a hospital,so as to provide reference for ra-tional drug use in clinic. METHODS:The utilization of opioid analgesic drugs in the hospital during 2014-2016 was analyzed and compared retrospectively in terms of consumption sum,DDDs,DDC,B/A,etc. RESULTS:Annual consumption sum of opioid an-algesic drugs in the hospital increased slightly in 2015,but decreased significantly in 2016. Fentany transdermal patches(8.4 mg), Oxycodone and acetaminophen tablets and Remifentanil hydrochloride for injection always took up the first 3 places in the list of DDDs. DDDs of Fentanyl citrate injection(0.1 mg)and Morphine sulfate sustained-release tablets increased year by year;while DDDs of Fentany transdermal patches(4.2 mg)and Fentany transdermal patches(8.4 mg)decreased year by year. DDC of all opi-oid analgesic drugs decreased in 2016,with the cancel of drug price addition at the end of 2016. B/A values of most drugs were close to 1.0;while B/A value of Oxycodone hydrochloride sustained-release tablets(40 mg)was much less than 1.0,and that of Fentany transdermal patches(8.4 mg)and Oxycodone and acetaminophen tablets were significantly more than 1.0 for consecutive 3 years. CONCLUSIONS: The variety and specifications of opioid analgesic drugs in the hospital is comprehensive during 2014-2016. The clinical utilization of opioid analgesic drugs is generally rational,but still needs to be supervised effectively and par-ticularly,so as to improve standard use of opioid andalgesic drugs.

Objective To investigate the clinical effects of ulinastatin in treating extensive burns patients of shock period.Methods 15 patients with extensive burns were assigned to the treatment group(8 eases)and the control group(7 cases)randomly,patients in the control group were given the routine therapy,while those in the treatment group Were also given ulinastatin in the early stage of shock period.The life symptoms,urine amount, shock lasting time and complications were observed in the fourth day after injury.Results Compared to the control group,the life symptoms were steadier,urine amount was more of equivalent,shock lasting time was shorter,and complications were less in the treatment group.Conclusion In the early stage of the shock period for extensive burns patients,ulinastatin can help the patients live through the shock period steady.

National Natural Science Foundation of China becomes a dominating competitiveness that reflects to hospitals' ability of scientific research in China.Based on application and fund availability of National Natural Science Foundation of Shanghai 6th people's hospital in recent years,this article compared data with other hospital's condition to analyze shortcoming and challenge.It also gave suggestions of selecting a subject,raising rate of support,training outstanding young researchers,enhancing interdisciplinary study,and advancing quality of academic papers.This article would give a reference to promote high-speed,harmonic and sustainable development of scientific research in our hospital.

Objective To evaluate the clinical value of double-balloon enteroscopy( DBE)in as-sessing the effect of mucosal healing in patients with moderate small bowel Crohn's disease( CD)treated with low-dose azathioprine. Methods CD patients who were naive to any immunomodulators or biological a-gents with lesions mainly located in ileu were screened by multislice CT enterography and anal-route DBE at baseline. Lesions at 150 cm proximal to ileocecal valve were assessed by DBE with Simple Endoscopic Score for CD( SES-CD)after 12 and 24 months of low-dose azathioprine treatment,respectively. Results A total of 36 patients were enrolled and the average tolerated dose of azathioprine was(61. 8 ± 17. 2)mg/day. The total rates of complete,near-complete,partial and no mucosal healing in 36 patients were 19. 4%(7/36), 5. 6%(2/36),27. 8%(10/36),and 47. 2%(17/36)at month 12 and 30. 6%(11/36),25. 0%(9/36), 33. 3%(12/36),and 11. 1%(4/36)at month 24,respectively. The baseline SES-CD score(OR=2. 71, 95%CI:1. 11-6. 63,P=0. 029)and duration of disease(OR=1. 27,95%CI:1. 10-1. 47,P =0. 001) were two relevant factors associated with mucosal healing of small bowel CD. Conclusion DBE has a signif-icant advantage in assessing post-therapy mucosal healing for patients with small bowel CD. The optimal time point for the first follow-up by DBE is at least 12 months after low-dose azathioprine treatment.

Objective To assess the clinical outcome of varicose veins with incompetent great saphenous vein(GSV) treated with ultrasound guided foam sclerotherapy. Methods Forty limbs with moderate to severe symptomatic varicose veins with incompetent GSV in 38 patients were injected with foam sclerosing agent (Fibro-Vein) under ultrasound guidance. There were 36 patients with unilateral varicose veins and 2 with bilateral varicose veins. No of them suffered from deep vein incompetence or perforating vein incompetence. Second injection was performed one month after the initial injection in 7 limbs. Thirty-eight of 40 limbs were followed up with clinical examination and duplex ultrasound scan 30-47 months (mean 40 months) after the treatment. Results Among 38 limbs with follow-up mild debilitation was found in two limbs(5. 3%). There were no other symptoms or complications. Duplex ultrasound demonstrated four type of results: type I, sclerosed GSV trunk with no detectable venous flow in 32 of 38 limbs (84. 2%) ;type II,patent GSV trunk in 3 limbs (7. 9%) ,two of them had mild reflux in the GSV trunk;type III,sclerosed GSV trunk and mild reflux in the GSV tributaries, 1/38(2. 6%) ; type IV,sclerosed proximal GSV trunk,patent distal GSV communicated with a superficial vein and mild reflux in the veins, 2/38 (5. 3% ). Conclusions Clinical examination and duplex ultrasound scan demonstrated excellent results of varicose veins with incompetent GSV treated with ultrasound guided foam sclerotherapy 40 months after the treatment. Sclerotherapy is less invasive treatment option for varicose veins with incompetent GSV with satisfactory clinical and cosmetic outcome.

Objective To observe the effect of a high temperature environment on IL-17 concentration , neutrophil and lymphocyte in peripheral blood of soldiers on a training task .Methods Totally 160 health training soldiers were randomly and equally divided into two groups .The test group was trained and exposed to an environment of ( 32 ±1 )℃ vs control group at ( 22 ±1 )℃ for 2 hours before the IL-17 levels in venous blood were measured and peripheral neutrophils and lymphocytes were determined.Results The body temperatures were (38.74 ±0.26),(39.23 ±0.24),and (39.51 ± 0.34)℃after training for 40 min,50 min,and 60 min under a high temperature environment , respectively, and there was a significant increase of body temperature compared to the soldiers trained under normal conditions (P <0.05).Their perceived exertion rating was 17.62 ±0.66, 18.03 ±0.56, and 18.47 ±0.84, respectively, much unlike the control group (P<0.05).After 2 hours of training under high temperature , the concentration of IL-17 was (7.12 ±4.03) pg/ml, while the number of neutrophils and lymphocytes was (6.43 ±1.27) ×109/L and (9.84 ±1.36) ×109/L, respectively in peripheral blood, significantly higher than in the control group (P <0.05).Conclusion The body temperature and rating of perceived exertion of the training soldiers are significantly elevated under a high temperature environment, and the concentration of IL-17, and the neutrophils and lymphocytes counts in peripheral blood are increased .

Objective To explore the correlation between the reliability and validity of Brunel balance assessment(BBA)with the activities of daily living(ADL).Methods The BBA,ADL and walking ability test were performed on 215 patients conforming to the inclusion standard by two professionals.The Pearson correlation analysis,factor analysis and descriptive statistical analysis were adopted.Results The BBA total score and Cronbach's α coefficient in 3 dimensions was 0.852～0.941(P＜0.01),moreover the relative coefficient of each item with its dimension was higher that that of other dimensions;3 common factors were extracted by the factor analysis,the contribution rate was 83.916％;but BBA had the ceiling effect,the relative coefficient of BBA with ADL and walking ability was 0.284-0.709(P＜0.05).Conclusion BBA has a good reliability and validity and can better reflect the functions of ADL and walk.

Objective To investigate the role of double-balloon enteroscopy (DBE) in the evolution of detection and surgical treatment of small bowel stromal tumors (SBSTs),based on nine years experience.Methods In this retrospective study,193 patients with localized SBSTs were divided into the CT-enterography (CTE) and/or DBE group (n =100) and conventional modalities group (n =93).These patients were further divided into the open surgery group (n =126) and laparoscopy-assisted resection group (n =67).The development of clinical diagnosis and surgical treatment strategies were compared before and after the introduction of DBE.Results The average age and tumor size were significantly smaller in the CTE and/or DBE group than those in the conventional modalities group,respectively (age:50.9 ± 12.1 vs.56.9 ± 11.6 years; tumor size:3.6 ± 1.3 vs.6.1 ± 2.6 cm,P ＜ 0.01).Before the introduction of DBE (from January 2001 to December 2002),all patients underwent conventional modalities,and only 4 cases/year for open surgery.Afterward,from January 2003 to December 2004,84.6％ (11/13) of SBSTs were detected by DBE.From January 2005 to December 2008,50.0％ (23/46) of SBSTs were found by CTE combination with DBE.From January 2009 to December 2011,80.5％ (33/41) of SBSTs were diagnosed by CTE,and the number of patients underwent operation increased up to 25 cases/year,which was nearly 5.3 folds higher than that before the introduction of DBE.Sixty-seven patients were successfully operated by laparoscopy-assisted resection,82.1％ (55/67) of them were detected by CTE ands/or DBE,89.1％ (49/55) of whom had low-or intermediate-risk SBSTs.Conclusion DBE plays an important role in optimizing the algorithm of detection and treatment of SBSTs.