Objective To measure the cancellous bone contents at different parts of the humeral heads of different ages and genders for data helpful for humeral head fixation.Methods Thirty-six patients with proximal humeral fracture were selected for this study who had been treated at our department with locking proximal humerus plate from June 2008 to April 2010.They were 18 men and 18 women,aged from 20 to 86 years (average,51.6 years).They were grouped according to age:group A ( ＜ 40 years),group B (40 to 60 years),and group C (＞ 60 years).A GE Sensation 16 CT scanner (GE Healtbcare,USA) was used to scan both of their affected and healthy humeral heads preoperation,with slices one mm thick.The bone density of cancellous bone was assessed by the CT value expressed in Hounsfield units.The maximum,minimum,and mean CT values were calculated for the cancellous bone in the humeral head in each image.CT images were processed by computer with custom software (Xiphoid 1.3,Image J 1.4g and Image-Pro Plus 6.0).All the data were analyzed with SPSS16.0.Results We found 4 weak point.s at the cortical bone of proximal humerus,correspondent with the 4 clinic CT types of proximal humeral fracture.The cancellous bone was the densest in the medial humeral head.The mean cancellous bone content was significantly lower in group C than in group A and B( P ＜ 0.05).There was a significant difference between men and women in group A in the BMD of cancellous bone ( t =4.744,P =0.001 ).Conclusions The cancellous bone content in the humeral head is related with age and gender.Since there is more cancellous bone in the medial part than in other parts of the humeral head,it is a reliable part for humeral head fixation.

Objective To study the anatomy of superficial palmar digital veins in fingertip,and explore the clinical application of superficial palmar digital veins as venous drainage in fingertip replantation.Methods One hundred fingers were studied with three methods: microanatomy,sectional anatomy,and X-ray.According to microanatomical observation,thirteen fingers in 10 cases with fingertip amputations and dorsal veins defect were replanted by anastomosis of palmar digital veins to reconstruct the venous drainage of the amputated digits. Results ( 1 ) 1 to 3 tiny superficial palmar digital veins can be found at the level of the onychorrhiza.The average diameters of the superficial palmar digital veins were 0.2-0.5 mm.(2)In clinical practice,13 replanted fingers were survived.After 3-18 months following-up,the appearance and function were satisfactory. Conclusion The distribution of the palmar digital veins was in some pattern.Anastomosis of the superficial palmar digital veins can not only improve the success rate of the fingertip replantation,but also avoid the complications of the other venous drainage methods.

Objective To evaluate epidemiological capacity of infectious disease in institutions of disease control and prevention,and to improve the ability of infectious disease control and prevention. Methods Questionnaires of epidemiological capacity of infectious disease evaluation in institutions of disease control and prevention which contained surveillance analysis,emergency response,plan system and so on were used to evaluate epidemiological capacity of infectious disease in all of city,district or county level of center for disease control and prevention in Ningbo,Shaoxing, Quzhou.The degree of attainment for the ability or (and)resources was divided into vary bad,bad,average,and good. Descriptive epidemiological methods were used to perform analysis and evaluation.Results The capability for monitoring notifiable infectious diseases reaching to good was 1 9 (76.00%),greater than that in non -statutory communicable diseases 2 (8.00%). Twenty four (96.00%) institutions reported that the most important factor limiting the epidemiological capacity of infectious disease was lack of human resources,and 20 (80.00%)of institutions supported infectious disease epidemiology staff to publish articles in academic journals,but scientific research ability reaching to good was 3(1 2.00%).Training subordinate institution capacity reaching to good was 1 0(40.00%),with 2 (8.00%)reporting very bad.Most abilities were not significant across different regions,only significant in non -statutory communicable diseases surveillance (χ2 =7.04,P =0.03).Conclusion Institutions of disease control and prevention had a certain epidemiological capacity of infectious disease,and almost balance in different regions.For further enhancing the ability,it is necessary to increase the number of personnel,and to improve the ability of education and training.

Objective To observe the clinical efficacy of Shugan Tiaoshen Acupuncture in the treatment of mild-to-moderate perimenopausal depressive disorder(PDD).Methods A total of 66 patients with mild-to-moderate PDD were randomly divided into the observation group and the control group,with 33 cases in each group.The observation group was treated with Shugan Tiaoshen Acupuncture,and the control group was treated with conventional western medicine for 8 weeks.After 2 months of treatment,the clinical efficacy of the two groups was evaluated,and the changes in Hamilton Depression Scale(HAMD-17)scores before and after treatment,as well as the scores of Menopausal Quality of Life Scale(MENQOL)were observed in the two groups.The changes in serum luteinising hormone(LH),follicle-stimulating hormone(FSH)and oestradiol(E2)levels were compared before and after treatment between the two groups,and the safety and the occurrence of adverse reactions in the two groups were evaluated.Results(1)During the study,3 cases in the observation group and 2 cases in the control group were lost to followup.Finally,30 cases in the observation group and 31 cases in the control group were included in the efficacy statistics.(2)After treatment,the total score of HAMD-17 and the scores of each factor in the two groups were significantly improved(P＜0.05),and the total score of HAMD-17 and the scores of anxiety/somatization factor and sleep factor in the observation group were significantly superior to those in the control group,the differences were statistically significant(P＜0.05).(3)After treatment,the total score of MENQOL and the scores of vascular dimension,physiological dimension and sexual life dimension in the two groups were significantly improved(P＜0.05),and the total score of HAMD-17 and the scores of vascular dimension and physiological dimension in the observation group were significantly superior to those in the control group,the differences were statistically significant(P＜0.05).(4)After treatment,the levels of LH,FSH and E2 in the two groups were significantly improved(P＜0.05),and the improvement of LH,FSH and E2 levels in the observation group was significantly superior to that in the control group(P＜0.05).(5)The total effective rate was 93.33%(28/30)in the observation group and 74.19%(23/31)in the control group.The curative effect of the observation group was superior to that of the control group,and the difference was statistically significant(P＞0.05).Conclusion Shugan Tiaoshen Acupuncture in the treatment of mild-to-moderate PDD can significantly improve the clinical symptoms of patients,improve the quality of life of patients,regulate the level of sex hormones,and have a significant effect.

Objective:To analyze the necessity of anastomosis of the cutaneous nerve by comparing anterolateral femoral flaps with versus without anastomosis of the anterolateral femoral cutaneous nerve in the repair of extremity soft tissue defects.Methods:A retrospective analysis was made of the clinical data of 30 patients with extremity soft tissue defects who had been admitted to Department of Orthopedics, The Sixth People＇s Hospital affiliated to Shanghai Jiaotong University School of Medicine from September 2019 to March 2022. The patients were assigned into 2 groups according to whether the anterolateral femoral cutaneous nerve was anastomosed or not in the repair of extremity soft tissue defects using anterolateral femoral flaps. In the anastomosis groups of 14 cases, there were 7 males and 7 females, with an age of (46.4±15.2) years and a flap size of (22.4±7.3) cm×(8.5±1.3) cm. In the non-anastomosis group of 16 cases, there were 11 males and 5 females, with an age of (39.9±15.8) years and a flap size of (23.0±6.4) cm×(9.0±2.1) cm. The 2 groups were compared in terms of flap survival, Semmes-Weinstein recovery degree and area of monofilament tactile sensation, and time periods for temperature sensation and two-point discrimination.Results:There was no statistically significant difference between the 2 groups in the preoperative general data, showing they were comparable ( P>0.05). All the flaps survived completely without vascular crisis. In the anastomosis group, the time periods required for Semmes-Weinstein recovery of monofilament tactile sensation to the areas of 20.0%, 50.0%, and 80.0% [(2.5±0.7) months, (6.7±1.1) months, and (11.0±1.2) months] were significantly shorter than those in the non-anastomosis group [(3.6±1.3) months, (8.6±1.4) months, and (15.0±2.2) months], the recovery area at the last follow-up [100.0% (100.0%, 100.0%)] was significantly larger than that in the non-anastomosis group [84.6% (81.7%, 89.9%)], and the time period for recovery of temperature sensation [(3.9±0.7) months] significantly shorter than that in the non-anastomosis group [(6.1±1.1) months] (all P<0.05). The time for recovery of two-point discrimination in the 14 patients in the anastomosis group was (10.4±1.7) months while only 7 of the 16 patients in the non-anastomosis group recovered two-point discrimination after (14.7±1.4) months, showing a significant difference between the 2 groups ( P<0.05). Conclusion:In the repair of extremity soft tissue defects using anterolateral femoral flaps, compared with no anastomosis of the cutaneous nerve, anastomosis of the anterolateral femoral cutaneous nerve may ensure more or less the sensory recovery of the flaps.

Objective Toinvestigatethestatusoftick-borneRickettsiaeinfectionsamongmurine-likeanimalsin differentareasofZhejiangprovince.Methods Liverandspleensamplesofmurine-likeanimalscapturedthroughnight trapping method were collected from Anji,Jinhua and Tiantai County according to their geographic locations and historical detection of Rickettsiae .Nest-PCR tests were used to determine the presence of the 16S rRNA genes of Anaplasma and Ehrlichia ,and the heat shock protein genes (groEL)of Rickettsiae (including typhus and spotted fever group)and Orientiainthesesamples.Results Atotalof851murine-likeanimalsbelongingto14specieswerecaptured.The predominant species were Rattus confucianus (30.32%),Apodemus agrarius (18.80%) and Thallomys paedulcus (1 1.75%)and they were significantly different among three areas (P<0.05 ).48 Rickettsia positive were found in 562 tested samples with the positive rate of 8.54%,among which the percentage of Anaplasma,typhus group Rickettsia, Orientia,Ehrlichia and spotted fever group Rickettsia were 3.38%,1.78%,1.78%,1.07% and 0.53% respectively. The positive rates of Anaplasma in Jindong (4.76%)and Anji (4.27%)were significantly higher than that in Tiantai (P<0.05 )while the spotted fever group Rickettsia were found only in Tiantai County.Moreover,Rattus confucianus-the predominant species of Zhejiang Province-had the highest infection rate of tick-borne Rickettsiae up to 14.97%.Co-infections with several Rickettsiae were existed among the same species.Conclusion Rickettsiae infections exist widely among different areas of Zhejiang province and the positive rates are significantly different among species.

Objective To explore the outcome and its influencing factors of the Multi - drug resistant tuberculosis(MDR -TB)patients with community management,and to provide the scientific basis for the further implementation of the community management of MDR - TB patients. Methods Retrospective study was conducted on MDR - TB patients diagnosed and treated with MDR - TB from January 2009 to June 2012 and the patientsˊ willingness and influence factors of outcome in community management were analyzed. Results 220 MDR - TB patients were under community management and the cute rate was 65. 91% . The cure rate of patients with degree in college or above ,occupation for workers,new type of patients,patients with no adverse reactions during drug injection therapy was relatively high. The cure rate of the patients who injected in home(86. 67% )was higher than who injected in community(68. 15% )and others (54. 84% ). The cure rate of the patients whose injection distance from home ≤5 km(67. 74% )was higher than whose injection distance from home ﹥ 5 km(36. 36% ). The cure rate of the patients with community doctor/ nurse follow - up management(70. 39% )was higher than those who without community doctor/ nurse follow - up management(55. 88% ). Through the analysis of needs for the community management,the results showed that 65. 91% of the patients were willing to accept the injection in the community,and 94. 09% patients chose medication at home. Conclusion The cute rate of MDR - TB patients should be improved in community management . In the future ,we should pay more attention to the patientsˊ needs in the development of community management for MDR - TB patients according to the actual situation,and to further strengthen the psychological support and community care for MDR - TB patients.

Objective To study the status on economic burden of diarrhea in Zhejiang province so as to provide evidence for allocation of health resource as well as decision-making on health issues. Methods Multi-phases stratified random cluster sampling was used to select samples in the population. Data was collected on the incidence of diarrhea in the last two weeks as well as on the related cost due to medical care etc. Results The overall incidence (person per year) of diarrhea was 0.26, with 0.29 in the rural and 0.22 in the urban areas respectively. The incidence of diarrhea in children less than 5 was 0.66 (person per year), higher than in any of the age groups. The average direct cost of medical treatment was 69.23 Yuan with average direct cost of non-medical care was 8.29 Yuan for every person, while the indirect cost was 48.43 Yuan. in conclusion, the average disease burden of diarrhea in the province was 1.697 billion Yuan per year, which accounted for 1%o of the GDP, with 1.217 billion Yuan in rural area and 0.480 billion Yuan in the urban areas respectively. The direct cost of medical care was 0.886 billion Yuan (52.21%) and the direct cost due to non-medical care was 0.124 billion Yuan (7.31%). The indirect cost appeared to be 0.480 billion Yuan (40.48%). Factors that affecting the cost would relate to: severity of diarrhea, medical insurance, location of residential area, age and education background of the patients, etc. Conclusion Programs on diarrhea prevention and control should be strengthened to reduce the economic burden caused by this disease while special attention should be paid to those children who are under 5 years of age and living in the rural areas.

Objective To investigate the seroprevalence of tick-borne diseases in humans and domestic animals from rural areas of Zhejiang province. Methods Anji county, Jindong district and Tiantai county were selected for samples collection according to their geographic locations and historical prevalence of tick-borne diseases. Blood samples of humans and domestic animals were collected in the three sites. An indirect immuno-fluorescent antibody test was used to determine the presence of IgG antibodies of Rickettsiae heilongjiangii, Orientia tsutsugamushi, R. typhi, Anaplasma phagocytos, Ehrlichia chaffeensis, Bartonella, R. hainan and Coxiella burnetii in these samples.Results Six hundred and eighty-three blood samples including 579 from humans and 104 from domestic animals(53 from cattles and 51 from sheep)were collected from the three sites. Antibody positive rates of Orientia tsutsugamushi, R. typhi, Ehrlichia chaffeensis and Coxiella burnetii were significantly different between these sites. IgG from all the 8 pathogens were detected in samples from humans. It was found that the sero-prevalence rates of R. typhi, Bartonella and C. burnetii(20.7%,10.9%, 5.5%)of adults were higher than those of other Rickettsiae under investigation. The seroprevalence of R. typhi increased along with age. IgG from the 7 pathogens were detected in samples from domestic animals except for Anaplasma phagocytos. The sero-prevalence rates of R. typhi, Bartonella and R. hainan(69.2%, 51.0%, 22.1%)of adults were higher than those of other Rickettsiae investigated. Conclusion Tick-borne diseases did spread widely in humans and domestic animals from different rural areas of Zhejiang province. The sero-prevalence rates of R. typhi,B. henselae, R. hainan and C. burnetii were higher than that from other pathogens.

Objective To evaluate the long-term immunogencity and effectiveness of live attenuated hepatitis A (HA) vaccine (H2 strain) after one dose injection, through a 15 years' follow up observation. Methods A total of 220 children with negative anti-HAV antibody (aged 1-3 y)were involved and followed up in Jiaojiang district, Taizhou city, Zhejiang province. Indicators would include seroconversion and geometric meantiter(GMT) levels after inoculation the vaccine with single dose at 2 m, 12 m, 6 years, 10 years and 15 years. Epidemiological observation was carried out within the 15 years to evaluate the relationship between vaccine coverage, the incidence of HA and the overall effectiveness. In the studied population, serum was tested by ELISA(calibrated by WHO international reference) and ABBOTT Axsym HAVAB mEIA. Results Seroconversion rates were found to be 98.6% and 81.3% after 2 months and 15 years of inoculation and slowly decreased. GMT level was 128 mIU/ml after 15 years, significantly higher than the required protective level of 20 mIU/ml,recommended by WHO experts. Effectiveness through the 15-year follow up program showed a significant correlation between vaccine coverage and incidence of HA in 1-15 years aged group (Kendall-Rank test, t =-0.931, P＜0.01). There was no HA case seen among the observed accumulated 236 413 person-year vaccines, compared to 4 HA cases discovered in the 27 206 personyear of the non-vaccinees. The overall protective rate reached 100%. Through a mass vaccination program on children, the whole population established an immune-defence to enable the incidence of HA decreased by 96.7%. Conclusion The long-term immunogencity and effectiveness of live attenuated hepatitis A vaccine (H2 strain) after one dose injection could last as long as 15 years.