Objective To evaluate the surgical techniques and clinical outcomes of treating osteoporotic fracture of proximal humerus with Spatial Subchondral Support (S3) locking plate of proximal humerus.Methods From July 2010 to July 2011,21 patients with osteoporotic fracture of proximal humerus,12 males and 9 females,were treated in our department.They were 66.0 years old on average (from 58 to 80 years old).According to the Neer classification system,13 cases were 3-part fractures,8 4-part fractures,and 2 combined with shoulder dislocation.All cases were evaluated carefully with routine CT scans pre-operatively to define the type of fracture and the involvement of articular surface.Open reduction and internal fixation with S3 locking plate of proximal humerus was performed 2 to 7 days after injury (average,4.0 days).Regular X-ray follow-ups were taken and complications recorded as well.Overall function evaluation was carried out according to the modified Constant-Murley score system (CMS) and visual analogue scale (VAS).Results The 18 cases were followed up for a mean duration of 18.0 months (from 12 to 24 months).No complications of wound infection,implant failure or impingement were observed during the follow-ups.Bone union was achieved after an average of 12.0 weeks (from 10 to 14 weeks).On average,the Modified CMS score was 80.2 and the VAS score 1.5.At the post-operative 10th and 13th months,X-ray manifested avascular necrosis of the humeral head respectively in 2 cases of 4-part fractures,who suffered from moderate pain which was relieved after conservative treatment.Conclusion Fixation with S3 locking plate of proximal humerus is a safe and effective treatment of osteoporotic fracture of proximal humerus,because it is rigid and avoids plate-related impingement.

In order to improve works of helping this special group,medical students' current ideological and political situation and characteristics are analyzed.Then applying the Satir family therapy into the medical students' ideological and political education process and analyzing the applicability of Satir into the ideological and political work from the three views of system,family values and humanity.Family tree technology,home remodeling,empty chair technique and iceberg metaphor technology of Satir family therapy are analyzed in details in ideological and political education of medical students with learning difficulties through some helping cases.the three views of system,family values and humanity of Satir family therapy have some value in helping students,building positive value instead of their negative mind towards learning.With the promotion of Satir family's concept and technology,it also helps the ideological and political educators have deep thoughts about the education methods.

Objective To report the preliminary clinical results of treatment of severely comminuted radial head fractures by replacement with floating cup radial head prosthesis. Methods In the period from August 2002 to June 2005, replacement with floating cup radial head prosthesis was performed to treat 10 cases of Mason Ⅲ , Ⅳ radial head fractures, of whom 9 were acute fractures and 1 old. Results All the patients were followed up for 6 to 40 months (mean 14.9 months). The mean flexion/extension of the elbow was 133.5? /9.0? , while the mean pronation/supination of the forearm was 78.5? /84.0? . There were 3 cases of mild pain, 1 case of mild valgus instability in the elbow and 3 cases of mild weakness. The Broberg and Morrey elbow scores averaged 93. The result was excellent in 6 cases, good in 3 and fair in 1, the excellent and good rates were 90% . Conclusion The replacement with floating cup prosthesis shows satisfying preliminary clinical outcome in the treatment of radial head fractures unable to be reduced, while its long- term result needs further follow- up

Objective To explore the possibility of treating tibial osteomyelitis with transfer of a compound flap composed of the sural nerve fasciocutaneous flap and the lateral gastroenemius muscle.Methods We observed in cadaver specimens the anatomical structure of the sural nerve fasciocutaneous flap and the lateral gastrocnemius muscle to design a compound flap. Fifteen cases of tibia] osteomyelitis were treated with sinus excision and thorough debridement before the skin defect area was covered with a sural nerve compound flap whose muscle was stuffed into the tibia] channel. Plates were replaced with unilateral fixators in 3 cases of tibial nonunion. Results We observed 5 to 6 perforating branches of blood vessels between the sural nerve fascioeutaneous flap and the lateral gastroenemius muscle, indicating that the two can be harvested simultaneously in one compound flap. The transferred compound flaps survived in 15 cases. Tibial os-teomyelitis was completely cured in 14 cases, 1 case healed after second debridement, and 3 cases of tibial nonunion healed 6 months later after a second stage iliac bone graft. No recurrence was found after a mean follow-up of 18 (10 to 26) months. Conclusion A compound flap composed of the sural nerve fascio-cutaneous flap and the lateral gastrocnemius muscle can be used to treat tibia] osteomyelitis effectively.

Objective To determine the prevalence,trends and risk factors of drug-resistant tuberculosis (TB) in Ningbo during 2007-2010,and to explore the efficient control strategy of drugresistant TB.Methods A cross-sectional study of regional anti-TB drug resistance was conducted in Ningbo.The registered and culture-positive TB patients were enrolled and drug sensitivity test was performed.The demographic and clinical information were collected from the national TB report system.Logistic regression model was used to determine the risk factors of drug resistance.Results Of 1613 enrolled TB patients,39.3％-48.3％ were resistant to any first-line anti-TB drug and 14.0％-19.9％ were multidrug resistant (MDR)-TB.The proportion of new cases resistant to any first-line anti-TB drug was 35.4 ％-42.1％ and MDR TB was 9.8％- 12.2 ％,which were both significantly lower than those of retreated patients (69.5％-72.7％ and 33.9％ - 54.5％,respectively).The multivariate Logistic regression model showed that anti-TB treatment history and migration were significantly associated with any drug resistance (OR=3.298,95 ％ CI 2.391 4.550and OR=0.771,95 ％CI 0.608 - 0.978,respectively) ; while age,treatment history and migration were also significantly associated with MDR-TB.Conclusions Drug-resistant TB prevalence showed a decrease trend in Ningbo,while the resistant rates in both new cases and retreated cases still remain at high levels. Improved case management,including directly observed treatment short-course and appropriate treatment regimens specifically for drug-resistant TB,should be developed to prevent further transmission and development of drug-resistant TB in this setting.

Aim To investigate the effect of salidroside on the phenotypic expression of osteoblast and the possible molecular mechanism in hypoxia environment.Methods MTT, Annexin V/PI double staining, alkaline phosphatase(ALP) activity assay and enzyme-linked immnosorbent assay(ELISA) were performed respectively to detect the effect of salidroside on regulating phenotypic expression of MG-63 cells exposed to hypoxia.Then RT-PCR and Western blot were conducted to detect the expression levels of Osterix and Runx2 which were related to differentiation.At last, we investigated the expression levels of components of the HIF-1α pathway by RT-PCR,Western blot and ELISA, respectively.Immunofluorescence confocal microscope technology and luciferase reporter assay were performed to explore nuclear translocation and transcriptional activity of HIF-1α.Results Salidroside could markedly promote MG-63 cell proliferation, inhibit hypoxia-induced apoptosis, stimulate cell differentiation and promote expression levels of components of the HIF-1α pathway in hypoxia environment.Conclusion Salidroside could regulate phenotypic expression of MG-63 cells through HIF-1α/VEGF signaling pathway in hypoxia environment.

Objective: To investigate the characteristics of neuropsychological factors in patients with persistent postural-perceptual dizziness(PPPD) and provide the basis for the psychosomatic comprehensive treatment. Methods: Cartel Personality Test (16PF), Symptom Checklist 90 (SCL-90), HAMA, HDMD, SAS and SDS were used to evaluate personality and mental state in patients with PPPD(PPPD group, n=65) and control group(n=63). Dizziness handicap inventory(DHI) was used to evaluate the degree of vertigo.The correlation analysis was carried out between the DHI scores and 16-PF, SCL-90 factor scores. Results: (1)16PF factor scores: the factor scores of assertiveness(8.50±1.84), excitability (6.59±1.73), boldness (7.46±1.78), sensitivity (7.25±1.79), doubtfulness (6.55±1.74), fantasy(6.20±1.60), anxiety(7.67±1.61) and tension(6.81±1.67)in PPPD group were higher than those in the control group, and the differences were statistically significant (all P<0.05). The gregariousness (4.38±1.65), intelligence (4.51±1.67), stability (3.51±1.75), independence (4.39±1.56) and self-discipline (4.70±1.82) factor scores in PPPD group were lower than those in the control group, and the differences were statistically significant (all P<0.05). (2)SCL-90 factor scores: the factor scores of somatization(1.62±0.40), anxiety (1.64±0.56), interpersonal sensitivity (1.79±0.42), terrifying(1.71±0.53), total points(150.77±21.60), total average score (1.62±0.51) in PPPD group were higher than those in control group (all P<0.05). There were no differences in obsessive-compulsive (1.50±0.55), depression (1.45±0.44), hostility (1.69±0.60), paranoia (1.76±0.53), somatization (1.42±0.49) and psychotic (1.29±0.35) between PPPD group and the control group (all P>0.05). (3)The factor scores of HAMA(9.08±1.77) and SAS(37.88±2.96)in patients with PPPD were higher than that in the control group, and the differences were statistically significant (all P<0.05). There was no significant difference in HAMD (6.19±2.82) and SDS (36.36±4.71) scores between PPPD group and control group (all P>0.05). (4)The DHI scores were positively correlated with assertiveness, sensitivity, tension and doubtfulness factors of 16PF.The DHI scores were positively correlated with somatization, interpersonal sensitivity, anxiety and terrifying factors of SCL-90. Conclusion Patients with persistent postural-perceptual dizziness suffer from personality changes, mental disorders and anxiety disorder.

Objective:To explore the effect of repetitive transcranial magnetic stimulation(rTMS) combined with cognitive behavioral therapy for insomnia(CBT-I)for menopausal women with insomnia.Methods:A total of 76 menopausal women with insomnia who were hospitalized from April 2020 to October 2021 were enrolled.Then they were randomly divided into observation group and control group, with 38 cases in each group.Both observation group and control group were treated with CBT-I. Meanwhile, the patients in observation group were treated with low-frequency repetitive rTMS, on the contrary, the patients in control group were treated with sham rTMS.The intervention lasted for 4 weeks.Insomnia severity index (ISI), Pittsburgh sleep quality index (PSQI) and polysomnography (PSG) were all recorded at baseline and 4 weeks after intervention, as well as adverse events. Data was analyzed by SPSS 22.0 software. Data which was normally distributed, was compared by independent t-test and paired t-test. Results:(1)The scores of ISI (16.39±4.03, 15.66±4.89) and the PSQI(14.97±2.70, 14.11±3.60) in observation group and control group at baseline were not significantly different( t=-0.716, -1.190, both P>0.05). After treatment, the ISI and PSQI scores of the observation group (10.08±3.65, 9.58±1.73)were lower than those of the control group (12.82±4.47, 12.13±2.32), and the differences were statistically significant ( t=2.926, 5.440, both P<0.05). (2) After treatment, all sleep parameters were significantly improved from baseline in observation group (all P<0.05). Sleep efficiency, wake time during sleep, and number of awakenings were significantly improved from baseline in control group(all P<0.05). Compared with control group((70.38±12.99)%, (17.39±11.75)%, (13.98±6.35)%), the observation group reported a greater statistically improvement in sleep efficiency, N3% and REM%((79.52±9.31)%, (22.80±6.05)%, (18.78±6.68)%, respectively)( t=-3.526, -2.524, -3.212, all P<0.05). Neither group had serious adverse effects. Conclusion:The rTMS combined with CBT-I can significantly improve the sleep quality in menopausal women with insomnia. With its high safety rTMS combined with CBT-I may be a recommended non-drug therapy among menopausal women with insomnia.

Objective To investigate clinical effect of minimally invasive knotless bridge-suture technique for acute achilles tendon rupture.Methods The clinial data of 23 patients with acute achilles tendon rupture treated in Department of Orthopaedics,Shanghai Jiao Tong University Affiliated Sixth People's Hospital from August 2017 to February 2018 were analyzed retrospectively.There were 21 males and 2 females,aged (37.1 ± 5.6) years,with an age range of 29-51 years.Minimally invasive knotless bridge-suture technique was performed in all cases until the soft tissue condition of the patients improved.Patients were followed up by outpatient review at 3 weeks,6 weeks,3rd,and 6th months postoperatively,followed by every 3 months,followed up 12 to 18 months,and the deadline was April 2019.Ratio of perimeter of the affected lower extremity to that of the uninjuried,number of repetitions for one leg calf rise in one minute,American Orthopaedic Foot and Ankle Society (AOFAS) anklehind foot score,the achilles tendon total rupture score(ATRS) and time to return to work were investigated at last follow-up,as well as complications during the follow-up period.Results Twenty-three cases were followed up.At last follow-up,ratio of perimeter of the affected lower extremity to that of the uninjuried was (92.7 ± 1.8) ％,number of repetitions for one leg calf rise in one minute was (25 ± 2) times,AOFAS ankle-hind foot score was (91.5 ±2.2) scores,ATRS was (92.6 ±2.4) scores,time to return to work ranged from 6 to 9 weeks.All patients underwent first-stage healing.No skin necrosis,superficial infection and sural nerve injury occurred.No achilles tendon re-rupture was seen during the follow-up period.Conclusion Minimally invasive knotless bridgesuture technique for acute achilles tendon rupture is applied easily and less invasive,enabling patients to return to work earlier and proved to be a secure and effective treatment.

Objective:To evaluate the clinical results of reduction and fixation via fibular osteotomy for treatment of old ankle fractures involving the posterior malleolus in middle-aged and elderly patients.Methods:A retrospective case series study was made for 13 middle-aged and elderly patients with old ankle fractures involving the posterior malleolus treated from July 2013 to March 2018 in Sixth People's Hospital Affiliated to Shanghai Jiao Tong University. There were 2 males and 11 females, with age of 48-63 years (mean, 54.8 years). The mean surgical period was 8-18 weeks from injury (mean, 9.6 weeks). According to Haraguchi classification, all posterior malleolar fractures were type I. According to Lauge-Hansen classification, there were 2 patients with pronation-external rotation type and 11 with supination-external rotation type. All patients underwent open reduction and fixation via fibular osteotomy. Bone healing time and postoperative complications were recorded. Clinical results were assessed by visual analogue scale (VAS) score and American orthopedic foot and ankle society (AOFAS) ankle-hind score.Results:All patients were followed up for average 20.3 months (range, 9-36 months). All patients had bone union, with the mean healing period of 12-15 weeks (average 14.8 weeks). No infection, implant loosening or breakage occurred after operation. X-ray film of one patient suggested mild traumatic arthritis. At the latest follow-up, VAS was improved to (1.0±0.2)points compared to pre-operative (5.3±0.6)points ( P<0.05), and the AOFAS ankle-hind score was improved to (85.2±7.4)points compared to pre-operative (42.4±6.7)points ( P<0.05). According to the AOFAS ankle-hind score, the results were excellent in 4 patients, good in 8, moderate in 1, with the excellent and good rate of 92%. Conclusion:For old ankle fractures involving the posterior malleolus in the middle-aged and elderly patients, reduction and fixation via fibular can reduce postoperative complications, facilitate bone healing, relieve ankle pain and improve function recovery.