Objective To investigate the characteristics,treatment and prognosis of Rowell's syndrome.Methods Clinical data were collected from 6 inpatients with Rowell's syndrome from July 2009 to July 2015,and retrospectively analyzed.Results All the patients were female,of them,2 developed skin lesions after sun exposure,2 had medication history,1 had Staphylococcus aureus infection before occurrence of skin lesions,and 1 had no obvious precipitating factor.Skin lesions spread from the face to the whole body in 4 cases,from the dorsal hauds to the whole body in 1 case,and were confined to the face,both hands and feet in 1 case.All the 6 patients had chilblain-like lesions in the digit tips,and 5 patients had fever.Among these patients,6 were positive for antinuclear antibodies (granular pattern),4 for anti-Sm antibodies,5 for anti-U 1RNP antibodies,4 for anti-SSA antibodies,2 for anti-dsDNA antibodies,and 1 was positive for both anti-SSA and anti-SSB antibodies.Histopathological examination revealed hyperkeratinization,mild hyperplasia,partial necrosis,many dyskeratocytes,liquifaction degeneration of basal cells in the epidermis,and perivascular infiltration of lymphocytes in the superficial dermis.After admission,1 patient was finally diagnosed with subacute cutaneous lupus erythematosus (SCLE),and 5 with systemic lupus erythematosus (SLE).All the 6 patients were treated with prednisone at a dose of 0.6-1.0 mg·kg-1 ·d-1,and 1 was also treated with gamma globulin (200 mg/d).During the process of glucocorticoid tapering,hydroxychloroquine was administered at 0.2 g twice a day.During 1-year follow-up,neither erythema multiform nor chilblain-like lesions recurred in 5 patients,and 1 patient was lost to follow-up.Conclusions Rowell's syndrome frequently occurs in women.Glucocorticoids are a mainstay of its treatment,and their tapering should be slower in patients with Rowell's syndrome than in those with lupus erythematosus.

Objective To explore the application value of carpal shoot through view in the palmar plating of distal radius fractures.Methods From March 2015 to May 2016,there were 62 acute distal radius fractures received various operation in our department,in which 48 patients were only performed volar locked plating.Among these 48 cases,there were 21 males and 27 females,with ages ranging from 17 to 75 years (mean 43.6±10.6 years).There were 15 cases of type A,11 cases of type B and 22 cases of type C distal radial fractures according to AO/OTA classification.All the operations were performed through modified Henry's approach between the radial artery and flexor carpi radialis.Once achieved satisfactory reduction,we performed rigid fixation of distal radius using anatomical locking plates.In all cases,bicortical drilling was performed.Screw lengths selected measured 1 to 2 mm less than the depth gauge number avoiding dorsal cortex penetration.After plate fixation of these 48 cases,standard posteroanterior and lateral radiographs were taken followed by the carpal shoot through view.To obtain carpal shoot through view,the patient's forearm was maximally supinated,the elbow flexed about 60°-70°and the wrist maximally dorsiflexed.The image intensifier beam is directed over the base of the thenar eminence.Compare the ratio of dorsal protrusion between standard view and carpal shoot through view,then statistical analysis was performed.After operation,CT scan was routinely taken to further test the effectiveness of carpal shoot through view.Results Five cases were detected dorsal cortex screw protrusion using standard posteroanterior and lateral views (10.4％,5/48).There were totally 16 cases (including the former 5 cases) of dorsal screw penetration uncovered by the carpal shoot through view(33.3％,16/48.Statistically significant difference was existed between the two fluoroscopy methods.Additionally,in 2 cases,a screw had penetrated the distal radioulnar joint (DRUJ),which was only apparent on the shoot through view.All the improper screws were exchanged and again were verified by the carpal shoot through view.The overall screw exchange rate was 37.5％ (18/48).Conclusion Compared with standard AP and lateral fluoroscopy,the carpal shoot through view can reliably reveals dorsal screw penetration.Meanwhile,it provides excellent visualization of DRUJ.

Objective To compare the therapeutic efficacies of fire-needle acupuncture and Halometasone cream in treating sub-acute and chronic eczema. Method Totally 114 patients were divided into a treatment group and a control group. The treatment group was intervened by using fire-needle acupuncture, and the control group was by Halometasone cream. Itchy score and Eczema Area and Severity Index (EASI) were used for comparison before and after intervention. Result There were significant differences in comparing the markedly-effective rate and total effective rate between the fire-needle acupuncture group and the Halometasone control group according to the itchy score (P＜0.01). There were no significant differences in comparing the markedly-effective rate and total effective rate between the two groups according to EASI (P>0.05). Conclusion Fire-needle acupuncture is superior to Halometasone cream for acute and chronic eczema in relieving itch, action time and effect-sustaining duration.

Objective: To explore a standard procedure for the treatment of combined dorsal and palmar internal fixation for complex four part distal radius fractures and assess its clinical results. Methods: From May 2009 to October 2016, 38 patients(39 sides)who suffered from complex four part distal radius fractures were performed operatively with open reduction and internal fixation via combined dorsal and palmar approach in Department of Orthopaedic Trauma, Qilu Hospital of Shandong University(Qingdao). The series included 22 males(22 sides) and 16 females(17 sides). Age of the patients was 53.5 years ranging from 25 to 79 years.According to Melone classification, there were 34 sides of type of Ⅳ, 5 of type Ⅴ.According to Frykman classification, there were 15 sides of type Ⅶ, 24 sides of type Ⅷ, and all the cases were type C3 according to AO/OTA classification.Preoperatively, the key articular fragments in four part distal radius fractures were identified and the individual fracture patterns from conventional X-ray and CT-scan were analyzed. All the patients were performed combined volar and dorsal fixation.Firstly, a palmar approach which gave access to and fix the palmar-ulnar fragment and the radial styloid fragment was performed.Then a limited dorsal approach across the third extensor compartment which gave access to the dorso-ulnar fragment and a limited dorsal arthrotomy to visualize the radiocarpal joint when necessary were performed.Through dorsal approach, we can address the dorso-ulnar fragment, free intra-articular fragment and direct visualize the joint.Use of a retinacular flap was routinely advocated to help prevent against tendon irritation and rupture.The follow-up control included conventional X-ray, range of motion(ROM), grip strength, and the disabilities of the arm, shoulder and hand index(DASH), as well as the patient-rated wrist evaluation(PRWE) score for functional outcome at 6 and 12 months. Results: Thirty-three patients(34 sides) were followed up for at least 12 months.The would healed well in all cases 2 weeks postoperatively, and no soft tissue infections, necrosis or neurovascular complications occurred.All the fractures of 38 cases(39 sides)healed averaged 3.6 months(ranging from 2.5-5.7 months), and no loss of reduction occurred postoperatively.Anatomic reconstruction with a step or gap of <1 mm was achieved in 37 cases(38 sides), Whereas 5 patients were lost to follow-up at 12 months postoperatively.ROM and grip strength were all recovered to over 85% of the unaffected side(exception of the bilateral patient). Median DASH-index and PRWE were 6.5(0-17) and 9.3(0-20)respectively. Conclusion Combined volar and dorsal approaches allow achieving anatomic reconstruction in complex four part intra-articular distal radius fractures and reveal good functional outcomes at intermediate follow-up.

In this paper, we introduce a coded excitation circuit for medical ultrasonic endoscope imaging system. This circuit is composed of TC6320 and its drive chip. The experiment demonstrates that this circuit can export frequency-adjustable, duration-controllable coded signals, and its voltage reaches +/-60 V. It still works well when excitant frequency reaches 30 MHz. Compared with the conventional medical ultrasonic pulse-echo imaging system, this coded excitation system has the potential of higher SNR and deeper penetration depth, especially for the small emission power system. This method has a bright future.
Endosonography ; instrumentation ; methods ; Equipment Design ; Humans ; Image Interpretation, Computer-Assisted ; methods ; Transducers

Objective To compare traditional open reduction and internal fixation versus minimally invasive reduction by a rapid redactor and percutaneous plate fixation for tibial plateau fractures.Methods From October 2015 to January 2017,we treated 40 patients with tibial plateau fracture.They were 27 males and 13 females,aged from 17 to 73 years.There were 15 cases of type [[,2 of type Ⅲ,6 of type Ⅳ,10 of type Ⅴ and 7 of type Ⅵ according to the Schatzker classification.Of them,20 were treated by traditional open reduction and internal fixation and the other 20 by minimally invasive reduction by a rapid redactor and percutaneous plate fixation.The 2 groups were compared in terms of operating time,intraoperative blood loss,incision complications,and Hospital for Special Surgery (HSS) score of the knee joint at final follow-ups.Results The 2 groups were compatible because there were no significant differences in all the preoperative demographic data but the interval from injury to surgery (P ＞ 0.05).The 40 patients were followed up for an average of 9.3 months(from 3.5 to 14.5 months).There were significant differences in operating time (103.2 ±35.1 minversus 110.9 ±42.3 min),intraoperative blood loss (157.5 ± 90.7 mL versus 235.0 ± 137.6 mL),active mobility time after operation (9.5 ± 4.0 d versus 12.2 ± 5.6 d),bony union time (14.5 ± 2.7 w versus 15.4 ± 2.9 w),hospital stay (12.1 ± 3.1 d versus 14.6 ± 3.4 d),knee flexion range (125.4° ± 28.3° versus 115.3° ± 21.5°),knee extention range (12.7°±1.4° versus 9.7°±1.5°) and HSS knee score (87.8±7.0 versus 83.1±8.5) (P ＜0.05),favoring the group of minimally invasive reduction.There was no significant difference between the 2 groups in the rate of complications[15％ (3/20) versus 10％ (2/20)] (P ＞ 0.05).Conclusions Compared with traditional open reduction and internal fixation,minimally invasive reduction by a rapid reductor and percutaneous plate fixation is a better option for tibial plateau fractures,due to its advantages of decreased operating time and hospital stay,less trauma and hemorrhage,fewer complications and more rapid functional recovery of the knee.

Objective: To evaluate a self-designed novel anatomical bone plate for fractures of ulnar coronoid process in cadaveric specimens. Methods: Our database search in the Imaging Center, Qilu Hospital of Shandong University (Qingdao) yielded CT reconstruction images of 45 normal adult elbows (26 males and 19 females) which met our criteria. On the 3D reformatted CT images, sagittal curvature angle of the ulnar coronal process (△1), tangent angle of the coronal process apex to olecranon fossa (△2), projective length (L) and projective height (H) were measured; the transverse width of the coronal process was also measured at 5 mm and 10 mm from the tip (K1 and K2). The minimum value was used for △2° in order to avoid cutting into the joint while the mean value for other parameters. After the shape of the plate and angles of the screws were designed using computer 3D software, a new anatomic plate for coronal process was produced. Five cadaver specimens were used to test the internal fixation of the coronal process with our novel anatomic bone plate. Attachment of the bone plate to the coronal process and screw penetration into the joint cavity were observed by X-ray and 3D CT scanning. Results: △1 was 45.52°±6.07°, △2 65.25°±7.09° (the minimum value 53.2°), L 52.27±7.78 mm, H 21.62±2.63 mm, K1 16.32±2.22 mm and K2 14.58±2.18 mm. Our new anatomic bone plate was designed based on the above data. X-ray and 3D CT scan after plate internal fixation showed that our self-designed bone plate produced fine attachment and no screws penetrated into the joint. Conclusion Our new anatomical bone plate may perfectly fit the anatomy of the adult ulnar coronal process in size and shape so that the coronary process can be fully covered and no screws will penetrate into the joint cavity.

Objective:To evaluate and compare efficacy of intravenous immunoglobulin (IVIG) versus recombinant human tumor necrosis factor-α receptor Ⅱ:IgG Fc fusion protein (rhTNFR:Fc) in the treatment of toxic epidermal necrolysis (TEN) .Methods:Clinical data were collected from patients with TEN treated with IVIG or rhTNFR:Fc in Wuhan No.1 Hospital from 2013 to 2019. There were 11 patients in the IVIG group, including 3 males and 8 females, aged 25-72 years, and the median TEN-specific severity-of-illness score (SCORTEN) was 3 points; there were 10 patients in the rhTNFR:Fc group, including 5 males and 5 females, aged 32-84 years, and the median SCORTEN was 2 points. These patients all showed no response to the 5-day treatment with prednisolone acetate at a dose of 0.6-1.0 mg·kg -1·d -1, and then received IVIG at a dose of 400 mg·kg -1·d -1 for 5 consecutive days, or subcutaneous injection of rhTNFR:Fc at a dose of 25 mg every other day for 4-6 sessions. Changes in skin lesions and adverse events were recorded in the 2 groups. Statistical analysis was carried out by using Mann-Whitney U test. Results:Compared with the rhTNFR:Fc group, the IVIG group showed a significant decrease in the time to onset of reduction of skin lesion exudate (1.73 ± 1.19 days vs. 3.00 ± 1.56 days, P < 0.05) , time to onset of pain relief in the lesion area (1.64 ± 1.28 days vs. 3.70 ± 1.63 days, P < 0.05) , time to lightening of color of the lesion base (2.45 ± 1.12 days vs. 3.90 ± 1.59 days, P < 0.05) , time to onset of new epidermis growth (3.09 ± 1.13 days vs. 5.20 ± 1.22 days, P < 0.05) , and in the time to onset of lesion drying at the intertriginous sites (4.82 ± 2.22 days vs. 7.90 ± 3.14 days, P < 0.05) . However, there was no significant difference in the length of hospital stay between the IVIG group (17.70 ± 8.33 days) and rhTNFR:Fc group (16.70 ± 4.71 days, P > 0.05) . No adverse reactions were observed during the treatment, and no recurrence or complications were found in the 21 patients during the follow-up of 6 months. Conclusion:IVIG and rhTNFR:Fc are both effective in the treatment of TEN, but IVIG is superior to rhTNFR:Fc in terms of the time to onset of pain relief, skin lesion exudate reduction and epidermal growth.

Objective:To compare the efficacy of lateral elbow dislocation approach with non-dislocation approach for open reduction and internal fixation of distal humeral coronal fracture.Methods:A retrospective cohort study was used to analyze the clinical data of 26 patients with distal humeral coronal fracture admitted to Qilu Hospital (Qingdao) of Shandong University from January 2018 to October 2021, including 10 males and 16 females, aged 15-80 years [(51.6±4.9)years]. According to Dubberley classification, there were 10 patients with type 2A, 5 with type 2B, 6 with type 3A and 5 with type 3B. Overall, 12 patients were operated via lateral elbow dislocation approach (dislocation approach group) and 14 via lateral elbow non-dislocation approach (non-dislocation approach group). The operation time, intraoperative bleeding volume, incision healing, three-dimensional CT assessment of the reduction within one week after surgery (separation or step>2 mm as poor), Mayo elbow performance score (MEPS) at 3 months after surgery and fracture healing at the last follow-up were recorded in both groups. Complications were also compared between the two groups.Results:All patients were followed up for 3-18 months [(10.5±3.3)months]. The operation time was (146.9±15.5)minutes in dislocation approach and (122.7±11.1)minutes in non-dislocation approach group ( P>0.05). The intraoperative bleeding volume was (113.3±9.7)ml in dislocation approach and (112.9±10.1)ml in non-dislocation approach group ( P>0.05). All incisions healed uneventfully in stage I. All patients had good reduction in dislocation group, while only 7 patients had good reduction and the other 7 patients presented a separation or step>2 mm in non-dislocation group ( P<0.05). The MEPS was (90.0±1.4)points in dislocation approach group at 3 months after surgery, including 9 patients being rated as excellent and 3 good, with the excellent and good rate of 100%. In constrast, the MEPS was (78.9±2.9)points in non-dislocation approach group at 3 months after surgery, including 5 patients being rated as excellent, 4 good, 4 fair and 1 poor, with the excellent and good rate of 64.3% ( P<0.05). All fractures were healed at the last follow-up. In non-dislocation approach group, osteoarthritis occurred in 7 patients, including 3 with screw protrusion, 2 with heterotopic ossification and 2 of advanced age with osteophyte formation around the joint. In dislocation approach group, osteoarthritis occurred only in 2 patients of advanced age, showing osteophyte formation around the elbow joint, with no screw cutting or heterotopic ossification. Conclusion:For distal humeral coronal fracture, the lateral elbow dislocation approach is able to provide complete exposure of the articular surface, obtain anatomic reduction, restore elbow function and reduce complications when compared with the non-dislocation approach.

Objective:To explore the protective effect and underlying mechanism of hyperbaric oxygen (HBO) on delayed encephalopathy after carbon monoxide poisoning (DEACMP) in mice.Methods:Totally 225 adult male Kunming mice were selected to establish CO poisoning model via intraperitoneal injection carbon monoxide (CO), and were randomly divided into the air control group, CO poisoning group, and HBO group. Each group was further divided into five time points group, that was 1, 3, 7, 14 and 21 d. The mice in the air control group were injected intraperitoneally with the same amount of air, and the HBO group received HBO treatment at the same time every day. DEACMP mice model was screened by behaviors using the open field test, new object recognition test and nesting test, and the content of myelin basic protein (MBP) were assayed. The mouse brain tissue and mitochondrial were prepared and malonialdehyde (MDA) and adenosine triphosphate (ATP) content were measured with ultraviolet spectrophotometer. MBP content in brain tissue and cytochrome C (CytC) content in the mitochondrial were measured by ELISA. The mitochondria membrane potential (MMP) was measured by flow cytometry.Results:Compared with the air control group, the content of carboxyhemoglobin (COHB) in blood increased significantly and the content of MBP in brain tissue decreased significantly in CO poisoning mice. CO poisoning mice showed motor ability and cognitive dysfunction. Compared with the air control group, the contents of MMP, CytC and ATP were significantly decreased ( P<0.01) in the CO poisoning group; while the MDA content was significantly increased ( P<0.01). Compared with the CO poisoning group, mice behaviors were improved significantly ( P<0.05), the content of MBP, MMP, CytC and ATP were increased ( P<0.05), while the MDA content decreased significantly ( P<0.01) in the HBO group. Conclusions:The abnormal mitochondrial function might be closely related to the occurrence and development of DEACMP, and HBO therapy plays an effective role in preventing and treating the DEACMP mice model via the mitochondrial pathway.