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.

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 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.

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.

OBJECTIVETo understand the effects of exposure to asbestos and GSTM1 genotypes on plasma activity of glutathione S-transferases (GSTs).

METHODSNinety-four workers exposed to asbestos and 51 controls were selected, and their general information, occupational history and personal behavior were collected by questionnaire. Venous blood specimen was collected from each of them and plasma was separated for detection of GSTs activity and lymphocytes for DNA extraction and GSTM1 genotyping.

RESULTSPlasma activity of GSTs in the asbestos-exposed workers (23.0 +/- 6.9) U/L was significantly lower than that in the controls (32.6 +/- 11.8) U/L, which declined with the length of employment in asbestos industry and the increase of cumulated dose of asbestos. Stratification of workers by GSTM1 genotypes showed that plasma activity of GSTs in asbestos-exposed workers with GSTM1+/+ or GSTM1-/- were (24.0 +/- 6.1) and (22.5 +/- 7.3) U/L, respectively, lower than those in the controls with the same genotypes (38.1 +/- 13.2) and (26.8 +/- 6.6) U/L. Plasma activity of GSTs in the control workers with GSTM-/- was significantly lower than in those with GSTM+/+, and, so did in asbestos-exposed workers, but without statistically significant difference.

CONCLUSIONExposure to asbestos could significantly decrease plasma activity of GSTs, and GSTM1 genotypes could affect on the activity of GSTs in the control workers, which was not so obvious in asbestos-exposed workers.

Adult ; Asbestos ; adverse effects ; Gene Frequency ; Genotype ; Glutathione Transferase ; blood ; drug effects ; genetics ; Humans ; Middle Aged ; Occupational Exposure ; adverse effects ; Time Factors

Objective To investigate the fixation sequence,key points and clinical value of a new minimally invasive surgery for one-stage treatment of femoral and ipsilateral tibial plateau fractures with a rapid reductor.Methods From October 2015 to January 2017,5 patients with femoral and ipsilateral tibial plateau fractures received surgery at our department.They were 4 men and one woman,aged from 23 to 65 years (mean,45.5 years).The femoral fractures were type A in 2 cases,type B in 2 cases and type C in one case according to AO/OTA classification.The tibial plateau fractures were type Ⅴ in 2 cases and type Ⅵ in 3 according to Schatzker classification.After the tibial plateau fractures were first fixated,Kirschner wires were inserted via the femoral condyle and distal tibia.A rapid reductor was used to reduce the tibial plateau and dual plates were implanted by percutaneous minimally invasive internal fixation.Then the same set of rapid reductor was used to treat femoral fractures by antegrade femoral nailing.The bone traction was completed via the femoral condyle and anterior superior iliac spine.The operative time,bone union time,knee functional recovery and hospital stay were recorded.Results The 5 patients were followed up for an average of 10 months (from 7 to 17 months).No delayed union,nonunion or malunion happened of either femoral or tibial plateau fractures.The healing time for femoral fractures ranged from 4 to 8 months,averaging 5.5 months;the union time for tibial plateau fractures ranged from 10 to 14 weeks,averaging 12.0 weeks.The knee flexion averaged 110° (from 95° to 130°).The overall functional recovery was rated as excellent in 2 cases and good in 3 according to the Karlstr(o)m & Olerud criteria.The average hospital stay was 18 days(from 13 to 32 days).Conclusion Minimally invasive surgery with a rapid reductor can treat femoral and ipsilateral tibial plateau fractures at one stage,leading to fine functional recovery of the knee and greatly reduced hospital stay in particular.

Objective:To compare reconstruction of acromioclavicular ligament versus internal fixation of acromioclavicular joint with clavicle hook plate in the treatment of Rockwood Ⅲ-Ⅴ acromioclavicular dislocation by reconstruction of coracoclavicular ligament with suture anchor.Methods:A retrospective analysis was conducted of the 56 patients who had been treated for Rockwood Ⅲ-Ⅴ acromioclavicular dislocation from January 2015 to June 2019 at Department of Orthopaedic Trauma, Qilu Hospital of Shandong University (Qingdao). Of them, 26 were treated by reconstruction of coracoclavicular ligament with suture anchor plus reconstruction of acromioclavicular ligament (reconstruction group) and 30 by reconstruction of coracoclavicular ligament with suture anchor plus internal fixation of acromioclavicular joint with clavicle hook plate (plate group). The 2 groups were compared in terms of operation time, intraoperative blood loss, Constant-Murley score and Subjective Shoulder Rating System (SSRS) score at the last follow-up, and complications.Results:The 2 groups were comparable because there were no significant differences between them in the baseline data before operation ( P>0.05). The reconstruction group was followed up for 6 to 15 months (average, 7.9 months) while the plate group for 7 to 18 months (average, 11.3 months). The average operation time was (79.9±12.6) min for the reconstruction group and (69.1±8.5) min for the plate group, showing a significant difference ( P<0.05). No significant difference was found between the 2 groups in the intraoperative blood loss [(68.5±19.1) mL versus (65.0±16.6) mL] ( P>0.05). The differences were statistically significant between the 2 groups in Constant-Murley score (87.9±3.4 for the reconstruction group versus 91.9±3.5 for the plate group) and in SSRS score (85.1±4.1 for the reconstruction group versus 88.6±3.0 for the plate group) ( P<0.05). All the wounds healed well in the reconstruction group except for one patient who reported numbness around the wound which disappeared spontaneously 3 months postoperation. In the plate group, incision infection occurred in 2 cases, the redness and swelling in one which responded to dressing change 3 weeks later and numbness around the incision in one which was recovered 5 months after operation. Conclusions:Both surgical procedures can achieve good to excellent clinical outcomes. Although reconstruction of both acromioclavicular and coracoclavicular ligaments takes more operation time, it may lead to better Constant-Murley and SSRS scores and fewer complications, and spare secondary operation.