Objective To evaluate the curative effect of conjoined tendon transfer for coracoclavicular ligament reconstruction in the treatment of Rockwood grades Ⅲ-Ⅳ acromioclavicular joint dislocation,c Methods A retrospective case control study was performed for 64 cases of acromioclavicular joint dislocation admitted from October 2007 to August 2014.There were 53 males and 11 females,with age of (43.8 ± 10.5) years (range,23 to 65 years).Rockwood grade Ⅲ was seen in 27 cases and grade-Ⅳ in 37.According to the treatments,26 cases underwent proximally based conjoined tendon transfer for coracoclavicular ligament reconstruction combined with clavicular hook plate (ligament reconstruction group) and 38 cases only treated with clavicular hook plate (internal fixation group).Visual analogue scale (VAS),Constant shoulder score and postoperative complications were compared between the two groups before and after operation.Results All patients were available for a mean follow-up of 3.7 months (range,2 to 4 months).VAS was (7.58 ± 1.03) points in ligament reconstruction group and (7.15 ± 1.03)points in internal fixation group before surgery (P ＞0.05),and was (2.38±0.94)points in ligament reconstruction group and (2.08 ± 0.99) points in internal fixation group 3 months after operation (P ＞ 0.05).Constant shoulder score was (86.46 ± 6.59) points in ligament reconstruction group and (87.68 ± 6.59) points in internal fixation group after operation (P ＞ 0.05).Six cases (16％) had recurrent joint dislocation in internal fixation group,while none of the patients in ligament reconstruction group had recurrence (P ＜ 0.05).Conclusion Improved procedure of proximally based conjoined tendon transfer for coracoclavicular ligament reconstruction can effectively reduce the recurrence rate of acromioclavicular joint dislocation.

Objective To observe the efficacy of anatomical locking plate combined with anchor nail internal fixation and clavicular hook plate in the treatment of Neer Ⅱ distal clavicle fracture and their impact on shoulder function.Methods Eighty patients with Neer Ⅱ distal clavicular fracture treated in the Eighth People's Hospital in Shanghai from January 2015 to December 2016 were divided into observation group and control group,each group 40 cases.The observation group was treated with anatomical locking plate combined with anchor nail,the control group was treated with clavicular hook plate.The efficacy,operation time,intraoperative blood loss,fracture healing time,postoperative hospital stay,shoulder function score and incidence of complication were observed in the two groups.Results The excellent rate was in the observation group was higher than that in the control group (97.50%(39/40) vs.80.00%(31/40),χ2=2.477,P<0.01).The operation time,intraoperative blood loss and postoperative hospital stay in the observation group and the control group were (53.36±4.69) min vs.(54.19±5.13) min,(69.65±7.17) ml vs.(70.38±8.29) ml,(7.39±1.64) d vs.(7.42±1.97) d,the differences between the two groups had no statistical significance (P>0.05);the fracture healing time in the observation group was longer than that of the control group ((23.65±2.19) w vs.(26.9±3.46) w,P<0.01).The shoulder joint Constant-Murley score in the observation group was (86.02±5.19) points,control group (68.46± 6.94) points,the difference was statistically significant (P<0.01).Observation group showed 2 cases of pain around acromion,the incidence rate of complications was 5.00%(2/40);7 cases in the control group had pain around acromion,2 cases suffered from impingement syndrome and 1 cases had delayed union,the incidence rate of complications was 25.00% (10/40).Conclusion Anatomical locking plate combined with anchor nail internal fixation is effective in the treatment of Neer II distal clavicle fracture.It has the advantages of fast fracture healing,good functional recovery of shoulder joint and less complications.

Objective Postoperative cognitive dysfunction (POCD) is a common complication of cardiac surgery, which seriously affects the prognosis of the patient.This study aimed to explore the risk factors for early POCD in patients undergoing cardiac valve surgery and the correlation between early POCD and the serum S100B protein level.Methods Eighty patients underwent mitral valve replacement surgery in combination with tricuspid plasty.At 1 day before and 5 days after surgery, we assessed the cognitive function of the patients and divided them into a POCD and a non-POCD group.We obtained such data as the age, sex, education, New EuroSCORE Ⅱ, and preoperative NYHA cardiac function grades and left ventricle ejection fraction (LVEF) of the patients, collected the venous blood to determine serum S100B protein concentration by ELISA, and analyzed the independent risk factors of early POCD using single-factor and binary logistic regression analyses.Results POCD was found in 20 (25%) of the patients, , Logistic regression analysis showed the independent risk factors for early POCD to be hyperglycemia (OR=6.038, 95% CI: 1.202-30.337), operation time (OR=6.423, 95% CI: 1.276-32.332), and aspartate aminotransferase (AST, 2 times higher than normal) (OR=12.878, 95% CI: 2.289-72.445).The serum S100B protein concentrations in the POCD group were (1.9±0.3) μg/L and (1.7±0.4) μg/L at 48 and 72 hours after cardiopulmonary bypass, significantly lower than (2.4±0.4) μg/L and (2.1±0.3) μg/L at 30 minutes and 24 hours (P<0.05), and so was it in the non-POCD group at 72 than at 48 hours postoperatively ([1.4±0.4]) vs [1.5±0.4] μg/L, P<0.05).Conclusion Long operation time, perioperative hyperglycemia and high AST are independent predictors and the serum S100B protein level is a significant marker of early POCD.

Objective To study the influence of traction on the blood circulation of femur head and its evaluation by DSA. Methods Using micro-catheter, transfemoral selective femoral circumflex arteriography in 22 healthy dogs was performed in unilateral hip before (Group A,n =22) and immediately (Group B,n=22) ,30( Group D,n =22) ,60(Group E,n=20) ,90( Group F,n = 10),120 (Group G,n=10) minutes during 2 kg skin hip traction, and immediately after traction removal (Group H,I,J,L and 0), and 30 minutes after traction removal with 60,90 and 120 minutes continuous traction(Group K,M and P),and 60 minutes after traction removal with 90 and 120 minutes continuous traction(Group N and Q). DSA was also performed immediately during 4 kg weight traction before continuous traction in 12 hips( Group C).Blood circulation of the femoral head was evaluated mainly by observing its perfusion and time of circulation. Femur head perfusion was assessed as good scoring 3,poor scoring 2 and extremely poor scoring 1. Femur head circulation time was assessed as normal scoring 3 .prolonged scoring 2 and remarkably prolonged scoring 1. Analysis of variance was employed for analysis of the angiographic findings between different groups.Results Good femoral head perfusion in Group A to Q was 22,0,0,0,0,0,0,22,22,1,18,0,0,8,0,0 and 1 hips respectively, poor one was 0,22,8,22,15,4,1,0,0,15,2,4,6,2,1,3 and 8 hips, respectively,extremely poor one was 0,0,4,0,5,6,9,0,0,4,0,6,4,0,9,7 and 1 hips, respectively; and normal femoral head blood circulation time was 22,0,0,0,0,0,0,22,22,1,18,0,0,8,0,0 and 1 hips, respectively, prolonged one was 0,22,9,22,15,4,2,0,0, 15,2,5,7,2,2,4 and 8 hips, respectively, remarkably prolonged one was 0,0,3,0,5,6,8,0,0,4,0,5,3,0,8,6 and 1 hips, respectively. F value of femoral head perfusion among group A and B,group B and C,group B,D,E,F and G,Group H,I,J,L and O,group K,M and P,Group N and Q was 437. 48,30. 25,29. 04,132. 69,143. 73,25.20, respectively, and their P value was all <0. 01. F value of femoral head circulation time among group A and B,group B and C,group B,D,E,F and G,Group H,I,J,L and O,group K,M and P,Group N and Q was 386. 26,31. 83,22.43,141. 94,119.69,21.68, respectively, and their P value was all < 0.01. Conclusions Traction could lead to ischemic response and circulation disorder of canine femoral head. The longer the traction time or the bigger the traction weight was, the poorer the femoral head perfusion and the longer the femoral head circulation time were, and the slower they recovered. DSA could directly reflect these changes in the femoral head with these angioarchitectural and hemodynamic indexes.

Objective To compare the efficacy and safety of a new low-dose oral contraceptive pill (YAZ) containing drospirenone 3 mg and ethinylestradiol 20 μg with placebo in reducing symptoms of premenstrual dysphoric disorder (PMDD). Methods This multicenter, double-blind, randomized clinical trial consisted of 2 run-in and 3 treatment cycles (84 days) with daily symptom charting; 187 women with symptoms of PMDD were randomized to either placebo group (n=94) or YAZ group (n=93), and assessed with daily record of severity of problems scale (DRSP) and clinical global impressions scale (CGI) before, during and after the treatments. Hormones were administered for 24 days, followed by 4 days of inactive pills. Results Compared with baseline level of DRSP, both groups got improvement after treatment; the YAZ group (median-28.7, range:-82.5 to 2.3) had greater improvement than that in the placebo group (median-23.7, range:-86.0 to 11.8), while there was not significant difference (P>0.05). The main adverse effects of YAZ included intermenstrual bleeding [13% (12/93) versus 3% (3/94)], menorrhagia [9% (8/93) versus 1%(1/94)], nausea [5%(5/93) versus 4%(4/94)] and skin rash [4%(4/93) versus 2%(2/94)]. Conclusions YAZ could improve symptoms of PMDD better than placebo, while without statistic significance in this study. The most common adverse effects are intermenstrual bleeding, menorrhagia, nausea and rash.

To study the characteristics of traditional Chinese medicine (TCM) syndrome factors of patients from different areas of China with human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS).

Objective:To explore the reliability of preoperative diagnosis of low-grade infectious nonunion using haematological testing and radioisotope scanning (bone 3-phase image).Methods:A retrospective study was conducted of the 265 patients with bone nonunion who had been treated at Department of Orthopaedics, The Sixth People’s Hospital Affiliated to Shanghai Jiaotong University and at Department of Orthopaedics, The Eighth People’s Hospital Affiliated to Shanghai Jiaotong University from June 2010 to June 2018.They were 151 males and 114 females, aged from 19 to 64 years (average, 39.7 years).The nonunions occurred mainly at the tibia (113 cases) and the femur (72 cases).The preoperative results of their white blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and radioisotope scanning were recorded.Taking the intraoperative pathological observations as the gold standards, the sensitivity, specificity, area under curve (AUC) of receiver operator characteristic (ROC) and Youden index were statistically analyzed respectively for every preoperative haematological tests and radioisotope scanning as well as for different combinations of the radioisotope scanning and one or more haematological tests.Results:Compared with the pathological observations, the radioisotope scanning showed a sensitivity of 80.7%, a specificity of 73.3%, an AUC of 0.770 and a Youden index of 0.540.In the combinations of radioisotope scanning and one haematological test, that of radioisotope scanning and CRP produced the largest AUC of 0.683, a sensitivity of 98.0%, a specificity of 70.3%, and a Youden index of 0.848.In the combinations of radioisotope scanning and 2 haematological tests, that of radioisotope scanning and WBC and ESR produced the largest AUC of 0.895, a sensitivity of 94.3%, a specificity of 67.3%, and a Youden index of 0.616 and all the 3 ones yielded an AUC of more than 0.880.The combination of radioisotope scanning and all the 3 haematological tests produced a sensitivity of 96.5%, a specificity of 79.7%, an AUC of 0.925 and a Youden index of 0.762.Conclusion:Combination of haematological testing and radioisotope scanning can be a reliable preoperative diagnosis of low-grade infection nonunion.

【Objective】 To detect alleles of rare blood group systems of red blood cells (RBC) of Duffy, Diego, Kidd, Dombrock, MNS, Lutheran, Kell, Colton, Scianna, YT, Knops, Indian and Vel of Li Ethnic Group in Hainan, so as to investigate the distribution characteristics of rare blood group alleles and provide references for safe blood transfusion. 【Methods】 The genotypes of 13 rare blood group systems in 300 Li people in Hainan were analyzed by PCR-SSP, and the gene frequency was analyzed . 【Results】 The allele frequencies of Duffy, Diego, Kidd, Dombrock, MNS, and Lutheran blood group systems of 300 Li people were as follows: Duffy: Fy^a=0.958 3, Fy^b=0.041 7; Diego: Di^a=0.066 7, Di^b=0.933 3; Kidd: Jk^a=0.450 0, Jk^b=0.550 0; Dombrock: Do^a=0.101 7, Do^b=0.898 3; MNS: M=0.818 3, N=0.181 7, S=0.028 3, s=0.971 7, Mur⁺ =0.576 7; Lutheran: Au^a=0.835 0, Au^b=0.165 0. The antigen genes of Kell, Colton, Scianna, Yt, Knops, Indian, Vel blood group systems were not polymorphic, and the genetypes were kk, Co^aCo^a, Sc1Sc1, Yt^aYt^a, Kn^aKn^a, In^bIn^b and Vel⁺, respectively. 【Conclusion】 The allele frequencies of Duffy, Diego, Kidd, Dombrock, MNS and Lutheran blood group systems of Li ethnic group in Hainan were polymorphic, while the allele frequencies of Kell, Scianna, Yt, Knops, Colton, Indian and Vel blood group systems were monomorphic.