To investigate the clinical improvement of limping gait in patients with ankylotic hips and limb length discrepancy.Methods:From 1996 to 2005,12 patients with ankylotic hips and limb length discrepancy were treated by distraction osteogenesis with a mono-lateral external fixator and an intramedullary nail.The limb length discrepancy was 6.20-12.50 (median 8.45) cm.Limping gait was classified according to the recommendations of the American Academy of Orthopedic Surgeons/Hip Society and scored according to Harris:no limping scored 11 points,mild limping scored 8 points,moderate limping scored 5 points,while severe limping scored 0 points.Limping gait was severe in all patients pre-operatively and the total score was 0.Results:All patients were followed up for 30.00-46.00 (median 38.55) months,and all reported improvement in limping gait.The gain in length was 6.00-12.50 (median 8.20) cm,and the mean residual limb length discrepancy was 0-0.50 (median 0.20) cm.The total treatment time was 41.00-82.00 (median 61.50) weeks,the lengthening time was 14.00-38.00 (median 29.55) weeks.At the last follow-up,10patients had mild limping gait and 2 had moderate limping gait; the total score was 90.00.The median score was 7.50 (P25 was 8.00,P75 was 8.00).According to Wilcoxon signed rank test,the post-operative limping gait scores were significantly higher than pre-operative (P=0.001 ).Conclusion:Femoral lengthening can improve the limping gait significantly in ankylotic hips and limb length discrepancy.

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 evaluate the clinical manifestations, endoscopic features and the clinical pathological characteristics of H. heilmannii-associated gastritis, and to compare these variables with those of H. pylori-ussociated gastritis. Methods The clinical data, endoscopic findings and pathologic characteristics of 3107 patients, who underwent endoscopy from 2005 to 2007, were retrospectively analyzed. Results Twenty-five cases of H. heilmannii infection were identified, the infection rates of H. heilmannii and H. pylori were 0.80% (25/3107) and 4.12% (1060/3107) respectively. Three cases were mixed infections. Of 25 patients, 20 showed such gastroenterologic symptoms to a greater or less extent as abdominal distending pain,nausea and anorexia, and other 5 cases were asymptomatic. All 25 patients showed chronic gastritis by en-doscopy, including chronic superficial gastritis (7/25, 28% ), erosion ( 3/25, 12% ), chronic atrophic gastritis (4/25, 16%), bile reflux(1/25, 4%), ulcer (1/25, 4%), polyp (1/25, 4%) and duodenal bulbar inflammation (2/25, 8% ). In rapid urease test, 3 cases were hyper-positive, 3 cases positive, 7 ca-ses mild-positive and 12 cases negative. According to histological observation, H. heilmannii scattered or ac-cumulated within the gastric pits, glandular lumen or mucus. The organism was observed in parietal cells with cell damage in one case. Sporadic lymphatic and plasmic infiltration were found in all patients with H.heilmannii infection, infiltration of neutrophils (12/25), gland atrophy and intestinal metaplasia (4/25)and lymphoid follicles (6/25) were also observed. Compared with H. pylori-associated gastritis, H. heilman-nii-associated gastritis showed less inflammation, less helicobacter density, mononuclear cell infiltration and neutrophilic activity ( P < 0.05 ). Conclusion H. heilmanaii mainly induces chronic gastritis, which is less severe than H. pylori-associated gastritis.

Objective: To investigate the mediating effect of insomnia among mobile phone addiction, aggressive behaviors and self-perceived identity among university students. Methods: A total of 740 university students were sampled from five universities in Binjiang District, Hangzhou City using a cluster random sampling method. The mobile phone addiction, aggressive behaviors and self-perceived identity were assessed using the Mobile Phone Addiction Index Scale, the Athens Insomnia Scale, the Chinese college students' version of the Buss-Perry Aggression Questionnaire, and the Self-Perceived Identity Scale, and the mediating effect of insomnia among mobile phone addiction, aggressive behaviors and self-perceived identity was examined using Process macro program and Bootstrap method. Results: A total of 740 questionnaires were allocated, and 700 valid questionnaires were recovered, with an effective recovery rate of 94.59%. The respondents included 221 men (31.57%) and 479 women (68.43%), and there were 607 respondents with a specialty of medicine (86.71%). There were 331 participants detected with mobile phone addiction (47.29%), 90 with aggressive behaviors (12.86%) and 289 with low-level self-perceived identity (41.29%), and the prevalence rates of mild, moderate, severe and extremely severe insomnia were 28.00%, 26.14%, 26.43% and 19.43% among respondents, respectively. Mobile phone addiction had a direct predictive effect on aggressive behaviors (β=0.301, P<0.001) and self-perceived identity (β=-0.129, P<0.001), and presented an indirect predictive effect on aggressive behaviors (effect of mobile phone addiction on insomnia: β=0.083, P<0.001; effect of insomnia on aggressive behaviors: β=0.999, P<0.001; effect of insomnia on self-perceived identity: β=-0.698, P<0.001). The contributions of mediating effects caused by insomnia were 21.61% and 31.02% to total effects. Conclusions Insomnia presents partial mediating effects among mobile phone addiction, aggressive behaviors and self-perceived identity among university students. Mobile phone addiction may directly affect aggressive behaviors and self-perceived identity, and indirectly affect aggressive behaviors and self-perceived identity via insomnia.

Peroral endoscopic myotomy (POEM) has emerged as a rescue treatment for recurrent or persistent achalasia after failed initial management. Therefore, we aimed to investigate the efficacy and safety of POEM in achalasia patients with failed previous intervention. We searched the MEDLINE, Embase, Cochrane, and PubMed databases using the queries “achalasia,” “peroral endoscopic myotomy,” and related terms in March 2019. Data on technical and clinical success, adverse events, Eckardt score and lower esophageal sphincter (LES) pressure were collected.The pooled event rates, mean differences (MDs) and risk ratios (RR) were calculated. A total of 15 studies with 2,276 achalasia patients were included. Overall, the pooled technical success, clinical success and adverse events rate of rescue POEM were 98.0% (95% confidence interval [CI], 96.6% to 98.8%), 90.8% (95% CI, 88.8% to 92.4%) and 10.3% (95% CI, 6.6% to 15.8%), respectively. Seven studies compared the clinical outcomes of POEM between previous failed treatment and the treatment naïve patients. The RR for technical success, clinical success, and adverse events were 1.00 (95% CI, 0.98 to 1.01), 0.98 (95% CI, 0.92 to 1.04), and 1.17 (95% CI, 0.78 to 1.76), respectively. Overall, there was significant reduction in the pre- and post-Eckardt score (MD, 5.77; p<0.001) and LES pressure (MD, 18.3 mm Hg; p<0.001) for achalasia patients with failed previous intervention after POEM. POEM appears to be a safe, effective and feasible treatment for individuals who have undergone previous failed intervention. It has similar outcomes in previously treated and treatment-naïve achalasia patients.