ObjectivesTo explore the clinical presentation, diagnosis and treatment of hemophagocytic syndrome (HLH) in children.MethodsThe clinical data from 11 hospitalized pediatric patients with HLH were collected and retrospectively analyzed from 2009 to 2013.ResultsIn 11 pediatric patients with HLH, 6 patients were Epstein-Barr virus associated-HLH, 1 patient was T-cell lymphoma associated-HLH, 2 patients had unknown reason, 2 patients had mutations in the UNC13D gene coding sequence, c.2459C>T/p.A832V (alanine to valine mutation) and c.3067C>T/p.R1023C (arginine to cysteine mutation) respectively. In 11 patients, 6 patients were improved after treatment and 5 patients were died.ConclusionsThe HLH in chil-dren lacks speciifc clinical presentation and progresses rapidly. It should be diagnosed and treated in time.

In numerous digestive reconstruction techniques after proximal gastrectomy for tumor of the gastroesophageal junction,widely used methods are esophagogastrostomy,esophagogastric tube reconstruction and jejunalinterposition reconstruction.More studies have been focused on jejunalinterposition reconstruction in recent years,from which a variety of modified reconstructions derive.In clinical practice,a flexible choice is needed according to the actual situation of patients.

Surgery alone for the adenocarcinoma of the esophagogastric junction (AEG) often gives unsatisfactory results, with a poor prognosis.At present, there is no unified therapeutic regimen specifically for AEG.Neoadjuvant therapy includes neoadjuvant radiotherapy, chemotherapy and chemoradiotherapy, but the applications and effects of them for AEG are still controversial.

SUMMARY Anklejointfractureisoneofthemostcommontypesoffracture.Therearemanyresearches on the injury mechanism,treatment principles and surgical techniques.A type of injury which combines posterior dislocation of fibula,known as the Bosworth injury,is relatively rare.In 1947,Bosworth first described this type of injury as an unusual ankle fracture dislocation with fixed posterior fracture disloca-tion of the distal part of the fibula.In this type of fracture,the proximal fibular shaft fragment locks be-hind the tibialis posterior tubercle.This rare ankle fracture variant is often not recognized in initial radio-graphs and requires a computed tomographic (CT)scan for verification.But there are already many re-ports,discussing the injury mechanism,treatment principles and surgical techniques.However,there are few reports of anterior dislocation of the fibula,caused by either injury or surgery.The mechanism of the injury is still not clear.This article reports a case of anterior dislocation of the fibula.We report a patient with left ankle open fracture (Lauge-Hansen pronation-external rotation stage Ⅲ,Gustilo ⅢA).Open reduction and internal fixation was done in the initial surgery,but ended up with poor reduction,resulting in fibula anterior dislocation,anterior dislocation of talus and tibia fibular dislocation.The fibula was dis-located anteriorly of the tibia,which rarely happened.The patient suffered severe ankle joint dysfunc-tion.The second operation took out the original internal fixation,reduced the fracture,and reset the in-ternal fixation.The function of ankle joint was improved obviously after operation.But because of the ini-tial injury and the two operations,the soft tissue around the fracture was greatly damaged.6 months after the second operation,and the fracture still not healed,so the bone graft was carried out in the third sur-gery.Two months after the third surgery,the function of the ankle was significantly better than before, but the fracture healing was poor,which needed further review.Through this case,we understand the rare type of ankle fracture with anterior dislocation of the fibula,and recognize that the timing and quality of initial surgery has a great impact on the patient’s prognosis and rehabilitation period.

The Hippocratic oath commands doctors to be the patients supreme advocate. Coupling this command with a well trained physician is the sine qua non of orthopaedic risk management. A favorable doctor and patient relationship is also essential. The occurrence of a malpractice lawsuit is more often the result of the failure to practice the art of medicine by the orthopaedist rather than a failure to apply the science of orthopaedics. The ER (emergency room) is a dangerous area. The risk of litigation in the emergency room is not directly proportional to the severity of injury. In fact, the risk of initiation of legal action is greater in cases of relatively modest disability.

We review the literature about Heterotopic Ossification (HO) and introduce its pathophysiology, classification, incidence, clinical presentation, diagnosis, prophylaxis and treatment in this article. HO is the presence of bone in soft tissue where bone normally does not exist. Mature HO has the same morphology as callus. It is considered that 3 conditions are necessary for HO: osteogenic precursor cells, inducing agents, and a permissive environment. Fever, swelling, erythema, and occasional joint tenderness appear in the early stage of HO. The most sensitive imaging modality for early detection of HO is three-phase bone scintigraphy which can also monitor the metabolic activity and degree of maturity of HO. Non-steroidal antiinflammatory drugs (NSAIDs) are the most effective for the prophylaxis of HO after the operation of hip replacement or acetabulum fracture. Surgical resection is the only treatment for patients with severe joint tenderness following HO.

Objective:To investigate the differences between emergency surgery and selective surgery treatment of ankle fractures with dislocation .Methods:In the study , 40 patients with ankle fracture and dislocation were treated and followed up from May 2013 to May 2014, and all the data were collected and analyzed .The subjects involved 29 male patients and 11 female patients .The patients were randomly separated into two groups , and the patients in group A were given surgical intervention within 6 hours af-ter injury , while those in group B were initially given close reduction and given selective operation when the soft tissue condition got better .Group A contained 13 male patients and 7 female patients with average age of 37.10;Group B consisted of 15 male and 5 female, with average age of 37.85.Results:The Baird-Jackson score was applied for assessment of the patients ’ outcomes.According to the score , the outcomes were classified into excellent , good, fair, and poor.In group A (emergency group), the outcomes were 13 (65.0%), 4 (20.0%), 3 (15.0%), and 0, respectively.In group B ( selective group), they were 11 (55.0%), 7 (35.0%), 2 (10.0%), and 0, respectively.The numbers of the patients from excellent to poor were 24 (55.0%), 11 (27.5%), 5 (12.5%), and 0, respectively. Conclusion: There is no significant difference in postoperative function between the two groups , however , early surgical intervention can benefit in accomplishing anatomical reduction much easier and shortening the time of hospitalization , which is cost-saving for the patients .

Objective To compare the outcomes of total hip replacement and minimally invasive dynamic hip screw in treating osteoporotic femoral intertrochanterie fractures.Methods Retrospectively analyze the clinical data of 56 patients with osteoporotic femoral intertrochanteric fractures who came to our hospital from July,2008-June,2012.Twenty eight cases who accepted minimally invasive dynamic hip screw were divided into the control group while 28 cases who accepted total hip replacement were divided into the experimental group.The blood loss and postoperative drainage,operative time,situation of implant loosening,the occurrence of postoperative complications and the clinical curative effect were compared between two groups.Results The differences in operative time,blood loss,and postoperative drainage flow,limited weight-bearing after operation was statistically significant between two group[(96.37 ± 20.42)min,(529.85±73.82) ml,(7.46±1.23) dvs (66.84±18.63)min,(152.79±37.35) ml,(14.32±2.62)d,t=5.653,24.117,12.542,P＜0.05].The differences in FRS score and Harris score between twogroups was not statistically significant [(27.75±3.59),(89.84±4.17) vs (26.41±3.16),(88.68±3.92),P＞ 0.05].The incidence in internal fixation loosening varied significantly with different degree of osteoporosis in the control group (66.7％vs18.8％,x2 =4.745,P ＜ 0.05) but not in the experimental group (11.1％ vs 10.0％,P＞0.05).Complication rate of the experimental group was significantly lower than the control group (3.6％vs 28.6％,x2 =4.766,P ＜ 0.05).Conclusions For the elder patients with osteoporotic femoral intertrochanteric fractures,the selection of surgical approach should be based on the patient's individual circumstances and the degree of osteoporosis.In the same time,attention should be paid to anti-osteoporosis therapy after operation.

Objective To evaluate the secondary internal fixation plus bone grafting for salvage of failed internal fixation for intertrochanteric hip fractures. Methods Between January 2001 and March 2008, 25 patients with intertrochanteric fractures who had suffered from failed initial internal fixation were treated with secondary open reduction and internal fixation and bone auto grafting. They were 15 men and 10 women, with a mean age of 50 (17 to 72) years. The mean interval between the initial operation and the revision was 12 (4 to 27) months. The failure of original internal implants involved the dynamic hip screw (DHS) in 12 patients, the dynamic condylar screw (DCS) in 3, the angular blade plate (ABP) in 1, the cephalomedullary nail in 3 and the cannulated screw in 6. The replacement of internal implants included PFN in 12 eases, DCS in 7, DHS in 4 and ABP (95°) in 2. Results The mean follow-up was 24 (6 to 84) months. The revisions were uneventful. Of the 25 nonunions, 24 healed (96.0%). The postoperative mean hip rating (Harris score) for the hip joint was 87(35 to 100) points. The X-ray films at the last follow-up revealed the coLlodiaphyseal angle averaged 120° ( 110° to 140°). No avascular necrosis of the femoral head or hip degeneration was found. Conclusion In properly selected patients, secondary internal fixation with bone grafting for failed open reduction and internal fixation of intertrochanteric hip fractures can provide a high rate of union and good clinical results with a low rate of complications.

Objective To investigate the impact of injecting hepatitis B immune globulin(HBIG)at third trimester of pregnancy on the nucleotide sequences of precore and basal core promoter(BCP)regions of hepatitis B virus(HBV)DNA.Methods One hundred and twenty pregnant women(67 in HBIG group and 53 in no-HBIG group)were enrolled in this study.Serum HBV DNA level was determined using quantitative real-time polymerase chain reaction(RT-PCR).Relevant serum markers (HBeAg,HBsAg)of HBV were detected by enzyme-linked immunosorbent assay(ELISA).Nucleotide fragments of HBV precore and BCP regions were amplified by nested PCR and then sequenced by automated DNA sequencer.Data were analyzed using t test and chi-square test.Results Sera of 33 women in HBIG group were collected before interruption with HBIG and at delivery.Precore and BCP regions of HBV DNA were amplified and sequenced successfully from double sera of 23 among 33 women. The rates of total nucleotide substitute in precore and BCP regions, that in precore region, and that in BCP region before and after interruption were 1.5% and 1.4%, 0.7% and 0.6%, 1.7% and 1.7%, respectively (Fisher's exact test, X2 =0.627, 0.689, 1.000, respectively,all P＞0.05). The rates of total mutations of hot points including 1896G→A,1899G→A,1762A→T,1764G→A before and after interruption were 27.2% and 13.0%, respectively (x2=5.717, P=0. 017). But the prevalences of these hot points mutations before and after interruption were 30.4%and 17.4%, 17.40/00 and 4.3%, 26.1% and 13.0%, 34.80/00 and 17.4%, respectively, which were all not significantly different (P＞0.05). The rates of nucleotide substitute in precore and BCP regions,that in precore region, and that in BCP region of 53 women in HBIG group and 47 women in no-HBIG group at delivery were 0.9% and 0.8%, 0.3% and 0.3%, 1.1% and 0.9%, respectively (Fisher's exact test, )x2=0.434, 0.839, 0.340, respectively, all P＞0. 05). The rates of total mutations of hot points of women in HBIG group and those in no-HBIG group at delivery were 5.7% and 10.1%,respectively, which was not significantly different (P＞0.05). These hot points mutations including 1896G→A,1899G→A,1762A→T, 1764G→A of women in HBIG group and those in no-HBIG group at delivery were 9.4% and 14.9%, 0 and 2. 1%, 7.5%0 and 10.6%, 5.7% and 12.8%, respectively,which were all not significantly different ( P＞0.05). Conclusions Antepartum interruption of HBV intrauterine infection with HBIG may not raise the nucleotide mutations in precore and BCP regions of HBV DNA. On the other hand, antepartum interruption may decrease mutations of hot points in the precore and BCP regions of HBV DNA.