Objective To investigate the pathological features and clinical outcomes of the arthroscopic treatment for calcifying tendinitis of the supraspinatus. Methods From March 2009 to October 2010,34 patients with calcifying tendinitis of the supraspinatus were treated with shoulder arthroscopy. Based on size of calcifying deposits, they were divided into three groups: small (＜10 mm), middle (≥ 10 mm, ≤20mm), and large (＞20 mm). All patients underwent arthroscopic calcium excision and subacromial decompression, and acromioplasty of shoulder was performed in 8 cases, rotator cuff neoplasty in 10. The preoperative and postoperative clinical data such as Constant's score, Visual Analog Scale (VAS) pain score and radiographs were adopted for evaluation. Besides, histological and scanning electronic microscopic examinations of calcium deposits were also carried out. Results All patients were follwed up for average 11.5 months.The patients were regularly examined at a time point of 1 month preoperatively, 2 days preoperatively and of the latest follow-up. The average Constant score was 36.1 ±6.9, 55.6±12.4 and 89.7±2.7 respectively; the average VAS pain score was 8.2±0.8,7.03±0.7,1.7±0.3 respectively. Both scoring systems revealed a significant difference before and after surgery. However, the clinical outcomes of the calcified deposit (small, middle, and large) showed on significant difference among the 3 groups. Collagen fibers were not degenerated around the calcified deposit, and no apoptotic or dead cells could be found, therefore, it is not a pathological calcification. Conclusion Recognition of calcifying tendinitis and good timing of surgery are keys to good clinical results. Shoulder arthroscopy is a safe, effective and minimally invasive method for the treatment of calcifying tendinitis of the supraspinatus. The patients with various size of the calcium deposit treated with shoulder arthroscopy can lead to an excellent clinical outcome postoperatively.

Objective To follow up a series of elderly patients who had acute femoral neck fracture, and to examine the performance of the combination of cemented stem and acetabular cup. Methods Forty-one elderly patients were followed up.The average age at operation was 72.1 years and follow-up was 3.2 years. Evaluations on the outcomes of hybrid hip arthroplasty included morphologic feature of bone, quality of cement mantle,and implant stability. Results No cement-related death intra- or postoperatively was documented and systemic diseases did not deteriorate peri-operatively. The total Harris Hip Score was 81.1 points. The bone type was evaluated as Type A, 20%; Type B,56%;Type C,24%. Quality of cement mantle was evaluated as Grade A, 37%; Grade B, 49%;and Grade C, 4%. Conclusion Hybrid total hip replacement is preferred in the elderly with acute femoral neck fracture.The immediate postoperative stability enables quicker rehabilitation of elderly patients and lowers the incidence of complications.Contemporary cementing techniques are mandatory in the operation.

BACKGROUND: Vascular injuries to the extremities are frequently concomitant with vascular defects. Vascular transplantation repair can induce infection and vascular occlusion, etc.OBJECTIVE: To analyze the outcome of vascular reconstitution in 44 patients with vascular injuries of the extremities undergoing vascular transplantation.DESIGN: A retrospective case analysis.SETTING: Department of Vascular Surgery and Department of Orthopaedics of Hospital Affiliated to Jinhua College of Profession and Technology.PARTICIPANTS: Forty-four patients with vascular injuries to the extremities undergoing autologous and artificial vascular transplantation were selected at the Department of Vascular Surgery and Department of Orthopaedics of Hospital Affiliated to Jinhua College of Profession and Technology from April 1994 to October 2003. There were 29 patients with open injury and 15 patients with closed injury.METHODS: A total of 52 blood vessels were transplanted into 44 patients, including 42 blood vessels in autologous vein transplantation (35 blood vessels in great saphenous vein transplantation by end-to-end anastomosis, 5 blood vessels in small saphenous vein transplantation by end-to-end anastomosis and 2 blood vessels in superficial femoral vein and popliteal vein transplantation) and 10 blood vessels in artificial and trimming vascular transplantation by interrupted suture technique in end-to-end anastomosis.MAIN OUTCOME MEASURES: Outcomes of autologous and artificial vascular transplantation.RESULTS: Three patients received amputated extremity. Six patients developed ischemic contracture. Seven patients developed imperfect recovery of nerve function. In other patients, blood flow in the graft was satisfactory, and there was good condition of blood circulation at the distal extremities.CONCLUSION: Autologous vein is the first choice in vascular transplantation, and prosthetic material is another choice when necessary. It is important to prevent the occurrence of complication after transplantation such as vascular infection.

ObjectiveTo summarize the results of stereotactic radiation therapy (SRT) with or without whole-brain radiotherapy (WBRT) in the treatment of multiple brain metastasis.MethodsFrom May 1995 to April 2010,totally 98 newly diagnosed multiple (2 - 13 lesions) brain metastases patients were treated in our centre.Forty-four patients were treated with SRT alone and 54 with SRT + WBRT.Dose fractionation schemes were 15 -26 Gy in 1 fraction or 24.0 -52.5 Gy in 2 - 15 fractions with 3.5 - 12.0 Gy per fraction,depending on the tumor volume,location,and history of prior irradiation.Kaplan-Meier and Cox proportional hazards regression analyses were used for survival analysis.The median age of the whole group was 55 years.The survival time was calculated from the date of radiation treatment to the day of death by any cause.ResultsThe median follow-up time for the whole group was 12 months,and the follow-up rate was 100％.The median overall survival time was 13.5 months for the whole group,there was no difference between SRT alone group and SRT + WBRT group ( 13.0 months vs.13.5 months,χ2 =0.31,P =0.578 ).The Karnofsky Performance Score ( KPS) at the time of treatment ( χ2 =6.25,P =0.012 ),the interval between the diagnosis of the primary tumor and brain metastases ( χ2 =7.34,P =0.025 ) and the status of extracranial metastases ( χ2 =4.20,P =0.040) were independent prognosis factors for survival in multivariate analyses.ConclusionsStereotactic radiation therapy is an effective and alternative treatment choice for multiple brain metastases.

Objective To investigate the risk factors related to the survival time of anti-protrusion cage in acetabular revision.Methods Data of 40 patients who had received acetabular revision using antiprotrusion cages between January 2002 and June 2010 were retrospectively analyzed.There were 16 males and 24 females,aged from 22 to 77 years (average,60.3 years).All patients were followed up for 12 to 82 months (average,39.2 months).According to the AAOS classification,there were 29 cases of type C and 11 cases of type D； while according to the Paprosky classification,there were 29 cases of type ⅢA and 11 cases of type Ⅲ B.The multiple regression analysis was utilized to investigate the relationships between different factors and anti-protrusion cage failure.The corresponding factors included gender,age,bone loss classification,superior or lateral migration of acetabular center of rotation,abduction angle,fixation manners (simple flange fixation or flange fixation plus transacetabular screw fixation),bone grafting techniques and cup type.Results At final follow-up,the average Harris score was 74.5±15.4.Two patients received rerevision due to prosthetic loosening.Obvious radiological loosening of prosthesis combined with pain was found in 2 cases.The statistical analysis indicated that superior migration of acetabular center of rotation,abduction angle and fixation manners were correlated with cup failure,especially when the superior migration was more than 8.5 mm or the abduction angle was larger than 53.5°.Flange fixation plus transacetabular screw fixation could reduce risk of cup failure.Conclusion There is a higher cup failure risk in acetabular revision using an anti-protrusion cage for patients with serious bone defect.However,implanting cup at the level of the true acetabulum as far as possible,decreasing abduction angle properly and using flange fixation plus transacetabular screw fixation can reduce cup failure risk.

Objective To study the short-term clinical outcomes of unicompartmental knee arthroplasty for medial compartmental knee osteoarthritis,and to compare 2 kinds of unicompartmental prosthesis.Methods From March 2010 to June 2013,data of 43 patients underwent unicompartmental knee arthroplasty (UKA) were retrospectively analyzed.17 patients (17knees) used rotating platform prosthesis,and 26 patients (28 knees) used fixed bearing prosthesis.There were 7 males (7 knees)and 9 females (10 knees) in rotating platform group,with an average age of 64.1 years (range,54-82 years);while 10 males (10knees) and 17 females (18 knees) in fixed bearing group,with an average age of 62.2 years (range,43-79 years).All patients presented signs of narrowed medial joint space,medial tenderness and pain on weight-bearing.X-ray and MRI were used for documenting joint narrowing and cartilage defect.The pain and the knee functions were recorded both pre and post-operatively with knee society score (KSS),2 cases of simultaneous anterior cruciate ligament (ACL) reconstruction were assessed with TegnerLysholm knee scoring scale as well.Results All 43 patients were followed up for 6 month to 37 months,and the average duration was 21.1 months.There were no dislocations,joint infection,deep venous thrombosis,prosthetic loosening,etc.The KSS in rotating platform group was 56.11 ±9.51 preoperatively,and 92.23±5.46 postoperatively.While the KSS in fixed bearing group was 57.11 ±9.56,and 93.69±6.37,respectively.There were statistical differences comparing between preoperative and postoperative KSS knee scores.There was no significant difference in KSS scores between rotating platform group and fixed bearing group.Conclusion Unicompartmental knee arthroplasty is a less invasive and effective method for knee osteoarthritis in medial compartment with less complications.There was no significant difference in clinical outcomes between rotating platform and fixed bearing design in terms of patients' satisfactory rate,clinical and functional outcomes in this short-term follow-up study.

Objective To investigate the efficacy of medial plantar flaps with cutaneous nerves on fixing palm skin defects for patients injured while working.Methods All cases with palm skin defects who received medial plantar flaps grafting from June 2003 to January 2013,were analyzed retrospectively.The data included 13 males and 10 females,with the mean age of 36 years old (range,18-61 years old).There were 16 cases with right hand injury and 7 cases with left,whose skin defects ranged from 3.6 cm×2.8 cm to 7.0 cru×5.5 cm.All cases had skin and soft tissue injury while 5 cases with vascular and nerve injury,3 cases with tendon involvement and being exposed,6 cases with open metacarpal fractures.15 patients were treated with emergency surgery within 8 hours after injury,while 8 patients were treated 10 days after debridement surgery.Results Altogether,23 patients who received medial plantar flaps grafting operations,with palm skin defects,were included in this study.All cases were followed up for 3 to 36 months with a average period of 18 month.The grafted flaps range from 4.6 cm×3.8 cm to 8.0 cm×6.5 cm.Among the patients,19 of them recovered excellently with healing by first intention,with 7-14 d healing time,fully-retained hand functions and palm appearance,and 4-8 mm for between two points distinguish test.Flaps survived fairly well in 3 patients because partial necrosis happened at plantar skin graft donor site.After being debrided and dressed,the wound healed at second phase with a healing time of 12-21 d and 5-9 mm for between two points distinguish test.The operated hands could flex and extend functionally in the follow-up period.Only one patient did not recovered from medial plantar flap grafting and the flap did not survive operationally.The patient recovered after another operation with groin skin grafting later.According to Gu Yudong et al' evaluation criteria,such as improved hand function,19 cases were scored as excellent recovery,3 cases as good,and 1 as poor.The excellent rate was 95.7％ (22/23).Conclusion Medial plantar flaps with cutaneous nerves are ideal flaps for palm skin defects restoration,which characterized by the advantages of fixed anatomical position,high survival rate and being good to the functional recovery and palm appearance.

Objective To analyze the characteristic of trauma in 246 fatal falls. Methods We collect 246 cases of fatal falls from Pudong district of Shanghai from 2005 to 2014, and then analyze the characteristics of trauma by using different parameters. Results The height in suicides by fall is higher than accidents by fall (25.7m:13.98m). In all fatal falls, head has a higher possibility in suffering trauma than other body regions (75.2%), while neck has a lower possibility (6.5%). The possibility of head trauma in accidents by fall is higher than suicides by fall (89.4%:75.2%). Conclusion Comparing with suicides by fall, victims in accidents by fall have lack of protection from limbs. Besides, the low rate of ifnding neck trauma suggests legal physicians should be more careful in examining this area.

Objective:To establish the control charts for early warning of diarrhea based on the syn-dromic surveillance data from enteric clinic in Beijing .Methods:The outpatient data from enteric clinic of a Grade Three General hospital in Haidian district , Beijing from April 1 to Oct.31, 2009 and from May 1 to Nov.10, 2010 were collected, according to the moving average method , the baseline calcula-ted, the value of probability αand μα, the early warning value based on the formula “w=Xj +μαSj”calculated and the early warning control charts drew at last .Results:According to the harmfulness , the severity and controllability of diarrheal diseases , the value of probability αwas determined as 0.01, thenμα( unilateral) as 2, based on the early warning value , the control charts of diarrheal diseases , bacillary dysentery and other infectious diarrhea were established .Conclusion:The enteric clinic requires to fur-ther collect baseline data to evaluate and continuously adjust the established control charts for the best early warning model in accordance with the enteric clinic .

OBJECTIVE:To investigate therapeutic efficacy of ezetimibe combined with tirofiban in the treatment of acute coronary syndrome patients and its influence on the content of ischemia modified albumin (IMA) in peripheral blood.METHODS:A total of 82 patients with acute coronary syndrome in our hospital from Jan.2016 to Jan.2017 were divided into observe group and control group according to random number table,with 41 cases in each groups.All patients were given general treatment containing statins,glyceryl trinitrate and so on.Control group was additionally given Ezetimibe tablet 10 mg orally once a day.Observation group was additionally given Tirofiban hydrochloride sodium chloride injection 5 mg intravenously once a day,on the basis of control group,for consecutive 15 d.Clinical efficacies of 2 groups were evaluated.The dose of glyceryl trinitrate,duration and frequency of angina pectoris attack,left ventricular function indexes (SV,LVDD,CO,LVEF) were compared before treatment and after last medication.The contents of IMA in peripheral blood were detected before treatment and 3,6,9,12,15 h after the first day medication.ADR of the 2 groups were observed closely during the treatment.RESULTS:The total response rate of observation group was 92.7％,which was significantly higher than 72.3％ of control group (P＜0.05).Compared with before treatment,dose of glyceryl trinitrate and the content of IMA in 2 groups were decreased significantly after last medication,duration and frequency of angina pectoris attack were shortened significantly;the levels of SV,CO and LVEF were increased significantly while the level of LVDD was decrease significantly;the effect of observation group was significantly better than that of control group,with statistical significance (P＜0.05).No severe ADR was found in all patients during the treatment.CONCLUSIONS:Based on general treatment of glyceryl trinitrate therapeutic efficacy of ezetimibe combined with tirofiban is better than that of ezetimibe alone in the treatment acute coronary syndrome patients,and can decrease the content of IMA in peripheral blood more quickly.