Objective To investigate the treatment and clinical outcomes in developmental dislocation of the hip in chil?dren above 8 years old. Methods We retrospectively reviewed the results of operation treatment for developmental dislocation of the hip in 94 children (112 hips) from 2006 to 2012. The age of the patients ranged from 8.2 to 13.6 years at the time of treatment, with an average age 9.8 years. In 94 patients, there are 18 males and 76 females. The patients were classified into three group based on the age at time of operation:Group 8-9 years old, Group 10-11 years old, Group 12-13 years old. The dislocation of hip was classified by T?nnis classification system:gradeⅡ34 hips, gradeⅢ29 hips, gradeⅣ49 hips. Surgery was performed in all the patients. The procedures consisted of open reduction of the hip, capsulorraphy, shortening and derotational osteotomy of proxi?mal femur, and acetabular osteotomy which include Pemberton osteotomy (66 hips), Salter osteotomy (30 hips), Ganz osteotomy (3 hips), Triple osteotomy (5 hips) and Chiari osteotomy (8 hips). McKay and Severin modified criteria were used to assess the func?tion and radiographic results of the hip. Results The average follow?up was 2.3 years ranged from 1 to 7 years. According to McKay modified criteria at final follow?up, 75 hips (67%) had excellent (22 hips) and good (53 hips) clinical results, 32 hips (29%) were fair and 5 hips (4%) were poor. According to the Severin criteria, the outcomes of T?nnis grade Ⅳgroup was significantly worse than T?nnis gradeⅡ,Ⅲgroup. There is no significant differences between T?nnisⅡandⅢtype groups. If the patients were classified by age at time of operation, the function of group 8-9 years old was significantly better than others group according to the McKay criteria; the group 12-13 years old was significantly worse than others group according to Severin criteria. Conclu?sion Open reduction with proximal femoral osteotomy and acetabular osteotomy was an effective procedure for the treatment of developmental dislocation of the hip in children above 8 years old. The surgical results were related to the age at time of treatment and T?nnis classification system; low dislocation (T?nnis Ⅱ, Ⅲ) and young age (younger than 10 years old) had better function and radiographic results compared with high dislocation (T?nnisⅣ) and elder age group.

Objective The objective was to discussing the difference between the Pemberton osteotomy and Salter osteot?omy which performed in patients between the ages of 2 and 3 years who suffered from developmental dislocation of the hip (DDH). Methods A retrospective review of the results of operation treatment for DDH in 59 children (84 hips) from January 1998 to De?cember 2008 was conducted. There are 10 boys (14 hips) and 49 girls (70 hips). The age of the patients was between 2-3 years old at the time of treatment 2.5±0.4 years. Surgery consist of open reduction of the hip, capsulorraphy, shortening and derotational oste?otomy of proximal femur, and innominate osteotomy which include Pemberton osteotomy (33 hips), Salter osteotomy (51 hips). McKay and Severin modified criteria were used to assess the function and radiographic results of the hip. Results The average follow?up time was 5.6±3.5 years ranging from 2 to 16 years. According to Severin criteria at final follow?up, 78 hips (93%) had ex?cellent and good results;4 hips were fair and 2 hips poor result. The radiology results in Salter osteotomy were better than Pember?ton osteotomy (rate of excellent and good results 100%vs. 82%,χ2=7.43, P=0.003). According to the McKay criteria Salter osteoto?my and Pemberton osteotomy have no significant difference in latest follow?up (the satisfactory rate 100%vs. 97%,χ2=1.56, P=0.39). 18 hips (21%) had proximal femoral growth disturbance which 10 hips in Pemberton group, 8 hips in Salter group. There is no significant difference (χ2=2.54, P=0.17). Conclusion Open reduction, innominate osteotomy and proximal femoral osteotomy were effective procedures for the treatment of DDH in children between 2-3 years old. More attention should be taken in Pember?ton osteotomy to prevent the acetabular bony edge absorption.

Objective:To investigate the surgical treatment, clinical effect and revision reasons of children with proximal femoral fibrous dysplasia(FD).Methods:The clinical data of 26 children with polyostotic FD of proximal femur who underwent surgery at Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital from June 2016 to June 2018 were retrospectively analyzed. There were 18 males and 8 females with a mean age of 9.2 years (range:5 to 16 years).One of them was McCune Albright syndrome. Fifteen cases were in first operation and 11 cases were in revision operation. The operation methods and results were reviewed,and the causes of revision were analyzed.Results:Among the 15 children who underwent the first operation,13 cases underwent osteotomy or fracture reduction and interlocking intramedullary nail(IMN) fixation;One case underwent valgus osteotomy and pediatric hip plate(PHP)internal fixation;One case underwent valgus osteotomy+lesion curettage+allogeneic bone graft+PHP fixation. Among the 11 children who underwent revision surgery,9 cases were treated with IMN fixation,1 case with PHP fixation,and 1 case with PHP fixation+allogeneic bone graft. The causes of revision included distal fixation failed in 6 cases,proximal fixation failed in 3 cases,plate fixation failed in 5 cases,and recurrence occurred after curettage and artificial bone graft in 2 cases. Patients were followed up for 1.4 years(range:1.0 to 3.5 years) after recent operation. The osteotomy or fracture healed well with good deformity correction. Postoperative complications included infection in 1 case and local bone partial resorption in 1 case.Conclusions:Osteotomy combined with rigid internal fixation is an effective surgical treatment for fibrous dysplasia of proximal femur in children. Internal fixation should cover the whole length of lesion. Intramedullary nail is the most common choice. Because the growth of height and the progress of the disease itself,this deformity is prone to recur in children,needing closely follow-up after operation.

Objective:To investigate the surgical treatment, clinical effect and revision reasons of children with proximal femoral fibrous dysplasia(FD).Methods:The clinical data of 26 children with polyostotic FD of proximal femur who underwent surgery at Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital from June 2016 to June 2018 were retrospectively analyzed. There were 18 males and 8 females with a mean age of 9.2 years (range:5 to 16 years).One of them was McCune Albright syndrome. Fifteen cases were in first operation and 11 cases were in revision operation. The operation methods and results were reviewed,and the causes of revision were analyzed.Results:Among the 15 children who underwent the first operation,13 cases underwent osteotomy or fracture reduction and interlocking intramedullary nail(IMN) fixation;One case underwent valgus osteotomy and pediatric hip plate(PHP)internal fixation;One case underwent valgus osteotomy+lesion curettage+allogeneic bone graft+PHP fixation. Among the 11 children who underwent revision surgery,9 cases were treated with IMN fixation,1 case with PHP fixation,and 1 case with PHP fixation+allogeneic bone graft. The causes of revision included distal fixation failed in 6 cases,proximal fixation failed in 3 cases,plate fixation failed in 5 cases,and recurrence occurred after curettage and artificial bone graft in 2 cases. Patients were followed up for 1.4 years(range:1.0 to 3.5 years) after recent operation. The osteotomy or fracture healed well with good deformity correction. Postoperative complications included infection in 1 case and local bone partial resorption in 1 case.Conclusions:Osteotomy combined with rigid internal fixation is an effective surgical treatment for fibrous dysplasia of proximal femur in children. Internal fixation should cover the whole length of lesion. Intramedullary nail is the most common choice. Because the growth of height and the progress of the disease itself,this deformity is prone to recur in children,needing closely follow-up after operation.

Objective To observe the clinical effects and safety of sodium valproate combined with decitabine for treatment of myelodysplastic syndrome (MDS). Methods Forty-two patients with MDS were enrolled in department of hematology in Shanxi Dayi Hospital from February 2012 to February 2017. According to random number table, the patients were divided into the control group (21 cases) and the experimental group (21 cases). The patients in the control group received decitabine at the dose of 20 mg·m-2·d-1, and intravenous infusion was completed in 2 hours, continuous therapy up to 5 days, 4 weeks as a course; the patients in the experimental group received combined medication, orally given sodium valproate 0.2 g once, 3 times per day. One week later, the dosage was added to 0.4 g once, 3 times per day. Both groups received at least 4 courses of treatment. The treatment was stopped when serious adverse reactions or obvious disease progression occurred. The bone marrow smear was rechecked every 4 weeks after treatment to evaluate the efficacy. The expressions of ASXL1, DNMT3A and TET2 in bone marrow cells were detected by fluorescence quantitative PCR before and after treatment. Results The total treatment response rate of the experimental group and the control group were 76.2 % (16/21) and 57.1 % (12/21) respectively, and there was statistically significant difference (P< 0.05); the total remission rate of the two groups was 47.6 % (10/21) and 38.1 %(8/21) respectively, and there was no significant difference (P> 0.05). All patients had slight adverse reactions, and the adverse reaction rate was 42.9 % (9/21) and 38.1 % (8/21), and there was no significant difference (P>0.05). The content of TET2 mRNA and DNMT3A mRNA after treatment in both groups were decreased compared with the expressions before treatment, and there were significant differences (P<0.05). However, there was no significant difference between the two groups after treatment (P> 0.05); the content of ASXL1 mRNA had no obvious change in the control group and a dramatic decrease in the experimental group compared with that before treatment (P<0.05). Conclusion Sodium valproate combined with decitabine has favorable effects and mild adverse reactions for treatment of MDS, besides, it can influence the expressions of TET2, DNMT3A and ASXL1.

Objective:To explore the application of engage-study-activate (ESA) flipped classroom combined with small private online course (SPOC) teaching in the practice teaching of rehabilitation medicine.Methods:A total of 87 students who practiced in the department of rehabilitation medicine from January 2018 to October 2020 were divided into control group ( n=43) and observation group ( n=44). The control group used routine teaching, and the observation group used ESA flipped classroom combined with SPOC teaching. The individual assessment results and team assessment results of the two groups of interns were compared, and the evaluation of teaching effect and the recognition of interns were analyzed. SPSS 22 0 was performed for chi-square test and t test. Results:The scores of medical history collection, specialized physical examination, treatment methods, individual assessment, humanistic communication, participation and team assessment in the observation group were better than those in the control group ( P<0.05). There was no significant difference in auxiliary examination score, diagnosis score and teamwork score between the two groups ( P>0.05). The scores of learning efficiency, classroom interaction ability, autonomous learning ability, combination of theory and practice, mastery of basic knowledge, clinical innovative thinking ability and teamwork ability in the observation group were higher than those in the control group ( P<0.05). The recognition of teaching in the observation group was 97.73% (43/44), which was higher than 81.40% (35/43) in the control group. Conclusion:ESA flipped classroom combined with SPOC teaching can improve the individual assessment results and group assessment results of interns, improve the educational environment, and its teaching effect is better than conventional teaching methods, which can improve the recognition of interns, so it has important application value in medical teaching.

Objective:To establish high performance liquid chromatography (HPLC) wavelength switching method to simultaneously determine the contents of chlorogenic acid, hydroxysafflor yellow A, ferulic acid, Nicotiflorin, Osthole and columbianadin in Tongluo Zhibi Prescription.Methods:The column was XBridge C18 column (250 mm × 4.6 mm, 5 μm); the mobile phase was acetonitrile (A)-0.1% phosphate water (B); gradient eluted, with flow rate: 1 ml/min, column temperature: 30 °C, detection wavelength 330 nm (0-14 min detection of chlorogenic acid, 15-80 min detection of ferulic acid, Nicotiflorin, Osthole, and columbianadin), 403 nm (14-15 min detection of hydroxysafflower yellow pigment A).Results:Chlorogenic acid, hydroxyrhodopsin A, ferulic acid, kaempferol 3-O-rutinoside, serpentin, and dihydroeurobicarpus angelicus acid ester showed good linearity ( R2 ≥ 0.999 8) within 0.029 7-1.485 0, 0.030 0-1.500 0, 0.009 9-0.495 0, 0.017 5-0.875 0, 0.028 4-1.420 0, 0.013 7-0.685 0 μg, respectively. The precision, stability (24 h), repeatability relative standard deviation ( RSD) were all <2%. The average spiked recoveries were all in the range of 95%-105%, and the RSDs were all in the range of 0.32%-1.67%. In 10 batches of test samples of Tongluo Zhibi Prescription, the content of the above six components, including chlorogenic acid, was determined to be 0.221 60, 0.314 30, 0.085 10, 0.032 95, 0.043 87, 0.026 21 mg/g in the following order. Conclusion:The established HPLC wavelength switching method is fast, simple and accurate, which can be used for simultaneous determination of the content of the above six components in Tongluo Zhibi Prescription, which provides reference for quality monitoring and new dosage form research of Tongluo Zhibi Prescription.