This study shows a case of a patient with synovial chondromatosis of the hip misdiagnosed as rice body bursitis. The patient complained of pain and limited activity in his left hip. He was diagnosed with synovial chondromatosis of the hip by medical history, physical examination, imaging examination and postoperative pathology. Based on literature review, the characteristics and differential diagnosis of the disease in epidemiology, imaging and pathology were discussed in detail, so as to improve the understanding of the disease and avoid misdiagnosis. He was treated with hip arthroscopy and obtained satisfactory therapeutic effect. The patient was followed up for 1 year without recurrence.

OBJECTIVE To establish the method for the content determination of ephedrine hydrochloride and pseudoephedrine hydrochloride in Shexiang zhuanggu plaster ，and to evaluate the quality of 222 batches of Shexiang zhuanggu plaster from 41 manufacturers. METHODS HPLC method was established. The determination was performed on Shimadzu Shim-pack GIS-C 18 column with mobile phase consisted of acetonitrile- 0.1％ phosphoric acid （3∶97，V/V）at the flow rate of 0.9 mL/min. The column temperature was set at 30 ℃，the detection wavelength was 210 nm，the sample size was 10 μL. Taking the content data of 222 batches of samples as index ，the cluster heatmap was drawn by Hiplot biomedical data visualization and analysis platform. RESULTS The results of the methodological investigation were in line with the requirements of the general principles stated in 2020 edition of Chinese Pharmacopoeia （part Ⅳ ）. The total contents of ephedrine hydrochloride and pseudoephedrine hydrochloride in 222 batches of samples from 41 manufacturers were 0.646-6.325 μg/cm2. Results of cluster heatmap analysis showed that these samples of 41 manufacturers could be divided into 3 categories. The contents of components in samples from different manufacturers varied greatly ，and the contents of components in different batches of samples from the same manufacturers also varied greatly. If the proposed limit of this product was that the total amount of ephedrine hydrochloride and pseudoephedrine hydrochloride per 1 cm2 would not be less than 1.00 μg，23 of the 222 batches of samples were unqualified. CONCLUSIONS The established method for the content determination of ephedrine hydrochloride and pseudoephedrine hydrochloride in Shexiang zhuanggu plaster is accurate and precise ，and can be used for the quality control. Some manufacturers should pay attention to optimizing production process and strengthening quality control.

Objective:To explore the impact of preoperative Naples prognostic score (NPS) on the survival prognosis of patients with thoracic esophageal squamous cell carcinoma (ESCC).Methods:From December 2014 to December 2020, a total of 134 patients who underwent radical esophagectomy in Department of Thoracic Surgery, Affiliated Taixing People′s Hospital of Yangzhou University were retrospectively analyzed. The NPS was calculated by the median values of preoperative serum albumin, total cholesterol, neutrophil to lymphocyte ratio (NLR) and lymphocyte to monocyte ratio (LMR), and then the enrolled patients were divided into NPS 0 group (20 cases), NPS 1 or 2 group (62 cases) and NPS 3 or 4 group (52 cases). Kaplan-Meier method was used to calculate survival rate and survival comparison was performed by log-rank test. The univa-riate and multivariate Cox models were used to analyze the relationship between NPS and survival prognosis.Results:The 1-, 3- and 5-year progression free survival (PFS) rates were 95.0%, 70.0% and 60.0% in the NPS 0 group, 66.1%, 24.2% and 24.2% in the NPS 1 or 2 group, and 48.1%, 3.8% and 1.9% in the NPS 3 or 4 group respectively, with a statistically significant difference ( χ2=31.27, P<0.001). In the NPS 0 group, the 1-, 3- and 5-year overall survival (OS) rates were 100.0%, 80.0% and 70.0% respectively. In the NPS 1 or 2 group, the 1-, 3- and 5-year OS rates were 96.8%, 36.7% and 32.3% respectively, while in the NPS 3 or 4 group, the 1-, 3- and 5-year OS rates were 90.4%, 32.7% and 5.8% respectively, and there was a statistically significant difference ( χ2=29.70, P<0.001). Univariate analysis found that sex, T stage, N stage, TNM stage and NPS were closely related to PFS and OS of patients with thoracic ESCC (all P<0.05). Furthermore, multivariate Cox regression analysis showed that T stage ( HR=1.46, 95% CI: 1.07-2.00, P=0.019), N stage ( HR=1.34, 95% CI: 1.02-1.76, P=0.037) and NPS (set NPS 0 group as the subvariable, NPS 1 or 2 group: HR=3.35, 95% CI: 1.58-7.11, P=0.002; NPS 3 or 4 group: HR=6.15, 95% CI: 2.89-13.11, P=0.001) were independent prognostic factors for PFS. Additionally, T stage ( HR=1.67, 95% CI: 1.01-2.77, P=0.046), N stage ( HR=1.44, 95% CI: 1.00-2.20, P=0.048) and NPS (set NPS 0 group as the subvariable, NPS 1 or 2 group: HR=3.10, 95% CI: 1.31-7.32, P=0.010; NPS 3 or 4 group: HR=5.09, 95% CI: 2.14-12.11, P=0.001) were independent prognostic factors for OS. Conclusion:Preoperative NPS plays an important role in predicting the survival prognosis of patients with thoracic ESCC.

Osteoporotic vertebral compression fracture (OVCF) can lead to lower back pain and may be even accompanied by scoliosis, neurological dysfunction and other complications, which will affect the daily activities and life quality of patients. Vertebral augmentation is an effective treatment method for OVCF, but it cannot correct unbalance of bone metabolism or improve the osteoporotic status, causing complications like lower back pain, limited spinal activities and vertebral refracture. The post-operative systematic and standardized rehabilitation treatments can improve curative effect and therapeutic efficacy of anti-osteoporosis, reduce risk of vertebral refracture, increase patient compliance and improve quality of life. Since there still lack relevant clinical treatment guidelines for postoperative rehabilitation treatments following vertebral augmentation for OVCF, the current treatments are varied with uneven therapeutic effect. In order to standardize the postoperative rehabilitation treatment, the Spine Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized relevant experts to refer to relevant literature and develop the "Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (2022 version)" based on the clinical guidelines published by the American Academy of Orthopedic Surgeons (AAOS) as well as on the principles of scientificity, practicality and advancement. The guideline provided evidence-based recommendations on 10 important issues related to postoperative rehabilitation treatments of OVCF.

The pelvic incidence (PI) is a key anatomical parameter for vertebral-pelvic sagittal plane stabilization, that is, the angle between the perpendicular to the sacral plate at its midpoint and the line connecting this point to the middle axis of the femoral head, which fully reflects the compensatory ability of the pelvis and it does not change with age, gender and position, but is closely related to race. The measurement result of PI varies with the measurement method. The measurement on the standing lumbosacral lateral radiographs is a classic measurement method, which is easy to operate and has strong practicability. Later, the improved three-dimensional CT measurement and measurement methods on bone specimens are based on this, which reduces the error in X-ray measurement. Early research focused on PI and spine-related diseases. Compared with normal people, a small PI value is likely to cause intervertebral disc degeneration or even herniation, a high PI can cause lumbar spondylolisthesis. The measurement of PI can predict the risk of disc degeneration and lumbar spondylolisthesis progression, providing an important reference for spinal sagittal orthopedic reconstruction. The influence of PI in hip joint diseases cannot be ignored. PI also has a predictive effect on the development of certain hip joint diseases, and has guiding significance for the treatment of diseases. The relationship between PI and hip osteoarthritis, hip dysplasia, femur acetabular impingement, and non-traumatic necrosis of the femoral head was reviewed through literature review. The results showed that the relationship between hip osteoarthritis and PI was still controversial. The higher pelvic incidence was observed in Crowe I patients with hip dysplasia, and the lower PI was observed in patients with femur acetabular impingement. The higher PI was associated with a greater likelihood of femoral head collapse in patients with non-traumatic necrosis of the femoral head.

Objective:To evaluate the hip C-arm fluoroscopy at primary position in internal fixation of femoral neck fracture.Methods:A retrospective study was conducted of the 69 patients with femoral neck fracture who had been treated from August 2015 to August 2018.They were divided into a primary position group ( n=35) subjected to C-arm hip fluoroscopy at primary position under symmetry traction of bilateral lower limbs for reduction of femoral neck fracture and a control group ( n=34) subjected to C-arm hip fluoroscopy at frog’s position on the healthy side for traction and reduction of the injured hip. The 2 groups were compared in terms of fluoroscopy frequency, times of resetting guide pin, intraoperative blood loss and total operation time. Results:The 2 groups were comparable due to insignificant significances between them in the preoperative general data like gender, age, fracture type, injury cause, or interval from injury to operation ( P>0.05). Compared with the control group, the primary position group showed less intraoperative fluoroscopy (7.2 times ± 0.5 times versus 16.1 times ± 1.2 times), fewer times of resetting guide pin (2.1 times ± 0.31 times versus 4.7 times ± 0.8 times), less intraoperative blood loss (96.8 mL ± 18.6 mL versus 198.1 mL ± 13.2 mL), and shorter total operation time (1.2 h ± 0.2 h versus 1.6 h ± 0.3 h). All the differences were statistically significant ( P<0.05). Conclusions:C-arm hip fluoroscopy at primary position may protect the stability after fracture reduction because bilateral lower limbs are under symmetrical traction and the hip position needs no alteration. Operation of C-arm fluoroscopy is easy and convenient and produces clear images. Therefore, this new mode of fluoroscopy has advantages of less intraoperative fluoroscopy and guide pin resetting, leading to significantly reduced intraoperative blood loss, ineffective operation time and anesthesia time.

Thyroid nodules are very common in the clinical practice. Fine needle aspiration ( FNA) is a major method for the final diagnosis of thyroid nodules. This review tried to cover the definition, current status, clinical significance, indications, contraindications, ultrasound evaluation, as well as preparations, steps, molecular diagnosis, cytology diagnosis, and possible pitfalls of this technique. Our purpose is trying to make this procedure universalized and standardized in order to serve more patients by providing clinicians with some helpful references and advice.

Objective To evaluate perioperative fluid infusion strategies in retroperitoneal tumor patients.Method Data of 89 retroperitoneal tumor patients in Peking University People's Hospital and Peking University International Hospital were collected and devided into intraoperative minor haemorrhage group (761 ml) and massive haemorrhage group (4 813 ml),including postoperative fluid treatment,input and output volume,serum brain natriuretic peptide level and postoperation complications.Results Fluid input on the 1st day after operation,the 2nd day,the 3rd day respectively were (7 565 ±4 757),(3 869 ± 727),(3 289 ± 897),(3 096 ± 567) ml in the minor haemorrhage group,and (13 927 ± 5 612),(5 192 ± 1 274),(3 786 ± 1 137),(3 797 ± 719) ml in the massive haemorrhage group (t =-4.637,-3.117,-2.460,-2.982,P =0.04,0.048,0.36,0.038).BNP level respectively were (33 ±25),(82 ±66),(116 ± 54),(145 ± 75) ng/ml in the minor haemorrhage;respectively,(70 ± 65),(165 ± 153),(256 ± 220),(442 ± 412) ng/ml in the massive haemorrhage group (t =-4.637,-3.117,-2.460,-2.982,P =0.041,0.038,0.046,0.04).The accumulative percentage of negative fluid balance was 100％ in 3 days after operation.Acute kidney injury (AKI),cardiac,respiratory events,major intraabdominal complications deep venous thrombosis developed in minor and massive haemorrhage group were 4.7％,7.1％,4.7％,14.3％,9.5％ vs.25.1％,27.6％,46.8％,10.6％,17.0％ respectively (x2 =2.89,5.89,19.96,0.044,0.674,P=0.049,0.015,0.001,0.834,0.412).Conclusions Multiple goals directed fluid strategy leads to a better outcome by decreasing the AKI rate.BNP level could be used as a goal marker in fluid treatment.

Objective To investigate the pattern of outpatients traffic,orchestra service resources,and optimize service provision,for a harmonized outpatient service.Methods A baseline survey was made at the outpatient department in 30 days(six hours per day,7:00-11:00,and 13:00-15:00).On such basis,data of the hospital's HIS system within the last five years were called into play for statistics analysis and simulation test,for the purpose of shift scheduling and resources allocation optimization.Results This study discovered each January-February as the valley of clinic visits and each July-August as the peak.52-week data analysis of a year found that the days of daily registrations between 4000-5000 are up to 163 days,those over 5000 are up to 86 days,of which Mondays with over 5000 registrations are up to 35 days.Each Monday is found to be a peak of outpatient visits,with significant drop during Saturdays and Sundays; daily registrations peak between 7:00-10:00 in the morning,while the traffic rises again during 13:00-14:00 in the afternoon,yet up to 26 ％of the morning peak only.Conclusion Statistics analysis of the outpatient service and emergency service at the outpatient department can help identify their patterns of operations,for effective improvement of service provision,alleviation of peak hour workload,shorten patient waiting time and better patient satisfaction.

Objective To investigate the outcome of the finger reconstruction using one toe transfer to repair the tissue defects of two fingers at the same time. Methods Two fingers joint tissue missing and finger defect of 8 fingers in 4 cases were reconstructed with dissociative transplants harvested from two parts of the same toe at the same time.Using the paratelum of the second toes reconstructed the indicis paratelum or finger tip,and using the proximal interphalangeal joint of the second toes repaired the proximal interphalangeal joint's tissue defects of the middle finger at the same time in 2 cases.Using the distal interphalangeal joint and the proximal interphalangeal joint of one second toe reconstructed the proximal interpha langeal joints of the index finger and the middle finger in 1 case.Using the proximal interphalangeal joint and the metatarsophalangeal joint of one second toe reconstructed the metacarpophalangeal joints of the index finger and the middle finger in 1 case. Results All the transplants survived.The patients were followed-up from 2 months to 46 months postoperatively.The function and shape of 2 resconstruction fingers were excellent as assessed with Criterion on Functional Evaluation on Finger Reconstruction issued by Chinese Society of Hand Surgery.Five resconstruction fingers were good.One resconstruction finger was fire. Conclusion For some appropriate cases with the tissue defects of 2 fingers such as the finger's paratelum,the interphalangeal joint or the metacarpophalangeal joint,this operated technique was a good method.