Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.

Objective:To investigate the effects of Traditional Chinese Medicine(TCM) syndrome factors on the analgesic efficacy of oxycodone after laparoscopic hysteromyomectomy.Methods:Two hundred female patients, of American Society of Anesthesiologists physical statusⅠorⅡ, aged 20-59 yr, with body mass index of 18-30 kg/m 2, scheduled for elective laparoscopic hysteromyomectomy under general anesthesia, were divided into 4 groups according to the TCM syndrome types: kidney deficiency and blood stasis type group (group A, n=65), damp-heat stagnation type group (group B, n=53), Qi stagnation and blood stasis type group (group C, n=43), and phlegm and dampness stagnation type group (group D, n=39). Postoperative pain was assessed using the numerical rating scale (NRS). When the NRS score≥4, oxycodone was slowly injected intravenously in a titrated manner until the NRS score<4 (loading dose). The patient-controlled intravenous analgesia solution contained oxycodone 100 mg in 100 ml of normal saline.The patient-controlled intravenous analgesia pump was set up to deliver a 1-ml bolus dose with a 10-min lockout interval and background infusion at a rate of 1 ml/h.The loading dose of oxycodone and consumption of oxycodone on 1st and 2nd days after operation were recorded. Results:Compared with A and C groups, the loading dose of oxycodone and consumption of oxycodone on 1st and 2nd days after operation were significantly increased in B and D groups ( P<0.05). There were no significant difference in the parameters mentioned above between group B and group D and between group A and group C ( P>0.05). Conclusion:The TCM syndrome factors can affect the analgesic efficacy of oxycodone after laparoscopic hysteromyomectomy, and the postoperative analgesic efficacy of oxycodone is weakened comparatively in the patients of damp-heat stagnation type and of phlegm and dampness stagnation type.

Objective To assess the value of four different techniques of detecting the Mycobacterium tuberculosis (MTB) in bronchoalveolar lavage fluid (BALF) in the diagnosis of tracheobronchial tuberculosis. Methods A total of 98 patients diagnosed as tracheobronchial tuberculosis were selected from May 1,2013 to June 30,2016. The clinical data was analyzed retrospectively,and the positive rates of MTB of the 960 cultrue, the direct smears , the modified Ziehl?Neelsen stain method and Xpert MTB/RIF assay were compared. Results The positive rates of the 960 cultrue,the direct smears,the modified Ziehl?Neelsen stain method and Xpert MTB/RIF assay were 20.4%(20/98),15.3%(15/98),70.4%(69/98) and 74.5%(73/98),respectively. Among the four techniques ,the positive rates of the modified Ziehl?Neelsen stain method and Xpert MTB/RIF assay were significantly higher than those of the 960 cultrue and the direct smears(P<0.05,respectively). However,no significant difference was found between the modified Ziehl?Neelsen stain method and the Xpert MTB/RIF assay (P > 0.05). Conclusions The modified Ziehl?Neelsen stain method and Xpert MTB/RIF assay for detecting the MTB in BALF have high clinical value in the diagnosis of tracheobronchial tuberculosis.

Objective To explore the epidemiological characteristics of adult allergic diseases,looking for risk factors of allergic airway disease in Shiqi District of Zhangshan,and to provide a scientific basis for the development of community health education.Methods The questionnaire which was designed by national respiratory allergic diseases research and epidemiological survey collaboration group was carried out,and the random cluster sampling method was used to extract a total of 2 000 adults from Shiqi District of Zhongshan City,and the questionnaires,physi calexamination,and laboratory tests were taken.Results In Shiqi District of Zhongshan,the incidence rate of adult respiratory allergic disease was 10.4％,including allergic rhinitis,allergic pharyngitis and allergic asthma,accounted for 54.33％,33.65％ and 12.02％.Most common cause is smoking and keeping pets.Among respiratory allergic disease population,smoking accounted for 28％ and keep pets accounted for 17.8％.Common allergens are mites,cockroaches,animal fur and flowers.Leather pilot assassination test positive rate of respiratory allergic disease population was 37.50％,including mites,cockroach accounted for 23.08％,7.21％ of animal fur,flowers accounted for 6.25％.Conclusion In Shiqi District of Zhongshan,adult respiratory allergic disease prevalence is same as the country,the majority is respiratory diseases.The most common cause is smoking and keeping pets.The most common allergens are mites,cockroaches,animal fur and flowers.The incidence maybe related to life behavior and the living environment.

Objective To collect domestic and foreign literatures on mini-invasive total hiparthroplasty (THA) and conventional THA so as to assay the clinical outcomes of the two treatments usingMeta analysis.Methods Randomized controlled trials (RCTs) of mini-invasive THA and conventionalTHA that met the inclusion criteria were collected in the computer-based retrieval combined with manualretrieval of databases such as MEDLINE,EMBASE,OVID,and ScienceDirect.Methodological qualityassessment of the included literatures was performed using Cochrane risk evaluation tool and Meta analysisof those literatures was made by employing RevMan 5.1 software.Two surgical approaches were comparedin regard of indices including postoperative Harris hip score,operation time,intraoperative blood loss andcomplications.Results The study involved 17 related articles (18 RCTs containing 1 560 patients),including 774 patients treated by mini-invasive THA and 786 by conventional THA.The study showedsignificant differences between mini-invasive THA and conventional THA in aspects of incision length[WMD=-5.93,95％ CI (-7.29,-4.57)],blood loss [SMD =-0.45,95％ CI (-0.77,-0.13)] and postoperative visual analog scale (VAS) [MD =-19.58,95％ CI (-26.38,-12.78)],whereas there were no significant differences regarding the postoperative Harris score [WMD =0.85,95％ CI (-3.50,5.20)],operation time [WMD=-0.99,95％ CI (-5.36,3.39)],blood transfusion volume [WMD =-66.29,95％ CI (-241.31,108.72)] and complication incidence rate [RR =1.01,95％ CI (0.61,1.66)].Conclusions Mini-invasive THA offers advantages of smaller incision,less intraoperative blood loss and milder postoperative pain over conventional THA but has similar effect with conventional THA in aspects of Harris hip score,operation duration,blood transfusion volume and complications.Moreover,high quality,multicenter and large scale RCTs are required to confirm the outcomes.

Objective To compare the biomechanical property of original and new dynamic sleeve three-wing screws.Methods Twelve artificial polymethylmethacrylate (PMMA) femoral models and twelve adult cadaver femurs were selected,and then adduction-type femoral neck fracture models were prepared.The specimens were divided randomly into 2 groups,and each group had 6 specimens.According to the operative approach,the fractures were fixed with original dynamic sleeve three-wing screw (DSTS) or new DSTS after anatomic reduction.Then the specimens were fixed in simulated uniped standing position with an instron-8874 servo-hydraulic mechanical testing machine.Ten key points at the proximal femurs and two key points at the femoral shaft were selected to be the positions at which the strain was recorded.The continuous load (PMMA group:0-1200 N; cadaver femur group:0-800 N) was put to the specimens at the rate of 10 mm/min.The strain values under the maximum load,the femoral head sinking displacement and the strain values of No.8 gauge under different loads were recorded.Results There was a peak at the No.8 resistance strain gauge under 1200 N in PMMA group,and the strain values of original and new DSTS were (-2744±35) and (-718±14) με,respectively.There was a peak at the No.8 resistance gauge under 800N in cadaver femur group,and the strain values of original and new DSTS were (-2813±38) and (-2032±22) με,respectively.The differences of strain values above were significant.The femoral head sinking displacement of the new DSTS was much less than that of original DSTS under the same load.Conclusion The new DSTS has better biomechanical properties,using which the femoral neck fracture can be fixed more stably.

Objective To compare the biomechanical effect of several commonly used internal fixators in treating the femoral neck fractures so as to provide clinical basis for the selection of ideal internal fixation.Methods Twelve artificial PMMA femoral models were selected,and the central neck of the specimens was sawn with an electric saw at Pauwels angle of 70° to form adduction type femoral neck fracture models.After anatomic reduction,the specimens were fixed with dynamic hip screw ( DHS),three hollow screws,proximal femoral nail (PFN) and dynamic sleeve three-wing screw according to the operative approach,respectively.Instron-8874 servo-hydraulic mechanical testing machine was used to fix the specimens which simulated uniped standing.Fifteen key points on proximal femur were selected as test points and were given gradation loading at speed of 10 mm/min with linear load 0-1 200 N.The strain of each point under 1200 N load,head sink displacement under different loads and the strain of eight points on principal pressure side were measured.Results There was a peak at the eight resistance strain gage at 1200 N load and the strain values of the DHS,three hollow screws,PFN and dynamic sleeve three-wing screw were (700 ±35) μεz,(756 ± 14) με,( 1362 ± 136) με and (3024 ± 127) με,with statistical significance (P ＜ 0.01 ).Under the same load,the head sink displacement in the group of dynamic sleeve three-wing screw was greater than that of the hollow screws group and the PFN group ( P ＜0.01 ),but smaller thau that of the DHS group ( P ＜ 0.01 ).The strain values at the eight resistance strain gage in the group of dynamic sleeve three-wing screw was larger than that of the other three groups under the same load (P ＜ 0.01 ),and the strain values increased with the increase of load at the same fixation group.Conclusion Dynamic sleeve three-wing screw has good biomechanical stability for treatment of femoral neck fracture,which can be applied in the clinical practice.

Objective To summarize the common types and clinical characteristics of ureter disease;which can increase manipulation difficulties and adverse events during rigid ureteroscopic procedures. Methods From Jan 2001 to Dec 2010,our team performed 317 rigid ureteroscopic Drocedures for ureteroscopic examination or treatment;including 60 difficult procedures(34 male and 26 female).The mean age of the patients was 37 years (range,18 to 71).The ureteral diseases were classifted into five types according to the pathological characteristics:Type Ⅰ calculous stenosis,Type Ⅱ neoplastic stenosis;Type Ⅲ non-congenital stenosis,Type Ⅳ congenital stenosis,Type Ⅴ expansion of tortuous ureters.The operative time,complications,and conversion to open surgery were evaluated,and the therapeutic methods were analyzed. Results Of the 60 difficuhly-manipulated procedures,the mean manipulated time was 75 min (range,31 to 200).Intra-operative complications occurred in 9 procedures,including 4 cases of mucosal bleeding,2 cases of submucosaI false passage and 3 cases of ureteral perforation.Eleven procedures were converted to open surgery. In five procedures only a double J tube was inserted for drainage due to the difficulty of entering the ureter.Fiftyfive patients were followed up for 17 months (range,3 to 110);48 patients were cured,5 patients improved and 2 patients were unchanged. Conclusions The five types of ureteral disease can increase operative difficulties and risks of rigid ureteroscopic procedures.We should be cautious during surgery and should stop manipulation or convert to other surgeries if necessary.

Objective To observe the biomechanieal properties of tendons repaired by five suture techniques in different stage of healing process.Methods After establishing the zone Ⅱ FDP transection model in 2nd,3rd,4th too of both feet in female fowls,the ruptured tendons were repaired with Modified Kessler ( M K ),Kessler plus running ( K +R ),double-strand Kessler ( DK ),double loop (DT) and modified double loop (MT) methods,respectively.Passive and active mobilizations were applied on the 3rd day and 21st day postoperatively.Animals were executed postoperatively,on the 14th,21st and 35th days,respectively and both feet were harvested for biomechanical test.Results Anatomical findings included: The breakage incidence of K+R group was smaller than that of MK group.The excellent and good results of K+R and DK groups were higher compared with that of MK group.Biomechanical results showed: The MK group had the poorest biomechanical results in every stage of tendon healing (P＜0.05) except that the results from MK group on the 35th showed no statistical difference compared with that of MT and DT in extreme load;K+R group exbited the greatest extreme load and tensile strength (P＜0.05);Biomechanical test results from all groups showed significant differences on different testing point: 35th day＞21st day＞14th day(P＜0.05 );No significant differences were found in all groups between the immediate postoperative results onlst day and that from 14th day.ConclusionDuring the recovery of tendon,biomechanical properties returned to the immediate postoperative level on the 14th day and increased along with time.K+R group shows the superiority to the other methods in biomechanical properties as well as low breaking incidence ratein every stage of tendon healing.Kessler plus running is an effective method with high strength against breakage and great resistance to adhesion formation.

Clinical practice is a key step that students take to become doctors.This paper does research in clinical teaching methods for ophthalmology through analyzing current problem of clinical practice in ophthalmology.In the clinical teaching,we should strength the building up of clinical teachers,stimulate students' interest and activity,take PBL(problem-based learning) into teaching method,make use of the principle of optimization medical care and the evidence-based medicine in clinical practice teaching,strength medical students' legal consciousness and cultivate capability of building up cooperative doctor-patient relationship,and improve quality of clinical teaching.