Objective To verify the effectiveness of a self-designed preoperative risk scoring system for elderly patients with hip fracture.Methods A total of 286 elderly patients with hip fracture were included for this prospective study who had been admitted from February 1,2014 to February 1,2016 to Department of Trauma and Orthopedics,Peking University People's Hospital.They were divided into 5 groups according to their scores by our self-designed preoperative risk scoring system for elderly patients with hip fracture:0 to 10 points,11 to 20 points,21 to 30 points,31 to 40 points and above 41 points.Postoperative complications and deaths were recorded.The correlations between their preoperative scores and postoperative medical complications or death were analyzed to verify the effectiveness of the preoperative risk scoring system for elderly patients with hip fracture.Results The 286 patients scored 24.9 ± 11.0 (from 0 to 69) preoperatively.The femoral neck fractures scored 24.0±11.0 and femoral intertrochanteric fractures 26.3±10.8.The incidence of medical complications was 4.00％ (1/25) in the 0 to 10 points group,4.17％ (3/72) in the 11 to 20 points group,14.66％ (17/116) in the 21 to 30 points group,23.53％ (12/51) in the 31 to 40 points group and 50.00％ (11/22) in the above 41 pints group.Conclusion As the incidence of postoperative medical complications in elderly patients with hip fracture is positively correlated with the scores by our self-designed preoperative risk scoring system for elderly patients with hip fracture,the preoperative risk scoring system can provide an effective prediction of surgical risks.

Objective To evaluate the efficacy of a modified risk scoring system in predicting the mortality during hospitalization in the elderly patients undergoing hip fracture surgery.Methods At the first stage,we retrospectively analyzed the clinical data of 1,562 elderly patients with hip fracture who had been admitted to Department of Trauma and Orthopedics,Peking University People's Hospital from January 2010 to December 2014.A multi-factor risk-adjustment model for surgical risks was constructed by multi-variate logistic regression analysis to obtain a modified preoperative risk scoring system for elderly patients undergoing hip fracture.At the second stage,a cohort of 1,356 elderly patients with hip fracture from January 2015 to December 2018 was included for a prospective evaluation of the modified risk scoring system.The patients included were divided into 5 groups according to their scores:a very low risk group of 0 to 10 points,a low risk group of 11 to 20 points,a moderate risk group of 21 to 30 points,a high risk group of 31 to 40 points and a very high risk group of ≥41 points.The consistency between the scores and the actual outcomes of the patients was observed and the receiver operating characteristic curve (ROC) was drawn accordingly.Results The 1,356 cases included in the study scored 25.12 ± 10.30 points (from 0 to 67 points).The in-hospital mortality was 0％ (0/96) in the very low risk group,0.23％ (1/443) in the low risk group,0.49％ (2/409) in the moderate risk group,2.16％ (6/278) in the high risk group,and 5.38％ (7/130) in the very high risk group.The area under the ROC curve was 0.825 (95％ CI:0.728-0.921,P ＜ 0.01).Conclusions As the in-hospital mortality is positively correlated with the scores of the modified preoperative risk scoring system for elderly patients undergoing hip fracture,the modified scoring system can be used to predict the in-hospital morbidity of the patients.The modified scoring system can be further verified and calibrated by multi-center clinical evaluation.

Objective To investigate the application value of closed single-port thoracoscopic and laparoscopic radical esophagectomy for esophageal cancer.Methods The retrospective and descriptive study was conducted.The clinical data of a 49-year-old male patient with esophageal cancer who was admitted to the Fujian Medical University Union Hospital in November 2018 were collected.The patient underwent closed single-port thoracoscopic and laparoscopic radical esophagectomy and three-field lymph node dissection.In the thoracic part,esophageal separation and thoracic lymph node dissection were performed with closed pneumothorax,semi-lateral position and multi suspension methods.In the abdominal part,gastric separation and lymph node dissection were accomplished with lifting of liver lobe and respective separation of greater curvature and lesser curvature of stomach.The operation time,volume of intraoperative blood loss,time for out-of-bed activities,time of postoperative drainage tube removal,volume of thoracic drainage fluid,postoperative complications,postoperative pathological examination results,time for discharge from hospital and results of follow-up were observed.Follow-up using outpatient examination and telephone interview was performed to detect tumor recurrence and metastasis of patients after operation up to February 2019.Count data were described as absolute number.Results The patient underwent successfully closed single-port thoracoscopic and laparoscopic radical esophagectomy and three-field lymph node dissection.The operation time and volume of intraoperative blood loss was 310 minutes and 120 mL.The patient resumed out-of-bed activities at 2 days after operation.The abdominal drainage tube,thoracic closed drainage tube and right cervical drainage tube were removed at 2 days after operation with fasting,acid suppression,nutritional support.The thoracic Abel drainage tube and the left cervical drainage tube were removed at 5 days after operation.The volume of thoracic drainage fluid was 550 mL.No obvious sign of anastomotic leakage was found on esophageal angiography at 5 days after operation.The patient recovered well after operation without hoarseness,pulmonary infection and chylothorax.The postoperative examination result of the patient showed midthoracic esophageal squamous cell carcinoma (pT3N1M0G3 ⅢB stage).The patient was discharged at 8 days after operation.The patient was followed up for 3 months,and was able to engage in light physical activity.CT reexamination showed no sign of local recurrence or distant metastasis of the tumor.Conclusion Closed singleport thoracoscopic and laparoscopic radical esopahgectomy for esophageal cancer is safe and feasible,with good short-term efficacy.

Objective To establish a preoperative risk scoring system for elderly patients with hip fracture on the basis of investigation into the factors influencing their mortality during hospitalization. Methods The data were collected from the database of hospitalization summary reports ( HSR ) of Beijing Public Health Commission concerning the 14, 577 patients who had been 55 years old or older and hospitalized for hip fracture from January 1, 2006 throughout December 31, 2010 at the 35 top-rank hospitals in Beijing. They were divided into a surgery group and a non-surgery group. Two multivariable risk-adjustment models were established for the 2 groups on the basis of an investigation into the factors influencing their mor-tality during hospitalization. Finally a preoperative risk scoring system for elderly patients with hip frac-ture was formulated according to the valuation of the least common multiples of β coefficients of the risk factors.Results Besides senior age and male gender, 10 different comorbidities were independently associated with in-hospital mortality, particularly pulmonary embolism, respiratory failure, renal failure and diabetes. The risk for inpatient mortality associated with a specific comorbidity was relatively higher in the surgery group than in the non-surgery group. The risk-adjustment models based on the variables had better accuracy in predicting in-hospital mortality ( ROC＝0.91 in surgery group versus ROC＝0.85 in non-surgery group ). In our preoperative risk scoring system for elderly patients with hip fracture, 10 points were for an age of 65 to 74 years old, 14 points for an age of 75 to 84 years old, 18 points for an age beyond 85 years old, 4 points for male gender, 20 points for pulmonary embolism, 18 points for respiratory failure, 10 points for renal insufficiency, 8 points for diabetes, 8 points for heart failure, 7 points for malignant tumor, 7 points for lung infection, 7 points for disturbance of water, electrolyte and acid-base balance, 6 points for arrhythmia, and 6 points for cerebral infarction, totaling 119 points. Conclusions The primary risk factors for in-hospital mortality in the elderly patients with hip fracture seem to be senior age, male gender and 10 different comorbidi-ties. A preoperative risk scoring system has been successfully established for elderly patients with hip fracture.

Objective:To investigate the morphology character of sagittally unstable intertrochanteric fractures and reduction methods.Methods: A retrospective study was used to analyze the clinical data of sagittally unstable intertrochanteric fractures cases,which were treated with proximal femoral nail anti-rotation (PFNA) fixation from March 2009 to June 2016.In the study,36 cases were followed up completely,in which 17 cases accepted open reduction,and the other 19 cases accepted minimally invasive reduction.The operation time,amount of bleeding,the fluoroscopy times,postoperative radiographic measurements,such as tip-apex distance (TAD) and sliding distance of the spiral screw,and hip Harris scores were analyzed.The morphology character of the fractures was documented and investigated.Results: The average follow-up time was 15 months.The amount of bleeding of the open reduction group was (170.5±19.7) mL,and the amount of bleeding of the minimally invasive group was (54.7±12.5) mL.The amount of bleeding of the minimally invasive group was significantly less than that of the open reduction group (P<0.001).Between the two groups,there were no significant differences in other evaluation parameter,including operation time (P=0.054),the fluoroscopy times (P=0.053),fracture healing time (P=0.305),postoperative radiographic measurements,such as TAD (P=0.317) and sliding distance of the spiral screw (P=0.206),and hip Harris scores (P=0.459).In regard to morphology character of the fractures,the proximal anterior unstable fractures with separation displacement were more common than the proximal posterior unstable fractures with impaction.The characteristic feature of the proximal anterior unstable fractures was the proximal anterior and medial long oblique fracture,and a V shape cortical defect in the distal fracture fragment on the externally rotation X-ray.Conclusion: Sagittally unstable intertrochanteric fractures can be divided into the proximal anterior unstable fractures with separation displacement,and the proximal posterior unstable fractures with impaction.The two types have their own morphology character individually.The reduction should be performed by minimally invasive techniques.

Objective This study aimed to investigate the protective effects of ademetionine 1,4-butanedisulfonate (SMT) against radiation injuries.Methods ICR mice were randomly divided into 7 groups,including normal control,irradiation-only,SMT administration-only,low-,medium-and high-dosages (250,500,1 000 mg·kg-1) of SMT pre-irradiation and high-dose of SMT post-irradiation in experimental groups.Blood and immunological experiments,organs index experiment and 30-day''s survival experiment were carried out to observe the protective effects of SMT on peripheral blood and immune system,organ index and the whole body injuries.Results Compared with irradiation-only group (4.23±1.16) ×109·L-1,the number of nucleated cells in bone marrow was (11.20±4.63) ×109·L-1 in the high dose of SMT pre-irradiation.The difference between two groups was significant.Compared with irradiation-only group (19.25±9.36),the colony forming unit-spleen was (39.00±7.57) in the high-dose SMT pre-irradiation group,there was a significant difference between the two groups.The index of liver,spleen,kidney and pancreas were significantly higher than those of the irradiation-only group in SMT administration groups.The survival rate of mice treated with SMT was increased,especially for the high dose group (46% lifted) when compared with irradiation-only group.Conclusion SMT can protect mice from radiation injuries.

Objective:To evaluate the meaning and value of high-frequency ultrasound in the diagnosis of carpal tunnel syndrome (CTS).Methods:In this study,48 patients (unilateral hand)with CTS were analyzed.The thickness of transverse carpal ligaments at the pisiform bone was measured using high-fre-quency ultrasound.Open carpal tunnel release procedure was performed in the 48 CTS patients,and the thickness of transverse carpal ligaments at the hamate hook bone measured using vernier caliper under di-rect vision.The accuracy of thickness of transverse carpal ligaments was evaluated using high-frequency ultrasound.High-frequency ultrasound measurement of thickness of transverse carpal ligaments at the ha-mate hook bone and pisiform bone,and determination of the diagnostic threshold measurement index using receiver operating characteristic (ROC)curve,sensitivity and specificity were performed and the correlation between the thickness of transverse carpal ligaments and nerve conduction study (NCS)ana-lyzed.Results:The thickness of transverse carpal ligaments in the CTS patients were (0.42 ±0.08)cm (high-frequency ultrasound)and (0.41 ±0.06)cm (operation)at hamate hook bone,and there was no significant difference between the two ways (t =0.672,P>0.05 ).The optimal cut-off value of the transverse carpal ligaments at hamate hook bone was 0.385 cm,the sensitivity 0.775,and the specificity 0.788.The optimal cut-off value of the transverse carpal ligaments at the pisiform bone was 0.315 cm, the sensitivity 0.950,and the specificity 1 .000.The transverse carpal ligaments thickness and wrist-in-
dex finger sensory nerve conduction velocity (SCV),wrist-middle finger SCV showed a negative correla-tion.Conclusion:High frequency ultrasound measurements of thickness of transverse carpal ligaments is a valuable method for the diagnosis of CTS.

Objective:To evaluate the effects of amelogenin(AML)on the migration,adhesion and proliferation of periodontal liga-ment stem cells(PDLSCs).Methods:PDLSCs were cultured with AML at 0.25,50 amd 100 μg/ml respectively.The migration, adhesion and proliferation of the cells were examined by wound healing migration assay,transwell migration assay,attachment assay, MTT assay and cell counting,respectively.Results:AML induced the migration of PDLSCs in a dose-dependent manner(P <0.05), increased the adhesion and proliferation of PDLSCs(P <0.05).Conclusion:AML may promote the migration,adhesion and prolifer-ation of PDLSCs.

Objective To evaluate the effects of transforming growth factor β1 (TGF-β1 )on migration, adhesion and proliferation of periodontal ligament stem cells (PDLSCs)and explore the mechanisms of PDLSCs-induced periodontal remodeling.Methods PDLSCs were isolated and identified from human teeth.The effect of TGF-β1 on migration of PDLSCs was evaluated using transwell migration assay.Cells attachment assay was used to test the effect of TGF-β1 on the adhesion of PDLSCs.In addition,the effect of TGF-β1 on the proliferation of PDLSCs was evaluated by MTT and cell growth rate assay.Results The results showed that TGF-β1 induced the migration of PDLSCs in a dose-dependent manner,improved the adhesion and proliferation of PDLSCs.So we propose that TGF-β1 may promote periodium remodeling by inducing PDLSCs migration,following adhesion and proliferation in these areas.Conclusion This study demonstrated for the first time that TGF-β1 increases the adhesion and migration of PDLSCs in vitro .The signal pathway is involved in the TGF-β1-induced migration of PDLSCs and the mechanical-chemical interaction during the orthodontic periodontal remodeling will be researched in our further studies.

Objective:To apply modified proximal femoral nail anti-rotation ( PFNA ) fixation tech-niques performed by percutaneous placement of guide wire combined with true lateral view and to make the procedures simpler.Methods:A retrospective study was used to analyze the clinical data of femoral intertrochanteric fractures cases, which were treated with conventional PFNA fixation or modified PFNA fixation performed by percutaneous placement guide wire combined with true lateral view in our hospital, from March, 2011 to May, 2014.In the study, 60 cases were followed for average 13 months.The oper-ation time, the amount of bleeding, the fluoroscopy time, postoperative radiographic measurements ( tip apex distance, TAD ) and hip function scores were analyzed.Results:In modified PFNA group, the amount of bleeding, the operation time and the fluoroscopy time were (70.5 ±12.5) min, (34.9 ±6.1) mL, ( 63.6 ±9.7 ) s respectively.In conventional PFNA group, they were ( 80.6 ±17.1 ) min, (47.8 ±6.7) mL, (68.5 ±8.7) s respectively.There were significant differences in the above respects between the two groups (P were 0.006, 0.013, and 0.022 respectively).There were no significant differences in TAD, fracture healing time, postoperative hip scores between the two groups (P>0.05). Conclusion:Fracture line is a natural entry point for some cases of femoral intertrochanteric fractures when we use proximal femoral nail anti-rotation to fix the fracture.Applying percutaneous insertion of the guide pin combined with true lateral view could reduce the operation time, amount of bleeding, and fluo-roscopy time significantly, make the procedures simpler and acquire satisfactory results .