Perimenopausal syndrome （MPS）， a common endocrine system disease， is one of the diseases responding specifically to traditional Chinese medicine （TCM）. The China Association of Chinese Medicine organized experts in endocrinology， gynecology， and interdisciplinary fields of both Western and Chinese medicine to discuss the advantages and challenges of diagnosing and treating MPS with Western medicine， TCM， and integrative medicine. Experts at the conference believe that MPS is initiated by estrogen decline and rooted in deficiency， with the pathogenesis being imbalance between Yin and Yang in the kidney. The hormone replacement therapy in Western medicine for menopause can rapidly alleviate related symptoms by quickly restoring the estrogen level and timely detect and delay complications of menopause， whereas such a therapy has certain risks， necessitating close monitoring of adverse reactions. Moreover， the various contraindications and precautions limit the clinical application of the hormone replacement therapy. TCM has advantages in synergistically alleviating symptoms such as hot flashes， sweating， sleep disorders， and emotional abnormalities of MPS without causing obvious adverse reactions. However， its efficacy is slower than the hormone replacement therapy， and the TCM evidence for preventing and treating complications of menopause remains unclear. Three suggestions were proposed for the future development of both Western and TCM for ameliorating MPS. First， an integrated diagnosis and treatment system for MPS with both Western and Chinese medicine should be established. Second， high-quality evidence-based interventions for MPS should be developed with TCM alone or in combination with Western medicine. Third， efforts should be made to promote the new TCM drug development and the interdisciplinary cooperation for treating MPS.

Objective:To investigate the early effects of cup in cup technique in reconstructing paprosky III acetabular bone defect in revision hip arthroplasty.Methods:From January 2017 to December 2019, a total of 20 cases (20 hips) with paprosky III acetabular bone defect were reconstructed by Cup-in-Cup technique, including 9 males and 11 females. The age ranged from 45 to 76 years, with an average of 64.6 years. The causes of revision were aseptic loosening of prosthesis in 17 cases and loosening of prosthesis caused by periprosthetic infection in 3 cases. There were 13 hips with acetabular bone defect of paprosky IIIA and 7 hips with paprosky IIIB. The acetabular side was repaired in 13 cases, and the acetabulum and femoral side were repaired in 7 cases at the same time. Harris hip score was used to evaluate hip function during postoperative follow-up. The occurrence of serious complications such as intraoperative vascular and nerve injury, postoperative prosthesis dislocation, periprosthetic infection and fracture were counted. The height and horizontal position of hip rotation center were measured by X-ray film.Results:The operation duration was 110±25 min (range 80-180 min) and intraoperative bleeding was 700±180 ml. All cases were followed up for 12-36 months, with an average of 18 months. At the last follow-up, the Harris hip score of 16 cases was more than 80, with excellen in 2 cases, good in 14 cases and fair in 4 cases. The Harris score was 84.3±7.5, which was significantly higher than that before operation 40.1±16.6 ( t=15.34, P<0.001). The height of hip joint rotation center on the affected side decreased from 34.2± 3.3 mm before operation to 18.6±2.8 mm after operation with significant difference ( t=15.11, P<0.001). The horizontal distance increased from 18.1±5.5 mm before operation to 26.2±7.3 mm after operation with significant difference ( t=-5.95, P<0.001). After operation, the height of hip joint rotation center on the affected side was slightly higher than that on the opposite side, with a significant difference between the affected side 18.6±2.8 mm and the opposite side 12.2±3.3 mm ( t=6.73, P=0.018). The horizontal position was 26.2±7.3 mm, which had no significant difference compared with the contralateral 30.1±5.5 mm ( t=-3.29, P=0.381). There was no vascular and nerve injury, periprosthetic infection or incision related complications. During the following-up, the prosthesis was in satisfied position without prosthesis or screw loosening and fracture. Conclusion:The reconstruction of paprosky III acetabular bone defect with Cup-in-Cup technique in revision hip arthroplasty can obtain satisfied early effects, with achieving relatively normal hip rotation center and initial stability.

Objective:To investigate the effects of different phototherapy intensities on the levels of malondialdehyde, a peroxidation product of intralipid, vitamin C and vitamin E in parenteral nutrition for premature infants.Methods:The parenteral nutrition for premature infants was prepared under strict aseptic condition and was divided into four groups based on different phototherapy intensities in simulated clinical settings, which were indoor light group, single-, double-, and three-sided phototherapy group. According to whether the nutrient solution shielded for light or not, each group was further divided into two subgroups: exposure or non-exposure group. The levels of malondialdehyde, vitamin C and vitamin E in all groups before phototherapy and 6, 12, 18, and 24 h after phototherapy were measured. Ten samples of parenteral nutrient solutions were prepared for each group, of which 2 ml were extracted for test at different time points. Repeated measurement analysis of variance was used for data analysis and the results were adjusted using Greenhouse-Geisser method if failed in Mauchly sphere test.Results:With the increase of phototherapy time, the malondialdehyde level increased in the exposure and the non-exposure subgroups in the one-sided phototherapy group [before phototherapy: (3.777±0.112) vs (3.746±0.141) nmol/ml; phototherapy for 6 h: (3.808±0.122) vs (3.715±0.145) nmol/ml; 12 h: (4.546±0.138) vs (4.507±0.136) nmol/ml; 18 h: (6.116±0.151) vs (5.239±0.156) nmol/ml; 24 h: (7.569±0.136) vs (5.300±0.200) nmol/ml; all P<0.05], but the level of vitamin C [before phototherapy: (62.507±0.205) vs (62.341±0.144)μg/ml; phototherapy for 6 h: (51.211±0.086) vs (58.128±0.076) μg/ml; 12 h: (43.288±0.084) vs (55.351±0.050) μg/ml; 18 h: (35.758±0.113) vs (51.215±0.093) μg/ml; 24 h: (33.473±0.075) vs (48.473±0.080)μg/ml] and vitamin E decreased [before phototherapy: (4.101±0.132) vs (4.084±0.141) μg/ml; phototherapy for 6 h: (3.761±0.119) vs (3.904±0.075) μg/ml; 12 h: (3.654±0.092) vs (3.729±0.087) μg/ml; 18 h: (3.385±0.102) vs (3.582±0.119) μg/ml; 24 h: (3.313±0.127) vs (3.438±0.113) μg/ml, all P<0.05]. The same situation was also observed in indoor light group, double-, and three-sided phototherapy groups. The malondialdehyde level at different time in the exposure subgroups were higher but the vitamin C and vitamin E levels were lower than those in the non-exposure subgroups, regardless of the phototherapy intensities (all P<0.001). (2) The analysis of all exposure phototherapy subgroups showed that the higher the intensity of light therapy, the higher the malondialdehyde level, and the lower the level of vitamin C and vitamin E, with statistical significance differences in any pairwise comparison. Analysis of all non-exposure subgroups showed statistically significant differences in the malondialdehyde level in any pairwise comparison (all P<0.05) except for the comparison between indoor light group and single-sided phototherapy group ( F=2.383. P=0.140). Moreover, the greater the phototherapy intensities, the lower vitamin C level, with statistically significant differences in any pairwise comparison. And statistical significance differences were observed in the vitamin E level in any pairwise comparison (all P<0.05) except for the comparison between double- and three-sided phototherapy groups ( F=1.358, P=0.259). Conclusions:Phototherapy can increase the malondialdehyde level in parenteral nutrient solution for premature infants and the degree of intralipid peroxidation, but can also lead to vitamin C and vitamin E loss in the parenteral nutrient and weaken its antioxidant capacity.

Objective:To provide clinicians with insights about the patients with breast cancer complicated with thyroid cancer and dermatomyositis,and to improve early detection of the diseases by observing the clinical characteristics of 1 case of breast cancer complicated with thyroid cancer and dermatomyositis and reviewing the literatures about the relationships between these three kinds of diseases.Methods:The medical information of this patient,including gender,age,clinical manifestations,glucocorticoid treatment dose,type of concurrent tumor and the time point it occured and therapeutic regimen were collected and recorded.These clinical data were retrospectively analyzed.Results:The patient with dermatomyositis was diagnosed with breast cancer and thyroid cancer in succession.Oral administration of 50 mg dexamethasone per day was continued in the treatment of dermatomyositis.Then the patient received 4 cycles of pirarubicin/cyclophosphamide (AC) followed by 4 cycles of paclitaxel/Hessaitin (TH) as neoadjuvant chemotherapy for breast cancer.During the 24 weeks of chemotherapy,the breast tumor size was gradually decreased while there was no significant change in thyroid tumor size.The clinical symptoms of dermatomyositis were also improved.The blood lactic acid dehydrogenase and alpha hydroxybutyrate dehydrogenase levels were decreased,but not obviously.After 8 courses of AC-TH neoadjuvant chemotherapy followed by radical resection of thyroid cancer,there was no significant improvement in the symptoms of dermatomyositis 1 week after operation and the myocardial enzyme levels remained unchanged.Then modified radical mastectomy was performed.The myocardial enzymes were examined again 1 week after the second operation all of them were decreased to the normal levels.The clinical symptoms of dermatomyositis were also improved.Conclusion:Although the relationships between the three diseases is still controversial,the clinical data of the patient and relevant literatures collected in this paper support that breast cancer is associated with thyroid cancer and dermatomyositis is associated with breast cancer,but not thyroid cancer.

By taking the course of laboratory hematology in Curtin University in Australia as an ex-ample, this paper introduced the characteristics of its teaching mode, teaching contents, teaching methods, assessment methods and laboratory practice. The advantages and disadvantages of education characteristics between Australia and China were compared and analyzed on the training methods and the training objec-tives, respectively. The education characteristics of laboratory hematology in Curtin University provided an important inspiration for our education reform in the field of medical laboratory in the future.

Objective To investigate the method of controlling leg length in total hip arthroplasty for CroweⅣtype devel?opmental dysplasia of the hip. Methods From February 2006 to February 2011, primary total hip arthroplasty were performed in 11 patients (3 males and 8 females, aged 54 year and ranged from 45 to 65 years) with CroweⅣtype developmental dysplasia of the hip using subtrochanteric femoral osteotomy. Leg length was measured in the method of preoperation plan combining with mea?surement in the course of operation. Five hips were involved in left side, 6 in right side. The average leg length discrepancy were 3.5 cm (ranged, 1.8-6.0 cm). All patients have lumbosacral pain. Clinical and radiographic characteristics were retrospectively re?viewed at the 3, 6 and 12 months after operation. Outpatient follow?up was conducted every year. The lumbosacral pain and degree of patient satisfaction were recorded. Moreover, leg length discrepancy, the bone union, prosthesis subsidence, and the hip Harris score were evaluated. Results Average follow?up was 4.5 years (3-8 years). The average length of resected bone was 2.2 cm (1.5-4.2 cm). The average leg length discrepancy were 1.0 cm (ranged,-1.5-1.5 cm). Lumbosacral pain of 8 patients was eliminated and slight pain was retained in 3 patients. Two patients were satisfied with the result of operation and 9 were extremely satisfied. No nerve injury and nonunion occurred. At the final follow?up, the mean Harris score improved from 45 ± 7.6 before operation to 93±6.6 (P<0.05). The mean union time was 5 months after operation (3-12 months after operation). The prosthesis subsidences were found in one case at the five years after operation and 1 case at the seven years after operation and with subsiding height of 3 mm and 6 mm respectively. No loosening and infection were found in all patients. Conclusion In treating patients with CroweⅣtype developmental hip dysplasia by THA, the length of resected subtrochanteric femoral should be conducted according to pa?tient's tolerance to pain reduced by leg extension. Therefore, the leg length is facilitated to improve the function of joint and to de?crease symptoms reduced by leg extension.

Objective To study the application of the combined detection of Golgi glycoprotein 73(GP-73),phosphatidylinositol proteoglycan 3(GPC3 )and percentage of AFP heteroplasmon(AFP-L3%)in the diagnosis of primary hepatocellular carcinoma (PHC).Methods The concentrations of GP-73,GPC3 and AFP-L3 were detected by enzyme-linked immunosorbent assay(ELISA) in 154 patients with PHC(PHC group),78 patients with cirrhosis(cirrhosis group)and 56 healthy subjects(control group).Then the detection results were statistically analyzed.Results The levels of GP-73,GPC3 and AFP-L3% in the PHC group were signifi-cantly higher than those in the liver cirrhosis group and the control group(P <0.05).The positive rates of GP-73,GPC3 and AFP-L3% in the PHC group were 66.2%,72.1% and 53.2% respectively.The positive rate in the combined detection of these three in-dices could reach 97.9%,which was higher than the sensitivity and accuracy in any single index detection and the combination de-tection.In the PHC group,the comparison between different levels of GP-73 and AFP-L3% with the AFP levels showed the statis-tically significant difference(P <0.05 ).Conclusion The combination detection of GP-73,GPC3 and AFP-L3% can improve the sensitivity and accuracy for diagnosing PHC and has reference significance in the differential diagnosis of early PHC.

Objective To investigate the indications and mid-term outcomes of periacetabular osteotomy through ilioinguinal approach for developmental dysplasia of the hip (DDH) in middle-aged (40-50years old) adult patients.Methods Data of 10 adult patients who had undergone periacetabular osteotomies through ilioinguinal approach for DDH from August 2005 to February 2010 were retrospectively analyzed.There were 7 females and 3 males,aged from 40 to 47 years (average,42 years).Bilateral hips were involved in 3 patients,and unilateral hip was involved in 7 patients.Before this hospitalization,1 patient had received Chari osteotomy,and 1 had received hip-shelf procedure.According to the T(o)nnis classification,3 hips were classified as Grade 0,5 as Grade Ⅰ and 2 as Grade Ⅱ.The Shenton line was discontinuous in 6 hips.The average lateral center-edge angle was 3.50°±4.88°; the average anterior center-edge angle was 1.80°±5.07°; the average acetabular index angle was 18.20°±3.01°; the average femoral head extrusion index was 31.30％±4.37％; the average Harris hip score was 67.40±7.75.Changes of the indexes mentioned above were observed during the whole period of follow-up.Results All patients were followed up for 10 to 76 months (average,37 months).The T(o)nnis grade improved in 2 cases,from preoperative Grade Ⅰ and Grade Ⅱ to Grade 0 and Grade Ⅰ at final follow-up,respectively.At final follow-up,the Shenton line was discontinuous in 2 hips; the average lateral center-edge angle improved to 30.40°±3.31°,the average anterior center-edge angle improved to 29.50°±3.03°,the average acetabular index angle decreased to 4.50°±2.55°,the average femoral head extrusion index decreased to 9.90％±4.33％; the average Harris hip score increased to 84.10±4.07.The major complications included 3 cases of lateral femoral cutaneous nerve palsy which recovered in 4 to 6 months,and 1 case of iliac fossa hematoma which disappeared in 2 weeks.Conclusion With more strict surgery indication and more meticulous manipulation,periacetabular osteotomy through ilioinguinal approach can achieve satisfactory results in the treatment of DDH in middle-aged adults,which can increase hip joint congruence,relieve hip symptom and delay progression of osteoarthritis.

Objective To explore the reasonability of posterior approach incision length in an unselected patient cohort with minimally invasive total hip arthroplasty (THA) and compare the clinical results of different incision lengths. Methods A consecutive unselected 256 patients who underwent primary unilateral THA between March 2001 and December 2007 were studied prospectively. Prior to the operation, the incision length was not deliberately selected for the patients. A posterior approach was used for all procedures with minimally invasive surgical techniques. The patients were divided into three groups according to the incision length at the end of surgery: mini-incision group ( ＜ 10 cm, 99 patients) , moderate incision group (10-14 cm, 112 patients) and standard incision group ( ＞ 14 cm, 45 patients). The in-hospital data including age, sex, diagnosis,body mass index (BMI),operation duration, intraoperative blood loss, total blood loss, preservation of the external rotators, anatomic repair of the capsule as well as postoperative radiographs were collected for analysis of the intraoperative and postoperative complications. The pain was estimated by using the individual visual analog scale (VAS) and the functional outcome evaluated by Harris hip score preoperatively and postoperatively. Results All the patients were followed up for an average period of 6.1 years (2.5-9.2 years). The incision length was shortened and optimized ( ＜ 14 cm) in 211 patients. There showed decrease of BMI, less intraoperative blood loss, less pain, satisfactory outcome but higher proportion of abnormal abduction angle of the acetabular prosthesis in the early postoperative period in the mini-incision group, with statistical difference compared with the other two groups (P ＜ 0.05). The preservation of the piriformis tendon, anatomic repair of the joint capsule, operation duration and Harris score at 6th postoperative week in the moderate incision group were similar to those in the mini incision group but showed statistical difference in comparison with the standard incision group ( P ＜0. 05). Conclusions Minimally invasive THA with a smaller posterior incision can attain safe and effective curative effect for the unselected patient cohort. A smaller but not necessarily miniincision may allow minimal soft tissue trauma for the surgeon to perform the procedure well and ensure a long-term clinical results.

Objective To analyze the risk factors related to intraoperative femur fracture in hip replacement and discuss the treatment countermeasures. Methods The medical records and radiographs of 38 patients with intraoperative femur fracture who were treated at Tianjin Orthopedic Hospital from December 2002 to December 2009 were retrospectively studied. Fractures were classified according to the Amstutz system or AAOS standard and the treatment methods were selected accordingly. Reduction and fixation was performed in 25 patients including 14 patients treated with interfragmentary or cerclage fixation, five with plate fixations and six with cortical strut graft. Shank prosthesis was replaced in 12 patients. Results The mean follow up period was 4.5 years, which showed successful union of the fractures in 36 patients and delayed union in two. Replacement of the prosthesis was needed in one patient for prosthesis loosening four years postoperatively. Conclusions Osteoporosis, violence, abnormal femur canal and over large prosthesis are the main causes of intraoperative femur fracture in hip replacement.Proper selection of treatment method according to fracture types may attain fracture union with a stable implant.