Research progress of bone graft resorption after Latarjet procedure for treatment of recurrent anterior shoulder dislocation / 中国修复重建外科杂志

OBJECTIVE@#To review the research progress of bone graft resorption after Latarjet procedure for the treatment of recurrent anterior shoulder dislocation, and provide a guide for further research on bone graft resorption.@*METHODS@#The relevant literature in recent years was extensively reviewed. The pathogenesis, classification, risk factors, clinical function impact, and management of bone graft resorption after Latarjet procedure for the treatment of recurrent anterior shoulder dislocation were summarized.@*RESULTS@#Bone graft resorption is the common complication after Latarjet procedure for the treatment of recurrent anterior shoulder dislocation. Stress shielding and poor blood supply may contribute to the occurrence of bone graft resorption. The absence of significant preoperative glenoid bone loss, open procedure, earlier graft healing may to be the risk factors for bone graft resorption. Various assessment methods and classification systems are used to evaluate the region and severity of bone graft resorption. Partial resorption may be considered as a natural glenoid remodeling process after the surgery, but severe and complete resorption is proved to be one of the reasons for failed procedures and there is no effective measure to prevent it, except for accepting revision surgery.@*CONCLUSION@#The pathogenesis, risk factors, clinical function impact of bone graft resorption after Latarjet procedure for the treatment of recurrent anterior shoulder dislocation has not been fully elucidated and there is a lack of effective management strategies, so further clinical and basic researches are needed.

Clinical and radiologic outcomes after tendon insertion medialized repair of large-to-massive rotator cuff tears / 中国修复重建外科杂志

OBJECTIVE@#To evaluate the effectiveness of tendon insertion medialized repair in treatment of large-to-massive rotator cuff tears (L/MRCT).@*METHODS@#The clinical and imaging data of 46 L/MRCT patients who underwent arthroscopic insertion medialized repair between October 2015 and June 2019 were retrospectively analyzed. There were 26 males and 20 females with an average age of 57.7 years (range, 40-75 years). There were 20 cases of large rotator cuff tears and 26 cases of massive rotator cuff tears. Preoperative imaging evaluation included fatty infiltration (Goutallier grade), tendon retraction (modified Patte grade), supraspinatus tangent sign, acromiohumeral distance (AHD), and postoperative medializaiton length and tendon integrity. The clinical outcome was evaluated by visual analogue scale (VAS) score, American Society for Shoulder and Elbow Surgery (ASES) score, shoulder range of motion (including anteflexion and elevation, lateral external, and internal rotation) and anteflexion and elevation muscle strength before and after operation. The patients were divided into two groups (the intact tendon group and the re-teared group) according to the integrity of the tendon after operation. According to the medializaiton length, the patients were divided into group A (medialization length ≤10 mm) and group B (medialization length >10 mm). The clinical function and imaging indexes of the patients were compared.@*RESULTS@#All patients were followed up 24-56 months, with an average of 31.8 months. At 1 year after operation, MRI showed that the medializaiton length of supraspinatus tendon was 5-15 mm, with an average of 10.26 mm, 33 cases in group A and 13 cases in group B. Eleven cases (23.91%) had re-teared, including 5 cases (45.45%) of Sugaya type Ⅳ and 6 cases (54.55%) of Sugaya type Ⅴ. At last follow-up, the VAS score, ASES score, shoulder anteflexion and elevation range of motion, lateral external rotation range of motion, and anteflexion and elevation muscle strength significantly improved when compared with those before operation ( P<0.05); there was no significant difference in internal rotation range of motion between pre- and post-operation ( P>0.05). The Goutallier grade and modified Patte grade of supraspinatus muscle in the re-teared group were significantly higher than those in the intact tendon group, and the AHD was significantly lower than that in the intact tendon group ( P<0.05). There was no significant difference in other baseline data between the two groups ( P>0.05). Except that the ASES score of the intact tendon group was significantly higher than that of the re-teared group ( P<0.05), there was no significant difference in the other postoperative clinical functional indicators between the two groups ( P>0.05). There was no significant difference in the incidence of re-tear, VAS score, ASES score, range of motion of shoulder joint, and anteflexion and elevation muscle strength between group A and group B ( P>0.05).@*CONCLUSION@#Tendon insertion medialized repair may be useful in cases with L/MRCT, and shows good postoperative shoulder function. Neither tendon integrity nor medialization length shows apparent correlations with postoperative shoulder function.

Long-term effectiveness of arthroscopic partial repair for massive irreparable rotator cuff tears / 中国修复重建外科杂志

OBJECTIVE@#To explore the long-term effectiveness of arthroscopic partial repair in treatment of massive irreparable rotator cuff tears from both the radiological and clinical perspectives.@*METHODS@#A retrospective analysis was conducted on the clinical data of 24 patients (25 sides) with massive irreparable rotator cuff tears who met the inclusion criteria between May 2006 and September 2014. Among them, there were 17 males (18 sides) and 7 females (7 sides) with an age range of 43-67 years (mean, 55.0 years). There were 23 cases of unilateral injury and 1 case of bilateral injuries. All patients were treated with the arthroscopic partial repair. The active range of motion of forward elevation and abduction, external rotation, and internal rotation, as well as the muscle strength for forward flexion and external rotation, were recorded before operation, at the first postoperative follow-up, and at last follow-up. The American Association of Shoulder and Elbow Surgeons (ASES) score, the University of California at Los Angeles (UCLA) shoulder scoring, and Constant score were used to evaluate shoulder joint function. And the visual analogue scale (VAS) score was used to evaluate shoulder joint pain. MRI examination was performed. The signal-to-noise quotient (SNQ) was measured above the anchor point near the footprint area (m area) and above the glenoid (g area) in the oblique coronal T2 fat suppression sequence. The atrophy of the supraspinatus muscle was evaluated using the tangent sign. The global fatty degeneration index (GFDI) was measured to assess fat infiltration in the supraspinatus muscle, infraspinatus muscle, teres minor muscle, upper and lower parts of the subscapularis muscle. The mean GFDI (GFDI-5) of 5 muscles was calculated.@*RESULTS@#The incisions healed by first intention. All patients were followed up with the first follow-up time of 1.0-1.7 years (mean, 1.3 years) and the last follow-up time of 7-11 years (mean, 8.4 years). At last follow-up, the range of motion and muscle strength of forward elevation and abduction, ASES score, Constant score, UCLA score, and VAS score of the patients significantly improved when compared with those before operation ( P<0.05). Compared with the first follow-up, except for a significant increase in ASES score ( P<0.05), there was no significant difference in the other indicators ( P>0.05). Compared with those before operation, the degree of supraspinatus muscle infiltration worsened at last follow-up ( P<0.05), GFDI-5 increased significantly ( P<0.05), and there was significant difference in the tangent sign ( P<0.05); while there was no significant difference in the infiltration degree of infraspinatus muscle, teres minor muscle, and subscapularis muscle, upper and lower parts of the subscapularis muscle ( P>0.05). Compared with the first follow-up, the SNQm and SNQg decreased significantly at last follow-up ( P<0.05). At the first and last follow-up, there was no correlation between the SNQm and SNQg and the ASES score, Constant score, UCLA score, and VAS score of the shoulder ( P>0.05).@*CONCLUSION@#Arthroscopic partial repair is effective in treating massive irreparable rotator cuff tear and significantly improves long-term shoulder joint function. For patients with severe preoperative fat infiltration involving a large number of tendons and poor quality of repairable tendons, it is suggested to consider other treatment methods.

Analysis of eye movement characteristics in newly diagnosed drug-naive Parkinson′s disease / 中华神经科杂志

Objective:To explore eye movement characteristics in newly diagnosed, drug-naive Parkinson′s disease (PD) patients and their correlation with motor and non-motor symptoms.Methods:Seventy-five newly diagnosed, drug-naive PD patients and 46 healthy controls (HCs) were included in this cross-sectional study. Patients were recruited from the Department of Neurology, Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine from November 2017 to December 2021, while HCs were recruited from the local community during the same period. For PD patients, motor severity was measured with the modified Hoehn and Yahr stage, Movement Disorder Society Unified Parkinson′s Disease Rating Scale part Ⅲ and the Freezing of Gait questionnaire. Non-motor symptoms were evaluated by serial scales such as Non-Motor Symptoms Questionnaire, 16-item odor identification test from Sniffin Sticks, 17-item Hamilton Rating Scale for Depression, Chinese version of Mini-Mental State Examination, Montreal Cognitive Assessment Basic and REM Behavior Disorder Screening Questionnaire. All subjects underwent oculomotor test including pro-saccade task and smooth pursuit eye movement (SPEM) task in the horizontal direction via videonystagmography. Visually guided saccade latency, saccadic accuracy and gain in SPEM at three frequencies (0.1, 0.2, 0.4 Hz) of the horizontal axis were compared between the 2 groups. The association between key oculomotor parameters and clinical phenotypes was explored in PD patients. The receiver operating characteristic (ROC) analyses of eye movement parameters as independent factors were also performed for detecting PD from HCs, then combining the saccadic latency, saccadic accuracy and the most significant SPEM gain (0.4 Hz) as the model to distinguish PD from HCs.Results:Relative to HCs, newly diagnosed, drug-naive PD patients showed prolonged saccadic latency [(210.4±41.3) ms vs (191.3±18.9) ms, t=-3.445, P=0.001] and decreased saccadic accuracy (88.4%±6.8% vs 92.2%±6.1%, t=3.064, P=0.003). SPEM gain in PD was uniformly reduced at each frequency(0.1 Hz: 0.68±0.15 vs 0.74±0.14, t=2.261, P=0.026; 0.2 Hz: 0.72±0.16 vs 0.79±0.16, t=2.704, P=0.008; 0.4 Hz: 0.67±0.19 vs 0.78±0.19, t=2.937, P=0.004). The ROC analyses of saccade latency, saccadic accuracy and gain in SPEM at 0.1, 0.2, 0.4 Hz as independent factors for detecting PD from HCs showed that the area under the curve (AUC) of each parameter was lower than 0.7: the AUC of saccade latency was 0.641 ( P=0.010), the AUC of saccadic accuracy was 0.681 ( P=0.001), the AUC of gain in SPEM at 0.1 Hz was 0.616 ( P=0.032), at 0.2 Hz was 0.652 ( P=0.005), at 0.4 Hz was 0.660 ( P=0.003). Combining the saccadic latency, saccadic accuracy and the most significant SPEM gain (0.4 Hz) revealed that the model could significantly distinguish PD from HCs with an 80.4% sensitivity and a 73.3% specificity (AUC=0.780, P<0.001). Prolonged saccadic latency was correlated with long disease duration ( β=0.334, 95% CI 0.014-0.654, P=0.041), whereas decreased SPEM gain was associated with severe motor symptoms in newly diagnosed drug-naive PD patients (0.1 Hz: β=-0.004, 95% CI -0.008--0.001, P=0.036; 0.4 Hz: β=-0.006, 95% CI -0.011--0.001, P=0.012). Conclusions:Ocular movements are impaired in newly diagnosed, drug-naive PD patients. These changes could be indicators for disease progression in PD.

Hyperlipidemia and intestinal microflora distributions among flying personnel / 预防医学

Objective@#To investigate the characteristics of intestinal microflora among flying personnel with hyperlipidemia, so as to provide insights into prevention of hyperlipidemia among flying personnel. @*Methods @#Flying personnel diagnosed with hyperlipidemia in a sanatiorium from October 2020 to February 2021 were included in the hyperlipidemia group, while flying personnel with normal blood lipids during the same period served as controls. Subjects' age, family history, physical examinations and blood testing results were collected from both groups. Fecal samples were collected, and intestinal microflora was sequenced followed by bioinformatics analysis. The diversity and abundance of intestinal microflora were compared, and the key bacteria were screened using LEfSe analysis.@*Results@#There were 29 subjects in the hyperlipidemia group with a median age (interquartile range) of 34 (12) years and 25 subjects in the control group with a median age (interquartile range) of 30 (12) years, and all subjects were men. There were no significant differences between the two groups in terms of age, flight duration, smoking, family history of metabolic diseases and waist circumference (P>0.05). The Shannon diversity index of intestinal microflora was lower in the hyperlipidemia group than in the control group (Z=4.370, P=0.026), and there was a significant difference in the overall structure of intestinal flora between the two groups, which were clustered into two groups. LEfSe analysis identified Herbaspirillum, Atopobium and Eggerthella as key microorganisms in the hyperlipidemia group, and Agathobacter, Dialister, norank_Eubacterium_coprostanoligenes_group, Alloprevotella and unclassified Bacteroidales as key microorganisms in the control group.@*Conclusions@#The species diversity and relative abundance of intestinal microflora are lower in flying personnel with hyperlipidemia than in those with normal blood lipids. Herbaspirillum, Atopobium and Eggerthella may be the key bacteria contributing to hyperlipidemia among flying personnel.

Risk factors for rotator cuff tears with long head of bicep tendon lesions and their effects on preoperative function / 中华骨科杂志

Objective:To investigate the risk factors of rotator cuff tears combined with long head of bicep tendon (LHBT) lesion and its effects on preoperative function.Methods:From January 2016 to January 2020, there were 680 patients with rotator cuff tears, including 260 males and 420 females, were included. The average age was 56.1±8.7 (range 27-74 years). There were 250 cases on the left side and 430 cases on the right side. There were 436 cases on the main side, while 274 cases had definite trauma before operation. The following were the Post rotator cuff tears classification, 133 cases in partial injury, 473 cases in small and medium size of rotator cuff tears, 74 cases in large and massive size of rotator cuff tears. The Habermayer-Walch classification of LHBT lesions was as following, 302 cases in type 0 (normal), 216 cases in type 1 (tendonitis), 29 cases in type 2 (dislocation and subluxation), 104 cases in type 3 (partial tear), 20 cases in type 4 (complete tear) and 9 cases in type 5 (SLAP injury above type II). The patient with rotator cuff tears were divided into partial tears group, medium and small tears group, large and massive tears group according to the classification of Post. The visual analogue scale (VAS), simple shoulder test (SST), Constant-Murley function score and the score of the University of California Los Angeles (UCLA) were recorded. The differences in age, sex, main side, trauma and LHBT lesion in patients with three types of rotator cuff tears were analyzed. The preoperative pain and function scores of patients with or without LHBT lesions in various rotator cuff tears were compared among the groups by t-test. The age, sex, main side, with trauma or not, and the classification of rotator cuff tears were analyzed by Logistic regression to investigate the risk factors of patients with rotator cuff tears with LHBT lesions. Results:There were 378 cases (55.6%) with LHBT lesions in 680 patients with rotator cuff tears, including 216 cases of tendinitis (57.1%), 104 cases of partial tear (27.5%), 29 cases of dislocation and subluxation (7.7%), 20 cases of complete tear (5.3%) and 9 cases of SLAP injury (2.4%). The incidence of partial injury, small and medium injury, large and massive rotator cuff injury combined with LHBT lesions were 35.3% (47/133), 57.5% (272/473) and 79.7% (59/74) respectively. The preoperative VAS score, UCLA score, Constant-Murley score and SST score were 5.20±1.52, 14.81±4.12, 41.45±4.93 and 4.56±1.96 respectively in rotator cuff tears group and 5.29±1.65, 14.34±4.01, 41.60±5.88, 4.47±1.97 in LHBT group ( P>0.05). In the partial rotator cuff tears group, the VAS score was 5.16±1.41 in patients with simple rotator cuff tears and 5.68±1.46 in patients with LHBT lesion ( t=2.004, P=0.047). Regression analysis showed that age ≥60 years and rotator cuff tears degree were the risk factors for rotator cuff tears with LHBT ( P<0.001). Conclusion:It is common for patients to have rotator cuff tears with LHBT lesions. The more severe the rotator cuff tears are, the higher the incidence of LHBT lesions will be. Patients with rotator cuff tears aged 60 and above are more likely to have LHBT lesions. However, the complications of LHBT could not affect the preoperative pain and functional scores of patients with rotator cuff tears.

Impact of BMI on fresh cycle embryo transfer outcome of IVF/ICSI in patients with early follicular phase prolonged protocol / 中华妇产科杂志

Objective:To investigate the impact of body mass index (BMI) on clinical effect and fresh cycle embryo transfer pregnancy outcome of in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) in patients with early follicular phase prolonged protocol.Methods:From January 1st, 2018 to July 1st, 2020, 2 257 cases of early follicular long-term protocol in IVF/ICSI and embryo transfer were collected using the clinical assisted reproductive technologies management system software database of the First Affiliated Hospital of Nanjing Medical University. Patients were divided into three groups according to the recommended Asian BMI cut-off points: low body mass group (BMI<18.5 kg/m 2), normal body mass group (18.5≤BMI<24.0 kg/m 2), and high body mass group (BMI≥24.0 kg/m 2). The ovarian stimulation characteristics among the groups were investigated. Then 1 741 fresh embryo transfer cycles were selected and divided into three groups as above, and then the ovulation induction and clinical outcomes were analyzed among the groups. Results:There were significant differences in the starting dosage of gonadotrophin (Gn), total dosage of Gn and days of Gn used among the low body mass group, normal body mass group, and high body mass group in the 2 257 IVF/ICSI cycles (all P<0.01). The high body mass group needed the most amount of Gn [(2 159±668) U] and longest Gn days [(12.3±2.5) days]. The estradiol and progesterone levels [(7 474±4 852) pmol/L, (3.4±1.9) nmol/L] on hCG trigger day in the high body mass group were lower than those in the low body mass group and normal body mass group (all P<0.01). The oocytes retrieved in high body mass group (8.4±4.1) were significantly lower than normal body mass group ( P<0.05). The normal fertilization number, the available embryo number and high quality embryo number were all lower in the high body mass group than other two groups, while no significant difference showed (all P>0.05). In 1 741 cycles of fresh embryo transfer, the average number of transplanted embryos in the low body mass group (1.2±0.4) was decreased compared with the other two groups ( P<0.05), while the biochemical pregnancy rate, clinical pregnancy rate and live birth rate in the normal body mass group were higher compared with the other two groups, but the differences showed no statistically significance (all P>0.05). Conclusions:Increased BMI might affect ovulation induction response in early follicular phase prolonged protocol IVF/ICSI patients, leading to the increase of Gn dosage and the extension of Gn induction days. Although there is no significant difference in pregnancy outcome among different BMI groups, considering the increased risk of adverse perinatal outcomes during subsequent pregnancy in overweight or obese patients, certain attention should still be paid to the control of BMI in patients receiving assisted reproduction treatment with early follicular phase prolonged protocol.

Arthroplasty options and affecting factors for the treatment of complex proximal humeral fractures / 中华创伤杂志

Patients with complex proximal humeral fractures suffer from poor bone quality，impaired blood supply of humeral head and a high risk of osteoporosis. With unpredictable clinical outcome，the treatment of complex proximal humeral fractures is challenging. Shoulder arthroplasty including hemiarthroplasty and reverse shoulder arthroplasty plays an essential role in the treatment of proximal humeral fractures. However，the indication and clinical outcome of shoulder arthroplasty are controversial. Combined with literature and authors' own clinical experiences，arthroplasty options and related influencing factors for the treatment of complex proximal humeral fractures are detailed under consideration of patients' age，quality of tuberosities，status of rotator cuff and revision surgery，etc.，which is helpful to define the extent of surgery and improve clinical outcome.

Blood donation recruitment and effect evaluation of blood services in Chongqing / 中国输血杂志

【Objective】 To study the status and conduct effect evaluation of blood donation recruitment of blood services in Chongqing, and explore its influencing factors, so as to provide reference for the regional homogenization of blood services in Chongqing. 【Methods】 19 blood services in Chongqing were investigated by questionnaire in terms of the input in human resources and funds, recruitment methods, document construction and effect evaluation. The statistical analysis was conducted. 【Results】 The average number of blood donors per 1 000 population in 19 blood services in Chongqing was 9.35±3.35. Among the 19 blood services, blood inventory warning occurred in 18, 6 of them reached Level 2 and 1 of them was Level 1. The number of blood donations per 1 000 population in blood banks with no more than 5 recruits or with less than 100 000 yuan/year recruitment fund was significantly lower than that in blood banks with more than 5 recruits or with more than 100 000 yuan/year recruitment fund(P<0.05). SMS and telephone recruitment were most commonly used in blood donation recruitment. Most blood banks have established corresponding system documents, but only one has established the method to evaluate the effect of blood donation recruitment. 【Conclusion】 The number of blood donations per 1 000 population in 19 blood services in Chongqing varies greatly, and the pressure of blood inventory warning is widespread. The input of human resources and financial fund have a certain impact on the number of blood donations per 1000 population, but not the alone factor. The recruitment method is a little bit more on the traditional side, and the blood donation recruitment and efficacy evaluation is in lack of documentary supporting. Regional homogenization should be achieved by integrating the resources of blood services, establishing the document framework of blood donation recruitment and effect evaluation, clarifying the evaluation content and unifying the evaluation standard.

Research progress in doctor-patient joint decision making / 中华全科医师杂志

In a modern society, with the development of economic status, people′s health consciousness is increasing as well, and the traditional medical model cannot meet the needs of health care. People-oriented medical care model represents the high-quality medical care, and the shared decision making as a new medical culture model, has been widely studied in recent years. This article summarizes the concept, significance, influencing factors and current situation of doctor-patient joint decision making at home and abroad, to provide reference for future study and clinical practice. It is hoped the doctor-patient joint decision making would be promoted in China and it would play a certain role in improvement of doctor-patient relationship.

Clinical and MRI results of arthroscopic repair for massive rotator cuff tear / 中华骨科杂志

Objective To investigate the clinical and MRI outcomes of the arthroscopic rotator cuff repair for massive ro tator cuff tear at minimum 2 years after surgery.Methods From October,2010 to March,2013,data of 79 shoulders in 77 patients with massive rotator cuff tear who were treated with arthroscopic rotator cuff repair were retrospectively analyzed.There were 42 male (44 shoulders) and 35 female (35 shoulders).The average age before surgery was 57.4 years (43.1-80.4 years).There were 64 right shoulders and 15 left shoulders.The dominate side were involved in 70 cases.A trauma history was documented in 52 shoulders.The symptoms persisted less than 3 months in 42 shoulders,between 3 and 6 months in 11 shoulders,between 6 and 12 months in 11 shoulders and more than 1 year in 15 shoulders.No revision case was included.The clinical results (range of motion,forward elevation strength,external rotation strength and American Shoulder & Elbow Surgeons (ASES) score and MRI results were collected.Results All 77 cases were followed up more than 2 years.The forward elevation (156.9°±20.0° to 103.2°± 54.5°),external rotation (40.6°±15.5° to 32.0°±21.4°),internal rotation (L1 to ~),forward elevation strength (9.7±4.7 lb to 4.6±4.9 lb),external rotation strength (11.1±5.1 lb to 8.3±5.4 lb) and ASES score (82.7±14.6 to 45.2± 17.4) were all improved significantly at the latest follow-up.During the surgery,complete repair were achieved in 68 shoulders.The forward elevation (146.4°±31.4° to 110.0°±56.7°),external rotation (45.0°± 14.8° to 34.1°±20.8°) and ASES score (78.6± 14.9 to 54.5± 13.9) were all improved signifi cantly at the latest follow-up in patients with partial repair during the surgery.But the forward elevation strength (10.5±4.9 lb to 6.2±3.2 lb) and external rotation strength (11.5±5.1 lb to 8.3±3.8 lb) were significantly better improved in patients who had complete repair.In 68 shoulders with complete repair during the surgery,20 shoulders were found to have rotator cuff re-tear.The retear rate was 29.4％.But none of the patient with postoperative re-tear received revision surgery.The forward elevation (152.0± 23.3 to 103.5±60.5),forward elevation strength (8.5±4.7 lb to 5.0±4.7 lb) and ASES score (76.9±16.5 to 40.8±18.6) were all improved significantly at the latest follow-up in patients with postoperative re-tear of the rotator cuff tendon.But the forward elevation (161.4°± 13.4° to 152.0°±23.3°),forward elevation strength (11.3±4.7 lb to 8.5±4.7 lb),external rotation strength (12.4±4.8 lb to 9.6±5.3 lb) and ASES score (86.0±13.0 to 76.9±16.5) were significantly better in patients with complete healed rotator cuff tendon comparing with the re-tear group.Conclusion The rotator cuff repair can significantly improve the shoulder function of massive rotator cuff tear even when the rotator cuff tendon can only be partially repaired or re-tear after the surgery.The shoulder function is significantly better in patients with complete healed rotator cuff tendon comparing with the partial repair group and the re-tear group.

Arthroscopic fixation with suture-bridge technique for greater tuberosity fractures / 中华骨科杂志

Objective To evaluate the outcome of arthroscopic fixation with suture-bridge technique for greater tuberosity fractures.Methods Between September 2014 to April 2016,data of 20 cases with greater tuberosity fractures who were treated with arthroscopic suture-bridge technique were retrospectively analyzed.There were 12 males and 8 females,with an average age of 51.2 years old (range,28-76 years).The average period from injury to surgery was 6 days (range,2-18 days).The postoperative X-ray of shoulder was collected.The active mobilization and strength rehabilitation were gradually introduced depended on patients' status.The preoperative and postoperative shoulder function were evaluated by Constant-Murley score,American Shoulder & Elbow Surgeons (ASES) score,visual analogue scale (VAS) pain score and UCLA score.Results All 20 patients were followed up for 15 months (range,12-30 months).There was no postoperative complication,including re-fracture,re-displacement,implant failure and wound infection.Shoulder joint activity at the last follow-up:lift on the proneness of motion 168°±7.54° (range,150°-180°),outer spin 65.5°±6.71° (range,50°-70°),and internal rotation averaged T6 (range,T4-T10).At the last follow-up,the mean Constant-Murley score was 93.50±3.24,mean ASES score 90.80±4.72,mean VAS pain score 0.30±0.57 and mean UCLA score was 32.40±1.90.At the last follow-up,the anterior flexion in the side of the shoulder joint,the external rotation and internal rota tion were compared with the healthy side,and no statistical difference was found,and the function of the shoulder joint was satisfactory.There were two cases of Bankart injury,and the Bankart restoration was fixed by the arthroscope.Conclusion The arthroscopic suture-bridge technique can achieve less trauma,more reliable fixation for fractures of greater tuberosity of humerus.The arthroscopic suture-bridge technique can effectively spread the shear force and torsion force,increase the fixed area,and promote fracture healing.The arthroscopic fixation with suture-bridge technique is an effective treatment for fractures of greater tuberosity of humerus.

Safety of Intra-articular Injection of Bevacizumab in the Knee Joint of Rabbit / 医药导报

Objective To evaluate the toxicity of the intra-articular injection of bevacizumab in the knee of the rabbit.Methods Thirty-two rabbits were divided into 3 experimental groups and normal control group.Three experimental groups were received intra-articular injection of bevacizumab (1, 2, 4 mg respectively) once every three weeks for two times and the normal control group was received the same amount of 0.9% sodium chloride solution.The animals were sacrificed after 6 weeks.Blood test was examined before and after treatment.Pathologic examinations of liver, kidney and artiluar tissue were taken after the sacrifice.The hematoxylin and eosin stain for synovium and cartilage were performed.The AB-PAS stain and Mankin's scale for cartilage were performed.Results All the rabbits kept normal physiological activity.There was no significant difference of major organs and articular tissue between experimental groups and normal control group.There was no significant difference for WBC, RBC, PLT, ALT, BUN and Mankin's scale among all groups.Conclusion No systemic toxicity effects were found for the intra-articular injection of bevacizumab in the knee of the rabbit.

Value of serum IL-33 and its soluble receptor ST2 in patients with chronic hepatitis B / 国际检验医学杂志

Objective To explore the clinical value of serum interleukin(IL)-33 and its soluble receptor ST2(sST2) level in patients with chronic hepatitis B.Methods A total of 65 cases with chronic hepatitis B were recruited into study group,meanwhile 60 healthy persons were enrolled in the control group from January 2014 to October 2016 in our hospital.IL-33,sST2 and alanine aminotransferase(ALT) were detected and compared in the two groups.Results The level of IL-33,sST2 and ALT were significant higher than those of the control group(t=6.542,7.218,6.324;P<0.05).IL-33 and sST2 levels in chronic hepatitis B patients with abnormal ALT level were significant higher than those with normal ALT(t=16.328,9.874,P<0.05).Conclusion The detection of IL-33 and sST2 in patients with chronic hepatitis B could help to understand the immune status of patients,and provide a theoretical basis for the treatment of chronic hepatitis B.

Effects of Rehabilitation Nursing Intervention on Quality of Life of Burn Patients:A Meta Analysis / 中国康复理论与实践

Objective To investigate the effects of rehabilitation nursing on quality of life in patients after burn injuries. Methods The re-ports about rehabilitation nursing for burn patients from January, 2004 to June, 2015 were searched and extracted from the databases of Chi-na Biology Medicine, China National Knowledge Infrastructure, Wangfang Data and Chongqing VIP Database, and analyzed with Review Manager 5.3. Results 11 non-randomized control studies (MINROS score:13~19) were eligible for meta-analysis. There were significant differences in the general health (MD=7.78, 95%CI:6.79~8.77, P<0.001), social function (MD=10.26, 95%CI:5.91~14.60, P<0.001), men-tal function (MD=9.71, 95%CI:6.87~12.55, P<0.001) and physical function (MD=6.88, 95%CI:3.95~9.81, P<0.001) between experimental group and control group. Conclusion Rehabilitation nursing can improve the quality of life of burn patients.

Efficacy analysis of two-stage reverse total shoulder arthroplasty for treating postoperative deep infection after surgeries for proximal humeral fractures / 北京大学学报(医学版)

Objective:To evaluate the clinical results of two-stage reverse total shoulder arthroplasty for treating postoperative deep infection after surgeries for proximal humeral fractures.Methods:From January 2013 to December 2014,8 consecutive patients with postoperative deep infection after surgeries for proximal humeral fractures who were treated with two-stage reverse total shoulder arthroplasty were ret-rospectively reviewed after the final follow-up.There were 1 man and 7 women with a mean age of (58.5 ±6.4)years,of whom 3 left shoulders and 5 right shoulders were involved.There were 2 patients with periprosthetic infection after hemiarthroplasty for proximal humeral fractures,and 6 patients with hu-meral head necrosis as well as implant-associated infection after open reduction internal fixation for proxi-mal humeral fractures with the locking plate.The diagnosis of postoperative deep infection was confirmed by either the preoperative cultures or the intraoperative biopsies during the first-stage surgery.At the first-stage surgery,all the patients underwent a thorough debridement,and then an antibiotic-impregnated bone cement spacer was placed after the removal of prosthesis or locking plate.During the second-stage surgery,the cement spacer was removed,and then a revision shoulder arthroplasty with the reverse shoul-der prosthesis was performed in all the patients who were routinely followed up after the second-stage sur-gery.The visual analogue score (VAS ),Constant score and University of California Los Angeles (UCLA)score were employed to evaluate the postoperative shoulder function.Results:The mean follow-up time was (19.9 ±8.0)months (range 12 to 35 months).At the end of the follow-up,the median forward elevation [100°(60°,140°)vs.25°(0°,90°),P=0.011],the median external rotation [15°(0°,50°)vs.5°(0°,20°),P=0.048],and the median internal rotation [L4 (buttock,T12) vs.buttock (buttock,L3 ),P =0.041 ]were all significantly improved postoperatively.The median Constant score [53.5 (32,74)vs.29.0 (10,57),P=0.012],the median UCLA score [20.5 (9, 26)vs.9.5 (5,15),P=0.012],and the median VAS score [1.5 (0,5)vs.5.0 (0,8),P=0.018]were all significantly improved after the surgery.No recurrence of infection,prosthetic loosening or neurovascular injury was noted by the last follow-up.Conclusion:Two-stage reverse total shoulder arthroplasty was an effective treatment for the postoperative deep infection after surgeries for proximal humeral fractures.The shoulder function was postoperatively improved to a certain degree.

Intraarticular injection of bevacizumab in treatment of osteoarthritis:a laboratory research on a rabbit model / 北京大学学报(医学版)

Objective:To evaluate the effects of intraarticular injection of bevacizumab、sodium hyalu-ronate (SH)and 0.9% sodium chloride injection in the treatment of osteoarthritis (OA)in a rabbit model.Methods:Twenty-four male rabbits were randomly divided into bevacizumab group,SH group and control group after the model of OA had been made.The bevacizumab group and control group received intraarticular bevacizumab (4 mg)and 0.9% saline injection respectively once per three weeks for 2 times.The SH group received intraarticular SH once a week for 6 weeks.After 6 weeks,the histological examinations of cartilage and synovium,electron microscopy and expression of vasculan endothelial growth factorl (VEGF),for the synovium,expression of MMP-1 ,Mankin’s scale,macroscopic observation for cartilage were performed.Results:The histological observation of the bevacizumab group and the SH group showed that bevacizumab could decrease the synoviocytes and inhibit fibrous hyperplasia in synovial underlayer compard with the control group.Reduced apoptosis of chondrocytes and more integrated struc-ture of matrix and more glycosaminoglycan were also found in the bevacizumab group and the SH group compared with control group.The expression of VEGF and MMP-1 ,Mankin’s scale,macroscopic obser-vation were significantly decreased in the bevacizumab group compared with the SH group and the control group (P<0.05).Conclusion:Intraarticular injection of bevacizumab and SH can relieve inflammation of OA and alleviate the pathologic process of OA.The Bevacizumab was better than the SH in therapeutic effect,which maybe implicate a better choice for the treatment of OA.

Children with Functional Abdominal Pain Treated with Shaoyao Gancao Decoction / 浙江中医药大学学报

Objective] To observe the clinical effect of Shaoyao Gancao Decoction on treating children functional abdominal pain to offer reference for further observation. [Method] Choose 200 children patients in pediatric outpatient department of Changxing County TCM Hospital, randomly divide them into treatment and control groups in order, n=100. The treatment one was administered revised Shaoyao Gancao Decoction, the control one orally took Medilac-Vita; both for 4 courses, then observe the cure effects. [Result] In treatment group, total effective rate 94.00%; for control one, it was 86.00%. The comparison of both had difference of statistical meaning( P<0.05). On comparing their abdominal pain relieve, in treatment group, there's more in first 2w and showed marked summit value in the first week; while in control one, there's no marked summit value; so the treatment group was more obvious than other one on relieving pain in the first 2w(P<0.05). The side effect occurrence rate of treatment group was less than other one, the difference between them had statistical meaning(P<0.05). [Conclusion] The revised Saoyao Gancao Decoction has marked cure effect on children functional abdominal pain, worth clinical promotion.

Arthroscopic coracoclavicular ligament reconstruction versus open modified Weaver-Dunn procedure for acromioclavicular joint dislocations:comparison of curative effect / 北京大学学报(医学版)

Objective:To compare the surgical outcomes between arthroscopic coracoclavicular ligament reconstruction and open modified Weaver-Dunn procedure for the treatment of acromioclavicular joint dis-locations.Methods:From January 2011 to June 2012, 63 consecutive patients with acromioclavicular joint dislocations who were treated with either arthroscopic coracoclavicular ligament reconstruction or open modified Weaver-Dunn procedure were retrospectively reviewed after the final follow-up.There were 49 men and 14 women with a mean age of (40.3 ±10.6) years.The mean time from injury to surgery was (10.3 ±5.3) d.According to the Rockwood classification, there were 45 patients with type V injury and 18 patients with typeⅢinjury.All the patients with typeⅢinjury claimed high level of sport activi-ty.The patients were divided into the arthroscopic surgery group (32 cases) or the open surgery group (31 cases) depending on the type of the surgery that each patient had taken.All the patients were rou-tinely followed up after the surgery.The visual analogue score ( VAS ) , American shoulder and elbow surgeons( ASES) score and University of California Los Angeles( UCLA) score were employed to evaluate the postoperative shoulder function.The postoperative radiographs of both shoulders were taken for each patient to evaluate the loss of reduction of the acromioclavicular joint.Re sults:The mean follow-up time was (29.6 ±6.0) months ( range:24 to 43 months) .No significant difference was found between the arthroscopic surgery group and the open surgery group with regard to the patient’ s age [(41.0 ±10.5) years vs.(38.0 ±10.8) years], gender (male/female,24/8 vs.25/6), classification (Ⅴ/Ⅲ,22/10 vs. 23/8), time from injury to surgery [(10.6 ±4.9) d vs.(10.1 ±5.7) d], dominant involvement (19/32 vs.17/31)and mean follow-up time [(29.8 ±6.4) months vs.(29.5 ±5.5) months], P>0.05.At the end of the last follow-up, no significant difference was noted between the two groups regarding the mean forward elevation [(164.4 ±17.2) degrees vs.(162.6 ±12.9) degrees], mean external rotation [(60.9 ±17.0) degrees vs.(57.3 ±15.8) degrees], mean internal rotation [(T12 ±3 vertebrae) vs. (T12 ±3 vertebrae)], mean ASES scores (96.0 ±5.1 vs.94.5 ±3.8)and UCLA scores (34.2 ±1.5 vs. 33.7 ±1.4), P>0.05.The rate of loss of reduction was significantly lower in the arthroscopic surgery group (1/32) compared with the open surgery group (7/31, P=0.026).Conclusion:Surgical treatment for acromioclavicular joint dislocations with either arthroscopic reconstruction or open modified Weaver-Dunn procedure could yield good results with no significant difference between the two groups as for the postoperative shoulder function.The rate of loss of reduction was lower in the arthroscopic surgery group compared with that of the open surgery group.

Clinical follow-up study after open Latarjet procedure in patients with recurrent an-terior shoulder dislocation / 北京大学学报(医学版)

Objective: To investigate the results of treating patients with recurrent anterior shoulder dislocation using open Latarjet technique in a retrospective study, and to discuss the detail of the surgical technique and the results of the procedure.Methods: In the study, 22 patients with recurrent anterior shoulder dislocation treated with open Latarjet technique were followed up.The average duration of the follow-up was 66.0 months.An X-ray film and a CT scan were performed before the surgery to evaluate the degenerative change of the gleno-humeral joint and the bony defect of the glenoid.An X-ray film and a CT scan were repeated at the end of the final follow-up to find out if there was any progression of the de-generative change of the gleno-humeral joint and if the transferred coracoid process united.Physical ex-aminations, American Shoulder & Elbow Surgeons ( ASES ) score, Constant-Murley score and Rowe questionnaire were used to evaluate the patients’ shoulder function before the surgery and at the end of the final follow-up.Results:Before the surgery the average forward elevation, external rotation and inter-nal rotation were 158.2°±28.7°, 55.3°±15.2°and T10 ( T3 -buttock) respectively.The average ASES score, Constant-Murley score and Rowe score were 77.6 ±17.5, 88.3 ±12.5 and 40.2 ±12.0, respectively.At the end of the final follow-up, no redislocation happened.The average forward eleva-tion, external rotation and internal rotation were 167.7°±12.7°, 54.3°±16.5°and T10 (T3-L3), respectively(P=0.138, P=0.765, P=0.439).No sigificant restriction was detected after the surgery regarding forward elevation,external rotation and internal rotation.The mean ASES score, Constant-Mur-ley score, and Rowe score significantly improved to 93.7 ±9.1 (P=0.001), 95.6 ±5.6 (P=0.008) and 96.4 ±4.4 (P<0.001) respectively after the surgery.A progression of the degenerative change of the gleno-humeral joint was detected in 3 patients.A non-union of the transferred coarcoid was detected in 1 patient.Conclusion:Open Latarjet procedure is effective in treating the recurrent anterior shoulder dislocation patient with severe glenoid defect.No significant progression of the degenerative change of the gleno-humeral joint is detected in average 5-year follow-up.