type-II Case Research Articles

Comparison of two surgical methods for the treatment of intertrochanteric fractures of the femur in elderly patients with knee osteoarthritis

To explore the difference in the effectiveness between proximal femoral nail anti-rotation(PFNA) and proximal femoral locking compression plate(PFLCP) of intertrochanteric fracture in the elderly patients combined with knee osteoarthritis. The clinical data of 65 intertrochanteric femoral fractures combined with knee osteoarthritis between June 2015 and February 2021 were retrospectively analyze. They were divided into two groups according to the different surgical methods. PFNA group was composed of 36 patients, 12 males and 24 females, aged from 61to 88 years old with an average of (77.0±6.4)years old. There were 17 cases of left injury and 19 cases of right injury. According to modified Evans classification, there were 3 cases of typeⅡ, 19 cases of type Ⅲ, 10 cases of type Ⅳ, and 4 cases of type Ⅴ. PFLCP group was composed of 29 patients, 11 males and 18 females, aged from 60 to 92 years old with an average of (78.8±6.5) years old. There were 14 cases of left injury and 15 cases of right injury.According to modified Evans classification, there were 2 cases of typeⅡ, 18 cases of type Ⅲ, 7 cases of type Ⅳ, and 2 cases of type Ⅴ. Comparison of operation time, intraoperation blood loss, postoperative bed time, incidence of postoperative complications, Harris score at 6 months and 1 year postoperation. All 65 patients were followed up ranging from 12 to 24 months with an average of (16.9±3.6) months. In the PFNA and PFLCP groups, the operation time was respectively (57.6±6.8) min and (77.4±6.5) min, the intraoperative blood loss was (128.3±50.3) ml and (156.3±23.9) ml, postoperative bed time was (4.0±2.5) days and (8.1±2.0) days, Harris score at 6 months postoperative was (45.3±8.6) points and (36.3±7.0) points. There were significant differences between two groups(P<0.05). Incidence of postoperative complications was 19.4%(7/36)and 34.5%(10/29), Harris score at 1 year postoperative was (60.8±6.7) points and (59.0±8.1) points.There was no significant difference between the two groups(P>0.05). Compared with PFLCP, PFNA treatment of elderly patients with knee osteoarthritis between the femoral intertrochanteric fractures shorter surgical time, less intraoperative blood loss, bed rest after surgery, short-term hip function recovery better, when the affected knee joint can tolerate traction, can be used as a priority.

Orthopaedic robot assisted closed reduction and cannulated screw internal fixation for the treatment of femoral neck fractures

To investigate the preliminary clinical effect of closed reduction and cannulated nail internal fixation for femoral neck fracture assisted by robot navigation and positioning system. From July 2019 to January 2020, 16 cases of femoral neck fracture （navigation group） were treated with closed reduction and internal fixation guided by robot system, including 7 males and 9 females, aged 25 to 72 years old with an average of （53.61±5.45） years old；Garden classification of fracture：3 cases of typeⅠ, 3 cases of typeⅡ, 8 cases of type Ⅲ, 2 cases of type Ⅳ. Non navigation group （control group）：20 cases of femoral neck fracture were treated with closed reduction and hollow nail internal fixation, 8 males and 12 females, aged 46 to 70 years old with an average of （55.23±4.64） years old；Garden typeⅠin 2 cases, typeⅡin 4 cases, type Ⅲ in 11 cases, type Ⅳ in 3 cases. The operation time, fluoroscopy times, guide needle drilling times, screw adjustment times, intraoperative bleeding volume and other indicators of two groups were evaluated. Both groups were followed up for 12 to 18 months with an average of （15.6±2.8） months. The fractures of both groups were healed without delayed union and nonunion. There was no significant difference in healing time between two groups（P=0.782）. There was no significant difference in Harris scores between two groups at the last follow-up（P=0.813）. There was no significant difference in operation time between two groups（P>0.05）. There were significant differences between two groups in fluoroscopy times, guide needle drilling times, hollow screw replacement times, and intraoperative bleeding volume（P<0.05）. Closed reduction and hollow screw internal fixation assisted by robot navigation system for femoral neck fracture has the advantages of minimally invasive operation, precise screw placement, and reduction of X-ray radiation damage during operation.

Imaging measurement and analysis of related indexes of variation of femoral head rotation center

To provide guidance for hip replacement by analyzing the variation of femoral head rotation center in different hip diseases. A total of 5 459 patients were collected from March 2016 to June 2021, who took positive and proportional plain films of both hips for various reasons. The relative position between the rotation center of the femoral head and the apex of the greater trochanter was measured. The positive variation is more than 2 mm above the top of the great trochanter, and the negative variation is more than 2 mm below the top of the great trochanter. A total of 831 patients with variation of femoral head rotation center were collected and were divided into 4 groups according to different diseases, and the variation was counted respectively. There were 15 cases in the normal group involving 10 cases of positive variation and 5 cases of negative variation. There were 145 cases of avascular necrosis of femoral head involving 25 cases of positive variation and 120 cases of negative variation. There were 346 cases of congenital hip dysplasia involving 225 cases of positive variation(including 25 cases of typeⅠ, 70 cases of type Ⅱ, 115 cases of type Ⅲ and 15 cases of type Ⅳ), and 121 cases of negative variation(including 50 cases of crowe typeⅠ, 60 cases of typeⅡ, 10 cases of type Ⅲ and 1 case of type Ⅳ). There were 325 cases of hip osteoarthritis group involving 45 cases of positive variation and 280 cases of negative variation. There was significant difference in variation of femoral head rotation center among the four groups(P<0.05). There was significant difference in variation of femoral head rotation center among different types of congenital hip dysplasia(P<0.05). There were significant differences in cervical trunk angle and eccentricity among different variations of femoral head rotation center(P<0.05). The variation of femoral head rotation center is related to cervical trunk angle and eccentricity. The variation of femoral head rotation center is an important factor in hip diseases. The variation of femoral head rotation center is different in different hip diseases. Avascular necrosis of the femoral head and osteoarthritis of the hip were mostly negative variations. With the aggravation of congenital hip dysplasia, the variation of femoral head rotation center gradually changed from negative variation to positive variation.The variation of femoral head rotation center should be paid attention to in the preoperative planning of hip arthroplasty. It is of great significance to select the appropriate prosthesis and place the prosthesis accurately.

Release of gastrocnemius aponeurosis and suture of the Achilles tendon end scar tissue managing the chronic Achilles tendon rupture

To investigate the clinical effect of scar tissue suture at the broken end of Achilles tendon after gastrocnemius aponeurosis release in the treatment of chronic Achilles tendon rupture. The clinical data of 17 patients with old achilles tendon rupture treated from January 2017 to December 2019 were analyzed retrospectively, including 15 males and 2 females, aged 26 to 53 years with an average of (35.2±11.6) years old, and the time from injury to operation was 37 to 92 days with an average of (49.3±13.3) days. Myerson's classification included 6 cases of typeⅡ and 11 cases of typeⅢ. The defect of the broken end of Achilles tendon was 2 to 5 cm with an average of(4.1±1.5) cm after partial scar tissue was removed. All patients were treated with gastrocnemius aponeurosis, appropriate excision of scar tissue at the broken end of Achilles tendon and direct suture. The continuity and healing of Achilles tendon were evaluated by color Doppler ultrasound 3 months after operation. The ankle plantar flexor strength was measured by ankle plantar flexor strength tester before operation and 1 year after operation. American Orthopaedic Foot and Ankle Society ankle hindfoot score (AOFAS) and Achilles tendon rupture score were used before operation and 1 year after operation Achilles tendon total fracture score (ATRS) was used to evaluate the clinical rehabilitation of Achilles tendon rupture. All patients were followed up for 12 to 18 months with an average of(13.6±1.8) months. The surgical incision healed in stageⅠ. Color Doppler ultrasound showed good continuity of Achilles tendon, local Achilles tendon slightly thickened and irregular fiber direction. The ankle plantar flexor force (92.2±3.9) N at 1 year after operation was significantly higher than that before operation (29.5±4.2) N (P<0.05);One year after operation, the AOFAS(91.20±3.30) was significantly higher than that before operation (42.20±4.40)(P<0.05);the ATRS (90.70±3.00) was significantly higher than that before operation(40.00±2.90)(P<0.05). The gastrocnemius aponeurosis release combined with scar suture of Achilles tendon end is an effective technique for the treatment of chronic Achilles tendon rupture, avoid injury to hallux flexor longus or flexor digitorum longus, with the plantar flexor muscle strength of the ankle was recovered well, is an effective method to treat chronic Achilles tendon rupture.

Treatment of open fracture of lower limb in high altitude area

To explore the treatment methods and experience of open fracture of lower limb in high altitude area. From January 2016 to January 2021, 62 patients with open fractures of lower limbs were treated by staged surgery with the concept of injury control orthopedics, emphasizing wound treatment and combining various fracture fixation methods. There were 51 males and 11 females, ranging in age from 14 to 59 years old, with a mean of (37.2±12.3) years old; and the course of disease ranged from 7 to 59 days, with a mean of (23.7±15.5) days. According to Gustilo Anderson classification, there were 14 cases of typeⅠ, 24 cases of typeⅡ, 14 cases of typeⅢA, 8 cases of typeⅢB and 2 cases of typeⅢC. The fracture repair and wound healing were observed, and the clinical efficacy was evaluated by Johner-Wruhs evaluation standard. Fifty-five patients were followed up, and the duration ranged from 4 to 36 months, with a mean of (14.7±8.5) months, and 7 cases were lost to follow-up. According to Johner-Wruhs evaluation criteria, 33 cases got an excellent result, 16 good, 4 poor and 2 bad. The wound healing was poor in 2 cases, partial necrosis of Achilles tendon in 1 case, nonunion of fracture in 1 case and delayed healing of fracture in 2 cases. It is an effective method to treat the open fracture of lower extremity in high altitude area to pay attention to the management of soft tissue injury, the management of wound moisturizing, staged operation of fracture and full protection of blood supply at the fracture end. Paying attention to the treatment of soft tissue injury and the management of wound moisturizing, staged operation of fracture and full protection of blood supply at the fracture end are effective methods for the treatment of open fracture of lower limbs in high altitude areas.

Effects of femoral offset and mechanical axis of the lower extremity on hip after osteotomy for adult developmental dysplasia of the hip

To investigate the effects of femoral offset and mechanical axis of the lower extremity on hip after osteotomy for adult developmental dysplasia of the hip (DDH). A clinical data of 62 adult patients with DDH (62 hips), who underwent periacetabular osteotomy combined with femoral osteotomy between January 2016 and May 2019 and met selective criteria, was retrospectively analyzed. There were 6 males and 56 females. The age ranged from 18 to 38 years, with an average of 24.4 years. Body mass index ranged from 15.8 to 31.8 kg/m 2, with an average of 21.8 kg/m 2. There were 44 cases of Hartofilakidis typeⅠ and 18 cases of typeⅡ. According to the modified Tönnis osteoarthritis staging, 46 cases were stage 0 and 16 cases were stageⅠ. There were 13 cases with pelvic anteversion, 40 cases with normal pelvis, and 9 cases with pelvic retroversion. Intraoperative blood loss, length of hospital stay, and complications were recorded. Postoperative hip function was evaluated by Harris score and International Hip Outcome Tool (iHOT) score. The femoral offset, collo-diaphyseal angle, hip-knee-ankle angle (HKA), knee valus angle, CE (Wiberg central-edge angle), anterior CE angle, and acetabular index angle were measured and the osteotomy healing was observed on X-ray films. Patients were grouped according to postoperative femoral offset (≥48 mm or <48 mm) and HKA [varus group (HKA<177°), normal group (HKA 177°-183°), and valgus group (HKA>183°)]. Harris score and iHOT score were compared between groups. Intraoperative blood loss ranged from 200 to 1 550 mL, with an average of 476 mL. The length of hospital stay ranged from 8 to 21 days, with an average of 13.3 days. All incisions healed by first intention. All patients were followed up 2.0-4.5 years, with an average of 2.8 years. At 1 year after operation, the Harris score and iHOT score of the hip joint significantly increased when compared with those before operation ( P<0.05); there were significant differences in the femoral offset, collo-diaphyseal angle, HKA, knee valus angle, CE angle, anterior CE angle, and acetabular index angle between pre- and post-operation ( P>0.05). According to the modified Tönnis osteoarthritis staging, 38 cases were stage 0 and 24 cases were stageⅠ; and there was no significant difference between pre- and post-operation ( χ 2=2.362, P=0.124). There were 11 cases with pelvic anteversion, 38 cases with normal pelvis, and 13 cases with pelvic retroversion, showing no significant difference when compared with that before operation ( χ 2=0.954, P=0.623). The pubic branch osteotomy did not heal in 9 cases, proximal femur osteotomy did not heal in 2 cases, and inferior pubic ramus stress fracture occurred in 5 cases. There were significant differences ( P<0.05) in the Harris score and iHOT score between femoral offset≥48 mm group ( n=10) and femoral offset<48 mm group ( n=52). There was no significant difference ( P>0.05) in Harris score and iHOT score between varus group ( n=13), normal group ( n=40), and valgus group ( n=9). Periacetabular osteotomy combined with femoral osteotomy can improve the femoral offset and mechanical axis of the lower extremity of patients with DDH, and improve the functional score of the hip. However, excessive increase of femoral offset during femoral osteotomy is not desirable, resulting in low postoperative functional score.

Clinical study of modified one stage posterior approach total en block spondylectomy and spinal reconstruction in the treatment of invasive thoracic vascular tumor

To explore the surgical method and safety of modified one stage posterior approach total en block spondylectomy combined with pedicle screw fixation and titanium mesh reconstruction for the treatment of invasive thoracic vascular tumor. The clinical data of 12 patients with invasive thoracic vasculay tumor from December 2012 to May 2015 was retrospectively analyzed. There were 8 males and 4 females, aged from 40 to 62 years with an average of 51.2 years, the course of disease was 2 months to 8 years with an average of 3.4 years. The lesions involved vertebral bodies:1 case of T2, 4 cases of T4, 1 case of T5, 2 cases of T6, 2 cases of T8, and 2 cases of T10. According to Tomita classification, there were 3 cases of typeⅠ, 3 cases of typeⅡ, 1 case of type Ⅲ, and 5 cases of type Ⅳ. The Japanese Orthopaedic Association (JOA) score was 8.0±2.7 before operation. One patient with T10 lesions had sensory dyskinesia below the umbilicus, and the muscle strength of both lower limbs was grade Ⅰ-Ⅱ, and the others 11 patients were grade Ⅲ-Ⅳ. All 12 patients underwent one stage posterior approach total en block spondylectomy and the pedicle screw fixation combined with titanium mesh reconstruction under general anesthesia and continuous motor evoked potential (MEP) spinal cord electrophysiological monitoring throughout the operation. The operation time, intraoperative blood loss and transfusion, postoperative pain and recovery of spinal cord function, bone graft fusion, tumor recurrence and other complications were followed up. All the operations were successful. The average operation time, intraoperative blood loss and blood transfusion were 5.5 h (4.5 to 6.0 h), 1 850 ml (1 650 to 2 500 ml), 1 050 ml (600 to 1 500 ml), respectively. All 12 patients were followed up for 5 months to 2.5 years with an average of 21 months. Local pain and lower limb muscle strength were improved to varying, and the nerve compression symptoms disappeared. The JOA score at 6 months after operation was 12.0±3.4, which was statistically significant difference compared with the preoperative 8.0±2.7 (t=3.20, P<0.05). Titanium mesh bone grafts were all fused in phaseⅠ, with an average fusion time of 4.5 months (3 to 7 months). During the follow-up period, there was no tumor recurrence, loosening or breaking of nails, sinking and displacement of titanium mesh. Modified one stage posterior approach total en block spondylectomy is an ideal surgical method for the treatment of invasive thoracic vascular tumors, which has a safe, reliable and long lasting efficacy.

Multi-objective optimization of smart community integrated energy considering the utility of decision makers based on the Lévy flight improved chicken swarm algorithm

A community integrated energy system can play a key role in alleviating urban energy shortages and environmental degradation, but the presence of multiple participants and links makes the operation of such a system more complicated. How to choose the optimal energy use strategy among different decision makers is a problem that urgently needs to be solved today. Therefore, first, this paper proposes a comprehensive energy multi-objective scheduling model based on the established smart community energy management framework, which considers the utility of decision makers. From the perspective of risk, the model divides decision makers into adventurous, intermediate and conservative types in order to study the impacts of different decision makers on energy use strategies. Second, to prevent the phenomenon of the solution of the intelligent algorithm falling into the local optimum, this paper innovatively uses the Lévy flight to optimize the learning step length of the chicken swarm algorithm to quickly solve the proposed mixed integer nonlinear programming model. Finally, the model is tested through multi-scenario simulation. The results show that decision makers have an important influence on energy use strategies, and different decision makers have different energy use strategies when utility is maximized. In addition, compared with the chicken swarm algorithm, the improved algorithm increases the utility of adventurous, intermediate and conservative decision makers in type-I cases by 0.54 %, 1.2 %, and 1.5 %, respectively; and in type-II cases by 4.5 %, 4.8 %, and 3.6 %, respectively.

Magnetic impurity in hybrid and type-II nodal line semimetals* *Project supported by the Zhejiang Provincial Natural Science Foundation of China (Grant No. LY19A040003).

We study the Kondo screening of a spin-1/2 magnetic impurity in the hybrid nodal line semimetals (NLSMs) and the type-II NLSMs by using the variational method. We mainly study the binding energy and the spin–spin correlation between magnetic impurity and conduction electrons. We find that in both the hybrid and type-II cases, the density of states (DOS) is always finite, so the impurity and the conduction electrons always form bound states, and the bound state is more easily formed when the DOS is large. Meanwhile, due to the unique dispersion relation and the spin–orbit couplings in the NLSMs, the spatial spin–spin correlation components show very interesting features. Most saliently, various components of the spatial spin–spin correlation function decay with 1/r 2 in the hybrid NLSMs, while they follow 1/r 3 decay in the type-II NLSMs. This property is mainly caused by the special band structures in the NLSMs, and it can work as a fingerprint to distinguish the two types of NLSMs.

Noncommutative Borsuk–Ulam-type conjectures revisited

Let H be the C*-algebra of a non-trivial compact quantum group acting freely on a unital C*-algebra A . It was recently conjectured that there does not exist an equivariant *-homomorphism from A (type-I case) or H (type-II case) to the equivariant noncommutative join C*-algebra A\circledast^\delta H . When A is the C*-algebra of functions on a sphere, and H is the C*-algebra of functions on \mathbb{Z}/2\mathbb{Z} acting antipodally on the sphere, then the conjecture of type I becomes the celebrated Borsuk–Ulam theorem. Taking advantage of recent work of Passer, we prove the conjecture of type I for compact quantum groups admitting a non-trivial torsion character. Next, we prove that, if the compact quantum group (H,\Delta) admits a representation whose K_1 -class is non-trivial and A admits a character, then a stronger version of the type-II conjecture holds: the finitely generated projective module associated with A\circledast^\delta H via this representation is not stably free. In particular, we apply this result to the q -deformations of compact connected semisimple Lie groups and to the reduced group C*-algebras of free groups on n&gt;1 generators.

Type-II Dirac points and edge transports in phononic crystal plates

The accidentally degenerate type-II Dirac points in sonic crystal has been realized recently. However, elastic phononic crystals with type-II Dirac points have not yet been explored. In this work, we design a two-dimensional phononic crystal plate in square lattice with type-II Dirac points for elastic waves. The type-II Dirac points, different from the type-I counterparts, have the tiled dispersions and thus the iso-frequency contours become crossed lines. By tuning structures to break the mirror symmetry, the degeneracies of the type-II Dirac points are lifted, leading to a band inversion. In order to have a further explanation, we also calculate the Berry curvatures of phononic crystals with opposite structure parameters, and it turns out that these two crystals hold opposite signs around the valley. The phononic crystal plates before and after the band inversion belong to different topological valley phases, whose direct consequence is that the topologically protected gapless interface states exist between two distinct topological phases. Topologically protected interface states are found by calculating the projected band structures of a supercell that contains two kinds of interfaces between two topological phases. Robustness of the interface transport is verified by comparing the transmission rate for perfect interface with that for defective interface. Moreover, owing to the special stress field distributions of the elastic plate waves, the boundaries of a single phononic crystal phase can similarly host the gapless boundary states, which is found by calculating the projected band structures of a supercell with a single phase, thus having two free boundaries on the edges. This paper extends the two-dimensional Dirac points and valley states in graphene-like systems to the type-II cases, and obtains in the same structure the gapless interface and boundary propagations. Owing to the simple design scheme of the structure, the phononic crystal plates can be fabricated and scaled to a small size. Our system provides a feasible way of constructing high-frequency elastic wave devices.

Comparison of measurement methods of lower limb length in hip arthroplasty for femoral neck fracture

To compare the accuracy of three methods for measuring the length of both lower limbs in hip arthroplasty for femoral neck fracture in the elderly, and to introduce a "shoulder to shoulder" anatomical location marking method for femur. From January 2017 to January 2019, 90 elderly patients with femoral neck fracture were treated with hip replacement, including 39 males and 51 females, aged 65 to 96(78.0±7.4) years, 56 cases of total hip and 34 cases of hemi hip. According to garden classification, there were 7 cases of typeⅡ, 63 cases of type Ⅲ and 20 cases of type Ⅳ. The patients were divided into three groups according to different measurement methods:contralateral contrast method (group A) of 19 cases, shuck test method (group B) of 28 cases, and "shoulder to shoulder" anatomical marker localization method (Group C) of 43 cases. The accuracy of the three methods was compared by measuring the length difference of lower limbs in vitro and imaging. All patients completed the operation successfully. After total hip arthroplasty, the length of lower limbs in group A was(12.9±8.6) mm, and that in group B was(10.3±4.4) mm. After hemiarthroplasty, the length of lower limbs in group A was (13.2±7.2) mm, group B was (8.7±3.5) mm, and group C was (6.3±2.8) mm; the measurement results of unequal length of lower limbs after total hip arthroplasty were(12.9±8.1) mm in group A, (9.6±4.0) mm in group B and (6.6±2.6) mm in group C. The results of factorial analysis of variance showed that the differences among the three groups were statistically significant (F=9.763, P<0.01). The difference between two groups showed that the length of lower limbs in group A and group B was higher than that in group C(P<0.05). There was no significant differencebetween total hip arthroplasty and hemiarthroplasty (F=0.270, P=0.605). Three different intraoperative measurement methods for postoperative lower limb length difference were group C<group B<group A, the accuracy of group C was the highest. The "shoulder to shoulder" anatomic localization marking method can reduce the length of lower limbs simply, effectively and accurately in the elderly patients with femoral neck fracture hip replacement.

Operative effect and treatment strategies for the low distal humerus fracture

Objective: To explore the operative effect and treatment strategies for the low distal humerus fracture. Methods: A retrospective analysis was conducted on the clinical data of 16 patients with the low distal humerus fracture between January 2016 and January 2018 at Department of Orthopaedics, Shanghai Tongji Hospital Affiliated to Tongji University.All fractures were coronal fractures of humeral head, partly combined fractures of humeral trochlea or posterior part. Fractures were classified according to Dubberley classification as 9 cases in type Ⅰ, 3 cases in typeⅡ and 4 cases in type Ⅲ.Selection of the kind of operative approach and internal fixation was made according to the fracture type and shape. For simple coronal fractures of humeral head or combining humeral trochlea fractures, which were relatively stable, single or multiple countersunk screws fixation by the lateral approach were chosen.For humeral head coronal fractures, which combining obviously displaced comminuted humeral trochlea factures, posterolateral locking plates and countersunk screws internal fixation by the olecranon osteotomy approach were chosen. The incision and elbow soft tissues were observed within 2 weeks after operation.The radiographic evaluation of fracture reduction, bone healing, internal fixation, arthritis and elbow range of motion were made at 3, 6, 12 months after operation. The Mayo elbow functional scores were documented for analysis of elbow joint function, and compared between different surgery groups by Kruskal-Wallis H test. Results: The follow-up time was (22.1±9.2)months(range: 15 to 39 months). The incisions healed well in 2 weeks after operation without soft tissue infection, necrosis or vascular complications. There was no fracture reduction loss or internal fixation loosening according to radiographic evaluation 3 months after operation. One case of ectopic ossification was observed 6 months after operation and inhibited by the treatment of non steroidal anti-inflammatory drugs.One case of ulnar neuritis occurred after operation and released after removing the long screw and loosing the ulnar.Osteoarthritis images were observed at the end of follow-up.Arc of motion was (120.4±11.2) ° in flexion and (5.5±1.9) ° in extension. The Mayo score was 88.7±9.1, including 11 excellent, 4 good, and 1 fair.The Mayo score was 90.1±3.7 in Dubberley classification type Ⅰcases, 89.7±4.6 in type Ⅱ cases and 84.5±5.8 in type Ⅲ cases. There were no significant differences in Mayo scores between 3 types cases according to Kruskal-Wallis H test. Conclusion: Choosing the appropriate surgical approach and composite internal fixation according to the fracture types and shapes of low distal humerus fracture, anatomic reduction of the articular surface and early functional exercise are the keys to obtain ideal curative effect.

Analysis of infants with moderate to severe laryngomalacia

Objective:To investigate the clinical features and the treatment of moderate-severe laryngeallacia, and the application of CO₂laser supraglotation in laryngeallacia.Method:Collecting the clinical data of 18 infants with moderate-to-severe laryngeallacia diagnosed in our hospital,10 cases were moderate. Eight cases were severe children; according to the classification of laryngeallacia, most of them were mixed type, including 2 cases of type Ⅱ, 3 cases of type Ⅲ, 5 cases of typeⅠ + type Ⅱ, 7 cases of typeⅡ+ type Ⅲ, and 1 case of typeⅠ+ typeⅡ + type Ⅲ. Among them, 8 patients underwent CO₂laser supraglotation,10 patients underwent conservative treatment.The children underwent surgery to evaluate the improvement of laryngeal wheezing, respiration, body weight, and Diet situation. All children were followed up for 12 months.Result:Eight cases with severe laryngeallacia receving CO₂laser supraglotation had rapid improvement after surgery, including laryngeal wheezing, dyspnea, and cough symptoms. They were completely cured 3 months after surgery; None of the 10 cases of moderate children were cured in 3 months, 2 cases of laryngeal wheezing and dyspnea basically disappeared in 6 months, 7 cases improved, 1 case was in the plateau stage; Despnea in 8 cases of children basically disappeared 12 months later and 2 cases with mild throat wheezing, continuing conservative treatment; The weight changes, diet and respiration were closely monitored in all 18 children. The weight of the 5 children after surgery in the 3, 6 and 12 months were significantly higher than that in the untreated children. The difference was statistically significant (P<0.05).Conclusion: Electronic laryngoscope should be taked when children are suspected of laryngeal asthma, which could help diagnose moderate-severe laryngeallacia. Follow-up should be done closely. CO₂laser supraglottic surgery for severe laryngeallacia, can relieve dyspnea, throat wheezing, eating difficulties and gain weight. The surgical is safety with very slight trauma and less complications, which is worth promoting; for moderate laryngeal softening, close follow-up is recommended, most of which can be treated conservatively. If there is a change in the condition, surgery should be considered.

Selective intrauterine growth restriction in monochorionic twins: changing patterns in umbilical artery Doppler flow and outcomes.

To describe changes in umbilical artery (UA) Doppler flow in monochorionic diamniotic (MCDA) twins affected by selective intrauterine growth restriction (sIUGR), to correlate Doppler findings with pregnancy course and perinatal outcome, and to report postnatal follow-up. This was a retrospective study of 140 MCDA twins with sIUGR. UA end-diastolic flow, defined as Doppler waveform pattern Type I (persistently positive), Type II (persistently absent or persistently reversed) or Type III (intermittently absent or intermittently reversed), was recorded at first examination and monitored weekly until double or single intrauterine fetal death (IUFD), bipolar cord coagulation or delivery. All neonates had an early neonatal brain scan, magnetic resonance imaging, when indicated, and neurological assessment during infancy. Rates (per 100 person-weeks) and hazard ratios (HR) of IUFD in the IUGR twin in each pregnancy were calculated considering UA Doppler pattern as a time-dependent variable. At first examination, there were 65 cases with UA Doppler waveform pattern Type I, 62 with Type II and 13 with Type III. Of the 65 Type-I cases, 48 (74%) remained stable, while 17 (26%) changed to either Type II absent (14%), Type II reversed (9%) or Type III (3%). Of 62 Type-II cases (47 with absent and 15 with reversed flow), 33 (53%) remained stable (18 with absent and all 15 with reversed flow). The 29 Type-II absent cases which changed became Type II reversed (24/47, 51%) or Type III (5/47, 11%). All 13 Type-III cases remained stable. Compared with Type I, the risk of IUFD (adjusted for estimated fetal weight discordance and amniotic fluid deepest vertical pocket) was highest when the pregnancy was or became Type II reversed (HR, 9.5; 95% CI, 2.7-32.7) or Type II absent (HR, 4.3; 95% CI, 1.3-14.3). Mild neurological impairment was more prevalent in the IUGR twin than in the large cotwin (7% vs 1%, P = 0.02). Risk stratification based on UA Doppler is useful for planning ultrasound surveillance. However, patterns can change over time, with important consequences for management and outcome. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Comparative analysis in ultrastructure and histological types for congenital cystic adenomatoid malformation

Objective To explore relationship between imaging classification and pathological type, and the electron microscopic ultrastructure by observing the ultrastructural features of congenital cystic adenomatoid malformation(CCAM). Methods Children with CCAM in the Guangdong Women and Children Hospital from May 2014 to November 2014, were analyzed, imaging classification was performed according to enhanced Computed Tomography (CT) scanning, and the surgical specimens were stained by HE and scanning electron microscope was used to observe the tissue structures of various of CCAM. Results Eight cases were enrolled in this research (5 boys and 3 girls), and the mean age of surgery was (5.4±1.1) month old.According to the features of enhanced CT scanning, there were 2 cases of the type-Ⅰ, and the other 3 cases of type-Ⅱ, and 3 cases of type-Ⅲ; According to the characteristics of the pathological types, there was 1 case of type-Ⅰ, 4 cases of type-Ⅱ, and the other 3 cases of type-Ⅲ.There was 1 case which classified as type-Ⅰ by CT, however classified as type-Ⅱ by pathological typing.The findings of CT features were in complete correspondence with the pathological types in the rest cases.Electron microscopic findings showed the alveolar spaces were enlarged, the alveolar cells were reduced, the lamellar bodies were decreased and immature and microvilli were also decreased.There was no significant difference between ⅠandⅡ type under the viewpoint of electron microscope.The common features between typeⅠ, and type Ⅱ included that the alveolar space was enlarged, the alveolar space had been pressed between enlarged alveolar space, the alveolar cell were decreased and immature, and fibrous hypertrophy was also found. Conclusions There are differences between ultrastructural analysis and clinical pathological typing which suggests the clinical importance of the electron microscopy ultrastructural analysis combined with pathology for typing.There need further clinical and laboratory studies, especially the combination of microscopy-electrical control microscope for typing with related predictive models for follow-up of CCAM. Key words: Congenital cystic adenomatoid malformation; Electron microscopy ultrastructural analysis; Pathology

Perioperative complications of intertrochanteric fractures in patients aged 80 years and over

Objective To investigate the prevention and management of perioperative complications of intertrochanteric fractures in elderly in-hospital patients(aged≥80 years). Methods Clinical data of 103 intertrochanteric fracture patients(31 male and 72 female)undergoing surgical treatment at our hospital from May 2010 to Nov.2015 were retrospectively analyzed.Their ages ranged from 80 to 99 years, with an average of 86.2 years.There were 3 Evan typeⅠ cases, 25 typeⅡ cases, 36 type Ⅲ cases, 37 type Ⅳ cases and 2 type Ⅴ cases.Of these, 82 received epidural anesthesia and 21 had general anesthesia.Intertrochanteric fractures were treated with proximal femoral nail(PFN)internal fixation in 101 patients and dynamic hip screw(DHS)internal fixation in 2 patients. Results The average operation duration and blood loss were 30 min and 60 ml in the PFN internal fixation group and 60 min and 150 ml in the DHS internal fixation group, respectively.The average hospitalization time was 16.7 days.One patient(0.9%)died after operation, 10(9.7%)had preoperative complications of bed rest with 3 cases involving the central nervous system and 4 cases involving the respiratory system, and 38 cases(36.9%)had postoperative complications with 13 involving the central nervous system.The average time from admission to operation was 6 days, with 65 cases above the average and 38 cases below the average, and there was a statistically significant difference in the incidence of postoperative complications between the two subgroups(30/65 or 46.2% for the former and 8/38 or 21.1% for the latter, χ2=6.49, P<0.05). Conclusions Elderly patients with intertrochanteric fractures should undergo surgery as soon as possible, preferably with epidural anesthesia.Proficiency in surgical kills, short operation time, close monitoring of preoperative and postoperative conditions, and proper and timely treatment are the key to ensuring surgical success. Key words: Aged, 80 and over; Femoral neck fractures; Perioperative care; Postoperative compeications

The characteristics of the gastroesophageal junction in gastroesophageal reflux disease under high–resolution esophageal manometry

Objective To analyze the characteristics of gastroesophageal junction(GEJ) in gastroesophageal reflux disease(GERD) using high resolution manometry(HRM), and the features in different GERD subtypes, reflux esophagitis(RE) and non–erosive gastrooesophageal reflux disease(NERD). Methods Sixty GERD patients were divided into two subtypes, RE(n=33) and NERD(n=27), based on the results of endoscopy. All patients received HRM, and were divided into three subtypes, typeⅠ, type Ⅱ and type Ⅲ according to the GEJ pressure morphology. HRM results among different subtypes were investigated. Results In 60 GERD patients, the GEJ was divided into three subtypes, including 26 cases of typeⅠ(RE=14, NERD=12), 29 cases of typeⅡ(RE=14, NERD=15) and 5 cases of type Ⅲ(RE=5). The characteristics of GEJ morphologic subtypes were analyzed. The total length of lower esophageal sphincter(LES) of three GEJ subtypes(typeⅠ, typeⅡ and type Ⅲ) were(3.35±0.56)cm, (3.29±0.87)cm and(2.43±0.22)cm, respectively. The LES intra–abdominal length of three GEJ subtypes were(2.41±0.68)cm, (3.07±4.59)cm and(0.00±0.00)cm, respectively. The LES rest pressure of three GEJ subtypes were(22.00±8.00)mmHg, (16.46±8.60)mmHg and(11.07±5.80)mmHg, respectively. The total length of LES were significantly different among three subtypes(P 0.05). Among type I and type II patients, there were no significant difference in LES–CD distance, total length of LES, LES intra–abdominal length and LES rest pressure between RE group and NERD group. Conclusion HRM can clearly distinguish the GEJ subtypes. To some extent, esophageal motility characteristics of the patients with different subtypes GEJ is various. However, it still needs further studies with larger sample size to confirm. Key words: Gastroesophageal reflux disease; High resolution manometry; Gastroesophageal junction

Prevention and management of accessory hepatic duct injury during laparoscopic cholecystectomy

To explore the prevention and management of accessory hepatic duct (AHD) injury during laparoscopic cholecystectomy (LC). Four cases of type Ⅰ AHDs were found in our series. In three cases, the injured ADHs were clipped by Hemolock during LC while another case was sutured during laparoscopic re-operation. Four cases of typeⅡ, Ⅲ, Ⅳ AHDs injury were found and treated by different intraoperative methods. Conclusion for preventing AHD injury during LC, anatomic identification is essential for surgeons. A small AHD ( 3 mm) injury requires an effective drainage. Key words: Cholecystectomy, laparoscopic; Injury of accessory bile duct

Vortex lattice in effective type-I superconducting films with periodic arrays of submicron holes

The vortex matter and related phenomena in superconducting films with periodic arrays of microholes (antidots) are studied within the nonlinear Ginzburg–Landau (GL) theory. By varying the GL parameter κ, the vortex–vortex interaction is fine tuned, from repulsive to attractive behavior. This interaction is of crucial importance for equilibrium vortex structures, the saturation number of the antidots, and the related quantities, such as critical current. Due to vortex attraction in effectively type-I samples, the giant-vortex state becomes energetically favorable (contrary to the type-II behavior). For the same reason, the number of vortices which can be captured by antidots, increases with decreasing κ. As a result, for given magnetic field, the critical current is larger for effectively type-I superconductors than in conventional type-II cases.