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Sun WC, Chen PA, Chen BPR, Lee WC, Kao HK, Yang WE, Chang CH. Classification of radial polydactyly based on physical characteristics. Pediatr Neonatol 2024; 65:133-137. [PMID: 37658029 DOI: 10.1016/j.pedneo.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/31/2023] [Accepted: 04/20/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Previous classifications in polydactyly of the thumb were by the level of duplication on radiography. This study aimed to develop a practical algorithm based on physical characteristics for treatment guidelines. METHODS The polydactylies were stratified using four physical characteristics: floating, symmetry, dominant side, and joint angulation/nail size. The algorithm identified the hypoplastic type and then stratified the polydactylies as symmetric and asymmetric. The asymmetric type was divided into ulnar dominant and radial dominant. The symmetric type was divided into adequate type and inadequate type. The prediction of treatments was studied retrospectively by the distribution of surgical procedures in 500 patients with 545 affected thumbs, by the new classification and the Wassel-Flatt classification. RESULTS Of the 545 polydactylies, 78 (14.5%) were categorized as the hypoplastic type, 369 (67.5%) as the ulnar-dominant type, 8 (1.5%) as the radial-dominant type, 70 (12.8%) as the symmetric adequate nail type, and 20 (3.7%) as the symmetric inadequate type. Treatments were excision and reconstruction in 403 polydactylies (73.9%), simple excision in 135 polydactylies (24.8%), and the Bilhaut-Cloquet procedure, ray amputation, and on-top plasty procedures were only performed in 7 polydactylies (1.3%). The distribution of surgical procedures was distinct among the new classification types and was similar among the Wassel-Flatt types. CONCLUSIONS The new classification stratified polydactylies by physical findings in a stepwise manner. Though surgical technical details are not included, this simple classification is useful for paediatricians and parents to understand how a surgical decision is made. LEVEL OF EVIDENCE Diagnostic Level IV.
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Affiliation(s)
- Wei Chien Sun
- Department of Paediatric Orthopaedics, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Po An Chen
- Department of Paediatric Orthopaedics, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Brian Po Rong Chen
- Department of Paediatric Orthopaedics, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Wei Chun Lee
- Department of Paediatric Orthopaedics, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Hsuan Kai Kao
- Department of Paediatric Orthopaedics, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Wen E Yang
- Department of Paediatric Orthopaedics, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chia Hsieh Chang
- Department of Paediatric Orthopaedics, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
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Yao F, Yin C, Yu W, Liu W, Yang G, Shen X. Intraoperative Observation of the Proper Digital Nerves in Wassel-Flatt Type Ⅳ Radial Polydactyly. J Hand Surg Am 2023; 48:1169.e1-1169.e6. [PMID: 36100486 DOI: 10.1016/j.jhsa.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 06/06/2022] [Accepted: 07/20/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of the study was to present the intraoperative findings of the relevant digital nerves of the duplicated thumbs in an excision and reconstruction procedure for the Wassel-Flatt type Ⅳ radial polydactyly. METHODS The study was conducted on patients with Wassel-Flatt type IV radial polydactyly who underwent excision and reconstruction between 2018 and 2021 at our institution. The ulnar digital nerve of the radial thumb and the radial digital nerve of the ulnar thumb were identified and traced intraoperatively. The level of the bifurcation of the nerves and abnormal findings were documented. RESULTS A total of 123 hands in 119 patients were included in this study. In 114 hands, the bifurcation of the nerves was located within 1 cm of the metacarpophalangeal flexion crease. The radial digital nerve to the ulnar thumb was abnormally compressed in deep fascial tissue in 7 of these 114 hands. In 5 hands, the level of bifurcation was more than 1 cm proximal to the crease. No radial digital nerve to the ulnar thumb was identified in the remaining 4 hands. CONCLUSIONS Although rare, abnormal nerve compression of the digital nerve may exist in duplicated thumbs of Wassel-Flatt type IV radial polydactyly. CLINICAL RELEVANCE In an excision and reconstruction procedure, we suggest that the bifurcation of the nerves should be identified before the nerve to the radial thumb is excised to avoid injuring the nerve to the main ulnar thumb.
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Affiliation(s)
- Feng Yao
- Department of Pediatric Orthopedics, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Chunhua Yin
- Department of Pediatric Orthopedics, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Wentao Yu
- Department of Pediatric Orthopedics, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Wei Liu
- Department of Pediatric Orthopedics, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Guang Yang
- Department of Hand Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Xiaofang Shen
- Department of Pediatric Orthopedics, Children's Hospital of Soochow University, Suzhou, Jiangsu, China.
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Du Z, Cui Y, Jiang H, Han D. Aesthetic outcomes of and anatomic reconstruction for Wassel type IV-D radial polydactyly using a modified Bilhaut-Cloquet procedure. Front Pediatr 2023; 11:1192168. [PMID: 37484763 PMCID: PMC10360172 DOI: 10.3389/fped.2023.1192168] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/26/2023] [Indexed: 07/25/2023] Open
Abstract
Wassel type IV-D thumb duplication is the most complex form and anatomic reconstruction is difficult. The aim of this study was to create an aesthetically satisfactory anatomical reconstruction for Wassel type IV-D radial polydactyly thumbs using the modified Bilhaut-Cloquet procedure. Surgery was performed on 24 thumbs with Wassel type IV-D radial polydactyly. To align the joint surfaces, the proximal phalanxes were unequally joined, primarily on the ulnar, and the distal phalanx was either symmetrically joined or unequally joined via curvature osteotomy. The patients were followed up for 12-91 months. The interphalangeal joint remained stable in all cases. The average functional score was 13.5 points (maximum 14 points). The overall average cosmetic score was 3.3 (maximum 4 points). Our modification of the Bihaut-Cloquet procedure produced good functional results for patients with Wassel type IV-D radial polydactyly. This method is used to correct the alignment and to stabilize the interphalangeal joint in both hypoplastic thumbs.
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Affiliation(s)
- Zijing Du
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Cui
- Department of Hand Surgery, Jinshan Hospital of Fudan University, Shanghai, China
| | - Hao Jiang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dong Han
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Chen PA, Sun WC, Chen BPR, Lee WC, Kao HK, Yang WE, Chang CH. Prediction of Surgical Outcomes of Radial Polydactyly From the Wassel-Flatt Type and Symmetry of Duplication. J Pediatr Orthop 2023; 43:e305-e309. [PMID: 36728384 DOI: 10.1097/bpo.0000000000002349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The Wassel classification is commonly used for cases of radial polydactyly but has not been used to predict surgical outcomes. This study aimed to investigate the predictive factors of surgical outcomes using the Wassel type and symmetry of duplication. METHODS Forty-five patients with 47 radial polydactylies were reviewed using the Japanese Society for Surgery of the Hand (JSSH) scores 4.6 years after minor thumb excision and reconstructive surgery. The symmetry index was defined as the metaphyseal width ratio of the minor thumb to the dominant thumb. The relationships between the JSSH scores and operation age, sex, side, follow-up duration, Wassel type, symmetric index, divergent angle, and joint angulation were analyzed by linear regression. RESULTS The mean JSSH score of the 47 thumbs was 18.3 points (range, 15-20). Five thumbs had fair or poor outcomes (scores <17), all of which were Wassel type IV. The hypoplastic type had a better JSSH score (19.4) than other Wassel types. The symmetric index had a negative relationship with JSSH scores, especially for Wassel type IV (r=-0.68, P =0.001). Linear regression revealed that the symmetric index was the only independent factor significantly associated with JSSH scores among Wassel type IV polydactylies ( P <0.05). The receiver operating characteristic curve suggested a symmetric index <0.74 could predict good or excellent outcomes. CONCLUSION The symmetry of the 2 duplicated thumbs is an important factor for surgical outcomes. The Wassel type IV polydactylies with a symmetric index >0.74 are at greater risk of fair or poor outcomes after excision and reconstruction, and further studies are warranted to confirm whether the Bilhaut-Cloquet procedure is a good choice. LEVEL OF EVIDENCE Level IV-Case-control study.
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Affiliation(s)
- Po An Chen
- Division of Pediatric Orthopedics, Bone and Joint Research Center, Department of Orthopedic Surgery, Chang Gung Memorial Hospital - Linkou Branch, Taoyuan, Taiwan
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Saito S, Makino A, Yamanaka H, Tsuge I, Morimoto N. Use of the duplication range concept for understanding morphology and predicting prognosis in thumb polydactyly. J Hand Surg Eur Vol 2023; 48:10-19. [PMID: 36204982 DOI: 10.1177/17531934221126864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study systematically and comprehensively analysed 129 thumb polydactylies in 122 patients using a duplicating range concept based on the level of skin and skeletal bifurcation. Numerical levels were defined along the longitudinal axis of the ulnar thumb duplicate from distal to proximal: level 0 (thumb tip) to level 6 (carpometacarpal joint). The relationships between duplication range and morphological parameters were evaluated. Nail asymmetry was associated with skin bifurcation levels 0 to 2. Proximal phalangeal asymmetry and interphalangeal joint deviation, associated with skin bifurcation levels were assigned scores of 1 to 2.5 and 1 to 2, respectively. Metacarpophalangeal joint deviation had a bimodal distribution, at levels 1.5 and 4 of the longitudinal axes. Morphological similarity was found in patients with the same duplication range. The duplication range concept could potentially improve our understanding of morphology variation and predicting prognoses in thumb polydactyly.Level of evidence: III.
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Affiliation(s)
- Susumu Saito
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Aiko Makino
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Yamanaka
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Itaru Tsuge
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Naoki Morimoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
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Liu Y, Xu X, Wang L, Lao J, Zhuang Y, Fang Y. Resection and reconstruction for radial polydactyly Type IV-D in 206 cases: a retrospective clinical analysis. BMC Musculoskelet Disord 2022; 23:167. [PMID: 35193542 PMCID: PMC8864877 DOI: 10.1186/s12891-022-05119-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Radial Polydactyly Type IV-D deformity is difficult to treat because of the most complex bone and soft tissue anomalies. Resection and reconstruction for one of the two thumbs was an option for treatment. Objective The study was to present our method of resection and reconstruction with a new incision for radial polydactyly Type IV-D and evaluate the clinical efficacy comprehensively using Rotterdam assessment system in a large sample. Methods 206 cases of type IV-D thumb duplication underwent resection and reconstruction surgical treatment between 2010 and 2019. Two equal triangle flap incisions were designed around the radial thumb. The radial thumb was resected and the ulnar thumb was reconstructed in aspects of bone, tendons, ligaments and abductor pollicis brevis. The clinical results were evaluated using Rotterdam assessment system. Results The mean follow–up period was 2.2 years (SD 1.5). The mean age of the patients was 9 months (SD 1.8) at the time of operation. The mean ranges of active IP and MP joint flexion and extension were 110° and 26°. The mean angulations for IP and MP joint instabilities were 3° and 11°, relatively. Angulation for palmar abduction was 58°. The mean appearance domain score was 8.9. The average parental satisfaction score was 2.5 and the average patient-reported pain score was 2.1. The mean functional domain score for all patients was 6.6. The average appearance domain score was 8.9. The mean patient-reported domain score was 4.5. The mean Rotterdam outcome score was 20.0, equivalent to 67% of the full score. The postoperative score of patients over two years old was significantly lower than that of patients under two years old. Conclusion Resection and reconstruction method with two equal triangle flap incisions was a recommended treatment for radial polydactyly Type IV-D. Level of evidence IV
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Affiliation(s)
- Yuzhou Liu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Xiuyue Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Le Wang
- Department of Pediatric Surgery, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, People's Republic of China
| | - Jie Lao
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Yongqing Zhuang
- Hand and Microvascular Surgery Department, Shenzhen People's Hospital, Guangdong Province, 518020, China
| | - Yousheng Fang
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China. .,Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, People's Republic of China. .,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China. .,Department of Hand Surgery, Shanghai Huashan Hospital, 12 Wulumuqi Zhong Road, Jing An District, Shanghai, 200040, China.
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Yao Y, Zhou H, Li L, Nan G. Epidemiological statistics of congenital thumb duplication in the Chinese population. J Orthop Surg Res 2021; 16:481. [PMID: 34372898 PMCID: PMC8351434 DOI: 10.1186/s13018-021-02567-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/17/2021] [Indexed: 12/28/2022] Open
Abstract
Background Thumb duplication is a very common congenital malformation. This study describes and compares the phenotypic manifestations of polydactyly between southwest and northeast China. However, previous studies had a limited sample size. Therefore, this study used a large sample. Methods A total of 3549 well-characterized thumb duplication cases were divided into group A (southwest China) and group B (northeast China). Results In group A and group B, the left-to-right ratio was 1:1.5 and 1:1.75, respectively, and the female-to-male ratio was 1:1.5 and 1:1.58, respectively. Conclusions There were no significant differences in gender distribution or the distribution of left and right polydactyly between the two groups, but the distribution of bilateral polydactyly was significantly different.
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Affiliation(s)
- Yingling Yao
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Stem Cell Biology and Therapy Laboratory, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.,Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Haolin Zhou
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang City, 110004, China
| | - Lianyong Li
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang City, 110004, China.
| | - Guoxin Nan
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Stem Cell Biology and Therapy Laboratory, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China. .,Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing, China.
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Saito S, Morimoto N. Interphalangeal joint deviation in floating-type radial polydactyly with malalignment of the flexor pollicis longus tendon: a case report. J Hand Surg Eur Vol 2021; 46:556-558. [PMID: 33459138 DOI: 10.1177/1753193420982209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Susumu Saito
- Department of Plastic and Reconstructive Surgery, Kyoto University, Kyoto, Japan
| | - Naoki Morimoto
- Department of Plastic and Reconstructive Surgery, Kyoto University, Kyoto, Japan
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Zhou T, Zhang X, Yu X, Bai Y, Chen H, Li J, Li H, Yu Y. Modified method for reconstruction of thumb abduction function in children undergoing surgical treatment of thumb duplication. J Child Orthop 2021; 15:97-105. [PMID: 34040655 PMCID: PMC8138790 DOI: 10.1302/1863-2548.15.200197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE This study was performed to evaluate a modified method of reconstructing the thumb abduction function in children undergoing surgical treatment of thumb duplication. METHODS This retrospective study included 33 children (38 thumbs) with Wassel type III to VII thumb duplication who underwent excision of the polydactylism and osteotomy of the preserved thumb. Among them, 16 children (19 thumbs) underwent reconstruction of the attachment of the articular capsule and collateral ligament of the metacarpophalangeal joint, abductor pollicis brevis and flexor pollicis brevis by the anchor technique (Group A), while 17 children (19 thumbs) underwent suturing the attachment of the above-mentioned soft tissues to the periosteum (Group B). All children were followed up for six years after surgery. The appearance, function and joint stability of the preserved thumb were compared between the two groups; the bone alignment and development were observed. RESULTS The deformity rate of preserved thumbs and the positive rate of lateral stress test were significantly lower in Group A than B (p < 0.05). The modified Tada score and the distance of first web were significantly higher in Group A than B (p < 0.05). Flexion, extension, adduction, abduction and palmar movement of the thumbs were good; bone alignment and development were good and no osteophyte or anchor shadow was left in the preserved thumbs in Group A. CONCLUSION Reconstruction of the abduction function using the anchor technique is effective in children undergoing surgical treatment for Wassel type III to VII thumb duplication and it may be superior to the conventional technique. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Tong Zhou
- Hebei Medical University, NO.361 East Zhongshan Road, Shijiazhuang 050017, Hebei, People’s Republic of China.,Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People’s Republic of China.,Department of Hand Surgery, The Second Hospital of Tangshan, NO.21 North Jianshe Road, Tangshan 063000, Hebei, People’s Republic of China
| | - Xu Zhang
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People’s Republic of China
| | - Xiaofei Yu
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People’s Republic of China
| | - Yanbin Bai
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People’s Republic of China
| | - Huan Chen
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People’s Republic of China
| | - Jia Li
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People’s Republic of China
| | - Hongjie Li
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People’s Republic of China
| | - Yadong Yu
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People’s Republic of China.,Correspondence should be sent to Yadong Yu, Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People’s Republic of China. E-mail:
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