Objective To investigate and compare the biomechanical stability between anatomical and overlapping reconstruction of the greater tuberosity in cadaveric humeral head replacement model. Methods Eight pair (16) fresh-frozen shoulder cadavers were match-paired into 2 groups. Four-part fracture model was created in all cadavers. Standardized humeral head replacement procedure was carried out in all specimens, and anatomical and overlapping reconstruction of the greater tuberosity was applied to each group respectively. Custom mounting apparatus and fixation jigs were designed for designated shoulder motion. A Binocular 3D Computer Vision metrical method was employed to measure the displacement of greater tuberosity relative to the humeral diaphysis. Results When the shoulder was external rotated to neutral position, the mean displacement of greater tuberosity in anatomical reconstruction group was (1.81?1.75) mm,while the mean displacement was (3.23?2.91) mm in overlapping group. Statistical difference was found between the 2 groups. When the glenohumeral joint was elevated to 30? and 60? forward flexion, the mean displacement of greater tuberosity in anatomical group was (4.01?5.00) mm and (5.99?6.97) mm respectively, while the mean displacement was (3.02?5.27) mm and (6.97?7.00) mm respectively in overlapping group. No statistical difference was found between the 2 groups during forward flexion measurement. Conclusion In cadaveric humeral head replacement model, anatomic greater tuberosity reconstruction shows better mechanical stability compared with overlapping reconstruction during external rotation to neutral position. This result suggests that there may be some loss in mechanical stability in overlapping fixed greater tuberosity. Even though standardized postoperative rehabilitation protocol are strictly followed, evident displacement of the greater tuberosity was detected. Postpone of the postoperative rehabilitation program after humeral head replacement for a decent period of time may benefit tuberosity healing.

Objective To analyze the oral glucose tolerance test (OGTT) curve characteristics in Chinese women with gestational diabetes mellitus (GDM) or gestational impaired glucose test (GIGT) and to evaluate whether omission of the third-hour plasma glucose measurement of the OGTT could alter the sensitivity of the diagnosis on GDM,and whether there is a close relationship between plasma glucose values of 50 g glucose challenge test (50 g GCT) or OGTT and insulin therapy. Methods A retrospective analysis on medical records of 647 cases with GDM from January 1,1989 to December 31,2002 and 233 cases with GIGT were performed. Among 647 cases of GDM,535 were diagnosed by 75g OGTT. All OGTT (535 with GDM and 233 with GIGT) results were evaluated. Results There were 112 cases of GDM diagnosed by elevated fasting plasma glucose without OGTT performed. Of 535 cases of GDM diagnosed by OGTT,49.2% (263/535) women were with fasting plasma glucose value ≥5.8 mmol/L;90.1% (482/535) women with 1hr plasma glucose values ≥ 10. 6 mmol/L;64.7% (359/535) were with 2 hr plasma glucose levels ≥9.2 mmol/L. There were only 114 cases (21.3%) with abnormal 3 hr plasma glucose levels among 535 women with OGTT,and when 3 hr plasma glucose reached cutoff value,49.1% the other three values of OGTT were abnormal and 34.2% with the other two values of OGTT. Among 233 women with GIGT,only 4 cases with the abnormal 3 hr plasma glucose. We also investigate use of the glucose values for the first 2 hours of OGTT only missed 19 cases of GDM,still discriminated 516 cases. Omission of the third -hour glucose tolerance test value only resulted in failure to diagnose 2.9%(19/647) of GDM cases and 1.72%(4/233) of GIGT cases in Chinese women. Plasma glucose levels ≥11.2 mmol/L following 50 GCT were highly associated with GDM necessitating insulin therapy (75.4%). An elevated fasting plasma glucose level was also associated with insulin therapy (59.7%).Conclusion Omission of the third -hour glucose tolerance test value still yielded a higher sensitivity of 97.1%(628/647) of GDM cases and 98.2%(229/233) of GIGT cases in Chinese women. It is practicable to omit 3-hour post -glucose ingestion value of the OGTT in Chinese women. Plasma glucose levels ≥11.2mmol/L following 50g GCT indicated 75.4% cases of GDM necessitating insulin therapy.

Objective To evaluate the results of delayed proximal humeral fractures treated by open reduction and internal fixation. Methods From January 2005 to July 2008, 26 patients with delayed proximal humeral fractures were treated by open reduction and internal fixation. There were 11 males and 15 females. The patients ranged from sixteen to 22-81 years old, with an average age of 49.3 years. The interval from injury to operation ranged 22 to 510 days, with a mean of 88 months. There were two-part fractue in surgical neck in 12 cases, two part in lesser tubercles of in one case,two part in greater tubercles in seven cases, three part in greater tubercles in three cases, four part in 2 cases and the splitting fracture in the head of humerus in one ease.The range of motion, VAS for pain, ASES (American sboulder and elbow surgeon's form) score, Constant score, UCLA (University of California-Los Angels scoring system)score and SST(Sim-pie Shoulder Test) for function evaluation were all recorded. The results were evaluated according to sex,age, injury side, operation times and combined injury by ANOVA.The correlation analysis was performed between operative time and results. Results The average forward flexion was 137.3°±35.1°, average exter-nal rotation was 28.9°±24.1° and internal rotation was T_(10). The mean VAS score was 0.7±1.2, the mean Constant was 83.1±17.9, the mean UCLA was 28.9±6.0, the mean SST was 8.7. There were no difference re-gaming sex, age, injury side, operation time and combined injury, fracture type and complications groups. No correlation existed between operative time and results. Conclusion It is very hard to treat delayed proximal humeral fracture due to high complication and demanding experience. With appropriate surgical technique, satisfactory results can be expected by open reduction and internal fixation.

Objective To compare the results of locking intramedullar nail and Locking plate in treating proximal humerus fractures and discuss features of each instrument. Methods A total of 54 patients with fresh two-part surgical neck fracture of proximal humerus were divided into intramedullar nail fixation group(26 patients)and locking plate fixation group(128 patients).with no statistical difference upon age,gender and dominate hand involvement in two groups.At final follow-up,physical examination and X-ray films were used to evaluate fracture healing of shoulder ioint.In the meantime,VAS score,ASES score,Constant-Murley score,UCLA and SST questionnaire were used to evaluate the function of the shoulder in two groups. Results All fractures were healed basically within 8 weeks postoperative-ly.No infection or av&scular necrosis were fouml during follow-up.The incidence rate of complication in locking plate fixation group was higher than that in intramedullar nail fixation group.Both groups obtained satisfactory functional recovery of shoulder ioint.There was no statistieal difference in regard to active for-ward elevation,external rotation besides body,active height of internal rotation,Constant-Murley scores,and SST scores in both groups.The average ASES score and VAS score of locking plate fixation group was significantly better than those of intramedullar nail fixation group. Conclusions Both fixations can treat surgical neck fractures of proximal humerus well.Locking intramedullar nail causes less trauma to the patient while Locking plate has advantages in patients'final functional recovery.

Objective To investigate the relationship of nerve growth factor (NGF) between serum and follicular fluid in patients with polycystic ovary syndrome (PCOS), and its effect on pregnancy outcomes. Methods From December 2011 to November 2012, 65 PCOS patients suffered with in vitro fertilization-embryo transfer (IVF-ET) were included in PCOS group and 31 non-PCOS patients with IVF-ET were used as control group. The expressions of NGF in serum and follicular fluid were detected by ELISA on the injection day of chorionic gonadotropin (HCG). The expression levels of NGF in serum and follicular fluid were compared between PCOS group and control group. Results The NGF levels in serum[(14.38±0.42) ng/L] and follicular fluid[(9.61±0.49)ng/L] were significantly higher in PCOS group than those of control group[(11.39±0.38) ng/L and (7.55 ± 0.40)ng/L]. In PCOS group, NGF levels in serum [(14.22 ± 0.35)ng/L] and follicular fluid [(9.30 ± 0.31)ng/L] were significantly lower in pregnant group than those of non-pregnant group[(14.51±0.43)ng/L, (9.86±0.46)ng/L, P<0.01]. Conclusion The increased levels of NGF in serum and follicular fluid of PCOS patients contribute to the pathogenesis of PCOS. The high expression of NGF in serum and follicular fluid may be harmful to pregnancy in PCOS patients.

Objective To develop a sensitive, specific, rapid and easy method for detecting E. coli O157 : H7 and other Shiga toxin-producing E. coli in food and clinical specimens. Methods A circular probe and capture probe specific for Shiga toxin-2 (stx2) gene had been synthesized and was used for determining the sensitivity of ramification amplification method (RAM). Different serotypes which contained stx2 gene, including an E. coli O157 : H7, an E. coli O46 : H38, an E. coli O111 : NM, an E. coli O22 : H8 and E. coli ATCC23716 (stx2 gene negative) were used for determining the specificity. All strains were detected by RAM to determine whether they contained stx2 gene. Real-time RAM was further studied to detect stx2 gene. Results The lowest number targets detected by RAM assay was 10 copies of stx2, indicating that RAM assay was as sensitive as conventional PCR. The result of specificity showed that different serotypes of strains were all positive for stx2 gene, while nonpathogenic E. coli ATCC23716 was negative. Among 32 isolates, 28 STEC isolates containing stx2 gene were positive by RAM assay, while others were negative. The RAM results were 100% in concordance with that of PCR. The real-time RAM results also showed that as many as 10 bacteria can be detected and the time of appearance of detectable signal was depended on the target concentration. Conclusion RAM assay can offer an alternative method for PCR to detect E. coli O157 : H7 and STEC in all types of specimens because of its simplicity and isothermal amplification.

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.

AIM:To study the effect of captopril on calcineurin and NF-?B p65 in the signal transduction pathway of the cardiovascular remodeling in hypertensive rats.METHODS:Using a animal model of hypertension induced by abdominal aortic banding,the rats were treated with captopril for 10 weeks.The blood pressure was observed with a tail cuff method.The heart weight and heart weight/body weight were measured.The expression of calcineurin and NF-?B p65 were studied by using immunohistochemistry.RESULTS:After treated with captopril,the blood pressure of the model rats was decreased(P

Objective To investigate the changes in the concentration of myocardin in children with lupus nephritis (LN) under different degree of vessel damage.Methods Forty-nine children diagnosed with LN by routine tissue immunolfuorescence, light microscope, and electron microscope were included, and 30 healthy children were included as control group. The pathological classiifcations were performed according to the ISN/RPS 2003 LN pathological classiifcation criterion. According to the Katafuchi evaluation method, the semi quantitative assessment of glomerular and kidney tubule damage was carried out, and the degree of vascular damage was evaluated at the same time. Double antibody sandwich method was used to detect the concentration of serum myocardin.Results The glomerular and kidney tubules damage in children with LN were signiifcantly aggravated with higher pathological classification (P<0.05). Glomerular damage was positively correlated with renal interstitial damage (r=0.96, P<0.01). The degree of vascular damage was related to the degree of glomerular injury and renal interstitial injury, while it was no related with the results of clinical tests. There were different concentrations of myocardin among mild-, moderate-, severe-vessel damage and control groups (F=378.61,P<0.001), and the concentration of myocardin in moderate- and severe-vessel damage groups were obviously lower than those in control group and mild-vessel damage group (P<0.01) while there was no difference between control group and mild-vessel damage group (P>0.05). According to pathological type, there were signiifcant differences in the concentration of myocardial between control group and different pathological types (F=626.793,P<0.01). FromⅡ,Ⅲ,Ⅲ+Ⅴ,Ⅳ toⅣ+Ⅴ, the concentrations of myocardial were decreased systematically, and there were statistic differences between groups (P all<0.05).Conclusion The concentration of myocardin in children with LN can relfect the renal vascular damage to a certain extent. Elevation of myocardin concentration may be helpful for the repair of vascular damage.

ObjectiveTo evaluate the effect of radiofrequency therapy in the arthroscopic treatment of subacromial impingement syndrome.MethodsFifty patients with subacromial impingement syndrome treated arthroscopically were enrolled in the study.Preoperatively,the average visual analogue scale (VAS)score of all 50 patients was 5.3±1.8; the average UCLA score was 15.8±4.2; the average Constant score was 65.6±16.2; the average Simple Shoulder Test(SST) score was 6.5±3.3; the forward elevation was averagely 127.4°±40.1°; the external rotation was averagely 34.4°±23.1°; the internal rotation was averagely at L1 level.Patients were randomly assigned to radiofrequency group which received subacromial decompression and Topaz radiofrequency treatment,or control group which only underwent subacromial decompression.The VAS score,UCLA score,Constant score,and SST score were used to evaluate the clinical outcomes 3 weeks,6 weeks,3 months,6 months and 1 year after operation.The assessment of shoulder range of motion included forward elevation、external rotation and internal rotation.The clinical outcome data were compared between the radiofrequency group and the control group,as well as before and after operation within each group.ResultsAt the final follow-up,the average VAS score of all 50 patients was 0.4±1.1; the average UCLA score was 32.9±3.0; the average Constant score was 96.4±5.1; the average SST score was 11.3±1.2; the forward elevation was averagely 161.5°±13.7°; the external rotation was averagely 52.2°±10.9°; the internal rotation was averagely at T7 level.There were statistical differences between preoperative and postoperative indexes mentioned above.However,there were no statistical differences in indexes between the radiofrequency group and the control group at any time point.ConclusionThe Topaz radiofrequency therapy has no significant impact on clinical outcome of arthroscopic treatment of subacromial impingement syndrome.