Congenital pseudarthrosis of the tibia(CPT) is one of the most challenging diseases confronting pediatric orthopedic surgeon.The goal of the treatment is to achieve primary union and minimize the incidence of refracture and residual deformities.An optimal surgical treatment for the management of CPT is currently unavailable.Combined surgery can obtain good results.However, duo to heterogeneity of the disease, variable patients require individualized treatment to get a better prognosis.

[Objective]To observe radiographic morphology of femoral head at skeletal maturity of the Salter innominate osteotomy for treatment of patients with Legg-Perthes disease and evaluate sphericity of the femoral head and congruity of the hip.Based on system review of literatures,thes attempted to determine the indications and methods of treatment.[Method]Sixteen patients of Legg-Perthes disease were treated by Salter innominate osteotomy before 1994.The mean age of patients was six years and seven months at operation.Of them,only were 12 patients followed up 10 years and ten months avergely and mean ages of patients were 17 years and 2 months at last follow-up.Growth of plate of femoral head and Y cartilage of acetabulum was closed,indicating skeletal maturity.[Result]According to Stulberg classification of outcome,there were four cases in Stulberg class Ⅰ and six patient in class Ⅱ and one patient in class Ⅲ and one patients in class Ⅳ and no case in class Ⅴ.Lower limb of shortening was averagely 1.5 cm(ranged 0.8~2.0 cm)and the range of motion of hips was almost normal and no abnormal gait was observed.[Conclusion]The Salter innominate osteotomy could keep sphericity of the femoral head and congruity with acetabulum of the hip for children with Legg-Perthes disease and also could be in aid of preventing premature arthritis of hip.

[Objective]To evaluate the results of intraoperative autologous blood transfusion in pediatric orthopaedic operation.[Method]Intraoperative blood salvage was reinfusioned in 17 patients by Cell Saver 5.The volume of reinfusion blood and complications were recorded.[Result]Among 17 patients,an average of(171?53)ml autologous blood was transfused intraopratively.The use of Cell Saver 5 was directly responsible for a 80% reduction in the total amunts of homologous blood.Four patients has experienced transient hemoglobinuria.No other complications appeared.[Conclusion]Reinfusion of blood salvage during pediatric orthopaedic operation is safe and effective.It is able to reduce the amount of homologous blood transfusion.

[Objective]To study the results of Ilizarov technique in treatment of the severe rigid talipes equinovarus deformity.[Method]The Ilizarov technique was used in 9 patients(11 feet)with the severe rigid talipes equinovarus deformity,in which one patient with syringomyelia,and the orthers with congenital club foot.[Result]Prospective goals of correction were made in all the cases.The results were assessed by Garceau criterion.For 9 patients(11 feet),6 feets achieved excellent result,4 feets good and 1 foot poor results respectively.[Conclusion]Ilizarov technique in treatment of the severe rigid talipes equinovarus deformity achieves a good clinical result.

Objective To analysis the imaging findings of tetralogy of Fallot and related pathological basis. Methods The clinical,pathologic and right ventriculography findings of 124 tetralogy of Fallot which were confirmed by surgery were retrospectively aralyzed. Results 124 tetralogy of Fallot were separated into type Ⅰ 62, Ⅱ 31, Ⅲ 6, Ⅳ 25 by Gray's classification,and slight,midrange,severe stenosis were 71 (0.51～0.6) ,33(0.41～0.5) ,20(<0.4) by Partiole's classcification. As to ventricular septal defect(VSD) ,infra-cristal ventricular septal defect were found in 116/124 in which crista supravcntricalaris appeared as girdle-shaped filling defect in lateral position, suprac-ristal ventricular septal defect were found in 8/124 in which crista supraventricularis appeared as round filling defect in orthophoric position. Conclusions Right ventriculography can precisely display stenosis of pulmary and ventricular septal defect(VSD). It has great valne in diagnosis and surgical therapy of tetralogy of Fallot.

ObjectiveTo investigate changes of the level of serum thyroxine after different style operation on thyroid gland,for guiding replacement therapy after surgery. MethodsTo select patients randomly,include the excision of adenoma of thyroid、the lobectomy of unilateral thyroid、the subtotal ectomy of bilateral thyroid and total resection of bilateral thyroid quaque forty,among the total,the patients who suffererd the total resection of bilateral thyroid take thyroxine 40mg bid orally everyday. To detect the serum thyroxine in all of the patients, when preoperation、ten days after operation、one month after operation and three months after operation. ResultsThe serum thyroxine in patients who suffererd the excision of adenoma of thyroid were had no marked changes compare to preoperation; Serum FT3 、FT4 in patients suffer the lobectomy of unilateral thyroid are lower than preoperation when ten days after operation (P＜0.01) ;Serum FT3、FT4 in patients sufferred subtotal ectomy of bilateral thyroid were lower than preoperation,when ten days after operation and one month after operation( P ＜ 0.01 ), then returned to the level of preoperation when three months after operation;the serum thyroxine of patients who sufferred the total resection of bilateral thyroid had no marked changes compare to preoperation,when they taker thyroxine 40mg bid orally everyday. ConclusionThe serum thyroxine level of patients who suffer the lobectomy of unilateral thyroid、the subtotal ectomy of bilateral thyroid and total resection of bilateral thyroid is lower than preoperation at different degree, they should be given replacement therapy properly.

Objective To investigate the effect of insulin-like growth factor-1 (IGF-1) on intercellular adhesion molecule-1 (ICAM-1) expression in rat model with congestive heart failure (CHF). Methods The model of CHF in male Sprague-Dawley rat was established using subcutaneous injection of isoproterenol. The rats were randomized into model group (n = 10),angiotensin converting enzyme inhibitors (ACEI) group ( n=10) and IGF- 1 group ( n = 10). The rats injected with saline were used as normal controls (n=10). The haemodynamic parameters of rats in each group were detected. The concentration of plasma angiotensin Ⅱ (Ang Ⅱ ) and expression of ICAM-1 in rat myocardium were determined by radioimmunoassay and immunohistochemistry,respectively. Results Compared with model group, ACEI and IGF-1 could rescue the diversities of hemodynamic parameters. In addition, ACEI and IGF-1 could also significantly down-regulated concentration of plasma Ang Ⅱ and inhibited ICAM-1 expression. Compared with ACEI, IGF-1 more significantly inhibited ICAM-I expression (0. 804 ± 0. 024 vs. 1. 254 ± 0. 059) and down-regulated concentration of plasma AngⅡ [(369.2±65.0) μg/L vs. (384.4±56.2) μg/L]. Conclusions IGF-1 can suppress ICAM-1 expression in rat model with CHF induced by isoproterenol. This effect may be related to inhibiting activation of RAS system.

Objective:To explore clinical application value of color Doppler ultrasound (CDU) assigned to diagnose triple-negative breast cancer (TNBC) and axillary lymph node metastasis (ALNM).Methods:A retrospectively analyzed of proved of clinical data on the 863 patients breast cancer in women by CDU inspection,operation and pathology.According results will be divided into TNBC group and non negative breast cancer (NTNBC) group via clinical pathological and immunohistochemical detection.Using multi-factor unconditioned Logistic regression analysis the CDU supposed the diagnosis and the correlation of TNBC.Results:The coincidence rate of CDU and pathological diagnosis was 90.96％ (785/863),78 cases (9.04％) remove breast masses,105 patients TNBC group and NTNBC group 680 patients.The mass circular or elliptic (48.57％ vsl0.70 ％),the tumor maximum diameter 5.0 cm (21.90％ vs 15.30 ％),micro calcifications (87.62％ vs 74.12 ％),state clearly (56.19％ vs 41.47 ％),no burr edge character (74.29％ vs 41.62 ％),peripheral hyperechoic halo ring (74.29％ vs46.76 ％),rear echo attenuation (72.38％ vs 46.76 ％),no ALNM (61.90％ vs 37.35％) comparing the two groups exists significant difference (P＜ 0.05),while the mass number,and vertical and horizontal diameter ratio,degree of echo,echo distribution and blood flow classification comparing the two groups were no significant difference (P＞ 0.05).The CDU fu points ＞ 10 divided into NTNBC and pathological coincidence rate 93.93％ (680/724),8 ～ 10 points TNBC suspected diagnosis coincidence rate 11.51％ (16/139),＜ 8 points TNBC tendency diagnosis coincidence rate 64.03％ (89/139),TNBC total diagnostic coincidence rate was 75.54％ (105/139).In CDU diagnosed 785 cases of breast cancer,the ALN enlargement in 319 cases (40.64％),with TNBC group was 61.90％ (65/105),NTNBC group was 37.35％ (254/680).Logistic regression analysis results:tumor assumes the circular or elliptic,edge without burr,peripheral hyperechoic halo ring,rear echo attenuation and ALNM with TNBC has certain correlation (P＜0.05).Conclusion:The seemingly benign breast diseases and axillary lymph node enlargement,the CDU,supposed less than 8 points,age 50 or less or not at the same time,menopause or having a history of breast cancer susceptibility to family,important reference index,clinical value has high of CDU diagnostic of TNBC and ALNM.

ObjectiveTo detect glucose-6-phosphate isomerase (GPI) in knee joint synovial fluid of active rheumatoid arthritis (RA) and explore the correlation between GPI and anti-cyclic citrulline peptide antibody (anti-CCP).MethodsGPI and anti-CCP in the synovial fluid were measured by enzyme linked immunosorbent assay(ELISA) from 22 patients with active RA and 37 patients with active osteoarthritis (OA).Student's t-test was used for intergroup comparison and Spearman's analysis was used for correlation analysis.ResultsThe level of GPI and anti-CCP in the synovial of active RA [ (9.6±8.4) μg/ml,( 14.61 ±18.64) U/ml] was significantly higher than that of active OA[ (0.9±1.8) μg/ml,(1.42±0.09) U/ml)].There was positive correlation between GPI and anti-CCP (r=0.447,P=0.037).ConclusionHigh expression of GPI is shown in active RA synovial fluid.It is suggested that GPI as an antigen that may participate in chronic synovitis,bone destruction and joint malformation.Both GPI and anti-CCP may be the laboratory markers for the diagnosis of RA.

Objective To investigate the role of lysyl oxidase (LOX) in synovitis and cartilage destruction by comparing the expression of LOX in synovial fluid and synovium of active rheumatoid arthritis (RA) and active osteoarthritis (OA).Methods LOX in the synovium was detected by immunohistochemistry from 14 patients with active RA,24 patients with active OA and 20 patients with knee injury (the control group).LOX in the synovial fluid was measured by enzyme linked immunosorbent assay (ELISA) from 14 patients with active RA and 24 patients with active OA.T-test was used for statistical analysis.Results The level of LOX expression in active RA synovium (0.012±0.007) was similar to that in active OA synovium (0.013±0.011,P＞0.05).But the expression of LOX in synovium of active RA and active OA was significantly higher than that in synovium of the control group (0.003±0.004,P＜0.01).The amount of LOX in the synovial fluid of active RA [(1.9±1.4) μg/ml] was significantly higher than that of active OA [(1.0±0.4) μg/ml,P＜0.05].Conclusion High expression of LOX in the synovial fluid and synovium of active RA and active OA suggest that LOX may be involved in chronic synovitis and cartilage destruction,and may be related with the extent of synovitis and cartilage destruction.