Objective To provide a good anatomical foundation for transposition of the branch of median nerve superficial flexor muscle repairing the movement branch of ulnar nerve to recover the function of intrinsic muscle, by anatomic study of the muscle branch of the superficial flexor muscle of the median nerve and the movement branch of ulnar nerve. Methods Twenty adult upper limb specimens immersed fixed by formalin were elected and expose the midian nerve and ulnar nerve. Then every anatomical index was measured. Simulate to manipulate that the branch of superficial flexor muscle repair the motor b ranch of ulnar nerve. Calculate the number of myelinated nerve fibers of the branch of superficial flexor muscle. Results The distance between the position into muscle and styloid process of radius and styloid process of ulna: (21.4±1.8)mm, the distance that can be separated: (27.1±1.2)mm, the transverse diameter: (1.2±0.2)mm, anteroposterior diameter: (0.7 ± 0.1 )mm. No injury separated distance between the sensory branch and motor branch of ulnar nerve: (7.1 ± 0.7)cm. The 4th muscular branches of median nerve flexor digitorum superficialis was 1378.9± 107.9. Conclusion The 4th muscular branches of median nerve flexor digitorum superficialis can be used to repair the motor branch of the ulnar nerve to recover the function of intrinsic muscle of hand.

Objective To investigate the clinical application of the combined the anterior malleolus flap and anterior tibia flap. Methods Based on the dissection of the perforating branches of anterior tibial artery on the middle and inferior section, the combined the anterior malleolus flap and anterior tibia flap was designed to repair the necrotic skin of anterior foot for 5 patients. The sizes of the flaps ranged from 17 cm×10 cm-10 cm× 5 cm. And the area of the flap was from tibial tuberosity(upper bound) to the line between internal malleolus and external malleolus (lower bound), and from the median line of one side of leg to the other side. Results Postoperatively, all flaps survived, and the primary healing of transplanted skin in donor site was achieved. The texture of flaps were excellent, the phenomenon of abrasion did not happen, and the clinical therapeutic efficacy was satisfactory after a follow up of 2-24 months. Conclusion It's a good method that combined the anterior malleohls flap and anterior tibia flap, which not only could enlarge the area of the flap but also has reliable blood supply, in repair of large size skin defect of anterior foot.

In forensic case, the location diagnosis determination of drowning has been one of the most important and dififcult diagnosis. Then diatom test is considered to be a relatively reliable method for the diagnosis of drowning. According to community characteristics inferred from diatoms into the different water region has been credibility. The study of the diatoms in different waters identiifcation is reference to the determination of the body drowned into the water area. In this paper, the research progress of diatom relevant biological characteristics and test methods on review for forensic workers is related to the further research and reference case in practice.

Objective To investigate the changing characteristics of myocardial movement in patients with dilated cardiomyopathy by three?di?mensional speckle tracking echocardiography(3D?STE). Methods The peak systolic global longitudinal train(GLS),global radial strain(GRS), global circumferential stain(GCS)and global area strain(GAS)of left ventricle were measured by 3D?STE technology in 69 patients with dilated cardiomyopathy. According to the left ventricular ejection fraction(LVEF),all patients were divided into group A(35%≤LVEF<50%)and group B (LVEF<35%). The differences of measurements were compared between two groups. The correlation between global myocardial strain in all direc?tions and left ventricular ejection fraction was analyzed. Results The GLS,GRS,GCS and GAS were significantly higher in group A than those in group B(P<0.01). The GLS,GRS,GCS and GAS were correlated with LVEF in group A(r=-0.871,0.610,-0.423,-0.797;P<0.05).The GCS,GRS and GAS were correlated with LVEF in group B(r=-0.517,0.368,-0.438;P<0.05). There was no significant correlation between GLS and LVEF in group B. Conclusion 3D?STE technology can be applied to evaluate the change of the myocardial movement. GLS is a promis?ing marker of the prognosis in patients with DCM.

Objective With the isocentric C-arm (Iso-C) three-dimensional computerized navigation system,cadaveric pelvic specimens were used to imitate double screw fixation of the symphysis pubic.Practicability and safety of the screw trajectory were examined postoperatively by local cadaveric dissections and imaging tests.Methods Pelvic specimens were harvested from 8 male and 7 female adult cadavers.Double screw placement in symphysis pubic was performed using the Iso-C three-dimensional navigation and entry point and safety trajectory was achieved.With the detailed local dissection postoperatively,distances from screw entry and exit points to unilateral structures (spermatic cord,femoral artery and vein,femoral nerve,obturator artery and vein,obtrurator nerve,and so on) were measured respectively.After complete removal of surrounding soft tissues of the specimen with only bony structure kept,the entry angle and length were calculated.Accuracy of double screw fixation of symphysis pubic was further checked using X-ray and CT.Results Entry point of the first screw was at the junction of unilateral pubic tubercle and transitional site of superior pubic ramus.Mean angle of the first screw with the horizontal plane was (7.7 ± 1.9) ° in men and (8.1 ± 1.7) ° in women.Mean angle between the first screw and coronal plane was (7.8 ± 1.8)° in men and (7.7 ±2.0)° in women.Entry point of the second screw was in the same place in the contralateral pubic tubercle.Mean angle between the second screw and horizontal plane was (30.6 ± 4.0) ° in men and (30.8 ± 3.4) ° in women.Mean angle between the second screw and coronal plane was (9.1 ± 3.0)°in men and (9.2 ± 3.3)°in women.Conclusions With the three-dimensional computerized navigation system,the bony channels of double screws implanted in the symphysis pubic are achieved and reliable.Percutaneous double screw fixation is feasible to treat the pubic symphysis diastasis.

Objective To investigate the effects of 6-minutes of walking exercise (6-MWE) on the exercise tolerance and left ventricular diastolic function (LVDF) of heart failure patients with a normal ejection fraction (HFNEFs).Methods Ninety grade Ⅱ or Ⅲ HFNEFs of the New York heart association (NYHA) were randomly divided into an exercise training group and a control group with 45 cases in each.The control group was treated with routine drugs.The exercise training group was treated with the same drugs plus 6-MWE.Before and after the sixmonth period of treatment,plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were determined,each subject's left atrial volume index (LAVI) was measured with a color ultrasonic cardiogram (UCG),and their 6-minute walk distance (6-MWD) was measured.Results Plasma NT-proBNP levels and 6-MWD improved significantly comparing with before treatment in both groups.The average 6-MWD,LAVI and plasma NT-proBNP level all improved significantly more in the experimental group.Conclusion 6-MWE can significantly improve the exercise tolerance and LVDF of HFNEFs,and improve their quality of life.Walking can be helpful in delaying the development of HFNEF.

ObjectiveTo assess the value of quantitative tissue velocity imaging (QTVI) in monitoring the establishment of levothyroxine-induced cardiomyopathy models on rabbits.MethodsThirty New Zealand purebred rabbits were divided into experimental group (n=20) and control group (n= 10).Hyperthyroidism models were established by peritoneal injection of levothyroxine (L-Thy) in experimental group (45 μg/ [kg · d]).The same dose of saline was given to rabbits in control group for 4 weeks.QTVI and conventional echocardiographic parameters were obtained at the beginning day and 1,2,4 weeks in two groups.According to the changes of ultrasound parameters,the rabbits of experimental group were divided into two subgroups:Concentric hypertrophy (CH) subgroup and eccentric hypertrophy (EH) subgroup.ResultsAt the first week,left ventricular ejection fraction (LVEF),fractional shortening (LVFS),mitral inflow peak velocity (E),average mitral annularsystolic peak velocity (Vs) and acceleration (a) increased obviously than before injection in experimental group (P＜0.01).At the second week,posterior wall thickness at end diastole (PWTd),interventricular septal thickness at end diastole (IVSTd) and left ventricular mass index (LVMI) increased obviously than before injection in experimental group and control group (P＜0.05),and the average mitral annular early diastolic velocity (Ve) was significantly lower (P＜0.01).Compared with control group,the average Ve was significantly lower in CH subgroup (P＜0.01),while LVEF,LVFS,average Vs,a and average Ve were significantly lower in EH subgroup (P＜0.01).ConclusionQTVI is valuable in the assessment of establishing levothyroxine-induced cardiomyopathy models on rabbits.

Objective To investigate the relationship between the expression of decay receptor 3 (DcR3) and the eliniealpathological parameters in human gastric carcinoma. Methods The expression of DcR3 was examined by RT-PCR in a series of 41 human primary gastric carcinomas and 41cases of normal tissue adjacent to tumor. Multiple clinical pathological factors were analyzed according to their relation with the expression of DcR3. Results The positive rate of expression of DcR3 was 56 %(23/41) in human gastric carcinoma. The expression of DcR3 in gastric carcinoma was significantly higher than that in normal tissues adjacent tumor. The expression of DcR3 was significantly correlated with different degrees of differentiation, lymph node metastasis and TNM staging (P <0.10), but there was no significant difference in DcR3 and other clinical pathological features such as tumor position and invasion depth (P>0.10). The multiple linear regression equation was Y=0.432-0.208X1+0.098X2+0,086X3. Conclusion DcR3 expression can be highly found in gastric carcinoma. The abnormal expression of DcR3 may promote tumorigenesis and progression. DcR3 may be important in evaluating the tumor differentiation, infiltration depth, lymph node metastasis and TNM staging of human gastric carcinoma.

Objective To investigate the clinical and pathological characteristics of normotensive pheochromocytomas ( NP) . Methods This retrospective study included 97 patients with a pathological diagnosis of pheochromocytoma at the Drum Tower Hospital Affiliated to Nanjing University Medical School during January 2004 to December 2013. All available clinical, biochemical, and radiological records were reviewed in these patients who were then categorized into hypertensive pheochromocytomas (HP) (n=64) and NP (n=33) groups. 97 cases of Adrenal Gland Scale Score of pheochromocytoma were examined, including tissue microscopic pathology assessment, ki67 and phenylethanolamine-N-methyltransferase ( PNMT ) immunohistochemistry and catecholamine type. Biochemical examinations of 95 subjects with primary hypertension ( PH) were recorded for comparative study. Results The patients with NP showed lower proportion of clinical triad than HP, inapparent metabolic disorders, and lower urinary catecholamine levels than HP, but showed higher results than primary hypertension. The weight of tumor was positively correlated with 24 hour urinary norepinephrine level in patients with HP(Y=1. 376+0. 653X,R2=0. 118, P=0. 028), but not in patients with NP;and the size or diameter of the tumor was negatively correlated with PNMT immunohistochemistry in patients with NP(Y=0. 940-0. 356X, R2=0. 494, P=0. 005), but not in patients with HP, indicating that NP may be misdiagnosed clinically. Conclusion Patients with NP have distinct clinical, biochemical, and pathological phenotypes; the phenotypic changes are closely related with the expression levels of catecholamine pathway products during the occurrence and development of the tumors.

BACKGROUND:Integrated Traditional Chinese and Western Medicine minimaly invasive treatment for halux valgus based on wrapped curtain method with “8”-shaped bandage and sub toe pad external fixation has been used for a long time in the clinic. This method abandons the internal implant fixationandexternal plaster fixation. After surgery, patients could take care of themselves. However, theactivity of the broken end may cause fracture nonunion, which once aroused scholars’ question. Recently, with the continuous improvement of foot biomechanics research, foot finite element model and applications become a reality.
OBJECTIVE:To evaluate thestability of osteotomy after the operation of wrapped curtain method with“8”-shaped bandage and sub toe pad external fixation on the basis of static finite element method.
METHODS:A young female volunteer with halux valgus was selected, whose body weight was 58 kg, and right foot halux abductor valgus angle was 24°; intermetatarsal angle was 13°; proximal articulator set angle was 7°; distal articulator set angle was 7°. CT was used to scan the right foot. ABAQUS software was applied to establish a finite element model of right foot halux valgus bone, and model of the first metatarsal neck minimaly invasive osteotomy was simulated based on wrapped curtain method with external fixation. Von Mises stress and displacement at the osteotomy endwere calculated.
RESULTS AND CONCLUSION:(1) The maximum stress was 0.067 MPa without external fixation, and the maximum stress was 1.258 MPa with the external fixation. Stress was mainly distributed in the outer edge of the osteotomy. (2) The maximum absolute displacement was 0.363 mm without external fixation, and the maximum absolute displacement was 0.716 mm with external fixation. The two largest displacements were both in the Z-axis direction. Statistical analysis confirmed that the four nodes absolute displacement and stress were significantly different (P< 0.01). (3) The maximum relative displacement was 0.101 mm. The maximum relative displacement was 0.046 mm with external fixation. The maximum relative displacement without external fixation was-0.102 mm and occurred in the Z-axis. The maximum relative displacement with external fixation was 0.110 mm and occurred in the Y-axis. (4) One-way analysis of variance confirmed that the four nodes relative displacements were not statisticaly significant in X-axisand Y-axis (P> 0.05). The four nodes relative displacements were statisticaly significant in Z-axis (P< 0.05). (5) These findings suggest that the external fixation based on wrapped curtain method after halux valgus surgery could effectively reduce osteotomy displacement. The moderate stress and elastic fixation are conducive to fracture healing.