Objective To explore the clinical significance of the inferior displacement sign on the initial anterioposterior (AP) view X-ray for fractures of humeral greater tuberosity.Methods This study retrospectively analyzed the imaging and clinical data of 24 patients with isolated fracture of humeral greater tuberosity who had sought medical treatment during the period from January 2008 to June 2015.They were 10 males and 14 females,with an average age of 54 years (from 19 to 68 years).Laterality:8 left sides and 16 right sides.The AP view X-ray films of the 24 patients present the inferior displacement sign defined as the inferior cortical margin of the greater tuberosity overlapping the proximal humeral shaft on the initial AP view.The patients received further CT examination to determine the displacement direction and whether the humeral neck fracture was complicated.Results A slight displacement of humeral anatomic neck fracture was shown on the initial AP view X-ray in 10 patients.Further CT examination revealed that humeral anatomic neck fracture was confirmed in 23 patients,the greater tuberosity was displaced posteriorly in 22 patients and posteroinferiorly in 2 patients.Radiographic measurements showed:the mean posterior displacement was 10.5 ±4.5 mm;the displacement between the humeral head and the humeral shaft was 2.5 ± 1.5 mm;the neck shaft angle was 147.2° ± 9.2°;the distance between the humeral head and greater tuberosity was 10.8 ± 3.4 mm;the overlap between the inferior edge of greater tuberosity and the upper edge of lateral humeral shaft was 12.5±5.9 mm.Pearson correlation analysis showed no correlation between the overlap and the head-tuberosity distance (P ＞ 0.05),but a significant correlation between the overlap and the neck-shaft angle (P ＜ 0.05).Conclusions The inferior displacement sign on the initial AP view X-ray is actually the overlap of posterior displaced greater tuberosity fracture shown on the X-ray.The posterior displaced greater tuberosity fracture complicated with slight displaced anatomic neck fracture is a presentation of the valgus impacted fracture of the proximal humerus.The inferior displacement sign in the fracture of humeral greater tuberosity can highly suggest the presence of occult or slight displacement of the humeral anatomic neck fracture.

SUMMARY Anklejointfractureisoneofthemostcommontypesoffracture.Therearemanyresearches on the injury mechanism,treatment principles and surgical techniques.A type of injury which combines posterior dislocation of fibula,known as the Bosworth injury,is relatively rare.In 1947,Bosworth first described this type of injury as an unusual ankle fracture dislocation with fixed posterior fracture disloca-tion of the distal part of the fibula.In this type of fracture,the proximal fibular shaft fragment locks be-hind the tibialis posterior tubercle.This rare ankle fracture variant is often not recognized in initial radio-graphs and requires a computed tomographic (CT)scan for verification.But there are already many re-ports,discussing the injury mechanism,treatment principles and surgical techniques.However,there are few reports of anterior dislocation of the fibula,caused by either injury or surgery.The mechanism of the injury is still not clear.This article reports a case of anterior dislocation of the fibula.We report a patient with left ankle open fracture (Lauge-Hansen pronation-external rotation stage Ⅲ,Gustilo ⅢA).Open reduction and internal fixation was done in the initial surgery,but ended up with poor reduction,resulting in fibula anterior dislocation,anterior dislocation of talus and tibia fibular dislocation.The fibula was dis-located anteriorly of the tibia,which rarely happened.The patient suffered severe ankle joint dysfunc-tion.The second operation took out the original internal fixation,reduced the fracture,and reset the in-ternal fixation.The function of ankle joint was improved obviously after operation.But because of the ini-tial injury and the two operations,the soft tissue around the fracture was greatly damaged.6 months after the second operation,and the fracture still not healed,so the bone graft was carried out in the third sur-gery.Two months after the third surgery,the function of the ankle was significantly better than before, but the fracture healing was poor,which needed further review.Through this case,we understand the rare type of ankle fracture with anterior dislocation of the fibula,and recognize that the timing and quality of initial surgery has a great impact on the patient’s prognosis and rehabilitation period.

Objective To investigate the clinical value of the 18F-FDG SPECT-CT combined with the image of CT in the diagnosis of lung cancer.Methods Retrospectively analysis images of 18F-FDG SPECT-CT and CT of 162 patients pulmonary tumor-like lesions from January 2013 to October 2013 were conducted.All the patients have been confirmed by the pathological mechanism or cytologic examination.Each patient has been firstly diagnosed by the 18F-FDG SPECT-CT along and then combined with the images of CT.The sensitive rate and the accurate rate of two methods were compared by x2 test.Results There were 40 benign lesions and 114 malignant ones in 162 patients.The sensitive rates of the two methods were 86.0％ and 96.5％ (x2 =6.63,P ＜ 0.05).The accurate rates of the two ways were 79％ and 96.3％ (x2 =7.76,P ＜ 0.05).The differences were statistically significant.Conclusion 18F-FDG SPECT-CT combined with the images of CT can increase the diagnostic sensitivity and accuracy.It has important clinical value.

Objective To investigate the episode of ischemic stroke in patients with serum homocysteine (Hcy),erythropoietin and its clinical significance (EPO)levels.Methods Detected 120 cases of first ischemic stroke patients serum Hcy,EPO lev-els and test results with 120 cases over the same period outpatient healthy compare.Used Logistic regression analysis and Pearson correlation analysis to determine the relationship between serum Hcy,EPO levels and ischemic stroke,ROC curve a-nalysis of clinical characteristics of Hcy and EPO.Results Serum Hcy,EPO level of ischemic stroke were respectively 23.1 ±12.6μmol/L and 32.4±11.2 mIU/L.The control level were respectively 10.4±2.8μmol/L and 17.6±5.2 mIU/L.Is-chemic stroke group were significantly higher.The results had statistical significance (P<0.05 or<0.01).Pearson correla-tion analysis showed that ischemic stroke serum Hcy levels and EPO levels were positively correlated (r=0.369,P<0.05). Logistic regression analysis showed that Ischemic stroke was positively related to serum Hcy level (P<0.05),and were not related to EPO (P>0.05).Conclusion The serum Hcy,elevated EPO levels associated with ischemic stroke.Serum Hcy is an independent risk factor of ischemic stroke.

Objective:To explore the effect of health management on morbidity risk of hypertension in population with endotheliocyte nitric oxide synthetase (eNOS)gene G894T mutation.Methods:A total of 360 cases,who were 45~60 years old and possessed eNOS gene G894T mutation but without hypertension,were screened using gene chips detection from people who received physical examination and recreation in Qingdao sanatorium and patients visiting to affiliated hospital of medical college of Qingdao University from Jun 2010 to Jun 2013. According to their compli-ance condition,they were divided into health management group (n=163)and control group (n=197,continued their intrinsical lifestyle).Both groups were followed up for two years,and their incidence rates of hypertension were compared.Results:After two-year follow-up,a total of 17 cases (10.43%)were diagnosed as hypertension a-mong 163 cases of health management group;it was significantly lower than that in control group (24.87%,χ2 =12.43,P =0.001).Conclusion:Scientific health management can effectively reduce incidence rate of hypertension in population with eNOS gene G894T mutation.

Objective To investigate the RHD gene polymorphism among the RhD negative Han individuals in Xuzhou.Methods The RhD antigen phenotypes were detected by routine serological techniques,and were identified with indirect antiglobulin test (IAT).The genotypes of RHD were detected by using sequence specific primer polymerase chain reaction(SSP-PCR).Results A-mong 110 RhD negative individuals,there were 5 cases carring RHD positive gene,47 cases carring RHD negative gene,22 cases carring RHD-CE(2-9)-D gene,17 cases carring DVI Ⅲ gene,2 cases carring weak D15 gene,and 17 carring DEL-1227A gene,re-spectively.Conclusion The RhD negative Han individuals present complex RHD gene polymorphism in Xuzhou region,and variant alleles such as RHD-CE(2-9)-D,DVI Ⅲ,DEL-1227A are given priority.

Methotrexate (MTX)was linked covalently to monoclonal IgG antibody (AU_(14-1)) to a mouse uterine cervical cancer with the use of dextran T-40 as the intermediate carrier. The molar ratio of IgG: MTX was 1: 20 in the conjugate. The conjugate retained full antibody binding activity at the AU_(14-1) concentration of 3.75?10~(-8) M measured by an indirect membrane immunofluorescence assay. The in vitro experiments confirmed that the conjugate not only showed target-selective antitumor effecacy but also was proved to be more effective in inhibiting the growth of HeLa cells than the effect of U_(14) cells, so that it confirmed the "evolutionary antigen" theory. It is suggested that AU_(14-1)-Dex-MTX conjugate may have good potentiality in clinical application.

A number of low molecular weight cationic peptides, named defensins,were purified from neutrophil granuals. Its in vitro cytotoxicity to HL-60 cell line anddirect viral inactivation were examined. The results showed that when incubated with NP-1 and NP-2(100?g/ml) fot 6 hours, more than 60% of HL-60 cells were killed. WhenHerpes simplex virus type I(HSy-I) and influenza virus B strain Beijing 87-1 wereincubated with NP-1(260?g/ml) at 37?C in water bath for 60 min, a marked reduction(98.2% and 90% ) in virus TCID_50 was observed. The results suggested that neutrophilgranulocyte might be able to synthesize peptides which have the cytotoxic and antiviralacitivities.

This paper reports 11 cases died of cerebral injuury. Grossly,various degree of cerebral contusions and subardchnoul hemorrhages were found in 10 cases, hemorrhags of brainstem in 3 cases and of hy-pohalamus in 1 case' Under light and scanning electron microscope, cerebral cortex contusions werefound in 10 cases, contusions and hemorrhages of white matter 3 cm far from the area of cerebral cortex contusbos in 6 cases, contusions of hypohalamus in 8 cases, of pons in 5 cases, of bulb in 4 cas-es, of lateral vertricular wall in 8 cases and of optic nerve in 4 cases. Degeneration, necrosis and is-chemical changes of nerve cells were found in 10 cases. Degeneration, disarrangement, breakage and necrosis of axon and myelin sheath in cerebrun and brainstems were Observed in 9 cases. In 7 out of 9cases, retfract balls of broken axons were seen. The causes of death of the cerebral trauma and the diffrential diagnosis were briefly discussed.

Objective To analyze clopidogrel combined with aspirin therapy of acute cerebral infarction the safety and efficacy of micro brain hemorrhage patients.Methods Select from May 2015 and May 2015 months in the hospital for diagnosis and treatment of 76 cases of acute cerebral infarction combined micro cerebral hemorrhage patient study,observation group in the conventional treatment at the same time giving oral aspirin and clopidogrel,the control group in the conventional treatment at the same time,only to give oral aspirin.To observe the nerve function defect National institutes of Health stroke scale score(National Institute of Health stroke scale,NIHSS)and daily life activities ability pap index,determination of patients' blood plasma viscosity,whole blood low shear viscosity,AA induction and the platelet maximum aggregation rate induced by ADP(MARAA,MARADP),observation records during the treatment patients with adverse reactions,were analyzed.Results Compared with before treatment,the observation group and control group after treatment for 2 weeks,NIHSS score,score and blood related indexes were significantly improved,statistically significant difference(P< 0.05).Compared with control group,the observation group after treatment the NIHSS score,pap score and blood related indexes were significantly improved,total effective rate increased significantly,the differences were statistically significant(P< 0.05).Two groups of adverse drug reactions occurred situation is no statistical difference.Conclusion Clopidogrel in combination with aspirin can effective treatment in patients with acute cerebral infarction combined micro brain hemorrhage,and security.