[Objective]To classify fractures of posterior malleolus by computed tomography and guide its clinical treatment.[Method]From January 2003 to October 2006,eighty-eight patients who had been treated surgically for the posterior malleolar fractures were reviewed.There were 53 males and 35 females.The mean age was 42.3 years(ranged,18～75 years).All the patients' preoperative radiograph and computed tomographic scans were reviewed,and each fracture was categorized according to the size,location and fracture line of the major fragment and the stable state of mortise.The classification was applied to treat 88 patients.[Result]On the basis of the computed tomographic images,the posterior malleolar fractures were categorized into four types.There were type Ⅰ(stable) in 23 cases,type Ⅱ(borderline) in 26 cases,type Ⅲ(big unstable posterolateral oblique) in 18 cases and type Ⅳ(medial-extension) in 21 cases.Type Ⅰ included type Ⅰ1(small shell)in 5 cases and type I2(small posterolateral oblique) in 18 cases.Type Ⅱ included type Ⅱ1(moderate posterolateral oblique without lateral-posterior dislocation of talus)in 15 cases and type Ⅱ2(moedrate postero-lateral oblique with lateral-posterior dislocation of talus)in 11 cases.All patients were followed up for an average of 31months(ranged from 12 to 48 months).According to the Baird-Jackson scoring system,the results were rated as being excellent in 62 cases,good in 13 cases,moderate in 8 cases,and poor in 5 cases,with the good-excellent rate being 85.2%.[Conclusion]Computed tomographic scans can demonstrate the pathoanatomy of the posterior malleolar fracture and provided guidance for clinical treatment.

Objective: To investigate the expression of α-B crystalline in triple-negative breast cancer (TNBC) and discuss its role in the prognosis and targeted therapy of TNBC by analyzing the correlation amongα-B crystalline and the clinico-pathological indi-ces of breast cancer. Methods:Immunohistochemistry SP assay was used to determineα-B crystalline expression in paraffin-embedded specimens of 30 cases of TNBC and 50 cases of non-TNBC tissues. The differences in protein expressions among tissues were com-pared, and correlation analysis was performed to determine the relationship between protein expression and clinico-pathological indi-ces. Results:The positive expression rate ofα-B crystalline was 66.67%in TNBC (20/30) and 42.00%in non-TNBC (21/50), which in-dicates that the expression is significantly higher in TNBC than in the non-TNBC tissues (χ2=4.566, P<0.05). The expression ofα-B crystalline in breast cancer has no significant difference in terms of age, tumor diameter, and cancer stage (P>0.05), but exhibits a differ-ence in terms of lymph node metastasis and the number of metastasized lymph nodes [P53, Ki67 (P<0.05)], which presents a positive correlation (r=0.251). Theα-B crystalline expression in TNBC has no significant difference among indices such as age, tumor diameter, nodal metastasis, number of metastasis, P53, cancer stage, and Ki67 (P>0.05). Conclusion:Significant differences were found inα-B crystalline expression between TNBC and non-TNBC.α-B crystalline is highly expressed in TNBC tissues, and the expression is signif-icantly higher in TNBC tissues than that in non-TNBC tissues.α-B crystalline is associated with poor prognosis of breast cancer. Conse-quently, the overexpression ofα-B crystalline in TNBC may be a reason for unfavorable TNBC prognosis.

Objective To investigate correlation study of serum hs-CRP,UA level and the correlation of dis-ease in elderly acute myocardial infarction patients , and provide a reference basis for clinical judgment for patients with illness development and prognosis prediction .Methods 40 aged patients with acute myocardial infarction pa-tients were selected as the research object ,and protionally random according to time admission the same period ran-domly selected were 40 cases of elderly patients with unstable angina pectoris ,40 cases of elderly patients with stable angina,40 cases of clinic medical normal healthy old people for controlled object .The levels of serum hs-CRP,UA and correlation was analyzed.Results The serum hsCRP,UA in the myocardial infarction group were (34.67 ±12.18)mg/L, (412.46 ±68.93)μmol/L,which in the unstable angina pectoris group were (17.21 ±8.39) mg/L,(274.19 ± 46.62)μmol/L,which in stable angina pectoris group were (5.25 ±1.40) mg/L,(297.41 ±37.43)μmol/L,which in the health group(4.96 ±1.24)mg/L,(279.64 ±34.78)μmol/L,the differences among the myocardial infarction group,unstable angina pectoris,stable angina pectoris group had statistical significance (P<0.05), the differences between myocardial infarction group and health group had statistical significance (P<0.05);Myocardial infarction patients prognosis group hs-CRP,UA group was obviously higher than that of the prognosis was good ,compared with statistical significance difference ( P <0.05 );In myocardial infarction group , unstable angina pectoris group , the hsCRP was associated with positive correlation exists between UA (P<0.05),stable angina pectoris group no correla-tion(P>0.05);Different prognosis in patients with myocardial infarction hsCRP is associated with UA has positive correlation between ( P<0.05) .Conclusion Elderly acute myocardial infarction patients serum hs-CRP,UA obviously increased ,and illness development correlation ,a high level of hs-CRP,UA patients often indicates poor prognosis .

Objective To study the change of thrombosis in rabbits arteries by electron microscope after thromb was lyses by urokinase targeted microbubbles.Methods A total of 24 rabbits with plateletrich thrombi in the femoral artery were randomized into 4 treatment groups (n = 6) :(1) ultrasound alone (US) ; (2) urokinase alone (UK); (3) ultrasound, non-targeted microbubble and urokinase (US + M + UK) ;(4) ultrasound, platelet-targeted microbubble and urokinase (US + R + UK).Urokinase targeted microbubbles were in conjunction with the surface of commercial microbubbles (SonoVue) by direct conjugation method.US was simultaneously applied transcutaneously over the thrombus up to 30 min.The thrombolytic effect was based on ultrasound, blood flow and histological observations at 120 min post treatment.Results US + R + UK group was completed recanalization (P ＜ 0.001).Scanning electron microscope examination showed thrombosis of the fiber network structure damage.Conclusions The main electron microscope change of RGDS urokinase targeted microbubbles dissolve thromb is thrombus fibrin network structure damage and fibrin dissolution.

ObjectiveTo explore the effect of rehabilitation evaluation and treatment on Guillain-Barré syndrome.MethodsThe rehabilitation treatment was performed in 21 patients with Guillain-Barré syndrome, and the therapeutic effect was evaluated with Lindmark Assessment.ResultsThe total effective rate of all patients was 90.47% in the upper limps and wrists, 85.71% in the hands and 95.23% in the lower limps.ConclusionThe rehabilitation can improve the therapeutic effect of Guillain-Barré syndrome.

Objective To demonstrate the cause of visual loss (VL) caused by pituitary adenomas (PAs),through retrospective study on the magnetic resonance imaging (MRI) radiological materials of patients with PAs.Methods Forty eight patients with PAs were selected,who received surgical treatment at our Hospital.Their medical records and MRI radiological films were reviewed.The relationship between the characteristics of PAs and the visual deterioration were analyzed.Neuro-ophthalmological findings were elevated with the relationship between the tumor and the supraelinoidal segment (C2 segment) of the internal carotid artery(ICA).Resuits On the coronal MR images,C2 segments of 28 sides(29.2%) were involved by the tumors whose value of VL in the ipsilateral eyes averaged 0.80±0.20 (range from 0.40 to 1.00).In the rest 68 sides (70.8%) without C2 segments involved,the valHe of VL in the correspondent eyes averaged 0.30±0.30 (range from 0.00 to 1.00).The difference was statistically significant (P<0.05).Conclusions If the C2 segment of ICA is invaded,the worse visual acuity would appear.which might be due to the markedly involved chiasmal arteries.

Objective To summarize the experience of unilateral endonasal transsphenoidal pituitary adeno-ma resection under neuroendoscopy. Methods 48 patients with pituitary adenoma were treated by unilateral en-donasal transsphenoid under neuroendoscopy. During the dissection of the adenoma, attention should be paid to pro-tect pituitary stalk and gland. Results The postoperative MRI detection revealed that the tumor was totally removed in 40(83.3%) cases,subtotally in 6(12.5%) ,and partially in 2(4.2%). All patients were followed up for 10 -36 months. Among the 38 patients with increased hormone level ,24 recovered to normal hormone level postoperatively; 14 were improved evidently;pituitary insufficiency was not found in 38 cases;7 patients have temporary diabetes in-sipidus but the symptom was released in three weeks. Conclusion The surgical treatment of pituitary adenoma by neuroendoscopic unilateral endonasal transsphenoid has its advantage in achieving both complete resection of tumor and sound protection of pituitary stalk and gland. Neuroendoscopic operation offers greater help in improving the pa-tients' quality of survival.

Objective To investigate the differential diagnosis of Reye syndrome and the characteristics of primary carnitine deficiency,and to provide diagnostic strategy for similar cases.Methods There was a case presented with fever,poor response,convulsions and hepatomegaly hospitalized in Wuhan Children's Hospital,and the clinical manifestations were described,the physical examination was comprehensively conducted,the auxiliary examination results were recorded,some pediatric specialists from ICU,neurology department,genetic metabolic department,digestive system department were invited to discuss the case.The treatment was adjusted according to the suggested opinions;the treatment effects and the final diagnosis were tracked.Results The primary diagnosis of the case was central nervous system infection or toxic encephalopathy at the time of admission,but Reye syndrome could not be excluded.Although the cerebrospinal fluid test and brain MRI examination detected nothing abnormal,liver function suggested alanine aminotrans ferase ALT increase,blood sugar decrease,the liver volume increase,which was detected by liver ultrasound.Blood amino acids examination revealed the carnitine level decreased,and it was confirmed as primary carnitine deficiency in the end.L-carnitine was used to treat the disease,and its effect was good.Conclusions Great importance should be attached to children with onset age,physical check-up,and multidisciplinary cooperation.Use monism to explain the illness and the auxiliary inspection as far as possible,so that it can get early diagnosis and treatment,and the outcome is good.

OBJECTIVE To study the rules of prelaryngeal node metastases in different glottic carcinoma in order to provide basic information for standard operation the laryngeal cancer. METHODS Prelaryngeal lymph node dissection was performed in 92 cases with glottic carcinoma.The differences of tumor staging, pathological typing, postoperative cervical or local recurrence, survival time were compared and analyzed between the groups of positive and negative prelaryngeal node. RESULTS There were 5 cases (5.4%) with positive prelaryngeal node among 92 cases. The prelaryngeal nodes in advanced laryngeal cancer (III, IV stage) was more easily to be metastasized than those in early stages (I, II), the difference was statistically significant. There was no significant difference in prelaryngeal node metastasis among different pathological types.The local and regional recurrence rates in positive prelaryngeal lymph node metastasis group were higher than those in the negative group, the difference was statistically significant. Compared with positive group, the negative group had a longer survival time,and the difference was statistically significant. CONCLUSION The rate of prelaryngeal node metastases is high in patients with advanced glottic carcinoma. Once the prelaryngeal node metastases occur, the recurrence rate will be increased and the prognosis is poor, that suggest the importance of standardized treatment.

Objective To evaluate the clinical efficiency of intermittent photic stimulation (IPS) with pattern and red color plastic plates in video-electroencephalography(EEG).Methods Three hundred and fifty-eight patients hospitalized in Wuhan Children's Hospital from March 2013 to March 2014 were selected,and they were examined by using stroboscope with a red plastic plate,a dots printed plastic plate,and ordinary white flicker for photic driving response (PDR),photoparoxysmal responses (PPR),photoconvulsive response (PCR).The results of patients with PDR,PPR,PCR were analyzed.Results The PDR synchronously evoked by the three flickering patterns were in 29 cases,and the amplitude of photic drivings evoked by ordinary white flicker and red flicker were higher than that of flickering dot pattern [(30.294 ± 7.767) μV,(31.103 ± 8.920) μV vs (24.436 ± 8.075) μV],and there were significant differences(t =2.983,2.815,P =0.003,0.008).However,there was no significant difference between ordinary white flicker and red flicker (t =0.368,P =0.710).The PPR evoked were in 17 cases,and 16 cases (94.12％) of them were evoked by red color,while 10 cases (58.82％) wcre evoked by white light,and 1 case only evoked by flickering dot pattern.However,stronger intensity and longer duration time of PPR were evoked by red color than by white light.In 3 patients with positive PCR,the epileptic seizure was more likely to be evoked by red color or pattern plastic plate.Conclusions IPS with red and pattem plastic plate is more potent in eliciting photosensitive epilepsy in video-EEG than the ordinary white light.Moreover,it could reduce the discomfort of eyes without influencing PDR in comparison to the ordinary white light.