Objective To observe the clinical outcomes of modified posteromedial and posterolateral approaches for the treatment of posterior tibial plateau fractures.Methods Between January 2006 and October 2011,25 patients with posterior tibial plateau fracture were identified.They were 17 men and 8 women,aged from 22 to 76 years (average,46.4 years).According to the AO/OTA classification,there were 4 cases of type 41-B1,6 cases of type 41-B2 and 15 cases of type 41-B3.According to Luo's three-column classification,they were all posterior column fractures.Ten patients with posterolateral tibial plateau fracture were treated by the modified posterolateral approach and the other 15 patients with posteromedial tibial plateau fracture by the modified posteromedial approach.The posterior fractures were fixated with a buttress plate.The knee function was evaluated at the last follow-up by the The Hospital for Special Surgery (HSS) Score.Results All the 25 cases were followed up for a mean time of 13.2 months (from 10 to 24 months).By the radiological Rasmussen criteria for fracture reduction,the mean score immediately after surgery was 16.5 points (from 13 to 18 points),with 20 excellent cases,4 good cases and one fair case.All patients were pain-free with full range of motion.Radiologically,bone union was achieved in all cases after a mean time of 13.9 weeks (from 12 to 18 weeks).No surgery-related complications were found.The mean HSS score was 91 points(range,74 to 97 points) and the good to excellent rate was 100％ (17 excellent and 8 good cases) at the last follow-up.The average range of knee motion ranged from 0° to 125°.Conclusion In the treatment of posterior tibial plateau fractures,because the modified posteromedial and posterolateral approaches can result in excellent fracture reduction under direct visualization and allow for posterior buttress plating,soft tissues can be well preserved and good functional results can be expected.

Case report of autopsy from acute water intoxication is very rare. It accounts for 0.1% of allautopsys done in our University. Recently forensic autopsy was made in a case of acute water intoxication. Water intoxication often causes medical dispate resulted from transfusion. Thus a forensic appraisal standard was advanced, including: ① There was history of reduction of exterocellular osmotic pressure ② Cerebral edema, lung edema and more excretion are shown in clinic. ③ Concentration of the blood sodium was lower than 120mmol/L. ④ The transfusion order or speed was not proper. ⑤ Cause of death from general disease, injury and poisoning can be ruled out by autopsy.

Objective To investigate the mutation characteristics of atlastin gene in Chinese patients with hereditary spastic paraplegia(HSP) and establish the base of gene diagnosis of HSP.Methods Mutation analysis of atlastin gene was made by use of polymerase chain reaction-single strand conformation polymorphism(PCR-SSCP) combined with DNA direct sequencing in 30 unrelated affected HSP individuals in China in which 20 cases were from autosomal dominant families and ten cases were sporadic HSP patients.Results No abnormal SSCP bands were found in the 30 individuals and the results of DNA direct sequencing were also normal.Conclusion Mutation of atlastin gene may be rare in Chinese HSP patients.

Objective To investigate the mutation characteristics of paraplegin gene in Chinese patients with hereditary spastic paraplegia (HSP) and establish the base of the gene diagnosis of HSP.Methods Mutation analysis of paraplegin gene was carried out by use of polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) combined with DNA direct sequencing in 22 unrelated affected HSP individuals in China, in which 8 probands were from autosomal recessive families and 14 cases were sporadic.Results All of the exons could be detected by PCR. 2 probands were found to have abnormal SSCP bands in exon 15 and 2 substitutes (G2063A, G2066A in exon 15) were found by DNA direct sequencing. But there were no changes in other patients of families.!The same abnormal SSCP bands and G→A substitutes were revealed in control individuals. So these changes were two polymorphisms, in which G2066A was not reported previously.Conclusion Mutations of paraplegin gene may be rare in Chinese patients with HSP. G2063A and G2066A are two polymorphisms, in which G2066A has not been reported previously.

BackgroundBoth accommodative abnormality and higher order wavefront aberrations associated with near work are interrelated with blurry retinal image.It is very important to investigate the higher order wavefront aberrations in stable and progressive myopic eyes before and after near work. ObjectiveThe present study wasto observe the high order aberration change of myopic eyes before and after computer work upon near work stimulation as well as the relationship of high order aberration changes to types of myopia. MethodsThe case-controlled design was used in this clinical study.Sixty right eyes of 60 subjects were enrolled,including 30 progressive myopias and 30 stable myopias with matched age and gender.Refractive errors of the subjects were completely corrected by the wearing of spectacles.The subjects remained the work for 1 hour in front of a computer monitor with 40 cm distance under the dark environment and nature pupil size,and the height of the eye and monitor center kept the same level.The changes of wavefront aberration in test eyes were measured with Complete Ophthalmic Analysis System before and after 1 hour of continuous computer work.The influences of computer-work and myopia types on wavefront aberration were analyzed in 3,4,5 mm pupil size.Root-mean-square (RMS) of aberrations was calculated as the index of higher order wavefront aberrations.ResultsThere were no significant differences in the higher order wavefront aberrations before and after computer work for the two types of myopic eyes under the 3,4,5 mm pupil.The RMS of higher order wavefront aberrations were similar between progressive myopia and stable myopia under the 3 mm pupil condition.Total higher order RMS,6th-order,5th-order and 3rd-order RMS were significantly higher in progressive myopic group compared with stable myopic group under the 4 mm pupil size ( RMS3:F =5.985,P =0.016 ; RMS5:F =3.975,p=0.049;RMS6:F=8.130,P=0.005:RMST:F=6.493,P=0.012) and 5mm pupil size(RMS3:F=13.132,P=0.000;RMS5:F =4.032,P=0.047 ; RMS6:F =4.393,P=0.038:RMST:F=10.508,P=0.002 ).The spherical aberrations were higher in progressive myopic group under the 3,4,5 mm pupil conditions in comparison with stable myopic group,but these alterations were insignificant between two types of myopias ( P＞0.05 ).Conclusions Higher order wavefront aberrations of progressive myopic eyes is comparable higher than the stable myopic eyes.Computer reading task dose not significantly impact the higher order wavefront aberrations on myopic eyes.

Objective:To isolate breast cancer stem/progenitor cells from human breast cancer and study their proliferation and differentiation biological characteristics over long-term passages in vitro. Methods:Human breast cancer stem/progenitor cells were enriched in suspension cultures as nonadherent mammospheres(MS). Serial sphere formation assay was performed to determine self-renewal ability of mammosphere-derived cells (MSDC). Differentiation was induced by culturing MSDC in DMEM-F12 supplemented with serum but without growth factors. The ratio of CD44~+/CD24~(-/low) cell population was evaluated by flow cytometry(FCM). Results:The mammospheres were formed after inoculation of primary breast cancer cells into culcutre medium with growth factors but without serum. The mammospheres contained undifferentiated cells similar to stem cells, which had self-renewal and extensive proliferation capabilities. With increasing passages, the cells tended to adhere and differentiate. The number of adhering and differentiating cells increased, and the amount and size of mammospheres decreased. The CD44~+/CD24~(-/low) cell population was enriched in the basal-like molecular subtype of human breast tumors. The biological behaviors of mammospheres varied between different specimens.Conclusion:Cancer cells with stem cell properties of self-renewal, indefinite proliferation and multi-lineage differentiation widely existed in human breast cancer tissues. The biological behaviors varied because of different origin of specimens and changed under the effects of environmental factors.

Objective To investigate the alternation of left ventricular systolic function in patients underwent transcatheter aortic valve implantation operation(TAVI) by three-dimensional speckle tracking technology (3D-STI).Methods Totally 20 patients with severe aortic stenosis were enrolled.All the subjects underwent successful TAVI operation.The real-time 3D full volume datasets on apical four-chamber view were acquired on before,7 days and 1 month after TAVI.Left ventricular global longitudinal strain(GLS),regional peak systolic longitudinal strain(LS),regional peak systolic circumferential strain(CS) and regional peak systolic radial strain(RS),were analysed using off-line TomTec software,the differences among the three groups were compared.Results Compared with the preoperation,aortic valve blood flow velocity (AV),mean aortic valve pressure gradient(mPAG) of 7 days after operation decreased significantly.Threedimensional left ventricular ejecation fraction(3D-LVEF) among the patients whose 3D-LVEF under 50％had a remarkable increase and whose 3D-LVEF exceed 50％ before operation had no significant change,while 1 month after operation the 3D-LVEF had a significant improvement compared with the preoperational data regardless of 3D-LVEF under 50％ or not.The GLS and LS of all segments of 7 days after TAVI were higher than pre-operation(all P ＜0.05),and it had a further improvement 1 month after TAVI.Conclusions LV systolic function had improvement early after TAVI.3D-STI is a new,convenient way to detect the global and regional left ventricular systolic function of TAVI patients.

Objective To study the effects of diagnostic ultrasound combined with microbubble contrast agent on augmentation thrombolysis in vivo and to discuss the synergism and mechanism of combination of urokinase. Methods Thirty-two rabbits of femoral vein thrombus were divided into four groups: simple urokinase group, ultrasound and contrast microbubble group, ultrasound and contrast microbubble combined with urokinase group, control group. Then according to the best parameter combination which was definited in previous experiment, the experiments combination of urokinase were performed. Color Doppler was used to evaluate the recanalization of different group in 15 rain,30 min and 60 min. Results After the treatment of 15 rain and 30 min,the recanalization rate in ultrasound and contrast microbubble combined with urokinase group improved significantly compared with other groups (P<0.05);after 60 min, the recanalization grade of ultrasound and contrast microbubble and urokinase group was evidently better than other two group. The result of immunohistochemistry showed that disaggregation of clot and fibrous in this group at 60 min was better than the results at 15 min, 30 min. Conclusions Diagnostic ultrasound with microbubble contrast agent showed superior effects of thrombolysis and the synergism of combination of urokinase in vivo.

Objective To explore the ultrasonic characteristics of cystic adventitial disease (CAD) and to evaluate the value of color Doppler ultrasound in diagnosis of CAD. Methods We retrospectively analyzed the ultrasonograms and other imaging methods of eight patients with CAD conformed by surgery in The first Hospital of China Medical University. Results Five of the eight CAD cases were confirmed by color Doppler ultrasound before surgery, and three were misdiagnosed. All the cases were single, with five in popliteal artery, two in iliofemoral artery, and one in external iliac vein. We divided the cysts into concentric cysts and eccentric cysts according to the cystic shape and the lumen stenosis. Six cases were eccentric cysts, in which two had septations;two cases were concentric cysts, and both had septations. The affected vessel expanded, but its shape did not change and the lumen was compressed. There were three layers of wall between the cyst and the lumen. The peak systolic velocity of the affected lumen increased and the distal end systolic peak velocity decreased when lesion occurred in artery. Distal end lumen reflux were slow when lesion occurred in distal veins. Angiography showed the stenosis of the affected lumen, which was described asscimitar sign. CT showed uniorlocular or multilocular cyst, and the compressed lumen. All of the eight patients underwent the diseased adventitia resected along with excision of the cyst. Conclusions The color Doppler ultrasound can display the location, shape, and internal echo of CAD, and thus it can accurately evaluate luminal stenosis and flow pattern. This is of important clinical significance for the diagnosis, treatment, and prognosis of CAD.

Objective To evaluate the effect of bifidobacterium-mediated CTP-NPRL2 on the growth and apoptosis of nude mouse renal carcinoma.Methods Recombinant plasmid pET15b-CTP-NPRL2 was constructed and transfected into bifidobacterium by electroporation,and then the expression of fusion protein CTP-NPRL2 was verified by Western blot.The nude mouse renal carcinoma model was constructed by subcutaneous injection of renal carcinoma cells suspension.The nude mice with renal carcinoma were equally and randomly divided into the observation group and control group(8 mice in each group).The mice in the observation group were treated with bifidobacterium containing recombinant plasmid pET15b-CTP-NPRL2 through tail vein injection,and the mice in the control group were treated with normal saline.All mice were treated once a week for four weeks,and then executed for evaluating the weight of mice and bearing tumors.Finally,the apoptosis of renal carcinoma was detected by TUNEL staining.Results The mass of nude mice was(26.24±1.98) g in the observation group and(23.28±2.17) g in the control group.The mass of bearing tumors was(1.37±0.12) g in the observation group and(1.68±0.18) g in the control group,and the differences were statistically significant(P＜0.05).The TUNEL detection results showed that the apoptosis index of renal carcinoma cell in the observation group(23.27±5.14)％ was significantly higher than that in the control group(10.37±2.58)％,and the difference was statistically significant(P＜0.05).Conclusion Bifidobacterium-mediated CTP-NPRL2 has an inhibitory effect on the renal carcinoma growth of nude mouse,and significantly increases the apoptosis of renal carcinoma cells.