Objective To compare the results of locking intramedullar nail and Locking plate in treating proximal humerus fractures and discuss features of each instrument. Methods A total of 54 patients with fresh two-part surgical neck fracture of proximal humerus were divided into intramedullar nail fixation group(26 patients)and locking plate fixation group(128 patients).with no statistical difference upon age,gender and dominate hand involvement in two groups.At final follow-up,physical examination and X-ray films were used to evaluate fracture healing of shoulder ioint.In the meantime,VAS score,ASES score,Constant-Murley score,UCLA and SST questionnaire were used to evaluate the function of the shoulder in two groups. Results All fractures were healed basically within 8 weeks postoperative-ly.No infection or av&scular necrosis were fouml during follow-up.The incidence rate of complication in locking plate fixation group was higher than that in intramedullar nail fixation group.Both groups obtained satisfactory functional recovery of shoulder ioint.There was no statistieal difference in regard to active for-ward elevation,external rotation besides body,active height of internal rotation,Constant-Murley scores,and SST scores in both groups.The average ASES score and VAS score of locking plate fixation group was significantly better than those of intramedullar nail fixation group. Conclusions Both fixations can treat surgical neck fractures of proximal humerus well.Locking intramedullar nail causes less trauma to the patient while Locking plate has advantages in patients'final functional recovery.

Objective To evaluate the results of delayed proximal humeral fractures treated by open reduction and internal fixation. Methods From January 2005 to July 2008, 26 patients with delayed proximal humeral fractures were treated by open reduction and internal fixation. There were 11 males and 15 females. The patients ranged from sixteen to 22-81 years old, with an average age of 49.3 years. The interval from injury to operation ranged 22 to 510 days, with a mean of 88 months. There were two-part fractue in surgical neck in 12 cases, two part in lesser tubercles of in one case,two part in greater tubercles in seven cases, three part in greater tubercles in three cases, four part in 2 cases and the splitting fracture in the head of humerus in one ease.The range of motion, VAS for pain, ASES (American sboulder and elbow surgeon's form) score, Constant score, UCLA (University of California-Los Angels scoring system)score and SST(Sim-pie Shoulder Test) for function evaluation were all recorded. The results were evaluated according to sex,age, injury side, operation times and combined injury by ANOVA.The correlation analysis was performed between operative time and results. Results The average forward flexion was 137.3°±35.1°, average exter-nal rotation was 28.9°±24.1° and internal rotation was T_(10). The mean VAS score was 0.7±1.2, the mean Constant was 83.1±17.9, the mean UCLA was 28.9±6.0, the mean SST was 8.7. There were no difference re-gaming sex, age, injury side, operation time and combined injury, fracture type and complications groups. No correlation existed between operative time and results. Conclusion It is very hard to treat delayed proximal humeral fracture due to high complication and demanding experience. With appropriate surgical technique, satisfactory results can be expected by open reduction and internal fixation.

Objective To investigate and compare the biomechanical stability between anatomical and overlapping reconstruction of the greater tuberosity in cadaveric humeral head replacement model. Methods Eight pair (16) fresh-frozen shoulder cadavers were match-paired into 2 groups. Four-part fracture model was created in all cadavers. Standardized humeral head replacement procedure was carried out in all specimens, and anatomical and overlapping reconstruction of the greater tuberosity was applied to each group respectively. Custom mounting apparatus and fixation jigs were designed for designated shoulder motion. A Binocular 3D Computer Vision metrical method was employed to measure the displacement of greater tuberosity relative to the humeral diaphysis. Results When the shoulder was external rotated to neutral position, the mean displacement of greater tuberosity in anatomical reconstruction group was (1.81?1.75) mm,while the mean displacement was (3.23?2.91) mm in overlapping group. Statistical difference was found between the 2 groups. When the glenohumeral joint was elevated to 30? and 60? forward flexion, the mean displacement of greater tuberosity in anatomical group was (4.01?5.00) mm and (5.99?6.97) mm respectively, while the mean displacement was (3.02?5.27) mm and (6.97?7.00) mm respectively in overlapping group. No statistical difference was found between the 2 groups during forward flexion measurement. Conclusion In cadaveric humeral head replacement model, anatomic greater tuberosity reconstruction shows better mechanical stability compared with overlapping reconstruction during external rotation to neutral position. This result suggests that there may be some loss in mechanical stability in overlapping fixed greater tuberosity. Even though standardized postoperative rehabilitation protocol are strictly followed, evident displacement of the greater tuberosity was detected. Postpone of the postoperative rehabilitation program after humeral head replacement for a decent period of time may benefit tuberosity healing.

Objective To develop a sensitive, specific, rapid and easy method for detecting E. coli O157 : H7 and other Shiga toxin-producing E. coli in food and clinical specimens. Methods A circular probe and capture probe specific for Shiga toxin-2 (stx2) gene had been synthesized and was used for determining the sensitivity of ramification amplification method (RAM). Different serotypes which contained stx2 gene, including an E. coli O157 : H7, an E. coli O46 : H38, an E. coli O111 : NM, an E. coli O22 : H8 and E. coli ATCC23716 (stx2 gene negative) were used for determining the specificity. All strains were detected by RAM to determine whether they contained stx2 gene. Real-time RAM was further studied to detect stx2 gene. Results The lowest number targets detected by RAM assay was 10 copies of stx2, indicating that RAM assay was as sensitive as conventional PCR. The result of specificity showed that different serotypes of strains were all positive for stx2 gene, while nonpathogenic E. coli ATCC23716 was negative. Among 32 isolates, 28 STEC isolates containing stx2 gene were positive by RAM assay, while others were negative. The RAM results were 100% in concordance with that of PCR. The real-time RAM results also showed that as many as 10 bacteria can be detected and the time of appearance of detectable signal was depended on the target concentration. Conclusion RAM assay can offer an alternative method for PCR to detect E. coli O157 : H7 and STEC in all types of specimens because of its simplicity and isothermal amplification.

Objective To analyze the oral glucose tolerance test (OGTT) curve characteristics in Chinese women with gestational diabetes mellitus (GDM) or gestational impaired glucose test (GIGT) and to evaluate whether omission of the third-hour plasma glucose measurement of the OGTT could alter the sensitivity of the diagnosis on GDM,and whether there is a close relationship between plasma glucose values of 50 g glucose challenge test (50 g GCT) or OGTT and insulin therapy. Methods A retrospective analysis on medical records of 647 cases with GDM from January 1,1989 to December 31,2002 and 233 cases with GIGT were performed. Among 647 cases of GDM,535 were diagnosed by 75g OGTT. All OGTT (535 with GDM and 233 with GIGT) results were evaluated. Results There were 112 cases of GDM diagnosed by elevated fasting plasma glucose without OGTT performed. Of 535 cases of GDM diagnosed by OGTT,49.2% (263/535) women were with fasting plasma glucose value ≥5.8 mmol/L;90.1% (482/535) women with 1hr plasma glucose values ≥ 10. 6 mmol/L;64.7% (359/535) were with 2 hr plasma glucose levels ≥9.2 mmol/L. There were only 114 cases (21.3%) with abnormal 3 hr plasma glucose levels among 535 women with OGTT,and when 3 hr plasma glucose reached cutoff value,49.1% the other three values of OGTT were abnormal and 34.2% with the other two values of OGTT. Among 233 women with GIGT,only 4 cases with the abnormal 3 hr plasma glucose. We also investigate use of the glucose values for the first 2 hours of OGTT only missed 19 cases of GDM,still discriminated 516 cases. Omission of the third -hour glucose tolerance test value only resulted in failure to diagnose 2.9%(19/647) of GDM cases and 1.72%(4/233) of GIGT cases in Chinese women. Plasma glucose levels ≥11.2 mmol/L following 50 GCT were highly associated with GDM necessitating insulin therapy (75.4%). An elevated fasting plasma glucose level was also associated with insulin therapy (59.7%).Conclusion Omission of the third -hour glucose tolerance test value still yielded a higher sensitivity of 97.1%(628/647) of GDM cases and 98.2%(229/233) of GIGT cases in Chinese women. It is practicable to omit 3-hour post -glucose ingestion value of the OGTT in Chinese women. Plasma glucose levels ≥11.2mmol/L following 50g GCT indicated 75.4% cases of GDM necessitating insulin therapy.

Objective To investigate the relationship of nerve growth factor (NGF) between serum and follicular fluid in patients with polycystic ovary syndrome (PCOS), and its effect on pregnancy outcomes. Methods From December 2011 to November 2012, 65 PCOS patients suffered with in vitro fertilization-embryo transfer (IVF-ET) were included in PCOS group and 31 non-PCOS patients with IVF-ET were used as control group. The expressions of NGF in serum and follicular fluid were detected by ELISA on the injection day of chorionic gonadotropin (HCG). The expression levels of NGF in serum and follicular fluid were compared between PCOS group and control group. Results The NGF levels in serum[(14.38±0.42) ng/L] and follicular fluid[(9.61±0.49)ng/L] were significantly higher in PCOS group than those of control group[(11.39±0.38) ng/L and (7.55 ± 0.40)ng/L]. In PCOS group, NGF levels in serum [(14.22 ± 0.35)ng/L] and follicular fluid [(9.30 ± 0.31)ng/L] were significantly lower in pregnant group than those of non-pregnant group[(14.51±0.43)ng/L, (9.86±0.46)ng/L, P<0.01]. Conclusion The increased levels of NGF in serum and follicular fluid of PCOS patients contribute to the pathogenesis of PCOS. The high expression of NGF in serum and follicular fluid may be harmful to pregnancy in PCOS patients.

This paper evaluates the quality of clinical literature on cupping therapy,analyzes the key factors that influencing the effects of cupping therapy,studies the operation position,tools,accompanied therapy,cupping,cupping frequency,course and other factors in the clinical application of cupping therapy,aiming to provide reference for clinical practice.

Objective To evaluate the effect of captopril and isoflurane preconditioning on cell apoptosis during myocardial ischemia/reperfusion (I/R) in rabbits.Methods Forty New Zealand white rabbits of both sexes,weighing 1.8-2.5 kg,were randomly divided into 5 groups (n =8 each) using a random number table:sham operation group (group S),group I/R,isoflurane preconditioning group (group I),captopril preconditioning group (group C) and captopril and isoflurane preconditioning group (group C + I).The animals were anesthetized with 3％ pentobarbital sodium 30 mg/kg.Myocardial ischemia was induced by occlusion of the left anterior descending branch of coronary artery for 30 min followed by 120 min of reperfusion.1.1％ isoflurane was inhaled for 30 min followed by 15 min washout before myocardial ischemia in group I.Captopril 25 mg/kg was given through a gastric tube into the stomach at 24 h before myocardial ischemia in group C.Captopril 25 mg/kg was given through a gastric tube into the stomach,24 h later 1.1％ isoflurane was inhaled for 30 min followed by 15 min washout,and then myocardial ischemia was performed in group C + I.The rabbits were sacrificed at the end of reperfusion and myocardial specimens were removed for microscopic examination and observation of ultrastructure,and for determination of the expression of Bcl-2 and Bax proteins (by Western blot).The apoptosis rate was detected by flow cytometry.Bcl-2/Bax ratio was calculated.Results Compared with group S,the apoptosis rate was significantly increased,the expression of Bcl-2 and Bax proteins was up-regulated,and Bel-2/Bax ratio was decreased in I/R,I,C and C + I groups (P ＜ 0.05).Compared with I/R,I and C groups,the apoptosis rate was significantly decreased,Bcl-2 protein expression was up-regulated,Bax protein expression was down-regulated,and Bcl-2/Bax ratio was increased (P ＜ 0.05),and the pathological changes were significantly attenuated in group C + I.Conclusion Regulation of Bcl-2/Bax ratio and inhibition of apoptosis in myocardial cells are involved in the mechanism by which isoflurane and captopril preconditioning reduces I/R injury in rabbits.

ObjectiveTo evaluate the effect of radiofrequency therapy in the arthroscopic treatment of subacromial impingement syndrome.MethodsFifty patients with subacromial impingement syndrome treated arthroscopically were enrolled in the study.Preoperatively,the average visual analogue scale (VAS)score of all 50 patients was 5.3±1.8; the average UCLA score was 15.8±4.2; the average Constant score was 65.6±16.2; the average Simple Shoulder Test(SST) score was 6.5±3.3; the forward elevation was averagely 127.4°±40.1°; the external rotation was averagely 34.4°±23.1°; the internal rotation was averagely at L1 level.Patients were randomly assigned to radiofrequency group which received subacromial decompression and Topaz radiofrequency treatment,or control group which only underwent subacromial decompression.The VAS score,UCLA score,Constant score,and SST score were used to evaluate the clinical outcomes 3 weeks,6 weeks,3 months,6 months and 1 year after operation.The assessment of shoulder range of motion included forward elevation、external rotation and internal rotation.The clinical outcome data were compared between the radiofrequency group and the control group,as well as before and after operation within each group.ResultsAt the final follow-up,the average VAS score of all 50 patients was 0.4±1.1; the average UCLA score was 32.9±3.0; the average Constant score was 96.4±5.1; the average SST score was 11.3±1.2; the forward elevation was averagely 161.5°±13.7°; the external rotation was averagely 52.2°±10.9°; the internal rotation was averagely at T7 level.There were statistical differences between preoperative and postoperative indexes mentioned above.However,there were no statistical differences in indexes between the radiofrequency group and the control group at any time point.ConclusionThe Topaz radiofrequency therapy has no significant impact on clinical outcome of arthroscopic treatment of subacromial impingement syndrome.

Objective To discuss complications in locking plate treating displaced proximal hu-meral fractures and explore preventive methods. Methods The study involved 92 patients who were treated with open reduction and internaI fixation with Locking plate from September 2004 to June 2007 and followed up for average 15.2 months(6-36 months).,There were 78 fresh fractures and 14 delayed ones.The average age of the patients was 47.7 years(17-83 years).American Shoulder and Elbow Surgeons Form(ASES)score,Constant-Murley score,University of California-Los Angels scoring system(UCLA) score and Simple Shoulder Test(SST)were used to evaluate the clinical results and observe range of mo-tion,recovery of pain and complications at the latest follow up.In the meantime.we observed the differ-ence of complications in different age,Sex,fracture side,operation time,injury causes,combined injury and fracture tvpe and compared the elinieal results between the patients with complications and those with-out. Results The average forward flexion wag(148.9 ±17.3)°(90°-170°).average external rota-tion up to(29.3 ±15.0)°(0°-70°)and average internal rotation reached T9(T4-L5).The mean VAS score was for(0.9 ±1.1)points(0-5 points).the mean ASES for(86.4 ±13.0)points(52-100points),the mean Constant score for(87.5±10.6)points(55-100 points),the mean UCLA for(30.2±4.0)points(18-35 points)and the mean positive answer of SST for 9.6(4-12).There were 17 pa-tients with complications.with incidence rate of 18.5%.As for incidence rate of complication.there was no statistical difierence upon different sex,time from injury to operation,injury side,combined injury,injury cause,fracture type or fixation type.However,there wag significant difierence in aspect of difierent ages.with incidence rate of complication for 25.5%in patients younger than 50 years old and 8.1% in those older than 50 years old(P＜0.05).Compared with non-complication group,complication group showed significant less extemal rotation and Constant-Murlev and UCLA functional score(P＜0.05).Conclusions Locking plate is a reliable method for displaced proximal humeral fractures.but there still with indication control and appropriate surgical technique,luring the whole procedure so as to reduce inci-dence rate of compl ication as possible.