0.05). JOA scores of group A is higher than those of group B on 1, 2, 4 weeks postoperatively and the difference is of statistical significance (P

Objective To evaluate the efficacy of anatomical locking titanium plate via the posterior elbow approach in the treatment of comminuted fractures of proximal ulna.Methods From January 2011 to December 2013,22 comminuted fractures of proximal ulna were treated by anatomical locking titanium plate via the posterior elbow approach.They were 14 men and 8 women,from 21 to 57 years of age (average,42.7 years).Nine cases were on the left side and 13 on the right.All were unilateral closed fractures.By the Schatzker classification,12 cases were type Ⅲ A,6 type Ⅲ C and 4 a combination of type Ⅲ A and type Ⅲ C.The Broberg & Morrey criteria were used to evaluate the elbow function one year postoperation.Results The follow-ups for the 22 cases ranged from 12 to 24 months (average,16 months).All the cases obtained clinical healing after 10 to 16 weeks (average,13 weeks).According to the Broberg & Morrey criteria,12 cases were evaluated as excellent,7 as good,and 3 as fair,yielding an excellent to good rate of 86.4％.No such complications as infection or necrosis of soft tissues,elbow stiffness,or obvious pain were observed during the follow-up period.Conclusion It is an effective treatment of comminuted fractures of proximal ulna with anatomical locking titanium plate through the posterior elbow approach.

Objective To synthesize the hydrophobic supraparamagnetic ironic oxide(SPIO) loaded and hydrophilic SPIO loaded polymeric nano-vesicles and to investigate the feasibility of using hydrophobic SPIO loaded and hydrophilic SPIO loaded polymeric nano-vesicles to display the tumor in MRI in vivo through animal experiments. Methods The polymeric nano-vesicles were prepared from poly (D, L-lactic acid) (PDLLA) and poly (ethylene glycol) (PEG) by a multiple emulsion/solvent evaporation method.The hydrophobic SPIO and hydrophilic SPIO were loaded in the polymeric nano-vesicles respectively.Eighteen nude mice models with human colorectal carcinoma xenograft were established. They were divided equally into three groups (n = 6). The three groups of nude mice models were injected with water-soluble SPIO, hydrophobic SPIO loaded and hydrophilic SPIO loaded vesicle via the mice caudal vein respectively.Dynamic MRI scan were performed in all the mice models. T2WI signal intensity and T2 relaxation time were measured in the tumor, liver and muscle by using T2 mapping software. ANOVA of repeated measurement was used to analyze if there were significant differences of signal intensity changes among the three groups, while Bonferroni method was used for pair-wise comparison. Results On T2 WI, tumors showed decrease in signal intensity after hydrophobic or hydrophilic SPIO loaded polymeric nano-vesicle injection, while no signal intensity decrease was found in the tumor after water-soluble SPIO administration. The maximum percentage of signal intensity decrease in tumor caused by hydrophobic SPIO loaded and hydrophilic SPIO loaded vesicle were 11.00%, 11.40%, respectively. There was statistical significant difference of signal intensity changes among these three groups (F = 10. 96, P ＜ 0. 01). The decrease in signal intensity in the groups with hydrophilic or hydrophobic SPIO loaded polymeric nano-vesicles injection were more pronounced as compared with that of water-soluble SPIO (P ＜ 0. 05), but there was no significant difference in signal intensity decrease between the groups of hydrophilic and hydrophobic SPIO-loaded polymeric vesicles injection (P ＞0. 05). The three agents could lead to signal intensity decrease in the liver. The maximum percentage of signal intensity decrease in liver caused by water-soluble SPIO, hydrophobic SPIO loaded and hydrophilic SPIO loaded vesicle were 32. 85%, 52. 77%, 56. 89%, respectively. There was statistical significant difference between these groups (F = 161.18, P ＜ 0. 01) . The groups of injecting hydrophilic and hydrophobic SPIO loaded polymeric nano-vesicles had the more obvious signal decrease than the one with water-soluble SPIO (P ＜ 0. 01). Hydrophilic SPIO loaded polymeric nano-vesicles exhibited more signal intensity decrease than hydrophobic SPIO loaded polymeric nano-vesicles (P ＜ 0. 01). All three agents could not lead to T2WI signal decrease in the muscle, and there was no significant difference in signal change on T2 WI among three groups (F = 0. 59, P ＞ 0. 05). Conclusion SPIO loaded polymeric nano-vesicles can cause significant T2WI signal loss in human colonic carcinoma on MR imaging in vivo. It can be used as tumor imaging contrast agents.

Objective To evaluate the relationship between the blood flow values generated from MR arterial spin labeling (ASL) perfusion imaging and pathologic indicators of angiogenesis including microvascular density (MVD) counts and vascular endothelial growth factor (VEGF) expression levels of VX2 carcinoma in rabbit soft tissue. Methods VX2 tumor was inoculated in the muscular tissue of right posterior limbs of 18 healthy New Zealand white rabbits ,on which arterial spin labeling perfusion imaging was performed by using flow sensitive alternating inversion recovery pulse sequence 3 to 4 weeks later. Arterial spin labeling images were transferred to an independent computer for post-processing and blood flow (BF) maps were generated from them. BF values were measured in 2-4 regions of interest (ROIs) for each tumor. The rabbits were sacrificed after MR imaging. The gross specimens of tumors were obtained and tumor tissues were taken from the non-necrotic regions corresponding to ROIs on BF maps. Immunohistochemical staining of the specimens was performed by using CD31 monoclonal antibody to calculate MVD counts, using VEGF antibody to calculate VEGF expression levels. Correlation between BF values and MVD counts as well as between BF values and VEGF expression levels was evaluated using Spearman correlative analysis.Results On BF maps, viable tumor tissues showed high BF values compared with muscle, but there were areas without blood perfusion in some tumors. Under microscope, the microvessels positively stained by CD31 appeared as light brown areas, and the cells positively staied by VEGF showed reddish brown areas within their cytoplasm. Totally 39 pieces of VX2 tumor tissue were analyzeed There was a significant positive correlation between the BF values(M =6. 4 ml · 100 g-1 · min-1 ) and MVD counts(M =6. 8) (r = 0. 906,P ＜ 0. 01 ), and no significant correlation between BF values and VEGF expression levels ( M = 8％ ) ( r =0. 116, P=0.483). Conclusion BF value can be used in evaluating angiogenesis of soft tissue tumor through its reflection of MVD counts, and thus may be helpful in evaluating the prognosis of soft tissue tumor and making plan for their treatment.

BACKGROUND: Chinese anatomical parameters of antedor atlantoaxial transarticular screw fixation have been rarely reported although the technique is a novel method out of China for patients with C1-C2 instability. OBJECTIVE: To provide Chinese anatomical data for anterior C1-C2 transarticular screw fixation. DESIGN, TIME AND SETTING: A measurement experiment was performed at the Department of Anatomy, Southern Medical University and Department of Orthopedics, Wuhan General Hospital, Guangzhou Command of Chinese PLA between September 2006 and April 2008. MATERIALS: A total of 50 sets of dried Chinese adult human C1 and C2 specimens, without regard to gender and age, but no abnormality and breakage, were measured with an electronic digital caliper (precision 0.01 mm) and a goniometer(precision 0.5°) made in China. METHODS: One proper screw was drilled through the atlantoaxial joint respectively in the direction to middle part of laterosuperior angle in the posterior of C1 lateral mass, and the screw point should not break through the superior facet articularsurface of the C1. In the procedure, the screw drilling point was at the junction of the lateral border of C2 body to 4 mm above the inferior border of C2 anterior arch. border of transverse foramen of C2 body and the median line of C2 body, and the distance between the inserting point and the medial border of transverse foramen of C2 body. RESULTS: The data from all specimens were involved in the result analysis. In the sagittal plane, the minimum lateral angulation of the screw tract was (10.80±2.10)°(left) and (10.76±2.40)°(right) respectively, and the maximum lateral angulation was (25.13±3.12)°(left) and (25.12±2.86)°(right), respectively. In the coronal plane, the minimum posterior angulation was (8.85±2.12)° (left) and (9.28±2.65)° (right) respectively, and the maximum posterior angulation was (26.96±3.09)°(left) and (27.49±2.51)°(right), respectively. The left screw tract length was from (17.48±2.10) mm to (25.41±2.59) ram, and the right was from (17.49±2.23) mm to (25.58±2.42) mm. The left distance between the inserting point and the median line of C2 body was (9.84±0.69) mm, and the right was (9.81±0.66) mm. The left distance between the median line of C2 body and medial border of transverse foramen of C2 body was (14.12±1.28) mm, and the right was (14.60±1.36) mm. The left distance between the inserting point and medial border of transverse foramen of C2 body was (6.28±1.38) mm, and the right was (6.79±1.39) mm. CONCLUSION: It is optimal for the anterior C1-C2 transarticular screw fixation to place the antedor screw with a length of 17 to 25 mm in lateral angulation ranging from 10° to 25° and the posterior angulation ranging from 9° to 27°. During the procedure, the dissecting distance from the middle of C2 body to lateral should not exceed 14 mm.

Objective To compare the diagnostic significance of pleural SLPI,IFN-γ and ADA for differenti-ating TPE from pleural effusions with the other etiologies. Methods Pleural effusion samples were obtained from 93 patients who were divided into the following groups: tuberculous pleural effusion,malignant pleural effusion, bacterial pleural effusion and transudative pleural effusion. The pleural effusion and/or serum levels of SLPI , IFN-γand ADA were determined. Results 1.The concentrations of SLPI, IFN-γand ADA in tuberculous pleural effusion was higher than that in malignant group, bacterial group and transudative group. 2. The diagnostic value of SLPI, IFN-γor ADA for the diagnosis of tuberculous PE is high respectively. The combinations of SLPI, IFN-γand/or ADA gained the more valuable diagnostic performance. Conclusion Pleural SLPI, IFN-γand ADA may be helpful for the differential diagnosis of tuberculous pleural effusion and the other pleural effusion. The combinations of SLPI or/and IFN-γor/and ADA further increased diagnostic value.

[Objective] To summarize image manifestations in intestinal tuberculosis (ITB) examined by multi-slice computed tomography enteroclysis (MSCT) and evaluate the diagnostic value of MSCTE in ITB,[Methods] The imaging findings were retrospectively analyzed in 15 cases of ITB that were confirmed by endoscopy or postoperative pathologic examination,including the location,number,shape,edge,surrounding tissue alterations of ITB and other associated changes in the peritoneum,mesentery and solid abdominal organs,and compared with endoscopy and pathology.[Results] In 15 patients,ileocecum was involved in 13 cases (87％),4 cases (27％) showed multi-segmental symmetric intestinal mural thickening,9 patients (60％) showed solid masses,1 case (7％) showed multi-segmental symmetric intestinal mural thickening and solid masses,1 case (7％) showed homogenous enhanced masses and perforation,12 cases (86％) showed enlarged lymph nodes (LNs) with rim enhancement,and 2 cases (13％) showed the comb sign of enhanced mesenteric vessels.Based on enhancement pattern of MSCTE,ITB was divided into three types:homogenous enhancement type (n=5);target sign type (n=2);caseous necrosis type (n=2).[Conclusion] The imaging features of ITB are diverse.MSCTE can clearly display the shape of intestinal mucosa,the alterations of intestinal wall and the relationship between lesion and adjacent tissues,which provides valuable information for the clinic diagnosis of ITB.

[Objective] To measure the diameter of the superior rectal vein (SRV) & theinferior mesenteric vein (IMV) by CT and analyze their relationship with lymphatic metastasis of rectal carcinoma.And to discuss the feasibility of utilizing SRV to prcdict lymph node metastasis of rectal cancer.[Methods] The CT imaging and pathological data of 105 rectal carcinoma patients were analyzed retrospectively.We measured and compared the diameter of every patient's SRV & IMV by CT in the presence and absence of microvascular tumor thrombus,signet ring cell,lymph node metastasis and distant metastasis.The accuracy of predicting lymph node metastasis for rectal carcinoma by the diameter of SRV were evaluated by ROC curve.[Results] There were statistical differences in the diameters of SRV and IMV between rectal cancer group with lymph node metastasis (D =4.34 mm,D =5.00 mm) and without (D =3.56 mm,D =4.81 mm;P ＜ 0.001,P =0.023).The differences were significant in the diameter of SRV between rectal cancer group with microvascular tumor thrombus or signet ring cell and without (P =0.019,P =0.044).However,the diameter of IMV showed no statistical difference between rectal cancer group with microvascular tumor thrombus or signet ring cell and without (P =0.605,P =0.663).And there was no statistical difference in the diameter of SRV or IMV between rectal cancer patients with distant metastasis and without (P ＞ 0.05).Regarding 3.75 mm as the cut-off value for the diameter of SRV to predict lymph node metastasis for rectal cancer patients,the sensitivity was 90.9％ and the specificity was 82.0％.Regarding 4.65 mm as the cut-off value for the diameter of IMV to predict lymph node metastasis for rectal cancer patients,the sensitivity was 87.3％ and the specificity was 38％.[Conclusions] It is completely feasible to utilize the diameter of SRV measured by CT to predict lymph node metastasis of rectal carcinoma with high sensitivity,accuracy,and relatively high specificity.

Objective To evaluate the clinical effect of mini-plate internal fixation via anterior elbow approach in treating coronoid process fractures.Methods A retrospective case series study was conducted on the clinical data of 43 cases of ulnar coronoid process fractures treated from December 2014 to December 2016.There were 29 males and 14 females,with an average age of 32.4 years (range,24-64 years).Twenty-four cases were injured on the right,and 19 on the left.There were 18 cases of simple coronoid process fractures,23 combined with ipsilateral capitulum radius fractures,and two combined with ipsilateral ulna olecranon fractures.According to the O'Driscoll classification,there were four cases of type Ⅰ,3 type Ⅱa,9 type Ⅱb,17 type Ⅱc,6 type Ⅲa,and 4 type Ⅲb.The elbow flexion and extension range was 40°-90°[(64 ± 18)°],and the rotation range 60°-130°[(83 ± 15)°].All the patients underwent mini-plate internal fixation via anterior elbow approach.The operation time,intraoperative blood loss,wound healing,fracture healing,and postoperative complications were recorded.Function of elbow joint was evaluated by Mayo elbow performance score (MEPS).Results All patients were followed up for 12-24 months (mean,15.7 months).The average operation time was 52 minutes (range,36-86 minutes).The average blood loss was 20 ml (range,10-50 ml).At the last follow-up,all were seen incision healing by first intention and clinical fracture healing.The index finger,and middle finger palmaris numbness occurred in one patient after surgery,and the patient recovered at 2 months of follow up.The elbow flexion and extension range was 86°-145° [(117 ± 114) °],and the rotation range of 114°-155° [(132 ± 17) °],showing significant difference in comparison with the preoperative measure (P ＜ 0.05).According to the MEPS one year after operation,14 cases were evaluated excellent,27 good,and four fair,with an excellent and good rate of 91％.Conclusion The mini-plate internal fixation via the anterior elbow approach is effective in treating ulnar coronoid process fractures,for the operation is simple,allows full exposure,reduction,or reconstruction under direct vision,and effectively restores the function of the elbow joint.

Objective To investigate application of modified isosceles triangle osteotomy which is designed with the assistance of Picture Archiving and Communication System ( PACS ) in supracondylar surgery for cubitus varus. Methods We reviewed the 31 patients who had been treated for cubitus varus from January 2012 to July 2017. They were 12 males and 19 females, aged from 17 to 24 years ( average, 20. 6 years) . Their elbow varus angles ranged from 14° to 35° (average, 22. 4°) . Preoperatively, the modified isosceles triangle osteotomy was designed using the PACS. The angle of osteotomy = carrying angle of the normal arm + the angle of cubitus varus. The lateral length of the isosceles triangle osteotomy was calculated according to the osteotomy angle. All the cases were fixated with a locking plate. Results The follow-ups lasted from 12 to 40 months ( average, 16 months ) . Bony union was achieved in the osteotomy site by all cases after 7 to 12 weeks ( average, 9 weeks ) . The carrying angles ranged from 8° to 15° ( average, 11°) at final follow-ups. The affected elbow obtained a range of flexion and extension from 126° to 150° ( average, 139°) and a range of rotation from 134° to 160° ( 144°) . According to the Mayo elbow performance score ( MEPS ) one year after operation, 23 cases were rated as excellent, 7 as good and one as fair, yielding an excellent to good rate of 96. 8％. No loss of carrying angle, neural deficit, malunion, delayed union, or myositis ossifi-cans of the elbow was observed during the follow-ups. Conclusion The PACS can be used in preoperative design of the modified isosceles triangle osteotomy for cubitus varus, leading to accuracy in the angle and length of the osteotomy to guarantee fine clinical results.