Objective To investigate the treatment of pronation external rotation ankle injuries and to evaluate its outcomes. Methods 58 cases of severe ankle injuries of pronation external rotation type who had been hospitalized between October, 2001 and October, 2003 were retrospectively analyzed. They were 42 males and 16 females, with an average age of 32.4 years old (16 to 61 years old). According to Lauge Hansen classification, 39 cases were grouped as grade Ⅲ, while other 19 cases as grade Ⅳ. Most cases were surgically managed, and routine examinations were done. Results The average follow up period was 16.4 months (from 10 to 36 months). The satisfactory outcome was 89.7%. 2 cases of osteoarthritis were observed. Conclusions In treatment of pronation external rotation ankle injuries, the key points are to correct the fibular shortening and external rotation and to take great care of technical details.

The efferent projections of the rostral ventrolateral medulla(RVL) to the hypothalamic paraventricular nucleus(Pa) and the thoracic cord were studied in the adult cat by using WGA-HRP or fluorescent retrograde tract-tracing method. After injection of WGA-HRP or fluorescent tracer Fast blue(FB) into one side of the Pa, retrogradely labelled cells were found in bilateral RVL, with an ipsilateral predominance. The labelled cells decreased in number from the caudal to the rostral level. After injection of FB into one side of the thoracic cord at T_2-T_3 segments, retrogradely labelled cells in the RVL were observed which increased in number from the caudal to the rostral level and reached the peak at 1.0-1.5mm caudal to the trapezoid body. Most of these cells were distributed in the ipsilateral RVL, and clustered in the region 0.0-1.0mm from the ventral surface of the medulla. After Diamino yellow 2HC1 and FB were injected into the Pa and the thoracic cord respectively, only single labelled cells were detected in the RVL, no double labelled cells were found. The above results suggest that the Pa and the thoracic cord receive separate fiber projections from different cells of the RVL.

The distribution of serotonin(5-HT), phenylethanolamine-N-methyltransferase (PNMT), substance P(SP) and leu-enkephalin(L-ENK) immunoreactive neurons in the rostral ventrolateral medulla (RVL) of the cat was studied with the immunohistochemical ABC technique, and the projection of 5-HT, SP and L-ENK positive neurons of the RVL into the thoracic cord was preliminarily investigated by a combined fluorescent retrograde transport and immunofluorescence method. The results indicate that 5-HT, PNMT, SP and L-ENK immunoreactive neurons mentioned above were localized primarily in the caudal part of nucleus paragigantocellularis lateralis and the rostral part of nucleus lateralis reticularis. SP positive cell bodies in the reticular formation close ventrolateral to nucleus ambiguus were also found. Some 5-HT, SP and L-ENK positive cells were situated in the area near the pia mater. In the most area of the RVL, 5-HT, PNMT, SP and L-ENK immunoreactive cell bodies had an overlapping distribution. 5-HT or PNMT or L-ENK positive neurons crowded, intertwined each other with their processes in the region at the levels 1.0-3.5mm caudal to trapezoid body, about 3.3mm lateral to the midline and about 0.8mm from the ventral surface of the medulla, and formed a longer or shorter continuous cell column which ran in the rostrocaudal direction. These three columns nearly coincided with each other at the level 1.5-2.5mm caudal to trapezoid body. Part of 5-HT, SP and L-ENK positive neurons in the RVL projected into the thoracic cord. The functional significance of these substances in the RVL was also discussed.

[Objective]To use urodynamic method to evaluate "free sacro-capsule"pre-operation and post-operation effect,also evaluate bladder and urethral function.[Method]Twenty children were included in this study.[Result]All children had none damage after operation.The PVR and DLPP of post-operative group are significantly decreased.The BC and MCC of post-operation group was significantly higher than pre-operation group(P

Objective To analyse the clinical features,imaging characteristics diversity of deep cerebral veins thrombosis (DCVT).Methods From 2004 to 2013,6 patients diagnosed as DCVT were recorded and a retrospective review of the cases were undertaken for the purpose of this analysis.Results Among the 6 patients with DCVT,4 were male and 2 were female,aged from 28 to 69 years old.The disease duration of 4 cases ranged from 2 to 7 days,remnants were 20 days and 3 months respectively.The first symptoms of 4 cases were headache,1 was feeblemindedness,and the other was hemiplegia.The secondary symptoms were disturbance of consciousness,apathy,diplopia and non-infectious fever.Non-contrast computed tomography showed low signal in the bilateral thalamus in four patients,high signal in the transverse sinus and straight sinus in one patient and high signal in torcular in one patient.Abnormal signal was found in bilateral thalamus on magnetic resonance imaging in all patients and some of them had abnormal signal in the mesencephalon or basal ganglia.The patients were definitely diagnosed as DCVT by magnetic resonance venography (MRV) or digital subtraction angiography (DSA).Among them,2 patients were confirmed by brain biopsy.Four patients were followed up with good outcome and 2 were lost to follow-up.Conclusions The clinical manifestations of DCVT are not specific.For acute-onset DCVT patients,the first symptoms are always headache and vomiting,while the main symptoms are declined cognition and slow reaction for chronic-onset ones.Along with the progress,the main symptoms of DCVT are disturbance of consciousness,psychiatric symptoms and intracranial hypertension.Changes in the bilateral thalamus and basal ganglia are especially main characteristics which are easily misdiagnosed as brain tumor according to the images.DCVT can be definitely diagnosed by no signal of deep cerebral veins on MRV or DSA.

Objective To explore the relationship between self-efficacy and self-management behaviors of patients with chronic obstructive pulmonary disease (COPD).Methods A total of 350 COPD patients form 5 residents' committees in shanghai were recruited by using a convenient sampling method and were scored using Chinese Self-efficacy Scale (CSES)and the self-management behaviors scale.Spearman's correlation analysis was performed to detect the relation of self-efficacy with self-management behaviors.Results Three hundred and twenty adults were included in this investigation,and their average FEV1/FVC was (57.86 ± 7.06)％,average score of self-efficacy was 74.2 ± 9.5.In self-management behaviors,time spent on physical exercise was (16.2 ± 33.9) minutes per week,and endurance exercises accounted for (109.0±49.0) minutes per week.The score of cognitive symptom management practice was 0.9 ± 1.0 and communication with physicians was 0.7 ± 0.8.Total score of self-efficacy was positively correlated with self-management behavior in each dimension (r values were 0.522,0.407,0.330 and 0.044,respectively ; all P ＜ 0.01).Conclusions Self-efficacy and self-management behaviors of COPD patients need to be improved,and self-efficacy may be related to self-management behaviors.

BACKGROUND: During the hip replacement, selection of prosthesis often depends on patients' bone condition. There has been no gold standard for selection of prosthesis. It will be of scientific significance to select femoral prostheses implanted under different bone densities through three-dimensional finite element analysis and simulated contrast mechanical tests.OBJECTIVE: Three-dimensional finite element analysis was employed to select femoral prostheses according to different bone densities, and simultaneously simulated contrast mechanical tests were performed to determine the age criteria regarding the selection of femoral prosthesis during the hip replacement.DESIGN, TIME AND SETTING: An open experiment was performed at the Second Department of Orthopedics, First Clinical Hospital of Jilin University and Institute of Biomechanics, Jilin University between September 2006 and May 2007.MATERIALS: Freshly adult femoral specimens were harvested from cadavers.METHODS: Three-dimensional finite element models of femur were established using Solidworks software. Following the known formula, the bone density and elastic modulus at different age brackets were calculated and input into the computer. The human one-foot standing condition was simulated and pressure was loaded on the reconstructed femoral models.MAIN OUTCOME MEASURES: Some biomechanical characteristics of uncemented and cemented femoral prostheses, such as the distress distribution and initial micromovement at different bone densities, were measured.RESULTS: Relatively well-distributed whole distress and slight initial micromovement of uncemented femoral prostheses were found in male patients at 30-60 years old and in female patients at 40-55 years old. Symptoms of cemented femoral prostheses the same as the uncemented femoral prostheses were present in male patients at 60-70 years and in female patients older than 55 years old.CONCLUSION: Results of three-dimensional finite element analysis and simulated contrast mechanical tests suggest that uncemented femoral prostheses provide better therapeutic effects in male patients younger than 60 years and in female patients younger than 55 years than cemented femoral prosthesis.

Objective To assess the significance of urethral sphincter electromyography (US-EMG) and external anal sphincter electromyography (EAS-EMG) for the diagnosis of multiple system atrophy (MSA).Methods US-EMG and EAS-EMG were performed in 9 patients who were diagnosed as MSA.Duration,motor unit action potentials amplitude,polyphasicity,as well as recruited pattern and amplitude during powerful contraction were recorded and analyzed.Results Among 9 patients who were diagnosed as MSA,7 cases showed neural injury by both US-EMG and EAS-EMG.There was significant difference of electromyographic findings between US-EMG group and EAS-EMG group (average volatility (μV):1063.44 ±499.92 vs 634.89 ±265.07; polyphasic wave:0(0,20％ ) vs 57％ (28％,63％ ) ; t =2.567,P=0.033;t =2.833,P=0.012).Conclusions Although US-EMG may be difficult to perform,US-EMG may have the same specificity as EAS-EMG for the diagnosis of MSA,especially for the diagnosis of MSA patients only with urination disorders,who are involved in Onuf neclear according to some of the abnormal indexes.

BACKGROUND:Acetabular cup orientation is critical for preserving the range of motion and preventing dislocation of the prosthesis. Cup malpositioning may result in an increased polyethylene wear rate,pelvic osteolysis and acetabular migration (aseptic loosening).There are no definite criterion for the orientation of the acetabular cup.OBJECTIVE:To explore the relationship between acetabular cup Position and the load distribution within the acetabulum and to confirm an optimal range of cup position.thereby providing a theoretical criterion from a biomechanical aspect for proper cup implantation in clinical work.DESIGN:Repeated measurements.SETTING:Second Department of Orthopaedics in the First Clinical Hospital of Jilin University.MATERIALS: One healthy male adult fresh Cadaveric pelvis was offered by the Department of Anatomy in Jilin University.METHODS:This experiment was carried out at the Institute of Orthopaedics in the First Clinical Hospital of Jilin University,and the Institute of Biomechanics in Jilin University from September 2005 to May 2006.Cadaveric pelvic was scanned with spiral CT,and then the two-dimensional images were evaluated using GE medical systems software and the outline of the pelvis was identified by the edge detective estimation.Pelvic coordinate data were put into the computer to build up a three-dimensional (3D) finite element model of the pelvic using Solidworks software.A P48 non-cemented cup from Tianjin Huabei Medical Instrument Factory was used,and the 3D measurement of the cup was carried out by CLY single-arm 3D measurement apparatus,which was made in Testing Technology Institute of China.The measurement data were transferred into computer.Through the CAD SliodWorks2003 software,the 3D model of the cup was automatically reconstructed. Afterwards, one-foot standing position was simulated to conduct the loading and constraint of the model,the Mises and shear force distributing of the cup were analyzed,forecasting the mechanical risk of prosthetic failure.MAIN OUTCOME MEASURES:The evaluation of Mises stress and shear force distributions under different cup positions.RESULTS:In the 3D finite element modeI of human pelvis.the number of total nodes was 103043 and the number of total elements was 69271.Abduction angle did not affect the Mises and shear force distributions between the range of 40°-50°(P>0.05).However,significant affects appeared in Mises and shear force once the abduction angle was<35°or>50°.The change of the cup anteversion within 5°-30°would not affect the Mises and shear forces in the acetabulum(P>0.05).CONCLUSION:A uniform load distribution on the cup-bone interface can be obtained when the cup abduction angle is from 40°to 50°.The change of the cup anteversion angle can not affect the load distribution in the acetabulum,therefore the cup abduction range of 40°-50°can be confirmed as the safe range for cup implantation.

Objective To investigate the self-efficacy levels and its influencing factors of community-based patients with chronic obstructive pulmonary diseases (COPD).Methods From October 2008 to March 2009,320 community COPD patients were recruited from a Shanghai community.They undertook questionnaires,scale survey and pulmonary function testing so as to investigate the influencing factors of self-efficacy.Results The total scale of self-efficacy was 74.24 ± 9.50 and the level of selfefficacy in 286 cases( 89.4％ )was intermediate.The knowledge of COPD,social supports,forced expiratory volume at 1 second (FEV1)/forced vital capacity (FVC) and self-management level were entered into regression equation and could explain 57.1％ of the total variance of independent variables.Conclusions The knowledge of COPD,social supports,FEV1/FVC and self-management level are the major influencing factors of self-efficacy in the COPD patients.We should improve the knowledge of disease and strengthen the psychological care and social supports so as to improve their quality of life.