Objective To evaluate intra-and interobserver reliability of analysis of lower limb alignment on DR digital images using AutoCAD.Methods Angles on AP view and long leg view were measured three times by two trained observers separately using these two methods in 140 knees.The intra-and interobserver intraclass correlation coefficients with 95% CIs of two methods were calculated and compared with Fisher z transformation and Z test.Paired t test was used in comparing time consumption.Results For AutoCAD method,inter ICCs were 0.942? 0.993 ,intra ICCs were 0.937～0.999.For X-ray films method,inter ICCs were 0.736～0.981,intra ICCs were 0.759～0.951.Corresponding ICCs of AutoCAD method were higher than those of X-ray films method,most of which had significant differences(P<0.01).The consuming time of two observers in measuring one knee using AutoCAD method was 89.6 seconds and 94.3 seconds shorter than those using X-ray films method respectively.Both had significant differences(P<0.01).Conclusion It was a fast reliable method to assess lower limb alignment on DR digital images using AutoCAD.

The pathological subtypes of breast cancer can be further divided into different molecular subtypes based on their immunohistochemical staining, such as estrogen receptor (ER) , progesterone receptor (PR) , human epidermal growth factor receptor2 (HER2) and Ki67 expression, including luminal subtype, HER2 overexpression subtype and triple negative subtype. The luminal subtype is defined as ER and/or PR positive. In molecular mechanism, the expression activity of ER can regulate the expression of PR, so the expression of ER and PR is usually consistent. However, in the process of detection, some breast cancers with inconsistent ER/PR expression often appear, especially those with ER (-) /PR (+) . There is still controversy about whether such cases are true. Patients with this type of breast cancer should be subjected to ER and PR immunohistochemical staining again, and then reclassified according to HER2 status. The expression of ER/PR is closely related to the efficacy of endocrine therapy for breast cancer, so its test results will directly affect the treatment options of clinician. This article will review and discuss the research progress of the causes and mechanisms of ER (-) /PR (+) breast cancer.

OBJECTIVEThis study aims to evaluate the nasolabial angle change and the correlation analysis ot Angle'Is Class II division 1 malocclusion patients with vertical growth pattern after tooth extraction orthodontic treatment and provide experimental results to help in making orthodontic treatment plan and treatments.

METHODSA total of 38 Angle's Class II division 1 malocclusion patients with vertical growth pattern and tooth extraction orthodontic treatment were included in this study. Pre- and post-treatment cephalometric X-rays were performed, and 18 measurement items were measured. The change values of pre- and post-treatment, youngsters, and adults were compared to analyze the correlation of the nasolabial angle change.

RESULTSThe nasolabial angle between youngsters and adults was enlarged after treatment, but the nasolabial angle of the adult group changed more significantly. Ul to FH, Ul to NA, U1-NA, Spr-Ptm were reduced after treatment, and the adult group decreased more significantly. The upper lip sulcus and flange thickness, A'-Ptm, upper lip length, and nose prominence were enlarged after the adolescent treatment, but the adult had a certain degree of decrease. The difference had statistical significance. In the correlation of the nasolabial angle change analysis of the two groups, namely, Ul to FH, Ul-NA and U1 to NA had significant negative correlation, significant positive correlation to the upper lip inclination angle, and more significant correlation in the adult group. Upper lip flange thickness and nasolabial angle were negatively correlated, and the upper lip sulcus thickness was positively correlated. However, no significant correlation was observed between these two in the adult group.

CONCLUSIONThe nasolabial angle change of adolescents with vertical growth pattern in class II division 1 malocclusion after extraction treatment is related to the upper anterior teeth hard tissue and upper lip soft tissue, whereas only adults and upper anterior teeth hard tissue are related.

BACKGROUND:Crowe IV developmental dysplasia of the hip is rarely seen clinical y. However, when treated with routine total hip arthroplasty, severe deformities in the bone and soft tissue can lead to high rate of operation failure and increased occurrence of complications. Total hip arthroplasty in combination with subtrochanteric osteotomy may be an option to resolve this problem.
OBJECTIVE:To retrospectively analyze the clinical outcome and safety of Crowe IV developmental dysplasia of the hip treated by the combination of total hip arthroplasty and subtrochanteric osteotomy in 17 cases.
METHODS:Twenty-one hips (17 cases) of Crowe IV developmental dysplasia of the hip treated by the combination of total hip arthroplasty and subtrochanteric osteotomy were retrospectively analyzed and fol owed for at least 2 years from January 2006 to June 2011. Complications, hip function, and radiological changes were evaluated.
RESULTS AND CONCLUSION:The mean fol ow-up period was (48.0±20.5) months. Harris’s score was increased postoperatively (P<0.05). The main complains were lower limb length discrepancy, difficulty in standing up from squatting, muscle weakness, and soft tissue tightness. One greater trochanter fracture occurred and was fixed by hook plate fixation. There were four femoral shaft splits treated by cerclage. One patient represented with femoral nerve palsy and got partial recovery until the latest fol ow-up. There was no deep infection, dislocation or prosthesis loosening. Crowe IV developmental dysplasia of the hip could be effectively treated by total hip arthroplasty in combination with subtrochanteric osteotomy, which requires high surgical techniques to control the complications. Further fol ow-up is required for long-term results.

A retrospective analysis was conducted for male Han patients aged 46 years or above undergoing serum test of total prostate specific antigen (tPSA) at our hospital from 2007 to 2009.Among them,there were 109 patients with complete clinical data (including a history of hypertension and dyslipidemia),including 36 type 2 diabetics and 73 non-diabetics.For type 2 diabetes and non-diabetes groups,the median values (lower quartile,upper quartile) of serum tPSA test results were 1.01 (0.44,3.43) μg/L and 2.26 (1.04,5.48) μg/L (t =-2.65,P ＜0.01) respectively.The serum level of tPSA in type 2 diabetics was significantly lower than that in non-diabetics.

BACKGROUND:Many scholars researched the biomechanics of middle clavicle fracture plate fixation, but little researched the plate position. OBJECTIVE:To observe the biomechanical characteristics ofanterior and superior plates for clavicle fracture with three-dimensional finite element models. METHODS:Three-dimensional finite element models of clavicle fracture with anterior and superior plates were established. The stress after anterior and superior plate fixation was analyzed. The maximum stress and displacement of plate fixation for clavicular fracture were observed under compression, torsion and three-point bending. RESULTS AND CONCLUSION:(1) In the compressed condition, the maximum stressand maximum fracture displacement were similar between the superior and anterior plate fixation (P> 0.05). (2) Under clockwise twist condition, the maximum stress and maximum fracture displacement were smaler in the superior plate fixation group than inthe anterior plate fixation group (P< 0.05). (3) Under counterclockwise twist condition, the maximum stress and maximum fracture displacement were similar between the anterior and superior plate fixation groups (P> 0.05). (4) Under three-point bending condition, the maximum stress was similar between the superior and anterior plate fixation groups (P> 0.05). The maximum fracture displacement was bigger in the superior plate fixation group than in the anterior plate fixation group (P< 0.05). (5) These findings suggest that superior fixation of clavicle fracture reconstruction plate has more advantages than the anterior plate fixation.

Objective To study the effect of continuous subcutaneous insulin injection(CSII) in treatment of type two diabetic patients with pulmonary infections. Methods From January 2001 to December 2005,83 type two diabetic patients with pulmonary infections were randomized to group CSII (42 cases) and group MSII(41 cases). The period of normalization of the blood glucose and cure of the pulmonary infections, cost and morbidity of low blood glucose were observed. Results Blood glucose of all patients in two groups reduced significantly. Significant difference was observed in the period of cure of the pulmonary infections, usage amount of insulin and morbidity of low blood glucose. In group CSII HbA1c, CRP and CHOL reduced significantly. Fasting CRP and high density lipoprotein-C (HDL-C) were remarkably increased. Conclusions Consecutive subcutaneous insulin pump injection is able to control the blood glucose better, to correct metabolic disorder, reduce the cost and hospital day and decrease the morbidity of low blood glucose. CSII is a better of method.

Objective To study the effects of intraoporative radio-frequency ablation on immune functions and survival of patients with multiple large hepatic cancer. Methods Forty five admitted patients with multiple large hepatic cancer from January 2003 to January 2007 were devided into: simple hepatic artery embohzation chemotherapy group (TACE group, n = 20) , local resection of multiple lesion + TACE (LR group, n = 13), and TACE + intraoperative radio-frequency ablation (IRFA group, n = 12). The changes of peripheral blood T-cell subsets were evaluated using flow cytometry, and a comparison of the complete remission rate and survival rate between the 3 groups was made and the survival rate analyzed with Kaplan-Meier method, the validity check with long-rank method. Results CD4+ , NK, and CD4+/ CD8+radio significantly increased 4 weeks after treatment only in IRFA group. The immune function was suppressed during the first week after treatment in local resection group. Tumor complete remission rate in IRFA group, local resection group and simple TACE group were 41.70%, 46. 20% and 25.50% respectively, the difference was not statistically significant between the 3 groups (x2 = 1.81, P > 0.05). the 1.5 year and 2.0 year survival rate in the 3 groups were 75.00%, 69. 20%, 30% (x2 = 7.96, P < 0.05) and 50.00%, 23.10%, 10. 00% respectively (x2 = 18.98 ,P <0.05), the mean survival period of patients in the 3 groups was 26. 56 months, 21.04 months, and 16.41 months respectively (x2 = 14.69, P < 0.001). Kaplan-Meier survival curve showed the overall survival rate in the IRFA group was significantly higher than that of the other 2 groups (x2 = 4.635, P < 0.05). The prolongation of the survival period in patient with multiple macronodular hepatic cancer after IRFA treatment was mainly due to the prolongation of survival period in tumor bearing patients (IRFA group vs LR group, x2= 4.615, P < 0.05). Conclusion IRFA prolongs the survival of patients with multiple macranodular hepatic cancer possibly by enhancing the functions of cellular immunity.

Objective To assess the feasibility of double phase subtraction angiography with second generation (128-slice )dual-source CT in low dose Flash spiral scan mode for the evaluation of cerebral vessel,compared with dual-energy subtraction angiogra-phy.Methods 60 patients underwent double phrase CT angiography were divided into group A (n = 30,with Flash spiral scan mode),group B(n=30,with dual-energy scan mode).The signal-to-noise ratio(SNR),the contrast-to-noise ratio(CNR)and the av-erage radiation of double phrase subtraction images were measured in two groups,respectively.The double phase subtraction images quality were graded by 2 independent readers on a 5-point scale(5=excellent)in double-blind,according to various degrees of the re-sidual bones,the vessel displayed and luminal integrity,respectively.Differences between two groups were analyzed by Mann-whit-ney test and t test.Results The double phrase image SNR showed no difference to both two groups(P >0.05).The image CNR of arterial and venous phase in group A were higher than that of group B(40.89±8.89 and 40.27 ±9.90 in group A vs 35.28 ±8.43 and 34.89±8.66 in group B;P <0.05)respectively.There were no singnificant difference in the bone removal image scores of doub-le phase and in the vessel image scores of venous phase to both two groups respectively(P >0.05).The vessel image scores of arterial phase were higher in group A than that of group B(4.93±0.25 vs 3.87±0.97;P <0.05).Some internal carotid in the base of skull has not good luminal integrity in group B.The mean dose length product (DLP)in group A was lower than that of group B,with a 39 percent reduction[(226±5.69 )mGy/cm vs (368 ± 21.35 )mGy/cm,P < 0.05 ].Conclusion With the roughly similar image quality to dual-energy double phase subtraction angiography,the cerebral vessels can be assessed using dual-source CT subtraction angiography in Flash spiral scan mode and a lower radiation dose.

Objective To describe a case of female sexual abnormality with 46, XX caused by an androgen-producing adrenocortical tumor and to explore the mechanism of abnormal androgen secretion from the tumor. Methods The tumor tissues as the experimental group were compared with the normal adrenal tissue. The LH/human chorionic gonadotropin ( hCG) receptor was determined by immunohistochemisty, the activity of 3β-hydroxysteroid dehydrogenase ( 3β-HSD ) , 17α-hydroxylase ( CYP17 ) , and 17β-hydroxysteroid oxidoreductase ( 17β-HSD ) by enzyme linked immunosorbent assay(ELISA) and the expression of mRNA of 3β-HSD2, 17β-HSDB3, CYP17, and LH/hCG receptor by real-quantitative polymerase chain reaction ( RQ-PCR ) . Results The immunohistochemisty results showed that the LH/hCG receptor was negative in the experiment group, but positive in control. The activity of 3β-HSD and CYP17 of the experiment group was higher than that in the control (P<0. 01), while the activity of 17β-HSD was lower(2 638. 798±70. 551 vs 9 148. 174±382. 836, P<0. 01) according to ELISA results. The relative contentof3β-HSD2mRNAoftheexperimentgroupwashigherthanthatinthecontrol(P<0.05),andtherelative content CYP17 mRNA of the experiment group was much higher than that in the control (P<0. 01). However, the relative content of 17β-HSDB3 mRNA and LH/hCG receptor mRNA were much lower than those in the control ( P<0. 01) by RQ-PCR. Conclusion Sexual abnormality and virilization could be caused by the excessive androgen secreted by androgen-producing adrenocortical tumor, which is an extremely rare disease. The mechanism of the secretion of androgen from the tumor remains unknown so far. It may be related to the increased activity of 3β-HSD and CYP17, but has no relationship with the expression of LH/hCG receptor.