Objective To summarize the techniques and results of midfoot amputation and discuss the role of the tendon balance in this operation.Methods Twenty-six traumatic midfoot amputions were performed from 1990 to 1999. The amputation level ranged from the base of metatarsal to the Lisfranc's joint. The bone stump should be smooth, round and arc featured, the amputation line needn't pass the joints, four extensor longus tendons were divided into two groups and the groups were weaved each other. Bone stump were drilled a hole through which extensor tendon stumps were re-attached to the bone stump. Anterior tibial tendon could also be re-attached to the front aspect of the bone stump with the above mentioned procedure. In case the navicular could not be preserved, midfoot amputation should be given up. Results Among the group, 15 cases were followed-up 2 to 10 years after operation. No case had equinovarus deformity, all cases could flex ankle dorsally to 0? or more, but 4 cases had painful callus on the stump, and 1 case slight ulceration. The other cases in the group got satisfactory outcomes. Conclusion In terms of midfoot amputation, different amputation level leads to different tendon imbalance. Proper tendon balance and appropriate stump repairing is of importance to reconstruct balanced plantar biomechanics,and then, to achieve good long term result.

Objective To explore the protective role of the receptor tyrosine kinase inhibitor in chondrocyte in vitro.MethodsReverse transcription-polymerase chain reaction (RT-PCR), immunocytochemistry (ICC) and toluidine blue staining were used to understand the changes of phenotype expression of collagenⅠ, Ⅱ and proteoglycan in chondrocyte in vitro. Results Genistein of 20 μg/mL and 25 μg/mL concentrations decreased the expression of collagen Ⅰ and increased the expression of collagen Ⅱ and proteoglycan (P< 0. 05). Conclusions This study showes that genistein can effectively inhibit the expression of collagen Ⅰ above certain concentration, and it can improve the expression of collagen Ⅱ and increase the synthesis of proteoglycan.

Objective To evaluate the relationship between varicocele (VC) and the prostativenouplexuby coloDoppleflow imaging(CDFI) and to explore the etiology of varicocele .MethodThe innediameterand the hemorrheologiparameterof spermativein and prostativenouplexuwere observed in 135 patientwith lefvaricocele(lefVgroup) ,51 patientwith bilat-eral V(bilateral Vgroup) and the control group(100 cases) by CDFI .The diameteof the prostativenouplexus(PVD) ,peak velocity of reflux flow (RFV) in the Valsalvtesand the peak velocity of antegrade flow (AFV) aresin 3 groupwere statistical-ly analyzed .ResultPVD and RFV in the bilateral Vgroup were greatethan those in the lefVgroup and the control group (P＜0 .01) .PVD and RFV in the lefVgroup had no statistical differencecompared with the control group (P＞0 .05) .AFV had no statistical difference among 3 group(P>0 .05) .PVD ,RFV and AFV in 30 caseof Vhad no statistical differencebe-tween before and afteoperation (P>0 .05) .Conclusion Bilateral Vmay be accompanied with potential systematic vascular abnormalities.

Objective To study the efficacy of treatment of proximal humeral fractures in elderly patients using cloverleaf plate combined with bone cement. Methods 13 aged patients with serious proximal humeral fractures were admitted from 2000.1 to 2001.6. Their X ray revealed displacement and crispation. After anterior reduction through the shoulder joint, the obvious osseous defects were filled with bone cement. Then the fractures were fixed with cloverleaf plates. Sling was applied for the patients postoperatively and the rehabilitation program started 3 weeks after operation. Results All the 13 cases were followed up. The follow up ranged from 5 to 10 months with an average of 8.3 months. The range of motion was satisfactory with a mean abduction over 90 degrees. X ray revealedthat no patient demonstrated osteonecrosis of the humeral head. Union was achieved in all the patients. According to Neers scale, the function of shouder was excellent in 10 cases, and good in 3 cases. Conclusion This methods is recommended for aged patients with osteoporosis, serious osseous defects and difficulty of using internal fixation alone, because it is convenient and reliable and can prevent replacement of joint prosthesis.

Objective To compare the value of transrectal ultrasonography(TRUS) and magnetic resonance(MR) in preoperative estimation of circumferential resection margin (CRM) of mid-low rectal cancer.Methods Both TRUS and MR were performed prior to surgery in 111 patients with mid-low rectal cancer.The CRM was evaluated and compared with the postoperative pathologic findings.Results The accuracy of TRUS and MR for CRM was 91.9％(102/111) and 85.6％(95/111),respectively,there was no statistical difference between them (P =0.137).Their specificities were 94.0％ (79/84)and 84.5％ (71/84),there was statistical difference between them(P =0.046).The consistency of the results between TRUS and pathology was better than that between MR and pathology(Kappa1 =0.783,Kappas =0.652).Conclusions TRUS is proved to have an important diagnostic value for CRM of mid-low rectal cancer.

Objective To investigate the imaging findings of giant cell glioblastoma(GCG).Methods Imaging findings of 8 cases with pathology-confirmed GCG were retrospectively reviewed and correlated with pathologic findings.Results All of the 8 cases were located in the cerebral hemisphere.On CT images, 1 lesion case was shown appeared as mixed density,4 lesions were shown as cystic and solid mass.Mural nodule were slightly hyperdense.On MRI images, all of 4 cases lesions were hypointensity on T1WI, mixed signal intensity or hyperintensity on T2WI and FLAIR, low signal intensity on DWI.The lesion showed nonuniform enhancement,with enhanced mural nodules and cyst walls,and mildmoderate or no peritumoral edema.Microscopically, the cells were arranged in perivascular pseudorosettes to form palisades.Cellular pleomorphism was a typical feature, including monstrous and multinucleated giant cells.Mitotic figures were usually numerous.Reticulin was abundant in the stroma.Immunohistochemistry showed staining for S-100, Vim, p53, GFAP.The proliferation rate determined by Ki-67 immunohistochemistry was 30%.Conclusion GCG has certain imaging characteristics,CT and MRI are effective in detecting the disease.

BACKGROUND: Coronary artery disease (CAD) risk in type Ⅱ diabetics is one of the hot topics in clinical research.OBJECTIVE: By using electron-beam tomography(EBT) technology, heart scans were performed to investigate coronary artery lesion in type Ⅱ diabetics and their CAD risks were evaluated as well.DESIGN: Comparative study based on type Ⅱ diabetics complicated with coronary artery lesion.SETTING: Gerontology department in a hospital affiliated to a military medical university of Chinese PLA.PARTICIPANTS: From January 2002 to June 2004, 93 inpatients between the ages of 36 and 78 in the Gerontology Department of Xijing Hospital, an affiliation to the Fourth Military Medical University of Chinese PLA, were selected(male 80, female 13) . Totally 25 of all the patients proved normal by physical examinations were set as normal control(male 22, female 3) group; other inpatients were divided into the abnormal blood glucose group and the coronary heart disease (CHD) group respectively according to their examination results. Of the 57 patients in the abnormal blood glucose group,49 were male and 8 were female. This group was divided into two subgroups:the impaired glucose tolerance group(IGT) containing 29 patients and the diabetes group containing 28 patients. In this group, 44 patients have had heart symptom of different extent. Of the 11 patients in the CHD group, 9 were male and 2 were female. Inclusion criteria: patients with type Ⅱ diabetes were defined by American Diabetes Association in 1979; patients with CHD were defined in the report of the Joint International Society and Federation of Cardiology/World Health Organization Task Force on the standardization of clinical nomenclature and criteria for diagnosis of ischemic heart disease in 1979, and they were all confirmed by coronary angiography. Exclusion criteeases.METHODS: Both plain EBT heart scanning and contrast-enhanced heart scanning were performed on the 93 patients to evaluate the occurrence of coronary artery calcification(CAC), the number of stenosed coronary arterie,and the number of soft plaques. Additionally, other examination results including blood glucose, blood HbA1c and blood lipid were also collected for comparison between the conditions of coronary artery and assessment of the CHD risk among groups.MAIN OUTCOME MEASUREMENTS: In all the groups, the occurrence of CAC, the number of stenosed coronary arteries and the number of plaques were compared, and the CHD risk was analyzed.RESULTS: The occurrence of coronary artery calcification was significantly increased in all the study groups as compared with the control group(x2 = 18.88, P < 0. 01 ). Increasing trend was also observed in the study groups when calculating the number of branches with coronary stenosis and plaques ( F = 10. 758, P < 0. 01; F = 9. 991, P < 0.01 ). CHD risk in diabetes was estimated to be 7. 514 (95% confidence interval, 1. 885 -63. 778).CONCLUSION: Coronary artery lesion can be easily observed in type Ⅱ diabetics,and high CHD risk is predicted in this population. Early diagnosis of CAD and early rehabilitation intervention in grade 2 are extremely important in improving the quality of life and reducing the disability ratio of type Ⅱ diabetics.Huang C, Gao JY, Wong XM, Li R, Yang AL, Zheng MW, Xue FB. Risk analysis of coronary artery disease in type Ⅱ diabetics.

Objective To investigate the correlation between seminal plasma hepatitis B virus (HBV) DNA copy and semen parameters and sperm DNA fragmentation (SDF).Methods The seminal plasma HBV-DNA was detected by the real-time PCR in 148 infertility males,and those with serum HBV-DNA above (positive) or below (negative) 5.0 × 102U/ml were analyzed respectively by semen parameters,sperm morphology and sperm DNA fragmentation (SDF).Results Of 148 male,60 (40.5％) were seminal plasma HBV-DNA positive,and of 60 positive patients,56 (93.3％) were serum hepatitis B e antigen(HBeAg) positive,which was higher than those of seminal plasma HBV-DNA negative males (31cases,35.2％).Serum HBeAg and HBV-DNA in seminal plasma HBV-DNA positive patients were 845.7(0.2 ～ 1455.0) S/CO and (1.7 ± 1.1) × 108U/ml,which were higher than those of HBV-DNA negative patients [HBeAg:0.1 (0.1 ～ 1374.0) S/CO;HBV-DNA:(2.3 ± 1.1) × 107 U/ml,P ＜ 0.01].Seminal plasma HBV-DNA positive patients exhibited lower semen volume,sperm concentration,the percentage of forward moving sperm and less normal morphology compared to HBV-DNA negative patients [(2.44±1.2)mlvs.(3.07±1.3)ml,(66.8±49.1) ×106/mlvs.(87.1 ±65.4) ×106/ml,(54.3± 16.1)％ vs.(59.1 ±15.3)％,(3.77 ±2.8)％ vs.(6.15 ±4.2)％,P＜0.05].The number of patients with teratozoospermia was significantly higher in seminal plasma HBV-DNA positive patients (56.7％ versus 34.1％,(P ＜ 0.01).The SDF in seminal plasma HBV-DNA positive patients was(18.1 ± 12.3)％,while it was(14.4 ± 8.4)％ in negative patients,and the difference of SDF in these two groups was significantly (t =2.197,P ＜ 0.05).Conclusion Seminal plasma HBV-DNA positive could affect the semen parameters,sperm morphology and SDF.

Objective To assess sperm chromatin structure assay (SCSA) and sperm chromatin dispersion test (SCD) for DNA fragmentation evaluation in human infertility, and the correlation between these two methods. Methods We used SCSA and SCD assays to detect DNA fragmentation in sperm from 134 infertile men. The correlation of SCSA and SCD assays was analyzed. The sperm DNA fragmentation index (DFI) was divided into 3 groups (≤15%DFI, >15~≤30%DFI and>30%DFI), and the difference between SCSA and SCD assays was assessed. Results The SCSA assay was strongly correlated with the SCD assay for sperm DNA fragmentation (r=0.915, P<0.001). There was no significant difference between>15~ ≤30%DFI and>30%DFI groups. However, SCD showed higher levels of DNA fragmentation than that measured by SCSA for≤15%DFI group (13.50 4.82 vs 9.79 2.60, P<0.001). Conclusion There is a strong positive correlation between SCSA and SCD assays in detection of DNA fragmentation. SCD assay showed higher levels of DNA fragmentation than that measured by SCSA for≤15%DFI group.

Objective To explore ultrasonic image for the normal anatomy of the larynx,and provide the basis of ultrasonic diagnosis in laryngeal diseases.Methods Ultrasound anatomy for the larynx was established by way of comparing the structures of four corpses and ultrasonic imaging of the larynx of normal control group.Results Ultrasonic image for the normal anatomy of the larynx was established by comparing the anatomy tomography of corpses and ultrasonic imaging of the larynx of normal control group.Conclusions Ultrasonography could be applied in the examination of the laryngeal diseases as it could show unambiguous ultrasonic imagings of the larynx,and adding an important complementary technique to clinical medicine.