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 Cervical instability was mostly caused by trauma. However, degenerative cervical instability was diagnosed rarely according to the present criteria although cervical degeneration was common in aged people. The study was aimed at investigating the results of surgical treatment for degenerative cervical instability and to define the indications for surgical intervention. Methods From April 1998 to April 2001, anterior cervical fusion and plate fixation were applied in fifteen patients, there were 6 males and 9 females aged from 44 to 65 years with an average of 55.2 years. The patients showed roentgenographic instability of the cervical spine associating with cervical postural symptoms. Spondylotic cervical myelopathy were excluded from the group. The cervical postural symptoms were those presented or aggravated with flexion-extension or rotational movements of the cervical spine, such as neck-shoulder pain, cervical spondylotic radiculopathy symptoms, sympathetic or vertebral artery symptoms. The symptoms lasted from 18 months to 4 years before the index surgery, all patients had received more than one year conservative treatments, but no any improvement. Seven cases were fused with iliac autograft, in which three cases were on single intervertebral spaces, four cases on double spaces, and grooved bone graft was used in the patient of double space fusion. Intervertebral fusion cage (Titanium mesh) was used in 8 cases; allograft was used in 2 single space cases; grooved autograft was used in 6 double space cases. Excised vertebral body was used as autograft material. Results The patients were followed up from 8 months to 4 years with an average of 25 months. All patients were satisfactory for the surgical results in follow-up period. All symptoms were released in 12 cases, occasional neck pain was found in 3 cases, and there was no abnormality presented in clinical examination. Solid fusion was achieved in all of cases at follow-up, the fused segment was stable judging by dynamic roentgenogram. Conclusion Fusion of the unstable segments is an alternative procedure for degenerative cervical instability in case the cervical postural symptoms are consistent with the radiographic features. Since some degenerative instability of cervical spine may spontaneously achieve re-stabilization, the indication of surgical fusion must be strictly limited to avoid over-treatment.

Objective　To study clinical value of ultrasoni c diagnosis in the congenital ureterostenosis. Methods　33 cases of ureterostenosis were measured with B-ultrasonographic examination, the resu lt of B-ultrasonographic examination was compared with the diagnosis of X-ray and surgery. Results　The localization rate and accord rate of B -ultrasonographic examination in diagnosis of ureterostenosis(obstruction) were 93.3% and 81.8% respectively. Conclusion　B-ultrasonographic examination in diagnosis of congenital ureterostenosis possesses greater advanta ge and better clinical value.

Objective To study the effect of the neck rotation and lateral bending on the vertebral artery blood flow, and to analyze the relationship between the artery blood flow and cervical vertigo. Methods Thirty patients with cervical vertigo were studied with exclusion of auditory vertigo and severe cardio-cerebrovascular disease, which involved 18 males and 12 females, whose average age was 52.13 years with a range of 42-73 years. They all had cervical degenerative change in different degree and neck-shoulder-back pain history. The study also included 15 volunteers without vertigo, 8 males and 7 females, the average age was 49.47 years with range, 38-70 years, they also had some cervical degenerative change. They were selected to detect the blood flow of bilateral intracranial segments of the vertebral arteries using TCD with the neck in neutral, bilateral rotation 15?,30?,45?,60? and bilateral bending. Results In neutral position, vertebral artery blood flow was lower in study group than in control(P

Objective:To evaluate the efficacy of Liangxue-Xiaofeng Decoction combined with acitretin A capsule in the treatment of psoriasis vulgaris. Methods:A total of 80 patients with psoriasis vulgaris from March 2015 to June 2019 in our hospital, who met the inclusion criteria, were divided into two groups according to the random number table method, 40 patients in each group. The control group was given acitretin A capsules on the basis of conventional western medicine treatment, and the study group was given Liangxue-Xiaofeng Decoction on the basis of the control group. Both groups were treated for 2 months and followed up for 6 months. The skin lesion area and Psoriasis Area and Severity Index (PASI) scores were performed before and after treatment. The levels of IL-8, IL-6 and TNF-α were detected by real time PCR amplification, and the levels of histone acetyltransferase (HATs) and histone deacetylase (HDACs) by ELISA. The adverse reactions and recurrence during the follow-up period were recorded and the clinical efficacywas evaluated. Results:The total effective rate of the study group was 82.5% (33/40) and that of the control group was 62.5% (25/40). The difference between the two groups was statistically significant ( χ2=4.012, P=0.045). After treatment, the PASI score of the study group was significantly lower than that of the control group ( t=7.921, P<0.01), and the serum levels of IL-8, IL-6 and TNF-α were significantly lower than those in the control group ( t=12.749, 13.933, 10.856, all Ps<0.01); the activity of HATs [(35.03 ± 3.79) g/L vs. (29.26 ± 2.41) g/L, t=8.125] of the study group was significantly higher than that of the control group ( P<0.01), and HDACs activity [(31.00 ± 2.71) g/L vs. (37.55 ± 3.08) g/L, t=10.098] of the study group was significantly lower than that of the control group ( P<0.01). Conclusions:Acitretin A capsule combined with Liangxue-Xiaofeng Decoction can reduce the level of inflammatory cytokines in patients with psoriasis vulgaris, and prevent the disease progression. The mechanism may be related to the regulation of homeostasis balance in acetylation.

Objective To summarize the clinical features and diagnostic flow of cervical spondylosis with proximal upper extremity amyotrophy;and further analyze the clinical effect of cervical anterior decompression and fusion on cervical spondylosis with proximal upper extremity amyotrophy.Methods Twenty-two cases of cervical spondylosis with proximal upper extremity amyotrophy were analyzed retrospectively from June 2006 to December 2013.Seventeen males and 5 females with an average age of (55.73 ± 8.64) years (38 to 68 years) were included.The mean preoperative course of disease was (19.2 ± 21.86) months (1-72 months).Clinical symptoms,imaging findings and electrophysiological findings were analyzed.The muscular strength recovery of atrophic muscles was evaluated by Manual Muscle Testing (MMT).The clinical improvement rate was evaluated by the Japanese Orthopedic Association (JOA) score,and the clinical satisfaction was assessed at followed up.Results The muscles involved in patients of cervical spondylosis with proximal upper extremity amyotrophy are mainly the deltoid muscle,biceps and scapula levator muscle.Most cases of imaging findings showed multi-segmental degeneration,of which C4,5,C5,6 segments were most common.Neuroelectrophysiological examination showed that affected muscles experienced obvious denervation and decreased action potential.The average follow-up time was (44.14 ± 20.51) months (14 to 102 months).At the last follow-up,the JOA score (16.29 ±0.59) in 17 cases was higher than preoperative (15.12 ± 0.93),the difference was statistically significant (F=51.814,P=0.000),and the average improvement rate was 73.3％.MMT assessment showed that 19 patients (86.4％) in this group had muscle strength recovery for more than 1 grade at the last follow-up.The average clinical satisfaction was 83.7％.Conclusion The clinical diagnosis of cervical spondylosis with proximal upper extremity amyotrophy requires a combination of clinical symptoms,imaging findings and neurophysiological examination results for comprehensive judgment.Anterior cervical decompression and fusion in the treatment of cervical spondylosis with proximal upper extremity amyotrophy patients can achieve good clinical results.

To investigate the therapeutic effect of peroxiredoxin-6(PRDX6)on ultraviolet-induced corneal injury in rats and explore the mechanism.The rat model of corneal injury was established by exposing to ultravio-let.Male wister rats were randomly divided into control groups,dexamethasone (DXM)groups and PRDX6 groups,the rats were administered four times a day and for 12 days.The corneal opacity was observed with a slit-lamp microscope.Histopathologic changes were observed with light microscopy.The content of corneal malonalde-hyde(MDA)was determined by thiobarbituric acid test and the total antioxidative capacity(TAOC)was detected by chemical colorimetric test.P38 MAPK signal pathway was detected with the method of Western blot and the gene expression of cytokines were measured by RT-PCR method.Compared with the control group,PRDX6 treat-ment significantly reduced corneal opacity,improved corneal pathology injury,decreased the MDA content and in-creased the TAOC.In the PRDX6 group the level of phosphorylated p38 protein was significantly lower than that in the control group.The gene expression of cytokine were different between control and PRDX6 groups(P <0.05).PRDX6 showed therapeutic effect in the rat model of ultraviolet-induced corneal injury.This maybe be concerned with that it could alleviated the oxidative damage,suppressed p38 MAPK phosphorylation and regulate the gene expression of cytokine.

Objective Method discussion of measuring curvature of cervical endplate based on reverse engineering software.Methods The CT scan images data (From C2 to C7) of 8 normal males were selected and inputted into Mimics 10.0 software for 3D reconstruction and separation (cervical spine is divided into C1-C7 isolated reconstructed 3D images).Another software NX Imageware 13.2 is used for further curvature measuring in lines named left,middle,right,anterior,middle,posterior which are derived from each superior and inferior endplate.In each line,15 different points which can perfectly show morphologic characters of the endplate are selected for statistic comparing between different points in the same endplate,different lines in the same endplate,different endplates in the same individual and the same endplate in different individuals.In addition,the correlation between the concavity and the width and depth of endplate is also analyzed.Results From inferior endplate of C2 to that of C6,except superior endplate of C7,there is significant difference between different points in the same line (P＜0.05),while it is opposite in the compare between lines in the same endplate,different endplates in the same individual and the same endplate (except inferior endplate of C4) in different individuals (P＞0.05).It showed significant correlation between the concavity and the width and depth of endplate.Conclusion Reverse engineering software is feasible to be used in evaluate morphologic characters of normal cervical endplate as a new method for measuring the detail parameters of them,it also explore the laws of the curvatures of cervical endplate initially and both of them will be of great use for cervical interbody cage design.

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 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.