Objective To investigate the feasibility of determining the surface density of RGD-containing peptide on allogenic bone by isotopic tracing technique using RGD peptide labelled with 125Ⅰ,and the impact of the input concentration of RGD-containing peptide on the surface density,and to obtain the history between the surface density and the input concentration of RGD-containing peptide.Methods The synthetic RGD-containing peptide was labelled with 125Ⅰ,and the specific radioactivity was calculated.The reactive solutions of RGD-containing peptide with the radioactive 125Ⅰ-RGD as a probe were prepared at the input concentrations of 0.01 mg/ml,0.10 mg/ml,0.50 mg/ml,1.00 mg/ml,2.00 mg/ml,4.00 mg/ml.Using EDC as the cross-linking agent,the reaction was carried out by placing the allogenic bone pieces into the reactive solutions of RGD-containing peptide with different input concentrations.After the reaction,the surface density of RGD-containing peptide grafted onto the allogenic bone pieces was calculated by evaluating the radioactivity and the surface area of the bone pieces.The impact of the input concentration of RGD-containing peptide on the surface density was measured and the curve was ascertained.Results After measuring in the radiodensity γ-counter,the result showed the RGD peptides have been marked with 125Ⅰ successfully.The allogenic bone pieces were radioactive after the reaction,which demonstrated that the RGD-containing peptide had been grafted onto the surface of bone pieces successfully.It was also found that with the increasing of input concentration,the surface density raised.Conclusion The surface density of RGD-containing peptide is related to its input concentration.With the increasing of input concentration,the surface density raises to the saturation value gradually.

Objective To establishe the reference range of low hemoglobin density (LHD ％) of health population in Humen District of Guangdong,and discuss the clinical application value.Methods Randomly selected from January 2015 to September 2016 in Humen Hospital of Dongguan City physical examination of 1 650 cases of healthy people as control group,and selected the same period by the clinical diagnosis of iron deficiency anemia (iron-deficiency anemia,IDA) group,67 cases of patients with IDA Sysmex XT-1800i fully automatic blood analyzer were used respectively to detect blood routine,and then based on the average haemoglobin concentration (mean corpuscular hemoglobin concentration,MCHC),calculate the LHD％,and the calculation results were analyzed.Results The control healthy crowd LHD％ value was 2.41％ ± 0.85 ％,95％ reference range was 0.74 ％ ～4.08％,male was higher than the female,the difference was statistically significant (t =3.209,P＜0.05).IDA patients before treatment LHD％ was 30.97％ ± 18.65％,significantly higher than the control group,the difference was statistically significant (t=19.536,P＜ 0.01),and with the level of hemoglobin (Hb) showed a negative correlation (r=-0.4313).LHD％ values after treatment in patients with IDA group were significantly lower,but the recovery speed was slower than the Hb and MCHC.By ROC curve analysis,when the cut-off of LHD％ value was 4.10％,the LHD％ for IDA early diagnostic sensitivity of 96.78％,specificity of 100％.Conclusion Established the reference range of low hemoglobin density (LHD ％) of healthy population in Humen district of Guangdong,and LHD％ is IDA good indicator of early diagnosis and curative effect of dynamic monitoring.

[Objective]To analize the complications in the treatment of the fractures around the knee joint with less invasive stabilization system(LISS).[Method]From July 2005 to October 2007,89 patients with 91 fractures around knee joint were treated with the LISS,including 45 fractures of distal femur and 46 fractures of proximal tibia.[Result]All patients were followed up for 13 to 29 months.The average time to union was 16 weeks(ranged,11-25 weeks).The functional outcome: 45 had an excellent result,35 had a good result and 11 had a fair result,with 87.9% excellent to good results.There were 10 patients(11%) with symptomatic hardware irritation,2 of them had soft-tissue disruption.Seven cases(8%) had malalignment,2(2%) loss of reduction,1(1%) delayed union,1(1%) failed fixation,1 superficial peroneal nerve injury and 1 profound peroneal nerve injury.Cold-welding occurred in 9 cases(10%) which resulted in difficult removal.[Conclusion]LISS is one of the reliable and effective methods in fixation of the fractures around the knee joint.However,its operation indications and operating instructions should be strictly followed.

Objective To investigate the clinical characteristics and outcomes of ipsilateral talar and calcaneal fractures.Methods From April 2003 to July 2011,22 patients with ipsilateral talar and calcaneal fractures were treated in our hospital.There were 20 males and 2 females with an average age of 30.2 years (range,17 to 51 years).The fractures occurred on the left side in 10 patients and on the right side in 12 patients.There were 8 cases of talar neck fracture,including 3 type Ⅰ,3 type Ⅱ and 2 type Ⅲ according to the Hawkins classification; there were 14 cases of talar body fracture,including 6 type Ⅱ,2 type Ⅲ and 6 type V according to the Sneppen classification.There were 13 cases of extra-articular calcaneal fracture and 9 cases of intra-articular fracture.Four patients had open fractures,including 1 type Ⅰ,2 type Ⅱ and 1 type llⅢA according to the GustiloAnderson classification.The average time from injury to surgery was 5.5 hours for patients with open fracture and 11 days for patients with close fracture.Seventeen patients underwent internal fixation and 5 patients underwent non-operative treatment.Results All patients were followed up for 25 to 89 months (average,41.5 months).Skin necrosis of the edges of the incision was found in 2 cases and wound infection in 1 case.No fracture nonunion and loss of reduction were observed in all patients.At final follow-up,the functional results were assessed according to the AOFAS score,and the average AOFAS score was 78.9 (range,53 to 95).The result was excellent in 5 patients,good in 10 and fair in 7,and the overall excellent or good rate was 68.2％.Traumatic arthritis was found in 12 patients who had undergone surgical treatment,including 5 cases in subtalar joint and 7 cases in ankle and subtalar joint.Diaz disease occurred in 1 patient who had undergone non-operative treatment.Conclusion Ipsilateral talar and calcaneal fracture is a complicated injury which has many fracture types.The fractures should be reduced anatomically,and traumatic arthritis is the most common complication.

BACKGROUND:Proximal humeral fracture fixation can provide a more stable fixation, has a stronger biomechanical stability, but open reduction and fixation wil cause extensive soft tissue dissection and heavy damage to the rotator cuff. Closed wear nail has a high failure rate of fixation, fracture re-displacement and other defects. OBJECTIVE:To investigate the technical methods of applying closed reduction, percutaneous pinning anatomical external fixation in repair of proximal humeral fracture, and to analyze the application characteristics and safety in different types of proximal humerus fractures. METHODS:Based on the special anatomical structure of proximal humerus, a shoulder external fixator has been independently researched and developed by author. The clinical data of 23 patients treated with closed reduction and percutaneous pinning anatomical external fixation (homemade) because of proximal humerus fracture at the Department of Traumatology, Tianjin Hospital during March 2010 to March 2014 were retrospectively analyzed. In accordance with Neer classification type, there were 19 cases of 2-part fractures of the humerus, 4 cases of 3-parts fractures of the humerus, with greater tuberosity avulsion fractures, which were al fresh fractures and were treated with closed reduction pinning and external fixation. Regular fol ow-up was conducted after treatment. Radiographic assessment, pain and function evaluation were conducted during fol ow-up, so as to work out the functional recovery, determine the final repair result. RESULTS AND CONCLUSION:Al patients were fol owed up for 6-24 months. Total y 23 patients initial y healed in fracture within 8 weeks. After treatment, visual analogue pain score of patients was 0.8 points. In the final fol ow-up, the American Shoulder and Elbow Surgery Association of shoulder function scoring system (ASES) score was an average of (91.7±2.6) points, Constant shoulder function score was an average of (88.3±4.7) points, the University of California (UCLA) shoulder joint scoring system score was (31.9±3.1) points, simple shoulder test (SST) system score was an average of (9.6±2.4) points. The shoulder function assessment (UCLA score) of these 12 patients was excel ent, of 9 cases was good, and of 2 cases was poor. The excel ent rate reached 91%after treatment. These results suggest that the application of closed reduction, percutaneous nailing anatomical external fixation in repair of proximal humerus fractures has the features of stable fixation, and smal damage of soft tissue. Standardizing the angle of closed nailing and entrance point, fixing from the intersection of three planes in arcuate-shape and connecting with external fixation can achieve a more stable fixed effects.

Objective To analyze the VP1-VP4 genetic region of enterovirus 71 ( EV71 ) strains isolated from children with severe or mild hand, foot and mouth disease ( HFMD) in Shenzhen in 2012. Methods EV71 strains were isolated from five children with mild HFMD and five children with severe HFMD in Shenzhen in 2012.Reverse transcription-polymerase chain reaction ( RT-PCR) method was used to amplify the sequence of VP1-VP4 genes of EV71 strains.The sequences of the amplified products were analyzed by comparing with those of the EV71 reference strains ( A, B and C genotypes) published in Gen-Bank using nucleotide alignment, amino acid alignment and phylogenetic tree analysis.Results The homo-geneity between the EV71 strains isolated from severe and mild cases was 95.1%-98.2% in nucleotides and 99.2%-100% in amino acids.The VP1-VP4 nucleotide sequences of 5 strains isolated from severe cases and 5 strains from mild cases in Shenzhen shared 87.9%-97.8% homologies in nucleotides and 97.3%-99.9% homologies in amino acids with the genotype C EV71 reference strain.The EV71 strains isolated from children in Shenzhen were highly similar with the EV71 strain (FJ439769) isolated in Fuyang in 2008 and the one isolated in Jingdezhen in 2011 (JQ806378, C4a subtype) in nucleotide sequences.Mutations at the residue 31 in the VP1 region ( N→D ) were detected in 3 strains isolated from children with severe HFMD.Conclusion All of the 10 EV71 strains isolated in Shenzhen in 2012 belonged to the sub-genotype C4a.The mutation ( aa31 N→D) in the VP1 region of EV71 might be related to the different clinical mani-festations of HFMD cases in Shenzhen area.

Objective To investigate the establishment of secure tunnel in fixation for the talar neck fracture when screws were fixed from the medial wall of talus.Methods The age of volunteers was limited from 20 to 60 years old,and the height of male volunteers was from 165 to 185 centimeters,while the female volunteers' height was from 155 to 175 centimeters.The body mass index (BMI) was less than 25.The volunteers who were not heavy manual workers or standing working for long time had no history of ankle or foot fractures,and there were no evidence of degeneration changes in ankle joints according to X-ray.At last there were 33 males in this study with an average age of 43.7 (21-59) years and an average height of 176.0 (168-184) centimeters.There were 22 females with an average age of 43.2 (22-60) years and an average height of 165.4 (158-172) centimeters.After the volunteers' ankle joints and feet were scanned by CT,the reconstructed images were stored in CD and the slice thickness was 0.75 millimeters.The SuperImageTM Orthopedics Edition1.1 software was used to display the images and perform three dimensional reconstruction.The height of talar neck and the height of tarsal canal were measured.The models that screws passing into tarsal canals were built.The maximal length and angle that screws were inserted in the middle 1/3 and in the inferior 1/3 of medial wall of talus and run along to two directions were measured.At last,the data were analyzed with SPSS 13.0 software.Results The height of talar neck and tarsal canal had no significant difference between left side and right side in the same gender.The height of male talar neck was greater than the female' s.The models of screws passing into tarsal canals was gained.The length and angle in different insert points and different directions of screw fixation were also gained.When the screws were inserted from the middle 1/ 3 of the medial wall of talus,the angle of screw fixation was much wider than that when the screws were inserted from the inferior 1/ 3 of the medial wall of talus.At last,the safe range of the length and angel of screw fixation was calculated.Conclusion Damage of the blood of talus during internal fixation should be avoided.The middle 1/3 of the medial wall of talus is the most favourable choice to the fixation.Combining the digital technology with internal fixation for talar neck fracture could promote the operation' s security and feasibility.

Objective To compare the effect and safety of endoscopic duodenal papillal incision combined dilatation(ESBD) and endoscopic sphincterotomy(EST) in the treatment of common bile duct stone.Methods A retrospective analysis of 71 cases of choledocholithiasis,according to surgical methods,were divided into group EST (45 cases) and group ESBD (26 cases).The effect and safety of the above two kinds of treatment was evaluated through observing the rate of one-time stone clearance and postoperative complications.Results The success rate of removing calculous of the two groups was above 95%,and there was no significant difference between the two kinds of treatment(EST and ESBD)(P>0.05).Recent complications:the incidence rate of hemorrhage of the EST group was 0.0%,which of the ESBD group was 3.8%,there was no significant difference between the two groups(P>0.05).The incidence rate of postoperative pancreatitis of the EST group was 8.8%,which the ESBD group was 3.8%,there was no significant difference between the two groups(P>0.05).The diameter of the removed stone of the two groups:the EST group was (0.70±0.35)cm,and the ESBD group was (1.41±0.69)cm,there was significant difference between the two groups(P<0.05).Conclusion There are no significant differences in early complications and the success rate of removing stone between the EST group and the ESBD group.However,ESBD preserved teat sphincter's physiological barrier function to the greatest extent and the diameter of the removed stone was obviously larger than the EST group.Therefore,it is much safer for those who have quite large common bile duct stone or people who are with joint periampullary diverticulum to be treated by ESBD.

Natural killer T (NKT) cells,a subset of lymphocytes that bridge innate and adaptive immune systems,involve in processes of infection immunity,tumor immunity,transplantation immunity and autoimmunity.A significant progress has been made in the mechanisms of origin,selection,differentiation and maturation of NKT cells.However,some viewpoints are still controversial,and need to be further intensively investigated.The potential therapeutic applications of functional NKT cells have been suggested in the prevention and the treatment of various diseases.

The posterior malleolus plays an important role in the stability and function of the ankle joint. Approximately 7%to 44%of ankle joint fractures are accompanied by posterior malleolus fractures. The current published data suggest a poor outcome for ankle fractures involving the posterior malleolus. Inappropriate reduction of the posterior malleolus fragment may re?sult in symptomatic malunion requiring corrective osteotomy. The posterior malleolus fractures were categorized into three types by Haraguchi:the posterolateral?oblique fractures (Type I), the transverse medial?extension fractures (Type II) and the small?shell fractures (Type III). Mangnus divided posterior malleolus fractures into two basic types: posterolateral and posteromedial types. Bartonícek classified the posterior malleolus fractures into four types on the basis of CT scan and 3D reconstructions, and taking into account the location, shape, size of the fragment and the integrity of the fibular notch:extraincisural fragment with an intact fibular notch (Type I), posterolateral fragment extending into the fibular notch (Type II), posteromedial two?part fragment involving the medial malleolus (Type III) and large posterolateral triangular fragment (Type IV). The fracture lines associated with posterior malleolus fractures appear to be highly variable. So far, no generally accepted clinically relevant classification of posterior malleo?lus fractures exists, and the indications of the operative management of these fractures were often determined by the size of the fragment. The anteroposterior and lateral views were used to evaluate the fractures of the fibular and the medial malleolus, as well as the rupture of the ligament and the presence of subluxation or dislocation of the talus. The determination of proper surgical ap?proach and the internal fixation should take into account the size, shape and displacement of the posterior fragment by CT scans, through CT and 3D reconstructions. The aim of treatment for posterior malleolus fractures is to reduce the displaced fragments ana?tomically, and to restore the stability of the tibiotalar joint and the distal tibiofibular syndesmosis.