VTK is not only an open-source code but also a powerful toolkit for visualization.According to the requirement of medical image processing and on the basis of visualization and display function of VTK,VC++6.0 is used to design and implement a three-dimensional system which can be integrated into PACS.This system is useful for advancing the post-processing function of PACS.

Objective To investigate the effects of creatine supplement on contractile properties of soleus (SOL) and extensor digitorum longus (EDL) in elder rat. Methods 20 male Sprague-Dawley rats were randomly divided into control group and creatine supplement group with 10 rats in each group. After 6 weeks, the content of creatine and phosphocreatine were detected by high performance liquid chromatography,and contractile properties were examined in SOL and EDL in vitro at 30 ℃. Results The content of creatine and phosphocreatine both in SOL and EDL were higher in the creatine supplement group than in the control group (P<0.05). In SOL, creatine supplements increased the maximum twitch tension (Pt), maximum titanic tension(P0), decreased time to maximum twitch tension (TPT), but only time from maximum twitch to half relaxation (TPR50) significantly decreased, compared with the control group. In EDL, creatine supplements significantly increased Pt, P0 and decreased TPT (P<0.05). But there was no significant difference in TPR50 between 2 groups (P>0.05). Creatine supplements significantly increased the fatigue resistance of the SOL and there was no significant effect on EDL. The force potentiation which occurred in EDL during the initial 20~30 s of the fatigue test significantly increased (P<0.05). Conclusion Creatine supplement is effective on the contractile properties of SOL and EDL in elder rats, but the effect is dependent on the fiber types.

Objective To discuss the short-term outcomes of uncemented APL stem hip hemiarthroplasty for unstable intertrochanteric fracture in elderly patients.Methods From July 2008 to December 2011,26 cases of intertrochanteric fractures were treated by hemiarthroplasty using uncemented APL stem.There were 10 men and 16 women with a mean age of 82.5 years (range,75-94 years).According to EvansJensen classification system,16 cases were type Ⅱ fractures,the other 10 were type Ⅲ.Results The mean operation time was 56 min (range,48 to 72 min).The average blood loss during the operation was 360 ml (range,240-600 ml).One of the patients died in the perioperative period,2 died during the follow-up.The other 23 patients were followed up with an average of 21.5 months (range,12-42 months).The patients were encouraged to walk with aid about 2-3 weeks postoperatively.Three months after the operation,the walking ability were almost recovered to pre-injury level in 21 cases.The acetabular wear,the prosthetic loosening and subsidence were not found.The complications included 1 case of cerebral infarction,1 case of deep venous thrombosis,2 urinary infection,1 skin ulcer due to the long-term use of cortical steroid and 2 heterotopic ossifications.According to Harris hip score,12 cases were classified as excellent,10 cases as good and 1 case as fair.Conclusion Hemiarthroplasty using uncemented APL stem is an effective way to treat the unstable intertrochanteric fracture in elderly patients.The quality of life of the elderly patients can be improved due to early mobilization after the surgery.

Objective To explore the mid-term efficacy of biological type,long-stem artificial caput femo-ris replacement operation in the treatment of unstable senile intertrochanteric fracture.Methods 73 patients accepted the treatment of biological type long-stem artificial caput femoris replacement operation,and 64 cases were followed. After 3 months of operation,these 64 patients were divided into four groups which marked as A,B,C and D according to the Berg balance scale(BBS).Accordingly,54 patients that in grade A,B and C would be brought into in long-term follow-up study.54 cases include 25 male patients and 29 female patients with an average age of 81.6 years old who aged from 73 to 94 years old.According to Evans-Jensen classification,28 cases were Evans-JensenⅡand the left 26 cases were Evans -JensenⅢ.Results The follow-up period was in the range of 24 to78 months (mean 42months).During this period,except the 9 death cases,there was no case of femoral trochanteric ununited fracture, femoral prostheses loosening or dislocation of hip joint.In total,3 cases occurred with loss of fixing wire,4 cases occurred with acetabular wear,one case was experienced prosthesis adjacent fracture and three cases of heterotopic ossification.According to the Engh standard,all femoral prostheses got osseous fixation.The rate of excellent and good result were 88.9%with in which excellent in 23 cases and good in 17 cases.Conclusion The application of biological type long-stem artificial caput femoris replacement in the treatment of unstable senile intertrochanteric fracture can achieve satisfactory mid-term efficiency.

Objective To evaluate the effect of serum LH level on the day of superovulation start on the prolonged gonadotropin-releasing hormone ngonist therapy on the outcomes of in vitro fertilization and embryo transfer (IVF-ET) in patents with ovarian endometriomas. Methods 75 patients with ovarian en-dometriomas were treated by laparoscopic cystectomy or laparotomy cystectomy or ultrasound-mediated cysts puncture, and gonadotropin-releasing hormone agonist (GnRH-α) was given for 3 to 4 times every 28 days after the operation. Superovulation started after 14 ～ 84 days of the last injection. All the patients were di-vided into two groups according to the level of serum LH. Group A included 30 patients whose level of LH was less than 0. 5IU/L, and group B included 45 patients whose level of LH was over 0.5IU/L and less than 1.5IU/L. The outcomes of IVF-ET were evaluated. Results The total ampoules of Gn administration and the ampoules of hMG needed in group A[(32.28±7.7) ampoules, ( 12.0±8. 9) ampoules,]were sig-nificantly more than that in group B[( 25.84±7. 1 ) ampoules, ( 6. 19±7.4) ampoules, P < 0.05] . The successful embryo implantation rate in group A( 18. 1% ) was lower than group B(26. 7% ), and the differ-ence has statistical significance ( P <0. 05). Conclusion The low level of serum LH on the superovula-lion day on the prolonged gonadotropin-releasing hormone agonist protocol will increase the ampoules of Gn administration and decrease the successful embryo implantation rate of IVF-ET, thus LH should be a more important reference parameter of superovulation start.

Objective To investigate the relationship between the methylation of CpG island of RUNX3 gene promoter and its expression in a human cutaneous malignant melanoma cell line A375, and to assess the role of RUNX3 gene methylation in the pathogenesis of human cutaneous malignant melanoma. Methods Cultured A375 cells were treated with various concentrations (0, 1, 5, 10, 20 μmol/l) of 5-azacyti-dine for 24 or 72 hours followed by another 5 days of culture. Then, methylation-specific PCR (MSP) was performed to evaluate the methylation status of RUNX3 promoter region, and Western-blot analysis to detect the protein expression of RUNX3 in A375 cells. Results The RUNX3 gene promoter region was hypermethylated in untreated A375 cells, along with the absence of protein expression of RUNX3. However, after the treatment with 5-azacytidine, the promoter region of RUNX3 gene was demethylated partly, and the expression of RUNX3 protein was restored in A375 cells. Further, the expression intensity was directly correlated with the concentration of 5-azacytidine. Conclusions The promoter hypermethylation of RUNX3 gene may be related to the silencing of RUNX3 gene expression in A375 cells, whereas 5-azacytidine can cause the demethylation of RUNX3 gene, reactivate the gene which has been inactivated by the promoter hypermethylation, and finally induce the re-expression of RUNX3 protein.

By analyzing the status of Cardiovascular Surgery advanced students,we discussed the characteristics and problems of clinical teaching for advanced students of Cardiovascular Surgery.Strategies of clinical teaching for advanced students of cardiovascular surgery are explored to improve the quality of clinical teaching.

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 explore the influence of alpha-fetoprotein (AFP) on the expression of drug-resistance gene MDR1 and chemotherapeutic sensitivity in hepatocellular carcinoma (HCC) cells.Methods A HCC cell line SMMC-7721/AFP, which was stably transfected with AFP gene, was established.mRNA and protein expressions of AFP and MDR1 were detected by real-time PCR and Western Blot,respectively.The sensitivity of SMMC-7721/AFP and SMMC-7721/EGFP cells with or without MDR1 silencing by siRNA to doxorubicin was tested by MTT assay.Immunohistochemistry was used to detect the expression of MDR1 genes-coded protein Pgp in 60 cases of HCC tissues, and the relationship between Pgp expression and serum AFP levels was analyzed.Results AFP mRNA and protein could be detected in SMMC-7721/AFP cells, but not in control cells, indicating that the AFP stably transfected cell line was successfully established.MDR1 mRNA and protein levels were higher in SMMC-7721/AFP cells than those in SMMC-7721/EGFP cells.MDR1 mRNA level in SMMC-7721/AFP cells was (52.7 ± 1.5) times as high as that in SMMC-7721/EGFP cells (P ＜ 0.05).The resistance to doxorubicin was increased by (12.8 ± 1.1) times after AFP transfection (P ＜ 0.05).The chemosensitivity to doxorubicin was increased after the expression of MDR1 was knocked down by siRNA.The expression of Pgp in HCC tissues was positively correlated with the serum AFP levels.Conclusion AFP could induce drug-resistance to doxorubicin in HCC cells by increasing the expression of MDR1.

Objective To investigate the impact of hepatitis B virus (HBV) infection on semen parameters,sperm DNA integrity,acrosin activity and sperm-nucleoprotein transition.Methods Semen samples from 527 subjects including 273 hepatitis B surface antigen (HBsAg) positive and 254 HBsAg negative,who sought medical attention and received in-vitro feritilization in reproductive medicine center of First Hospital of Wenzhou Medical University from Jan 2011 to Oct 2012 were collected.Semen parameters,sperm DNA fragmentation index (DFI),sperm-nucleoprotein transition and acrosin activity of both HBsAg-positive and HBsAg-negative subjects were analyzed.Results Semen parameters of both groups were within the normal range,but sperm concentration and percentage of forward moving sperms of HBsAg positive group were significantly lower than those of HBsAg negative group (P=0.000),while percentage of static sperms of HBsAg positive group were significantly higher than that of HBsAg negative group (P =0.000).DFI in HBsAg positive and negative group were (17.85 ± 0.70) ％ and (11.85 ± 0.50) ％,respectively,which was significantly different (t=6.951,P=0.000).Percentage of sperms with normal morphology in both groups were within the normal range,but sperms with neck and tail deformity in the HBsAg positive group was significantly higer than those in HBsAg negative group (all P＜0.05).Acrosin activity of sperms in HBsAg positive group was significantly lower than that in HBsAg negative group (t=3.756,P=0.000).Linear regression analysis indicated that serum HBsAg level was reversely correlated with sperm concentration (r=-0.140,P =0.021),but positively correlated to DFI (r =0.151,P =0.014).Conclusions HBV infection not only affects the routine semen parameters and sperm morphology,but also compromises sperm function including impaired DFI and acrosin activity.However,the impact of anti-HBV agents on sperm quality and male fertility requires further research.