[Objeetive] To assess the reproducibility and accuracy of four ratios used to measure patellar height,named the Blackburne-Peel,Caton Deschamps,Insall-Salvati and modified Insall-Salvati,before and after totalknee arthroplasty.[Methods]The patellar height was measured,by means of the four ratios,on the pre-and post-operative lateral radiographs of 44 patients(45 knees)who had undergone total knee arthroplasty.Two independent observers measured the films sequentially,in identical conditions,totally 720 measurements per observer.[Results]Before operation there was greater interobserver variation using either the Insall-Salvati or modified Insall-Salvati ratios than that when using the Caton-Deschamps or Blackburne-Peel methods.This was due to difficulty in identifying the insertion of the patellar tendon.Before operation,there was a minimal difference in reliability between these methods.After operation the interobserver difference was greatly reduced using both the Caton-Deschamps and Blackburne-Peel methods,which used the prosthetic joint line,compared with the Insall-Salvati and modified Insall-Salvati,which refered to the insertion of the patellar tendon.[Conclusion]The theoretical advantage of using the Insall-Salvati and modified Insall-Salvati ratios in measuring true patellar height after total knee arthroplasty needs to be balanced against their significant interobserver variability and inferior reliability when compared with other ratios.

[Objective]The patellar tendon lengths were compared in the knees with a history of patellar instability and in normal knees in Chinese,and the significance of patellar tendon length measurement in the knees of patellar instability was discussed.[Method]Totally 49 knees of 43 patients with patellar instability were reviewed from Jan.2003 to Dec.2005,including 15 males and 28 females and 6 paients with both instahle patellas.The mean age was 21.4 yrs(from 18~28 yrs),and the mean height was 163 cm(155~173 cm).And,50 normal control knees of 50 volunteers including 16 males and 34 females.The mean age was 24.2 yrs(from 18~35 yrs),and the mean height was 165cm(154~177 cm).The patellar tendon length,the distance between tibial tubercle and the anterior edge of tibial plateau and Insall-Salvati index on the lateral X-ray plain with 30? flexion of keens were measured and analyzed.[Result]The patellas tendon length of patients was longer than that of normal volunteers(53.3?2.7mm,47.3?3.3 mm,P0.05)of the distance from tibial tubercle to the anterior edge of tibial plateau between patients and volunteers.However,difference of Insall-Salvati index between patients and volunteers was significant(1.33?0.17,1.06?0.14,P

OBJECTIVE: Previous opinions consider the secondary diffuse osteoporosis as the very cause of vertebral fractures in patients with ankylosing spondylitis (AS). However, recent studies on bone mineral density (BMD) and vertebral fractures in AS patients reveal that there is no relation between the two. This article aims at investigating the association of lumbar vertebral fractures with clinical, laboratory, and imaging indexes in AS patients.METHODS: A contrast observation was performed between 65 AS patients and 62 healthy physical examinees, whose lumbar vertebral plain radiographs were taken for checking vertebral fractures. Disease activity evaluation indexes included C-reactive protein, erythrocyte sedimentation rate, finger-to-ground distance, Schobar's index score, Bath AS radiology index (BASRI) and syndesmophyte score. Dual energy X-ray absorptiometry technique was used to measure BMD levels of lumbar vertebras and femurs.RESULTS: Out of the total 65 AS patients, 10 ones (15.4%) had lumbar vertebral fractures, with 4 ones with wedge deformities and the other 6 ones with biconcave deformities. BMD levels of Lumbar vertebras and femurs in AS patients were significantly lower than those in controls (P < 0.01). There were significant differences in Schober's index scores, finger-to-ground distance scores, Bath scores, syndesmophyta scores and intertrochanter BMD values between AS patients with and without vertebral fractures (P < 0.01 ). Multiple logistic regression analyses revealed that intertrochanter BMD values were independently associated with lumbar vertebral fractures in AS patients (P =0.043).CONCLUSION: There is a correlation between low femoral BMD levels and the risk of lumbar vertebral fractures in patients with AS, especially at the intertrochanter area.

BACKGROUND:Signal transducer and activator of transcription 3 (STAT3) is an important cytokine signaling pathway, which plays an important role in inflammatory diseases. However, it is unclear whether gene polymorphism of STAT3 is associated with rheumatoid arthritis in the Chinese Han population. OBJECTIVE: To explore the association of gene polymorphism of STAT3 with rheumatoid arthritis in the Chinese Han population. METHODS:Four tag-single-nucleotide polymorphisms (tag-SNPs) in STAT3 were selected from the Chinese Han population of HapMap database. The study was performed with 228 rheumatoid arthritis cases and 228 normal controls. Four tag-SNPs (rs12601982, rs2293152, rs8078731 and rs9912773) were examined by matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry. RESULTS AND CONCLUSION:The frequency of GG genotype at rs9912773 was 18.9% and 10.5% respectively in rheumatoid arthritis and control groups, and there was a significant difference between the two groups (P < 0.05). These results indicate the possible association between the STAT3 gene polymorphism at rs9912773 and the susceptibility of rheumatoid arthritis in the Chinese Han population.

Objective To investigate the clinical characteristics of speech disorders in children with cerebral palsy (CP) and any relationship between those characteristics and cranial magnetic resonance images.Methods A sample of 138 children with CP were given the ＜ s-s ＞ language development test,a Chinese-language articulation test and oral motor scores to quantify their functional speech and articulation.The characteristics of their speech disorders,articulation and oral motor dysfunction were then related with abnormalities in their cranial magnetic resonance images (MRIs).Results Of the 138 MRIs,only 9 were normal.Three showed non-specific abnormalities (delayed myelination and/or broadening of the space outside the brain) and 122 (91％) showed specific abnormalities.Among the children with specific abnormalities,51.6％ had speech reception delay and 74.6％ had speech expression delays.The dysarthria rate was 71.3％,including 8.7％ with no speech ability at all.The main MRI abnormalities were lesions of the basal ganglia (23％),lesions of the cerebellum (11.5％),periventricular leukomalacia (PVL) (47.5％),extensive cortical or subcortical lesions (6.6％) and focal cerebral injury (11.5 ％).The corresponding oral motor scores increased successively.The children with lesions of the basal ganglia or cerebellum were most likely to manifest speech expression delay and dysarthria.The children with cortical or subcortical lesions or PVL also showed speech expression delay and dysarthria.However,the children who had a focal cerebral injury generally performed well on the speech ability assessment.Twelve children had no speaking ability at all,and in 7 of them the lesions were of the basal ganglia.Conclusions The probability and severity of speech disorders in children with cerebral palsy relate with specific abnormalities detectable with cranial MRI.Those with lesions of the basal ganglia or cerebellum will be more likely to show more severe speech disorders.

Objective To investigate the changes in toll-like receptor 4 (TLR4) and nuclear transcription factor-κB (NF-κB) expression in the livers of diabetic rats after exercise at different intensities.Methods Fifty Sprague-Dawley rats were randomly divided into a control group (NC),a diabetic group (DM),a low intensity exercise group (LIE),a medium intensity exercise group (MIE) and a high intensity exercise group (HIE),each of 10.The control group was given a normal diet.Type 2 diabetes was induced in the others through feeding a high-fat and high-sugar diet,as well as injecting a small dose of streptozotocin intraperitoneally.The three exercising groups swam to 40％,70％ and 100％ of their exhaustion times once a day,6 d/w for 6 weeks.Due to infection,drowning and other reasons,only 8 rats in each of the DM,LIE and MIE groups,as well as 7 in the HIE group survived.After the intervention,body weight,liver weight and fasting blood glucose (FBG) were tested.The expression of TLR4 and NF-κB mRNA in the livers was tested using RT-PCR technology,and the expression of TLR4 and NF-κB protein in the liver was tested using immunohistochemistry.Results Compared with the NC group,the average body weight and liver weight of the other four groups decreased significantly,while the FBG and the expression of TLR4 and NF-κB mRNA and protein increased significantly.There were significant differences among the exercise groups with the lowest values in the MIE group.Conclusion Six weeks of aerobic exercise can reduce FBG and the level of expression of TLR4 and NF-κB mRNA and protein in the liver,at least in rats.The effect of exercise at medium intensity is best.

BACKGROUND:Some overseas searchers have shown that,the midvastus approach in total knee arthroplasty(TKA)can reserve the complete medial structure of quadriceps femoris,improve the functional recovery of knee extension apparatus,but also preserve the blood supply of medial knee joint and maintain proprioceptive sense of knee joint.OBJECTIVE:To evaluate the early functional outcome of midvastus approach and standard medial parapatellar approach in TKA.DESIGN:A prospective,randomized,double-blind,comparative study.SETTING:Changzheng Hospital Affiliated to the Second Military Medical University of Chinese PLA.PARTICIPANTS:From March 2004 to March 2006,34 patients undergoing bilateral TKA simultaneOusly were admitted to the Changzheng Hospital Affiliated to the Second Military Medical University of Chinese PLA,including 7 males and 27 females.They aged 56-78 years with a mean of 70.5 years,and consisted of 24 cases with osteoarthritis,and 10 cases with rheumatoid arthritis;24 cases with bilateral genu varum,9 cases with bilateral enu valgum,and 1 case with lateral genu varum and contralateral genu valgum.Informed consents were obtained from all the included patients.Materials:Press Fit Condylar(PFC)Sigma knee prosthesis(DUPUY Company),the central tibial pad was added with a polyethylene prominence,while the corresponding femoral prosthesis was treated with anterioposterior steotomy,identical with the remained prosthesis.METHODS:The surgical approach of 34 patients was randomized into a midvastus approach in one knee and a standard medial parapatellar approach in the other knee.The comparison included the surgical parameters and clinical parameters.mevemnt,the time of performing an active straight leg raise,the time of reaching 90°knee flexion,range of motion and complications.RESULTS:All of 34 patients were involved in the result analysis.There was no significant difference in the surgical time botween the two roups.The assessment revealed significantly less blood loss[(286±29.8)Ml,(368±35.8)Ml,P＜0.05],fewer lateral release in valgus knee(20%,50%,P＜0.05),less pain in the first week(P＜0.05),earlier return of active straight-leg raise[(1.8±0.3)days,(4.5±0.8)days,P＜0.01],earlier reach of 90° knee flexion [(3.2±0.8)days.(7.1±1.2)days,P＜0.01]and greater range of motion at 45 day[(107±20)°,(98±12)°,P＜.05]in the midvastus approach group.CONCLUSION:The midvastus approach,which is based on diminished disruption of extensor mechanism and peripatellar pIexus of vessels,relieves pain and improves range of motion in the early rehabilitation period following TKA.

Objective To study the effects of living environment conditions and animal-animal interaction on the blood hormone levels and psychological behavior in Chinese tree shrews .Methods Chinese tree shrews were raised in ca-ges of different space sizes or were administered reserpine for 15, 30, 60, 120, 180 days, respectively.Then the animals were anesthetized by ether inhalation , and blood samples were taken from the heart to detect the levels of blood testosterone (T), estradiol (E2), endothelin (ET), adrenaline (A) and noradrenaline (NA) by radioimmunoassay (RIA).Results 1.Chinese tree shrews were bred in large cage (D1group) or small cage (X1 group) for 15, 30, 60, 120, 180 days, re-spectively.Compared with the animals bred in the large cage (D1 group), the level of blood testosterone (T) was signifi-cantly reduced (P<0.01), and the levels of adrenaline , noradrenaline and endothelin were significantly increased in the small cage group (P<0.01 for all).2.The animals raised in small cages in close neighborhood with large cages for 15, 30, 60, 120, 180 days, respectively.The levels of testosterone, adrenaline and noradrenaline in the large cage group (X2 group) were significantly higher than those of the small cage group (X1 group) (P<0.01 for all).3.The adrenaline and noradrenaline levels were significantly lower in all the reserpine groups (P<0.01 for all).4.The animals bred in small cages (X1 group) and in small cages in close neighborhood with large cages showed sudden loss , reduced appetite, testicu-lar atrophy , penile prolapse and stress symptoms .The animals of the reserpine groups appeared gentle temperament , signif-icantly reduced activity and reduced appetite .However , after stopping the reserpine administration and feeding them in large cages , the animals gradually returned to normal behavior .Conclusion Both animals living environment conditions and animal-animal interaction may cause changes of blood hormone levels and psychological behavior in Chinese tree shrews.

Objective:To analyze the mistakes in the application of tuina therapy in the rehabilitation of stroke,in order to elevate the clinical effects in the treatment of stroke by tuina.Methods:The issues are found out by searching and analyzing the relevant articles on tuina treatment of stroke.Results:In the tuina treatment of stroke,mistakes exist in the intervening time of the treatment,in the emphasis of tuina with negligence of rehabilitation,in the assessment of therapeutic effects,in the selection of the manual techniques and acupoints,and in the negligence of health education.Conclusion:In the tuina treatment of stroke,it is advisable to start treatment in the early stages,use the manual techniques in different phases,to cooperate with rehabilitation at the proper time and to emphasize health education,in order to avoid or reduce the occurrence of misuse syndrome,and eliminate the appearance of disuse syndrome,for displaying the unique advantage of tuina therapy fully and promoting the innovation and development of TCM rehabilitative techniques.

Objective To investigate the associations of variants in signal transducer and activator of transcription 4 (STAT4) in Chinese Han population with rheumatoid arthritis (RA). Methods The study was performed in 228 RA cases and 228 controls. Haplotypes from the HapMap database Chinese population were used to select tag-single-nucleotide polymorphisms (SNPs) (r2=0.9) in STAT4 gene. Twenty-three SNPs located in STAT4 gene were examined by multiplex polymerase chain reaction (PCR) and matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS). The Hardy-Weinberg equilibrium (HWE) was tested by a chi-square and Fisherˊs analysis. Differences in genotypes of the STAT4 polymorphism variants were evaluated using a Chi-square test. All statistical analyses were done with Haploview 4.1 software. Results Significant difference was detected in three SNPs (rs11685878, rs129888 and rs16833437) in allele frequencies analysis (χ2=6.014 8, 4.024 8, 5.539 1, P<0.05). Association was detected for three SNPs (rs11685878, rs16833437 and rs12988825) in genotype analysis ( χ2=6.814 9, 6.098 7, 6.691 7, P<0.05). Conclusion STAT4 may associate with susceptibility in Chinese Han population.