Objective To investigate and discuss the feasibility and clinical outcome of the minimally invasive two-incision total hip arthroplasty. Methods From February to June 2004, 17 cases of the minimally invasive two-incision total hip arthroplasty were performed. There were 7 males and 10 females with an average age of 69 years from 58 to 75 years. Preoperative diagnosis of the patients included 5 of osteoarthritis, 4 of osteonecrosis and 8 of femoral neck fracture. The operations were performed with Versys cementless prosthesis and minimally invasive instruments provided by Zimmer Company. Operation time, blood loss, length of incisions, average postoperative hospitalization, and operation related complications were analyzed. Blood transfusion was performed while hemoglobin of the patients was less than 8 g. Results The patients were followed up from 6 to 12 months with an average of 8 months. The average operation time was 95 mins (85 to 170 mins). The average blood loss was 280 ml (190 to 450 ml) and blood transfusion was carried out in 4 cases of femoral neck fracture (average, 400 ml). The average length of anterior incision was 5.0 cm (4.6 to 6.5 cm) and that of posterior incision was 3.7 cm (3.0 to 4.2 cm). All the patients were ambulatory the day after surgery. 11 cases were discharged 5 days and 6 cases discharged 7 days after operation. Postoperative measurement on X-ray film showed that the average angles of abduction and anteversion of acetabular cup were 46?(43? to 55?) and 21?(17? to 23?) respectively. Proximal femoral split fracture occurred in one case, in which the fluoroscopy demonstrated the femoral component was stable and well positioned, and the patient walked without weight-wear for 2 months and was found with stable prosthesis evaluated at 3 and 6 months postoperatively. None of infection, dislocation or injury of vessel and nerve happened. Conclusion Anterior and posterior two-incision total hip arthroplasty has the advantages of muscle sparing, minimally invasive, less blood loss, rapid recovery; however, this technique is time consuming, special instruments and fluoroscopy are needed.

Objective To evaluate the diagnostic value of color Doppler ultrasonography(CDUS)and molybdenum mammography for breast tumor.Methods 86 breast diseases which were diagnosed by the surgery and pathology,were prospectively analysed,40 in mammary carcinoma,and 46 in mammary benign disease.All the patients were examined with CDUS,CDFI and molybdenum mammography.Diagnosis was made in every case compared using two methods(CDUS and molybdenum mammagraphy)with any using only one method.Results There is significant difference between mammary carcinoma and mammary benign disease in CDUS.The mammary carcinoma patients'blood stream signal is abundant. The diagnostic veracity of using both CDUS and molybdenum mammography for breast tumor is obvious higher than that of the any only one method.Conclusion Combined CDUS with molybdenum mammography which is the optimal methods of the mammary image examination,can improve the diagnostic veracity of breast tumor.

This study was aimed to investigate the protective effect of catalpol against high glucose induced injury on vascular endothelial cells (ECV-304). ECV-304 cells were culturedin vitro. MTT method was applied to detect cell viability. NO and LDH level were measured by spectrophotometer method. The effect of catalpol against high glucose induced injury on ECV-304 was observed. The results showed that there were no obvious changes in cell viabilities of ECV-304 cultured in normal concentration of glucose medium among groups with different concentrations of catalpol. Compared with the control group, cell viability was significantly decreased (P< 0.01), the NO secretion was significantly reduced (P< 0.01), the LDH level was increased obviously (P< 0.01) in the high glucose (30 mmol·L-1 glucose) injury model group. The high osmotic (24.5 mmol·L-1 mannitol) group was set up as a positive control. Comparison between the low dose (1 ng·μL-1 catalpol + 30 mmol·L-1 glucose), middle dose (10 ng·μL-1 catalpol+ 30 mmol·L-1 glucose), and high glucose (30 mmol·L-1 glucose) injury model group showed no changes on cell viability and NO (P> 0.05); while the LDH level was reduced (P< 0.01). Comparison between the high dose catalpol (100 ng·μL-1 catalpol + 30 mmol·L-1 glucose) group and the high glucose model group showed that the cell viability was obviously increased (P< 0.01); NO secretion was increased (P< 0.05); and the LDH level was obviously reduced (P< 0.01). It was concluded that catalpol had protective effect against high glucose induced ECV-304 injury through the regulation of NO and LDH level. The effect of high dose was obvious.

OBJECTIVE To explore the drug-resistance,the existing forms,genotype,and transfer ways of extended spectrum ?-lactamases(ESBLs) and plasmid AmpC enzyme in Klebsiella pneumoniae.METHODS The drug sensitivity of K.pneumoniae to 17 antibiotics was done by slip-diffusion and microdilution methods.The genotype of two enzymes was assessed by PCR and sequencing.The transfer ways of K.pneumoniae drug-resistant gene were identified by transconjugants-test.RESULTS The ESBLs were mainly produced in 55 cefoxitin resistant K.pneumonia strains.The major genotypes of ESBLs and plasmid AmpC nzyme were CTX-M,MIR and DHA.These genes could be transferred from clinical isolates to recipient bacteria.CONCLUSIONS ESBLs as well as AmpC enzymes are the most important resistance mechanism in K.pneumoniae.The resistance could be transferred through the bacterial conjugation.

OBJECTIVE To study the drug resistance genes in imipenem-resistant Pseudomonas aeruginosa.METHODS Five main drug resistance genes:IMP,VIM,SPM and GIM which are pertinent with metal ?-lactamase and outer membrane protein oprD2 gene were analyzed using PCR method.RESULTS The oprD2 genes in 48 strains of imipenem-resistant P.aeruginosa were negative,and in 14 strains were positive from all 62 strains tested.There were 16 strains with positive IMP type and 5 strains with positive VIM type metal enzyme genes positive,7 metal enzymes producing strains were with negative oprD2 gene.The SPM and GIM metal enzyme genes detected were all negative.CONCLUSIONS The loss of outer membrane protein oprD2 gene is the main mechanism of imipenem resistance in P.aeruginosa in Tai′an area.

AIM:To investigate the changes of Wnt signaling pathway in catalpol-induced proliferation of rat bone marrow mesenchymal stem cells (BMSCs).METHODS:The BMSCs were isolated from SD rats , purified by differ-ential time adherent method and divided into control group and catalpol (1.0 mg/L) group.Flow cytometry was used to de-tect the proliferation index of BMSCs .The mRNA levels of Wnt3a, Wnt5a, Wnt11 and β-catenin was evaluated by real-time PCR.In addition, the protein expression level of β-catenin was determined by Western blotting .RESULTS:Prolife-ration index was increased from 8.90%±0.46% to 17.93%±1.68% after treatment with catalpol (P<0.01).Com-pared with control group , the mRNA expression of Wnt5a, Wnt11 andβ-catenin was all increased with catalpol treatment . No difference of Wnt3a mRNA expression between control group and catalpol group was observed .Meanwhile, the protein expression of β-catenin was increased in catalpol group compared with control group .CONCLUSION:Catalpol promotes BMSCs going into the cell cycle .Classical and non-classical Wnt signaling pathways are activated in this process .

Objective To evaluate the effects of the non-supine position and the supine position during the second stage of labor on delivery outcomes.Methods In total,642 singleton term primiparas in the Fourth Hospital of Hebei Medical University between January 2013 and March 2014 were divided into the non-supine position group (n=320),which included the lateral (n=204) and hands-and-knees position (n=116),and the supine position group (n=322) according to primipara's choice.Delivery outcomes in the two groups were compared using the Student's t test,Mann-Whitney rank sum test and the x2 test.Results The incidence of caesarean section was similar in the non-supine position and supine position groups [0.9％(3/320) vs 1.9％ (6/322),x2=0.438,P=0.508].Compared with the supine position group,women in the non-supine position group had a higher incidence of perineal lacerations grede Ⅰ [85.2％ (270/317) vs 65.2％ (206/316),x2=33.884],longer duration of the second stage of labor [48.0 min (31.0-78.0 min) vs 41.0 min (25.0 67.3 min),Z=-3.066] and greater blood loss after 2 hours of labor [240.0 ml (200.0-287.5 ml) vs 210.0 ml (160.0-260.0 ml),Z=-3.736],but a significant reduction in posterolateral episiotomies [5.3％(17/317) vs 23.4％ (74/316),x2=41.908],perinealedema [13.6％ (43/317) vs 21.2％ (67/316),x2=6.430] and meconiumstained liquor [20.8％ (66/317) vs 33.2％ (105/316),x2=12.356] (all P＜0.05).In the non supine position group,fetal heart rate showed fewer early decelerations,variable decelerations and late decelerations than in the supine position group [10.1％ (32/317) vs 17.1％ (54/316),x2=6.593; 2.8％ (9/317) vs 6.6％ (21/316),x2=5.079; 3.2％ (10/317) vs 7.6％ (24/316),x2 6.139; all P＜0.05,respectively].Conclusions The non supine position during the second stage of labor may improve delivery outcomes.

BACKGROUND: Currently, the morphologic characteristics of the torn discoid lateral meniscus remain unclear, andmorphological indexes used to evaluate the discoid lateral meniscus tears still need to be explored. OBJECTIVE: To discuss the specificity and sensitivity of discoid lateral meniscal tears in children using morphological indexes. METHODS: Seventy-three patients (seventy-six knees) with torn discoid lateral meniscus underwentarthroscopy and MRI data of knee examinations were retrospectively reviewed. All MR images were double-blinded, independently, retrospectively analyzed by attending radiologist (doctor A) and sports physician (doctor B). The following morphological signs of discoid lateral meniscus, such as a internal displaced free edge sign, a hypertrophic free edge sign and a hypertrophied-horn sign, were selected to evaluate the discoid lateral meniscus tears. The likelihood of the discoid lateral meniscus tears was analyzed on basis of arthroscopic findings constituted the gold standard. Sensitivity, specificity and accuracy of MRI diagnosis of the discoid lateral meniscus tears by two physicians were calculated, and the consistency of diagnosis results by two physicians was evaluated using the Kappa statistics.RESULTS AND CONCLUSION: (1) The sensitivity, specificity and accuracy in the diagnosis of discoid lateral meniscustears by internal displaced free edge sign for doctor A were 19%, 94% and 53%, respectively, and for doctor B were 21%, 97% and 55%. (2) The sensitivity, specificity and accuracy in the diagnosis of discoid lateral meniscus tears by hypertrophic free edge sign for doctor A were 52%, 100% and 74%, respectively, and for doctor B were 57%, 97% and 75%. (3) The sensitivity, specificity and accuracy in the diagnosis of discoid lateral meniscus tears by hypertrophied-horn sign for doctor A were 26%, 97% and 58%, respectively, and for doctor B were 24%, 100% and 58%. (4) The sensitivity, specificity and accuracy in the diagnosis of discoid lateral meniscus tears by binding morphological index for doctor A were 86%, 91% and 87%, respectively, and for doctor B were 88%, 94% and 91%. (5) The Kappa statistics for discoid lateral meniscus tears respectively demonstrated a good inter-observer agreement (K > 0.75, P < 0.001). (6) These findings suggest that single morphological index used to evaluate the discoid lateral meniscus tears shows a good specificity, but which also shows a low sensitivity, while a binding morphological index can significantly improve the diagnostic sensitivity. Morphological characteristics may be reliable indexes to evaluate the discoid lateral meniscal tears in children.

Objective To study the life style and the status of nutrition knowledge for the children of Pinggu district of Beijing,and to provide evidences for targeted education and guidance.Method Using cluster sampling method,15 118 pupils aged 7-13 yeas in Pinggu district of Beijing were investigated for their nutrition knowledge,sports and diet habits using the questionnaire investigation method.The children at grades 1-3 were defined as the junior group,those at grades 4-6 were defined as the senior group,all pupils were divided into urban and rural groups according to the distance to pinggu district town center.The Excel 2003 was used for databases.The status was analysed using SPSS13.0 statistical software.Chi-square test wcs used for comparing categorical data.Result Totally 13 192 questionnaires were returned,accouting for 87.26％; 11 364 of them were valid,accouting for 75.17％.The awareness rates about the fruits and vegetables which are rich in nutrients,the food rich in calcium,the food rich in protein,nutrient deficiency anemia was relatively low,they were respectively 58.33％,62.72％,58.83％,43.18％; the awareness rates on the relationship between diet and health,effects of obesity on the health,excessive dringking is harmful and eating more salt was harmful,were relatively high:88.82％,92.33％,94.27％,and 83.74％,the differences between gender,grade,area and students' awareness of the comparison,were statistically significant (P＜0.05).The awareness rate of the question about what is dietary pyramid was 18.77％,the differences between different gender and grade were statistically significant (P＜ 0.01).The questionnaire of eating habits:the students who do not or occasionally have breakfast accounted for 14.84％; the rate of three meals which were irregular accounted for 14.46％; children who do not like to eat grains,vegetables and fruit,respectively accounted for 18.59％,21.61％,4.23％; the number of children who do not like to drink milk and eat soy products was high,the proportion was 38.52％ and 60.17％.At the same time the differences in time between sex,grade,areas,were statistically significant (P＜0.05).The questionnaire about movement and sleeping habits:the students who like walking,playing,climbing and other way to relax after class accouted for 59.94％,the exercise time was 30 minutes or more accounted for 40.99％,51.14％; students who ride bike or walk to school,children who ensure 9-10 hours for sleeping every day accounted for 84.86％,differences between different sex,area and grade were statistically significant (P＜0.01).Conclusion The children in this district generally had lack of the nutrition knowledge.There were many bad diet habits,while sport habits were also poor.In order to improve diet and sport habits of rural school children,we should do targeted nutrition and health education to children.

Fifty-four children, aged 1.5-3.5 years, were selected from a nursery and divided into three groups. To the children in group 1 multivitamin fortified formular milk powder of Hai-He brand (70g daily) was given as a supplementary food in addition to the normal diet and whole milk powder of Hai-He brand was given to group 2 as another supplementary food. The third group served as control. This observation was lasted for three months. At the end of the third month, the increments of body weight of the children, tricep skinfold and circumference of upper arm of group 1 were higher than those of group 3 significantly, but there were no significant differences between group 1 and group 2. The hemoglobin content of group 1 increased by 0.8g/dl but group 2 and 3 decreased by 0.53g/dl and 0.72g/dl respectively. At the end of our observation, the concentrations of vitamin B1, C and PP in urine of group 1 were higher than those of other two groups by vitamin load test.Thus, we may consider that the multivitamin fortified milk powder is better than the whole milk powder in improving the vitamin and iron nutritional status of young children.