Objective To explore the clinical significance of the inferior displacement sign on the initial anterioposterior (AP) view X-ray for fractures of humeral greater tuberosity.Methods This study retrospectively analyzed the imaging and clinical data of 24 patients with isolated fracture of humeral greater tuberosity who had sought medical treatment during the period from January 2008 to June 2015.They were 10 males and 14 females,with an average age of 54 years (from 19 to 68 years).Laterality:8 left sides and 16 right sides.The AP view X-ray films of the 24 patients present the inferior displacement sign defined as the inferior cortical margin of the greater tuberosity overlapping the proximal humeral shaft on the initial AP view.The patients received further CT examination to determine the displacement direction and whether the humeral neck fracture was complicated.Results A slight displacement of humeral anatomic neck fracture was shown on the initial AP view X-ray in 10 patients.Further CT examination revealed that humeral anatomic neck fracture was confirmed in 23 patients,the greater tuberosity was displaced posteriorly in 22 patients and posteroinferiorly in 2 patients.Radiographic measurements showed:the mean posterior displacement was 10.5 ±4.5 mm;the displacement between the humeral head and the humeral shaft was 2.5 ± 1.5 mm;the neck shaft angle was 147.2° ± 9.2°;the distance between the humeral head and greater tuberosity was 10.8 ± 3.4 mm;the overlap between the inferior edge of greater tuberosity and the upper edge of lateral humeral shaft was 12.5±5.9 mm.Pearson correlation analysis showed no correlation between the overlap and the head-tuberosity distance (P ＞ 0.05),but a significant correlation between the overlap and the neck-shaft angle (P ＜ 0.05).Conclusions The inferior displacement sign on the initial AP view X-ray is actually the overlap of posterior displaced greater tuberosity fracture shown on the X-ray.The posterior displaced greater tuberosity fracture complicated with slight displaced anatomic neck fracture is a presentation of the valgus impacted fracture of the proximal humerus.The inferior displacement sign in the fracture of humeral greater tuberosity can highly suggest the presence of occult or slight displacement of the humeral anatomic neck fracture.

Objective To investigate the expression of OX40 on CD4+T cells in patients with ulcerative colitis (UC)and the role of OX40/OX40L interaction for the cytokine production of lamina propria(LP)-CD4+T cells from UC.Methotis LP-CD4+T cells were purified.The expression of OX40 molecule was measured with FACS.LP-CD4+T cells were cultured with different stimuli and proliferation was assessed.The cytokines concentrations of the culture supernatant were detected.Results No difference of the OX40 expression was observed among the CD4+T cells from peripheral blood(PB)of UC patients,LP of non-inflammatory colonic tissue in UC patients and control PB.However.the expression of OX40 was significantly higher on LP-CD4+T cells from inflammatory colonic tissue in UC patients.In vitro culture with antigen presenting cells,the levels of IFNγ and TNFα secreted by LP-CD4+T cells from the inflammatory colonic tissue were significantly higher than those from the non-inflammatory colonic tissue(both P＜0.01).The levels of IFNγ and TNFα secreted by LP-CD4+T cells from the inflammatory colonic tissue were further increased by anti-OX40 MoAb stimulation.but suppressed significantly by adding anti-OX40L MoAb (compared with non stimulation,P＜0.01,respectively).The IFNγ and TNFα secretion of the LP-CD4+T cells from the non-inflammatory colonic tissue were not significantly different with and without anti-OX40 or anti-OX40L MoAbs stimulation.IL-4 and IL-10 produced by LP-CD4+T cells from the inflammatory or non-inflammatory colonic tissue were not significantly changed when adding different stimuli.Conclusions OX40 is highly expressed on LP-CD4+T cells from inflammatory colonic tissue in patients with UC.AntiOX40L MoAb can inhibit the proinflammatory cytokines secreted by these cells.It is indicated that OX40+T cells are involved in the immunopathological process in UC and blockage of the interaction of OX40 and OX40Lis a new strategy to be considered for the treatment of the disease.

Objective To observe the variations and distribution of the pulmonary fissures of normal subjects in China on multi-planar recontruction (MPR) images of 64- slice helical CT.Methods A total of 1235 subiects underwent 64- slice helical CT scan with a slice thickness of 0.6 mm.The MPR images were observed to find normal interlobar fissures and the variations including the accessory fissures occurred in lobar or segmental lungs.Results Of the all cases,no variation was seen in 80.08%(989/1235),and pulmonary fissure variations occurred in the remaining 19.92%(246/1235).Among pulmonary fissure variations,20.33% (50 cases) occurred bilaterally,with the other 79.67%(196 cases) unilaterally.Of the unilateral pulmonary fissure variations,63.01%(155 cases) was seen in right lungs,and 16.66% (41 cases)was found in left lungs.There was neither oblique nor horizontal fissure in 1.22%(3 cases) of right lungs.Absence of oblique fissure happened more frequently in left lungs (6.91%,17 cases) than right lungs(3.65%,9 cases).Incomplete oblique fissure happened more frequently in left lungs (8.53%,21 cases)than in right lungs(4.06%,10 cases).Totally,absence of the horizontal fissures were found in 27.24%(67 cases) of the subjects,and incomplete horizontal fissures were found in 9.76% (24 cases).Accessory fissure were found in 83.33%(205 cases) of the subjects,and they happened more frequently in right lungs than in left lungs(53.66%,132 cases on the right,while 29.67%,73 cases on the left).Accessory fissures on right lower lobe and segments happened much more than on the left(40.65%,100 cases on the right,while 7.72%.19 cases on the left).Lingular fissures in the lungs were found in 15.85%(39 cases).The changes in shape and location of the oblique and horizontal fissures were found in 41.06%(101 cases),and happened more frequently in right lungs than left lungs (35.37%,87 cases on the right,5.69%,14 cases on the left).Conclusions Sixty-four-slice helical CT with MPR can clearly display pulmonary fissures and their variations,and it can distinguished small lesions from small vessels.

Objective To explore the incidence, etiological and protective factors, and preventive countermeasures of deep venous thrombosis (DVT) in patients undergoing hip surgery. Methods Four hundred and forty-one patients who had hip fracture surgery in our department from January, 2005 to May, 2010were analyzed retrospectively. They were 223 males and 218 females, aged 65.7 years. (range, 22 to 87). A binary logistic regression was performed, using gender, age, duration of surgery, surgery type, anesthesia type, blood transfusion, physical therapy, thrombo-prophylaxis and complication as covariates, taking DVT incidence as the dependant variable. Results The patients obtained a median follow-up of 17.2 months (range, 3 months to 4 years and 7 months). Sixty-nine patients developed DVT (incidence, 15.6%).Analysis of multiple variables showed that duration of surgery, anesthesia type, blood transfusion, hypertension and diabetes were risk factors to DVT. Physical therapy and thrombo-prophylaxis were protective factors.Age, gender and surgery type had no statistically significant influence on DVT (P ＞ 0.05). Conclusions The DVT incidence after hip fracture surgery is high. In order to decrease the DVT incidence, surgeons should try their best to estimate risk factors for every patient perioperatively, avoid general anesthesia or blood transfusion, shorten operating duration, effectively control complications, actively perform physical therapy or thrombo-prophylaxis, and prolong the anticoagulant therapy for patients with higher risk factors.

Brain natriuretic peptide(BNP) is a cardiac hormone mainly secreted by myocytes in the ventricular wall. It has strong action of natriuresis, diuresis, vasodilation, inhibition of renin-angiotensin-aldosterone system and sympathetic nervous system. The increased levels of BNP and NT-proBNP have been reported in children’s cardiovascular diseases in numerous stu-dies and can reflect cardiac function. This article simply reviews the BNP and NT-proBNP about its biology character, detection method, medical reference range and its progress in pediatric cardiovascular disease.

Objective To analyze the prevalence and risk factors related to the diabetic patients with hypertension in the Kailuan group workers.Methods A total of 9 498 type 2 diabetic patients were followed up for 5 years,regarding myocardial infarction,stroke,and death incident.The cumulative incidence of hypertension in diabetic patients and the evaluated risk factors of hypertension were analyzed.Results The prevalence of hypertension in 9 489 subjects with diabetes was 63.3％,higher than that in subjects without diabetes(42.0％,P＜0.01).Aging,smoking,obesity,high blood levels of triglycerides,total cholesterol,and low-density lipoprotein-cholesterol were the risk factors of diabetic patients with hypertension,in whom the morbidity of myocardial infarction,cerebral infarction,cerebral hemorrhage,and renal dysfunction was 3.3％,6.0％,0.9％,and 18.8％,respectively,all higher than those (2.1％,2.6％,0.3％,and 10.9％) in diabetic patients without hypertension (P＜0.01).By the end of follow-up for 5 years,incidences of cerebral infarction,cerebral hemorrhage,and death in diabetic patients with hypertension were higher than those with normal blood pressure (P＜0.05),but no difference in incidences of myocardial infarction between the 2 groups (P＞0.05).The 5-years cumulative incidence of hypertension in the diabetic population was 40.1％.Male sex,smoking,snoring,obesity,and hypertriglyceridemia were the risk factors of hypertension in diabetic patients (P ＜ 0.05).Conclusion The prevalence and the 5-years cumulative incidence of hypertension in diabetic patients increased significantly.Diabetic patients with hypertension may have higher risk of cerebrovascular events and kidney dysfunction.

ObjectiveTo establish a mathematical formula for choosing the manner of replacement fluid infusion in continuous renal replacement therapy (CRRT), so as to provide the basis for improving the treatment effect. Methods A mathematical formula for choosing the manner of replacement fluid infusion with continuous veno-venous hemofiltration (CVVH) was taken as an example, and it was compared with the result of standard replacement fluid in order to analyze the effect of different manners of infusion.① Comparison parameters: the plasma volume (Vreturn) and some electrolyte concentration (Creturn) in back way of CRRT (if other thing was solute, filter coefficient should be 1.0).② Research objects: the actual replacement fluid (for example, the most complex should be sorted into A and B type) mode (pre or post) was compared with the standard replacement fluid (the A and B in one).③ Based on the formula of standard replacement, four equations in different conditions were derived: pre-dilution and post-dilution mode; same direction and same ratio; same direction and different ratio; different direction and same ratio; different direction and different ratio.Results The calculated results of Vreturn (except hematocrit) and Creturn were same to the standard only following the rule of same direction and ratio for A and B no matter pre-dilution mode or post-dilution mode, and it was different from the standard in others. In pre-dilution mode and post-dilution mode, it showed:① A and B in same direction and different ratio: Vreturn and Creturn were different from the standard for the alterative ratio of B.② A and B in different direction and same ratio: Vreturn was same to the standard, but Creturn was different from the standard for the completely different and more complex computational formula.③ A and B in different direction and different ratio: both Vreturn and Creturn were different from the standard. The different Vreturn was due to the different ratio of B. The different Creturn was caused by different ratio of B and the completely different computational formula.Conclusions① For parts of replacement fluid which must be separated ( for example, bicarbonate formula ), the result is same to the standard, and is predicted and mastered only following the rule of same direction and ratio. Otherwise, we need to calculate the two parameters over and over again. The result will run out of our judgment. The wrongness of losing water and electrolyte disorders maybe come out.② Accordingly,the formula could be used to analyze the same case like the separated replacement infusion, for example, a large number of citrates as regional anticoagulation were infused only in the front of filter, while the replacement fluid can be done in varied forms.

Objective:To study the environment suitability of multi-parameter patient monitor. Methods: Choosing six different types of multi-parameter patient monitor from different manufactures, we tested six main parameters of the multi-parameter patient monitor when they had gone through the environmental tests, and the test limits come from field environment. Results:Each of the samples was not up to the standards. Conclusion:At present a clear most of the multi-parameter patient monitor in the market are designed and produced for using indoors, which are not suitable for using in field environment. We need to enhance the protection of the multi-parameter patient monitor against field environment, and improve the environment suitability.

Objective:To investigate the relationship between emotion variability and assessment of psychiat-ric symptoms in middle school students,and validate that by structure equation modeling.Method:A total of 129 junior middle school students aged 13 -15 years were selected and assessed with the SCL-90 scale for psychiatric symptoms,the Adolescent Daily Emotion Regulation Questionnaire (ADERQ)for emotion regulation strategies, daily reconstruction method (DRM)for emotion variability during two weeks.Results:The students had higher positive emotion score than negative emotion score [(2.7 ±0.7)vs.(1.4 ±0.3),P <0.001],and higher negative emotion variability than positive emotion variability [(0.4 ±0.1 )vs.(0.3 ±0.1 ),P =0.012].Positive emotion variability and negative emotion variability were positively correlated with total scores of SCL-90 (r =0.34,0.24;Ps <0.001).Structural equation modeling revealed positive emotion variability,negative emotion variability and e-motion regulation strategy of cognitive appraisal had a direct effect on psychiatric symptoms (the path coefficient were 0.21,0.28,-0.24;Ps <0.001),cognitive immersed strategy had a direct effect on psychiatric symptoms and negative emotion variability(the path coefficient was 0.14,0.13,P =0.037,P =0.041).Conclusions:It suggests that both negative emotion variability and positive emotion variability play an important role in psychiatric symp-toms.

After the development and service of information resources in medical library of CDC were described in aspects of its characteristics and service target, the development and service strategies of information resources in medical library of CDC in health information era were analyzed with suggestions put forward for meeting the demands of scientific workers, such as construction of the service platform for sharing digital medical and health literature resources in Hubei Province, development of big data-oriented innovative medical information resources, construction of mobile equipments-based service platform for medical information resources, enforcement of team construction, optimization of staff allocation.