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.

SUMMARY Anklejointfractureisoneofthemostcommontypesoffracture.Therearemanyresearches on the injury mechanism,treatment principles and surgical techniques.A type of injury which combines posterior dislocation of fibula,known as the Bosworth injury,is relatively rare.In 1947,Bosworth first described this type of injury as an unusual ankle fracture dislocation with fixed posterior fracture disloca-tion of the distal part of the fibula.In this type of fracture,the proximal fibular shaft fragment locks be-hind the tibialis posterior tubercle.This rare ankle fracture variant is often not recognized in initial radio-graphs and requires a computed tomographic (CT)scan for verification.But there are already many re-ports,discussing the injury mechanism,treatment principles and surgical techniques.However,there are few reports of anterior dislocation of the fibula,caused by either injury or surgery.The mechanism of the injury is still not clear.This article reports a case of anterior dislocation of the fibula.We report a patient with left ankle open fracture (Lauge-Hansen pronation-external rotation stage Ⅲ,Gustilo ⅢA).Open reduction and internal fixation was done in the initial surgery,but ended up with poor reduction,resulting in fibula anterior dislocation,anterior dislocation of talus and tibia fibular dislocation.The fibula was dis-located anteriorly of the tibia,which rarely happened.The patient suffered severe ankle joint dysfunc-tion.The second operation took out the original internal fixation,reduced the fracture,and reset the in-ternal fixation.The function of ankle joint was improved obviously after operation.But because of the ini-tial injury and the two operations,the soft tissue around the fracture was greatly damaged.6 months after the second operation,and the fracture still not healed,so the bone graft was carried out in the third sur-gery.Two months after the third surgery,the function of the ankle was significantly better than before, but the fracture healing was poor,which needed further review.Through this case,we understand the rare type of ankle fracture with anterior dislocation of the fibula,and recognize that the timing and quality of initial surgery has a great impact on the patient’s prognosis and rehabilitation period.

Objective To study the application effect of insulin aspart alone or in combination with metformin to treat diabetes.Methods 80 patients with diabetes from February 2014 to February 2015 were studied.They were randomly divided into observation group and control group,40 cases in each group.The observation group was given insulin aspart therapy combined with metformin hydrochloride tablets.The control group was treated with insulin aspart.The blood glucose levels,insulin dosage were recorded,the incidence of hypoglycemia was analyzed in the two groups.Results After treatment,the blood glucose levels in the two groups were lower than before treatment,the decrease of the observation group was more significant than the control group,the difference was statistically significant (P <0.05).The two groups showed no significant difference in mean blood glucose and glycemic lowest (P >0.05), the highest blood glucose value of the observation group was lower than the control group [(7.3 ±1.1)mmol/L vs (8.5 ±1.8)mmol/L)],there was statistically significant difference (t =3.597 8,P =0.000 2).The average blood glucose level of the observation group was also shorter than the control group,there was statistically significant differ-ence (t =10.880 3,P =0.000 2).After treatment,NIHSS scores of the two groups were decreased,NIHSS score reduce the magnitude of the observation after treatment was significantly higher than the control group (4.33 ± 0.82)vs.(5.24 ±1.25),there was significant difference(t =3.849 8,P =0.000 2).The effect of improving lipid levels observed were significantly better than the control group,the difference was statistically significant (P <0.05). Conclusion Combination of insulin aspart and metformin hydrochloride tablets in the treatment of patients with dia-betes to control blood sugar levels is better than the effect of single treatment with insulin aspart,insulin aspart therapy combined with metformin hydrochloride tablets in patients with diabetes can reduce postprandial 2h,fasting glucose, reduce the incidence of hypoglycemia,it should be popularized and used in the clinical.

162 cases of the in patients sick with herniated lumbar disc were randomly divided into three groups, including 82 cases in the observation group treated by manual manipulations plus external herbal application, 40 cases in the control group Ⅰ treated only by external application of herbal drugs, and 40 cases in the control group Ⅱ treated only by manual manipulations. The total effective rate was 90.2% in the observation group, 82.5% in the control group Ⅰ and 85.0% in the control group Ⅱ, indicating a significant difference (P＜0.05) in comparison of the therapeutic effects between the observation group, the control group Ⅰ and control group Ⅱ. In the treatment of herniated lumbar disc by manual manipulations plus external herbal application, the therapeutic effect is precise and obviously higher than that in the treatment by single manual manipulations or by external application of herbal drugs.

BACKGROUND:The increase of serum cholesterol levels is positively correlated with the increasing incidence of osteoarthritis. Little is known about the role of high-fat diet in the degeneration of articular cartilage and induced arthritis.
OBJECTIVE:To observe the morphology change of the articular cartilage of New Zealand rabbits after high-fat diet, and explore the role of food in the articular cartilage degeneration.
METHODS:Forty New Zealand white rabbits were randomly divided into two groups. In control group, rabbits were fed with basal diet. In high-fat diet group, rabbits were fed with high-fat diet (20%lard and 80%basal diet). Fasting blood samples was taken every 4 weeks, to detect the triglyceride and total cholesterol levels. After rabbit were fed for 28 weeks, the knee joint was grossly observed and the femoral condyle cartilage was scanned by scanning electron microscope.
RESULTS AND CONCLUSION:Compared with the control group, the triglyceride and total cholesterol levels were significantly increased in the high fat group (P<0.05). Under scanning electron microscope, the high-fat group showed rough surface of condylar cartilage, shal ow pouch, messy arrangement, irregular shape and uneven size. The surface of cartilage exhibited focal denudation, irregular arrangement, uneven porosity and fractured cavity. Under higher magnification, smal mountain-like structure of cartilage surface became shal ow and flattened, the pores disappeared. Long-term high-fat diet may induce and aggravate cartilage damage, suggesting it may be involved in the pathogenesis of osteoarthritis.

Objective To investigate the clinical value of the 18F-FDG SPECT-CT combined with the image of CT in the diagnosis of lung cancer.Methods Retrospectively analysis images of 18F-FDG SPECT-CT and CT of 162 patients pulmonary tumor-like lesions from January 2013 to October 2013 were conducted.All the patients have been confirmed by the pathological mechanism or cytologic examination.Each patient has been firstly diagnosed by the 18F-FDG SPECT-CT along and then combined with the images of CT.The sensitive rate and the accurate rate of two methods were compared by x2 test.Results There were 40 benign lesions and 114 malignant ones in 162 patients.The sensitive rates of the two methods were 86.0％ and 96.5％ (x2 =6.63,P ＜ 0.05).The accurate rates of the two ways were 79％ and 96.3％ (x2 =7.76,P ＜ 0.05).The differences were statistically significant.Conclusion 18F-FDG SPECT-CT combined with the images of CT can increase the diagnostic sensitivity and accuracy.It has important clinical value.

Objective To investigate the episode of ischemic stroke in patients with serum homocysteine (Hcy),erythropoietin and its clinical significance (EPO)levels.Methods Detected 120 cases of first ischemic stroke patients serum Hcy,EPO lev-els and test results with 120 cases over the same period outpatient healthy compare.Used Logistic regression analysis and Pearson correlation analysis to determine the relationship between serum Hcy,EPO levels and ischemic stroke,ROC curve a-nalysis of clinical characteristics of Hcy and EPO.Results Serum Hcy,EPO level of ischemic stroke were respectively 23.1 ±12.6μmol/L and 32.4±11.2 mIU/L.The control level were respectively 10.4±2.8μmol/L and 17.6±5.2 mIU/L.Is-chemic stroke group were significantly higher.The results had statistical significance (P<0.05 or<0.01).Pearson correla-tion analysis showed that ischemic stroke serum Hcy levels and EPO levels were positively correlated (r=0.369,P<0.05). Logistic regression analysis showed that Ischemic stroke was positively related to serum Hcy level (P<0.05),and were not related to EPO (P>0.05).Conclusion The serum Hcy,elevated EPO levels associated with ischemic stroke.Serum Hcy is an independent risk factor of ischemic stroke.

BACKGROUND:Reduction and fixation are presently used for middle and inferior humeral fractures. The methods of fixation approach include anterolateral (including modified upper arm anterolateral), posterior and medial approaches. The repair approach of middle and inferior humeral fractures remains controversial. OBJECTIVE:To compare efficiency and safety of anterolateral and medial approach fixation with compression plate and screw for middle and inferior humeral fractures. METHODS:A total of 90 cases of middle and inferior humeral fractures treated in Chongqing Red Cross Hospital were equaly and randomly divided into experimental group and control group. In the control group, patients were subjected to compression plate and screw through anterolateral approach. In the experimental group, patients were subjected to compression plate and screw through medial approach. Operation time, intraoperative blood loss, complications and the recovery of shoulder joint and elbow joint function were compared in patients of both groups. RESULTS AND CONCLUSION:Intraoperative blood loss was significantly lower in the experimental group than in the control group (P < 0.05). No significant difference in operation time and fracture healing time was found between the two groups (P > 0.05). During 6 months of folow-up, no significant difference in shoulder joint function Neer score and elbow joint function Mayo score was detected between the two groups (P > 0.05). During the folow-up period, no wound infection, bone nonunion or chronic osteomyelitis appeared in both groups. These data confirm that the effects of medial approach and anterolateral approach for middle and inferior humeral fractures are similar. Medial approach leads to less blood loss, can effectively make up for the defects of the traditional repair scheme, and can be considered as one of fixation approach for middle and inferior humeral fractures.

The clinical application of 18F-FDG PET/CT in thyroid tumor is primarily for restaging of patients with DTC but having a negative 131i whole-body scan in the presence of elevated serum Tg and TgAb levels.In parallel with the accumulation of clinical experience and increasing clinical utilization of 18F-FDG PET/CT,the application of 18F-FDG PET/CT in thyroid tumors is also broadened.This review aims at updating the application of 18F-FDG PET/CT in different types of thyroid tumors.

[Summary] Adrenocortical carcinoma is a rare disease with poor prognosis, and its pathogenesis is mainly related to genetic mutations, abnormal expressions of steroidogenic factor-1, insulin-like growth factor 2,cell growth factors including vascular endothelial growth factor, dysfunction of Wnt pathway, as well as dysregulation of microRNA and DNA methylation. In recent years, the intensive molecular studies provide a brand-new methodology to distinguish adrenocortical carcinomas from benign tumors in early stage.