As the structure of shoulder joint is complex, proper method s should be adopted to treat the injured shoulder joint according to the type an d position of the trauma. Conservative treatment has been widely used to treat t he slightly displaced or stable fractures (including those of the proximal humer us, clavicle and shoulder blade), and most of the fresh dislocations of shoulder joint and acromioclavicular joint if the injuries are not serious. As for the o bvious unstable shoulder fractures, recurrent dislocation of shoulder joint, sev ere dislocation of acromioclavicular joint, dislocation of shoulder joint accomp anied with fracture, and rotator cuff tear, an operation should usually be the r ight choice. In either conservative or operative treatment, earlier systematic f unctional rehabilitation should be widely used in order to achieve satisfactory functional recovery of should joint.

Objective: To build a relationship model of perceived academic self-efficacy, learning stress, and learning burnout of high school students. Methods: 674 high school students were surveyed with Learning Stress Scale of High School Students, The Perceived Academic Self -efficacy Scale, Scale of Learning Burnout of High School Students. Results: Learning stress had a direct effect on a low level of learning efficacy, perceived alienation to teacher and physical exhaustion (The direct effect value were -0.22,0.12,0.27). At the same time, perceived basic ability and perceived control partially mediated the impact of learning stress on the low level of learning efficacy, perceived alienation to teacher and physical exhaustion (the mediated effect value were -0.155 and-0.264, 0.066 and 0.299, 0.089 and 0.233). Perceived basic ability and perceived control fully mediated the relationship between learning stress and emotional exhaustion (the mediated effect value were 0.033 and 0.387). Conclusion: The students with a higher level of stress reported suffering more learning burnout than those with a lower level of stress, and vice versa.

OBJECTIVE:To explore the effects of olmesartan medoxomil on blood pressure variability(BPV)and vascular en-dothelial function of patients with mild and moderate essential hypertension. METHODS:Sixty patients with mild and moderate es-sential hypertension were included in study group,and other 60 healthy volunteers were included in control group. Study group was given olmesartan medoxomil 20 mg orally,qd,for 4 weeks,followed by same dose if their SBP≤140 mmHg and DBP<90 mmHg till 12th weekend;those patients with SBP>140 mmHg or DBP≥90 mmHg received double dose till 12th weekend. Aver-age blood pressure,BPV,FMD and NMD of study group were measured before and after treatment as well as the changes in se-rum concentrations of NO and ET,and then compared with control group. RESULTS:Compared with before treatment,average blood pressure,BPV and ET level of study groups were decreased significantly after treatment,serum level of NO was increased significantly,while FMD and NMD were improved significantly,with statistical significance (P<0.05);there was no statistical significance,compared with control group (P>0.05). There were 3 cases of mild diarrhea and 2 cases of mild dry cough,and they relieved after medication withont speical treatment. CONCLUSIONS:Olmesartan medoxomil can play a good effect on de-creasing blood pressure and is tolerable. It can also improve the vascular endothelial function.

AIM:To explore the surgical effect of total hip joint replacement on the severe degenerative arthritis secondary to congenital hip dysplasia.METHODS:The experiment was carried out in the Department of pedics,General Hospital of Chinese PLA between June 1998 and December 2005.①116 adult patients(128 hips) with arthritis secondary to dysplastic hip received total hip replacement,including 13 males(15 hips) and 113 females(106 hips),aged from 16 to 66 years(average of 42.6 years).According to Crowe classification system,there were 57 cases(60 hips) of typeⅠ,20(23 hips) of typeⅡ,16(20 hips) of type Ⅲ and 23(25 hips) of type Ⅳ.②The acetabula were reconstructed at the true acetabular location.Except one case,all patients were given biological fixation of cementless acetabular cups including 83 hips with routine total hip replacement,and 27 hips with smaller cup;11 hips with routine total hip replacement after granular bone grafting,and 7 hips with a smaller cup after autologous femoral grafting on the superior margin of acetabula.119 biological prostheses were used to reconstruct the femoral cups including 4 common cemented shafts,6 long cemented shafts,and 4 S-ROM prostheses.③Harris hip score was adopted to evaluate the hip function,and X-ray photographs were used to observe the location of prostheses.RESULTS:①The Harris hip scores increased from 38.5 preoperatively to 88.5 postoperatively.②No prosthesis displacement,dislocation of hip joint or repair was found in patients,and the length of treated limbs meanly prolonged by 2.3 cm.Additionally,the incision healed primarily.③Radiographically,the positions of the prostheses were normal,and the bone grafts fused with the host bone successfully.The average bone coverage was 95%(90%-100%);radiolucentline was observed at between the acetabular cup and host acetabula in 2 cases,and 1 at femur.④Adverse effects:Sciatic nerve tension injury was found in 1 case and recovered in 4 months,the femoral nerve tension injury in 1 case and recovered in 3 months,and hip rest pain remained in 4 cases.CONCLUSION:In the treatment of arthritis secondary to dysplastic hip with total hip replacement,it is better to reconstruct the acetabulum at the true acetabular location.Moreover,the individualized appropriate selection of femoral prostheses is a key factor to obtain good curative effects.

Human Y chromosome contains sex determining region and the genes associated with spermatogenesis.Genomics of the human Y-chromosome association with male infertility appeared and new exploration for male infertility was formed.Though the genes of Y chromosome lack of meiotic recombination,Y chromosome did not disappear,but also it is being in evolution.It includes several families of satellite sequences and the alphoid repeats,Alu repeats associated with male infertility.A total of 107 genes were listed in the database in Y chromosome.The male specific region on Y(MSY) harbours 156 transcription units of which half(78) are suspected to encode proteins,27 protein or protein families identified,11 protein only expressed in the testis associated with spermatogenesis.It is likely that the genes on Y chromosome play an important role not only on spermatogenesis,but also on prostate,brain or other organs.

Objective To improve the surgical technique for the removal of huge staghorn stones. Methods 202 cases treated with an incision of the intrarenal sinus supplemented by a postrenal lower pole segmental incision for the removal of huge kidney stones were studied. Results The biggest stone was 9.8 cm?5.0 cm?3.2 cm and in one case the stones amouned to 74. The average postoperative hospitalization days was 12.8. Postoperative examination with KUB+IVU or B ultrasound revealed residual stone in 9 cases, the diameters being less than 0.8 cm. Conclusions The procedure needs no interruption of renal pedical and with the advantages of simple,less bleeding,complete removal of calculus,and preservation of renal function.

Objective To observe the reparative response and expression of basic fibroblast growth factor (bFGF) protein in the rotator cuff subjected to subacromial impingement. Methods Subacromial impingement of the infraspinatus tendon was experimentally created in 50 male SD rats by thickening the undersurface of the acromion with one platelike bony transplantation of the ipsilateral scapular spine. The contralateral shoulders that had undergone a sham operation were used as controls. The rats were sacrificed at 3, 7, 14, 28, and 56 th day, the whole shoulder joint was removed for detecting bFGF protein and the reparative response in the impinged infraspinatus tendon. Computer image analysis system were used to monitor the expression intensity and numbers of positive cells of bFGF protein. The OD scores and the size of area represent the expression intensity and numbers of positive cells respectively. Results All rats with experimental subacromial impingement showed an infraspinatus tear on the bursal side of the tendon. The shoulders in the control group were found intact without any alteration. There was proliferating cells in the fragmented tendons and vascularised connective tissue covering the area of ruptured area, whose source was the subacromial bursa. Few tenocytes and bursal cells expressed bFGF protein in unwounded tendons. In contrast, tendons subjected to impingement exhibited an increased signal for bFGF protein in both resident tenocytes concentrated along the epitenon and infiltrating fibroblasts and inflammatory cells from the subacromial bursa. Conclusion The bFGF protein is upregulated during tendon healing and the subacromial bursa is the main source of both bFGF secreting and rotator cuff repair; one should preserve as much as possible the subacromial bursa.

Objective To evaluate the effect of incision of the intrarenal sinus plus postrenal low pole segmental incision for removal of calculus on the renal hemodynamics. Methods The hemodynamic changes of intrarenal and incisional sites in 98 cases with complex calculi were consecutively monitored by color Doppler ultrasonograph before operation and also 1 month,3 months,6 months after operation.The ratio(S/D) of the peak flow-rate in systole(S),the flow-rate at the end of diastole(D),and the resistant index(RI) of the intrarenal chief renal arteries and intersegmental arteries and interlobar arteries were analyzed.The signals of blood stream in segmental incision were divided into four classes(Ⅰ to Ⅳ) and were observed. Results The changes of the intrarenal hemodynamics were related to the degrees of hydronephrosis(P0.05),but it caused the blood stream to be obstructed in the area of incision where the signals of blood stream showed classes Ⅲ to Ⅳ.The patients generally recovered after 3 to 6 months,and the time of recovery was associated with the degrees of hydronephrosis Conclusions It is concluded that the incision of the intrarenal sinus plus postrenal low pole segmental incision for removal of calculus is an effective and safe method for treat-ment of complex renal calculus.

Objective To determine the sensitivity and accuracy of CT do ub le-contrast arthrography (CTA) in detecting underlying soft-tissue and bony abno rmalities of recurrent anterior glenohumeral dislocations. Methods From March 19 90 to May 2003, 31 patients with the signs and symptoms of recurrent anterior in stability, which were 23 males and 8 females with an average age of 26.7 years ( ranging, 22 to 46 years), were recruited for the study. All patients suffered fr om more than three times of glenohumeral dislocations, underwent CT arthrography after intraarticular injection of air and radiographic contrast medium before o peration. The surgical procedures included open Bristow operation in 25, Bankart operation in 3, Putti-Platt operation in 2, and a combination of Bankart and ca psular tightness operation by arthroscopy in 1. Each patient also underwent arth roscopy or open surgery and the observations were compared with CTA. Results Les ions of labrum and capsulo-ligamentous complex were the two most common abnormal ities demonstrated by surgical findings, which were respectively found in 28 and 20 patients at surgery. Anterior glenoid labral abnormalities, including of tea r, detachment, degeneration, were detected on CTA in 26 of 28, 2 of glenoid labr al degeneration were undetected on CTA, and the accuracy rate diagnosis on CTA w as 93.5%, while the sensitivity of CTA was 92.8%. Capsular lesions, including of marked medial scapular insertion, glenoid marginal stripping, and loss of inter vening scapular marginal soft tissues, were detected on CTA in 19 of 20, 1 of ca psular glenoid marginal stripping was undetected on CTA, and the accuracy rate d iagnosis on CTA was 87.1%, while, the sensitivity of CTA was 95%. Subscapularis tendon abnormalities, including of tears and irregularities, were visualized in 7 cases on CTA, but only 4 of which were identified during surgery. Furthermore, all of 15 Hill-Sachs defects, 6 Bankart bony defects, and 1 rupture of supraspi natus tendon suggested by CTA, were identified during surgery. For 26 of the pat ients with above kinds of lesion resulting in recurrent anterior glenohumeral di slocation, the accuracy rate of diagnosis was 83.7%. Conclusion The utilization of CT double-contrast arthrography can improve the understanding of multiple les ions associated with recurrent shoulder dislocation, it is contributed to select proper operative procedure.

Objective To supply safe mechanic refererence for reduction of thoracolumbar burstfracture with pediclc screws and lay biomechanic foundation for developing a new type of digitizing pediclc screws. Methods The change of stress and its scope of pediclc screws during reduction of thoracolumbar burstfracture were tested to determine the relationship of the degree of reduction with stress and strain. Results A total of 15 burstfracture specimens were obtained successfully. Stress was small and changed mildly at the beginning of reduction stage. Stress presented transparent elevation tendency at the stage of body height of 75% of intact until at the stage of 90%. When the height of vertebral body restored from 90% to 95%, the curve of stress changed gently. The maximum stress of left screw was 98.4?10.3 and the right was 101.2?13.4. The stress of bilateral screws did not differ significantly. It was calculated that the left strain was (34.64?3.84)N and the right one was (35.544?3.61)N, the moment was (5.20?0.58)Nm of the left and (5.33?0.54)Nm of the right. There was not significant difference between the strain and the moment of bilateral screws. Conclusion The safe range of reduction force is between 4.5Nm and 6Nm. The burstfracture of vertebral body can be both reduced successfully and prevented from overpropping.