Objective To observe the impacts of valsartan combined with amlodipine or hydrochlorothiazide regimen on blood pressure variability (BPV) in elderly hypertensive patients.Methods Eighty elderly patients with hypertension were randomized into valsartan and amlodipine (the amlodipine group, n=38) or valsartan and hydrochlorothiazide (the hydro-chlorothiazide group,n=37) group.The 24-hour dynamic blood pressure was monitored at baseline, 6-week and 12-week after treatment for the blood pressure and blood pressure variability. The control rate of blood pressure was calculated at 6-week after treatment, and side effects were observed during the treatment.Results Values of 24 h systolic blood pressure (SBP), daytime SBP, nighttime SBP, morning SBP and 24 h systolic blood pressure variability (SBPV) were significantly low-er at 6-week and 12-week than those of baseline in both two groups(P<0.05). There was an interaction between the group-ing factors and time on 24 h SBP, daytime SBP, nighttime SBP, 24 h SBPV and daytime SBPV (P<0.05). At the 6 and 12-week treatment, 24 h SBP, daytime SBP, nighttime SBP and daytime SBPV were significantly lower in amlodipine group than those in hydrochlorothiazide group (P<0.05). At 12-week treatment, 24 h SBPV was significantly lower in amlodipine group than tjat in hydrochlorothiazide group (P<0.01). There were no significant differences in control rate of blood pressure and side effects between two groups. Conclusion Valsartan in combination with amlodipine or hydrochlorothiazide can both ef-fectively control BPV in elderly hypertensive patients, and valsartan conbined with amlodipine has better effects on lowering blood pressure and BPV.

Clinical data and radiological findings of 78 patients with distal radial fractures,who underwent plain X-ray film and muhislice CT (MSCT) examinations,were retrospectively analyzed.Twenty nine associated carpal bone factures were detected on X-ray film in 21 cases;while 47 associated carpal bone fractures were detected on MSCT in 29 cases (P ＜ 0.05).The missed diagnosis rate of X-ray was 38％.Results indicate that MSCT can significantly improve the detect rate,which should be recommended for diagnosis of associated carpal bone fractures in distal radial fractures.

Objective To detect the MRI manifestations and discrimination of tuberculous spondylitis and pyogenic spondylitis with atypical features in early stage. Methods Six patients with pathologically proved tuberculous spondylitis and 7 patients of pyogenic spondylitis with atypical clinical features and were included. MRI features of the vertebral bodies, intervertebral discs, paraspinal soft tissues and their enhancement patterns were analyzed. Chi-Square test was used to compare the MRI features of two diseases. Results Patients with pyogenic spondylitis had a significantly higher incidence of disk space narrowing (8 intervertebral bodies), abnormal signal in superior/inferior of vertebral body (12 intervertebral bodies) and endplate with high signal (13 intervertebral bodies), which were not seen in the patients with tuberculosis spondylitis (P<0.05).Patients with tuberculous spondylitis had a significantly higher incidence of local abnormal signal in anterior of vertebral body (4 intervertebral bodies) and paraspinal abscess spanning vertebral body (5 intervertebral bodies), while none of them was found in patients with pyogenic spondylitis (P<0.05). Conclusion MRI is accurate for the differentiation of tuberculous spondylitis and pyogenic spondylitis with atypical feature in early stage.

Anxiety is usually generated because of the threatened feeling. The data of electrocardio, respiration, blood volume pulse and skin conductance signals were collected. The arithmetic of Relief were used for the feature selection and combined with k-Nearest Neighbor (kNN) arithmetic and Support Vector Machine (SVM) arithmetic for classification. The results show that the combination of Relief-SVM is better than combination of Relief-kNN on the recognition of anxiety state. The emotion recognition based on multi-physiological signals is superior to that based on one single signal.
Algorithms ; Anxiety ; Artificial Intelligence ; Humans ; Pattern Recognition, Automated ; Support Vector Machine

Objective To investigate the value of dynamic contrast-enhanced magnetic resonance imaging ( DCE-MRI) in differentiating serological negative early stage rheumatoid arthritis (RA) from osteoarthritis (OA)in hand. Methods Plain MRI, enhanced MRI of whole hand and DCE-MRI of single slice were performed in 53 patients suspected of RA or OA and 18 healthy volunteers. Twenty-three of them were diagnosed as RA,including 18 cases of serological negative RA and 18 of them were diagnosed as OA after 3 to 6 months follow-up. The contrast rate,slope, thickening of synovial membrane were measured on DCE-MRI in three groups and the MRI findings were also were detected in both RA and OA groups. The contrast rate and slope of synovial membrane were compared among three groups using rank sum test. The thickening of synovial membrane were compared among three groups using variance analysis. MRI signs of RA and OA group were evaluated with rank sum test Results The dynamic contrast rate of synovial membrane in RA group,OA group and control group was(100.78±61.96)%,(40.44±15.43)% and (23.56±9.14)%,respectively.Individually,RA group to OA group,u=3.101,P=0.002;RA group to control group,u=4.669,P=0.000;OA group to control group,u=3.482,P=0.000.The slope of contrast curve of synodal membrane of RA group,OA group and control group was 72.50°±13.34°,45.39°±9.94°,14.56°±5.75°,respectively.Individually,RA group to OA group,u=8.002,P=0.000;RA group to control group,u=17.102,P=0.000;OA group to control group,u=9.100,P=0.000.The synovial membrane thickening of RA group,OA group and control group was(3.3±0.5),(2.8±0.7)and (1.4±0.6)mm,respectively.Individually,RA group to OA group,q=2.622,P=0.011;RA group to control group,q=9.583,P=0.000;OA group to control group,q=6.961,P=0.000.Conclusion The quantitative index of DCE-MRI,including contrast rate and synovial membrane thickening may provide useful information for differentiating OA from semlogical negative early stage RA.The contrast rate and thickening of synovial membrane in RA group are higher than those in OA group.Many signs of MRI Can help differentiate OA from RA.

Objective To set up the 3D-finite element(FE)model of normal acetabulum-cartilage-femoral head,so that to provide an effective model for biomechanical analysis of femoral head.Methods(1)The hip joint in one healthy adult male volunteer was scanned by MRI at coronal section.The 3D reconstruction model of acetabulum-cartilage-femoral head was constructed with MATLAB and ANSYS software.(2)The 3D orthotropy finite element model of the acetabulum-cartilage-femoral head was constructed by givig the corresponding material parameters to the different structures of the model of acetabulum-cartilage-femoral head and divided into networks through ANSYS software.(3)The standing status was imitated on the model to set boundary condition and loading and then calculated.The effect of the model was evaluated in comparison with that of literature.Results A 3D orthotropy FE model of acetabulum-cartilage-femoral head was established successfully,including 89 961 points of 448 159 units.The maximal displacement was on the femoral head,and the maximal Von Mises stress was on the femur neck.The stress analysis was the same as the results of literature and the actuality.Conclusion A 3D orthotropy FE model of acetabulum-cartilage-femoral head can be setup based on MRI images,which can provide a reasonable and effective model for biomechamical analysis of femoral head.

Objective To study the risk factors of MRI for the prediction of collapse in patients with avascular necrosis of the femoral head.Methods Twenty-two patients (39 hips) diagnosed avascular necrosis of femoral head by MR were enrolled in our study.The following MR appearances were evaluated:bone marrow edema,joint fluids,signal intensity and location of the lesion.The volume and surface area of the necrosis zone were calculated.The time of follow-up was 18-84 months (median,25 months).Logistic regression analysis was used to predict the risk factors by SPSS 13.0.The maximum value of Youden index was selected as the critical point to predict the collapse of femoral head and to define the sensitivity,specificity and accuracy.Results In the 39 hips with femoral head necrosis,21 hips had collapse.Bilateral collapse occurred in 5 cases.In 25 hips with the necrosis surface larger than 25％,collapse occurred in 21 (84％); In 8 hips with the volume of femoral head necrosis larger than 30％,collapse occurred in all cases; 1n 33 hips with the necrosis locating at the superolateral quadrant,collapse occurred in 21 (63.6％); In 22 hips with necrotic areas showing heterogeneous signal intensity,collapse occurred in 18(81.8％) ;In 25 hips with large amount of joint effusion,collapse occurred in 16 (64％) ;in 18 hips with bone marrow edema,collapse occurred in 13 (65％).Joint fluid,heterogeneous signal intensity and lesions in the superolateral quadrant,volume ratio,and area ratio were the high risk factors,while bone marrow edema was a relatively low risk factor.The area under ROC curves for area ratio of NASA was greater than that for volume ratio (0.987 vs 0.902).When the critical value for area ratio was 26.7％,the true positive rate was 95.2％,true negative rate was 94.4％,and Youden's index was 0.896.Conclusions The collapse of necrosis of femoral head may result from many factors.The femoral head was easy to collapse when it had large enough area of necrosis and mixed signal intensity,a large amount of joint effusion,bone marrow edema,and superolateral quadrant location.The critical value for area ratio to predict the collapse of femoral head was about 26.7％.The area ratio is more accurate than volume ratio in predicting the collapse of necrosis of femoral head.

Objective To report retrograde transposition of composite tissue flap pedicled with peroneal artery in the treatment of bone and soft tissue defects following calcaneal osteomyelitis.Methods During the period from January 2008 through January 2015,47 patients with bone and soft tissue defects following calcaneal osteomyelitis were treated by retrograde transposition of composite tissue flap pedicled with peroneal artery.They were 43 men and 4 women,aged from 24 to 67 years(average,43.6 years).After radical focus debridement,the areas of skin defect ranged from 2 cm × 2 cm to 5 cm× 5 cm and the bone defects ranged from 1.5 cm × 1.0 cm × 2.0 cm to 3.0 cm × 3.0 cm × 4.5 cm.Results All the 47 patients were followed up for 6 to 72 months (average,25.2 months).Relapse of osteomyelitis occurred in 2 cases but secondary bone graft was needed in none.All the patients recovered their walking function.The texture and color of the composite tissue flaps were similar to those of normal skin,without obvious swelling.The flaps appeared good and imposed no obstacle to wearing shoes.The ankles and hind feet of the patients scored from 58 to 91 points (average,76.6 points) according to the American Orthopaedic Foot and Ankle Society (AOFAS) evaluation system,giving 7 excellent,32 good and 8 fair cases.Hallux flexion contracture without skin ulcer was observed in 10 cases 6 months after surgery,necessitating no surgical intervention.Conclusion Retrograde transposition of composite tissue flap pedicled with peroneal artery can effectively treat bone and soft tissue defects following calcaneal osteomyelitis,leading to a low recurrence rate and good foot appearance.

Melorheostosis is a rare disorder of osteopathia. The clinical characteristics of melorheostosis in children is totally different from that in adults. The radiographic features of melorheostosis include the hyperostosis in endosteal on the one side of the cavum medullare and formed streakiness. The soft tissue contracture of the limb and joint deformities are the symptoms of melorheostosis. Here, the authors reported a melorheostosis case of 6 years old girl who suffered from severe valgus deformity of the right knee with permanent patellar dislocation. A surgical stabilization was applied with lateral soft tissue release, medial soft tissue stabilization and transferred the vastus medialis laterally (kinetic stability). After 19 years follow up postoperatively, the limb developed well in satisfied alignment with good function of knee joints, even participated in some sports activities. Other authors reported a similar case of melorheostosis with surgical treatment and achieved good outcomes in limb realignment and reduction. The further suggested that the surgical treatment should be produced before epiphyseal closure.

Objective To explore the appropriate treatment according to the grading system of adolescent idiopathic cervical kyphosis.Methods A retrospective study was performed in 115 adolescent patients with idiopathic cervical kyphosis.The patients were divided into 4 groups according to the magnitude of kyphosis.The initial Cobb angle of 4 groups were 12.7°±1.4° 25.4°±4.8°,47.2°±4.4° and 62.6°±5.7° respectively.The patients in group I were treated with the collar support for 4-8 weeks.The patients in group Ⅱ were treated with skull traction (3-5 kg) and then fixed by cranio-cervical-thoracic plaster.According to the angles between the tangents of posterior vertebral body at each level on lateral cervical radiograph in extension,the anterior fusion levels of the group Ⅲ and angles and range of osteotomy in the group Ⅳ were decided.In group Ⅳ,the patients were treated by two steps.The anterior release and posterior osteotomy were performed firstly.Then skull traction (1/10 body weight) was maintained in order to correct the deformity for 7-10 days,fusion and anterior fusion with autologous bone graft and internal fixation was completed.Results Post-operative radiograph showed that Cobb angle were -5.5°±2.0°,-8.2°±6.1°,-4.5°±6.6° and -2.9°±7.9° in Ⅰ-Ⅳ group after treatment.The deformed appearance of the patients improved significantly.A improvement neck pain and neurologic function were found in all patients.Post-operative MRI showed that physiological curve of the cervical spine was restored,and the cerebrospinal fluid line was clear in the previous kyphosis area.Conclusion Adolescent idiopathic cervical kyphosis has specific characteristics.Surgical strategy is determined by the severity of deformity.