Objective To discuss the methods of the operative treatment for posterior tibial tendon dysfunction (PTTD). Methods From December 2002 to June 2005, 8 cases of PTTD were treated with operations, including 2 males and 6 females with an average age of 47 years (range, 36 to 56 years). Left side was involved in 6 cases, and right side was affected in 2 cases. Stage Ⅱposterior tibial tendon dysfunction were 2 feet and stage Ⅲ were 6 feet. Every case with special operative treatment, for instance lateral column lengthening, arthrodesis, repair posterior tibial tendon, spring ligament reefing, flexor digitorum longus tendon transfer and so on. Every bone operation was combined with one or more than one sofe tissue operation. Anterior transfer and strengthening of posterior tibial tendon were performed in 4 cases, spring ligament reefing in 2 cases, flexor digitorum longus tendon transfer in 4 cases. All patients were fixed with plaster cast at inversion position for 4-6 weeks, then changed to plaster splint fixing at neutral position for 4 weeks. Functions of ankle and foot were evaluated before and after operation. Results All patients were followed up for an average of 28 months(range, 12 to 40 months). According to Maryland foot score, 2 were fair and 6 were failure in preoperative, 4 were excellent, 3 were good and 1 was fair in postoperative. The total excellent and good rate was 87.5%. The specific index of X-ray improve obviously(P

Circulating tumor DNA (ctDNA) has shown great potential in targeted therapy efficacy prediction, monitoring, high-risk population screening, differential diagnosis, minimal residual disease (MRD) monitoring, and prognosis prediction. The detection of specific gene mutations in ctDNA had been included in clinical practice guidelines for certain tumors to predict the drug efficacy and monitor resistance. A small number of approved companion diagnostic reagents have been used in clinical setting. However, the clinical validity of most ctDNA-related biomarkers it still in the research stage. Besides, the establishment and validation of laboratory-developed tests (LDT) are also problems that need to be solved urgently. Therefore, for the moment, the clinical application of ctDNA analysis is like two sides of a coin, with both opportunities and challenges.

Objective To evaluate the performance of KRAS gene mutation detection in 2014 external quality assessment ( EQA ) program and discuss the problems in clinical laboratories .Methods The sample panel of 2014 EQA program contained 5 artificial formalin-fixed, paraffin-embedded ( FFPE) samples.The participating laboratories were asked to report their results before the deadline .The scores of EQA and the rate of overall coincidence , false positive and false negative were calculated .Results The EQA program for KRAS testing was set twice a year .In 2014, 58 and 57 valid lab results were submitted respectively.About 79.31%(46/58)and 94.73%(54/57) of the laboratories were correct for all samples. The coincidence rate of positive samples were 93.53% ( 217/232 ) and 96.49% ( 165/171 ) . The coincidence rate for negative ones were 100%(58/58) and 98.25% (112/114).The false-negative ratio was 1.29%( 3/232 ) and 0%.The false-positive ratio was 4.14% ( 12/290 ) and 3.15% ( 9/285 ) . Conclusions The results of 2014 EQA for KRAS gene mutation testing suggested that the performance of laboratories had been improved significantly , however , the false-negative and false-positive results had always been the major problems affecting the accuracy of KRAS mutations testing .Laboratories needed to standardize the testing process and manufacturers should optimize the reagents and the way of interpretation , to guarantee the performance of KRAS gene mutation detection .

Objective To establish a way to measure the injury severity of articular surface due to posterior malleolus fracture and investigate its clinical significance based on three-dimensional reconstruction technique.Methods Between May 2009 and March 2014,138 cases of peri-ankle injury combined with posterior malleolus fracture were treated.Lateral radiographs were reviewed to measure the ratio of posterior fragment area to distal tibial plafond area using the common method.Three-dimensional CT images were examined to measure ratio of the area of injury using the three-dimensional measuring method.Statistical comparison was made using the t-test and intraclass correlation coefficient (ICC).Results Measurement failed on 33 lateral radiographs and 13 three-dimensional CT images.Six cases cannot be measured by both imaging technology,so results of 98 cases were compared.Ratio of posterior fragment area to tibial plafond area was (16.2 ± 7.2) ％ measured by radiographs and was (29.6 ±10.1) ％ by three-dimensional CT scans (P ＜ 0.05).Three-dimensional CT measurements showed higher intra and inter-observer agreement (ICC of 0.973 to 0.942) than that in radiographic measurements (ICC of 0.875 to 0.860).Conclusion Three-dimension CT assessment of the extent of injury to articular surface because of posterior malleolus fracture is reliable and reproducible,but radiographic assessment may underestimate the injury and influence the choice of surgical indications.

Objective To investigate the establishment of secure tunnel in fixation for the talar neck fracture when screws were fixed from the medial wall of talus.Methods The age of volunteers was limited from 20 to 60 years old,and the height of male volunteers was from 165 to 185 centimeters,while the female volunteers' height was from 155 to 175 centimeters.The body mass index (BMI) was less than 25.The volunteers who were not heavy manual workers or standing working for long time had no history of ankle or foot fractures,and there were no evidence of degeneration changes in ankle joints according to X-ray.At last there were 33 males in this study with an average age of 43.7 (21-59) years and an average height of 176.0 (168-184) centimeters.There were 22 females with an average age of 43.2 (22-60) years and an average height of 165.4 (158-172) centimeters.After the volunteers' ankle joints and feet were scanned by CT,the reconstructed images were stored in CD and the slice thickness was 0.75 millimeters.The SuperImageTM Orthopedics Edition1.1 software was used to display the images and perform three dimensional reconstruction.The height of talar neck and the height of tarsal canal were measured.The models that screws passing into tarsal canals were built.The maximal length and angle that screws were inserted in the middle 1/3 and in the inferior 1/3 of medial wall of talus and run along to two directions were measured.At last,the data were analyzed with SPSS 13.0 software.Results The height of talar neck and tarsal canal had no significant difference between left side and right side in the same gender.The height of male talar neck was greater than the female' s.The models of screws passing into tarsal canals was gained.The length and angle in different insert points and different directions of screw fixation were also gained.When the screws were inserted from the middle 1/ 3 of the medial wall of talus,the angle of screw fixation was much wider than that when the screws were inserted from the inferior 1/ 3 of the medial wall of talus.At last,the safe range of the length and angel of screw fixation was calculated.Conclusion Damage of the blood of talus during internal fixation should be avoided.The middle 1/3 of the medial wall of talus is the most favourable choice to the fixation.Combining the digital technology with internal fixation for talar neck fracture could promote the operation' s security and feasibility.

ThemagneticFe3O4nanoparticlesweresynthesizedbyco-precipitationmethod,andthenmagnetic Fe3 O4@Au nanoparticle was synthesized to improve the affinity of particle surface. L-Cys-GA3 was grafted on the surface of gold clad by self-assembly method, and then dropped it on glassy carbon electrode, for further manufacture of MIP/Fe3 O4@Au by using electropolymerzation L-Cys. The surface morphology and particle size distribution of Fe3 O4@Au were studied by TEM. The structure and composition of gibberellins A3, MIP and nMIP were studied by IR. The test system was optimized, and the results showed that when the cycles of electropolymerization was 30, acetic acid:methanol (1:8, V/V) was chosen as eluent, elution time was optimized for 5 min and rebinding time for 7 min, the sensor got a high stability and good recognition ability for gibberellins A3 . The concentration of gibberellins A3 in the range of 1 . 0 × 10-11-1 . 0 × 10-8 mol/L had a relationship with the oxidation peak current of probe, with the detection limit of 2. 57×10-12 mol/L. The sensor was successfully used for the determination of GA3 in beer sample.

Objective To investigate the effect of sustentaculum tali screw placement on outcomes following open reduction and internal fixation (ORIF) of intraarticular calcaneal fractures.Methods A retrospective analysis was made on 139 patients with intraarticular calcaneal fractures treated by ORIF from April 2008 to January 2012.According to Sanders classification,there were 9 patients with type Ⅱ fractures,87 with type Ⅲ fractures and 43 with type Ⅳ fractures.Fracture reduction followed by placement of calcaneal anatomic plate or anatomic locking plate was performed via calcaneal lateral L-shape incision.All the patients received X-rays and CT scans within postoperative 2 weeks.Placement of screws in sustentaculum tail was detected by CT volume rendering to visualize implants combined with multiplanar reconstruction imaging (MPR).Patients were divided into accurate fixation group (Group A,n =28),marginal fixation group (Group B,n =58),and non-fixation group (Group C,n =53) based on radiological results.Intra-and peri-operative parameters,time to partial weight-bearing,time to full weight-bearing,fracture healing time,and clinical outcome were compared among groups.Functional outcome was assessed using American Orthopedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scale.Results Postoperative X-rays indicated accurate fixation of sustentaculum tail in 64 patients,marginal fixation in 22,and non-fixation in 53,but CT images manifested accurate fixation in 28 patients,marginal fixation in 58,and non-fixation in 53.Group A had operation duration of (93 ±11) min and intraoperative blood loss of (252 ± 27) ml,longer or higher than those in Group B [(85 ±8) min,(194±16) ml] and Group C [(57±6) min,(136 ±13) ml] (P＜O.05).There was no significant difference in mean hospital stay among the three groups (P ＞ 0.05).Ninety-two patients were followed-up for 12-38 months (mean 18.5 months) and 85 patients completed foot and ankle exercise as planned.Moreover,no significant differences were observed among groups concerning time to partial and full weight-bearing,fracture healing time and AOFAS score at the final follow-up (P ＞ 0.05).Conclusion Sustentaculum tali screw placement has no apparent effect on the short-term outcome of surgical treatment for calcaneal fractures.

Objective To provide references for anatomical reduction and correct implantation in treatment of distal fibular fracture by analyzing morphological characteristics of distal fibula on three-dimensional (3D) modes.Methods 16-row spiral CT scans of 126 normal ankle structures from May 2009 to June 2014 were collected.Surface shaded display technique was used to reconstruct 3-D images of bones around the ankle.The distal fibula was extracted using 3D segmentation technique.The parameters of distal fibula were measured by selecting points,lines and surfaces on the 3D models.Results The morphological characteristics of distal fibula were complicated.Significant differences were observed between males and females in most parameters (P ＜ 0.05),but not in the length between the plane of the most lateral point of the tibial anterior node and the most distal point of the fibula,the length between the midpoint of lateral border of the fibula and its opposite cortex on the plane of the most proximal border of the fibular fossa or the mean angle of posterior crest of the fibula (P ＞ 0.05).The intra and interclass correlation coefficients (ICC) were excellent.Conclusions When a lateral plate is used for internal fixation of distal fibula,the plate should be placed as proximally as possible.When a posterior-lateral plate is used,the screws to be inserted on the plane proximal to the initial point of anterior node of the tibia can be fixed bi-cortically.When a posterior plate is used,pre-contour of the plate before insertion is required.

Objective To investigate the effects of sevoflurane anesthesia on the expression of c-Jun N-terminal kinase (JNK) and neuronal apoptosis in hippocampus in juvenile rats.Methods Forty healthy male SD rats, aged 30-35 days, weighing 100-110 g, were randomly divided into 2 groups (n = 20 each): control group (group C) and sevoflurane group (group S) . Group C inhaled a gas mixture of oxygen and air for 5 h and group S 3% sevoflurane for 5 h. The concentration of oxygen in both groups was maintained at 30% . Ten rats in each group were scarified at 1 h after regaining consciousness and the hippocampi removed for determination of phospho-JNK expression (by immuno-histochemistry and Western blot) and neuronal apoptosis (by TUNEL) . Another 10 rats were selected at 24 h after regaining consciousness to assess the cognitive function using Morris water maze. Results Compared with group C, phospho-JNK expression was significantly up-regulated, the number of apoptotic neurons increased, the latency prolonged and the duration of staying at the original platform quadrant shortened in group C ( P ＜ 0.05 or 0.01) . Conclusion Inhalation of 3.0% sevoflurane can induce neuronal apoptosis in hippocampus by activating JNK signaling pathway, thus leading to cognitive decline in juvenile rats.

Objective To discuss the curative effect of computer assisted pre-operation plan (CAPP) in treating the geriatric intertrochanteric femoral fracture.Methods The data of intertrochanteric fractures treated with PFNA-Ⅱ between March 2012 and June 2015 were retrospectively analyzed.They were divided into two groups by preoperative design.One group was the CAPP group consisting of 53 patients with a mean age of 75.3 years (range,60-92 years).According to the Evans Classification,there were 12 Evans type Ⅰb,9 Evans type Ⅰc,15 Evans type Ⅰd and 17 Evans type Ⅱ fractures.The other group was the non-CAPP group consisting of 74 patients with a mean age of 76.6 years (range,62-95 years).There were 18 Evans type Ⅰb,15 Evans type Ⅰc,20 Evans type Ⅰd and 21 Evans type Ⅱ fractures.Operation time,intraoperative blood loss,times of fluoroscopy during operation and days of hospital stay were compared.The hip joint function was evaluated by Harris score at the final follow-up.Results The CAPP meanly cost 24.7 min.The consistency of the surgery and CAPP was up to 100％.In the CAPP group,the average operation time was 46.8±6.5 min;the average times of fluoroscopy during operation were 12.0±2.3 times;and the average blood loss was 154.4±27.6 ml.In the non-CAPP group,the average operation time was 57.8±10.3 min;the average times of fluoroscopy during operation was 20.9±3.2;and the average blood loss was 235.0±65.8 ml.All above data in the CAPP group were significantly lower than those in the non-CAPP group.The mean days of hospital stay were 13.9±1.3 days in the CAPP group and 14.3±1.4 days in non-CAPP group.The days of hospital stay had no significant difference between the two groups.Forty-five patients with an average follow-up period of 18.3 months were reviewed in the CAPP group.Fifty patients were followed up with an average period of 19.2 months in the non-CAPP group.At the final follow-up,the average Harris score was 88.6±2.8 points (range,84-96 points) in the CAPP group and 87.5±3.2 points (range,80-95 points) in the non-CAPP group.Conclusion CAPP system is convenient and efficient.It can facilitate the treatment of intertrochanteric fracture effectively.