Objective To evaluate intra-and interobserver reliability of analysis of lower limb alignment on DR digital images using AutoCAD.Methods Angles on AP view and long leg view were measured three times by two trained observers separately using these two methods in 140 knees.The intra-and interobserver intraclass correlation coefficients with 95% CIs of two methods were calculated and compared with Fisher z transformation and Z test.Paired t test was used in comparing time consumption.Results For AutoCAD method,inter ICCs were 0.942? 0.993 ,intra ICCs were 0.937～0.999.For X-ray films method,inter ICCs were 0.736～0.981,intra ICCs were 0.759～0.951.Corresponding ICCs of AutoCAD method were higher than those of X-ray films method,most of which had significant differences(P<0.01).The consuming time of two observers in measuring one knee using AutoCAD method was 89.6 seconds and 94.3 seconds shorter than those using X-ray films method respectively.Both had significant differences(P<0.01).Conclusion It was a fast reliable method to assess lower limb alignment on DR digital images using AutoCAD.

BACKGROUND:Crowe IV developmental dysplasia of the hip is rarely seen clinical y. However, when treated with routine total hip arthroplasty, severe deformities in the bone and soft tissue can lead to high rate of operation failure and increased occurrence of complications. Total hip arthroplasty in combination with subtrochanteric osteotomy may be an option to resolve this problem.
OBJECTIVE:To retrospectively analyze the clinical outcome and safety of Crowe IV developmental dysplasia of the hip treated by the combination of total hip arthroplasty and subtrochanteric osteotomy in 17 cases.
METHODS:Twenty-one hips (17 cases) of Crowe IV developmental dysplasia of the hip treated by the combination of total hip arthroplasty and subtrochanteric osteotomy were retrospectively analyzed and fol owed for at least 2 years from January 2006 to June 2011. Complications, hip function, and radiological changes were evaluated.
RESULTS AND CONCLUSION:The mean fol ow-up period was (48.0±20.5) months. Harris’s score was increased postoperatively (P<0.05). The main complains were lower limb length discrepancy, difficulty in standing up from squatting, muscle weakness, and soft tissue tightness. One greater trochanter fracture occurred and was fixed by hook plate fixation. There were four femoral shaft splits treated by cerclage. One patient represented with femoral nerve palsy and got partial recovery until the latest fol ow-up. There was no deep infection, dislocation or prosthesis loosening. Crowe IV developmental dysplasia of the hip could be effectively treated by total hip arthroplasty in combination with subtrochanteric osteotomy, which requires high surgical techniques to control the complications. Further fol ow-up is required for long-term results.

Objective To explore the effect of narrative therapy on family environment and values in adolescents with emotional disorder.Methods 35 adolescents with emotional disorder and their parents from Affiliated Brain Hospital,Nanjing Medical University were enrolled and treated by narrative therapy.Family environment was assessed using Family Environment Scale-Chinese Version (FES-CV)and was compared between pre-and posttherapy.Results 28 adolescents with emotional disorder and their parents completed therapy.The cohesion,independence,intellectual orientation,active-recreation orientation and organization in FES-CV showed higher scores at post-therapy than at pre-therapy ((6.89 ± 2.56) vs.(4.21 ± 3.21) ; (5.54 ± 1.35) vs.(4.68 ± 1.51) ;(4.75±2.07)vs.(3.50±2.12);(4.07±2.65)vs.(2.50±2.32);(3.68±1.77)vs.(2.50±1.62)respectively).The contradict in FES-CV showed lower scores at post-therapy than at pre-therapy ((2.75 ± 2.44) vs (5.25 ± 2.50)).The values of adolescents with emotional disorder and their parents had a positive change after narrative therapy.Conclusion Narrative therapy is effective on the positive change of FES-CV and values of adolescents with emotional disorder and their parents.

Objective:To investigate the inhibitory effect of RNA interference (RNAi) on the expression of multidrug resistance (MDR1) gene and analyze the altered sensitivities of human renal carcinoma cell line to cisplatin.Methods:Three small interfering RNA (siRNA) sequences targeted MDR1 gene were synthesized and transfected into renal carcinoma A498 cells. The expression level of MDRl mRNA was measured by RT-PCR to identify the most effective siRNA sequence. The recombinant plasmid was packed by lentivirus and transfected into A498 cells. RT-PCR was used to screen the A498 cells with the optimal silencing efficacy. The MDR1 protein expression level in the cloned cells was verified by Western blotting. The inhibitory effect of cisplatin on the proliferation of A498 cells was assessed by MTT assay and the IC_(50) value was calculated. Results:The 3 siRNA sequences suppressed MDR1 gene expression at different degrees. The siRNA 1 sequence silenced MDR1 gene more effectively with a significant reduction of 67%. The MDR1 protein expression greatly decreased in screened A498 cells compared with non-transfected cells (P<0.01), and the IC_(50) value of cisplatin on screened A498 cells was significantly decreased by 83.37% (P<0.01). Conclusion: The RNAi could effectively inhibit the expression of MDR1 gene and increase the sensibility to cisplatin in human renal carcinoma A498 cell line, which make it possible to reverse the resistance of renal carcinoma to chemotherapy.

Objective:To study the clinicopathologic characteristics and the prognostic factors of triple negative breast cancer,and to study the correlation between clinicopathologic features and EGFR expression.Methods:Clinical characteristics and prognosis of 200 breast cancer patients diagnosed between 1997 and 2004 were reviewed.The paraffin embedded tissues were selected and tissue microarray blocks were made.Immunohistochemical staining was used to evaluate the expression of ER,PR and HER2 for breast cancer molecular type.EGFR expression was evaluated to analyze its correlation with the clinical characteristics and prognosis.Results:Fourty-two cases(21%)of 200 were triple negative breast cancer(TNBC).There was no significant difference between TNBC and non-TNBC in clinicopathologic parameters such as age,tumor size,clinical stage,and lymph node status.However,there was significant difference in histological category and menostasis status between the two groups(P<0.05).Among TNBC,17 0f 42 died during the follow-up(the overall suivival rate was 59.52%),while 26 0f 158 non-TNBC died(the overall survival rate was 83.54%).EGFR was significantly overexpressed in TNBC(69.05%)and it was associated with lymph node status and histological category.Conclusion:Although the incidence of TNBC is low,it has a poorer prognosis than other subtypes.EGFR is highly expressed in TNBC and may serve as a prognostic index and an important therapatic target for breast cancer.

Objective To investigate the clinical efficacy of combined detection of VCA-IgA and Rta-IgG in the diagnosis of nasopharyngeal carcinoma.Methods From May 2013 to November 2014, 3 913 serum samples(male 2 367,female 1 546) from healthy people who had health examination in our medical center were collected and 169 serum samples(male 118,female 51) were collected from the patients who were diagnosed as nasopharyngeal carcinoma by pathological biopsy.Serum samples in two groups were detected by EBV RTA-IgG, VCA-IgA assay ( ELISA ) respectively.SPSS17.0 statistical software and receiver operating characteristic curve ( ROC) were applied to data analysis.Results The Rta-IgG positive rates of EB virus were 93.5%in NPC group (158/169) and 2.4%(93/3 913) in healthy group;while the VCA-IgA positive rates were 79.3%in NPC group ( 134/169 ) and 8.9% ( 349/3 913 ) in healthy group. The sensitivity(χ2 =14.49,P<0.05) and specificity(χ2 =157.15,P<0.05) of Rta-IgG in the diagnosis of nasopharyngeal carcinoma were significantly better than that of VCA-IgA. Using VCA-IgA/Rta-IgG combined detection analysis, not only failed to effectively improve the diagnosis of nasopharyngeal cancer, but to reduce the detection sensitivity to 72.8%( 123/169 ) , compared with Rta-IgG detection only. Conclusions Rta-IgG is significantly better than that of VCA-IgA.There was no significant improvement in the clinical diagnostic efficacy of nasopharyngeal carcinoma using VCA-IgA/Rta-IgG combined detection mode.

Objective To compare the recessive and dominant blood loss and total blood loss during the perioperative period between proximal femoral nail antirotation(PFNA)and artificial femoral head replacement in the treatment of Evans Ⅲ,Ⅳ type femoral intertrochanteric fractures for providing clinical evidence on selection of operative methods. Methods A retrospective study was conducted to analyze 61 older hospitalized patients with Evans Ⅲ,Ⅳ type femoral intertrochanteric fractures in Jimo City Traditional Chinese Medical Hospital from January 2009 to September 2014.The PFNA was adopted in 33 cases and the artificial femoral head replacement in 28 cases.The dominant blood loss was recorded,and total blood loss and recessive blood loss in the two groups were calculated by Gross equation according to the dominant blood loss,body height,body weight and hematocrit of pre-and post-operation. Results The average dominant blood loss in the intraoperative period was much less in the PFNA fixation group(106.2 ± 53.8)ml than in the artificial femoral head replacement group(274.6 ± 80.3)ml(P<0.05).The average recessive blood loss in the perioperative period was much less in artificial femoral head replacement group(577.0 ± 52.2)ml than in PFNA group(821.8 ± 69.5)ml(P<0.001).The total blood loss during the perioperative period was not significantly different between proximal femoral nail antirotation(896.0 ± 227.5)ml and artificial femoral head replacement(908.6 ± 204)ml(P>0.05). Conclusions There is obvious difference in the dominant blood loss between PFNA and artificial femoral head replacement for treatment of Evans Ⅲ,Ⅳ type femoral intertrochanteric fractures in the elderly patients.The proper operative method should be chosen based on the general condition of the elderly and fracture types.

The chemical composition of essential oil, which from the leaves of Chimonanthus grammatus obtained by hydrodistillation were analyzed by GC-MS, and their possible antibacterial properties were screened. According to the results from GC-MS analysis, fifty-three components comprising 99.99% of the essential oil were identified. The major components of essential oil were 3-(4, 8-dimethyl-3,7-nonadienyl)(E) -furan (13.1%), bornyl acetate (12.66%), and 6,6-dimethyl-3-methylene-bicyclo[3.1.1] heptane (7.06%), etc. Antibacterial activity of essential oil was employed by two complementary test systems of disc diffusion and MIC/ MBC tests, which showed obviously antibacterial activity against all of the tested bacteria.
Anti-Bacterial Agents ; pharmacology ; Calycanthaceae ; chemistry ; Gas Chromatography-Mass Spectrometry ; methods ; Oils, Volatile ; analysis ; pharmacology ; Plant Leaves ; chemistry

Objective To investigate the early outcomes of revision hip arthroplasty using restoration modular (RM) stem.Methods Fifty-nine patients underwent revision hip arthroplasty with RM stem from April 2012 to June 2015 in our center with a minimal of two years follow-up.The patients including 24 male and 35 female had a median age of 61.0 (56,66) years.The median BMI was 24.0 (22.5,26.0) kg/m2,while the median interval from the primary surgery was 10.5 (6.0,14.5) years.The rea sons for revision inculded infection in 8 patients,aseptic loosening in 45,recurrent dislocation in 1,and periprosthetic fracture in 5.There were 3 cases of type B2 and 2 cases of B3 periprosthetic fracture according to Vancouver classification.The bone defects severity was conducted according to Paprosky classification that 14 patients in type Ⅱ,31 in type ⅢA,8 in type ⅢB,and 1 in type Ⅳ.Acetabular component were revised in 56 cases.Patients were followed up at 3 months,6 months,1 year and annually thereafter for clinical and radiological evaluation.Results All the patients were followed up with a median duration of 30.4 (27.3,37.9)months,the median Harris score significantly improved from 37 (31,53) points preoperatively to 84 (80,95) points at the last follow up (Z=-6.681,P=0.000).There were 3 patients had perforation or fracture intra-operatively,two of them were fixed by strut allograft.The other one who did not compromise the implant stability was not fixed.Extended trochanteric osteotomy was applied in 14 cases and they healed well at 3-6 months during follow-up.There was one case of early dislocation at 6 days postoperatively,which was treated with close reduction and immobilization without recurrence.No infection,stem fracture,hematoma formation and sciatic nerve injury were reported.No femoral component loosening was identified at the latest follow-up.Median subsidence was 1.0 (0,2.0) mm with the maximum case 6.0 mm and 3 cases 3.5 mm.All of subsidence developed within the first year postoperatively but without further aggravation.The affected leg lengthened 17.5± 10.1 mm (range 2-40 mm) after operation.The affected leg was shorter 17.5± 12.6 mm (shorter 44.4 mm to longer 3.0 mm) than that in the normal side pre-operatively.However,the distinction decreased to 0.1±9.6 mm postoperatively (shorter 24.8 mm to longer 22.4 mm,t=-10.538,P=0.000).Conclusion Early satisfactory results are achieved in hip revision using RM modular stem at the femoral side.The modular design could simplify the surgical procedure with better control of leg length and joint stability.Long-term follow-up is still required for further evaluation.

Objective:Using primary care chronic disease management as a case,it aims to explore an economic incentive model for integrated primary healthcare services based on value pricing.Additionally,practical needs and implementation recommendations are proposed.Methods:With the help of the health technology assessment framework,it proposes that integrated health services can be priced through service effectiveness and service utility,and develops an economic incentive model with value pricing at its core based on the patient-centered incentive model for innovative healthcare services,including financing,payment,appraisal,and distribution,and puts forward feasible suggestions in the light of the needs and actuality of primary integrated services in China.Conclusion and Recommendation:The value-based pricing model for integrated health services serves as a theoretical foundation for the transformation of primary healthcare service functions and the enhancement of service dynamics,aligning with China's value-oriented service procurement strategy.This research contributes to the academic discourse by providing localized insights and a scholarly tone,contributing to the advancement of knowledge in the field.