Objective To evaluate the assistant medial approach used in the surgical management of intraarticular fractures of calcaneus.Methods From January 2005 to December 2009,33 patients with intraarticular fracture of calcaneus were treated by open reduction and internal fixation through the expanded lateral L-shape approach and the assisted medial approach.They were 27 men and 6 women,aged from 18 to 62 years (average,36 years).There were 15 left sides and 18 right sides.According to Sanders' classification system,there were 27 patients with type Ⅲ displaced calcaneal fracture and 6 with type IV.Four cases were complicated with fracture of lumbar vertebra,one with pilon fracture and one with fracture of acetahulun.Fracture healing was observed and the Bǒhler and Gissane angles were measured.The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale system was used to evaluate the functional recovery.Results All patients were followed up postoperatively to assess their functional outcome.The follow-up duration was 6 to 24 months (mean,12 months).All incisions healed primarily and all fractures obtained bony union in an average of 8 weeks (from 6 to 24 months).All the Bǒhler and Gissane angles were corrected and AOFAS scores were improved.There were significant differences between preoperation and pestoperation in all indexes( P ＜ 0.05).Conclusion As the medial approach can be used to assist the expanded lateral L-shape approach in treatment of the intraarticular fractures of the calcaneus,the reduction and insertion of internal implants can be improved to achieve satisfactory functional outcome.

BACKGROUND:In recent years,studies have shown the effects of tumor necrosis factor-a(TNF-а)on fibroblasts at different organizations in a tissue-specific and dose-dependent manner.OBJECTIVE:TO investigate the biologic effects of TNF-а and its signal transduction pathway-specific kinase inhibitors on mouse embryonic fibroblasts(NIH3T3).METHODS:NIH3T3 cells were cultured in vitro,and then the cells were assigned into 3 groups.Cells in the control group were cultured in DMEM high-glucose medium with 2%serum;those in the TNF-а group were cultured in 100 μg/L TNF-аmedium;those in the TNF-а+Anti-TNFRSF 1 B group were firstly cultured in medium with 50 μg/L Anti-TNFRSF 1 B for 1 hour,and then placed in the medium with 100 μg/L TNF-а.RT-PCR and Western blot methods were used to evaluate mRNA and protein expressions of type Ⅰ collagen and matrix metalloproteinase 3(MMP3)in each group.RESULTS AND CONCLUSION:In this experiment,NlH3T3 cells cultured with a certain concentration of TNF-а,the specificity kinase signal of transduction pathway presented with phosphorylation or protein activation,and the signal pathway was activated,which promoted MMP3 activation,and significantly reduced the expression of type Ⅰ collagen.The effect of TNF-а was certainly inhibited,but not completely eliminated after adding its signal transduction pathway inhibitor Anti-TNFRSF1 B.This further proves the role of TNF-а on NIH3T3 activation.

Objective To investigate the prevalance and risk factors of post-stroke depression(PSD)in patients with the first ever stroke during first year after stroke.Methods A total of 60 eligible stroke patients were followed up for 12 months after the first ever stroke and Hamilton Rating Scale for Depression,Activity of Daily Living Scale,Neurological Functional Deficit Scores,Social Support Scale and Eysenck Personality Questionnaire(EPQ)were used to investigate the incidence and risk factors of PSD in 2 weeks,3,4 and 12 months,respectively.Results The prevalence of PSD after the first ever streke was 18.18%(12/66),29.23%(19/65),38.09%(24/63),31.67%(19/60)in 2 weeks,3,4 and 12 months after the attack of stroke,respectively.Logistic regression analysis indicated that the major risk factors of PSD were female and introvert(b=-1.55,P=0.001;b=1.59,P=0.047)in 2 weeks,poor social support,low grade of neurological functional deficit score and female(b=-0.19,P=0.005;b=0.26,P=0.01;b=2.84,P=0.03)in 3 months.poor social support and low grade of neurological functional deficit score in 6 months and 12 months after stroke re-spectively(6 months:b=-0.24,P<0.001;b=0.35,P=0.004.12 months:b=-0.17,P=0.001;b=0.33,P=0.002).Conclusions The prevalence of PSD is considerable and the risk factors of PSD are different in different stage.

BACKGROUND: Artificial nerve grafts of human hair keratin are a kind of biological products. It has low antigenicity,absorbability and stimulation to nerve fiber growth following specific biochemistry. It is hoped to have better effect than otherartificial nerve grafts.　 OBJECTIVE: To investigate the anatomy and histocompatibility of artificial nerve grafts of the human-hair keratin, and toobserve its effects on the repair of peripheral nerves. 　 DESIGN, TIME AND SETTING: Randomized, controlled, animal experiment. The study was performed at the Animal CentralLaboratory of Affiliated Hospital of Qingdao University Medical College between November 2006 and June 2008. MATERIALS: Artificial nerve grafts of human hair keratin is a compound of human hair processed by specific controlledbiochemistry based on ground substance, embedded with a layer of biological membrane. It has low antigenicity, absorbabilityand stimulation to nerve fiber growth following specific biochemistry. METHODS: Eighteen Wistar rats were randomly divided into three groups. The sciatic nerve, 10 mm, was removed andtransplanted with human-hair keratin graft, skeletal muscle and untreated hair, respectively.MAIN OUTCOME MEASURES: The characteristics of histomorphology and anatomy were observed at 8, 12, 24 weeks afterthe surgery. RESULTS: White tissues appeared between the broken ends of the sciatic nerve at 8 post-operative week in the graft group,and appeared in the graft space in human-hair keratin at the 12th week. At the 24th week, a large amount of infantile myelinatednerve fibers were observed under optical microscope regenerating around the human hair, which was partially degraded andabsorbed. Schwann cells were observed under an electron microscope and myelinization. 　 CONCLUSION: The artificial nerve grafts of the human-hair keratin are well compatible with the body tissues, and couldinduce nerve regeneration.

Objective To evaluate the clinical outcome of operative management of displaced intraarticular fractures of the calcaneus using locking plates. Methods From October 2004 to October 2006, 34patients with close displaced intraarticular fractures of the calcaneus were fixed with Calcaneal locking Plates through the extensive lateral approach. The right foot was involved in 20 patients. The mean age was 34 yesrs with a range of 19 to 42 years. Accordiing to Sanders' classification system, there were 16 patients in style Ⅱ and 18 in style Ⅲ The mean interval between injury and operation was 13 days Standard reduction and fixation techniques were performed to realign all components of the intra-articular calcaneal fracture using a locking calcaneal fracture plate. The result were evaluated with AOFAS (American Orthopaedic Foot & Ankle Society) ankle-hindfoot scale. Results Twenty-eight patients were followed up. The follow-up duration ranged from six to forty months, with the mean of twenty months. angle and were measured at, The average B(o)hler angle was 29° and 30° and the average Gissane was 122° and 125° seven days and three months after operation. Bone union was achieved in all cases. All incisons had healed smoothly. No patient sustained lateral impingement syndrome or soft tissue complications The mean AOFAS scores that was measured three months and six months after operation was 74. Conclusion The application of the calcaneal locking plates through extended lateral approach is proved to be an effective treatment for displaced intra-articular calcaneal fracture, offering the combination of good reduction and early rehabilitation.

Objective To understand the epidemiologic feature of human parainfluenza virus type 3 (HPIV-3) in Shanghai,and to provide scientific evidence for formulating prevention and control measures in the future.Methods A total of 164 nasopharyngeal aspirates samples taken from children with acute respiratory infection (ARI) were collected from Xinhua Hospital Affiliated to Shanghai Jiaotong University and sent to Shanghai Public Health Clinical Center from June 2009 to June 2010.Samples were detected for HPIV-3 by reversed transcription-polymerase chain reaction (RT-PCR).Full-length hemagglutininneuraminidase (HN) gene (1 719 bp) of five positive samples were sequenced for phylogenetic analysis.Comparison between two groups was evaluated by the precise chi-square test (two sided).Results Of 164 samples,70 samples were infected with parainfluenza virus,and HPIV-3 was detected positive in 23 samples with the positive rate of 32.86％.HPIV-3 infections were most common in spring and summer,and most of infections were mainly found in 13-36 month-old infants.Five Shanghai isolates and 36 reference sequences from different countries and areas were divided by HN gene-based phylogenetic tree into three clusters (A,B and C).Five Shanghai isolates and five Beijing isolates belonged to C3a group.The homologies of nucleotide and amino acid sequences between five Shanghai isolates and five Beijing isolates were 99.0％-99.5％ and 99.7％-100.0％,respectively.Conclusions HPIV-3 accounts for a high proportion in children with ARI in Shanghai.C3a group may be the main lineage of HPIV-3,which suggests that HPIV-3 may be of regionally correlation.

Objective To explore the feasibility of immediate breast reconstruction with subpectoral implantation of silicon gel prosthesis after nipple-areola complex (NAC) sparing modified radical mastectomy. Methods A total of 28 patients of 0,I,II stage breast cancer were implanted with silicon gel prosthesis immediately after they underwent skin-sparing modified radical mastectomy. NAC conservation depended on frozen section result. Results NAC of all the 28 patients were conserved. During 2-18 months (median15 months) follow-up, bilateral breasts were symmetrical and in good appearance with a 96.5% excellent rate. No local recurrence, distant metastasis or obvious complications occurred. Conclusions Immediate breast reconstruction with subpectoral implantation of silicon gel prosthesis after NAC sparing modified radical mastectomy is proven to be an effective and safe method with the advantage of good appearance and shorter recovery time in early-stage breast cancer.

Objective To detect the expression of Cytokeratin 19 (CK19) and human mammaglobin (hMAM) mRNA in the peripheral blood of breast cancer patients dynamically and to evaluate its clinical significance.Methods The expression of CK19 and hMAM mRNA was evaluated by real-time fluorescent quantitative reverse transcriptase pelymerase chain reaction in the peripheral blood of 40 breast cancer patients and 10 healthy volunteers.Results The expression of CK19 and hMAM in the peripheral blood of 40 breast cancer patients were higher than healthy donors.The positive expression rate of CK19 and hMAM was descending tendency during treatment.The different staging expression rate had no differences between before treatment and during treatment,but after treatment the expression rate had remarkably differences (CK19:P=0.044;hMAM:P=0.005).If the expression of CK19 and hMAM was continual positive,the rate of recurrence and metastasis would be higher (P＜0.001).Coneluslons Real-time fluorescent quantitative RT-PCR may detect the expression of CK19 and hMAM in the peripheral blood of breast cancer patients,and it is a sensitive and specific technique.The resuits suggest a possible use of this approach for evaluating prognosis,monitoring recurrence.

Developments of chronobiology abroad are forging ahead in elucidating the cellular and molecular basis and the influential factors of circadian clock such as light, jet lag, pharmaceutical. This article also reviews the influence of circadian system on human physiology and disease occurrence. The circadian-based therapy holds promising future and the research emphasis is on prognosis and prevention.
Biological Clocks ; Chronobiology Phenomena ; Circadian Rhythm ; physiology ; Drug Chronotherapy ; Jet Lag Syndrome

Objective To explore the relationship between the levels of Cu, Fe, Mn, Zn in serum and Parkinson disease (PD). Methods A total of 40 patients with PD (PD group) and 40 control subjects (control group)were enrolled in this study. Serum levels of Mn were measured by graphite atomic absorption, and Cu ,Fe, Zn were measured by inductively coupled plasma(ICP)mass spectrometry. Resudts There were significantly increase in the levels of Mn and Fe in PD group than those in control group [(0.269±0.326) μ mol/L vs (0.125±0.054) μmol/L, P< 0.05, (1.512±0.949) μmol/L vs (0.676±0.111) μmol/L, P< 0.01)]. There were no significant difference in the levels of Cu and Zn between two groups (P> 0.05). Condusion Micreelements may play important roles in pathogenesis and development of PD, especially Fe and Mn.