Objective To study the ventricular-arterial coupling in the patients with type 2 diabetes mellitus (DM) by ultrasound.Methods Eighty patients with DM were divided into 2 groups:normal left ventricular ejection fraction (EF) group (DMN,EF≥50 ％,n =40) and abnormal EF group (DMA,EF＜50％,n =40).At the same time,42 healthy volunteers were selected as a control group.The left ventricular (LV) relative wall thickness (RWT),mass index (LVMI),stroke volume (SV),stroke works (SW),ratepressure product (RPP),systemic vascular resistance index (SVRI),LV end-systolic elastance (Ees),arterial elastance index (Ea) and ventricular vascular index (VVI) were measured and calculated.Longitudinal strain (LS) of myocardial segment including base(LSBA),papillary muscle (LSPM) and apex (LSAP) were analyzed by two-dimensional speckle tracking imaging.Results (1) Compared with the control,the RWT and LVMI were all increased (P ＜0.01),but the LSBA,LSPM and LSAP were decreased (P ＜ 0.01) in the DMN and DMA groups (P ＜0.01).In DMA group,the RWT,LSBA,LSPM and LSAP were decreased (P ＜0.01).Compared with the DMN group,the LSBA,LSPM and LSAP were decreased in DMN group (P ＜0.01).(2) Compared with the control,the Ea,VVI,RPP and SVRI were increased,but the Ees was decreased (P ＜0.05)in DMA group (P ＜0.01).In the DMN,RPP was increased compared with the control group (P ＜0.01).Compared with the DMN group,the Ea,VVI,RPP and SVRI were increased,but Ees was decreased in the DMA (P ＜0.05).(3)The LSBA,LSPM and LSAP were all positively correlated with VVI(P ＜0.01).Multiple regression analysis showed that the LSAP,RWT,LVMI and SW were independent predictor of VVI (b' =-0.613,-0.290,0.290 and-0.205,P ＜ 0.05).Conclusions The ventricular-arterial coupling is normal in the DMN group,but is abnormal in DNA group.LSAP is independent predictors for ventricular-arterial coupling.

ObjectiveTo determine the peripheral serum expressions and clinical value of carcinoembryonic antigen (CEA) and carbohydrate antigen CA19-9,CA242,CA72-4 and a single sialic acid ganglioside (CA50) antigen in advanced pancreatic cancer patients treated by three-dimensional conformal radiotherapy (3D-CRT) combined with endogenous field hyperthermia.Methods60 patients inoperable,advanced pancreatic cancer were treated by 3D-CRT combined with endogenous field hyperthermia.Radiation dose (DT) was 46 ～ 66 GY/23 ～ 33 F.Hyperthermia temperature was 41 ～ 43 ℃ 2 times/week,lasted 60 min each time.The expressions of CEA,CA19-9,CA242,CA72-4 and CA50 in peripheral serum were detected by Electrochemiluminescence immunoassay (ECLIA) every 2 weeks during treatment,and correlation were analyzed with tumor diameter,clinical stage,lymph node metastasis.Results From the 8th week,with 3D-CRT combined with endogenous field hyperthermia ongoing,CEA,CA19-9,CA50 andCA242 expression levels showed a gradual decline.CEA,CA19-9,CA50 and CA242 expression levels were (6.22 ± 2.71 ) μg/L,(43.44 ± 12.93 ) μg/L,(23.21 ± 7.71 )g/L and (24.26 ± 8.92) μg/L in 6 weeks,respectively.The difference was statistically significant among week 6 and week 0,week2,week 4 ( P ＜0.05),however there was no significant difference between week 6 and week 8 ( P ＞ 0.05 ).The CA724 expression did not change significantly ( P ＞ 0.05 ).There were positively correlation between CEA,CA199,CA50 and CA242 with pancreatic cancer tumor size,clinical stage and lymph node metastasis( respectively r =0.877,0.725,0.826,all P ＜ 0.01 ),however CA72-4 had no correlations ( P ＞ 0.05).ConclusionsCEA,CA19-9,CA50 and CA242 expressions in peripheral serum of pancreatic cancer patients were closely related to the treatment.Their joint detection can be served as independent objective evaluation reference information for the treatment efficacy and prognosis.

Objective To investigate the function of the left ventricular (LV) myocardial regional contractility in hyperthyroid by measuring the LV rotation and torsion using speckle tracking imaging (STI).Methods 58 patients with hyperthyroidism had accepted 131 I treatment the first time and cured and improved after treatment for 6 months were enrolled.According to the course of disease,they were divided into two groups:Group A,duration less than 6 months,28 cases;Group B,duration more than 6 months,30 cases.30 normal cases age and gender matched were enrolled as control group.LV peak rotation and torsion of endocardium and epicardium at basal and apical of levels were measured using STI in groups A and B before and after treatment,and correlation with cardiac function and structure parameters,heart rate,blood pressure,and the thyroid hormone were analyzed.Results ①Comparing group A and group B before and after treatment with control group,there was no statistically significant in the LV structure and function parameters (LVDd,LVDs,IVSd,PWd,LVEF) (P ＞0.05).②As for LV peak rotation of endocardium and epicardium at apical levels (EN PAR,EP-PAR) before treatment,group A was higher than the control group (P ＜0.05),group B was lower than the control group (P ＜0.01);After treatment,group A has improved (P ＜0.01),group B has improved only in EP-PAR (P ＜0.05),and there was no statistically significant compared with the control group (P ＞0.05).③ LV peak torsion of endocardium and epicardium (EN-Ptor,EP-Ptor) in group A was higher than the control group before treatment (P ＜0.05),group B was lower than the control group (P ＜0.01) ;After treatment,group A has improved (P ＜0.05),group B has only improved in EP-Ptor(P ＜0.05),and comparing with the control group,there was no statistically significant (P ＞0.05).④LV peak apical rotation and LV torsion were positively correlated with systolic blood pressure,heart rate,E-peak,A-peak,LVOT-V in different degree (P ＜0.01 or P ＜0.05),but no correlation with FT3,FT4,TSH (P ＞0.05).Conclusions Myocardial contractile function strengthens in early patients with hyperthyroidism and lessens with the extension of the course.Have not yet appeared heart diseases in patients with hyperthyroidism whose myocardial regional systolic function had changed,short duration can recover after treatment,but the long duration can not restore completely.Change of myocardial motion of patients with hyperthyroidism is associated with blood flow dynamics.

BACKGROUND: The most frequently encountered problem that an orthopedic doctor encounters in treating humerus fracture is how to choose the exact direction and amount of load applied on humerus.OBJECTIVE: To explore the clinical significance of establishing a three-dimensional model and finite element analysis in treating humerus fracture and to provide theoretical basis for applying appropriate axial stress.DESIGN: The three dimensional model of humerus was reconstructed, on which compression from different directions was applied.SETTING: Orthopedic department of an affiliated hospital and life science laboratory of a university.MATERIALS: A humerus specimen received CT scanning and the trial was conducted in Shanghai Changhai Hospital and Life Science Laboratory of Tongji University from April 2002 to April 2004.METHODS: The three dimensional model of humerus was established and relevant calculation was completed with ANSYS 5.6 software. The humerus model was divided into 2 729 nodes and 49 041 units based on a three-dimensional ten-node tetrahedron as one unit. The distribution and intensity of axial compression on the fracture gap section were calculated and analyzed in the following conditions, i. e. when the humerus was fixed in X, Y and Z directions and the fracture gap section was 30°, 45°, 90° to Z axis.MAIN OUTCOME MEASURES: The axial pressure on the fracture gap section in different conditions to provide evidence for clinical treatment.RESULTS: The stress applied on the fracture gap was relatively concentrated and was 2 -3 times stronger than that in other areas, and it was generally symmetrically distributed within 10 mm around the fracture gap.CONCLUSION: The required load on humerus fracture should be calculated before a suitable implant is applied to accommodate the movement of humerus without compromising healing of the fracture.

BACKGROUND: The biomechanical features of Swan-like memory compression connector designed for fractures in hemerus or the parts adjacent to joints are analyzed through biomechanical calculation and experimental measurements.OBJECTIVE: To analyze the relative memory biomechanieal significance through biomechanical measurement of Swan-like memory compression connectorDESIGN: Both biomechanieal calculation and the experimental measurement were conducted for mutual supplementation and confirmation SETTING: The Orthopaedic Department of Changhai Hospital Affiliated to Second Military Medical University of Chinese PLA and the Life Science and Tissue Engineering Institute of Tongji University MATERIALS: This experiment was conducted at the laboratory of Orthopaedic Department of Changhai Hospital Affiliated to Second Military Medical University of Chinese PLA and the Life Science and Tissue Engineering Institute of Tongji University between January 2001 and May 2003.Totally 20 hemerus from adult males who died of craniocerebral injury were chosen.METHODS: Humid hemerus from the adult corpse was chosen to prepare fracture. Encircling the prescale followed by fixation of Swan-like memory compression connector, then we measured the stress produced by compression part and encircle part at fixing the fracture.MAIN OUTCOME MEASURES: ①The stress of holding part; ② the stress of the compression part RESULTS: The stress range of holding part contacting with humerus was 2.42-22.68 N, and the stress in the fracture face, which was produced by compression part, was about 13.6 Mpa.CONCLUSION: The stress of holding part of Swan-like memory compression connector is useful in fixing the fracture parts of humerus, and the stress of compression part is suitable for the healing of fracture.

BACKGROUND: During the therapy of the fracture of humerus, the main problem is the loading direction and power of the stress.OBJECTIVE: To analyze the choice of the different loading manners using Swain Memory Compression Bone Reduction Apparatus so as to provide the clinical evidence for the set position of the internal fixation apparatus, the loading direction and power during the therapy of the fracture of humerus.DESIGN: To construct the three-dimensional finite element model of the fracture of humerus with different loading manners.SETTING: Department of Orthopaedics of Changhai Hospital of Second Military Medical University of Chinese PLA; College of Life Sciences and Bioengineering of Tongji University,MATERIALS: The study was conducted during the period from January 2001 to May 2003 in the Orthopedic Laboratory of Changhai Hospital of Second Military Medical University of Chinese PLA and the laboratory of Life Science and Bioengineering Academy of Tongji University. The samples of the humerus taken from the wet adult cadavers, and the Swain Memory Compression Bone Reduction Apparatuses of the corresponding size were prepared.METHODS: The CT scanning was done on the samples of the wet humerus to obtain the cross section image of each layer of the humerus.The images were analyzed by a large-scale finite element analysis software ANSYSS.6 to construct the three-dimensional model of the humerus, Swain Memory Bone Reduction Apparatus and the fixed humerus using Swain Memory Bone Reduction Apparatus.MAIN OUTCOME MEASURES: To get the reference values for the clinical therapy through the comparison of the power endurance with different loading manners.RESULTS: The three-dimensional model of the fixed humerus using Swain Memory Bone Reduction Apparatus reflects the real anatomical configuration and the biomechanics behavior; meanwhile the status of the power endurance of humerus with different loading manners is also obtained.CONCLUSION: The three-dimensional model of the fixed humerus using Swain Memory Bone Reduction Apparatus may provide an accurate model for the basic study of the biomechanics behavior of the normal and fixed humerus after the fracture.

BACKGROUND: The biomechanical features of arch-dental shape memory connector designed for fractures in pelvis or the parts adjacent to joints are analyzed through biomechanical calculation and experimental measurements.OBJECTIVE: To explore the relationship between the changes in shape of arch-dental shape memory connector and the load on it.DESIGN: Both biomechanical calculation and the experimental measurement were conducted for mutual supplementation and confirmation.SETTING: The Orthopedic Department of Changhai Hospital Affiliated to the Second Military Medical University of Chinese PLA and the Life Science and Bioengineering College of Tongji University.MATERIALS:The trial was conducted from at Shanghai Changhai Hospital and Life Science Laboratory of Tongji University from April 2002 to April 2004. The subjects were arch-dental shape memory connectors.METHODS: We calculated the stress in and around the fracture face produced by arch-dental shape memory connector according to Moire principle and we also measured the changes in the shape of arch-dental shape memory connector. The relationship between load and the changes in the shape of arch-dental shape memory connector was explored.MAIN OUTCOME MEASURES: To explore whether the results of biomechanical calculation and those of the experimental measurement are consistent.RESULTS: Biomechanical calculation found that the relationship between the load (P) and the displacement(δ) in arch-dental shape memory connector was P = 13.69δ. The experimental measurement found that the load on the connector and the displacement were in a linear relationship.CONCLUSION: The relationship between the load and the displacement in arch-dental shape memory connector was linear within its elastic range and the biomechanical calculation results were consistent with the results of the experimental measurement.

BACKGROUND: Various therapies can be used to treat humeral fracture,but serious complications like bone disunion, etc. Are often left over. New biomechanical analytical methods are tried to be applied to provide new approaches for the functional prognosis in humeral fracture and bone disunion.OBJECTIVE: To construct humeral three-dimension model to explore its correlated biomechanical significance.DESIGN: To construct humeral three-dimension finite element model. SETTING: Department of orthopedics of a military medical university-affiliated hospital and institute for biological science and bioengineering of a university.PARTICIPANTS: The study was conducted in Shanghai Changhai Hospital and the Laboratory of Biological Science of Shanghai Tongji University. One piece of typical adult wet humerus sample was selected.INTERVENTIONS: Cross section image of each humeral layer was obtained from the selected wet humerus sample by CT scanning, and humeral three-dimensional model was constructed by large finite element analytic software ANSYS5.6.MAIN OUTCOME MEASURES: ① Biomechanical features of the constructed humeral three-dimension mode; ② Differences from clinical reality and key similarities.RESULTS: The constructed humeral three-dimensional model vividly reflected the true humeral anatomic morphology and biomechanical behavior. Its precision was judged by the comparison with CT image.CONCLUSION: The construction of humeral three-dimension finite element model provides a precise model for the researches of normal humeral mechanical behavior and the basic mechanics of internal fixation after fracture.

Objective To evaluate the clinical efficacy of three-dimensional conformal radiotherapy (3D-CRT) combined with thermochemotherapy in the treatment of locally advanced pancreatic cancer (LAPC).Methods From June 2008 to June 2011,70 patients with LAPC were divided into radiotherapy group (30 patients) and combination group (40 patients).Radiotherapy used 3D-CRT with a 90％ to 95％ isodose curve,a single dose of 1.8 to 2.OGy,and total radiation dose 50 ～ 70 Gy.The combination group patients received simultaneous thermotherapy at 41.5 ～43.5 ℃ (1 h/fraction,twice a week for 6 times),and hyperthermia given simultaneously injected using arsenic trioxide 20 mg,recombinant mutant human tumor necrosis factor(rmhTNF) intravenous infusion of 10 million U,4 to 6 times,or 3D-CRT at the same time and the treatment given after gemcitabine(0.6 ～ 1.0 g/m2) on Days dl and 8 and cisplatin (DDP) (20 ～ 30 mg/m2) on Days d1-3 intravenous infusion,repeated every 28 days for 3 ～ 6 cycles.Results At 3 months after treatment,the total response (complete remission and partial remission) rate was 70.0％ (49/70),the efficiency of radiotherapy combined with chemotherapy,and radiotherapy combined with thermo-chemotherapy were 56.5％ and 88.2％,and the radiotherapy alone group was 56.7％.There were significant difference in efficiency between radiotherapy combined with thermo-chemotherapy group compared to radiotherapy-chemotherapy group and radiotherapy group (x2 =4.68,4.98,P ＜ 0.05),the last two groups showed no significant difference (P ＞ 0.05).The 1-year and 2-year survival rate was 46.8％ and 20.3％,respectively.The 1-year and 2-year survival rates were 52.4％ and 26.7％ in combination group,and 42.5％ and 16.2％ in radiotherapy group (x2 =14.17,P ＜ 0.05 ; x2 =9.74,P ＜ 0.05).No serious complications such as perforation,bleeding,and high fever were seen during treatment and follow-up.Conclusions 3D-CRT combined with thermochemotherapy is well tolerated and is relatively effective for the LAPC patients.

Objective:To study the biomechanical basis of swan like memory compressive connector (SMC) for treating fractures and nonunions, and the facilitating effects of dynamic memorial stress of SMC for bone healing. Methods:By computer emulation and three dimensional (3D) finite element analysis, the biomechanical behavior of humeral type connector for fixing humerus was emulated and analyzed. The finite element model of humeral type connector was divided into 3 487 units. The number of nodes was 5 397. The element was a unit with 20 nodes, 4 faces. The finite element model of humerus was divided into 5 783 units, the number of nodes was 9 863. And the finite element was a 3D unit with 10 nodes, 4 faces.Results:When the connector fixated humerus, it came in for tension stress in its inner surface, and compressing stress in its outer surface. The maximum first structural major stress of metamorphosed compressive part was 224.5 MPa and -34 MPa, far less than its utmost stress and fatigue limit. The initiative memorial bone holding force for maintaining axial stability was 125.05 N, and the longitudinal initiative memorial compression force was 196 N. The stress distribution in fixed humerus was even, the stress in most nodes was positive stress. Conclusion:The SMC has good anti fatigue and reuse characters. The dynamic memorial compressive stress field is good for the stability of fixation and enhancement of bone healing.