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Objective: To investigate the levels of sex hormone and fertility in female patients after hematopoietic stem cell transplantation (HSCT), as well as their correlation with conditioning regimens, and analyse the effect of hormone replacement therapy (HRT) in young women after HSCT. Methods: Retrospective case series study. The clinical data of 147 women who underwent HSCT in the First Affiliated Hospital of Soochow University from January 2010 to January 2021 were retrospectively analyzed. The sex hormone levels were measured and followed-up, and the survival, menstrual fertility and the use of HRT of the patients were also followed-up. The sex hormone levels were measured after transplantation, and the ovarian function was evaluated. Independent sample t test and χ 2 test were used for comparison between the two groups. Results: The median age of the 147 patients was 26 (range, 10-45) years. Of them, 135 patients received allogeneic HSCT and 12 patients received autologous HSCT. Furthermore, 129 patients received myeloablative conditioning, and 18 patients received reduced conditioning dose. The median follow-up time was 50 months (range, 18-134 months). Five patients died of disease recurrence during follow-up. Of the 54 patients with subcutaneous injection of zoladex, three recovered menstruation spontaneously after transplantation, and all of them were myeloablative conditioning patients, one patient gave birth to twins through assisted reproductive technology. Ninety-three patients did not use zoladex before conditioning, two patients with aplastic anemia with non-myeloablative transplantation resumed menstruation spontaneously, and conceived naturally. The level of follicle stimulating hormone after transplantation in patients receiving myeloablative conditioning regimen was significantly higher than that in patients receiving reduced-dose conditioning regimen [(95.28±3.94) U/L vs. (71.85±10.72) U/L, P =0.039]. Among 147 patients, 122 patients developed premature ovarian failure, 83 patients received sex hormone replacement therapy after transplantation, and 76 patients recovered menstruation and improved endocrine function. Conclusions: The incidence of premature ovarian failure is high in female patients after HSCT, and patients have a chance at natural conception. Reducing the dose of conditioning regimen and the application of zoladex before transplantation can reduce ovarian of conditioning drugs. HRT after transplantation can partially improve the endocrine function of patients.

Objective: To explore the clinical characteristics, the correlation between lactate, procalcitonin and disease severity of imported malaria from Africa. Methods: The clinical data of 186 patients with imported malaria were collected from January 1, 2018 to April 30, 2021 in the Guangzhou Eighth People's Hospital, Guangzhou Medical University. The general conditions, clinical symptoms, laboratory tests, treatment, and prognosis of the patients were analyzed retrospectively. Receiver operating characteristic (ROC) curves were drawn to evaluate the value of relevant indicators in predicting severe malaria. Results: A total of 186 patients were divided into severe cases ( n =48) and non-severe cases ( n =138) in this study, of which the mean age was (38.3±10.3) years, 169(90.9%) cases were male, 17(9.1%) cases were female. The main infection species was Plasmodium falciparum , in a total of 166 cases (89.2%). The severe cases were all falciparum malarias . Compared with the non-severe group, the lactic, procalcitonin, white blood cell count and neutrophil count of the severe group were all increased, the differences were all statistically significant (all P <0.01); the percentage of monocytes, red blood cell count, hemoglobin, hematocrit and platelet count were all decreased, the difference were all statistically significant (all P <0.01). The areas under the ROC curves (AUC)(95% CI ) of lactate, procalcitonin, red blood cell count, hemoglobin, hematocrit and platelet count for predicting severe malaria was 0.753(0.663-0.844), 0.755(0.670-0.841), 0.782(0.700-0.864), 0.738(0.652-0.823), 0.760(0.676-0.844), 0.778(0.699-0.857), respectively (all P <0.01). When the Youden indexes were at their maximum, the best cut-off value of lactic was 2.29 mmol/L, with sensitivity in predicting of severe malaria was 56.3%, and the specificity was 93.5%; the best cut-off value of procalcitonin was 2.12 μg/L, with sensitivity in predicting of severe malaria was 77.1%, and the specificity was 68.1%. The fatality rate of severe malaria was 4.2% (2/48). Conclusions: Anemia and thrombocytopenia are common indicators for predicting the severity of malaria. Lactic and procalcitonin also have higher predictive value for severe malaria, which could help to identify severe malaria as early as possible, improve the cure rate and reduce the risk of death.

To analyze whether the serum concentration of estradiol on the day of progesterone conversion could predict the pregnancy outcome of frozen-thawed embryo transfer in hormone replacement cycle. In this paper, a case-control study was conducted to retrospectively analyze the 230 cycles of hormone replacement therapy-frozen thawed embryo transfer(HRT-FET)conducted by the Department of Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 2018 to December 2020. The concentration of serum estradiol was between 139.5-3 941.0 pg/ml. According to the percentile of serum estradiol concentration on the day of endometrial transformation, patients were divided into three groups: control group (<25th percentile, n =58), high estradiol group (25th-75th percentile, n =112) and ultra-high estradiol group (>75th percentile, n =60). Comparing the basic characteristics and pregnancy outcome of the three groups, the main observation index was the live birth rate, and the secondary observation index was the clinical pregnancy rate. F test and Kruskal-Wallis ( H ) test were used to compare the measurement data, and χ 2 test was used to compare the counting data. The results showed that there was no significant difference in age, anti-Müllerian hormone(AMH), antral follicle count(AFC), body mass index(BMI), years of infertility and the proportion of primary infertility among the three groups( F =2.375, H =5.479, H =5.374, F =1.391, H =4.779, χ²=1.969, P >0.05). FET cycle treatment: There was no significant difference in the concentration of progesterone (P) before transformation, the thickness of endometrium on the day of transformation, the proportion of single embryo transfer and blastocyst transfer among the three groups ( H =5.359, H =5.957, χ²=0.626, χ²=4.532, P >0.05). The days of estrogen administration before endometrial transformation in the three groups during the FET cycle were 13.0 (12.0, 14.0) days in the high estradiol group and 13.0 (12.0, 15.0) days in the ultra-high estradiol group, which were significantly longer than those in the control group 13.0(12.0, 13.3)days. The E2 concentration before intimal transformation in high estradiol group was 1 560.4 (1 170.2, 1 848.2) pg/ml, while that in ultra-high estradiol group was 2 420.9 (2 131.0, 2 849.2) pg/ml, which was significantly higher than that in control group 238.8 (206.9, 287.0) pg/ml. The pregnancy outcome of the three groups: the clinical pregnancy rate of the three groups was 37.9% in the control group, 51.8% in the high estradiol group and 40.0% in the ultra-high estradiol group, of which the high estradiol group had the highest clinical pregnancy rate, followed by the ultra-high estradiol group. But there was no significant difference among the three groups (χ²=3.853, P >0.05). The embryo implantation rate of the three groups was 19.3%, 25.0%, 32.8%, respectively, and the embryo implantation rate of the ultra-high estradiol group was the highest, but there was no significant difference among the three groups (χ²=5.544, P >0.05).The live birth rate of the three groups was 37.9%, 39.3%, 40.0%, respectively, and the difference was not statistically significant (χ²=0.05, P >0.05). A total of 14(13.5%) abortions occurred in 104 clinical pregnancies, all of which occurred in the high estradiol level group. Of the 104 clinical pregnancies, 24 (23.1%) had twin pregnancies, which occurred in the high estradiol level group (10 cases) and the ultra-high estradiol level group (14 cases). There were no twin pregnancies in the control group. Ectopic pregnancy occurred in 4 of 230 FET cycles (1.7%), 2 in control group and 2 in high estradiol group, and no ectopic pregnancy in ultra-high estradiol group.

Objective: To investigate the effect of ultrasonic parameter settings on maximum temperatures in the drilling site and penetration time and determine the most suitable parameters for efficient and safe robot-based ultrasonic bone drilling in spinal surgery. Methods: Five adult bovine thoracic and lumbar vertebrae specimens (T 10 -L 6 ) were cut into 10 mm thick slices. A total of 50 slices were obtained. Among them, 30 and 20 slices were used for cancellous bone experiments and cortical bone experiments, respectively. In the cancellous bone experiment, the slices were randomly divided into three groups, corresponding to different feed rates of 0.8 mm/s, 1.6 mm/s, and 2.4 mm/s, respectively, with 10 slices in each group. The cancellous part of each slice was drilled 9 times with different output powers from 20% (48 W) to 100% (120 W). In the cortical bone experiment, the slices were randomly assigned into two groups, corresponding to a different feed rate (0.8 mm/s and 1.6 mm/s). Drilling was performed on the cortical part of each slice 4 times with different output power, which increased from 70% (84W) to 100% (120 W). All experiments were conducted at room temperature of 25 ℃. Maximum temperature and penetration time were recorded. The maximum grinding temperature and penetration time of cancellous bone and cortical bone under different output power and feed rate were compared. Results: At the same feed rate, the maximum temperature of the cancellous bone decreased as output power increased. There were statistically significant differences in the maximum temperature between the output powers of 120 W and 24 W under different feed rates(61.2 ℃±9.4 ℃ vs 70.9 ℃±5.7 ℃, 59.2 ℃±7.1 ℃ vs 69.5 ℃±10.7 ℃, 55.5 ℃±5.5 ℃ vs 69.2 ℃±9.3 ℃, all P <0.05). At the premise of the same output power, there was no significant difference in the maximum temperature among different feed rates (all P >0.05). At the feed rate of 0.8 mm/s, the maximum temperature of cortical bone decreased as the output power increased. The maximum temperature at the output power of 120 W was significantly lower than that of 84 W ( P =0.048). However, at the feed rate of 1.6 mm/s, the maximum temperature could not be significantly lowered by the increase in output power ( P >0.05). Under the same output power, the maximum temperature at the feed rate of 1.6 mm/s were all significantly lower than those of 0.8 mm/s (all P <0.05). The penetration time of cancellous bone did not decrease significantly with the increase in the output power (all P >0.05) while it decreased significantly as the feed rate increased (all P <0.05). Regarding cortical bone at the feed rate of 0.8 mm/s, the increase in output power could not shorten the penetration time ( P >0.05); at the feed rate of 1.6 mm/s, the penetration time at the output power of 120 W was significantly shorter than that of 96 W ( P =0.008). With the same output power, the penetration time at the feed rate of 1.6 mm/s were significantly shorter than those at 0.8 mm/s (all P <0.05). There was no statistical difference in the penetration failure rate among different feed rates with the same output power (all P >0.05). The penetration failure rate was 0 when the output power of cancellous bone was 48 W and above and the output power of cortical bone were 108 W and 120 W. Conclusions: The maximum temperature of vertebral cancellous bone and the cortical bone is primarily influenced by the output power and the feed rate, respectively; the penetration time of cancellous bone and the cortical bone is affected by the feed rate and both of feed rate and output power, respectively. The most suitable parameters are output power of 120 W and feed rate of 2.4 mm/s for cancellous bone and output power of 120 W and feed rate of 1.6 mm/s for cortical bone.

Objective: To explore the value of serum parathyroid hormone (PTH) in the diagnosis of primary aldosteronism (PA) and to investigate an optimal cut-off of serum PTH to distinguish PA from nonfunctional adrenal tumor (NFA). Methods: The clinical data of patients with adrenal incidentaloma in Chinese PLA General Hospital from January 1, 2017 to December 31, 2019 were collected. The data of PA and NFA by clinical characteristics and evaluation on endocrine function were retrospectively analyzed. The logistic regression model was used to find the potential risk factors of elevated PTH. The receiver operating characteristic(ROC) curve was used to evaluate the efficacy of PTH in diagnosis of PA and to explore the best cut-off value. Results: A total of 773 patients were included. There were 356 PA patients (203 males, 57.0%), aged (50±11) years and 417 NFA patients (219 males, 52.5%), aged (51±12) years. The serum PTH level in patients with PA was significantly higher than that in patients with NFA [63.1 (48.4, 80.3) ng/L vs 41.7 (34.1, 51.7) ng/L, P <0.05], as well as the proportion of patients with elevated PTH level (47.8% vs 7.2%, P <0.05). Logistic regression analysis showed that having PA and deficiency of Vitamin D were risk factors for PTH elevation (both P <0.05). The ROC curve showed that the best cut-off value of PTH for the diagnosis of PA in patients with vitamin D deficiency was 56.44 ng/L, with a sensitivity of 66.5% and a specificity of 83.0%, and that in patients with normal vitamin D was 48.81 ng/L, with a sensitivity of 70.5% and a specificity of 72.6%. Conclusions: Patients with PA tend to show increased levels of serum PTH compared with NFA patients. The level of serum PTH can be used as one of the valuable indexes in screening of PA.

Objective: To summarize the classification and clinical treatment experience of cervical massive hemorrhage in multiple centers. Methods: From April 2012 to October 2020, clinical data of 42 patients with cervical massive hemorrhage were retrospectively analyzed, including 27 cases from Shanghai Changzheng Hospital, 7 cases from Hunan Provincial People's Hospital, 4 cases from Longkou People's Hospital and 4 cases from Laizhou People's Hospital. According to bleeding position (P), bleeding vessel (V), cerebral blood supply (C), and the presence or absence of associated injury (A), 42 patients were classified as "PVCA", and summarize the methods of pre-hospital emergency and in-hospital treatment based on the "ABC" treatment principles: airway rebuild (A), effective arterial hemostasis and bleeding stop (B), and cerebral blood flow reconstruction within the time window (C). Results: Within the 42 cases of cervical massive hemorrhage, there were 3 cases of type P1 (below cricoid cartilage), 28 cases of type P2 (cricoid cartilage-mandibular angle), 11 cases of type P3 (mandibular angle-skull base); 22 cases of type V1 (arterial hemorrhage), 11 cases of type V2 (main venous hemorrhage), 7 cases of type V3 (simple superficial vein or small artery hemorrhage), 2 cases of type V4 (mixed arteriovenous hemorrhage); 5 cases of type C0 (no symptoms of cerebral ischemia and neurological dysfunction), 33 cases of type C1 (transient cerebral ischemia without sensory disturbance), 4 cases of type C2 (symptoms of cerebral ischemia and neurological dysfunction); 39 cases of type A0 (no other system damage was involved) and 3 cases of type A1 (combined with other system damage). All 42 patients received operations, 25 patients received open surgery of vascular reconstruction+hematoma/foreign body removal (7 cases of vascular ligation, 14 cases of direct suture repair, 4 cases of vascular interposition), 17 patients received hybrid surgery (carotid angiography+covered stent repair+hematoma/foreign body removal). The surgical technique success rate the was 100%. All the hemorrhagic shock was corrected, hematoma compression was relieved, and the symptoms of cephalic ischemia were improved. There were 4 cases of local cranial nerve injury, 1 case of incision hematoma and 6 cases of postoperative hyper perfusion. During the average 14.3 months follow-up, there was no operation related myocardial infarction, stroke or death, no re-rupture or re-dissection, and 50% asymptomatic restenosis was found in 1 case one year after received covered stent endovascular repair. Conclusion: Based on the "PVCA" classification and "ABC" treatment principle, it is safe and effective to rescue cervical massive hemorrhage.

Objective: To investigate the predictive value of myoglobin (Mb) for the prognosis of sepsis related chronic critical illness (CCI). Methods: Retrospective study was conducted on septic patients with the length of ICU stay equal or greater than 14 days, and sepsis-related organ failure assessment (SOFA) score equal or greater than 2 on the 14th day in ICU in the First Department of Critical Care Medicine at the First Affiliated Hospital of Sun Yat-sen University from January 2017 to March 2020. Patients' clinical and laboratory data were collected on the 1st and 14th day in ICU. The survival on day 28 in ICU was recorded. According to the myoglobin levels on day 1 and day 14, all subjects were divided into myoglobin elevation group and decline group. Kaplan-Meier survival curve was used to compare the cumulative survival rate at day 28. Cox regression analysis was used to analyze the independent risk factors of mortality. Receiver operating characteristic (ROC) curve was used to analyze the prognostic value of myoglobin. Results: A total of 131 patients with sepsis related CCI were recruited, including 58 patients in the elevation group and 73 in the decline group. The Mb level in elevation group on day 1 was significantly lower than that in decline group [172.40(59.99, 430.53) μg/L vs. 413.60(184.40, 1 328.50) μg/L, Z =3.749, P =0.000], and the Mb level on day 14 was the opposite change in two groups [483.65(230.38, 1 471.75)μg/L in elevation group vs. 132.20(76.86, 274.35)μg/L in decline group, Z =5.595, P =0.000]. Kaplan-Meier survival curve analysis showed that the 28-day cumulative survival rate of the elevation group was significantly lower than that of decline group (χ²=7.051, P =0.008). Cox ratio regression analysis suggested that elevated myoglobin was an independent risk factor for 28-day mortality in septic patients with CCI ( OR =2.534, 95% CI 1.212-5.295, P =0.013). ROC curve analysis suggested that the sensitivity of myoglobin elevation in predicting mortality related to CCI within 28 days was 64.5%, and the specificity was 32.0% with area under the curve(AUC) 0.661(95% CI 0.550-0.773, P =0.007) and Jorden Index was 0.325. Conclusion: Elevated myoglobin, an independent risk factor for mortality within 28 days in ICU, can predict the prognosis of sepsis related chronic critical illness.

Objective: To analyze the clinical characteristics of the severe or critically ill patients with novel coronavirus pneumonia (COVID-19), and evaluate the impact of complicated myocardial injury on the prognosis of these patients. Methods: A retrospective study was conducted in 54 patients who admitted to Tongji hospital from February 3, 2020 to February 24, 2020 and met the criteria of severe or critical conditions of COVID-19. The clinical characteristics and hospital mortality rate were analyzed and compared between the patients with or without myocardial injury, which was defined with 3 times higher serum cardiac troponin value. Results: The age of the 54 patients was 68.0(59.8, 74.3) years. Among all the patients, 24 (44.4%) patients were complicated with hypertension, 13 (24.1%) with diabetes, 8 (14.8%) with coronary heart disease, and 3 (5.6%) with previous cerebral infarction. During hospitalization, 24 (44.4%) of the patients were complicated with myocardial injury and 26 (48.1%) patients died in hospital. In-hospital mortality was significantly higher in patients with myocardial injury than in patients without myocardial injury (14 (60.9%) vs. 8 (25.8%), P =0.013). Moreover, the levels of C-reactive protein (153.6 (80.3, 240.7) ng/L vs. 49.8 (15.9, 101.9) ng/L) and N-terminal pro-B-type natriuretic peptide (852.0 (400.0, 2 315.3) ng/L vs. 197.0 (115.3, 631.0) ng/L) were significantly higher than patients without myocardial injury (all P <0.01). Conclusions: Prevalence of myocardial injury is high among severe or critically ill COVID-19 patients. Severe or critically ill COVID-19 patients with myocardial injury face a significantly higher risk of in-hospital mortality. The study suggests that it is important to monitor and manage the myocardial injury during hospitalization for severe or critically ill COVID-19 patients.

Reports a case of diabetic foot patient with right toe pain, ulceration for 4 years and aggravation for 1 month. After rigorous medical treatment and related examinations, transeversal bone transfer of tibia was proposed. However, the skin condition on the inner side of the lower leg was not good before the operation, so the transversal bone removal of the fibula was performed. Two segments of the lateral fibula were osteotomized with miniature osteotomies. The two osteotomy lines were about 10 cm apart. The distal osteotomy line is about 10 cm from the tip of the lateral malleolus. On the 8th day after the surgery, the bone was moved every 6 hours and was extended inwards by 1 mm every day. After 14 days, the bone was moved back for another 14 days. Skin temperature from preoperative to postoperative, ankle brachial index, CT angiography, CT value, visual analogue scale (VAS) of pain and wound healing were evaluated by comparison. The wound was completely healed 28 days after the operation.

Objective: To evaluate the mid-term outcomes of coronary artery bypass grafting (CABG) with left radial artery (RA) graft bypassed to right main coronary artery (RCA) of severe stenosis. Methods: Between September 2014 and April 2019, a total of consecutive 47 patients who had severe stenosis (≥90%) of RCA underwent total arterial revascularization, with left RA bypassed to RCA. There were 31 males and 16 females, with a mean age of (56.5±9.7) years old. The perioperative outcomes were observed and mid-term results were followed up. Results: A total of 46 left internal mammary artery (LIMA) grafts, 47 left radial artery (LRA), and 40 right RA grafts (RRA) were harvested with pedicles. LIMA was bypassed to LAD in 43 patients, RRA was to diagonal branches, ramus or oblique marginal in 37 cases, and LRA was to RCA. All grafts (except 3 composite Y or T grafts) were single. Mean graft number was 2-4 (2.7±0.9). There was one death due to cardiac tamponade. Three patients had postoperative atrial fibrillation, 1 had a forearm hematoma, 1 had acute renal insufficiency, and 2 had acute myocardial infarction. The mean tracheal intubation duration was 3.5-20.3 (8.3±4.7) hours, and the mean hospital stay was 6-13 (7.1±2.9) days. The average follow-up was 3-47 (23.3±7.5) months, with a follow-up rate of 86.96% (40/46). There were no major cardiovascular events during the follow-up. Three month after surgery, the mean left ventricular ejection fraction was significantly improved than that of pre-operation (60.0%±4.0% vs 42.4%±7.5%, P= 0.003). Computed tomography angiography (CTA) examination showed that 58.7% (27/46) of patients had patent LRA after a mean follow-up duration of (19.5±7.3) months. Conclusion: CABG with LRA bypassed to RCA of severe stenosis proves to be safe and effective, with good mid-term outcomes.

To establish the experts consensus on the management of delirium in critically ill patients. A special committee was set up by 15 experts from the Chinese Critical Hypothermia-Sedation Therapy Study Group. Each statement was assessed based on the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) principle. Then the Delphi method was adopted by 36 experts to reassess all the statements. (1) Delirium is not only a mental change, but also a clinical syndrome with multiple pathophysiological changes. (2) Delirium is a form of disturbance of consciousness and a manifestation of abnormal brain function. (3) Pain is a common cause of delirium in critically ill patients. Analgesia can reduce the occurrence and development of delirium. (4) Anxiety or depression are important factors for delirium in critically ill patients. (5) The correlation between sedative and analgesic drugs and delirium is uncertain. (6) Pay attention to the relationship between delirium and withdrawal reactions. (7) Pay attention to the relationship between delirium and drug dependence/withdrawal reactions. (8) Sleep disruption can induce delirium. (9) We should be vigilant against potential risk factors for persistent or recurrent delirium. (10) Critically illness related delirium can affect the diagnosis and treatment of primary diseases, and can also be alleviated with the improvement of primary diseases. (11) Acute change of consciousness and attention deficit are necessary for delirium diagnosis. (12) The combined assessment of confusion assessment method for the intensive care unit and intensive care delirium screening checklist can improve the sensitivity of delirium, especially subclinical delirium. (13) Early identification and intervention of subclinical delirium can reduce its risk of clinical delirium. (14) Daily assessment is helpful for early detection of delirium. (15) Hopoactive delirium and mixed delirium are common and should be emphasized. (16) Delirium may be accompanied by changes in electroencephalogram. Bedside electroencephalogram monitoring should be used in the ICU if conditions warrant. (17) Pay attention to differential diagnosis of delirium and dementia/depression. (18) Pay attention to the role of rapid delirium screening method in delirium management. (19) Assessment of the severity of delirium is an essential part of the diagnosis of delirium. (20) The key to the management of delirium is etiological treatment. (21) Improving environmental factors and making patient comfort can help reduce delirium. (22) Early exercise can reduce the incidence of delirium and shorten the duration of delirium. (23) Communication with patients should be emphasized and strengthened. Family members participation can help reduce the incidence of delirium and promote the recovery of delirium. (24) Pay attention to the role of sleep management in the prevention and treatment of delirium. (25) Dexmedetomidine can shorten the duration of hyperactive delirium or prevent delirium. (26) When using antipsychotics to treat delirium, we should be alert to its effect on the heart rhythm. (27) Delirium management should pay attention to brain functional exercise. (28) Compared with non-critically illness related delirium, the relief of critically illness related delirium will not accomplished at one stroke. (29) Multiple management strategies such as ABCDEF, eCASH and ESCAPE are helpful to prevent and treat delirium and improve the prognosis of critically ill patients. (30) Shortening the duration of delirium can reduce the occurrence of long-term cognitive impairment. (31) Multidisciplinary cooperation and continuous quality improvement can improve delirium management. Consensus can promote delirium management in critically ill patients, optimize analgesia and sedation therapy, and even affect prognosis.

Objective: To investigate the prevalence of latent tuberculosis infection (LTBI) in patients with inflammatory arthritis, and to compare the efficacy of tuberculin skin test (TST) and QuantiFERON-TB Gold (QFT) in screening for LTBI in these patients. Method: Medical records of 149 patients with inflammatory arthritis admitted to inpatient of Peking University International Hospital from December 2015 to December 2017 (diagnosis with rheumatoid arthritis, ankylosing spondylitis, sero-negative spondyloarthropathy, psoriatic arthritis, or reactive arthritis) who accepted TST or QFT were collected. The information included gender, age, history of tuberculosis infection, calcifications presence in chest X-ray or chest CT, TST result, QFT result, medication history before test, and biological treatment and all the patients were made a follow-up. Results: The positive rate of TST was 18.2%(14/77) and that of QFT was 27.1%(26/96), and the overall consistency between the two tests was fair. The rate of LTBI diagnosed by QFT was 22.9%(22/96). The positive rate of TST in patients older than 50 years was significantly higher than those younger than 50 years, but there was no significant difference between the two groups screened by QFT. The M-N values in QFT were decreased in both the patients above the age of 50 and in the patients using immunosuppressive agents. A total of 64 patients accepted biological agent therapy, and in those with a positive result of TST or QFT, only 2 cases received anti-LTBI treatment, but the other 14 cases without anti-LTBI treatment. None of them developed active tuberculosis in the following 3-24 months. Conclusion: The prevalence of LTBI in patients with inflammatory arthritis is consistent with that reported in rheumatoid patients, which is higher than in general people. In patients with inflammatory arthritis older than 50 years, especially those accepted immunosuppressive agents therapy, the immunity may be impaired and QFT is more sensitive than TST for screening LTBI.

Objective: To investigate the effects of calcium supplementation during the pregnancy and early infancy stage on body mass index (BMI) and gut microbiota in the infants. Methods: A total of 1 752 healthy pregnant women and their infants (breast feeding) in two maternal and child health care hospitals of Beijing were chosen as the subjects in this study from May to October 2016. Questionnaires were used to obtain the general information and supplementation of calcium and vitamin D in mothers and their infants. The body length and weight of infants at birth and 6 months were recorded to calculate the BMI. The random number table method was used to randomly select 40 infants from each group for gut microbiota analysis (If less than 40 infants were all included in this study, 23 infants in the pregnancy and early infancy would be all treated with calcium supplements. There were 6 infants who was not added calcium during the pregnancy but added in the early infancy). Then it was compared that the effects of calcium supplementation during the pregnancy and early infancy on the BMI and gut microbiota composition of infants were determined at birth and 6 months. Results: Compared to the group with no calcium supplementation during the pregnancy ((12.76±1.23), (17.68±0.76)kg/m(2)), the BMI of infants at birth and 6 months in the group with calcium supplementation during the pregnancy ((13.51±0.47), (17.91±0.23)kg/m(2)) were significantly higher( P< 0.05). In the group with maternal calcium supplementation, the BMI at 6 months ((18.63±0.52)kg/m(2)), BMI increment ((5.71±0.54)kg/m(2)) and the content of lactobacillus (21.04%±3.68%) in the only calcium supplementation subgroup in the early infancy were higher than those in only vitamin D supplementation subgroup ((17.69±0.89) kg/m(2), (4.17±1.01) kg/m(2) and 12.28%±3.86%) ( P< 0.05). In the group without maternal calcium supplementation, the content of lactobacillus (20.15%±4.87%) in the only calcium supplementation subgroup were also higher than those in only vitamin D supplementation subgroup (14.64%±3.71%) ( P< 0.05). Conclusion: Appropriate calcium supplementation during the pregnancy is good for the growth and development of the fetus. Calcium supplementation in the early infancy could increase the BMI of infants, and promote the growth of intestinal lactobacillus.

Objective: To observe the effect of sepsis single-disease manage system on the improvement of sepsis treatment and the value in predicting mortality in patients with sepsis. Methods: A retrospective study was conducted. Patients with sepsis admitted to the Department of Surgical Intensive Care Unit of Sun Yat-Sen University First Affiliated Hospital from September 22, 2013 to May 5, 2015 were enrolled in this study. Sepsis single-disease manage system (Rui Xin clinical data manage system, China data, China) was used to monitor 25 clinical quality parameters, consisting of timeliness, normalization and outcome parameters. Based on whether these quality parameters could be completed or not, the clinical practice was evaluated by the system. The unachieved quality parameter was defined as suspicious parameters, and these suspicious parameters were used to predict mortality of patients with receiver operating characteristic curve (ROC). Results: A total of 1 220 patients with sepsis were enrolled, included 805 males and 415 females. The mean age was (59±17) years, and acute physiology and chronic health evaluation (APACHE Ⅱ) scores was 19±8. The area under ROC curve of total suspicious numbers for predicting 28-day mortality was 0.70; when the suspicious parameters number was more than 6, the sensitivity was 68.0% and the specificity was 61.0% for predicting 28-day mortality. In addition, the area under ROC curve of outcome suspicious number for predicting 28-day mortality was 0.89; when the suspicious outcome parameters numbers was more than 1, the sensitivity was 88.0% and the specificity was 78.0% for predicting 28-day mortality. Moreover, the area under ROC curve of total suspicious number for predicting 90-day mortality was 0.73; when the total suspicious parameters number was more than 7, the sensitivity was 60.0% and the specificity was 74.0% for predicting 90-day mortality. Finally, the area under ROC curve of outcome suspicious numbers for predicting 90-day mortality was 0.92; when suspicious outcome parameters numbers was more than 1, the sensitivity was 88.0% and the specificity was 81.0% for predicting 90-day mortality. Conclusion: The single center study suggests that this sepsis single-disease manage system could be used to monitor the completion of clinical practice for intensivist in managing sepsis, and the number of quality parameters failed to complete could be used to predict the mortality of the patients.

Objective: To assess the feasibility, efficacy and indication of posterior C1-C2 transarticular screw fixation for atlantoaxial instability assisted by intraoperative 3-dimensional fluoroscopy-based navigation., Methods: From November 2005 to October 2012, 58 patients with atlantoaxial instability underwent posterior C1-C2 transarticular screw fixation assisted by intraoperative 3-dimensional fluoroscopy-based navigation. Those with excellent atlantoaxial reduction and no need for decompression underwent percutaneously minimally invasive procedures. Operative duration, blood loss volume, reduction of atlantoaxial joints and postoperative neurovascular complications were recorded. Screw positions were studied by postoperative computed tomography (CT) and divided into 3 categories. The follow-up period was at least 3 months. Local symptoms (assessed by visual analogue scale (VAS) score), neurological conditions (Nurick classification) and bone graft fusion were evaluated., Results: Among them, the procedure was either open surgery (n = 51) or percutaneously minimally invasive surgery (n = 7). A total of 111 screws were placed satisfactorily. Five patients underwent only unilateral C1-C2 transarticular screw fixation. No severe complications were encountered. The mean operative duration was 202.2 ± 54.2 minutes and the average volume of blood loss 412.6 ± 281.2 ml. And the values were comparable to those for the traditional fluoroscopy-guided free-hand procedures. No statistical significance existed between open and percutaneously minimally invasive procedures in operative duration, blood loss volume and precision of screw placement. The patients with incompletely reduced C1-C2 dislocation had comparable clinical outcomes with those with complete reduction. After a 3-month follow-up, all of them showed significant improvements of local symptoms. VAS score decreased from 4.5 ± 1.3 preoperatively to 0.7 ± 0.8 postoperatively while the Nurick classification improved from 2.4 ± 1.1 to 0.6 ± 1.0. And bone graft fusion was satisfactory., Conclusions: Posterior C1-C2 transarticular screw fixation for atlantoaxial instability assisted by intraoperative 3-dimensional fluoroscopy-based navigation is both feasible and safe. Combined with minimally invasive techniques, this procedure may achieve greater precision and minimal invasion.

Objective: To explore the histological outcomes of tendon-bone healing in anterior cruciate ligament (ACL) reconstruction with cortical press-fit bolt (CPB)., Methods: Twenty-four healthy female or male New Zealand White rabbits (2-3 months old) underwent bilateral ACL reconstruction with extensor digitorum longus tendon. A random method was used to decide one knee would receive the routine ACL reconstruction (control group) and another cortical press-fit bolt fixation (experimental group). After general anesthesia, extensor digitorum longus tendon was harvested and ACL reconstruction performed. All animals were sacrificed at 4, 8 and 12 weeks postoperation. Radiological and histological examinations were made at each timepoint. The specimens were stained with different methods to observe the pathological changes of tendon graft, bone tunnel and cortical press-fit bolt., Results: More revascularization and massive new bone were found in tendon-bone junction of experimental group at 4, 8 and 12 weeks postoperation. The circum-graft new vessel proportion of the experimental and control groups were 0.48 ± 0.12 and 0.26 ± 0.05 respectively (P < 0.05). In the experimental group, more cartilage cells were present in tendon-bone junction at 12 weeks and the circum-graft new bone areas in two groups were 0.41 ± 0.11 and 0.21 ± 0.10 mm(2) respectively (P < 0.05)., Conclusion: Cortical press-fit blot may improve tendon-bone healing after ACL reconstruction in rabbits. The application prospects of this procedure are promising.

Objective: To evaluate the efficacies of arthroscopic debridement and removal of osteophyma for olecroanon and olecranon fossa plasty for posterior impingement of elbow joint., Methods: Between 1999 and 2008, a total of 21 cases were diagnosed with osteoarthritis and posterior elbow impingement. There were 15 males and 6 females. And there were 16 right and 15 left cases. They included volleyball players (n = 7), tennis players (n = 7), golf enthusiasts (n = 4) and fencers (n = 3). The average duration of onset-operation was 3.5 years (range: 2.5 - 8). Arthroscopic exploration revealed synovial hyperplasia hypertrophy, cartilage degeneration and olecranon fossa hyperplasia with deformed olecranon fossa. Debridement and plasty were performed. Loose bodies were removed from elbow joint in 6 patients. Partial resection of posterior olecranon tip was performed and osteophytes or fibrous tissue removed in this area. Dynamic observation showed no posterior elbow impingement., Results: Postoperative follow-up was conducted in 19 cases and 2 cases became lost to follow-up. The average follow-up period was 25.3 months (range: 18 - 42). All patients were evaluated preoperatively and postoperatively with the Hospital for Special Surgery Elbow Assessment Scale. The outcomes were excellent (n = 12), good (n = 7) and fair (n = 2). Postoperative patients elbow swelling and pain relieve, sports and life function returns to normal, elbow flexion and rotating mobility obviously improved. With the elbow radiological films to measure the range of motion, the average range of motion was 90.5° preoperatively and improved to 130° postoperatively. There was significant improvement in all cases., Conclusion: Posterior elbow impingement is caused by hyperextension trauma and elbow overuse during specific sporting activities. Arthroscopic debridement and olecroanon or olecranon fossa plasty demonstrates excellent results for posterior impingement of elbow joint.

Objective: To evaluate the repair of rotator cuff tear by allogenic cortical bone anchors with the technique of suture bridge., Methods: A total of 18 patients with rotator cuff tear were recruited during the period of June 2006 to June 2009. There were 7 males and 11 females with an average age of 45.2 years old (range: 34 - 65). The locations included left shoulder (n = 11) and right shoulder (n = 7). Rotator cuff tear was repaired by allogenic cortical bone anchors with the technique of suture bridge under arthroscopy. The efficacy was evaluated by University of California Los Angeles (UCLA) standard score., Results: The average follow-up period was 17.6 months (range: 12 - 36). The excellent rate of treatment was 100%. All rotator cuff tears were healed. Only 2 cases had minor pain and there was no limitation of joint activity. The bone anchor fully integrated with the subject area at Month 3 post-operation., Conclusion: The advantages of repairing rotator cuff tear by allograft cortical bone anchors with the technique of suture bridge includes minimal trauma, a large tendon bone area, firm fixation and a low cost. It is a better approach of repairing rotator cuff tear.

Objective: To study sexual behavioral characteristics, infection status of HIV and sexually transmitted infections (STDs) among women who have sex with women (WSW) in Beijing., Methods: A total of 150 WSWs were recruited by snowball sampling in several main types of activity sites of WSW (including NGOs, salons, bars, etc.) in Beijing during September 2010 to April 2011. Information on demographic factors, sexual behavioral characteristics, infection status of STDs, and use of medical care were collected by questionnaire investigation. Serum samples, vaginal and cervical swabs were taken for each subject to test HIV, hepatitis B (HBV), hepatitis C (HCV), syphilis, herpes simplex virus (HSV), neisseria gonorrhoeae, chlamydia trachoma, bacterial vaginosis, trichomonas vaginalis and mycotic vaginitis., Results: The age range of the subjects was from 19 to 46 years old. Approximately 82.67% (124/150) of them aged 20 to 29 years old, and 54.00% (81/150) were unmarried. Approximately 76.67% (115/150) had an education level of college degree or above, and 70.67% (106/150) were migrants. Approximately 66.66% (100/150) of the subjects considered themselves as homosexual, 28.00% (42/150) as bisexual. The age at first homosexual sex ranged from 11 to 30 years old. The median of number of female sex partners in last 1 year was 1, and 33.78% (50/148) of the subjects had 2 or more female sex partners. Approximately 20.27% (30/148) of the subjects applied sex instruments, of which 66.67% (20/30) never or seldom used condoms. Hand-clitoris and hand-vagina contacts were the main types of woman-to-woman sex, accounting for 91.22% (135/148). 12.00% (18/150) of the subjects had sex with men during last year. Among them, 50.00% (9/18) used condoms at last heterosexual sex, and 66.67% (12/18) never or seldom used condoms at last heterosexual sex in past 1 year. One subject provided paid sex service for men, and used condoms every time. In the past one year, 45.33% (68/150) of the subjects had symptoms of STDs, but only 36.76% (25/68) of them sought medical care. The infection rate of STDs was 34.67% (52/150). The infection rates of NG and GV were both 16.11% (24/149), and those of mycotic vaginitis, chlamydia trachoma, and TV were 8.72% (13/149), 4.03% (6/149), and 0.67% (1/150), respectively. The numbers of subjects tested positive for HBV, HCV, and syphilis were all 1. No subjects were found HIV positive or HSV-2 positive., Conclusion: Multiple sexual partners and heterosexual sex behavior were common among WSW in Beijing. More than 1/3 of the subjects were infected with STD.

Objective: To explore the prevalence and mutation pattern of H221Y at reverse transcriptase (RT) among the subtype B' of human immunodeficiency virus1 (HIV-1) in antiviral therapy-failure patients., Methods: A total of 1363 sequences, comprising of 1205 therapy-failure individuals and 158 therapy-naive individuals, were submitted to the Stanford HIV drug resistance database (SHDB) to analyze the frequency and mutation pattern of H221Y., Results: The prevalence of mutation H221Y in the therapy-failure population was significantly higher than that of the therapy-naive (6.59% vs 0.60%) (χ(2) = 6.59, P = 0.027). The emergence of H221Y usually accompanied the position mutations of T215, M184, K103 and Y181 of RT, and the pattern of TAMs/H221Y/Y181C/I was common. Frequency of H221Y in the regimen of AZT/ddI/NVP was more popular than the other 4 regimens (14.6% vs 3.5%, 4.9%, 2.3%, 2.6%, all P < 0.01)., Conclusion: With a unique mutation pattern, H221Y has a low prevalence in the individuals of first-line therapy-failure patients.

Objective: To evaluate the association of a high ankle brachial index (ABI) with microvascular diseases of diabetes and to compare its strength with that of a low ABI., Methods: ABI was obtained in 3293 patients undergoing the screening of chronic complications at the Diabetic Center, No. 306 Hospital of PLA during the period of September 2003 to June 2010. The patient profiles and laboratory data were reviewed. The associations of ABI with microvascular diseases of diabetes were determined by univariate and stepwise Logistic regression analysis., Results: ABI was normal in 3060 patients. 44 had ABI measurements < 0.7, 139 had ABI measurements between 0.7 - 0.9, and 50 had ABI measurements > 1.3. Multivariate analysis indicated that the factors significantly associated with a high ABI were smoking (OR: 2.605; 95%CI: 1.458 - 4.656, P = 0.001) and systolic blood pressure (OR: 1.019; 95%CI: 1.005 - 1.033, P = 0.006). The conditions of nephropathy, neuropathy and retinopathy were not associated with a high ABI., Conclusion: Diabetics with a high ABI carry not more adverse atherosclerotic risk factors and suffer no more severe microvascular diabetic complications than those with a normal ABI.

Objective: To analyze sexual behavior characteristics and sexually transmitted diseases such as AIDS infections in man who have sex with men (MSM) of Beijing Chaoyang district., Methods: Through selecting 10 MSM as seed in Chaoyang district of the existing education member companion in its main activity place, using snowball sampling to select 1008 people that 16 years old or above, nearly a year had sex with male in Chaoyang to conduct an investigation.Questionnaires were used to investigate the general conditions, characteristics of sexual behaviors, condom usage, AIDS knowledge awareness and sexually transmitted diseases history. Each participant was asked to exsanguinated 5 ml peripheral blood for applying ELISA for HIV, syphilis helicoids detection and HIV positive samples confirm test. Using χ(2) test on the statistical analysis of the data., Results: In the 1008 MSM, most of them were with the age of 20 - 29 years old (66.6%, 671/1008), giving priority to unmarried (79.1%, 797/1008), college degree and above culture during accounted for 43.3% (436/1008), 56.2% (566/1008) had both male and female sexual partners; the rate of temporary sexual partners who were one-night stand objects or friends or guest was 72.2% (226/313). The forever condom utilization rate was 29.0% (170/587) in MSM who had both male and female sexual partners, lower than that who had both male and female sexual partners (47.2%, 345/731). That the study objects of HIV infection who can use condom correctly rate was 3.6% (16/442), and that who never or occasionally used condom rate was 8.5% (24/228). AIDS, gonorrhea and other sexually transmitted diseases (to give priority to the acuteness wet wart) infection rates were 4.8% (6/124), 10.5% (13/124) and 8.9% (11/124) in those who had the history of group sex, and that was 5.9% (52/884), 1.9% (17/884) and 2.3% (20/884) in those who without the history of group sex. The research object's gonorrhea and other sexually transmitted diseases (to give priority to the acuteness wet wart) who provided commercial sex service infection rates were 7.7% (9/117) and 6.8% (8/117), significantly higher than those who did not provide a commercial sex service object of study subject (2.4% (21/891)and 2.6% (23/891))., Conclusion: HIV infection is high among MSM population. Types and identification of sexual partners, and condom use are associated with HIV and STD infection.

Objective: To evaluate the efficacy and safety of Chinese medicinal shensongyangxin capsules in the treatment of paroxysmal atrial fibrillation., Methods: From August 2007 to July 2008, Beijing Chaoyang Hospital conducted a multicenter study, select the eleven hospital's outpatient subjects, aged 18 to 75 years old, male or female, paroxysmal atrial fibrillation (at least one electrocardiogram diagnosis) seizure frequency ≥ 2 times/month, according to the ratio 1:1:1, subjects were randomly divided into three groups: a. shensongyangxin group, taking shensongyangxin capsule 4 + propafenone analogues 150 mg, 3 times a day; b. propafenone group, taking propafenone tablets 150 mg + 4 shensongyangxin analogues, 3 times a day; shensongyangxin capsule + propafenone group, taking shensongyangxin capsule 4 + propafenone 150 mg, 3 times a day. The treatment course is 8 weeks, with 3 times of follow-up., Results: Total of 349 cases of paroxysmal atrial fibrillation, which 117 cases in shensongyangxin group, 115 cases in propafenone group; 117 cases in shensongyangxin + propafenone group. The baseline data analysis showed that there were no significantly difference (P > 0.05) among the three groups of atrial fibrillation seizure frequency, vital signs, general condition, medical history, 24-hour ambulatory ECG, 12-lead normal electrocardiogram, cardiac ultrasound and symptoms. The comparison before and after (8 weeks) treatment showed that the frequency (from 6 times/m to 2 times/m in each group, P < 0.01), number of cases [from 46 (43.3%) to 22 (20.8%), 43 (43.4%) to 25 (25.3%), and 40 (40.6%) to 31 (29.2%), respectively P < 0.01] and duration time of attack of atrial fibrillation (from 4 h to 0.5 h, 4 h to 0.5 h, and 4.25 h to 0.5 h, respectively P < 0.01) all decreased in three groups. No significant difference among the three groups comparing the overall effect (62.3%, 58.6%, and 58.5%, respectively, P > 0.05), while the efficacy of TCM symptoms in shensongyangxin group (80.2%) was better than that of propafenone group (67.7%) (P < 0.05). Safety evaluation showed that adverse reaction rate was 1.8% in shensongyangxin group, and 8.2% and 5.4% in propafenone group and shensongyangxin + propafenone group., Conclusion: Shensongyangxin capsules and propafenone have comparable efficacies in the treatment of PAF. The efficacy of TCM symptoms is better than propafenone. Shensongyangxin capsules have an excellent profile of safety.

Objective: To analyze the occurring rules of human immunodeficiency virus (HIV) drug resistance under an unique therapy model among HIV-1 infected individuals on antiretroviral therapy (ART) in rural areas of Henan, China., Methods: A cohort of 75 individuals on an ART regimen of zidovudine (ZDV), dideoxyinosine (ddI) and nevirapine (NVP) was established in March 2003. A total of 12 surveillance were conducted and 788 person-times were studied until 2010. The parameters of CD4 cell count and viral load (VL) were tested in each survey. And genotypic resistance testing was performed in patients with a failure of viral suppression. Survival analysis was used to estimate the occurrence time of resistance., Results: The cumulative mortality rate was 16% (12/75) in the cohort. And the cumulative resistance rate was 88% (66/75) from 2004 to 2010. The rate of resistance reached 54.7% and the probability from susceptibility to drugs developing resistance decreased drastically from 100% to 45.3% within the first 1 year of initiation. The occurrence time of resistance for half of individuals in the cohort was at 12.0 months (95%CI 8.6 - 17.0) after initiation, 25.1 months (95%CI 19.0 - 33.3) in those whose VL was less than 4.0 lgU/ml and 4.8 months (95%CI 4.1 - 5.6) at VL > 4.0 lgU/ml during the first investigation. The individuals with an early occurrence of resistance within 12 months carried high risks for a failure of viral suppression and a decrease of CD4 counts., Conclusion: The occurrence of resistance rises with the course of therapy. And the greatest probability for resistance is within the first 1 year of initial therapy. A high level of VL has a significant impact on the development of resistance. Preventing the occurrence of resistance during the initial therapy remains a key goal.

Objective: To evaluate the efficacy of sternocleidomastoideus radiofrequency carbonation with local anesthesia under arthroscope for the treatment of congenital muscular torticollis in adults., Methods: Twenty-six cases of congenital muscular torticollis were treated by radiofrequency carbonation with local anesthesia under arthroscope. The right side was in 14 patients and left in 12. There were 11 males and 15 females with an average age of 22 years old. Sternocleidomastoideus and clavicula were pre-operatively marked. Through an artificial lacuna, arthroscope and radiofrequency probe were inserted., Results: The mean follow-up period was 25 months (range: 15 - 71). According to the motion deficits, craniofacial asymmetry, head tilt and subjective assessment, there were 19 excellent and 7 fair outcomes. Most patients showed a marked improvement in neck motion and head tilt with satisfactory functional and cosmetic outcomes. There was no nerve or vascular injury, no recurrence, infection and scar. The overall efficacy was satisfactory., Conclusion: The radiofrequency therapy for torticollis with local anesthesia under arthroscopy has a satisfactory efficacy. The advantages are minimal trauma, simple procedure, less pain and better cosmetics.

Objective: To study the incidence and risk factors of HIV and syphilis seroconversion among men who have sex with men (MSM) in Beijing., Methods: A total of 550 MSM were recruited on the basis of community and followed up after 6 and 12 months in Beijing. Each subject was investigated by only one investigator at one time to collect information on demographics and behaviors. Blood samples were collected to test HIV and syphilis seroconversion. ELISA was used for screening test, west blotting (WB) and Particle agglutination were used for confirmatory test., Results: A total of 550 MSM investigated, among which 4.5% (25/550) were HIV-positive and 29.3% (161/550) were syphilis-positive. For 525 HIV-negative MSM, 87.0% (457/525) retained during the 12-month investigation. Seroincidence for HIV and syphilis were 3.37/100 person-years (95%CI = 1.66 - 5.08) and 9.32/100 person-years (95%CI = 5.87 - 12.77) respectively. HIV seroconversions for those who performed and did not perform rectal douching after homosexual anal intercourse in the past 3 months were 7.11/100 and 0.76/100 person-years respectively. Multivariate Cox regression analysis revealed that rectal douching after homosexual anal intercourse in the past 3 months (HR = 9.23, 95%CI = 2.08 - 40.88) was significantly associated with HIV seroconversion. Syphilis seroconversions for those who met male sex partners in parks, public washrooms or bathhouses in the past 3 months were 41.77/100 and 7.97/100 person-years respectively. Syphilis seroconversions for those who performed and did not perform rectal douching after homosexual anal intercourse in the past 3 months were 16.17/100 and 4.92/100 person-years respectively. In the past 3 months, meeting male sex partners in parks, public washrooms or bathhouses (HR = 4.67, 95%CI = 1.77 - 12.34) and performing rectal douching after homosexual anal intercourse (HR = 3.09, 95%CI = 1.40 - 6.83) were significantly associated with syphilis seroconversion., Conclusion: The seroconversions of HIV and syphilis during the follow-up visits in this MSM cohort study in Beijing were very serious, and that the associated factors for seroconversions were rectal douching after homosexual anal intercourse and meeting male sex partners in parks, public washrooms or bathhouses.

Objective: To investigate the clinical classification of chronic achilles tendinitis and analyze the surgical technique and efficacy of arthroscopic surgery., Methods: Twenty-two patients (16 males, 6 females) with chronic achilles tendinitis were recruited. The average age was 33.5 years old (range: 17 - 53). Sixteen cases were caused by sport injury while 6 cases had no definite etiological factor. The Achilles tendinopathy was divided into three types according to clinical characteristics and the results of X ray, CT scan and MRI examination of ankle: Type 1, hypertrophy (n = 10); Type 2, calcified tubercle (n = 5); Type 3, fiber tear (n = 7). All cases were treated with endoscopic debridement of ventral neovascularized area, peritendineum and Achilles tendon by shaver and radiofrequency (RF) probe., Results: The patients were followed-up for a mean of 14 months (range: 9 - 15). Evaluated by our criteria and visual analogue scale, the post-operative efficacy was excellent in 12 cases, good in 8 and fair in 2. No postoperative complications, such as neurovascular injury, infection and rupture of Achilles tendon, was recorded., Conclusion: This scheme of classifying is helpful to the diagnosis and effective treatment of chronic Achilles tendonitis. With a high safety and a satisfactory efficacy, arthroscopic surgery has the advantages of minimally invasiveness.

Objective: To explore the relationship between the -344T/C polymorphism of aldosterone synthase (CYP11B2) gene and essential hypertension in Chinese Mongolian population., Methods: By cluster-sampling method, a total of 1575 Mongolian people in Tongliao city of Inner Mongolia were included in this study. And 417 subjects were normotension, 596 subjects were prehypertension and 562 subjects were essential hypertension. A survey was conducted to collect data by personal interview using a standard questionnaire, meanwhile fasting blood samples were drawn. Height, weight, waist circumference, blood pressure, blood-fat indexes and fasting plasma glucose were measured. The variant genotypes of CYP11B2 were identified by PCR assays. The relationship between the -344T/C polymorphism of CYP11B2 gene and essential hypertension were analyzed by multinomial logistic regression model., Results: Crude prevalence of prehypertension among Mongolian people was 37.84% (596/1575) and hypertension was 35.68% (562/1575). The age-standardized prevalence of prehypertension was 38.57% and hypertension was 31.53%. The frequency of the T and C allele was 0.66 (481/728) and 0.34 (247/728) for normotension group, 0.69 (696/1042) and 0.33 (346/1042) for prehypertension group, 0.71 (706/998) and 0.29 (292/998) for hypertension group. The multiple logistic models showed CYP11B2 variant genotypes were associated with prehypertension (TT/CC, OR = 1.33, 95%CI: 0.87 - 2.01; TC/CC, OR = 1.74, 95%CI: 1.13 - 2.67; TC + TT/CC, OR = 1.49, 95%CI: 1.01 - 2.22); CYP11B2 variant genotypes were associated with hypertension (TT/CC, OR = 1.70, 95%CI: 1.07 - 2.70; TC/CC, OR = 1.59, 95%CI: 0.98 - 2.50; TC + TT/CC, OR = 1.66, 95%CI: 1.06 - 2.58)., Conclusion: CYP11B2 gene -344T/C polymorphism were associated with essential hypertension in Chinese Mongolian population.

Objective: To study the effect of arthroscopy debridement for adolescent ankylosing spondylitis (AS) with early hip-joint disease., Methods: A total of 22 cases (26 hips) of adolescent AS were recruited. There were 15 males and 7 females. The distribution was as follows: left side (n = 10), right side (n = 8) and bilateral (n = 4). The average age was 16 (14 - 19) years old. The procedures included adhesion relief of hip joint, removal of hyperplasic synovial membrane, degenerated cartilage debris and repairing exfoliated debris or exposed subchondral bone on hip joint., Results: All patients were followed up for an average of 26 (6 - 84) months. Most patients experienced pain relief, restored function and the range of motion. According to Harris hip joint score and VAS pain score evaluation system, the outcomes were excellent (n = 6) fair (n = 14) and poor (n = 2). There was no case of total hip replacement., Conclusion: Arthroscopic debridement for adolescent ankylosing spondylitis with early hip joint disease is effective to improve joint motion and relieve pain.

Objective: To construct a high-throughput suspension microarray for detecting the hotspot gene mutations of p53, p16, retinoblastoma (Rb) and epidermal growth factor receptor (EGFR) and to investigate the significance of this multimarker panel in molecular diagnosis of non-small-cell lung cancer (NSCLC)., Methods: The specific probes of normal or mutated sequences targeting the hotspot mutation sites of p53, p16, Rb and EGFR were designed and immobilized to carboxylated Luminex microspheres (micro-beads). Genomic DNA was extracted from 65 specimens of cancer tissues and 20 adjacent normal lung tissues. p53, p16, Rb and EGFR genes were amplified by PCR, hybridized with the specific probes on the beads and measured using Luminex 100., Results: The single gene mutations of p53, p16, Rb or EGFR in NSCLC specimens were 53.8% (35/65), 20.0% (13/65), 7.7% (5/65) or 35.4% (23/65) respectively. The para-tumor normal tissue specimens were 5.0% (1/20), 5.0%(1/20), 0 and 0 respectively. For combined detections of four genes, the sensitivity, specificity and accuracy were 81.5% (53/65), 90.0% (18/20) and 83.5%(71/85) respectively. The mutation rates of this panel in stage I, stage II and stage III were 78.3% (18/23), 80.0% (16/20) and 86.4% (19/22) respectively., Conclusions: A high-throughput suspension microarray with a higher specificity and sensitivity has been built. It may be used to simultaneously detect the gene mutations of p53, p16, Rb or EGFR in NSCLC specimens. This suspension microarray is helpful to improve the sensitivity of molecular diagnosis of NSCLC and guide the molecular targeting therapy of NSCLC.

Objective: To investigate whether the polymorphism of osteoprotegerin (OPG) gene is associated with the change of BMD (bone mineral density) after alendronate therapy in postmenopausal women with osteoporosis and determine the correlation between genotypes and therapeutic effect., Methods: Eighty postmenopausal osteoporotic patients were recruited with an average age of (64.2 +/- 7.7) years old. Every patient took oral alendronate (Fosamax) 70 mg weekly and Caltrate 600 mg daily for 12 months. At pre- and post-treatment, BMD was measured at lumbar spine 2 - 4 and hip sites. PCR-RFLP was performed for three polymorphisms at the promoter site of OPG gene (A163G, T245G and T950C)., Results: One-year therapy was accomplished in 67 patients. Patients with G allele (genotype AG and GG) of site A163G, the baseline BMD of vertebral L2-4, inter-troche and total hip were lower than genotype AA [(0.732 +/- 0.113) g/cm(2) vs (0.819 +/- 0.157) g/cm(2), (0.775 +/- 0.101) g/cm(2) vs (0.843 +/- 0.124) g/cm(2) and (0.667 +/- 0.105) g/cm(2) vs (0.725 +/- 0.091) g/cm(2)]. Patients with G allele (genotype TG and GG) of site T245G, baseline BMD of vertebral L2-4, inter-troche and total hip were lower than genotype TT [(0.723 +/- 0.111) g/cm(2) vs (0.819 +/- 0.155) g/cm(2), (0.776 +/- 0.102) g/cm(2) vs (0.840 +/- 0.124) g/cm(2) and (0.670 +/- 0.109) g/cm(2) vs (0.721 +/- 0.091) g/cm(2)]. After one-year therapy, at site A163G, the percentage of BMD change at inter-troche was higher in genotype AA than in genotypes AG and GG [2.50 (3.47)% vs 0.88% (3.47%)%, P = 0.014]. While at site T245G, the percentage of BMD change at inter-troche and total hip were higher in genotype TT than in genotype TG and GG 2.50% (3.47%) vs 0.61% (3.31%), P = 0.011; 2.72% (2.68%) vs 0.89 (3.01%), P = 0.046]., Conclusion: The G allele of sites A163G and T245G may be the risk allele of postmenopausal osteoporosis. Furthermore, patients with genotypes AA (A163G) and (T245G) show a better therapeutic effect to alendronate.

Objective: To assess the clinical value of multi-slice spiral CT portal venography in prediction of esophagogastric variceal bleeding., Methods: The relation was detected between esophagogastric variceal bleeding and the location of left gastric vein orifice on portal system. Also the correlation was studied between the severity of esophageal varices endoscopically and the diameter of portal vein with multi-slice spiral CT portal venography. Sixty-nine patients with esophagogastric varices confirmed by both endoscopy and 16-detector row CT portal venography due to cirrhosis were enrolled., Results: Excellent image quality of portal collateral vessels with CTPV was obtained in all patients. The portal and left gastric veins were visualized both with CTPV 69/69 (100%). Esophageal and gastric varices were visualized with CTPV 62/69 (89.9%) and 50/69 (72.5%) respectively. The left gastric vein orifice was located on the portal vein in 42 cases. There was correlation between esophagogastric variceal hemorrhage and the location of left gastric vein orifice (Chi(2) = 4.406, P < 0.05). But no relation was found between the severity of esophageal varices and the diameter of portal vein (P > 0.05)., Conclusion: CTPV can not only provide important and accurate information of collateral circulation in patients with portal hypertension, but also measure the diameter of collateral blood vessel. There is a higher probability of esophagogastric variceal bleeding for the patients with left gastric vein orifice on portal vein. The combined approaches of CTPV and endoscopy can not only diagnose the severity of esophagogastric varices, but also predict the risk of esophagogastric variceal bleeding.

Objective: To evaluate the curative effect of RIGIDfix tibial and femur cross pin system used for hamstring grafted reconstruction of anterior cruciate ligament (ACL) in arthroscopy., Methods: Thirty two cases with ACL ruptures were reconstructed arthroscopically with hamstring grafts and the grafts fixed with RIGIDfix cross-pin on both femoral and tibial sides. They included 18 males and 14 females with a mean age of 28 (20-45) years old; the mean time from injury to operation was 3.6 (2.5-6) months. And each knee was checked by MRI and X-ray preoperatively. Through arthroscopy, we found 19 ACL ruptured from femoral attachment point, 13 from tibial point, 3 cases combined with medial meniscus injury and 4 cases with articular cartilage injury of medial femoral condyle. After semitendinosus or gracilis harvesting, the hamstring grafts were pre-tensioned and woven, the diameter of 4 or 5 strands grafts was 7-8 mm. To position and drill tibial tunnel on ACL stump of tibial crest, and to drill femoral tunnel at 10:00 to 11 o'clock of femoral intercondylar fossa transtibial with knee flexed to 90 degree, the depth of femoral tunnel was 30 mm. The RIGIDfix guide was inserted through tibial tunnel up into the femoral tunnel to drill the sleeve and interlocking Trocar across the lateral femur and keep the two sleeves fixed to the lateral femur. Insert RIGIDfix guide into the tibial tunnel, keeping the top of guide 2-3 mm beneath the endostoma of tibial tunnel, drill the sleeve and interlocking Trocar across the lateral tibia and keep the two sleeve fixed to the lateral tibia. The graft was pulled into the tunnel (the 30 mm mark on the graft should be at the edge of femoral hole) to insert the RIGIDfix cross pins from femoral tunnel to tibial tunnel, while inserting the second, third, fourth cross pin, the graft should be kept under tension. Then a knot was tied through tibial bony bridge using the Enthibond thread switched to the end of tendon grafts. We finally observed the tension of tendon grafts and the impingement of fossa intercondylic under arthroscopy., Results: With a 16-month follow-up evaluation, all of the patients' injured knees were stable and the average Lysholm knee score increased from 62.5 to 94.5. Rulermetr device values were less than 2 mm of sagittal displacement in 28 patients and 4 mm in 4. Postoperative Lachman was negative in 30 patients and weakly positive in 2. According to the IKDC scores, 30 patients reported normal function, 2 reported nearly normal function and none reported abnormal or severely abnormal function., Conclusion: The grafting method of fixing both femur and tibia sides with absorbable cross pins is feasible. In this way, the graft is stabilized to allow for reconstruction. A surgeon should refrain from dissecting the tendon and enlarging the tunnel so as to promote the healing of tendon and bone.

Objective: The fixation strength of the hamstring tendon graft on the tibial side is considered the weak point in anterior cruciate ligament (ACL) reconstruction. This work tested the hypotheses that some of these devices will resist graft slippage under loads better than others, and that some will have higher ultimate strength than others., Methods: Fourteen fresh frozen human cadaver knees underwent fixation of the hamstring tendon harvested from the knee to be used as graft material to reconstruct the ACL and were divided into two equal groups based on the fixation methods: bioabsorbable interference screw group and Intrafix group. A MTS 858 MiniBionix II testing machine was used to carry out tensile testing under an axial load parallel to the tibial tunnel with a velocity of 10 mm/min. Ultimate failure load, displacement of 100N, displacement of 400N, stiffness and mode of failure were recorded respectively., Results: The maximum load for the Intrafix fixation group was (719.094+/-160.478) kgxmxs(-2), significantly higher than that of the bioabsorbable interference screw fixation group [(476.640+/-64.226) kgxmxs(-2), P<0.05]. The displacement levels of 100 kgxmxs(-2) and 400 kgxmxs(-2) for the Intrafix fixation group was (1.025+/-0.326) mm and (4.728+/-1.992) mm respectively, not significantly different from those of the bioabsorbable interference screw fixation [(1.335+/-0.539) mm and (7.564+/-4.307) mm respectively, t=0.2173, 0.0944, both P>0.05], and the stiffness of the Intrafix fixation group was (96.770+/-36.848) kgxm(-1)xs(-2) not significantly different from that of the bioabsorbable interference screw fixation group [(63.976+/-31.003 kgxm(-1)xs(-2)), t=0.0967, P>0.05]. After randomized t-test of significance, the displacement levels of 100N and 400N of these 2 groups were not significantly different., Conclusion: Both tibial site fixation with bioabsorbable interference screw and that with Intrafix in ACL reconstruction with 4-stranded hamstring tendon grafts can meet daily physiological demand. Tibial site fixation with Intrafix shows a higher failure load.

Objective: To observe the effects of a newly developed technique to transform the dish-like bone defect into contained bone defect and adopt the cancellous bone obtained from bone cut to make parvula impacted bone graft to repair the bone defect of tibial plateau in total knee arthroplasty (TKA) for osteoarthritis (OA) patients with severe varus or valgus., Methods: 54 OA patients (74 knees) with severe varus or valgus (> 25 degrees ) received TKA. The average depth of the bone defect at the tibial plateau measured in the operation was 18.23 mm and the average thickness of the bone cut was 9.97 mm. The average depth of the dish-like bone defect left after bone cutting was 8.78 mm and the defect occupied averagely 31.5% of the total section area. The sclerotic bone layer was removed to the depth of the cancellous bone by saw blade or reamer, which made the defect to be contained. Small holes were drilled in the contained bone defect. Fragments 5-8 mm in diameter were made from the cancellous bone osteotomized from the femur and tibia were impacted into the bone defect. The defect was finally covered by a bone slice to make a flat tibial section allowing the tibia prosthesis to be firmly seated on it by routine technique. Follow-up was conducted for 32.2 months on average., Results: The tibial deformity was repaired effectively and reliable support for the prosthesis at the tibia side was provided. Subsequent X ray films showed that no bone defect was seen under the prosthesis and the position of the prosthesis was fine. No autograft resorption and complete radiolucency between the graft and the tibial host bone appeared during the follow-up. The average KSS score raised from 45.6 preoperatively up to 94.5 postoperatively., Conclusion: In comparison with other techniques, the impacted autografting technique more effectively reconstructs the bone defects of tibial plateau in TKA. The cancellous bone obtained from the bony end can be used fully, thus over-cutting can be avoided and the mechanical characteristics of the knee joint would not be disturbed.

The transmission route of TCM knowledge in ancient China primarily included doctor's transmission and non-doctor's transmission. The doctor's transmission mode included lineage-teaching system, elementary study system, transmission between schools and the clinical effects on the society etc. Non-doctor's transmission mode included literati's interests, literati's sickness, literati's health cultivation, the interests of top society, literati's recoding etc. Different transmission modes played an important role in the transmission and conservation of TCM knowledge as well as a reference to developing the transmission of present-day TCM knowledge.

Objective: To study the changes of amplitude of low-frequency fluctuation (ALFF) of the resting-fMRI in the mesial temporal lobe epilepsy (mTLE) with bilateral hippocampal sclerosis (HS), and discussed its underlying neuro-pathophysiological mechanism., Methods: The resting-fMRI data of 20 TLE patients with HS and 20 normal volunteers were performed ALFF analysis. The amplitude of the blood oxygenation level-dependent activation of the resting-state brain was investigated. The brain structures showing increased and decreased ALFF in TLE patients were demonstrated by comparing to normal subjects with 2-sample t-test with threshold of P < 0.01., Results: By comparison with that of normal subjects, the regions showing increased and decreased ALFF in TLE patients were distributed in the brain symmetrically and bilaterally. The regions showing increased ALFF were distributed with center of limbic system, such as parahippocampal gyri, amygdala, hypothalamus, dorsal anterior cingulate gyrus and part of posterior insular lobe, as well as the neocortices such as primary sensorimotor cortices, occipital cortices, inferior temporal gyri, orbital gyri, and the subcortical structures of verbal brainstem and mesial cerebellum. The point with maximal increased ALFF (T = 6.02) located in the right precentral gyru (15, - 12.51). While the regions showing decreased ALFF covered the areas of default mode, such as posterior cingulate cortex/ precuneus and medial prefrontal cortex /ventral anterior cingulate cortex, as well as other structures such as dorsal lateral prefrontal cortices, superior temporal gyri, caudate heads, dorsal brain stem and the posterior cerebellum (3, -78, -21) with the maximal decreased ALFF (T = -4.42)., Conclusion: The method of ALFF allows the direct observation to the epileptic activation in TLE. The increased ALFF is considered the facilitation such as the epileptic activity generation and propagation; while the ALFF decrease is considered the function inhibition in these regions, especially implies the suspension in the default mode activity.

Objective: To investigate the clinical and laboratory features of acute promyelocytic leukemia (APL)., Methods: 513 APL patients in the last two decades were retrospectively analyzed in this research. We investigated the clinical features including age, sex, abnormality of peripheral hemogram before treatment, therapeutic effect and follow-up and laboratory data such as morphology, immunology, cytogenetics and molecular biology (MICM)., Results: The median age of the APL patients was 33 years old and the ratio of male and female was 1.21:1. Before treatment, the median level of WBC was 4.3 x 10(9)/L and the detection rate of abnormal promyelocyte on blood film was 85.8%; with immunophenotypic detection, the expression levels of CD117, CD34, HLA-DR, CD7, CD14 and CD19 in APL were found to be lower and the expression levels of CD2, CD33 and MPO higher than those in other subtypes of acute myelocytic leukemia (AML) (both P < 0.01). Specific abnormal chromosome t (15;17) was detected in 91.7% of the patients, of whom 75.9% had standard translocation of t (15;17), being the most common one and 15.8% of the patients had t (15;17) with additional abnormal chromosome. There was only 7.5% of the patients with normal karyotype. However, the presence of both simple translocation and complex translocation was seldom seen. With molecular biological detection, PML/RARalpha fusion gene positive rate was 99.6%. In a relatively long clinical follow-up, we found that the complete remission (CR) rate in APL patients was 84.7%, incidence of DIC was 13.4% and five-year survival rate was 30.7%. The median count of WBC in CR group was lower than that non-remission group (P < 0.01). There were no significant differences on expressions of CD34 and CD2 and changes of cytogenetics between the two groups (P > 0.05)., Conclusions: Comprehensive evaluation of MICM could be of important significance in the diagnosis and prognosis judgment for APL patients. The CR rate in these patients with high WBC count was considerable low.

Objective: To explore the effective sexually transmitted infections (STI)/AIDS intervention strategies among female sex workers at the metropolis areas with low prevalence., Methods: A comprehensive intervention was carried out among female sex workers in eight recreation establishments which have representative characters in Chaoyang district, and the effects of intervention was subsequently evaluated by a questionnaire from September 2005 to February 2006. The data were analyzed by SPSS11.5., Results: The study subjects aged 17-40 year old (25.22 +/- 5.81), and 203 (89. 82%) of them had high or middle school education background. 166 were unmarried, and 205 (90.70%) had no job, and 244 (99. 12%) subjects were migrants. After intervention, the correct answer rates for the knowledge of STI/ AIDS rose from 52.6% to 75.4% (chi2 = 22.701, P < 0.01); and the correct use of condom were higher than those of baseline, with the rise from 22.12% to 34.76% (chi2 = 8.14, P < 0.05)., Conclusion: The STI/AIDS comprehensive intervention measures were effective and should be evaluated and generalized in the similar metropolis regions.

Objective: To investigate the dynamics of expression of Toll-like receptor 4 (TLR4), an innate immune molecule, in patients early after renal transplantation and the role thereof in the renal transplantation immunity., Methods: Eighteen patients early after renal transplantation were divided into rejection group (n = 3) and non-rejection group (n = 15) according to the rejection episode record within two weeks. 1, 4, and 7 days after transplantation peripheral blood samples were collected. Three-color fluorescent staining flow cytometry was used to detect the expression of TLR4 and CD80 in the CD14 positive monocytes., Results: (1) The expression rates of TLR4 in the monocytes 1, 4, and 7 days after transplantation were (21.38 +/- 16.02)%, (11.81 +/- 8.49)% and (4.15 +/- 3.80)% respectively in the non-rejection group with a downtrend; and the expression rate of TLR4 at the 7th day was significantly lower than those at the 1st and 4th days (both P < 0.05); the expression rates of TLR4 in the monocytes 1, 4, and 7 days after transplantation were (3.59 +/- 1.18)%, (21.5 +/- 20.54)% and (17.05 +/- 12.92)% respectively in the rejection group, showing an increasing trend, however, without significant differences among any 2 values (all P > 0.05). (2) The link relative ratio of TLR4 expression of day 4 vs day 1 after renal transplantation in the rejection group was significantly higher than that in the non-rejection group (P < 0.05). The link relative ratio of TLR4 expression of the day 7 vs day 4 after renal transplantation in the rejection group was significantly higher than that in the non-rejection group (P < 0.05). One case of the rejection group underwent removal of the graft because of irreversible rejection at day 5 after renal transplantation, in which the TLR4 expression rate was decreased day 7. (3) In the non-rejection group, the expression of CD80 at the days 1, 4, and 7 after transplantation displayed a downtrend, however, without significant differences between any 2 values (all P > 0.05). In the rejection group, the expression of CD80 1, 4, and 7 days after transplantation were elevated in different degrees, however, without significant differences between any 2 values (all P > 0.05)., Conclusion: The dynamics of expression of TLR4 in the patients early after renal transplantation is accordance with their immune state. The link relative ratio of TLR4 expression in the rejection group is significantly higher than that in the non-rejection group.

Objective: To investigate the therapeutic effect of small diameter, multiple porous, low drill velocity decompression and hip arthroscopy in treatment of early avascular necrosis of femoral head (ANFH)., Methods: 226 ANFH patients (383 hips), 169 males (296 hips) and 57 females (87 hips), aged 36.5 (14 - 64), underwent drilling decompression with 3.5 mm Steinmann pin at a low velocity under the C-arm X-ray monitoring, all the 383 hips were decompressed with Steinmann pin, small diameter, multiple porous, low drill velocity. Synovectomy and cartilage trimming were performed through hip arthroscopy at the same time on the 209 hips combined with hip arthrosynovitis or cartilage trauma. 164 cases were followed up for 35 months (3 - 60 months)., Results: The Harris score was increased from 68 (56 - 78) pre-operatively to 79 (58 - 92) post-operatively. Excellent curative effect was found in 198 of the 383 hips (69.5%) with a Harris score > 80, medium curative effect was found in 70 hips (24.5%) with a Harris score between 70 and 79; and bad effect found in 17 hips (6.0%) with a Harris score < 69. During the follow-up, these 17 hips presented progress in staging of clinical course and collapse of femoral head. 139 hips with hydrops articuli were treated with arthroscopy, and 87 of the 139 hips underwent hip MRI during the follow-up. It was found that the hydrops articuli decreased in 59 hips and increased in 10 hips. Complications were found in 10 cases and all of them were recovered after treatment., Conclusion: The effect of small diameter, multiple porous and low drill velocity decompression is equal to or surpasses traditional core decompression. Small diameter decompression has the advantage of less osseous destruction of femoral head, delaying femoral head collapse and improving blood circulation in the necrosis zone of femoral head. Hip arthroscopy can greatly improve the therapeutic effect of ANFH through scavenging pain-producing substance, removing the cartilage chips caused by isolation or undermining dissection, and correcting internal environment disorder.

Objective: To study the relationship of the sensitivity of tumor cells to chemotherapeutic agent between in vivo and in vitro., Methods: Mouse lymphoma cells of the line E14 were cultured and melphalan resistant EL4 cell line (EL4/melphalan) was established by culturing EL4 cells with continuous low-concentration and intermittent gradually-increasing-concentration of melphalan in vitro. MTT assay was used to evaluate the drug sensitivity and the resistance index of the EL4/melphalan cells to melphalan was calculated. EL4/melphalan and EL4 cells of the concentration of 5 x 10(8)/L were inoculated separately into 20 C57BL/6 mice subcutaneously. 12 days later, the EL4 and EL4/melphalan tumor-bearing mice were randomly divided into 2 groups respectively, 5 mice in each group. Treatment groups were given 7.5 mg/kg melphalan intraperitoneally, and control groups were given the same volume of normal saline. The tumor size was observed every other day., Results: Compared with the EL4 cells, the EL4/melphalan cells had no obvious changes morphologically. They could grow in RPMI 1640 medium containing 5 mg/ml melphalan. The resistance index was 2.87 against melphalan. After the treatment of melphalan of the dose 7.5 mg/kg, the tumor sizes of the treatment groups and control groups inoculated with both EL4 cells and the EL4/melphalan cells gradually decreased at the similar speed, and about one week later all tumors disappeared. However, the tumors of the control groups grew progressively and all the mice died at last., Conclusion: The chemotherapeutic effects of tumors in vivo have nothing to do with the effects of the chemotherapeutic agents on tumor cells in vitro. The tumor cells resistant to melphalan in vitro remain sensitive to the drug in vivo.

Objective: To develop a simple screening tool for low bone mass of postmenopausal women., Methods: 405 postmenopausal women in Shanghai who visited the department of osteoporosis consecutively, aged 62.8 +/- 8.0 (47 approximately 90), underwent questionnaire survey on the risk factors of osteoporosis and fracture. Dual energy X-ray absorptiometry (DXA) was conducted on the left or right femoral neck to measure the bone mineral density (BMD) to identify osteoporosis (T-score

Objective: To approach the values of arthroscopic minimally invasive surgery (MIS) in diagnosis and treatment of benign bone and joint tumors., Method: 20 cases of benign bone and joint tumors were diagnosed and treated by arthroscopic MIS. There were 9 males and 11 females in the group. Their average age was 26 years old (from 19 to 37). There diseased region: 9 in distal femurs, 6 in knee joints, 4 in calcaneus, 1 in distal tibia. Plain radiographies, MRI examinations and CT scans were performed with all patients preoperatively, among them 12 patients were inspected by ECT. In the treatments of distal femoral and calcaneal benign tumors, firstly, Kirschner wires were drilled into the pathological regions under the monitor of C-arm; then 6 mm diameter hollow drills were drilled follow the guide Kirschner wires and run-through the opposite side of cortical bone; then the arthroscope was inserted to check-up the pathological regions, then curettes or bite clamps were inserted from the opposite side to clean up tumor tissues; finally, 8 of the 13 were embedded with allograft gelsiccation bone, other 6 were embedded with carbonate hydroxyapatite cement. One case of distal tibia epidermoid cyst were removed under arthroscope and filled with allograft bone. 6 soft connective tissue tumors in knee articular cavities were removed under the monitor of arthroscope., Result: According to pathological reports, 6 were yellow pigments tumors in knee articular cavities, 4 were osteoid osteomas of femoral bones, 3 were osteofibrous dysplasias, 2 were nonossifying fibromas, 4 were bone cysts of calcaneuses, one was distal tibia epidermoid cyst. All patients were followed up with 7 months to 4.6 years (average 25 months). No recurrence occurred, and their joint functions were well., Conclusion: It is an accurate, minimally invasive and easy to manipulate technology to treat benign bone and joint tumors with the monitor of arthroscope.

Objective: To discuss the value of arthroscopic techniques in determining the indications of unicondylar arthroplasty., Methods: Twenty-four patients with knee osteoarthritis, 14 males and 19 females, aged 63 (49 - 74), who were scheduled to undergo unicondylar arthroplasty were arthroscopically evaluated at the beginning of surgery. Arthroscopy showed injury of degree IV in the tibial and femoral cartilages in the medial compartment, severe abrasion of meniscus, and exposure of subchondral bone. Unicondylar arthroplasty was given up on 8 cases because of cartilage injuries in the lateral compartment, while the surgery was performed on the other 16 cases. All cases underwent synovium debridement, 5 of which underwent meniscus repair or partial meniscectomy in the lateral compartment, 4 underwent patellar reticulum releasing and peri-patellar denervation, 3 cases underwent synovium plica resection, and 4 cases had their loose bodies removed. Follow-up was conducted on 16 cases for 14 months on average., Results: The average Lysholm score of the patients was 67.5 preoperatively and became 94 postoperatively. After operation, the symptoms of locking and pain were relieved. The functional evaluation result was excellent in 12 cases, good in 2, and fair in 2., Conclusion: Arthroscopic evaluation of intra-articular structures is valuable in determination of unicondylar arthroplasty indications. Arthroscopic procedures are valuable in minimizing preoperative symptoms.