Objective To investigate the application of 3D printing technique in the treatment of obsolete pelvic and acetabular fractures.Methods The clinical data of 23 patients with obsolete pelvic and acetabular fractures were retrospectively analyzed who had been surgically treated in our hospital from January 2006 through January 2016.3D printing technique was used in surgical planning in 11 of them,including 8 males and 3 females,with an average age of 33.8 ±4.9 years (3D group).The other 12 patients received conventional surgery without using 3D printing technique.They were 9 males and 3 females,with an average age of 34.8 ± 8.3 years (conventional group).The primary pelvic fractures in both groups were all type C according to the Tile classification system.The patients complicated with acetabular fracture in the 3D group and the conventional group were 10 and 11 cases respectively.The operative time,blood loss,blood transfusion.intraoperative fluoroscopy,visual analogue score (VAS) and Majeed score were compared between the 2 groups.Results The 2 groups were compatible in terms of preoperative general data (P ＞ 0.05).For the 3D group and the conventional group,operative time was 166.4± 24.2 min versus 222.5 ± 49.0 min.blood loss 2,063.6 ± 484.3 mL versus 2,700.0 ± 597.0 mL,blood transfusion 13.2 ± 3.2 U versus 17.6 ± 4.5 U,and intraoperative fluoroscopy 7.4 ± 1.3 times versus 11.7 ± 3.6 times.There were significant differences between the 2 groups in the above indexes (P ＜ 0.05).The 3D group and the conventional group obtained an average follow-up of 18.4 months and 21.7 months,respectively.The postoperative VAS scores were respectively 1.8 ±-0.9 points and 3.4 ± 1.0 points for the 2 groups,showing a significant between-group difference (P ＜0.05).The Majeed scores at the last follow-ups were respectively 85.7 ± 4.2 points and 84.9 ± 3.1 points for the 2 groups,showing no significant between-group difference (P ＞ 0.05).There were no such complications in the 3D group as iatrogenic nerve injury,vascular injury,nonunion or internal fixation failure.One patient in the conventional group suffered transient iatrogenic injury to the sciatic nerve.Conclusions 3D printing technique can provide helpful guidance for diagnosis and fracture classification preoperatively.It improves the patient's perioperative safety by benefiting intraoperative reduction,shortening operative time,and reducing intraoperative blood loss and intraoperative fluoroscopy.

Objective To investigate the effects of erythropoietin (EPO) on myocardial apoptosis and protein kinase B (AKT) expression in rats of chronic heart failure (CHF). Methods Thirty male adult SD rats were randomly divided into two groups, sham-operated (Sham) group (n=6) and model (Model) group (n=24). The abdominal aortic coarctation was used to build CHF model. Sixteen survived rats after operation were randomly divided into two groups including EPO group and con-trol (Control) group. EPO group was received 3 000 U/kg EPO intraperitoneal injection 3 times/week for 4 weeks, and Sham group and Control group were received same volume of normal saline. The echocardiography was used to evaluate cardiac function after 4 weeks, 8 weeks and 12 weeks of treatment. After 12 weeks, all rats were sacrificed after 24 h fasting. The cell morphology and myocardial apoptosis were observed, and apoptosis index (AI) was calculated. Myocardial P-AKT/AKT pro-tein expression was detected by Western blot assay. Results Echocardiography showed that ventricular hypertrophy was found in model group after four weeks, heart failure 8 weeks. Compared with Control group, left ventricular ejection fraction (LVEF) was significantly higher after EPO intervention for 4 weeks (P < 0.05), systolic interventricular septum thickness (IVSs), end-systolic left ventricular posterior wall thickness (LVPWs), diastolic interventricular septum thickness (IVSd), af-ter left ventricular end-diastolic wall thickness (LVPWd) were significantly lower (P<0.05). The value of AI was significant-ly lower in EPO group than that of Control group (23.87%±1.45%vs 35.58%±2.81%, P<0.01). The OD value of P-AKT/AKT was significantly decreased in Control group (0.35±0.06) than that of Sham group (0.81±0.17), the value was significant-ly increased in EPO group (1.61±0.16) than that of Control group (P<0.01). Conclusion EPO can improve heart function, inhibit myocardial apoptosis,and promote pro-phosphorylation of AKT in rats with chronic heart failure.

Type 1 diabetes mellitus(T1DM)is a disease that seriously harms children′s health.It often occurs in childhood and is a major public health problem all over the world.T1DM can cause damage to multiple systems including nervous, circulatory, urinary systems, etc.The etiology, prevention and treatment of T1DM have become a research hotspot.With the deepening of researches, the influence of T1DM on cognitive function in children has attracted increasing attention.T1DM can damage the brain structure, neurological development and cognitive function of children, influencing intelligence, attention, memory, executive function, etc.This paper reviews the recent researches between T1DM and cognitive function of children, so as to improve the awareness of pediatricians.

Objective To explore the feasibility of tubeless 2 μm laser vaporesection in treating pediatric ureter cysts by ureteroscopy.MethodsClinical data of 33 ureter cysts patients who received tubeless 2 μm laser vaporesections by ureteroscopy were reviewed. The median age of patients was 4 years with a range from 1 to 7 years. The operations were carried out by RevoLix 2 μm laser through ureteroscopy without ureter stents and catheters indwelling.ResultsAll operations were successfully performed. And no serious complications occurred after the operations.ConclusionsTubeless transurethral 2 μm laser treatment by ureteroscopy was a superior micro-invasive surgery method for pediatrics with ureter cysts, with advantages of little blood loss, high safety, convenient operation and infrequent complications.

Objective: To analyze the clinical features of dyslipidemia in patients with primary biliary cholangitis (PBC). Methods: The clinical and laboratory data of 136 PBC patients in Peking Union Medical College Hospital from 2010 to 2016 were retrospectively analyzed.The liver function was compared between patients with normal and abnormal blood lipids. Results: Among 136 PBC patients, 100(74%)had abnormal serum lipids. The incidence of increased cholesterol, low-density lipoprotein and triglyceride was 61%(59/96), 58%(48/83) and 47%(46/97), respectively; while that of reduced HDL-C was 26%(21/82). The incidences of pruritus [26%(26/100) vs. 8%(3/36), χ²=4.93, P=0.032], serum total bilirubin (TBIL) [17.3(12.2, 28.2) μmol/L vs. 14.5 (9.4, 21.1) μmol/L, Z=2.25, P=0.024], direct bilirubin (DBIL)[5. 5 (3.4, 12.4) μmol/L vs. 4.4(2.9, 7.1) μmol/L, Z=2.00, P=0.045], and glutamyl aminotransferase (GGT)[193.0(64.3, 454.8)U/L vs. 105.5(53.5, 179.5)U/L, Z=2.02, P=0.043], alkaline phosphatase(ALP)[183(86, 351)U/L vs. 135(85, 188) U/L, Z=1.98, P=0.048] in PBC patients with dyslipidemia were significantly higher than thosein patients with normal serum lipids.Pearson regression analysis showed that in PBC patients with dyslipidemia, the ALT was positively corrected with TG and TC(r=0.248 and 0.272, P=0.015 and 0.008); ALB was positively correlated with LDL-C(r=0.335, P=0.002); DBIL was positively corrected with HDL-C(r=0.252, P=0.022); TC was positively correlated with ALP and GGT(r=0.313 and 0.346, P=0.002 and 0.001); GGT was positively correlated with LDL-C(r=0.251, P=0.022). Conslusion Increased TC and LDL-C were more common in PBC patients. PBC patients with dyslipidemia have more severe liver damage than the patients with normal serum lipids.

OBJECTIVETo investigate the survival and development conditions of community-based organizations (CBOs) for HIV/AIDS prevention and control among men who have sex with men (MSM) in Chinese cities including Shanghai, Hangzhou, Chongqing.

METHODSThis study employed both qualitative (focus groups) and quantitative (questionnaire survey) methods to obtain information from 15 MSM CBOs in three Chinese cities.

RESULTSThe mean work time of the 15 CBOs for HIV/AIDS prevention and control among MSM was 6.7 years (2.1-11.3 years), and the majority of their funds was from international cooperation projects (80 447 000 RMB, 73.0%) from 2006 to 2013. The survival cost of MSM CBOs apart from expenditure of activities was 2 240-435 360 RMB per year. As it was shown in the graph, the survival and development of MSM CBOs was closely related to the development of international cooperation projects. There was a few small size MSM CBOs taking part in the prevention and control of HIV/AIDS and their work content was limited before 2006. From 2006 to 2008, some international cooperation projects were launched in China, such as the China Global Fund AIDS project and the China-Gates Foundation HIV Prevention Cooperation program. As a result, the number of MSM CBOs was increased sharply, and both the scale and 2012, the performance of these programs further promote the establishment of new MSM CBOs and the development of all MSM CBOs with regard to the work places, full-time staffs, work contents, work patterns and the specific targeted population. After 2012, most international cooperation programs were completed and the local department of disease prevention and control continued to cooperate with MSM CBOs. However, the degree of support funds from the local department was different among different regions. Where the funds were below the half of program funds, the development of MSM CBOs ceased and work slowed down. Besides, there were still some constraints for the survival and development of MSM CBOs, such as insufficient funds, no legitimate identity, the outflow of talents and the unsustainable development.

CONCLUSIONThe survival and development of MSM CBOs was closely related to the development of international cooperation projects in China. Some departments of disease prevention and control took over the cooperation with MSM CBOs when the international cooperation projects were completed. Given the survival cost of MSM CBOs and the constraints of MSM CBOs development, it needs further investigation on how to ensure the local departments of disease prevention and control to take over the cooperation with MSM CBOs and how to cooperate with MSM CBOs.

Acquired Immunodeficiency Syndrome ; China ; Cities ; Communicable Diseases ; Community Health Services ; Financial Support ; HIV Infections ; Homosexuality, Male ; Humans ; International Cooperation ; Male ; Organizations, Nonprofit

OBJECTIVETo understand the syphilis infection and its high risk factors among men who have sex with men (MSM) recruited from different channels.

METHODSSupported by the China-Gates Foundation HIV program from July to December 2011, we cooperated with community based organizations to conduct syphilis testing intervention among MSM from 14 cities (Beijing, Shanghai, Tianjin, Chongqing, Harbin, Shenyang, Qingdao, Xi'an, Nanjing, Wuhan, Hangzhou, Changsha, Kunming, and Guangzhou) and one province (Hainan province). Participants were recruited from different channels by the staff of local CBOs, Demographic (e.g. age, marital status, and education) and behavioral (e.g. condom use and sexual partners) data were collected using anonymous questionnaires. Blood samples were also collected to test for syphilis. A total of 34 100 MSM participated in the survey. Participants were excluded from data analysis (1 399, 4.1%) if they did not receive syphilis tests or they completed less than 80.00% of the key questions in the survey. Chi-square tests were used to understand the socio-demographic and behavioral differences between each group. Results of syphilis tests were also compared. Logistic regression models were used to test the statistical significance of these differences.

RESULTSA total of 32 701 MSM were enrolled and received syphilis testing. The average age of participates was 30.96 ± 9.57. And among them, 2 284 cases (7.0%) were recruited from gay bathhouses, 4 774 (14.6%) from gay bars, 6 266 (19.2%) from the internet, 1 997 (6.1%) from the parks/toilets and 17 380 (53.1%) from other channels. MSM recruited from the bathhouses had the highest syphilis infection rate than other 4 groups: gaybars (4.5%, 216/4 774), internet (6.7%, 422/6 266), parks/toilets (8.3%, 166/1 997), other channels (6.4%, 1 103/17 380) (χ² = 164.58, P < 0.001). The multivariate logistic regression analysis showed that being > 20 years of age (P < 0.001), having more than 2 homosexual partners in recent 3 months (8.0% (1 408/17 714), OR (95% CI) = 1.44 (1.04-1.98)), having no sex with females in past 3 months (6.8% (1 446/21 276), OR (95% CI) = 1.25 (1.07-1.46)), and not using condom at last anal sex (8.0% (769/9 668), OR (95% CI) = 1.13 (1.03-1.25)) were associated with a higher probability of being infected with syphilis. Whereas MSM married (7.2% (456/6 305), OR (95% CI) = 0.84 (0.73-0.98)), having a college or a higher education (5.3% (829/15 684), OR (95% CI) = 0.60 (0.53-0.67)), being local residents (6.5% (1 843/28 185), OR (95% CI) = 0.73 (0.61-0.87)) and living in the local province of project cities (6.6% (170/2 593), OR (95% CI) = 0.67 (0.53-0.85)) were protective factors.

CONCLUSIONMSM who were recruited from gay bathhouses have a higher rate of syphilis infection than those in channels relatively. They are older, with low education levels and high-risk sexual behaviors. Tailored interventions are required in the future, especially for MSM from gay bathhouses.

Adult ; China ; Condoms ; Demography ; Homosexuality, Male ; Humans ; Logistic Models ; Male ; Risk Factors ; Safe Sex ; Sexual Behavior ; Sexual Partners ; Surveys and Questionnaires ; Syphilis ; Universities

Objective ToexplorethevalueofMRIinthediagnosisofcoronaryarteryandmyocardiallesionsinchildrenwithKawasaki disease.Methods CardiacMRIof38patientswithKawasakidiseasewereretrospectivelyanalyzed.MRIsequencesincludedthree dimensionalsteady-statefreeprecession (3D-SSFP)coronaryarteryimaging,first-passperfusiontoassessmyocardialischemia,late gadolinium-enhancedmagneticresonanceimaging(LGE-MRI)toassessmyocardialhistologyfeatures,and2D-SSFPcinesequenceto evaluatecardiacfunction.Themaximumdiametersofcoronaryaneurysmsmeasuredin3D-SSFPwerecomparedwiththosemeasured inechocardiography(ECHO)byBland-Altmananalysis.Results Amongthe38cases,therewere28cases(73.7%)withaneurysmal dilatationinrightcoronaryartery(RCA)orleftcoronaryartery (LCA).Thehighestincidenceofaneurysmaldilatationwasinleft anteriordescendingbranch (LAD)in23cases,andfollowedbyRCAin19cases.ThemaximumdiameterofRCAaneurysm (7.66± 2.10)mm washigherthanthatofLADaneurysm (6.11±1.96)mm withP＜0.05.Myocardialfirst-passperfusionin5casesshowed leftventricularandventricularseptumsubendocardialischemia,LGE-MRIin5casesshowedmyocardialdelayedenhancementinleft ventricularfreewallandventricularseptum,andtheleftventricularejectionfractionsin4caseswerelessthan50%,withanaverage of(34.0±15.9)%.3D-SSFPandECHOshowedgoodconsistencyinthemaximaldiametermeasurementofRCAandLADaneurysm. Conclusion TheimagingfeaturesindifferentsequencesofMRIcanbeusedtocomprehensivelyevaluatethecoronaryarteryand myocardialhistologicalcharacteristicsofKawasakidisease,includingcoronaryaneurysms,thrombosis,myocardialfibrosisandchanges ofventricularfunction.

Objective To summarize the clinical data of macrophage activation syndrome (MAS) in adult-onset Still's disease (AOSD) patients and provide evidence for clinical diagnosis and treatment. Methods We retrospectively reviewed the clinical data of AOSD with MAS patients in the First Affiliated Hospital of Zhengzhou University from January 2012 to August 2018, and compared with patients with AOSD alone. Data were analyzed by t-test, Mann-Whitney U test, x2 test or Fisher exact test. Results A total of 14 AOSD with MAS patients were enrolled, accounting for 7.6％(14/185) of AOSD patients at the same period, including 2 males and 12 females. The median duration of AOSD in MAS was 1.3 (0.25, 4) months. Compared with the AOSD group, the age of onset was younger in the MAS group (t=-2.038, P=0.037), and the proportion of splenomegaly (t=9.020, P=0.003), pericardial effusion (t=8.663, P=0.003), pleural effusion (t=4.754, P=0.029) was higher. The white blood cell count (t=-4.171, P<0.01), hemoglobin level (t=-2.661, P=0.008), platelet count (t=-5.672, P<0.01), neutrophil count (t=-5.082, P<0.01), albumin (t=-3.426, P<0.01), fibrinogen (t=-5.986, P<0.01), ESR (t=-2.941, P=0.003), CRP (t=-2.014, P=0.044) was significantly decreased, ALT (t=-3.227, P<0.01), AST (t=-3.105, P=0.002), triglyceride (t=-5.612, P<0.01), ferritin>2000 μg/L (t=7.833, P=0.005) was significantly increased. Fourteen patients with AOSD complicated with MAS were treated with glucocorticosteroids, 5 with methylprednisolone, 8 with cyclosporine A, 8 with intravenous immunoglobulin (IVIG), 2 with etoposide, and 1 with tocilizumab. After treatment, 11 cases recovered and 3 cases died. Conclusion Younger AOSD patients tend to complicated with MAS, especially at the early course of the disease, and splenomegaly occur more frequently clinically compared to patients without MAS. When blood cell count, fibrinogen and ESR decreases, triglyceride and ferritin levels increases in AOSD patients, the occurrence of MAS is indicated. Timely treatment can improve the prognosis of patients.