Objective: To investigate the epidemiological characteristics of pulmonary tuberculosis in Ningbo City from 2011 to 2020, so as to provide the evidence for developing the control measures of pulmonary tuberculosis. Methods: The data pertaining to pulmonary tuberculosis cases in Ningbo City from 2011 to 2020 were collected from the Tuberculosis Management Information System of the Chinese Disease Control and Prevention Information System. The temporal distribution, population distribution, regional distribution and case report by hospitals were descriptively analyzed. Results: Totally 38 305 pulmonary tuberculosis cases were reported in Ningbo City from 2011 to 2020, with an incidence rate of 48.71/105. The incidence of pulmonary tuberculosis appeared a tendency towards a decline ( P<0.05 ), with an annual reduction rate of 5.29%. There were 15 784 smear-positive cases ( 41.21% ), and the proportion of smear-positive cases appeared a tendency towards a reduction from 2011 to 2015 ( P<0.05 ), and a rise from 2016 to 2020 ( P<0.05 ). The number of reported pulmonary tuberculosis cases peaked from March to May (10 973 cases, 28.65%), and a higher incidence rate of pulmonary tuberculosis was found in men than in women ( 64.55/105 vs. 32.20/105, P<0.05 ). The highest incidence of pulmonary tuberculosis was found in cases at ages of 15 to 25 years ( 72.93/105 ), followed by in cases at ages of 65 years and greater ( 69.97/105 ), and farmers were the predominant occupation among the pulmonary tuberculosis patients ( 12 279 cases, 32.06% ). During the period from 2011 to 2020, pulmonary tuberculosis cases were reported across the 10 districts or counties of Ningbo City, and the top three high incidence of pulmonary tuberculosis were seen in Yinzhou District ( 59.91/105 ), Fenghua District ( 56.19/105 ) and Beilun District ( 56.01/105 ). The proportion of pulmonary tuberculosis cases reported by designated pulmonary tuberculosis hospitals increased from 72.16% in 2011 to 99.74% in 2020 in Ningbo City. Conclusions The incidence of pulmonary tuberculosis appeared a tendency towards a decline in Ningbo City from 2011 to 2020, and the annual decline rate meets the requirements of the WHO strategic goal of ending pulmonary tuberculosis; however, the control measures for pulmonary tuberculosis require to be intensified among men, youths, and farmers.

Objective To evaluate the clinical application of open reduction and internal fixation and bone grafting on treatment of pilon fractures of tibia.Methods Forty cases with Pilon fractures of Ⅱ,Ⅲ tibia who underwent open reduction and intemalfixation and bone grafting treatment were selected as our subjects.Those 40 cases were performed follow-up for 8.0-60.0 months,and average was 31.5 months.The ankle joint symptoms and functional Mazur scoring system were used to evaluate the function of ankle joint.Results Of the 40 patients,15 cases were with excellent ankle function,and 19 cases were good,4 cases were poor and 2 cases were worse.The excellent and good rate was 85％ (34/40).Conclusion Open reduction and internal fixation and bone grafting is proved as the effective treatment on Ⅱ,Ⅲ tibia pilon fractures.

Objective To observe the difference of FKBP-12 expression level between in Alzheimer's disease model mice's brains and in control mice's brains.Methods Taking the Senescence Accelerated Mouse imported from Japan(SAM-P/8)as the Alzheimer's disease model mouse,and SAM-R/1 mouse as control,observe the distribution difference of FKBP-12 between in Alzheimer's disease model mice's brains and in control mice's brains both in mRNA level and in protein level with the methods of RT-PCR and immunohistochemistry staining.The mice were divided into four groups of 4,6,8,10 months old.Results There was no distribution difference of FKBP-12 between in Alzheimer's disease model mice's brains and in control mice's brains both in mRNA level and in protein level.Conclusion FKBP-12 probably has no relativity with the accelerated aging process of the Alzheimer's disease model mice imported from Japan.

Objective To investigate surgical outcomes of treatment of pilon fractures of Ruedi -Allgower types Ⅱ and Ⅲ by raft screws fixation combined with bone grafting.Methods 21 patients with pilon fractures of Ruedi -Allgower types II and Ⅲ received surgery were selected.They were 15 men and 6 women,23 to 68 years of age(average 38.2 years).16 cases were closed and 5 cases open.12 cases were type II and 9 cases type III.Intervals between injury and operation ranged from 7 to 14 days,with 8.5 days on average.All of them were treated with raft screws fixation by plate type L combined with bone grafting.Results All cases were followed up for an average of 12 months(range from 8 to 30 months).Fractures healed from 16 to 24 weeks,with 18.2 weeks on average.According to the Burwell -Charnley radiological criteria,anatomical reduction was achieved in 17 cases,and fair reduction in 4.According to the Mazur clinical criteria,ankle functions were rated as excellent in 8 cases,good in 10 cases,fair in 2 cases and poor in 1 case.The rate of excellent and good was 85.7%.Conclusion Raft screws fixation combined with bone grafting are effective for the pilon fractures of Ruedi -Allgower types II and Ⅲ,preventing articular surface collapse and leading to anatomic reduction,and has stable fixation and early functional rehabilitation.

Objective : To analyze the screening results of Mycobacterium tuberculosis (MTB) and HIV co-infections in Ningbo City from 2012 to 2020, so as to provide insights into improving the tuberculosis control strategy. Methods : Data pertaining to HIV antibody testing among tuberculosis patients, MTB testing among HIV/AIDS patients, treatment of patients with MTB and HIV co-infections and prognosis of anti-tuberculosis therapy were collected from the annual working reports for the management of MTB and HIV co-infections in Ningbo City from 2012 to 2020, and the screening, treatment and prognosis of MTB and HIV co-infections were analyzed. Results : A total of 35 385 newly identified tuberculosis patients were reported in Ningbo City from 2012 to 2020, and there were 5 854 cases receiving HIV testing. The annual mean percentage of HIV screening was 17.57%, and the HIV screening rate appeared a tendency towards a rise in Ningbo City from 2012 to 2020 (χ2trend=4 926.309, P<0.001). Eleven patients were tested positive for HIV, with an annual mean HIV positive rate of 0.19%. A total of 26 043 HIV/AIDS patients received MTB screening, with an annual mean screening rate of 95.78%, and the annual screening rate of MTB appeared a tendency towards a rise in Ningbo City from 2012 to 2020 (χ2trend=79.077, P<0.001). A total of 81 tuberculosis patients were detected, with an annual mean detection rate of 0.31%. Among the 92 patients with MTB and HIV co-infections, there were 81 patients receiving anti-tuberculosis and antiviral therapy simultaneously (88.04%), 8 cases receiving anti-tuberculosis therapy alone (8.70%), 2 cases receiving antiviral therapy alone (2.17%) and 1 case without therapy (1.09%). Among the 89 MTB and HIV co-infected patients receiving anti-tuberculosis therapy, 27 cases were cured (30.34%), 53 cases completing the course of treatment (59.55%) and 7 cases died. Conclusions The MTB screening rate among HIV/AIDS patients and the percentage of MTB and HIV co-infected patients with successful anti-tuberculosis treatment were high in Ningbo City from 2012 to 2020; however, the HIV screening rate should be improved among tuberculosis patients.

ObjectiveTo investigate the clinical efficacy of fire needling plus filiform needles in treating knee osteoarthritis and its effect on the patients’ quality of life.MethodOne hundred and one patients with knee osteoarthritis were randomly allocated to fire needling, filiform needle and combination groups. They were treated with fire needling, filiform needles and fire needling plus filiform needles, respectively. An assessment was made using the WOMAC Osteoarthritis Index and the 36-item Short Form Health Survey (SF-36) in the 101 patients with knee osteoarthritis before and after treatment.ResultFire needling, filiform needles and fire needling plus filiform needles all had a marked therapeutic effect on knee osteoarthritis. The effect of fire needling plus filiform needles was better than those of fire needling and filiform needles (P<0.05,P<0.01). After four weeks of treatment, SF-36 quality of life item sub-scores increased in all the three groups of patients compared with before treatment (P<0.01); SF-36 role physical and general health scores were higher in the combination group than in the fire needling group (P<0.05, P<0.01); SF-36 physical functioning, role physical, general health, social functioning and mental health scores were higher in the combination group than in the filiform needle group (P<0.01).ConclusionFire needling plus filiform needles can effectively treat knee osteoarthritis and improve the patients’ quality of life. Its effects are superior to those of fire needling and filiform needles.

Objective To evaluate the effect of lung protective ventilation strategy on inflammatory responses in brain tissues of elderly patients requiring one-lung ventilation (OLV) during radical resection for esophagus cancer.Methods Sixty patients of both sexes,aged 65-80 yr,weighing 45-75 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective radical resection for esophageal cancer,were divided into volume-controlled ventilation (VCV) group (n =30) and VCV plus protective ventilation strategy group (PV group,n =30) using a random number table.In group VCV,the tidal volume was set at 10 ml/kg during two-lung ventilation (TLV) and at 7 ml/kg during OLV with inspiratory/expiratory ratio 1:2.In group PV,the tidal volume was set at 7 ml/kg during TLV and at 5 ml/kg during OLV with inspiratory/expiratory ratio 1:2 and positive end-expiratory pressure 5 cmH2O,and lung recruitment maneuver was performed every 45 min.End-tidal pressure of carbon dioxide was maintained at 35-45 mmHg,and bispectral index value at 40-60 in both groups.Before induction of anesthesia (T1),at 10 min of TLV (T2),at 30 min of OLV (T3),at 15 min after restoration of TLV (T4) and at 24 h after operation (T5),jugular bulb venous blood samples were taken for determination of serum glial fibrillary acid protein,tumor necrosis factor-α and interleukin-6 concentrations by enzyme-linked immunosorbent assay.The cognitive function was assessed using Mini-Mental State Examination before operation (T0),at T5 and at 3 and 7 days after operation (T6,7).The occurrence of postoperative delirium was recorded.Results Compared with group VCV,the serum concentrations of tumor necrosis factor-α,interleukin-6 and glial fibrillary acid protein were significantly decreased at T3-5,Mini-Mental State Examination scores were increased at T6,7,and the incidence of postoperative delirium was decreased in group PV (P＜0.05).Conclusion The mechanism by which lung protective ventilation strategy decreases the development of postoperative cerebral dysfunction is related to reduction of inflammatory responses in brain tissues of elderly patients requiring OLV during radical resection for esophagus cancer.

Objective To evaluate the predictive value of fracture risk assessment tool (FRAX) for determining fracture probabilities in middle-aged and elderly patients with type 2 diabetes.Methods Retrospective analysis was carried out on 153 type 2 diabetic patients aged over 50 years undergoing dual energy X-ray absorptiometry measurements.Fracture risk factors including age,gender,height,weight,body mass index,history of previous fragility fractures,parental history of hip fracture,history of smoking,excessive drinking,long-term use of steroid hormone,history of rheumatoid arthritis,the history of secondary osteoporosis diseases,and femoral neck T-score of bone mineral density (BMD) were recorded.FRAX scores with BMD (FRAX/BMD) and without BMD (FRAX/-) were calculated.Therapeutic interventions were recommended if the 10-year risk of fractures was more than 3％ for hip osteoporotic fractures and more than 20％ for other major fractures.Subjects were separated into the identical treatment recommendation group and the different treatment recommendation.Fracture risk factors were compared between groups.Results 133 (6.9 ％) patients had identical fracture risk predictions in the FRAX calculation,regardless of whether BMD join in or not.Age,gender and femoral neck T scores had significant differences between the two groups (all P＜0.001),while other risk factors had no statistical differences between the two groups (all P＞0.05).Conclusions In most middle-aged and elderly patients with type 2 diabetes,the FRAX/-provides the same prediction as FRAX/BMD value for predicting fracture risk,which shows that fracture risks can be predicted without bone density examination.The FRAX/-has higher predictive values on fracture for people who are younger,male,and has higher BMD.

Objective To evaluate the effects of lung-protective ventilation on the cerebral oxygen metabolism and postoperative cognitive function in elderly patients requiring one-lung ventilation (OLV).Methods Sixty patients of both sexes,aged 65-80 yr,weighing 45-75 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective radical resection for esophageal cancer performed via video-assisted thoracoscope with general aneshesia,were divided into 2 groups (n =30 each)using a random number table:volume-controlled ventilation group (group VCV) and protective ventilation group (group PV).In group VCV,the tidal volume (VT) was set at 10 ml/kg during two-lung ventilation (TLV) and at 7 ml/kg during OLV.In group PV,the VT was set at 7 ml/kg during TLV and at 5 ml/kg during OLV with positive end-expiratory pressure of 5 cmH2O,and lung recruitment maneuver was performed every 45 min with inspiratory pressure at 15,20 and 25 cmH2O,PEEP 5 cmH2O,3 breaths per pressure,5 s/breath.Before induction of anesthesia (T1),at 10 min of TLV (T2),at 30 min of OLV (T3) and at 15 min after restoration of TLV (T4),blood samples were taken from the radial artery and jugular bulb for blood gas analysis,and pH value,arterial oxygen partial pressure (PaO2),arterial carbon dioxide partial pressure (PaCO2),arterial oxygen saturation (SaO2) and jugular venous oxygen saturation (SjvO2) were recorded.Oxygenation index (OI),intrapulmonary shunt (Qs/Qt),arteriovenous blood O2 content difference (Da-jvO2) and cerebral O2 extraction rate (CERO2) were calculated at the same time.Cognitive function was assessed using Mini-Mental State Examination at 7 days and 1 month after operation,and the development of postoperative cognitive dysfunction was recorded.Results PaO2,DajvO2,CERO2 and Qs/Qt were significantly higher and SjvO2 and OI were lower at T2-4 than at T1 in two groups (P＜0.05).PaO2,SjvO2 and OI were significantly lower and Qs/Qt and CERO2 were higher at T3 than at T2,and Da-jvO2 was higher at T3-4 than at T2 in two groups (P＜0.05).Compared with group VCV,PaO2,PaCO2,SjvO2 and OI were significantly increased and Qs/Qt,Da-jvO2 and CERO2 were decreased at T3,the Mini-Mental State Examination scores were increased on postoperative day 7,and the incidence of postoperative cognitive dysfunction was decreased in group PV (P＜O.05).Conclusion Lungprotective ventilation is helpful in improving postoperative brain function of elderly patients requiring OLV.

Objective: To observe the effects of acupuncture on synovial pathology, synovial mast cell degranulation and tryptase expression and to investigate the relationship between the functions of mast cells and effects of acupuncture on early adjuvant arthritis in rats. Methods: Forty-six male Wistar rats were randomly divided into normal control group (n=16), untreated group (n=15) and acupuncture group (n=15). Adjuvant arthritis was induced by injection of 0.1 mL Freund's complete adjuvant in right hind limb footpad. Normal control group and untreated group received no acupuncture treatment, while rats in the acupuncture group were treated with sterilized disposable stainless steel needles inserted perpendicularly as deep as 2 to 3 mm at Xuanzhong (GB39), 6 mm at Shenshu (BL23) and 7 mm at Zusanli (ST36) for eight times (15 min each time) every two days. Setting the modeling day as the 0 day of the experiment, the body weight and paw volume of the rats were measured every three days from the 0 day. In the end, synovial tissues of the right hind ankles were sampled and made into paraffin sections. Then they were firstly stained with hematoxylin-eosin for observing synovial pathology to evaluate the effects of acupuncture on adjuvant arthritis, then stained with toluidine blue for observing the number and degranulation ratio of synovial mast cells and finally detected by immunohistochemical staining method to investigate the expression of tryptase in synovium. Results: Compared with the untreated group, the body weight of rats in the acpuncture group was increased significantly (P<0.05), while the paw volume decreased obviously (P<0.01). Hematoxylin-eosin staining showed that acupuncture significantly inhibited inflammatory cell infiltration, synovial cell hyperplasia, and synovial fibroplasia in synovium of rats with adjuvant arthritis as compared with the untreated group (P<0.05). Toluidine blue staining showed that acupuncture could significantly diminish the numbers of total and degranulated mast cells in rats with adjuvant arthritis (P<0.01), which were significantly higher in the untreated group than in the normal control group (P<0.01). Showing by immunohistochemical staining, the expression of tryptase in synovium in the acupuncture group was decreased as compared with the untreated group (P<0.01). Analyzed by Spearman's bivariate correlation, the number of mast cells and degranulation ratio of mast cells were positively correlated with the pathological scores (r=0.837, P<0.01; r=0.634, P<0.01). Conclusion: Acupuncture can improve pathological condition of inflammatory synovium in rats with early adjuvant arthritis by inhibiting the function of synovial mast cells, which may play an important underlying role in the immunoregulation of acupuncture on adjuvant arthritis.