Objective To investigate the effect of intravenous injection of tranexamic acid on reducing bleeding effect in invasive total hip replacement.Methods In our hospital from April 2015 to April 2016, 50 cases of total hip joint replacement patients as the object of study, patients were randomly divided into observation group and control group, 25 cases in each group.The control group were injected with 0.9% NaCl injection;observation group received intra-articular injection of tranexamic acid after suture, the transfusion volume of blood, complications, hemoglobin concentration, and rate of blood transfusion were compared between the two groups.Results The rate of blood transfusion in the control group was 52.0%, significantly higher than that of the observation group (24.0%), and the difference was statistically significant (χ2 =4.16, P<0.05).The drainage (260.1 ±78.6) mL and transfusion volume (230.8 ±60.1) mL in observation group were better than control group (370.04 ±56.2)mL and (380.2 ±40.6)mL,with statistical significance (P <0.05).The hemoglobin concentration in observation group was lower than control group(P <0.05).There were 2 cases of hematoma, 5 cases of paining in observation group and 3 cases of hematoma, 6 cases of paining in control group, with no statistical significance (χ2 =0.368, P>0.05).Conclusion Tranexamic acid is the main method for prevention of postoperative bleeding, but could not reduce postoperative complications.

Currently,independent clinical medial femoral plate is more needed to apply in more complex C3 distal femoral fractures and knee valgus orthopedic surgery.The doctors always pre-bent the contralateral femoral lateral plate in order to achieve close to the natural shape of the bone.The cold deformation of the plate can change the metallographic structure and the biomechanics,and the position of the screw holes in the plate may also affect the healing of fractures.Compared with traditional manufacturing techniques,3D printing technology as a core technology in third industrial revolution,instead prior manufacture of molds,removing the large amount of material in the manufacturing process and the complex process of forging a final product,it is more suitable for difficult to machine materials,manufacture,inspection shape design,assembly,testing and fast reverse engineering.Therefore,a personalized interior distal femoral plate with 3D printing technology was designed,and the application of the plate,the current situation and prospects of 3D printing technology and other aspects were summarized in this article.

Objective:To investigate the pathway of C.albicans-induced murine thymocyte apoptosis.Methods:The chages of TNF-? level in murine plasma and caspase-3 activity were measured by ELISA and flurorescence spectrophoto meter respectively;FCM measurement was adopted for the expression levels of related genes.Results:The level of TNF rise,the caspase-3 activity serengthen significantly and bax,p53 gene expression are upregulated.Conclusion:It is possible that C.albicans elicits apoptosis in murine thymocytes by upregulating bax and p53 gene expression as well as raising the serum TNF-? level to strenghen the activity of caspase-3.

Objective To improve the selection of flying cadets of the Air Force of People′s Liberation Army of China ( PLAAF) by analyzing the differences of medical identification of lumbar spondylolysis between PLAAF and the US Air Force ( USAF) .Methods Flight crew who had been checked for lumbar spondylolysis during hospitalization at the Air Force General Hospital between 2013 and 2015 were chosen.The results of their medical identification were compaired according to PLAAF and USAF Medical Standards Directory, and their differences and possible reasons were analyzed accordingly.Results The qualified rate of PLAAF was about 85%, which was very close to the standards of USAF, but the difference was not of any statistical significance(P>0.05).Conclusion The standards of our medical identification of lumbar spondylolysis was similar to those of USAF, suggesting that the selection of flying cadets can be improved.

Objective To investigate the effects of continuous end-eiastoloc volume index(CEDVI) adjusted by right venteicular ejection fraction(RVEF) in using for volume resuscitation of critically ill patients.Methods 51 critically ill patients who Swan-Ganz volume pulmonary artery catheters were inserted in via right internal jugular or subclavian vein underwent fluid therapy.Fluid was infused according to the relationship of RVEF and CEDVI.And the relationship of RVEF and CEDVI was that when RVEF was 0.2,0.3,0.35,0.4 and 0.5,respectively,CEDVI is 200～400ml/m~2,150～180ml/m~2,125～150ml/m~2,100～120ml/m~2,50～60ml/m~2 respectively.When RVEF is

Objective To analyze the characteristics of the dynamic changes of the radiological X-ray images in chest after applying a pulmonary surfactant(PS) named curosurf to hyaline membrane disease in grade Ⅲ～Ⅳ of the premature lungs,and to study the clinical values of the follow-ups with chest films after applying PS to evaluate its effects and to detect the complications in chest. Methods To review the definite cases of HMD in grade Ⅲ～Ⅳ with final clinical and radiological diagnosis so as to analyze the radiological image manifestations in ehest after applying PS to the premature lungs for half an hour, for 6 hours,for 24 hours, for 48 hours and for 5 days. Results Shortly after the application of PS,according to the chest films,just half an hour later, 15 cases improved their degrees of the transmittance of the two lungs; 16 cases progressively ameliorated their manifestations in chest, taking the turn for the better than the previous images; 5 cases had no improvement, among which 1 developed a complication of pulmonary hemorrhage,and 3 developed pulmonary air leakage; 3 eases accompanied with pulmonary inflammation-like lesions; 11 cases presented patent arterial duets(PDA). Generally speaking, the X-ray image manifestation was the same as the clinical symptoms. Conclusion A dynamic observation of the X-ray films in chest after the application of PS is able to make a correct iudgement of the lesions of HMD in grade Ⅲ～Ⅳ,and can promptly detect its complications if taking a short-term review.

BACKGROUND:The living standard of farmers and herdsmen in Xinjiang Uygur Autonomous Region, China is significantly lower than that of urban residents in general. Meanwhile, the shortage of doctors and medicines and lack of medical knowledge are the main reasons for local farmers and herdsmen to suffer from knee osteoarthritis. Most of the farmers and herdsmen are not aware of or prevent knee osteoarthritis in the early days to remove pathogenic factors, which results in a serious condition at the time of their medical treatment. OBJECTIVE: To investigate the main pathogenic factors of knee osteoarthritis in Uygur, Kazakh and Han populations in pastoral areas of northern Xinjiang Uygur Autonomous Region, China.METHODS:The permanent residents of Uygur, Kazakh and Han ethnic groups in northern Xinjiang, China who met the criteria were selected by the method of stratified, multistage and cluster random sampling during June 2012 to October 2014. The investigation of knee osteoarthritis was conducted among al the residents who meet the inclusion criteria using the method of home scene closed questionnaire. X-ray lateral plain film examination of the knee joint was performed among the patients presenting with the symptoms of knee osteoarthritis. The database was established. The multi-factor and unconditional Logistic regression analysis was conducted among the 40 variables using SPSS 20.0 software. RESULTS AND CONCLUSION:The 3 402 of 3 540 questionnaires were valid. The Logistic regression analysis suggest that the common pathogenic factors in Han, Uygur and Kazakh ethnic groups are associated with older ages, female gender, high body mass and drink alcohol. Smoking, history of internal disease, high education level, standing position, climbing, trauma, family history, fried food, housing conditions and amenorrhea, different nationalities, churchgoing of ethnic minorities are also the major risk factors. Among the three ethnic groups, the prevalence of female patients in Uygur and Kazak ethnic groups is significantly higher than that of Chinese Han nationality. The morbidity is different among these three nationalities. The dietary preferences cannot be determined as the related influencing factor of knee osteoarthritis. Whether the means of transportation, residence climate and environment, the number of pregnancies and deliveries, drinking tea or not, the type of tea are related to knee osteoarthritis remains unclear.

Objective To investigate the value of dual-phase 18F-FDG PET/CT for differentiating pancreatic cancer from pancreatitis.Methods Dual-phase 18F-FDG PET/CT scanning was prospectively performed on patients with suspicious pancreatic lesions.Patients with solid focal pancreatic lesions proved by histopathology or clinical follow-up were enrolled and divided into 3 groups according to the maximum diameter of the focus: ≤2.0 cm (group A), >2.0 cm and ≤ 4.0 cm (group B), >4.0 cm (group C).SUVmax at (60±10) min and (120±15) min after FDG injection was defined as early and delayed SUVmax (SUVearly and SUVdelayed), respectively, and retention index (RI) was calculated.The differences of SUVearly, SUVdelayed and RI between pancreatic cancer and pancreatitis were analyzed with Mann-Whitney u test.ROC curve was used to determine the optimal cutoff values of the above three parameters and corresponding diagnostic efficiencies were obtained.The AUC was compared with MedCalc software.Results A total of 196 patients (152 pancreatic cancers and 44 pancreatic inflammatory lesions) with solid focal pancreatic lesions were enrolled.The AUC of SUVdelayed was significantly larger than that of SUVearly (0.83 vs 0.79, z=3.64, P<0.01).Numbers of patients in group A, B and C were 45, 96 and 55 respectively.There was no significant difference of the maximum diameter between pancreatic cancers and pancreatitis lesions in all three groups (z values:-0.39,-1.52,-1.41, all P>0.05).The SUVearly, SUVdelayed and RI of pancreatic cancers were all higher than those of pancreatitis in group A and B (z values: from-4.59 to-3.00, all P<0.01).The diagnostic sensitivity and accuracy of SUVearly > 3.6 combined with RI > 0 for diagnosing pancreatic cancer were higher than those of SUVearly > 3.6: 96.4%(27/28) vs 75.0%(21/28), 95.6%(43/45) vs 82.2%(37/45).The AUC of SUVdelayed was significantly larger than that of SUVearly in group B (0.81 vs 0.77, z=2.06, P<0.05).The optimal cutoff value of SUVdelayed in group B was 5.3, with the corresponding sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 84.4%(65/77), 13/19, 91.5%(65/71), 52.0%(13/25) and 81.2%(78/96), respectively.RI of pancreatic cancers was significantly higher than that of pancreatitis (25.0%(15.8%-35.7%) vs 14.4%(4.6%-18.7%), z=-2.39, P<0.05) in group C.The optimal cutoff value of RI in group C was 19.0%, with the corresponding sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 68.1%(32/47), 7/8, 97.0%(32/33), 31.8%(7/22) and 70.9%(39/55).Conclusions The SUVdelayed and RI of dual-phase 18F-FDG PET/CT might be useful for diagnosis of pancreatic tumors.SUVearly > 3.6 combined with RI >0 could be helpful to improve the diagnostic sensitivity and accuracy in patients with the maximum diameter of lesions ≤2.0 cm.The diagnostic value of SUVdelayed might be better than that of SUVearly in patients with the maximum tumor diameter of >2.0 cm and ≤4.0 cm.Only RI could be used for diagnosing pancreatic tumors in patients with the maximum tumor diameter > 4.0 cm.

Objective To analyze clinical and pathological features of dermatomyositis with panniculitis as a skin manifestation.Methods Clinical data were collected from 9 cases of dermatomyositis with panniculitis as a skin manifestation in Department of Dermatology of Zhongshan Hospital affiliated to Fudan University from October 2012 to July 2016,and their clinical and pathological features were analyzed.Results Of the 9 cases,6 were female and 3 were male,and the age ranged from 28 to 73 years.Panniculitis lesions of the 9 patients all manifested as painful indurated plaques or nodules on the buttock,thigh,waist,back,abdomen,upper extremities and cheeks.These lesions occurred before,after or simultaneously with the onset of characteristic skin and muscle lesions of dermatomyositis,especially preceded the onset of characteristic lesions of dermatomyositis by 30 years in 1 case.Histopathological examination of lesions showed liquefaction degeneration of basal cells,inflammatory infiltration of lymphocytes and plasma cells around blood vessels,in the fat lobules as well as between the lobules and septa in the dermis.The necrosis and calcification of lipocytes,lipomembranous changes,fibrinoid necrosis of damaged vessel walls and microvascular occlusion were observed in some cases.Because panniculitis preceded the onset of characteristic lesions of dermatomyositis,2 patients were misdiagnosed with lupus panniculitis and morphea profunda for several times.Most patients had good response to systemic glucocorticoids combined with immunosuppressive agents,while the patients with lipomembranous fat necrosis had poor response to the combination therapy.Conclusions Panniculitis lesions of dermatomyositis are histologically characteristic,and may do not coincide with the onset of characteristic lesions of dermatomyositis.If panniculitis lesions precede characteristic lesions of dermatomyositis,patients will be easily misdiagnosed.Thus,persistent follow-up visit will be of great importance for the diagnosis.

Objective To analyze the security and effectiveness of the accurate resection and reconstruction of pelvic tumor with computer navigation and to evaluate the feasibility of pelvic ring structure and mechanics reconstruction using finite element analysis.Methors From December 2008 to June 2010,tumor resections assisted by computer navigation technology and pelvic reconstructions with assembly prosthesis designed by finite element analysis were performed in 12 patients with internal hemi-pelvic malignant tumors.There were 8 male and 4 female patients,with the average age of 39.7 years(range,25-53).The malignant tumors involved chondrosarcoma(4 cases),osteosarcoma(2),Ewing sarcoma(2),malignant fibrohistiocytoma(1),and metastatic tumor(3,in which including renal cell carcinoma 1 case,thyroid carcinoma 1,and breast carcinoma 1).According to Enneking staging classification,there were 1 case in Ⅰ A,2 cases in ⅠB,2 cases in Ⅱ A.and 4 cases in Ⅱ B.The local recurrence of tumor and functional results were followed up postoperatively.Results There were no nerves,vessels and pelvic organs injuries intra-operatively.The postoperative X-rays showed that the excised regions were proper to the preoperative schedule and en bloc resections were performed in all patients.All assembly prostheses were in satisfactory position.and the screw fixation was accordance with the finite element biomechanical analysis.All the cases were followed up for average 18.2 months (range,8-26).There were 1 case with local recurrence and pulmonary metastasis,1 case with deep infection,and 1 case with deep vein thrombosis.No prosthesis dislocation,loosening,breaking,and limb length discrepancy occurred in all patients.The average MSTS93 functional score was 70%in all patients at 6 months,and 68 % in 6 patients at 20 months follow.up.Conclusion The resection and reconstruction of pelvic tumor assisted by computer navigation is a safe and effective procedure.The finite element analysis can provide accurate biomechanical guidance to the reconstruction of pelvic ring.