Objective To understand the current status of Toxoplasma gondii(TOX)infection among pregnant women and to explore the risk factors in some areas of Lhasa City,Tibet. Methods From 2015 to 2016,3 districts(counties)of Lhasa City were chosen as the investigation sites,and 200 pregnant women in each district(county)were selected as the investigation objectives. Meanwhile,450 pregnant women from Xuzhou,Yangzhou,Wuxi cities in Jiangsu Province were chosen as the con?trol. Then the blood samples of the pregnant women both in Lhasa and Jiangsu were detected by ELISA for TOX antibodies IgG , IgM,and the detection results were analyzed and compared. In addition,the individual information of the pregnant women in Lhasa City was surveyed by questionnaires,and the related risk factors of TOX infection were analyzed. Results Among 600 pregnant women investigated in Lhasa City,there were 99 pregnant women with positive TOX antibodies,and the positive rate was 16.50%,which was significantly higher than that(5.11%)of the pregnant women in Jiangsu Province(P<0.05). There was no statistically significant difference among the 3 districts(counties)of Lhasa City in the positive rates of pregnant women (P>0.05). The positive rates of the women who preferred raw meat or had the intimate contact with animal were high. Conclu?sions Compared with Jiangsu Province,the infection rate of TOX among pregnant women in Lhasa City is high. Therefore,the comprehensive measures including health education,early examination and treatment should be taken actively,so as to prevent and control TOX infection in this area.

Objective:To analyze the operation technique and the methods to avoid early complications on the learning curve for bilateral direct anterior approach (DAA) total hip arthroplasty (THA).Methods: We retrospectively studied a series of continued cases with bilateral avascular necrosis of the femoral head (AVN) or degenerative dysplastic hip and rheumatoid arthritis that were treated by DAA THA in Beijing Jishuitan Hospital.A total of 22 patients with 44 hips were analyzed from June 2014 to August 2016 in this study.There were 17 males and 5 females,and the median age was 48 years(range: 34-67 years).All the surgery was done by DAA method by two senior surgeons.The clinic characters,early surgery treatment results and complications were analyzed.Results: We used the cementless stems in all the cases.The average operating time was (167±23) min;the average blood loss was (775±300) mL;the blood transfusion was in average (327±341) mL;the wound drainage in average was (111±73) mL Most of the patients could move out of the bed by themselves on the first day after operation,5 patients could walk without crutches on the first operating day,and 13 patients could squat on the third days after operation.The patients were discharged averagely 4 days after operation.We followed up all the patients for averagely 16 months (range: 8-24 months).There was no loosening or failure case in the latest follow up.In the study,2 patients had great trochanter fracture,2 patients had thigh pain,4 patients had lateral femoral cutaneous nerve palsy,and 3 patients had muscle damage.The Harris scores were improved from 29±8 preoperatively to 90±3 postoperatively (P<0.01).Conclusion: The DAA THA can achieve faster recovery and flexible hip joint after operation.However it is a kind of surgery with high technique demanding.Carefully selected patients,and skilled technique,can help the surgeon avoid the early complications.It is associated with high complication rate in the learning curve for bilateral DAA THA.

Objective:To evaluate the effectiveness of conducting multiple arthroplasty to treat multiple joints disease in terms of quality of life ( QOL) and function improvement.Methods:We compared our results with the reported results of single and dual arthroplasty to see if there is any improvement in QOL, functional scores or complications.In this study, 13 patients admitted to Department of Adult Reconstruc-tive Surgery, Beijing Jishuitan hospital from 2005 to 2009 were included.Questionnaires SF-36 were used to evaluate the QOL.Harris hip score, American Knee Society Score ( KSS) were used to evaluate the joint function.The patients were evaluated before surgery to the latest follow up.Results:SF-36 has changed as follow:physical function 4.17 ±14.43→65.83 ±24.76, role physical 25.00 ±26.11→60.42 ±45.8, bodily pain 23.83 ±21.41→76.88 ±20.89, general health 53.33 ±33.87→76.67 ± 14.67, vitality 50.42 ±17.25→71.67 ±16.28, social functioning 29.17 ±33.50→73.96 ±33.90, role emotional 22.08 ±35.61→77.77 ±41.03, mental health 53.33 ±25.70→82.67 ±14.41, which indicated that they all improved greatly after the surgery ( P <0.05 ) .Harris score increased from 37.68 ±14.71 before the surgery to 83.36 ±13.54 after the surgery.KSS has also showed sharp im-provement (P<0.001) in both clinical score (42.52 ±23.83→77.74 ±20.67) and function score (-2.61 ±22.56→65.65 ±30.76).Conclusion:Multiple arthroplasty is one of the most effective me-thods which can markedly improve the quality of life in patients with multiple joints disease.But compli-cations are common and joint functions are relatively poor.

Through analyzing the problems of time,selection mode,research plan,and tracking review in the ethical review of scientific research projects,this paper put forward the corresponding countermeasures:standardized application procedures,diverse selection mode,standardized research plan,and strict tracking review.It aimed to improve the quality of ethical review of scientific research projects and improve the ethical review system.

Objective To investigate the characteristics and risk factors for allogeneic transfusion after unilateral total knee arthroplasty (TKA).Methods 852 patients (663 female and 189 male) underwent primary unilateral TKA from January 2014 to December 2014 were included.Average age of included patients were 64.9±7.9 years old (22-87).829 patients were osteoarthritis,others rheumatoid arthritis.The ASA score,BMI,doctor groups,diabetes,hypertension,thrombus (duplex color Doppler ultrasonography),pre-HGB,pre-HCT,pre-TP,pre-Cr,pre-BUN,pre-PT,operation time,starting MABP of the operation,anesthesia and TXA were collected.Potential risk factors for allogeneic transfusion were analyzed statistically via univariate and multivariate regression analysis.Results The preoperative hemoglobin level in 71 (8.3％) patients were lower than that in normal (male ＜120 g/L,female ＜110 g/L).The hematokrit in 27 (3.2％) patients were lower than that in normal (male ＜40％,female ＜37％).TXA was used in 740 (86.9％) patients during the operation.Allogeneic transfusion was performed in 202 (23.7％) the patients after TKA.The differences in the following items within two groups were statistically significant via univariate analysis (P＜0.05),female and male,≥70 and ＜ 70 years,pre-HGB normal and low,pre-HCT normal and low and with and without TXA.Female [OR=2.283,95％CI (1.405,3.711)],patient age of 70 years or older [OR=2.048,95％CI (2.064,4.292)],preoperative hemoglobin level low [male ＜ 120 g/L,female ＜ 110 g/L,OR=1.506,95％CI (1.376,4.427)] and preoperative hematokrit below normal [male ＜ 40％,female ＜ 37％,OR=3.412,95％CI (1.086,6.591)] were independent predictors for postoperative allogeneic transfusion in multivariate regression analysis.Conclusion The allogeneic transfusion rate after unilateral TKA was 23.7％.Female,older than 70 years and preoperative anemia were independent predictors for postoperative allogeneic transfusion after TKA.TXA can effectively decrease the postoperative allogeneic transfusion rate and the amount of transfusion.

Objective To detect the impact of Diltiazem on the major adverse cardiac events (MACE) in six months after percutaneous coronary intervention (PCI).Methods A total of 192 patients after PCI with coronary atherosclerotic heart disease were enrolled in this study.The patients were randomly divided into Diltiazem therapy group (101 patients) and non-Diltiazem therapy group (91 patients).The high-sensitivity C-reactive protein (hs-CRP) was assessed before and 24 h after PCI,and the incidence of Major adverse cardiovascular events(MACEs) were assessed at the sixth month after PCI.Results Compared with before PCI,hs-CRP level increased significantly in both group after PCI (P＜0.01),but hs-CRP level was lower in Diltiazem therapy group than in non-Diltiazem therapy group (P＜0.05).Compared with non-Diltiazem therapy group,there was lower incidence of MACEs during six months follow-up in Diltiazem therapy group.Conclusions Diltiazem can decrease the incidence of MACEs during six months after PCI.

Objective To investigate the expression profiles of microRNA in early esophageal squamous cancer and normal esophageal tissues and verify the significantly different expression miRNAs , further to study the effects on proliferation of EC109. Methods The microarray assay was performed to analyze miRNA expression profiles in three pairs of early esophageal squamous cancer and the corresponding normal esophageal tissues. Quantitative real-time polymerase chain reaction (qRT-PCR) was used in another 38 pairs samples to further verify the differentially expressed miRNAs . Three verified miRNAs ( miR-29a, miR-221 and miR-222) mimics were transfected into EC109 respectively and CCK8 method was used to study the effect of cell proliferation in each miRNA. Results Microarray technique selected 53 miRNAs that differentially expressed in early esophageal squamous cancer and normal esophageal tissues , 32 miRNAs were up-regulated and 21 miRNAs were down-regulated. qRT-PCR verified that miR-29a was significantly down-regulated (P < 0.05) and miR-221, miR-222 were significantly up-regulated (P < 0.05) in early esophageal squamous cancer tissue. Over-expression of miR-29a could significantly inhibit the proliferation of EC109 (P < 0.05) whereas over-expression of miR-221 or miR-222 could both significantly promote the proliferation of EC109 (P < 0.05). Conclusion There was significant difference of miRNAs expression between early esophageal squamous cancer and normal esophageal tissues, and the differentially expressed miRNAs could be used as new biomarkers for early diagnosis of esophageal squamous cancer.

Objective To investigate the influence of uremic serum on the monocyte chemoattractant protein 1 (MCP-1) expression of human umbilical vascular endothelial cells (HUVECs) in vitro and the effect of up-regulation of berne oxygenase 1 (HO-1) on the synthesis of MCP-1 of HUVECs in uremic milieu. Methods HUVECs were incubated to confluence and then preineubated with heroin and/or protoporphyrin zinc IX (ZnPP)for 6 hours.The cultures were subsequently incubated with M199 cell medium containing 10% serum of healthy people or with medium containing 10% serum of maintenance hemodialysis (MHD) patients.HO-1 protein and mRNA expression was detected by immunohistochemistry and semi-quantitative RT-PCR.MCP-1 mRNA expression was measured by semi-quantitative RT-PCR,and MCP-1 protein was quantified by ELISA. Results Up-regulated expression of MCP-1 mRNA and protein was detected in HUVECs incubated with medium containing 10% serum of MHD patients.The protein synthesis was 2.95 folds of the control.Heroin induced expression of HO-1 mRNA and protein,and concurrently inhibited the up-regulated MCP-1 expression induced by uremic serum.Such effects of heroin could be blocked by ZnPP. Conclusions Uremic serum induces the expression of MCP-1 in HUVECs.Up-regulated expresson of endothelial HO-1 induced by heroin inhibits the enhancement of MCP-1 synthesis.HO-1 may be beneficial to the alleviation of endothelial cell injury in uremic milieu.

Objective To investigate the early outcomes of reconstruction of severe acetabular bone defects by the use of tantalum trabecular metal cup combined with tantalum augment in total hip replacement.Methods From April 2014 to December 2015,23 patients (24 hips) underwent total hip arthroplasty by the use of tantalum trabecular metal cups combined with tantalum augments.There were 11 males (12 hips) and 12 females (12 hips),with the average age 54 years (range,38-65 years).We tried to reconstruct an annular support for the cup.If an annular support cannot be reconstructed,the cup obtains primary stability based on the three point fixation rationale.Flexible placing of the TM cup combined with the augments helped reconstruction of the socket ring or supporting points,thus achieving rigid primary stability of the cup and restoring center of rotation.Harris hip score and Western Ontario and McMaster Universities (WOMAC) osteoarthritis index score were recorded.Any severe intraoperative complications including vascular or nerve injury and severe postoperative complications such as periprosthetic joint infection,dislocation or periprosthetic fracture were reported.The vertical position of the center of rotation from the interteardrop line and the horizontal position of the center of rotation from the teardrop were measured and analyzed.Results The average follow-up duration was 16 months (range,7-28 months).The mean Harris hip score was 35.3±12.1 preoperatively and 82.7±8.3 postoperatively (t=-16.991,P＜0.001).The mean WOMAC score was 39.1 ±24.0 preoperatively and 87.2± 11.4 postoperatively (t=-7.671,P＜ 0.001).The average vertical location of the center of rotation was 44.02± 11.65 mm preoperatively and 22.96±8.24 mm postoperatively.All the tantalum cups and augments were stable.There was no periprosthetic joint infection,dislocation,nerve injury or periprosthetic fracture.Conclusion Reconstruction of Paprosky Ⅲ acetabular bone defects by the use of tantalum trabecular metal cup combined with tantalum augment can achieve good primary stability and restore the center of rotation with almost normal hip biomechanics.The short-term outcomes are satisfied.

Objective To investigate the related factors on effects of uterine artery embolization (UAE) in the treatment of dysmenorrhea in patients with adenomyosis, and to construct and validate the efficacy prediction model. Methods A total of 127 cases of adenomyosis patients with symptoms of dysmenorrhea in Guangzhou No.1 People′s Hospital and Nanfang Hospital of Southern Medical University from June 1999 to December 2009 were reviewed. The evaluation standard was to improve the degree of dysmenorrhea, the related factors of efficacy were analysed. Combined with artificial neural network theory, the effect prediction model was constructed, and the effectiveness of the model was evaluated using receiver operating characteristic (ROC) curve, and the effectiveness of the cut-off point was calculated. The model was validated by 68 cases of patients with adenomyosis in the Nanfang Hospital from January 2010 to November 2014. Results (1) In 127 cases of dysmenorrhea patients, UAE treatment was effective in 98 cases, effective rate was 77.2% (98/127). (2) Age was an independent predictor of effective UAE treatment (HR=1.129, P=0.026);in the range of this study, the greater the age, the higher the UAE treatment efficiency. (3) The developing situation of ovary branches of uterine artery was an independent predictor of effective UAE treatment (HR=0.460, P=0.020), the efficiency of patients whose intraoperative bilateral uterine artery ovarian branch did not develop was 89.7%(35/39), the efficiency of patients whose unilateral uterine artery ovarian branch was developing was 84.1% (37/44) and the efficiency of patients whose bilateral uterine artery ovarian branch were developing was 59.1% (26/44). (4) Blood supply of adenomyosisis was an independent predictor of effective UAE treatment (HR=0.313, P=0.001). Type Ⅰ (bilateral predominated) patients, efficiency was 93.5%(43/46);typeⅡ(bilateral balanced) patients, efficiency was 78.0%(39/50);type Ⅲ (unilateral predominated) patients, efficiency was 51.6% (16/31). (5) UAE for the treatment of adenomyosis efficacy of artificial neural network prediction model was constructed, the model′s area under the ROC curve was 0.808, the optimal cut-off point was 0.669 13. Actual verification of the model, sensitivity was 96.5%, specificity was 81.8%, positive predictive value was 96.5%and negative predictive value was 81.8%, the total accuracy was 94.1%. Conclusions (1) Age, the developing situation of ovary branches and blood supply of adenomyosis are the independent predictors of effective UAE treatment. (2) The artificial neural network prediction model is satisfied with the accuracy and the accuracy of prediction.