Objective To evaluate the safety and efficacy of CT-guided percutaneous transhepatic gallbladder drainage(PTGBD)in treatment of high-risk acute cholecystitis(AC)patients.Methods CT-guided PTGBD was performed in 29 patients with high-risk AC.The therapeutic results were evaluated by comparing the preoperation and postoperation clinical manifestations and laboratory results.Results The implantation of PTGBD catheter was successfully accomplished with single procedure in all patients.Complica-tions occurred in 2 cases,including abdominal pain in 1 case and a small amount of gallbladder bleeding in 1 case,and the incidence of complications was 6.9%.Compared with preoperation,the pain number rating scale(NRS)score,temperature(T),white blood cell count(WBC),C-reactive protein(CRP),total bilirubin(TBIL),alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were significantly decreased 3 days after PTGBD(P<0.001).Except for 1 case of choledocholithiasis with continuous abdominal pain after PTGBD,the postoperation symptoms of the other patients were significantly relieved.Followed up for 3 months,2 cases of calculous AC recurred after PTGBD,and the recurrence rate of cholecystitis was 25.0%.Conclusion For high-risk AC,the CT-guided PTGBD is a safe and effective treatment method,and it can remarkably relieve the clinical symptoms.Patients with calculous AC have higher risk of recurrence and might benefit from definitive cholecystectomy.

Tuberculosis （TB） and human immunodeficiency virus infection / acquired immune deficiency syndrome （HIV/AIDS） are both serious global public health threats. Early detection of infected persons and/or patients through TB/HIV bi-directional screening is crucial for prevention and control strategy in China and globally. In recent years， with the promotion and application of new TB and HIV detection technologies worldwide， TB/HIV bi-directional screening technologies and strategies have made remarkable changes. This expert consensus introduces the significance and challenges of TB/HIV bi-directional screening， summarizes important progress of research and applications， and makes recommendations on screening measures and procedures to further strengthen TB/HIV bi-directional screening in China.

A 28-year-old woman presented with a 4-year history of fatigue and sleepiness and was found to have central hypothyroidism and mood disorder. The patient had normal thyroid volume and did not show any other pituitary axis involvement. Over the course of the disease, her symptom improvement matched with the free thyroxine (FT 4) rebound and the adjustment of antipsychotic medication. The patient′s grandmother had central hypothyroidism, and her mother and uncle had lowered or inappropriately normal thyroid stimulating hormone. Hence, genetic involvement was highly suspected, but whole exon sequencing did not reveal a pathogenic variant. Levothyroxine tablets were prescribed to maintain a normal median level of FT 4, and mood disorder medications were adjusted by specialists. Isolated central hypothyroidism is extremely rare, and we report this case aiming to raise awareness of this condition.

Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.

Objective:To analyze imaging features on high resolution CT (HRCT) and MRI of facial nerve venous malformation (FNVM).Methods:A total of 23 patients with pathologically confirmed FNVM were retrospectively included from January 2016 to December 2020 in the Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine. All patients underwent preoperative temporal bone HRCT, non-contrast MRI, diffusion weighted imaging (DWI) and dynamic contrast enhanced MRI (DCE-MRI). The location, morphology, and signal intensity of the lesions, as well as the enhancement pattern on DCE-MRI were reviewed. The time-intensity curve (TIC) was analyzed and the apparent diffusion coefficient (ADC) was measured.Results:The locations of FNVM lesions were geniculate ganglion ( n=19), mastoid segment ( n=1) and internal auditory canal ( n=3). Among 19 cases in geniculate ganglion, HRCT showed honeycomb-like bone change ( n=13) or expansive bone destruction with sharp border ( n=6). The case located in mastoid segment also presented as honeycomb-like changes. The other 3 cases in internal auditory canal presented with patchy hyperdensity bone change ( n=2) or resorptive bone destruction ( n=1). All 23 lesions demonstrated as irregular nodules with obviously heterogeneous enhancement on MRI. The lesions showed isointensity ( n=14), hypointensity ( n=8) or hyperintensity ( n=1) on T 1WI, and hyperintensity ( n=15) or isointensity ( n=8) on fat-suppression T 2WI. The ADC values of the lesions were (1.18±0.20)×10 -3 mm 2/s. A characteristic "point-to-plane" progressive enhancement pattern displayed on DCE-MRI, with type Ⅰ TIC (persistent pattern) presented. Conclusion:The imaging characteristics of FNVM are honeycomb-like bone changes on HRCT and"point-to-plane"progressive enhancement pattern on DCE-MRI.

Objective To improve the clinical understanding of glucagonoma. Methods A total of 14 cases of glucagonoma were admitted to our hospital, and the clinical features of these cases were retrospectively analyzed. Results (1) The female/ male case ratio was 1 : 1. (2) The median age of onset was 47 years (range 33-61), while the median age at diagnosis was 50 years (range 33-64). (3) The most common initial presentation was necrolytic migratory erythema (7/ 14, 50％). (4) Hyperglycemia was the most common presentation at the time of diagnosis (14/ 14, 100％), followed by necrolytic migratory erythema (13/ 14, 92.9％). (5) The misdiagnosis rate before admission to our hospital was as high as 85.7％ (12/ 14), and the most common misdiagnosis was eczema (7/ 12, 58.3％). (6) The median time from onset of probable symptoms to diagnosis was 4 years. (7) The median plasma glucagon level at diagnosis was 798 pg/ ml (range 200-2853). (8) The median length of the longest tumor diameter of the pancreatic tumors at diagnosis was 4. 0cm ( range 2. 2-8. 0). ( 9) 57. 1％ of primary pancreatic glucagonomas localized in the tail of the pancreas. (10) 57.1％ of patients (8/ 14) had metastases at the time of diagnosis. Conclusions (1)Necrolytic migratory erythema is a relatively sensitive and specific symptom for diagnosis of glucagonoma. (2) The diagnosis for glucagonoma was often delayed, and misdiagnosis was common. ( 3) Most glucagonoma patients had metastases at the time of diagnosis.

Objective: To sample survey the relationship between acute mountain sickness and mental health of officers and soldiers, so as to provide theoretical direction for the psychological prevent and counsel of them. Methods: In May 2017, 61 officers and soldiers were selectedas subject investigated, and divided to AMS group included 35 persons and non-AMS group included 26 persons according to the finding of theAMS symptom division point table, then used symptom self-testing tableto test and evaluate the mental health of them. Results: The AMS group showed significantly higher scores on the psychological parameters such as omatization, interpersonal sensitivity, depression, anxiety, phobicanxiety, parnoid ideation and so on (105.20±13.82, 1.37±0.26, 1.14±0.21, 1.16±0.19, 1.16±0.18, 1.06±0.11, 1.10±0.17, 1.22±0.19, P<0.05) . Conclusion The mental factors of omatization, interpersonal sensitivity, depression, anxiety, phobic anxiety, parnoid ideation and so on had great influence on AMS, we should pay attention to these factors and carry on mental intervention, and enhance anti-stress ability of individual, to ensure the successful completion of plateau military mission.

Objective To evaluate the effect of hydrogen sulfide on myocardial exogenous apoptotic pathway in a rat model of hemorrhagic shock and resuscitation.Methods Sixty clean-grade healthy male Sprague-Dawley rats,aged 8 weeks,weighing 250-300 g,were divided into 4 groups (n =15 each) using a random number table method:sham operation group (group S),sham operation plus sodium sulphid (NaHS) group (group S+NaHS),hemorrhagic shock group (HS group),and hemorrhagic shock plus sodium sulphid group (group HS+NaHS).Rats only underwent arterial and intravenous puncture in group S.Hemorrhagic shock was induced by withdrawing blood from the femoral artery until mean arterial pressure (MAP) was reduced to 35-40 mmHg within 10 min and maintained for 1.5 h.NaHS 28 μmol/kg was intraperitoneally injected at 10 min before resuscitation in group HS+NaHS.The equal volume of NaHS was administered at the same time in group S+NaHS.Immediately before blood letting and at 0,1.5,2,3,4 and 6 h after blood letting (T1-5),MAP was recorded and blood samples were collected from the femoral vein for determination of serum creatine kinase (CK) and lactate dehydrogenase (LDH) concentrations by chemical colorimetry.Rats were then sacrificed and hearts were removed for examination of the pathological changes of myocardial tissues (with a light microscope) and for determination of cell apoptosis (by TUNEL),expression of caspase-3 and caspase-8 (by Western blot) and expression of Fas and FasL (by immunohistochemistry).Apoptosis index was calculated.Results Compared with group S,MAP was significantly decreased at T1-5,the serum CK and LDH concentrations at T1-5 and apoptosis index at T5 were increased,and the expression of Fas,FasL,caspase-3 and caspase-8 was up-regulated in group HS (P＜ 0.05).Compared with group HS,MAP was significantly increased at T1-3,the serum CK and LDH concentrations at T3-5 and apoptosis index at T5 were decreased,and the expression of Fas,FasL,caspase-3 and caspase-8 was down-regulated in group HS+NaHS (P＜0.05).The pathological changes of myocardial tissues were significantly attenuated in group HS+NaHS when compared with group HS.Concclusion The mechanism by which hydrogen sulfide attenuates myocardial injury induced by hemorrhagic shock and resuscitation is associated with inhibiting the exogenous apoptotic pathway in rats.

Objective To prolong the working time of the crew under a high temperature and high humidity environment in armored vehicles , improve work efficiency , and to prevent excessive heat load from doing any harm to the human body . Methods The man-machine environment was analyzed , the corresponding environment and the conditions aboard were further quantitatively studied , and man-machine-environment interactions were analyzed .Also,a questionnaire survey was conducted at the same time .Results and Conclusion The thermal equilibrium and thermal comfort calculation program were compiled and validated through the questionnaire survey in order to provide support for environment assessment and protection design .

Objective In this article,we report and discuss the clinical presentation of antithyroid drug(ATD)-induced agranulocytosis.Methods We retrospectively studied 36 cases of ATD-induced agranulocytosis over the past 14 years in PUMC hospital.Results ATD-induced agranulocytosis patient's age ranged of 16-62 years old.88.9％ of ATD-induced agranulocytosis occured with a large ATD treatment.91.7％ patients occured in the first three month of drug therapy.A case occured agranulocytosis when 8 months duration.94.4％ patients occurs secondary infections.Conclusion This study showed that ATD-induced agranulocytosis considered to be dose dependent,not irrelevant to sex,age and the drug.