Objective  To understand the current status of surgical treatment for hemophilia osteoarthropathy (HO) in China.  Methods  Using an online questionnaire, select domestic hospitals that partici-pated in the compilation of the 'Guideline for perioperative management of hemophilia patients undergoing orthopaedic surgery in China ', in addition to members of the National Joint Surgery Group, and the Orthopedic Branch of the Chinese Medical Association for targeted investigation and analysis.  Results  A total of 17 domestic hospitals were included, all of which were general hospitals. Hospitals that started HO surgery treatment before 2000 accounted for 35.29%. A total of 3057 surgical cases of HO were reported by those hospitals. The most commonly performed surgical procedures were hip and knee joint replacement. The most commonly used coagulation factor replacement regimen was recombinant coagulation factor preparation. Ten hospitals reported finding patients with transfusion-related infectious diseases. Bleeding and hematoma formation were the most frequently reported surgical complications. Excessive length of hospital stay and high economic costs were the most frequently reported problems.  Conclusions  Surgical treatment for HO in 17 hospitals is mainly carried out in some large comprehensive medical centers in the eastern region. Compared with the patient base, the popularity and number of surgeries are still relatively insufficient. It is necessary to further standardize the treatment system by standardizing factor replacement and strengthening rehabilitation to improve surgical treatment outcomes.

Objective:To observe the effect of genetic inactivation of adenosine A 2A receptor on apoptosis in the prefrontal cortex and on the expression of phosphorylated p38 mitogen-active protein kinase (p38MAPK) in mice with chronic hypoxic hypercapnia. Methods:Sixteen male wild-type mice and 16 male mice in which the adenosine A 2A receptor gene had been knocked out were randomly divided into a 4 weeks group (including 4HH+ /+ and 4HH-/- subgroups) and a normal control group (including NC+ /+ and NC-/- subgroups). The 4HH+ /+ and 4HH-/- group mice were exposed to an atmosphere containing 9-11% O 2 and 5-6% CO 2 8 hours a day, 6 days a week for 4 weeks. The apoptosis index (AI) in their prefrontal cortices was then evaluated using terminal-deoxynucleoitide transferase mediated nick end labelling (TUNEL) staining. The expression of p38MAPK protein in the prefrontal cortices was measured using western blotting. Results:The average AI had increased significantly in the 4HH+ /+ and 4HH-/- groups compared with the controls, with significantly more apoptotic cells in the 4HH+ /+ group than in the 4HH-/- group. In the 4HH+ /+ and 4HH-/- groups the average expression of p38 protein in the prefrontal cortex was significantly higher than among their controls. Moreover, the average expression of p-p38MAPK protein in the prefrontal cortex of the 4HH-/- group was significantly lower than in the 4HH+ /+ group.Conclusion:Adenosine A 2A receptor knockout inhibits apoptosis in the prefrontal cortex and down-regulates the p38MAPK activation of mice after exposure to chronic hypoxic hypercapnia.

Oral and maxillofacial space infections (OMSI) are common diseases of the facial region involving fascial spaces. Recently, OMSI shows trends of multi drug-resistance, severe symptoms, and increased mortality. OMSI treatment principles need to be updated to improve the cure rate. Based on the clinical experiences of Chinese experts and with the incorporation of international counterparts′ expertise, the principles of preoperative checklist, interpretation of examination results, empirical medication principles, surgical treatment principles, postoperative drainage principles, prevention strategies of wisdom teeth pericoronitis-related OMSI, blood glucose management, physiotherapy principles, Ludwig′s angina treatment and perioperative care were systematically summarized and an expert consensus on the diagnosis and treatment of OMSI was reached. The consensus aims to provide criteria for the diagnosis and treatment of OMSI in China so as to improve the level of OMSI treatment.

Objective: To evaluate the effectiveness of different laboratory methods for the supplementary diagnosis of pulmonary tuberculosis（PTB）and provide reference data for the early diagnosis of PTB. Methods: A total of 298 suspected PTB patients, who were diagnosed and treated in the outpatient department of Shanghai Tongren Hospital from January 2016 to December 2018, were divided into 3 groups: active PTB (138 cases)，inactive PTB (43 cases) and non-PTB (117 cases) group. Sputum acid-fast staining, MGIT liquid culture system and Xpert MTB/RIF test were performed to detect the sputum specimens. The sensitivity and specificity were compared by Chi-square test. Results: The three methods showed certain significance for distinguishing active PTB, inactive PTB combined with non-PTB (χ 2 values were 89.08, 138.94 and 137.12 respectively, all P＜0.01). There was no significant difference for the positive rate of the three methods between inactive PTB and non-PTB. The sensitivities of acid-fast staining, MGIT liquid culture, Xpert MTB/RIF test and the combination of three methods in the diagnosis of active PTB were 45.7% (63/138), 63.8% (88/138), 65.4% (87/133) and 78.2% (104/133) respectively. The sensitivities of MGIT culture and Xpert MTB/RIF test were significantly higher than that of acid-fast staining (χ 2 was 35.79 and 11.26 respectively，all P＜0.01). There was no significant difference for the sensitivities between MGIT liquid culture and Xpert MTB/RIF test（χ 2 was 29.87, P＞0.05) . The sensitivity of combined detection was higher than that of single detection（χ 2 was 30.84, 64.62, 70.14, respectively, all P＜0.01）. The diagnostic specificities of the three methods and their combination were 99.1%（116/117), 98.3%（115/116）, 99.1%（113/114) and 97.3%（110/113）respectively. There was no significant difference for the specificities of the three methods. Conclusion High sensitivities of MGIT liquid culture and Xpert MTB/RIF test were shown in PTB diagnosis. Combined detection of the three methods may improve the sensitivity of detection.

Objective To evaluate a new type of adult scapular anatomical locking plate which was designed for fixation of the major fracture fragment based on the characteristics of major fracture location and posterior surgical approach.Methods The Computed Tomography (CT) data of the scapula were collected for this studv of the 80 normal adults who had undergone CT scanning from January 2015 to January 2018 at Department of Orthopedics,Hanzhong Central Hospital.They were 43 males and 37 females.3D models of the scapula were reconstructed using the CT data by computer.After scapular neck (CD),scapular lateral border (D)E),angulus scapulae (EF),scapular spine (HJJ2 and HKK2),and angles of the scapula (∠ CD)E,∠ DEF,∠ HKK2 and ∠ HJJ2) were measured,our new type of adult scapular anatomical locking plate was designed to meet the requirements of operation and fixation.Results The main parameters of the scapula at the major fixation region were CD of 10.27 ±0.99 mm,DE of 73.03 ±6.27 mm,EF of 52.03 ±6.85mm,HJ of 36.27 ± 2.10 mm,HKof41.44±2.58mm,∠ CDE of128.61° ± 6.30°,∠DEF1of 167.11 °±3.83°,∠DEF2 of 173.01 °±4.45°,∠HJJ2 of 133.43°±7.47°,and ∠HKK2 of 123.55°± 7.84°.The new type of claw-shaped scapular locking plate we had designed conformed to the segmental lengths and the angles between the adjacent segments of the scapula.Conclusions Our new type of adult scapular anatomical locking plate mav be used to fix the major scapular fracture fragment,providing a new choice to solve the problem in fixation of complex scapular fractures.However,its clinical practicality and effectiveness needs further clinical research.

Objective:To explore the expression level of serum interleukin-17 (IL-17) in the patients with psoriasis vulgaris and the changes of interleukin-6 (IL-6) and interleukin-23 (IL-23) levels secrered by the HaCaT cells after stimulated with IL-17,and to clarify its clinical significance and the intervention effect of shikonin.Methods:Twenty-five normal controls,29 patients with psoriasis vulgaris and different groups of HaCaT cells (blank control group,IL-17-24 h group,IL-17-36 h group,IL-17-48 h group,shikonin+-IL-17 group,CsA+-IL-17 group and IL-17 group) were used as the subjects.The levels of serum IL-17 in the patients with psoriasis vulgaris and the levels of IL-6 and IL-23 in supernatant of HaCaT cells in various groups were measured by double antibody sandwich enzyme-linked immunosorbent assay (ELISA) and real-time polymerase chain reaction RT-PCR was used to detect the expression levels of IL-6 and IL-23 p19 mRNA in HaCaT cells in various groups.At the same time,Cell Counting Kit-8 (CCK-8) method was used to detect the viabilities of HaCaT cells in various groups.Results:The level of serum IL-17 of the patients in psoriasis vulgaris group was increased compared with nomral control group,especially in the severe skin lesion group (P＜0.05).The levels of IL-6 and IL-23 in HaCaT cells and supernatant and their mRNA expression levels in IL-17-24 h,IL-17-36 h and IL-17-48 h groups were significantly higher than those in blank control group (P＜0.01).The expression levels of IL-6 and IL-23 in HaCaT cells and supernatant and their mRNA expression levels in shikonin+IL-17 and CsA+IL-17 groups were lower than those in IL-17 groups (P＜0.05).No statistical differences were found in the cell viabilities between each drug treatment group and blank control group (P＞0.05).Conclusion:The expression level of IL-17 in the patients with psoriasis vulgaris is significantly increased,especially in the patients with severe psoriasis vulgaris.IL-17 can promote the secretion of IL-6 and IL-23 in HaCaT cells in a time-dependent manner.Shikonin can inhibit the proinflammatory effect of IL-17.

Objective:To explore the value of two-dimensional speckle tracking echocardiographic imaging (2D-STI) for assessing partial and global left ventricular functional changes at pre-and post-percutaneous coronary intervention (PCI) in patients with chronic total coronary occlusion.
Methods:Echocardiograph was conducted in 23 chronic total coronary occlusion patients at pre-PCI and 1 day, 3, 6 months post-PCI to examine left ventricular ejection fraction (LVEF), meanwhile 2D-STI was applied to obtain the global longitudinal strain (GLS) value of left ventricle.
Results:In all 23 patients, for LVEF, compared with pre-PCI (59.29±12.15)%, it was increased at 3 and 6 months post-PCI (60.00±12.35)%and (61.37±11.8)%respectively, all P<0.05;for GLS value, compared with pre-PCI (-12.77d wit )%, it was decreased at 1 day and 3, 6 months post-PCI (-13.23ecrea)%and (-15.67ecrea)%, (-16.97ecrea)%respectively, all P<0.05.
Conclusion:PCI could effectively improve left ventricular function in patients with chronic total coronary occlusion, 2D-STI technology may quantitatively assess those changes at the early stage.

Objective To understand the health status of medical staffs in a tertiary hospital of Chongqing City to provide the basic information and scientific basis for formulating the interventional measures.Methods The physical examination data of 1 397 medical staffs in 2013 and 2 178 medical staffs in 2015 were selected as the research objects and performed the summary analysis according to the abnormal indexes distribution,sex and age.Results A total of 1 397 persons completed the physical examination in 2013,the abnormal indexes were detected in 1 250 people,the detection rate of sub-health status was 89.48％;2 178 people in 2015 completed the physical examination,the abnormal indicators were detected in 2 046 people,the detection rate of sub-health status was 93.94％.The comparison of two-year health examination data showed the different degrees of increasing trend in bilateral breast hyperplasia,gallbladder polyps,thyroid cysts,low density lipoprotein cholesterol.Conclusion The health status of medical staffs is not optimistic,so the self health care consciousness of medical staffs needs to be elevated.

Objective    To evaluate the outcomes and summarize the clinical experience of totally endoscopic mitral valve repair with artificial chordae implantation. Methods    From May 2013 to June 2016, 71 patients with mitral valve insufficiency were admitted to our hospital who underwent totally endoscopic mitral valve repair with artificial chordae implantation. There were 47 males and 24 females with the age of 46.0±14.4 years ranging from 13-78 years. The pathogenesis included degenerative valvular diseases in 63 patients, congenital valvular diseases in 4, infectious endocarditis in 2, rheumatic disease in 1 and cardiomyopathy in 1. Prolapse of anterior, posterior, or both leaflets was present in 26 (36.6%), 19 (26.8%), and 25 (35.2%) patients, respectively; one patient (1.4%) presented valve annulus enlargement and thirteen were associated with commissure lesion. The mitral regurgitation area ranged from 4.2 to 26.3 cm2 (mean, 12.2±5.6 cm2). All the procedures were performed by total endoscopy under cardiac arrest. 5-0 Gore-tex sutures were used as the material of artificial chordae which was implanted one by one. Results    There was no in-hospital death. One patient was transferred to mitral valve replacement, and one median sternotomy due to bleeding. The mean cardiopulmonary bypass time was 156.0±31.6 min and aortic cross-clamp time 110.0±20.1 min. We finally had 39 isolated mitral valve repair, 28 mitral valve repair combined tricuspid valve repair, 3 mitral valve repair combined atrial septal  defect closure, and 1 mitral valve repair combined correction of partial anomalous pulmonary vein connection. Each patient was implanted artificial chordae of 2.5±1.7 (ranging from 1 to 7), and 65 patients received mitral annulus (full ring). The intraoperative transoesophageal echocardiography found no mitral regurgitation in 44 patients, the area of mitral regurgitation was 0-2 cm2 in 24, and 3 patients with mitral regurgitation>2 cm2 experienced serious systolic anterior motion. Of the 3 patients with systolic anterior motion (SAM), one transferred to mitral valve replacement, one underwent mitral re-repair, and one took conservative treatment. The mean follow-up was 12.7±10.5 months (range: 1 to 36 months), while 2 patients were lost to follow up with the follow-up rate of 97.2%. Recurrent severe regurgitation occured in 3 patients, moderate in 5, mild or trivial in 27 and no regurgitation in 36. During the follow-up, 1 patient died of myocardiopathy-induced heart failure post discharge, 1 suffered from cerebral infarction, and no patient underwent reoperation. Conclusion    The totally endoscopic surgical treatment of mitral valvuloplasty with artificial chordae is reliable for patients with mitral valve prolapse, which provides favorable clinical efficacy and outcomes. The difficulty lies in how to determine the appropriate length of the chordae and keep the stability of length.

Objective To investigate the differences in tumor volume and metastatic tumors of the liver and regional lymph nodes between contrast-enhanced computed tomography (CT) and diffusion-weighted magnetic resonance imaging (DWMRI) through a comparative analysis,as well the useful information for target volume delineation,and to guide radiotherapy in clinical practice.Methods A total of 40 patients with pancreatic cancer were enrolled and underwent contrast-enhanced CT and DWMRI in the same position.The target volume was delineated,the major axis of the maximum tumor section was measured,and the numbers of liver metastatic tumors and metastatic tumors of the lymph nodes with a diameter of 5-8 mm or＞8 mm were measured based on the CT and DWMRI images.The analysis was performed by using paired t-test or paired Wilcoxon rank sum test.Results The mean gross tumor volume (GTV) delineated by contrast-enhanced CT and DWMRI was 54.95 cm3 and 41.67 cm3(P =0.000),and the mean value-different value was 13.28 cm3.The major axis of the maximum tumor section measured by contrast-enhanced CT and DWMRI were 4.18 cm and 3.94 cm (P=0.000),respectively,and in two patients,dCT was smaller than dDWMRI.A total of 83 liver metastatic tumors were identified by contrast-enhanced CT,and 112 were identified by DWMRI;the liver metastatic tumors detected by contrast-enhanced CT accounted for 74％ of those detected by DWMRI.As for the metastatic tumors of the lymph nodes with a diameter of 5-8 mm or＞8 mm,103 or 46 were detected by contrast-enhanced CT,and 200 or 56 were detected by DWMRI,and the tumors detected contrast-enhanced CT accounted for 52％ or 82％ of those detected by DWMRI.There were significant differences in all data between contrast-enhanced CT and DWMRI.Conclusions GTV and the major axis of the maximum tumor section measured by DWMRI are lower than those measured by contrast-enhanced CT,and contrast-enhanced CT is sensitive in detecting the metastatic tumors of the liver and lymph nodes.However,it is necessary to conduct further controlled experiments with reference to pathology.