Objective To investigate the clinical effect and to summarize the experience of percutaneous radiofrequency ablation (RFA) of spleen together with splenic artery balloon block in treating hypersplenism due to cirrhosis and portal hypertension. Methods Under the situation of splenic artery occlusion with balloon, RFA of the spleen was performed in 15 patients with hypersplenism caused by cirrhosis and portal hypertension. The mean duration of RFA was (46.4±5.4) min. Routine blood tests were conducted at 3 days, one week, one, 3 and 6 months after the treatment, and abdominal CT angiography was performed one month after RFA. The results were analyzed. Results One patient developed massive bloody pleural effusion at left thorax three days after RFA, which was improved after hemostasis and thoracic drainage. No severe complications occurred in other patients. Abdominal CT angiography performed one month after RFA showed that the ablated extent by RFA was accounted for about 34.3%-71.8% proportion of the spleen, with a mean of (56.20 ±13.09)%. Preoperative blood tests indicated that the count of white blood cells, red blood corpuscles and blood platelets was (3.88±1.75)×109/L, (4.06±0.37) × 1012/L and (48.14± 11.33)×109/L, respectively. One month after RFA the count of white blood cells and blood platelets increased to (5.62±1.61) ×109/L and (132.29±33.20) ×109/L respectively. When compared with the preoperative data, the differences in the count of white blood cells and blood platelets were statistically significant (P<0.05). Conclusion For the treatment of hypersplenism due to cirrhosis and portal hypertension, percutaneous radiofrequency ablation of spleen together with splenic artery balloon block is quite safe and this technique has satisfactory short-term effect.

BACKGROUND:Proximal femoral nail antirotation and femoral head replacement could quickly recover hip function in intertrochanteric fractures in the elderly, but whose efficacy is better remains controversial. OBJECTIVE:To compare the differences in the effects of proximal femoral nail antirotation and femoral head replacement on intertrochanteric fractures in the elderly by using a meta-analysis. METHODS:The relevant literatures were searched in PubMed, Cochrane, CNKI, Wanfang database and VIP, and other relevant journal such asChinese Journal of Orthopaedicsand Orthopedic Journal of Chinafor articles published in recent five years. Randomized controled trials concerning proximal femoral nail antirotation and femoral head replacement for the treatment of intertrochanteric fractures in the Chinese elderly were colected. Baseline data, operation time, intraoperative blood loss, postoperative out-of-bed time, length of stay, Harris score, complication rate and number of death were colected and processed using RevMan 5.30 software for meta analysis. RESULTS AND CONCLUSION:Totaly 37 clinical controled trials with 3 216 patients were recruited. Meta-analysis results showed that compared with femoral head replacement, proximal femoral nail antirotation was at a disadvantage in postoperative out-of-bed time, length of stay and joint function in the early stage. No significant difference in complication and mortality was detected between proximal femoral nail antirotation and femoral head replacement. However, proximal femoral nail antirotation had some advantages such as short operation time, smal trauma, and less intraoperative blood loss, and showed good midterm and long-term outcomes of joint function.

Objective To establish the a staging system based on scoring of ketamine associated urinary dysfunction (KAUD) and evaluate its diagnosis performance and clinical value.Methods A retrospective analysis of 135 admitted KAUD patients from September 2009 to September 2015 was performed.All patients were classified into three stages according to bladder and upper urinary tract impairment, and treated with subsequent strategy.The behavioral modification and pharmacotherapy was performed in stage Ⅰ which image investigation was normal.Hydrodistension and intravesical perfusion was used if pharmacotherapy failed in stage Ⅱ patients who had bladder impairment in image or urodynamics.Augmentation cystoplasty or cystectomy with urinary diversion was optional if aforementioned treatment failed in stage Ⅲ who had upper urinary tract involvement and abnormal renal function.The voided volume, micturition interval, and nocturnal void frequency as recorded in their 3-day bladder diary, PUF, ICPI and ICSI score after treatment in one month, were compared with their baseline data prior to treatment.Ketamine abusing history, renal and liver function, bladder and upper urinary tract changes, urodynamics and radioisotope renography correlation with stages were analyzed.A scoring system was established and the concordance between the clinical staging and model staging of each patient was compared.Receiver operating characteristic curve was employed to testify the sensitivity and specificity.Results There were 39, 80 and 16 patients included in each stage respectively.After subsequent strategy of treatment, voided volume, micturition interval, and nocturnal void frequency, PUF, ICPI and ICSI were improved significantly.Age (P =0.018), ketamine abusing history (P =0.006), eGFR (P =0.001), ALT (P =0.037), γ-GT (P ＜ 0.001), bladder (P =0.013) and ureteral changes (P ＜ 0.001), hydronephrosis (P ＜ 0.001) and radioisotope renography abnormality (P =0.01) were correlated with clinical stages.In total, 107 cases' stages based on scoring were accordant with clinical stages (30, 65 and 12 cases in each stage respectively).AUC of the scoring model ROC was 0.922 on cut point between Ⅰ and Ⅱ stages and AUC of the scoring model ROC was 0.978 on cut point between Ⅱ and Ⅲ stages.Conclusions We presented a scoring staging system of KAUD based on ketamine abusing history, laboratory test results, and imaging findings.It might be helpful to evaluate the progression on bladder and upper urinary tract, and provide a reference for treatment.This staging system based on scoring still needs further validation and improvement.

Objective To identify the risk factors of chronic ketamine-induced upper urinary tract dysfunction (KUUTD).Methods Medical records of 103 patients with ketamine-associated urinary dysfunction(KAUD) from Sep.2009 to Jul.2015 were retrospectively reviewed.All the patients were divided into the upper urinary tract dysfunction group(n =39)or the normal group(n =64)according to the diagnostic criteria.Indexes such as general features (age,gender,BMI),drug-abusing characteristics (abusing time,frequency,dose,abstinent period),duration of LUTS,pelvic pain and urgency/frequency symptom score(PUF score),serum parameters (WBC,ALT,AST,γ-GT),bladder diary (daytime inter-void interval,nocturia,average urine volume),urodynamic data (maximum cystometric capacity,post-void residual,maximum urethral closure pressure,maximum and average flow rate,instable contraction,bladder compliance) and imaging manifestations were compared between the two groups.Logistic regression analysis was performed for the evaluation of variables with statistical significance.Results There was significantly difference between the two groups in BMI (t =2.127,P =0.043),drug-abusing frequency (t =2.335,P =0.029),abstinent period (t =3.451,P =0.003),duration of LUTS (t =2.289,P =0.036),PUF score (t =3.030,P =0.004),γ-GT value(t =2.697,P =0.012),MCC(t =5.056,P ＜ 0.001),MUCP(t =3.015,P =0.008),BC (t =8.562,P ＜ 0.001) and imaging findings of bladder contracture (x2 =15.155,P ＜0.001).The multivariate Logistic regression analysis showed that drug-abusing frequency(OR =1.279,P =0.038),abstinent period(OR =0.394,P =0.028),γ-GT value (OR =1.007,P =0.032),MCC (OR =0.775,P =0.011)and BC (OR =0.013,P =0.008)were the key factors of KUUTD.Conclusion Consecutive and frequent drug abuse,combination with chronic obstructive cholangitis,reduced capacity and low compliance bladder are the risk factors of upper urinary tract dysfunction associated with ketamine abuse.

Objective To study the distribution of Nogo-A in the retina and the changes after the optic nerve(ON) injury in hamsters. Methods In this experiment,ON was crushed at 2?mm behind of the eyeball.After 3?d,5?d and 7?d post-axotomy,the Nogo antiserum immunoreactive staining on section of the retina was performed. Results Nogo was expressed at every layer of the retina with the strongest expression on 3?d post-axotomy.The numbers of Nogo-A positive RGCs decrease as the survived time increased.Conclusion Nogo-A in the retina is not unique secretion from the neuroglia.The change in the distribution and level of expressed of Nogo-A in the retina is correlated with time advancement after injured of ON.

Objective To explore the relationship between visfatin and mild cognitive impairment(MCI)in patients with type 2 diabetes mellitus(T2DM).Methods A perspective study involving 75 hospitalized T2DM patients were divided into groups with(MCI,n=35)and without (NMCI,n =40)mild cognitive impairment.Another 30 non-diabetic patients were chosen as normal control(NC).Fasting plasma levels of glucose (FPG),insulin (FINS),lipid,glycosylated hemoglobin (HbAlc),HOMA-IR and visfatin were measured and calculated.Results The serum visfatin level was higher in MCI(28.81±3.32)μg/L than in NMCI(20.69±3.40)μg/L and NC(19.06±2.35)μg/L (F=96.491,P＜ 0.01).Visfatin was negatively correlated with Montreal Cognitive Assessment (MoCA) total score (MoCA-TS) (r =-0.646,P ＜ 0.01),but positively correlated with course of disease,waist hip ratio,FPG,HbAlc,FINS,HOMA-IR and triglyceride (r=0.282,0.276,0.318,0.496,0.339,0.433,0.309,P＜0.05 or P＜0.01).MoCA-TS was negatively correlated with course of disease,HbAlc,HOMA-IR,triglyceride,total cholesterol,low density lipoprotein cholesterol (r =-0.582,-0.365,-0.234,-0.330,0.277,-0.238,P＜0.05 or P＜0.01),but positively correlated with high density lipoprotein cholesterol(r=0.290,P＜0.05).Higher values of visfatin(OR =3.246,P＜0.01),HbAlc(OR=2.308,P＜0.01)and course of disease(OR=1.634,P＜0.05)were the risk factors for MCI.Conclusions The elevated visfatin level might be a risk factor for MCI in T2DM patients.

Objective Plasma circulating DNA can be em-ployed in place of bone marrow examination for the auxiliary diagnosis of leukemia.This study aimed to explore the clinical application of the plasma DNA level in evaluating the effect of chemotherapy on chronic leukemia. Methods We collected blood samples from 52 patients with chronic myelogenous leukemia (CML) (33 in the chronic phase, 7 in the acceleration phase, and 12 in the blast phase) , 85 with chron-ic lymphocytic leukemia (CLL) (28 with complete remission, 27 with partial remission, and 30 with no remission), 4 patients with hairy cell leukemia (HCL), and 80 healthy subjects.We simultaneously obtained plasma DNA and recombinant plasmid DNA using the BI-LATEST DNA Kit and examined the human β-actin gene and the level of plasmid DNA by real-time quantitative PCR. Results Before chemotherapy, the median value of plasma DNA was 149.46(30.63-496.91)ng/ml in the CML and 101.54(69.10-258.14) ng/ml in the CLL patients, both significantly higher than in the healthy controls (19.05[12.67-25.92]ng/ml) (P<0.01).After chemotherapy, the plasma DNA level of the CML patients was remarkably decreased, but still higher than that of the controls ( P<0.01).The CML patients in the chronic phase showed a markedly higher level of plasma DNA (302.89[93.33-541.52]ng/ml) than those in the blast phase (43.19[23.54-70.03]ng/ml) and acceleration phase (28.11[16.21-92.07]ng/ml) (P<0.05).The CLL patients with CR exhibited a significantly lower level of plasma DNA (24.29[14.64-30.74]ng/ml) than those with PR (106.88 [96.23-143.25]ng/ml) and NR (460.73[284.57-653.38〗ng/ml) (P<0.01), but all dramatically higher than that of the healthy controls (P<0.01) Conclusion The quantification of plasma DNA has a clinical application value in evaluating the effect of chemo-therapy on chronic leukemia.

Objective To assess the therapeutic value of transcatheter arterial chemoembolization combined 125iodine seed implantation for primary hepatic carcinoma with portal vein tumor thrombus.Methods The data of 23 patients ranging from 34 to 70 years old [ average age ( 56 ± 8) years ] with primary hepatic carcinoma with portal vein tumor thromhosis of type Ⅱ and type Ⅲ were retrospectively collected.The tumor number of liver parenchyma ranged from 1to 15 ( median number 4).The average diameter of tumor thrombus was (20.5 ± 1.5 ) mm and average length was ( 37.4 ± 2.6 ) mm.All of the tumors of liver parenchyma in 23 patients were treated by transcatheter arterial chemoembolization (TACE) and tumor thrombus were treated with 125iodine seed implantation.Before the 125iodine seed implantation,the formula dosage,the number,the spatial distribution,the intensity of radioactivity and the matched peripheral dosage of seed were calculated by treatment planning system (TPS).Then the 125iodine seeds were implanted in different levels and locations of port vein thrombosis under CT guided.Results The follow-up period ranged from 1to 26 months.The times of transcatheter arterial chemoembolization were 1to six times (median time 3.1±0.4) and the 125iodine seed implantation in the port vein thrombosis were 1to 2 times ( median time 1.4 ± 0.5 ).The numbers of implanted 125iodine seeds were 4 to 17 ( median number 7.0 ± 1.0).The median survival time was 18.0 months (3-24 months).The 3,6 and 12 months survival rates were 91.3％ ( 21/23 ),69.6％ ( 16/23 ),and 60.9％ ( 14/23 ).There was no severe side-effect related to therapy.Conclusions Transcatheter arterial chemoembolization combined 125iodine seed implantation for portal vein tumor thrombosis could significantly prolong the median survival time of patient with primary hepatic carcinoma with portal vein tumor thrombosis.

Objective To characterize the female urinary microbiome associated to OAB (overactive bladder) and investigate relationships between urinary microbiome and psychological factors.Methods 30 women with OAB and 25 asymptomatic controls were recruited and required to finish the overactive bladder symptom score,self-rating anxiety scale,self-rating depression scale and quality of life questionaires.Urine specimens were collected by transurethral catheterization and processed for 16S rRNA gene sequencing.Sequencing reads were processed using QIIME.Analyses for bacterial genera biomarker was used LEfSe algorithms.Bivariate correlations were assessed using Pearson's correlation.Results The two cohorts showed no significance difference in their demographic characteristics.OAB patients had significantly higher scores on overactive bladder symptom score,self-rating anxiety scale,self-rating depression scale and quality of life than controls (P ＜ 0.001).We found that bacterial diversity (Chao1 index:1 854.09 ± 1 239.34) and richness (Simpson index:0.75 ±0.23) were decreased in OAB samples than those of controls (Chao1 index:2 866.27 ± 1 795.22;Simpson index:0.86 ± 0.12;P =0.02).At the family level,Enterobacteriaceae and (17.6％ vs.8.1％;P =0.03) Bifidobacteriaceae (14.8％ vs.3.6％;P =0.01) were significantly more abundant in the OAB samples than the controls.Compared to controls,7 genera increased in OAB patients (e.g.,Proteus and Aerococcus) and 13 reduced (e.g.,Lactobacillus and Prevotella).There are negative correlations between scores on Self-Rating Depression Scale and both Chao1 (r =-0.458,P =0.011) and shannon indexes (r =-0.516,P =0.003) in OAB patients,which indicates that OAB patients with depression have further reductions in bacterial diversity and richness.Conclusions The aberrant urinary microbiome may serve as disease biomarkers and potential therapeutic targets of OAB.A negative correlation between depression scores and both bacterial richness and diversity in OAB patients indicated that there might be a connection between central nervous system and urinary microbiome.

Objective To explore the relationships among the central nervous system,the lower urinary tract and urinary microbiome by a rat model of stress-induced voiding dysfunction.Methods Rats were randomly assigned to stress group (exposure to water-avoidance stress for 10 days),stress-withdrawal group (exposure to the stress and then withdrawal for 2 weeks) or control group.On day 11 for stress and control groups or 2 weeks after day 11 for stress-withdrawal group,the Light-dark box transition test,lower abdominal pain threshold,micturition frequency and cystometry measurements were determined.Urine specimens were collected and processed for 16S rDNA gene sequencing.Results Compared to control group,the water-avoidance stress dramatically decreased in the time spent in the light area (P ＜0.01) and decreased mechanical pain threshold in stress group,which were reversed in stress-withdrawal group.While there was no significant difference in the micturition frequency between the control and stress-withdrawal groups,the stress group (20.33 ± 3.77) showed significantly more micturition frequencies than control (8.14 ± 2.23) and stress-withdrawal group (9.67 ± 1.89) (P ＜ 0.01).The stress dramatically increased voiding contractions in both the stress (7.33 ± 1.79) and stress-withdrawal (4.83 ± 1.06) groups compared to control rats (2.71 ± 1.38) (P ＜ 0.05).However,the stress-withdrawal group showed less voiding contractions than the stress group (P =0.03).The bacteria diversity in stress group were dramatically higher than those of the other two groups (P ＜ 0.01).Almost all specimens of the control rats were dominated by Enterococcacae,whereas samples from the stress group contained more diverse bacteria.The diversity of microbiota in the stress-withdrawal group was between those of the other two groups.LEfSe identified genera differed significantly among groups:Lactococcus and Proteus were significantly increased in in the stress-withdrawal group;Halomonas,Aggregatibacter,Haemophilus,Pseudomonas and Streptococcus were significantly higher in the stress group.Conclusions Water-avoidance stress experiments demonstrated the impact of stress on bladder function and urinary microbiome,which tended to be ameliorated after a two-week withdrawal from stress.Further research is needed to understand the connections between central nervous system,bladder and urinary microbiome.