Objective To investigate curative effects of hypothermia on the secondary axotomy of nondisruptive axonal injury (NDAI) after diffuse brain injury (DBI).Methods A total of 16 male Sprague-Dawley rats were randomly and equally divided into hypothermia group (at 32℃ for 6 hours) and control group (at 37.5℃ ).The axonal swelling and axonal balls were detected by means of NF68kD immunochemistry after DBI caused by fluid percussion.The changes of maximal density of axonal swelling and axonal balls in callosum,diencephalon-mesencephalon,pons-oblongata and cerebellum were compared 24 and 72 hours after injury between both groups.Results NF68kD immunochemistry well showed axonal swellings and axonal balls in whole brain.The axonal swelling and axonal balls were significantly decreased 24 hours after DBI in both groups (P<0.05),especially in diencephalon-mesencephalon ,pons-oblongata and cerebellum (P<0.01).While there showed significant decrease of axonal swellings and axonal balls in pons-oblongata and cerebellum in hypothermia group 72 hours after DBI (P<0.05,P<0.01) but insignificant changes in the callosum and the diencephalon-mesencephalon compared with control group (P>0.05 ).Conclusions Hypothermia can retard the progress of mild or severe NDAI at early stage,which would taper with the longer time after injury except for partial mild NDAI.Hypothermia may prevent mild NDAI from secondary axotomy.

Objective To investigate the feasibility of urethral prefabrication with vaginal mucosa in female-to-male transsexuals and to compare the urologic complications after penile reconstruction in female-to-male transsexuals between prefabrication group and forearm group.Methods Prefabrication of the neourethra with tubed vaginal mucosal graft was performed for 22 female-to-male transsexual patients from 2007 to 2016,while radial forearm flap,known as the traditional tube-within-tube method,was used to construct the neourethra for other 31 cases.Results All of the reconstructed penises survived completely and allowed the patients to urinate while standing in the prefabrication group.Phalloplasty by using the vaginal mucosal graft for urethroplasty significantly decreased the donor scar,the duration of the second operation and the incidence rates of urologic strictures,comparing with the forearm group (P＜0.05).Conclusions It is reliable to use the prefabrication of the neourethra with tubed vaginal mucosal graft in phalloplasty female-to-male transsexual patients.

BACKGROUND:As a kind of undifferentiated precursor cells,the phenotypic differentiation of bone marrow mesenchymal stem cells (BMSCs) remains immaturity,thus it presents weak rejection following transplantation.However,the in vitro directional differentiation of BMSCs into neuronal cells is easy affected by various factors.OBJECTIVE:To observe the immunomodulatory effect and the potential of BMSCs differentiate into neuronal-like cells.DESIGN,TIME AND SETTING:A contrast observation was conducted at the Department of Cytology,Third People's Hospital of Wuxi from January 2008 to March 2009.MATERIALS:Bone marrow was harvested from chips of cancellous or ilium bone dudng hip joint surgery.METHODS:Firstly,the BMSCs were separated and cultured to establish mixed lymphocyte reaction (MLR) system.Secondly,2 samples of peripheral blood mononuclear cells (1×10~5/well) were added into 96-well plate,and then BMSCs treated by mitomycin were added according to different ratios (BMSCs/peripheral blood monouclear cells).At the end,the cells were cultured as follows:Method 1:DMEM+10% fetal calf serum+1 μmol/L RA +20 μg/L basic fibroblast growth factor+20 μg/L epidermal growth factor.Method 2:DMEM+2% dimethyl sulfoxide +100 μmol/L butylated hydroxyanisole.MAIN OUTCOME MEASURES:The growth rate of lymphocyte was measured by ~3H-Thymidine,and the effect of BMSCs on lymphocyte proliferation was observed.Additionally,the differentiation potential of BMSCs into neuronel cells was determined by immunofluorescenca and immunohistochemistrical staining.RESULTS:①The BMSCs inhibited lymphocyte proliferation in MLR system and the influence on proliferation of lymphocyte was direct related to ratio of BMSCs.②Under a light microscope,cytoplasm of BMScs were shrinkd,which presented typical perikaryon morphology at hour 2 after culture with method 1.The majority of BMSCs were formed neuronal-like cells without number changes at hours 3-5,which turned to be dipolar or multipolar neuronal shapes at day 3.There were 60%-70% neuronspecific enolase,45%-50% glial fibrillary acidic protein were positive expressed.However,the positive rate of nidogen was decreased 3.4%.Cells cultured with method 2 became smaller after 2 hours,formed dipolar or multipolar body cells,and most of cells were died after 48 hours.The 40%-50% neuronspecific enolase,35%-40% glial fibrillary acidic protein was found to be positive.The positive rate of nidogen was temporary increased to 63% at hour 2 after culture；however,it was decreased to 1.6% after 48 hours.CONCLUSION:BMSCs can differentiate into neuronal-like cells,as well as inhibit lymphocyte proliferation in MLR system,which possess down regulation effect on alloimmunity-reaction.

Objective To explore the efficacy and safety of anterior cervical discectomy and fusion assisted with microscope.Methods Thirty-seven patients with cervical spondylosis were included to be retrospectively ana lyzed,including 21 males and 16 females.All these patients had accepted anterior cervical discectomy and fusion (ACDF) assisted with microscope from October,2015 to February,2018,and they were aged from 22 to 77 years old (51.5±6.2 years on the average).In these patients,30 cases were operated on single segment,6 cases were operated on double segments,and 1 case was operated on 3 segments.Among all the patients,15 patients of which (40.54％) had cervical spondylotic myelopathy and 22 patients of which (59.46％) sufferered from cervical spondylotic radicu lopathy.All the operations were performed with a conventional transverse anterior cervical incisions,an intervertebral distractor was placed.The decompression was completed under the microscope,and the fixation was performed under direct vision.Moreover,the operative time,intraoperative blood loss and surgery-related complications were recorded.Follow-up was carried out at different times,including 7 days,1 month,3 months,6 months and every year after operation.Japanese Orthopaedic Association (JOA) score was used to calculate the rate of improvement in neurological function,which can evaluate the clinical efficacy.And cervical dysfunction index (NDI) was used to assess cervical function.Results All patients in this group underwent successful decompression under the microscope.The operation time was 90-160 min,with an average of (110.67±36.42) min;The intraoperative blood loss was 20-110 ml,with an average of (36.00±29.11) ml.All patients were followed-up for 12-31 months,with an average of (15.2±4.7) months.The JOA score improved from 8.37±3.26 preoperatively to 15.96 ± 1.50 at the last follow-up,and its difference had signifi cance in statistics (t=8.592,P=0.000).Neurological function improvement rate could be graded:excellent in 31 cases and good in 6 cases,the excellent and good rate was 100％;NDI was reduced from 19.01 ± 6.47 preoperatively to 5.81 ± 2.58 at the last follow-up,with statistical significant difference (t=5.127,P=0.000).During the follow-up,1 screw was found loosened and slightly withdrawn in 1 female patient at 3 months after operation,of whom had not obvious discomfort.The patient was continuously observed and there was no screw withdrawal again.Moreover,there were no complications such as cerebrospinal fluid leakage,hoarseness and difficulty in swallowing.Conclusion Microscope-assisted ACDF can provide safe and adequate decompression without significantly extending the operation time,which is satisfactory in clinical results.Even in some cases of 1 or 2 segments of intervertebral disc nucleus prolapse,it is possible to avoid a more traumatic ACDF.And it is worthy of clinical promotion.

Objective:To explore the relationship between hemoglobin variability (Hb-var) and risk of all-cause death and cardiovascular death in patients with peritoneal dialysis (PD), and to provide basis for reducing the risk of death in PD patients.Methods:It was a multicenter retrospective cohort study. The clinical data of regular PD patients from Nanfang Hospital of Southern Medical University, Shunde Hospital of Southern Medical University, Foshan First People's Hospital and Ganzhou People's Hospital from July 1, 2008 to December 31, 2019 were collected. Hb-var was calculated based on hemoglobin at baseline before PD and in the first year after PD. The patients were divided into low Hb-var group, moderate Hb-var group and high Hb-var group according to the tertiles of first year Hb-var, and the differences of baseline clinical data among three groups were compared. Follow-up endpoints included death, transfer to hemodialysis, transfer to kidney transplantation, transfer to other centers, loss of follow-up, or on December 31, 2021. Cox regression analysis model was used to analyze the association of the first-year Hb-var with all-cause death and cardiovascular death. Fine-Gray competitive risk regression model was used to evaluate the impact of competitive events on mortality risk.Results:A total of 1 562 patients with PD were included in the study, aged (47.6±13.8) years old, with 821 males (52.6%) and baseline hemoglobin of 81 (69, 94) g/L. Hb-var in the first year of PD was 26.6 (16.7, 40.3) g/L. There were statistically significant differences in age, body mass index, serum albumin, hemoglobin, serum creatinine, serum calcium, serum phosphorus, intact parathyroid hormone and the proportion of renin-angiotensin system inhibitors among low Hb-var group (<20.0 g/L), moderate Hb-var group (20.0-35.5 g/L) and high Hb-var group (≥35.5 g/L, all P<0.05). The follow-up time was 33 (19, 51) months, and 208 patients (13.3%) died, among which 111 patients (53.4%) died of cardiovascular death. Multivariate Cox regression analysis showed that the higher Hb-var in the first year, the lower the risk of all-cause death ( HR=0.98, 95% CI 0.97-0.99, P=0.018) and cardiovascular death ( HR=0.98, 95% CI 0.97-0.99, P=0.041) in PD patients. Compared with low Hb-var group, the risk of all-cause death ( HR=0.56, 95% CI 0.37-0.82, P=0.003) and cardiovascular death ( HR=0.54, 95% CI 0.31-0.95, P=0.032) was lowest in the high Hb-var group. The competitive risk regression model analysis showed that Hb-var in the first year was still negatively correlated with the risk of all-cause death ( HR=0.98, 95% CI 0.97-0.99, P=0.041) and cardiovascular death ( HR=0.98, 95% CI 0.97-0.99, P=0.039). Conclusion:High Hb-var in the first year is associated with low risk of all-cause death and cardiovascular death in PD patients with severe anemia at baseline.