Objective To compare the infection free and overall survival between first and subsequent tunneled cuffed hemodialysis catheters in geriatric patients.Methods The study involved57 geriatric patients [32 male,25 female; mean age (72.4 ± 6.7) years]undergoing maintenance hemodialysis in our blood purfication unit over a period of 72 months.Among a total of 131 catheters and 2686 catheter months including 57 first catheters and 74 consecutive catheters,48 wire guided exchange (WGE) and 26 removal and replacement (RAR),55/131 (42.0％) catheters were exchanged because of catheter-related bacteremia (CRB),37131 (28.2％) exchanged because of malfunction or cuff extrusion,39 /131 (29.9％)catheters were removed electively or was still functional at the end of the study period.Results One-year survival rates for first and consecutive catheters were 35.8％ and 28.4％,respectively.There was no difference in the overall survival between first catheters group and subsequent catheters group [(29.8±7.9)months vs.(28.7±6.0)months,t=0.711,P=0.443].However,infection free survival of first catheters group was significantly prolonged in comparison with that of subsequent catheters group [(13.1 ± 3.5) months vs.(11.6±2.7) months,t =2.415,P=0.018].The overall and infection-free survival in WGE group were not different with those of RAR group [(28.2 ± 7.2 ) months vs.( 28.5 ± 5.8 ) months,(11.1±3.1)months vs.(12.2±2.1)months,t=-0.163,0.103,P＞0.05].The infection free survival of first catheters group and WGE group was prolonged in comparison with that of in situ group[(13.1±3.5)months and (11.1±3.1)months vs.(8.2±2.1)months,t =7.602,5.601,P＜0.05].Conclusions WGE is safe and effective in the elderly patients if the tunnel and the exit site are not infected and has the potential benefit of preserving the vascular access site.

Objective To investigate the types and outcome of vascular access in patients with end stage renal disease (ESRD) initiated hemodialysis (HD), and provide the basis for advancing the proportion of planned HD with arteriovenous fistula (AVF). Methods Clinical data, vascular access types at the initiation of HD, the outcomes of all types of dialysis access and the conversion of renal replacement therapy of ESRD patients who initiated HD in the first affiliated hospital of zhejiang university between January 2009 and December 2011 were retrospectively studied. Results A total of 836 patients were included in our study. Among them 510 were males and 326 were females. The average age was (49.77 ± 17.65) years old. The major primary diseases were primary glomerular disease (72.73%), diabetic nephropathy (11.60%)and hypertensive nephrosclerosis (3.95%). Only 73 patients (8.73%) used AVF as the vascular access at the initiation of HD, another 763 patients (91.27%) used central venous catheter. Six months after the start of dialysis, 542 patients (81.5%) had used AVF as permanent vascular access, 123 patients (18.5%)had used the tunneled cuffed catheter, 54 patients had received a transplant and 55 patients had converted to peritoneal dialysis. The results of logistic regression analysis suggested that being male, patients from outside hangzhou and patients whose glomerular filtration rate were lower than 5 ml·min-1·(1.73 m2)-1 were the risk factors of using central venous catheters at the initiation of HD. Conclusions Only a minority of patients used AVF at the initiation of HD, but most of the other patients switched to AVF within the following six months. Increasing the proportion of AVF as the vascular access of planned HD is still our current goal.

Objective To analyze the effects of mild traumatic brain injury ( mTBI) on functional brain network parameters and to study the properties of small world of patients. Methods Ten patients with mild traumatic brain injury and 13 healthy controls matched by age and sex were collected from the Ninth People's Hospital Affiliated to Medical College of Shanghai Jiao Tong University. Resting functional magnetic resonance images of all subjects were collected. Functional networks were constructed and brain network properties were analyzed. Results The brain injury group and the healthy control group had small world at-tributes in the selected sparseness range. The global efficiency of patients with mTBI patients was significantly reduced compared to healthy control group (0. 174±0. 141 vs 0. 184±0. 062),t=2. 417,P=0. 025),and the shortest path length was increased compared to healthy control group (0. 797±0. 930 vs 0. 734±0. 488),t=-2. 083,P=0. 048). Conclusion The functional brain network of patients with mTBI patients has small world attributes,and the parameters of functional brain network of patients have changed.

Objective To construct the platelet-specific Metrnl gene knockout （Plt-Metrnl^-/-）mice model. Methods Based on the Cre-LoxP system, Metrnl^loxp/loxp mice, previously constructed in our laboratory, were mated with Pf4-Cre mice to generate Plt-Metrnl^-/- mice. The genotypes of the offspring were identified, and tissues of the platelet, other peripheral blood cells, heart, liver, spleen, lung, kidney, brain, colon, and bone marrow were collected. The expression of the Metrnl gene in Plt-Metrnl^-/- mice was investigated by quantitative real-time PCR and western blot. Also, the blood routine index was tested in Plt-Metrnl^-/- mice. Results Compared with wild-type mice, the level of Metrnl protein in platelets was significantly decreased in Plt-Metrnl^-/- mice. There was no significant difference in mRNA and protein levels of other peripheral blood cells and tissues, as well as in blood routine index, growth, and development between Plt-Metrnl^-/- mice and WT mice. Conclusion Platelet-specific Metrnl knockout mice（Plt-Metrnl^-/- mice）model was successfully constructed.