Objective To evaluate the safety, feasibility and efficacy of CT-guided percutaneous hollow screw fixation in the treatment of patients with sacroiliac complex injury. Methods Forty-five patients (at age range of 15-58 years) with sacroiliac complex injuries including 20 males and 25 females were enrolled in this study. There were 28 traffic injuries and 17 fall injuries. Fourteen patients with sacral fractures ( 15 patients with Dennis type Ⅰ fractures and nine with Dennis type Ⅱ fractures), 12 with sacroiliac joint dislocation, six with sacral fracture combined with sacroiliac joint dislocation and nine with sacroiliac joint complex injury. All patients were treated by CT-guided percutaneous hollow screw fixation. The functional exercise was performed early after operation. Results Seventy-two hollow screws were installed in 45 patients, with the operation time for 21-68 minutes ( average 37 minutes) and the operative blood loss for 30-75 ml. Of all, 38 patients were followed up for 6-26 months. According to the Majeed functional criteria, the score of the patients was 72-96 points (average 90. 3 points ), which showed that the results were excellent in 33 patients and good in two, with excellence rate of 92%. No iatrogenic nerve injury, incision infection or screw fracture were detected. Conclusion CT-guided percutaneous hollow screw fixation takes advantages of precise direction, stable fixation and safe operation and hence is one of safe and effective methods for treatment of sacroiliac complex injury.

OBJECTIVEChanges in the osteogenesis of diabetic rat bone marrow mesenchymal stem cells (BMSCs) by the regulation of Lnk/stem cell factor (SCF)-cKit signaling were investigated.

METHODSBMSCs were isolated from diabetic rats and identified by immunocytochemical staining. These cells were divided into the control group (untransfected group), negative control group (transfected with control plasmid), and RNA interference group (transfected with Lnk-targeting RNA interference plasmid). Western blot was performed to analyze the effect of interference. The BMSCs were induced for osteogenic differentiation under diabetic conditions, and Western blot was used to examine the expressions of Lnf, SCF, and cKit in Lnk/SCF-cKit signaling and osteogenic proteins alkaline phosphatase (ALP), osteocalcin (OCN), and collagen type I al (ColIal).

RESULTSIsolated cells expressed CD₄₄ and CD₉₀ but not CD₁₁b or CD₄₅. This phenomenon was characteristic of BMSCs. Compared with other diabetic BMSCs, cells in the RNA interference group expressed low Lnk but high SCF and cKit (P < 0.05). Thereafter, 28 days after induction of osteogenic differentiation, cells in the RNA interference group expressed low Lnk but high SCF, cKit, ALP, OCN, and ColIal compared with other diabetic BMSCs (P < 0.05).

CONCLUSIONThe inhibition of Lnk expression and activation of SCF-cKit pathway may improve the osteogenic differentiation of BMSCs under diabetic conditions.

Alkaline Phosphatase ; Animals ; Bone Marrow Cells ; Cell Differentiation ; Cells, Cultured ; Diabetes Mellitus, Experimental ; Hematopoietic Stem Cells ; Mesenchymal Stromal Cells ; Osteocalcin ; Osteogenesis ; RNA Interference ; Rats ; Signal Transduction ; Stem Cell Factor ; Transfection

Objective To explore the correlation between anxiety,depression and the symptoms of interstitial cystitis/bladder pain syndrome (IC/PBS) patients,improving the psychological knowledge of IC/PBS patients,providing theoretical basis for psychological intervention.Methods During November 2009 to October 2011,54 IC/PBS patients including 42 women and 12 men patients were treated,with mean age of (41.0±12.4) years and mean course of the disease of (63.0±59.2) months.O'Leary-Sant questionnaire was used for IC/PBS symptoms assessment,and Visual Analogue Scale (VAS) was used to evaluate pain associated with bladder,Self-rating Anxiety Scale (SAS) was used for anxiety assessment,and Beck Depression Inventory Ⅱ (BDI-Ⅱ) was used for depression assessment.The relationship between depression,anxiety and the symptoms of IC/PBS patients was evaluated.Results Of the 54 IC/PBS patients,mean ICSI score was (15.0±1.84) points,mean ICPI score was (8.0±2.6) points,mean O'Leary-Sant questionnaire score was (24.0±3.9) points,mean VAS score was (7.0± 1.0) points,mean anxiety score was (52.0± 7.2) points,with 35 cases (64.8％) suffering from anxiety symptoms.Mean depression symptoms score was (16.0±4.5) points,with 41 cases (75.9％) suffering from depressive symptoms.The degree of anxiety and depression were associated with education level,the sleep quality and monthly income of IC/PBS patients.Anxiety and depression had no definite correlation with marital status and working conditions.Anxiety and depression were closely related (proportion) with the symptoms (frequency,urgency,pain or discomfortrelated to bladder) of IC/PBS patients.Conclusions Anxiety and depression are common in patients with IC/PBS,and they are related to symptom severity.In order to improve the quality of life,much attention must be paid to psychological condition assessment and treatment of IC/PBS patients.

Objective To classify patients with pelvic pain and to improve the understanding of etiology and to guide treatment by using a clinical phenotype system (UPOINT) and to examine the relationship between UPOINT and symptoms in patients with interstitial cystitis/painful bladder syndrome. Methods From November 2009 to October 2011,54 IC/PBS patients including 42 female and 12 male patients were treated.The mean age was 41.0 ± 12.4 yrs (range from 21 to 76 yrs).Median symptom duration was 63.0 ± 59.2 months ( range from 6 to 240 months).54 patients with interstitial cystitis/painful bladder syndrome were classified in each domain of UPOINT,that was urinary,psychosocial,organ specific,infection,neurological/systemic and tenderness.Symptoms were assessed using the Interstitial Cystitis Symptom Index,Pain/Urgency/Frequency score and visual analogue scale for pain/urgency/frequency.Clinically relevant associations were calculated. Results In the 54 IC/PBS patients,median ICSI score was 15.0 ± 1.84 points ( range from 9 to 19 points) ; Median PUF was 20.0 ± 2.3 points ( range from 14 to 25 points) ; Median pain associated with bladder score of VAS was 7.0 ± 1.0 points (range from 5 to 10 points).The percent positive for each domain was urinary 100％,psychosocial 44％,organ specific 96％,infection 33％,neurological/systemic 24％ and tenderness 28％,respectively.All patients were included in at least 2 domains,with 2 domains of 11％,3 domains of 38％,4 domains of 36％,5 domains of 13％ and 6 domains of 2％.The number of domains was associated with greater symptom duration ( Spearman r =0.76,P ＜0.01 ) but not age.The number of domains was also associated with poorer general interstitial cystitis and pain symptoms ( Spearman r =0.89,P ＜ 0.01 ) but not with frequency or urgency.The psychosocial domain was associated with increased pain,urgency and frequency,while tenderness was associated with increased ICSI score,PUF score and urgency.The neurological/systemic domain was associated with increased ICSI score while the infection domain was not associated with any increased symptoms. Conclusions The UPOINT phenotyping system can classify patients with interstitial cystitis according to clinically relevant domains.The UPO1NT system can act as the guiding theoretical basis for directing multimodal therapy,it deserves clinical promotion.

Objective To analyze the causes of under-staging in first transurethral resection of bladder tumor (TURBt) and find out solutions. Methods We retrospectively analyzed 118 cases (93 males and 25 females) of non-muscle invasive bladder cancer and compared the grade and stage between the first TURBt with the second transurethral resection (TUR) or partial cystectomy (PC) or radical cystectomy (RC) from January 2006 to March 2011.The mean patient age was 63.0 ±8.6 yrs.The tumors located in lateral,dome and posterior wall were 71,23,24 respectively; 75 of them were with single and 43 were with multifocal lesions; the sizes of tumor ranged from 0.5 -4.0 cm and 39 of them were ≥3.0 cm; The procedures performed by senior and junior urologist were 53 and 65 cases,respectively.In the study,we used the 2004 WHO/ISUP and 2002 TNM classification system for grading and staging.The data were analyzed with x2 and the logistic regression test to find out the causes of under-staging in first TURBt. Results There were 13 and 105 cases with high-grade Ta and T1 (low-grade T1 44 cases,high-grade T1 61 cases) in first TURBt,respectively.The finial stages were low-grade Ta(2),high-grade Ta(6),low-grade T1 (36),highgrade T1 ( 38 ),T2 (36) and 39 cases (33.1 ％ ) were under staged ( P ＜ 0.01 ).There were 17 and 22 under-staged cases compared with the second-TUR group (60 cases) and PC/RC groups (58 cases),respectively.The reasons of under-staging were related to tissue morphology changes (63 cases) and the absence of the detrusor muscle (56 cases) in specimens collected during the first TURBt.Multivariate analyses revealed that large tumors ( ≥3 cm),and lateral/dome/anterior wall tumors were independent risk factors to the absence of the detrusor muscle in the resected specimens with OR (95％ CI):3.766 ( 1.263 -11.225 ),and OR (95 ％ CI):5.951 (2.186 - 16.203 ),respectively.While surgery performed by senior surgeons was the protective factor to the presence of detrusor muscle,OR (95％ CI):0.274 (0.127 -0.593). Conclusions It is difficult for the first TURBt to completely avoid under-staging.The causes were related to tissues morphology changes and the absence of underlying detrusor muscle in specimens collected during the first TURBT procedure.Tissues morphology changes and the absence of detrusor muscle are related to the tumors location and size.A senior urologist and second-TUR can improve the under-staging.

Objective To Investigate the clinical relationship between the interstitial cystitis and female hormone imbalance.Methods A retrospective analysis of 58 cases of IC female patients in our hospital from January 2006 to April 2012.The patients' age ranged from 21 to 76 years,and the average age was 40.2±12.4 years old.The suffering time of disease ranged from 9 to 120 months,and the average duration was 64.3±55.7 months.At the 1st,12th,22th day of the menstrual cycle,the O'Leary-Sant and PUF questionnaires were used to score,in order to analyze the relationship between IC symptoms and the menstrual cycle.The symptoms scores between postmenopausal patients and No menopause patients were compared.At the same time,the medical records and follow-ups were reviewed for all patients.Results 51 cases of IC premenopausal female patients suffered more urinary frequency,urgency,and bladder pain during the menstrual period.The proportion respectively were 54.9 ％ (28/51),60.8％ (31/51).The O'Leary-Sant scores of the 1st day were more significant difference than the12th and the 22th day (P＜0.05),but there was no significant difference between the 12th day and the 22th day (P＞0.05).The PUF scores of the 1st day were significant different than the 12th and the 22th day (P＜0.05),but there was no significant difference between the 12th day and the 22th day (P＞0.05).The average scores of O'Leary-Sant and PUF in 7 postmenopausal patients were statistically significant lower than non-menopausal patients (P＜0.05).The incidence of 58 cases with uterine fibroids,breast hyperplasia,ovarian cysts,endometriosis (48.3％,41.4％,5.2％,13.8％) were higher than the average persons (P=0.001,0.460,0.001,0.048),which were significantly higher than the incidence of the general population (30.0％,40.0％,0.3％,7.0％) excepting breast hyperplasia.Conclusions The symptoms of urinary frequency,urgency,and bladder pain in IC patients were more serious during the menstrual period than the other periods.The symptoms of the non-postmenopausal patients were more serious than the postmenopausal patients.The incidence of IC patients associated with hormone imbalance diseases was higher than the general persons,indicating that the fluctuation of female hormone level was likely to be one cause of IC onset.

Type B aortic dissection is a life-threatening aortic disease.With the development of clinical classification and diagnostic method,the mortality of type B aortic dissection has been greatly decreased.In respect of treatment,endovascular repair due to minimally invasive advantages become the first choice for the treatment of complicated type B aortic dissection.For non-complicated type B aortic dissection,endovascular repair also gradually replace drug treatment,and showed good efficacy.Open surgery is only available for patients who ate not suitable for endovascular repair or repair failure or patients with connective tissue disease.

Objective:To evaluate the efficacy and safety of physician-modified fenestration TEVAR for treating type B aortic dissection with unhealthy or short anchoring zone.Methods:Clinical data of patients with type B aortic dissection who received TEVAR for left subclavian artery fenesration from May 2016 to Dec 2018 were analyzed prospectively.Results:The technical success rate was 93.2%. One case was converted into chimney stenting. One case suffered type Ⅰendoleak. One case had type Ⅲ endoleak. There were no deaths or neurological complications during the perioperative period, and the mean hospital stay was 9.2 (5-26) days. The median follow-up time was 30 (12-42) months. One case developed type Ⅰ endoleak during follow-up. No retrograde dissection occurred and all LSA stents remained patent.Conclusion:Physician-modified fenestration TEVAR is safe and effective for the treatment of type B aortic dissection with unhealthy or short anchoring zone.

Objective: To investigate the effects of 25-hydroxyvitamin D3[25(OH) D3,D3] on NLRP3 inflammasome activation and inflammatory response of bone marrow mesenchymal stem cells (BMSCs) from diabetic rats. Methods: BMSCs were isolated from diabetic rats and identified by immunocytochemical staining. The cells were divided into diabetic control group (without D3 treatment),low concentration group(treated with 1 × 10-5 mmol /L of D3),intermediate concentration group(treated with 1 × 10-4 mmol /L of D3),and high concentration group(treated with 1 × 10-3 mmol /L of D3) (n = 10),BMSCs from normal rats were used as the normal control group(without D3 treatment). Inflammation-related proteins including NLRP3 in BMSCs were examined by western blot analysis. Results: The cultured cells expressed biomarkers of BMSCs. VDR expression in normal control,diabetic control and low concentration groups was less than that in intermediate concentration and high concentration groups(P ＜ 0. 05). Compared with all diabetc groups,normal control group expressed less NF-κB,NLRP3,ASC,Caspase-1,IL-1β,IL-18 and IL-6(P ＜ 0. 05). Additionally,diabetic control and low concentration groups showed stronger expression of NF-κB,NLRP3,ASC,Caspase-1,IL-1β,IL-18 and IL-6 than intermediate concentration and high concentration groups(P ＜ 0. 05). Conclusion: 25-(OH)2-D3 can inhibit the activation of NLRP3 in BMSCs and suppress the inflammatory response of BMSCs from the diabetic rats.

Objective To compare and analyze the effect of minimally invasive percutaneous nephrolithotomy compare with traditional open surgical in treatment of kidney stones outcome. Methods Selected 120 patients with kidney stones from January 2009 to January 2014 in our hospital, all patients had complete clinical data, included 60 cases of renal sinus traditional lines pelvis lithotomy, established as the control group, and the remaining 60 routine minimally inva-sive percutaneous nephrolithotomy surgery, set up minimally invasive group, the operative time, blood loss, postoperative fistula time and hospital stay and complications were compared between two groups. Results 60 patients with invasive group homogeneity of puncture success and smooth gravel, stone successful in 58 cases, the success rate was 96.7%(58/60). Intraoperative complications pneumothorax, colon injury does not appear, one-time stone clearance rate was 80.0%(48/60). Stable vital signs after surgery, no nephrectomy, severe complications wound fistula, pneumothorax oc-curred. 4 cases of postoperative urinary tract infection sustained high fever, anti-infection cure. 1 case duodenal injury control group intraoperative peritoneal injury in 2 cases, 2 cases of postoperative fever, intestinal fistula, urinary tract infection in 8 cases. Operative time, blood loss, postoperative fistula compare the time and duration of hospitalization, of observation group improved significant than the control group, the difference was statistically significant (P<0.05 or P<0.01). Conclusion Minimally invasive percutaneous nephrolithotomy in the treatment of kidney stones with less trau-ma, less bleeding, fewer complications, shorter hospital stays and can be worthy of promotion and application.