Objective:To explore the efficacy, adverse reactions, and feasibility of high-definition transcranial direct current stimulation(HD-tDCS) treating major depressive disorder(MDD) patients with anxious distress.Methods:Sixty cases of MDD with anxious distress admitted to Zhenjiang Mental Health Center were recruited as participants. All patients were allocated into either the active treatment group or the sham group based on the random number table method. HD-tDCS was utilized in both groups to stimulate the left dorsolateral prefrontal cortex on the basis of conventional antidepressant treatment. In the active group, 2mA current stimulation was used for 20 min, and in the sham group, a 30-sceond stimulation was adopted at the beginning and the end of the stimulation. Participants in both group were treated once a day, five times a week for two consecutive weeks. Anxiety and depression symptoms of the patients were assessed respectively by the Hamilton depression scale(HAMD 17), the Montgomery-Asberg Depression Rating Scale(MARDS), the Hamilton Anxiety Scale(HAMA), and the Beck Anxiety Inventory(BAI) at the baseline, 2nd, 4th, and the 6th weekend of the treatment. The differences between active treatment and sham groups were analyzed by repetitive measure analysis of variance and simple effect analysis. Fisher′s exact probability test was used to compare the effective rate, remission rate and adverse reaction rate between the two groups. Results:(1) The interaction of times and groups was significant in HAMD 17( F=3.29, P<0.05) and BAI( F=2.99, P<0.05). In all measurement instruments, the main effects of groups( F=4.40-7.94) and times( F=35.42-247.59) were significant( P<0.05).(2) Findings from the simple effect analysis showed that: there were no significant differences in the scores of HAMD 17 at baseline and the 2 nd assessment between the two groups. Similarly, no significant differences were found in BAI at baseline, the 2nd and the 6th weekend of the treatment between two groups( P>0.05).(3) The scores of HAMD 17 at the 4th and the 6th week, BAI at the 4th weekend of the treatment in the active group were significantly lower than that in the sham group( P<0.05).(4) At the 4th weekend of the treatment, the active group had a remission rate of 16/20 and a response rates of 19/20, which were higher than 9/19 and 13/19, respectively, in the sham group( P<0.05). Also, the remission rate(18/20) in the active group was higher than that in the sham group(11/19) at the 6th weekend of the treatment.( P<0.05). As for the response rates, differences were not found between the two groups at the 6th weekend of the treatment.(5) The overall dropout rate had no significant differences in-between( P>0.05). As for the safety outcome, the rate of adverse events(e.g., itching, tingling and headache) showed no significant differences between the two groups. Additionally, no severe adverse events or mania was reported. Conclusions:This study indicated that HD-tDCS has significant efficacy and high safety in the treatment among MDD patient with anxious distress. Nevertheless, further large sample clinical studies are warranted to confirm the findings of the current investigation.

Objective:To explore the efficacy, adverse reactions, and feasibility of high-definition transcranial direct current stimulation(HD-tDCS) treating major depressive disorder(MDD) patients with anxious distress.Methods:Sixty cases of MDD with anxious distress admitted to Zhenjiang Mental Health Center were recruited as participants. All patients were allocated into either the active treatment group or the sham group based on the random number table method. HD-tDCS was utilized in both groups to stimulate the left dorsolateral prefrontal cortex on the basis of conventional antidepressant treatment. In the active group, 2mA current stimulation was used for 20 min, and in the sham group, a 30-sceond stimulation was adopted at the beginning and the end of the stimulation. Participants in both group were treated once a day, five times a week for two consecutive weeks. Anxiety and depression symptoms of the patients were assessed respectively by the Hamilton depression scale(HAMD 17), the Montgomery-Asberg Depression Rating Scale(MARDS), the Hamilton Anxiety Scale(HAMA), and the Beck Anxiety Inventory(BAI) at the baseline, 2nd, 4th, and the 6th weekend of the treatment. The differences between active treatment and sham groups were analyzed by repetitive measure analysis of variance and simple effect analysis. Fisher′s exact probability test was used to compare the effective rate, remission rate and adverse reaction rate between the two groups. Results:(1) The interaction of times and groups was significant in HAMD 17( F=3.29, P<0.05) and BAI( F=2.99, P<0.05). In all measurement instruments, the main effects of groups( F=4.40-7.94) and times( F=35.42-247.59) were significant( P<0.05).(2) Findings from the simple effect analysis showed that: there were no significant differences in the scores of HAMD 17 at baseline and the 2 nd assessment between the two groups. Similarly, no significant differences were found in BAI at baseline, the 2nd and the 6th weekend of the treatment between two groups( P>0.05).(3) The scores of HAMD 17 at the 4th and the 6th week, BAI at the 4th weekend of the treatment in the active group were significantly lower than that in the sham group( P<0.05).(4) At the 4th weekend of the treatment, the active group had a remission rate of 16/20 and a response rates of 19/20, which were higher than 9/19 and 13/19, respectively, in the sham group( P<0.05). Also, the remission rate(18/20) in the active group was higher than that in the sham group(11/19) at the 6th weekend of the treatment.( P<0.05). As for the response rates, differences were not found between the two groups at the 6th weekend of the treatment.(5) The overall dropout rate had no significant differences in-between( P>0.05). As for the safety outcome, the rate of adverse events(e.g., itching, tingling and headache) showed no significant differences between the two groups. Additionally, no severe adverse events or mania was reported. Conclusions:This study indicated that HD-tDCS has significant efficacy and high safety in the treatment among MDD patient with anxious distress. Nevertheless, further large sample clinical studies are warranted to confirm the findings of the current investigation.

Since the autologous fat transplantation was reported by a German surgeon, Gustav Neuber, in 1893, the technical method of autologous fat transplantation, the transplantation concepts and application range have undergone tremendous changes and progress. In recent years, with the advanced research on adipose derived stem cells (ADSCs), the application field of autologous fat has been widespread. From initially used for soft tissue filling, it gradually expanded to orthopedic surgery, reconstructive surgery and cosmetic surgery, such as treatment of scar, skin and tendon adhesion, Renault syndrome, breast enhancement, facial rejuvenation and body shaping. The Nanofat transplantation technology originated from autologous fat transplantation, and it is not an exact nanotechnology for the technology itself. However, due to its remarkable effect on local skin rejuvenation, the Nanofat transplantation has become one of the hot issues in orthopedics in recent years.

Objective: Autologous lymph nodes fragmentary transplantation combined with vascular endothelial growth factor-C (VEGF-C) on athymic nude mice to explore the association between regeneration of lymphatic vessel and tumor cell migration. Methods: A total of 45 nude mice were randomly divided into 3 groups: Group A, simple autologous lymph nodes fragmentary transplantation, n=15; Group B, autologous lymph nodes fragmentary transplantation together with VEGF-C, n=15; Group C, without any intervention, n=15. At 1 month, 2 months and 6months after surgeries, the axillary lymph nodes of 5 mice in each group were dynamically examined by in vivo indocyanine green (ICG) fluorescence imaging respectively. The regenerated lymph nodes and relevant skin were evaluated using hematoxylin-eosin (H&E) staining and the skin was quantitatively analyzed via immunofluorescence staining for lymphatic vessel endothelial hyaluronan receptor 1(LYVE-1) as well. Results: One month after surgery, the right regenerated axillary lymph nodes in group B (5/5) were visible by in vivo ICG fluorescence imaging, whereas the same signals were not detected in group A (0/5). The results were the same at 2 and 6 months after surgery. HE staining showed that the cortical, paracortical, and medullary regions of the right axillary lymph nodes of the experimental group B were clear, and the lymphatic vessel structure was present, accompanied by lymphocyte infiltration. Immunofluorescence staining of the right upper limb showed that the expression of LYVE-1 in the lymphatic endothelium of the B group was significantly higher than that in group A (P<0.001) and the control group (both P<0.001). Conclusions Due to the promising consequence of regenerated lymph nodes, the procedure of autologous lymph nodes fragmentary transplantation combined with VEGF-C in athymic nude mice provides a reliable animal model for the next stage research.

Objective To discuss the neuroimaging characteristics of transcranial ultrasound in end‐stage renal disease ( ESRD ) with restless legs syndrome . Methods T ranscranial sonography ( TCS ) was performed in ESRD with restless legs syndrome ( RLS + group , n ＝ 41 ) ,ESRD without restless legs syndrome ( RLS － group , n ＝57) and control group ( n ＝47) ,w ho were enrolled in the Second Affiliated Hospital of Soochow University from January 2017 to December 2018 . T he differences of the neuroimaging characteristics of TCS in substantia nigra ( SN ) ,brainstem raphe ( BR) and red nucleus ( RN ) among the three groups were analyzed . Results T he rate of SN hypoechogenicity was significantly higher in RLS +group ( 36 .6% ,15/41) than that in RLS － group ( 19 .3% ,11/57) and control group( 8 .5% ,4/47) ( χ2 ＝10 .6 ,P＜0 .05) . T he rate of abnormal BR echogenicity was significantly higher in RLS + group ( 34 .1% , 14/41) and RLS － group ( 29 .8% ,17/57) than that in control group( 10 .6% ,5/47) ( χ2 ＝7 .7 , P ＜0 .05) . T he rate of RN hyperechogenicity was significantly higher in RLS + group ( 51 .2% ,21/41 ) than that in RLS － group ( 21 .1% ,12/57) and control group ( 10 .6% ,5/47) ( χ2 ＝19 .8 , P ＜0 .05 ) . Between RLS+and RLS － groups ,when SN ,BR and RN were all of positive performance ,the accuracy of diagnosing RLS+ reached 70% ( 7/10 ) . Conclusions The echogenicity changes of SN ,BR and RN on TCS could provide valuable neuroimaging information for the clinical diagnosis and treatment of ESRD with restless legs syndrome .

Objective: To discuss the neuroimaging characteristics of transcranial ultrasound in end-stage renal disease (ESRD) with restless legs syndrome. Methods: Transcranial sonography (TCS) was performed in ESRD with restless legs syndrome (RLS+ group, n=41), ESRD without restless legs syndrome (RLS- group, n=57) and control group (n=47), who were enrolled in the Second Affiliated Hospital of Soochow University from January 2017 to December 2018. The differences of the neuroimaging characteristics of TCS in substantia nigra (SN), brainstem raphe (BR) and red nucleus(RN) among the three groups were analyzed. Results: The rate of SN hypoechogenicity was significantly higher in RLS+ group (36.6%, 15/41) than that in RLS- group (19.3%, 11/57) and control group(8.5%, 4/47) (χ²=10.6, P<0.05). The rate of abnormal BR echogenicity was significantly higher in RLS+ group (34.1%, 14/41) and RLS- group (29.8%, 17/57) than that in control group(10.6%, 5/47) (χ²=7.7, P<0.05). The rate of RN hyperechogenicity was significantly higher in RLS+ group (51.2%, 21/41) than that in RLS- group (21.1%, 12/57) and control group (10.6%, 5/47) (χ²=19.8, P<0.05). Between RLS+ and RLS- groups, when SN, BR and RN were all of positive performance, the accuracy of diagnosing RLS+ reached 70% (7/10). Conclusions The echogenicity changes of SN, BR and RN on TCS could provide valuable neuroimaging information for the clinical diagnosis and treatment of ESRD with restless legs syndrome.

Objective To investigate the prevalence of restless legs syndrome (RLS) in peritoneal dialysis patients and analyze the related risk factors.Methods This study was a cross-sectional study.The patients receiving maintenance peritoneal dialysis from January 2017 to December 2017 in the Peritoneal Dialysis Center of the Second Hospital Affiliated to Soochow University were selected as the study subjects.RLS was screened for peritoneal dialysis patients by epidemiological field investigation based on the RLS diagnostic criteria of the International Restless Leg Syndrome Research Group in 2014.Clinical data and laboratory examinations of selected patients were collected and the differences of clinical indicators between RLS and non-RLS patients were compared.The risk factors related to RLS were analyzed by logistic regression.Results Seventy-six cases of RLS were screened out from 396 PD patients.The prevalence of RLS was 19.2％.Compared with non-RLS group,RLS group patients had longer dialysis age,less 24 hours urine volume,and elevated blood intact Parathormone (iPTH) and alkaline phosphatase (AKP) (all P ＜ 0.05).There was no significant difference in primary disease ratio,sex,age,body mass index,blood pressure,hemoglobin,creatinine,urea nitrogen,uric acid,ferritin,serum iron,transferrin saturation,blood calcium,blood phosphorus,total cholesterol,triglyceride,low density lipoprotein,high density lipoprotein,eGFR,Kt/V,Ccr between RLS and non-RLS group patients (all P ＞ 0.05).Multivariate logistic regression analysis showed that long dialysis age (OR=1.010,95％CI 1.001-1.018,P=0.022) and high blood AKP (OR=1.005,95％CI 1.001-1.010,P=0.021) were independent risk factors for RLS in peritoneal dialysis patients (both P ＜ 0.05).Conclusions The prevalence of RLS is high in peritoneal dialysis patients.Long dialysis age and high blood AKP are independent risk factors for RLS.

Objective To analyze the therapeutic effect and prognosis of peritoneal dialysis in patients with end-stage polycystic kidney disease.Methods A retrospective analysis was performed on patients with polycystic kidney disease who were treated with peritoneal dialysis for more than 3 months between July 2007 and September 2016 in the Second Hospital Affiliated to Soochow University.A total of 45 patients were enrolled in this study.Another 45 patients of non-diabetic nephropathy were selected as the control group matched by gender,age,and time of PD initiation.The information of the two groups such as general data,dialysis related complications,incidence of peritonitis,prognosis was recorded.Survival analysis was performed using the Kaplan-Meier method and Log-rank test.The risk factors affecting patients' survival were analyzed with Cox regression model.Results There were no significant difference in pre-dialysis age,sex ratio,blood pressure,urine volume,body weight,eGFR,biochemical data,and the proportion of hypertension and diabetes mellitus in the polycystic kidney group and control group.24 h ultra-filtration volume,4 h D/Pcr,Kt/V and Ccr between the two groups showed no significant difference (all P ＞ 0.05).The incidence of peritonitis and the time of the first peritonitis in the two groups respectively as one episode per 82.4 months vs one episode per 81.5 months,(35.8±22.8) months vs (34.5±20.9) months had no statistical difference.The ratio of hernia (6.6％ vs 2.2％),thoracic and abdominal leakage (4.4％ vs 2.2％),dialysate leakage (0 vs 0),catheter dysfunction (4.4％ vs 6.6％),exit-site infections (11.1％ vs 6.6％),tunnel infections (4.4％ vs 2.2％) and non PD related infections (11.1％ vs 13.3％) had no significant difference.The 1-year,3-year,5-year patient survival of two groups respectively were 95.2％ vs 93.3％,78.9％ vs 75.0％,67.6％ vs 64.9％ (P=0.475),and 5-year technique survival was 78.7％ vs 76.7％ (P=0.623),demonstrating no obvious difference.Cox regression analysis showed that age and serum albumin were risk factors for the survival of patients.Conclusions The effect and prognosis of peritoneal dialysis in patients with polyeystic kidney and non polyeystic kidney were similar.Peritoneal dialysis is not the contraindication of polycystic kidney.Peritoneal dialysis can be used as a routine renal replacement therapy in patients with polycystic kidney disease.

Objective To explore the clinical features of female recurrent major depression(MD) patients with and without suicidal ideation.Methods 301 female recurrent major depression patients were interviewed by specially trained interviewers using computer evaluation system and divided into suicidal ideation group and non-suicidal ideation group according to suicidal ideation.The comparisons between the two groups were investigated on items of demographic, clinical data, assessment of psychopathology, Eysenck neuroticism questionnaire, stressful life events.Results 66.4％ of MD patients have suicidal ideation.Compared with non-suicidal ideation group, there were more total number of MD symptoms (8.58±0.77, OR=2.476, P=1.154× 10-9) and melancholia symptoms (6.74±1.07, OR=1.546, P=0.001) and it was more common in the factors of less appetite (OR=2.201, P=0.011), lose weight (OR=2.030, P=0.004), early morning awakening (OR=1.774, P=0.045), worthless (OR =2.352, P=0.014), impaired decision-making (OR=2.044, P=0.018), hopelessness (OR=7.130, P=6.651 × 10-9) ,helpless (OR=2.046, P=0.049) in suicidal ideation group.Also in suicidal ideation group the scores of neuroticism dimension (OR=1.631, P=0.024) were higher, and they were more suffered from stressful life events (OR=1.302, P=0.008).Binary logistic regression analysis indicated that total number of MD symptoms (OR=4.840, P=1.154×10-8) ,stressful life events (OR=1.392, P=0.014) and hopelessness (OR=3.528, P=0.008)were significantly associated with suicidal ideation.Conclusion Specific clinical features are associated with suicidal ideation among female patients of recurrent depression disorder.Hopelessness, stressful life events are risk factors of suicide ideation in female recurrent major depression patients.Integrated clinical assessment should be taken for recurrent major depression patients with suicidal ideation.

Objective To explore the clinical features of female diagnosed recurrent major depression (MD) comorbidity with general anxiety disorder (GAD).Methods 301 females patients with recurrent major depression were interviewed by specially trained interviewers with using computer evaluation system and divided into comorbidity group and non-comorbidity group according to whether comorbid MD with GAD or without GAD.The comparison between the two groups included items of demographic,clinical data,assessment of psychopathology,Eysenck neuroticism questionnaire (EPQ),stressful life events,parental bonding instrument.Results 25.2％ of patients of MD coexistence GAD.There was no significant difference in sociodemographic data between the two groups.Significant differences among total number of depression symptoms(OR=1.439,95％ CI =1.049-1.975,P =0.024),duration of illness(OR=1.253,95％ CI =1.010-1.475,P=0.048),psychomotor agitation(OR=2.031,95％ CI =1.123-3.676,P=0.019),suicidal thought(OR=2.228,95％ CI =1.010-4.912,P=0.047),anxiety(OR =5.547,95％ CI =1.935-15.896,P=0.001),irritable(OR=1.956,95％ CI =1.081-3.542,P=0.027) were identified between the two group.In the comorbidity group,the score of nenroticism dimention derived from EPQ was also higher(OR=2.287,95％ CI =1.674-3.124,P=2.287× 10-7) than that of non-comorbidity group.There was no significant difference of stressful life events between two groups(OR=1.118,95％ CI =0.913-1.368,P=0.280).Conclusion This study suggests the phenomena that female patients of recurrent depression disorder comorbidity with general anxiety disorders is common in clinical.The patients comorbid MD and GAD have more symptoms,neuroticism and be worse in severity.