Objective:To evaluate the value of curative effect in neuromyelitis spectrum disease (NMOSD) based on circulatory function evaluation of intracerebral glymphatic system by using diffusion tensor imaging analysis along the perivascular space.Methods:The clinical and imaging data of 23 patients diagnosed with NMOSD at Tianjin Medical University General Hospital from March 2018 to December 2019 were retrospectively analyzed in this study. The clinical data included expanded disability status scale (EDSS), average relapse rate (ARR) and retinal nerve fiber layer (RNFL) thickness at baseline and 1 year follow-up after treatment. Among the 23 NMOSD patients, there were 22 females and 1 male, aged from 21 to 71 (45±13) years old. All the patients underwent MR scans at both baseline and 1 year after treatment, and the scanning sequences included cerebral 3D-T 1WI, T 2WI, diffusion tensor imaging and cervical spinal sagittal 3D-T 2WI, and the cervical spinal cord volume and bilateral diffusion tensor imaging analysis along the perivascular space index (ALPS index) were calculated. The partial correlation test was used to analyze the correlations between ALPS index and the clinical indicators such as EDSS, ARR, and bilateral RNFL, with the control variables as gender, age, years of education and course of disease. The multiple linear regression model was used to analyze the independent predictors for ALPS index and EDSS after treatment. Receiver operating characteristic curve (ROC) and area under the curve (AUC) were used to evaluate the diagnostic value of NMOSD treatment outcome by using ALPS index. Results:When controlling for gender, age, years of education and course of disease, there were significant negative correlations between right ALPS index and EDSS ( r=-0.50, P=0.048), bilateral average ALPS index and EDSS ( r=-0.53, P=0.034), left ALPS index and ARR ( r=-0.58, P=0.018), while there was significant positive correlations between right ALPS index and RNFL ( r=0.88, P=0.008) at 1 year follow-up after treatment. Multiple linear regression analysis showed that cervical spinal cord volume was an independent impact factor of bilateral average ALPS indexes (β=0.24, 95%CI 0.10-0.38, P=0.002), and bilateral average ALPS indexes (β=-3.22, 95%CI -5.97--0.48, P=0.024) and right RNFL (β=-0.05, 95%CI -0.08--0.02, P=0.002) at baseline were the independent impact factors of EDSS after treatment. ROC curve analysis showed that the bilateral average ALPS index at baseline had the best efficacy in predicting the curative effect of NMOSD patients with AUC=0.92. Conclusions:After treatment, NMOSD patients with severe clinical disability, high frequency of disease attack, poor visual performance, and severe cervical spinal cord atrophy have more serious impairment of intracerebral glymphatic system circulatory function. The ALPS index could help in predicting the clinical curative effect of NMOSD patients.

Obesity is a global public health problem that imposes a heavy economic burden on society. The current main strategies for treating obesity include lifestyle interventions, pharmacological treatments, endoscopic treatments and metabolic surgery. With the development of medical technology, weight reduction by intragastric occupancy devices represented by intragastric balloons and intragastric capsules are gradually emerging. Intragastric balloons are used to reduce weight by occupying the volume of the stomach with balloons filled with different volumes of gas or liquid, among which ReShape, Orbera, Obalon, Elipse and Spatz balloons are gradually used in patients with mild to moderate obesity due to their non-invasive, high safety and reusable advantages. Intragastric capsules are recommended in overweight and obese patients for weight loss through hydrogels with transient superabsorbent swelling properties and completely noninvasive. Both approaches achieve weight loss by limiting gastric volume, increasing satiety and reducing food intake. Despite the presence of adverse gastrointestinal events associated with nausea, vomiting, and abdominal distention, they offer new ideas for the non-invasive clinical treatment of obesity.
Humans ; Capsules ; Weight Loss ; Obesity/surgery* ; Overweight ; Stomach/surgery*

Objective:To explore the experience of the treatment of patella inferior pole fracture with non excitation tension band technique.Methods:From April 2009 to December 2019, 76 patients with inferior patellar fracture were treated with non excitation tension band technique. There were 42 males and 34 females; The age was 35.48 ± 18.12 years (17-66 years), with an average of 35 years. There were 45 cases on the left and 31 cases on the right. Causes of injury: fall injury in 46 cases, bicycle injury in 16 cases and traffic accident injury in 14 cases. The time from injury to operation was 0.25-5 d, with an average of 3.2 d. There were 18 cases of open fractures, 64 cases of articular surface fractures and 52 cases of comminuted fractures. Open fracture patients were debridement first, and all cases were fixed with non excitation tension band technique. The intraoperative fracture reduction, postoperative fracture healing and internal fixation were observed. The knee function was evaluated according to the degree of claudication, the use of supports, the feeling of joint strangulation, joint instability, pain, swelling, stair climbing and squatting.Results:All 76 patients successfully completed the operation and were followed up for 18.24 ± 6.18 months (range 12-24 months). There was no wire fracture during and after operation. All incisions healed in the first stage after operation, and there was no deep venous thrombosis of lower limbs. The X-ray film showed that there was no further fracture and fracture displacement after operation, and there was no Kirschner wire slip before the internal fixation was taken out. Only one case had steel wire relaxation due to buckle (which did not affect fracture healing). All fractures healed well, with an average of 7.5 weeks, and the fracture line basically disappeared. 12 months after operation, according to Lysholm knee score standard, the knee function of patients was evaluated. The score of 76 cases was 95.40±4.60 points (range 82-100 points): excellent in 54 cases, good in 21 cases and fair in 1 case. The excellent and good rate was 98.7%. According to the visual analogue scale (VAS) pain score standard, the patients were scored for postoperative pain. The score of 76 cases was 0.09±2.05 points (range 0-3 points): 4 cases had mild pain, with an average score of 0.09.Conclusion:The results of the treatment of patellar inferior pole fracture with tension free band technique are satisfactory, the pain caused by tissue irritation by the internal fixation was lower, clinical application can be popularized.

Objective: To understand the basic characteristics, sexual behavior and the use of recreational new drugs of young men who have sex with men (MSM) in Tianjin, and to explore the characteristics of young MSM who use recreational drugs, so as to provide reference for the policy making of HIV/AIDS prevention and control in universities. Methods: From January 1, 2018, solstice to December 31, 2018, participants were recruited in the bathrooms, bars and social network sites in Tianjin by snowball sampling. The basic demographic information, sexual behavior and recreational drug use of the participants were collected through face to face interviews and questionnaires. Logistic regression was used to analyzed the characteristic differences drug users and non users among young MSM. Results: A total of 826 young MSM were included in the study, 32 were infected with HIV, and the overall prevalence rate was 3.87 %. Totally 371 (44.92%) were drug users. Rush Poppers were the most common used drug ( 98.65 %). Of the young MSM using new drugs, 306 (82.48%) multiple drugs were used, 65 people ( 17.52 %) only one drug has been used. Among new drug users, multiple drug users had higher HIV prevalence rate (16.92%) than single drug users (4.57%). There were statistically significant differences between drug users and non users in age, age of first sexual behavior, household registration, sexual orientation, education level, sexual partners seeking routes, unprotected anal intercourse and HIV testing history( OR=3.70，5.51，0.51，0.60，4.64，0.40，0.52，1.98，2.29，P <0.05). Conclusion The utilization rate of recreational drugs among young MSM in Tianjin was high. Relevant departments should strengthen the propaganda of recreational drugs and HIV prevention among college students, improve the sexual health awareness of young MSM, and establish a long term HIV and recreational drug prevention system.

To explore whether ultrasound measurement of optic disc height can evaluate intracranial hypertension and the value of ultrasound measurement of optic nerve sheath diameter combined with optic disc height in the diagnosis of elevated intracranial hypertension. Methods Enrolled patients who needed lumbar puncture in the Department of Neurology of the First Hospital of Jilin University between July 2019 and November 2020.Complete ultrasound examination before lumbar puncture，measure ONSD and ODH. According to the lumbar puncture pressure，the patients were divided into normal intracranial pressure group and intracranial hypertension group. Singlefactor and multifactor analysis were performed to obtain the relationship between ICP and each ultrasound data. Analyze the correlation between ICP and ONSD and ODH. Generate ROC curve，evaluate and compare the value of ONSD，ODH and ONSD combined with ODH in diagnosing intracranial hypertension. Results A total of 78 patients，39 cases in each group. There was no statistical difference in baseline data between the two groups. （1） ONSD［（5.04±0.34） mm］in intracranial hypertension group is higher than normal intracranial pressure group［（4.17±0.38） mm］（P<0.001）；ODH［0.81 （0.59-1） mm］in intracranial hypertension group is higher than normal intracranial pressure group［0.39 （0-0.59） mm］（P<0.001）；（2）Correlation analysis showed that ICP was positively correlated with ONSD （r=0.779，P<0.001）and ODH（r=0.572，P<0.001）；（3） The cutoff value of ODH for diagnosing elevated ICP is 0.54 mm，the sensitivity and specificity are 85% and 72%，respectively；the cutoff value of ONSD for diagnosing elevated ICP is 4.68 mm，the sensitivity and specificity are 87% and 95%，respectively；The sensitivity and specificity of ONSD combined with ODH in the diagnosis of elevated ICP are 95% and 95%，respectively；（4）Compare the value of the three in diagnosing elevated ICP，ONSD is greater than ODH （P=0.036），ONSD combined with ODH is greater than ONSD（P=0.043）or ODH （P=0.001） alone. Conclusion Ultrasound measurement of ODH can be used to diagnose intracranial hypertension.ONSD combined with ODH can improve the sensitivity of diagnosing elevated ICP.

Objective To discuss the necessity and feasibility of intraoperative use of treatment planning system (TPS) to make real-time planning for the treatment of retroperitoneal metastatic carcinoma with CT-guided 125I seed brachytherapy.Methods The clinical data of 20 patients with retroperitoneal lymph node metastases,who received CT-guided 125I seed brachytherapy during the period from January 2013 to December 2015,were retrospectively analyzed.The patients were divided into group A (n=10) and group B (n=10).The intraoperative TPS was employed to formulate the real-time planning for the patients of group A,while real-time planning was not adopted for the patients of group B.The quality verification of preoperative planning and postoperative effect was conducted for the patients of both groups.Comparing the preoperative and postoperative absorbed dose,the minimum absorbed dose (D90) error percentage of 90％ target volume,the error percentage of the covered volume by 90％ prescription dose to the target volume (V90),the error percentage of the covered volume by 100％ prescription dose to the target volume (V100),and the error percentage of the covered volume by 150％ prescription dose to the target volume (V150) were calculated in all patients of both groups,and the results were statistically analyzed.Results The mean error percentage of D90,V90,V100,V150 in group A were (-1.30±6.80) Gy,(-0.60±2.10)％,(-0.47±2.70)％ and (89.60±282.00)％ respectively,which in group B were (-9.33±46) Gy,(11.50±13.7)％,(-13.40±15.90)％ and (10.37±2.00)％ respectively.The differences in the error percentage of D90,V90 and V100 between group A and group B were statistically significant (P＜0.05 in all),while no statistically significant difference in the error percentage of V150 existed between group A and group B (P＞0.05).Conclusion The use of intraoperative TPS real-time planning can significantly improve the consistency of target region dose before and after seed implantation and make the dose distribution more reasonable,which is of great value for the standardization of CT-guided 125I seed brachytherapy of retroperitoneal lymph node metastases.

Objective To evaluate the safety and efficacy of CT-guided radioactive 125I seed implantation in treating retroperitoneal lymph node metastasis due to recurrent cervical cancer after radiotherapy.Methods A total of 10 patients with retroperitoneal lymph node metastasis (12 lesions in total)due to recurrent cervical cancer after radiotherapy,who were treated with CT-guided 125I seed implantation during the periodfrom November 2011 to October 2015,were included in this study.The diameters,that were perpendicular to each other,of the involved lymph nodesranged from 1.7 cm×1 cm to 6.5 cm×5 cm,the diameter of 6 involved lymph nodes (50％) was ＜5.0 cm and the diameter of other 6 involved lymph nodes (50％) was ≥5.0 cm.With the help of treatment planning system for brachytherapy,the source distribution was formulated.Under CT guidance,the 125l seedswith the activity of 0.3-0.7 mCi were implanted.Postoperative validation showed that D90 (90％ minimum prescription dose received by the target volume) was 36-110 Gy (median 59 Gy).After the treatment,the changes in lesion size,pain relief and complications were recorded.Results The 10 patients were followed up for 4.3-16.1 months,the median follow-up time was 9.7 months.The 2-month local control rate and the 2-month effective rate were 100％ and 58.3％,respectively.The 2-month,6-month and 12-month survival rates were 100％,66.7％ and 58.3％,respectively.The median survival time was 12.1 months.One patient (10％) died of gastrointestinal bleeding at five months after treatment,six patients (60％) died of distant metastases,three patients (30％) survived withno evidence of local recurrence.No major complications such as massive hemorrhage,intestinal infection,bone marrow suppression or other 125I seed-related complications occurred.Conclusion For the treatment of retroperitoneal lymph node metastasis due to recurrent cervical cancer after radiotherapy,CT-guided radioactive 125I seed implantation has satisfactory short-term curative effect,and this technique is safe and feasible.

As a standard method for early stage prostate cancer, 125Ⅰ seed implantations are used widely in America. Although there are guidelines from American Brachytherapy Society and American Association of Physicists in Medicine, some hospitals still cannot implant the seeds properly according to the guidelines. Complications were observed inevitably. The medical events about seeds implantation in America from 2002 were investigated and the reasons were analyzed in this paper. Additionally, some solutions were given to avoid the medical events, so that the practitioners in China can learn from it and make sure the 125Ⅰ seeds implantation can be developed healthily and smoothly.

Objective To investigate the effect of different hypoglycemic methods on tibial osteotomy (HTO)in patients with diabetes mellitus,and to seek a more scientific and reasonable clinical intervention model.Methods From February 2016 to January 2017,sixty patients with knee osteoarthritis and diabetes mellitus were randomly divided into the control group and the observation group,with 30 cases in each group.Patients in the control group were treated with Acarbose and Aspartic Insulin 30 injection method for blood glucose intervention.Patients in the observation group were treated with vildagliptin and Aspartic Insulin 30 injection.The changes of fasting blood glucose(FPG),postprandial 2 h blood glucose(2 hPG),glycosylated hemoglobin(HbAlc),body mass index(BMI)and other indicators of the two groups were measured before treatment,before surgery and 6 months after surgery,and the adverse reactions of the two groups of patients were compared.Results Repeated measures analysis of variance showed that there were statistically significant differences in FPG and 2 hPG of the two groups collected before treatment,before surgery and 6 months after surgery(F=85.40,617.06; P<0.05).Independent sample t test showed that HbAlc in the control and the observation group((7.9±0.9)%,(7.5±0.8)%)were significantly lower than those before treatment((9.8 ±1.5)%,(9.5±1.2)%)(t=5.95,7.60,P<0.05),at 6 months after surgery,BMI((25.83±1.78)kg/m2) in the observation group was significantly lower than that in the control group((27.35 ± 2.41)kg/m2)(t=2.78,P<0.05).The number of adverse reactions in the observation group was 2 cases(6.67%),significantly lower than that of the control group of 13 cases(43.33%),the difference between the two groups was statistically significant(χ2=10.756,P<0.05).Conclusion Vildagliptin combined with Aspartic Insulin 30 injection can not only effectively control the perioperative blood glucose levels in patients with HTO,but also can help the patients to control the body weight and reduce the incidence of adverse reactions.This method has a positive effect on the recovery of HTO.

Objective To discuss the commonly used puncturing approaches in CT-guided 125I seed implantation for lumbar lymph node metastases in order to provide safe and reliable technical guidance for clinical practice.Methods Under CT guidance,125I seed implantation for lumbar lymph node metastases was performed.According to different locations of metastatic lymphadenopathy (left waist,right waist or middle waist),the corresponding puncture route and implantation method were adopted.Meanwhile,different puncturing approach was designed in order to avoid damage to vital organs.Results For the performance of 125I seed implantation for the lymphadenopathy located at the left waist,right waist and middle waist,the commonly used puncturing approaches were percutaneous transthoracic lumboiliac costal muscle method (i.e.back approach),trans-hepatic trans-duodenal method (i.e.lateral approach) or back approach method,and trans-mesenteric approach together with coaxial needle method (i.e.anterior approach) respectively.Conclusion It is clinically feasible to use different puncturing approaches in performing 125I seed implantation for lumbar lymph node metastases,the suitable puncturing approach can ensure a successful and safe operation.